Biomedical subjects
Publications and source records attributed to R Jedeikin.
A case of paraquat poisoning was successfully treated which would have been considered lethal according to a reported prognostic index. Main features in the treatment were removal of paraquat by gastric lavage, forced diuresis, hemodialysis, and charcoal hemoperfusion. Early ventilation with low FIo2 and with positive end-expiratory pressure (PEEP) were also utilized.
Brain-type isoenzyme of creatine kinase was measured serially in 45 healthy and 22 severely asphyxiated term infants. The enzyme was measured in cord blood and in venous, capillary, or arterial blood at six to eight hours, 24 to 30 hours, and 72 to 80 hours after birth. In the healthy infants a brief rise of CK-BB occurred at six to eight hours; CK-BB activities were greater than 2.5 log-transformed standard deviations above the mean of the control values in ten of the asphyxiated infants and in none of the control infants. When normal CK-BB activity was used as a predictor of good neurologic outcome and elevated CK-BB as a predictor of subsequent neurologic abnormality, the outcome was predictable from the CK-BB activity in 17 of 22 cases (77%) and in 11 of the 12 survivors (92%). Eight of the 12 surviving infants had neonatal seizures and outcome was predictable from CK-BB activity in all cases. We conclude that serum CK-BB activity, especially when measured in cord blood and at six to 12 hours of life, correlates with neurologic outcome after severe asphyxia, and that measurement of CK-BB compares favorably with radionuclide and computerized tomographic scanning as a method of predicting neurologic outcome after asphyxia.
Isoenzymes of creatine kinase (ATP:creatine phosphotransferase; EC 2.7.3.2; CK) were measured by electrophoresis in serum from cord blood and skin-puncture blood taken from 45 healthy full-term infants during the first three postnatal days. Mean total CK activities (in U/L at 30 degrees C) were 185 in cord samples, 536 in samples taken between 5--8 h postnatally, 494 between 24--33 h, and 288 in the 72-100 h samples. Values for all three isoenzymes increased to a peak over this period, with the highest values generally being found in the samples taken 5--33 h after birth; the subsequent decline was most rapid for CK-BB. Serum CK isoenzymes in cord samples and those taken at 72--100 h in the 11 babies delivered by cesarian section did not differ significantly from those of babies delivered vaginally. However the postnatal increases in total CK, CK-MM, and CK-MB (but not in CK-BB) were significantly greater in those patients born by vaginal delivery. The reasons for the increases in CK isoenzymes after birth are not clear, but our results and reported studies on the ontogeny of CK suggest that CK-MB cannot be regarded as a "cardiac-specific" isoenzyme in the neonatal period.
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In 30 patients having prostatectomies, 15 patients (group I) given single-injection epidural anesthesia using bupivacaine and morphine (4 mg) were compared with 15 patients (group II) given epidural bupivacaine without morphine. Patients in group I had pain relief for a mean duration of 27 hours and did not request additional analgesia. Patients receiving bupivacaine alone had pain relief for an average of 6.2 hours after surgery; all required narcotics postoperatively. It was concluded that the addition of 4 mg of morphine to the local anesthetic for epidural anesthesia in patients having prostatectomies results in excellent postoperative analgesia.
The insecticide Endrin is a highly toxic chlorinated hydrocarbon which can cause severe CNS and respiratory derangement. Death usually follows intoxication within 24 hours. A 19-year-old male developed convulsions and gross pulmonary edema after the ingestion of Endrin. His trachea was intubated and constant positive pressure ventilation with PEEP of up to 28 cm H2O was instituted. The patient survived and recovery appeared to be complete. Severe pulmonary edema is not a common finding in patients who have Endrin poisoning. The use of PEEP above 15 cm H2O is a controversial issue; however, we believe that it contributed significantly to the survival of our patient.
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Ischemic myocardial damage was identified as a complicating feature in the clinical course of 12 newborn infants who died in congestive failure with cerebral arteriovenous malformation. Electrocardiograms of 11 patients showed signs of chamber hypertrophy and T wave and ST segment features of varying degree compatible with ischemia or infarction. Histological evidence of myocardial necrosis or infarction was detected in seven of the ten infants from whom autopsy material was still available.
STUDY OBJECTIVE: To evaluate the opioid-sparing and analgesic effect of diclofenac sodium in ambulatory nonimmersion extracorporeal shock wave lithotripsy (ESWL). DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: Large referral hospital. PATIENTS: Twenty-seven ASA physical status I and II patients with upper renal tract nephrolithiasis. INTERVENTIONS: ESWL was performed with a sedative-analgesic technique. Diclofenac sodium 75 mg or an equal volume of saline was given intramuscularly 45 minutes prior to the procedure. Fentanyl and midazolam were added to maintain adequate sedation and analgesia. MEASUREMENTS AND MAIN RESULTS: Demographically, both groups were comparable. In the diclofenac sodium group, heart rate was slightly higher, treatment time was shorter, more shock waves were administered (p < 0.02), and less fentanyl was required (p < 0.02). Mean arterial pressure was lower and arterial oxygen saturation by pulse oximeter was higher in the diclofenac sodium group. There were no differences between the groups in voltage, stone size, fragmentation, dose of midazolam administered, or overall assessment by both the doctors and patients. CONCLUSIONS: Patients administered diclofenac sodium received a greater number of shock waves, required less fentanyl, and showed a marginal improvement in hemodynamic stability and oxygenation during ambulatory nonimmersion ESWL.
The Atlas AR-8800, an impedance pneumograph respiratory monitor, is claimed to detect both apnea and hypoventilation. The authors tested the monitor on eight anesthetized patients and found the apnea alarm to be effective and efficient. In addition, the ventilation alarm index, a system specific to this monitor, detected hypoventilation and also differentiated between irrelevant body movements and apnea.
A case of acute carbamazepine poisoning is described, which demonstrates all the immediate side effects of poisoning. Emphasis is placed on water intoxication and hyponatremia as the main cause of irreversible cerebral damage.