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Biomedical subjects

S A Bergman

Publications and source records attributed to S A Bergman.

At least 19 recordsLinked to original sources
PubMed1999

Ketamine: review of its pharmacology and its use in pediatric anesthesia.

The management of the uncooperative pediatric patient undergoing minor surgical procedures has always been a great challenge. Several sedative techniques are available that will effectively alleviate anxiety, but short of general anesthesia, no sedative regimen is available that will enable treatment of the uncooperative child. Ketamine produces a unique anesthetic state, dissociative anesthesia, which safely and effectively enables treatment of these children. The pharmacology, proposed mechanisms of action, and clinical use of ketamine (alone and in combination with other agents) are reviewed and evaluated.

Anesthesia, Dental↗
PubMed1994

Accuracy of clinical examination versus computed tomography in detecting occult lymph node involvement in patients with oral epidermoid carcinoma.

PURPOSE: To determine the accuracy of clinical examination versus computed tomography (CT) scanning in detecting positive cervical lymph nodes (N) in patients with epidermoid carcinomas of the oral cavity, 27 patients with epidermoid carcinomas were reviewed. PATIENTS AND METHODS: The patients underwent 40 neck dissections, 20 with N- and 20 with N+ necks histologically. All patients were examined by the same clinician, and all CT scans were read by the same radiologist. Patients with clinical and CT N- necks underwent neck dissection only if the neck had to be entered to resect the primary tumor or if the primary tumor was T3 or T4 with a high probability of microscopic metastasis. RESULTS: Of the 20 necks that were histologically N-, 16 (80%) were clinically diagnosed as N- and 4 (20%) N+ versus 18 (90%) N- and 2 (10%) N+ diagnosed by CT scan. Of the 20 histologically N+ necks, 12 (60%) were clinically diagnosed as N+ and 8 (40%) N- versus 11 (55%) N+ and 9 (45%) N- diagnosed by CT scan. All lymph nodes diagnosed as N- by both clinical examination and CT scan were less than 1 cm in diameter. Overall, clinical examination of the neck was correct in 28 patients (70%) and the CT scan was correct in 29 patients (73%). Both clinical examination and CT scan were more accurate in diagnosis of N- necks. In 31 necks (78%), the CT and clinical examination were in agreement. Of these, 10 of 10 (100%) were correctly positive. Of the 21 in which both were negative, 14 were histologically N-, and 14 (67%) were correct. Overall, in those cases in which both CT and clinical examination were in agreement, the diagnosis was correct in 24 of 31 (77%). CONCLUSION: These results suggest that there is no significant difference in the accuracy of clinical examination versus CT scanning in detecting both positive and negative cervical nodes. When both CT and clinical examination agree, positive cervical nodes are almost always correctly diagnosed. However, one third of the negative cervical nodes were incorrectly diagnosed. Improved methods for detecting occult disease are still needed.

Carcinoma, Squamous Cell↗
PubMed1992

Immediate mandibular stabilization following resection of advanced oral cavity carcinoma using the Joe Hall Morris external fixation device.

Internal mandibular fixation after resection of advanced oral cavity carcinoma with mandibulectomy has a significant complication rate. We placed the Joe Hall Morris (JHM) external mandibular appliance in 29 patients undergoing mandibulectomy for advanced oral cavity carcinoma. Fourteen patients received postoperative radiation therapy (RT). Three of 29 patients (10%) had complications associated with the JHM appliance: one patient had a broken connecting bar, a second had loosening of a single pin, and a third had loss of fixation requiring complete replacement of the appliance. Complications not associated with the appliance occurred in 8 patients (28%) including mandibular exposure (1), orocutaneous fistula (2), partial flap dehiscence (4), and flap necrosis (1). Oral continence was maintained in 26 patients, and occlusion was normal in 27. The appliance was removed in 12 weeks to 6 months in all patients. The JHM appliance allows for a reliable and rapid immediate fixation of the mandible with acceptable functional and aesthetic results, and no delay or interference with postoperative radiotherapy. Since the life expectancy of these patients is short, most do not require subsequent permanent fixation after removal of the appliance.

Adult↗
PubMed1991

Imipramine-fentanyl antinociception in a rabbit tooth pulp model.

Antinociception of imipramine (I) and its effect in combination with fentanyl (F) was evaluated in rabbits using electrically-induced lick chew responses via tooth pulp stimulation as the model of nociception. Acute i.v. injections of I elicited a graded dose response comparable to i.v. morphine (M) with I ED 50 = 4.35 mg/kg (2.31-8.14, 95% CL) and M ED 50 = 1.81 mg/kg (1.11-3.90), with no differences in the slopes between the two curves. The lethal dose of I was 10 mg/kg. An i.v. dose of I twice the ED 50 elicited an antinociceptive effect of more than 50% maximum possible effect (MPE) for 90 minutes with peak effect of 82% MPE occurring at 15 minutes. These effects of I were not reversed by a morphine-reversal dose of naloxone (0.1 mg/kg i.v.) but were reversed with a ten fold dose of naloxone. F ED 50 values (mcg/kg) were lowered from 11.35 to 2.70, 0.74 and 0.33 with increasing pretreatment doses of I (1.0, 2.1 and 3.2 mg/kg). These magnitudes of potency increases of F were 4.2, 15.3 and 34.4 fold respectively. A single i.v. ED 50 dose of I extended the time to 50% MPE of an ED 90 dose of F from 26 minutes to 77 minutes; of a 2 X ED 50 dose of F from 17 minutes to 28 minutes. Data points for three different combinations of I and F fell significantly within the synergistic field of an ED 50 isobologram and a polynomial equation described the curve best fitting the data points. F alone (i.v. ED 50 dose) increased the PaCO2 values to 74% above controls and three different combinations with I showed no increases in PaCO2 values above controls. I alone did not significantly cause any change in PaCO2 values from controls.

Analgesics↗
PubMed1989

Effects of midazolam on fentanyl antinociception and respiration in a rabbit model.

Clinical antinociception is difficult to assess because of difficulties with controls and the incorporation of bias. The rabbit antinociceptive model is highly sensitive and predictive of analgesia in humans. We found that the combination of midazolam with fentanyl enhanced antinociception compared with fentanyl alone. In addition, with this model there were relatively unimportant increases in respiratory depression.

Analgesics↗
PubMed1982

Dental extractions in patients with acute nonlymphocytic leukemia.

Dental extractions in patients with leukemia are controversial, since they may lead to hemorrhage, delayed wound healing and infection. However, the retention of diseased teeth in these patients may also lead to infectious complications during chemotherapy. With adequate hematologic values and specific surgical techniques, 119 extractions were performed on 28 patients with acute nonlymphocytic leukemia. No serious adverse sequelae occurred, and the prevalence of other adverse affects was comparable with that in nonleukemic patients. It is concluded that with proper precautions, extractions can be performed on these patients.

Acute Disease↗
PubMed1981

Maintenance of function and esthetics after partial mandibulectomy without bone grafting.

Partial mandibulectomy done for en bloc resection of oral or oropharyngeal cancer often produces a characteristic deviation of the chin toward the resected side. This results in esthetic, masticatory, and speech disabilities. The Joe Hall Morris biphase external pin fixation appliance was used in 20 patients, with excellent results in preventing such complications. In 12 to 14 weeks it maintained excellent stability of the remaining mandibular segments, which prevented muscle and scar contracture. None of the patients required bone grafting or other reconstructive surgery. The appliances also allowed the patients to open their mouths for intraoral care in the immediate postoperative period. Postoperative radiation or chemotherapy could be initiated without delay while the appliances were in place.

Adult↗
PubMed1977

Functional independence of donor and recipient cardiac tissues of single and double heart transplant patients revealed by chronobiology.

3 total (single) and 1 double-heart-transplant patients were studied for temporal changes in the electrical events of cardiac function. Results of statistical analyses document the existence of circadian rhythms in the donor and recipient P--P or R--R intervals. However, for 1 total-heart-transplant patient studied at intervals during the year following implant and the double-heart-transplant patient 5 mth after surgery, the period (tau) of the rhythm in the P--P or R--R interval of the recipient tissue deviated greatly from that of 24.0 h. For the total-heart-transplant patient studied 1 mth prior to death, the tau was 32.3 h; for the double-heart-transplant patient, the tau was 29.0 h. In both patients, the donor heart tissue continued to exhibit a 24-h rhythm. These findings imply that changes in tau for the rhythm in P--P or R--R interval may reflect aspects of disrupted physiologic, feedback, regulatory mechanisms or perhaps graft rejection. Although additional study is required, the possibility that alteration in tau is associated with rejection is intriguing since if documented, then the noninvasive monitoring of ECG and subsequent analysis of data for significant deviations of tau from 24.0 h will be useful as an additional tool for monitoring host tolerance for the heart implant.

Bed Rest↗
PubMed1976

Fluid therapy in the critically injured patient.

Sufficient clotting factors to ensure coagulation and replacement of lost volume and oxygen-carrying capacity are necessary to obviate many of the complications that may occur when massive transfusions are used in patients with multiple injuries. A regimen that has been successful includes immediate infusion of plasma protein fraction, packed red cells, fresh-frozen plasma, and nonspecific platelets.

Blood Coagulation Disorders↗