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R V Trubuhovich

Publications and source records attributed to R V Trubuhovich.

17 recordsLinked to original sources
PubMed2004

Further commentary on Denmark's 1952-53 poliomyelitis epidemic, especially regarding mortality; with a correction.

Berthelsen and Cronqvist recently published an article in Acta Anaesthesiologica Scandinavica including aspects which could lead on to further discussion about the Danish 1952-53 poliomyelitis epidemic. This paper considers how Bjørn Ibsen's initial approach to treatment during the epidemic was successful, as well as how it could have failed; the roles played by ventilatory failure vs. gross neurologic destruction in causing deaths; and compilations from publications of statistics concerning mortality of the epidemic. The Blegdam Hospital concept of 'life-threatening poliomyelitis' is revisited, along with its division into six anatomico-clinical categories for the 345 patients so classified. Attention is drawn to the severity of assorted cerebral lesions demonstrated in 114 of the 115 autopsies conducted from the 144 fatal cases. Despite an overall mortality rate of 41.6% among the entire epidemic's sickest patients, a lowest mortality rate of 11% in the last 18 of such patients is identified. Note is made of the difficulty in reconciling various sources for certain features -- for which the 1956 book on the epidemic, edited by H.C.A. Lassen, has been freely used. Some folklore about aspects of management is mentioned. In the light of other recent research by Dr Berthelsen an essential correction is needed in dating 'Bjørn Ibsen's Day', amending 26 August 1952 to the 27th.

Anesthesiology↗
PubMed1991

Important abnormalities in recordings of somatosensory evoked potentials in coma.

We have chosen six illustrations showing how much vital information can be obtained from median nerve SEPs during the first 24 hours in coma. With avulsion of brachial plexus roots there was loss of SEPs at the cervical cord and the scalp from the affected side. In a severe injury of the cervical cord there was preservation of brachial plexus potentials, while SEPs at the cervical cord were absent. After critical deterioration in a case of repeated subarachnoidal hemorrhage, scalp SEPs with very short latency occurred, which is a finding suggestive of destruction of cortical SEP generators heralding a fatal outcome. In a case of brain injury combined with central hyperthermia, there was initially a loss of scalp SEPs probably due to the combined effect of these factors. In a case of brain injury there were bifid peaks at the scalp level. It is important to assess central sensory conduction time only to the first scalp SEP, otherwise an erroneously abnormal state may be inferred. In a patient with clinical and EEG evidence of brain death there was a loss of far-field thalamic potentials at the neck. It is important to be aware of such presentations to be able to provide corroborative assurance for the assessment of prognosis.

Adult↗
PubMed1988

Patient selection for intensive care: a comparison of New Zealand and United States hospitals.

To examine how the use of intensive care varies, we compared 5,030 adult ICU admissions in 13 U.S. hospitals with 1,005 patients in two New Zealand (N.Z.) hospitals. Despite similar national demographic and hospital patient characteristics, there were substantial differences in the use of intensive care. The N.Z. hospitals designated 1.7% of their total beds for intensive care compared to 5.6% in the U.S. hospitals. The average age for N.Z. admissions was 42 compared to 55 in the U.S. (p less than .0001). The N.Z. ICUs admitted fewer patients with severe chronic failing health (N.Z. 8.7%, U.S. 18%) and following elective surgery (N.Z. 8%, U.S. 40%). Approximately half the N.Z. admissions were for trauma, drug overdose, and asthma while these diagnoses accounted for 11% of U.S. admissions. When controlled for differences in case mix and severity of illness, hospital mortality rates in N.Z. were comparable to the U.S. This study demonstrates substantial differences in patient selection among these U.S. and N.Z. ICUs that have equal technical and manpower capabilities and provide similar high-quality intensive care. Physicians from both countries justify the differences on medical criteria; however, both approaches to patient selection cannot be optimal. Additional outcome comparisons between acutely ill patients treated in the U.S. and N.Z. could help refine ICU selection criteria and improve the precision of clinical decision-making.

Adult↗
PubMedDate not supplied

Acute brain swelling.

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Acute Disease↗