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Biomedical subjects

S C Shapira

Publications and source records attributed to S C Shapira.

At least 55 records · Page 3Linked to original sources
PubMed1994

Safety of surgical intervention during the second trimester of pregnancy. A case report.

Surgical and anesthetic interventions during pregnancy are not hazard free. While an increase in fetal resorption and the abortion rate during the first trimester is well documented, a second-trimester intervention is assumed to be relatively safe. A case of acute transient oligohydramnios, fetal growth arrest and limb reduction anomaly following second-trimester abdominal surgery is reported for the first time.

Female↗
PubMed1993

Electronic pressure algometry of deep pain in healthy volunteers.

Deep pressure pain threshold (PPT) and pressure pain tolerance (PPtol) were measured by pressure algometry at the mastoid processes, external malleoli, and sternum in 24 healthy volunteers. The algometer consisted of a force displacement transducer with a 0.25 cm2 pressure tip linked to a recorder. The rate of force application was approximately 1kg/sec/0.25cm2. High intersubject variation was noted at all sites for both PPT and PPtol. Mean PPT and PPtol values at the sternum were 5.2kg +/- 2.1 and 8.1kg +/- 2.4, respectively, and significantly higher than at the other sites. PTT did not differ significantly between the sexes or between dominant and nondominant sides. PPtol, on the other hand, was lower in the women, but significantly so only at the malleoli. On repeat examination, comparison between the mean values at each site showed no statistical differences in any instance. Pressure algometry, as used in this study in healthy subjects, proved a reliable technique for the estimation of deep PPT and PPtol values. It may possibly serve for screening the response to experimental pain in various groups of pain patients.

Adult↗
PubMed1993

Transfusion-related adult respiratory distress syndrome.

Leukocyte antibodies are the major cause of nonhemolytic transfusion reactions. One of the less frequent but severe forms of this reaction is the adult respiratory distress syndrome, or transfusion-related acute lung injury. This rare phenomenon is the result of leukocyte antibodies forming immune complexes with granulocytes, complement activation, sequestration of activated granulocytes in the pulmonary capillary bed, and their degranulation associated with release of proteolytic and cytotoxic substances. This cascade causes endothelial damage with increased capillary permeability. Plasma fluids and proteins accumulate in the interstitial and intra-alveolar spaces, leading to respiratory insufficiency. We present two patients with transfusion-related adult respiratory distress syndrome associated with leukocyte HLA antibodies, who were successfully treated in our hospital. The pathogenesis, diagnostic measures and treatment of this uncommon yet critical condition is discussed.

Adrenal Cortex Hormones↗
PubMed1991

[Patient-controlled i.v. morphine for acute postoperative pain].

The use of patient-controlled i.v. analgesia for postoperative pain relief in 60 cases is described. 0.1% morphine was given by Bard or Graseby microprocessor. After a loading dose of 2-6 mg, the pump delivered a bolus of 0.8-1.5 mg of morphine every 8-12 min. The dosages necessary to provide good analgesia varied from 30-85 mg (mean 48). Good pain scores of 0-2 (on a scale of 5) were obtained in 92%. The method was also found satisfactory by the families and health care providers, and is highly recommended for control of postoperative pain.

Acute Disease↗
PubMed1991

[Fentanyl vs alfentanil anesthesia for in vitro fertilization].

In a prospective double-blind study, 36 women undergoing ultrasonically guided oocyte retrieval for in vitro fertilization (IVF) were examined. Anesthesia in 19 was based on alfentanil, up to 0.025 mg/kg and in 17, fentanyl, 0.0025 mg/kg. There were no significant differences between groups with regard to age, weight, duration of procedure and pregnancy rate. There were no complications aside from nausea and vomiting. Amnesia for the puncture and analgesia were always perfect. Induction was significantly shorter for alfentanil, 1.3 +/- 0.7 min, than for fentanyl, 3.4 +/- 2.2 (p less than 0.01). All who received fentanyl were drowsy at the end of the procedure, while those in the alfentanil group were fully awake and able to move from operating table to stretcher with minimal help. We therefore recommend alfentanil as the base for anesthesia for IVF.

Alfentanil↗
PubMed1991

[Problems raised by the administration of a peridural block in patients receiving anticoagulant therapy].

More and more patients likely to get an epidural block are treated with anticoagulant or antiplatelet drugs. An epidural hematoma may be consecutive to an injury of the epidural venous plexus. The mechanisms of action of the different drugs are reviewed. The bleeding time is not an infallible indication of aspirin or other non steroidal antiinflammatory drugs platelet defect. The protocol used in our institution for the administration of an epidural block in this group of patients is discussed.

Anesthesia, Epidural↗
PubMed1988

Gastrointestinal perforations in the neonatal period.

Forty-eight neonates were treated for gastrointestinal perforation during a 9-year period. In 30, perforation occurred within the first week of life. Thirty-six were preterm infants and many had a history of obstetric and postnatal complications. Perforation resulted from necrotizing enterocolitis in 26 patients, whereas in 14 neonates spontaneous perforation occurred in an apparently normal bowel, with no evident cause (idiopathic perforation). In 6 patients perforation was associated with meconium ileus. Primary closure was carried out for perforations of the duodenum and stomach. Intestinal perforations were usually treated by resection and enterostomies. The overall mortality rate in this series was 46%. The highest mortality rate was associated with necrotizing enterocolitis (62%). The mortality rate was only 14% in patients with idiopathic perforation. Despite improvement in the prognosis of neonatal gastrointestinal perforations in recent years, it is still discouraging, reflecting the difficulty in preventing and treating necrotizing enterocolitis.

Enterocolitis, Pseudomembranous↗
PubMed1982

Quantitative peritoneal lavage in the assessment of intraperitoneal inflammatory processes.

Quantitative peritoneal lavage in order to assess the volume of the intraperitoneal fluid was performed in 34 female patients with acute abdominal pain and signs of peritoneal irritation. The peritoneal lavage was done using the dye-dilution technique with Evans-Blue Human Serum Albumin Complex (EBA) as a marker. In 22 patients with intraperitoneal inflammatory process the mean volume of exudate in the peritoneal cavity was 585.1 ml while in patients without any intraperitoneal inflammatory process the mean volume of the intraperitoneal fluid was 128.7 ml. This difference between the volumes was statistically significant (p less than 0.05). It is felt that an intraperitoneal fluid volume of above 250 ml is a highly suggestive indicator of an intraperitoneal inflammatory process. A quantitative peritoneal lavage with EBA as a marker can therefore be used as a diagnostic tool in the evaluation of patients with acute abdominal pain.

Adolescent↗
PubMedDate not supplied

The efficacy of integrating "smart simulated casualties" in hospital disaster drills.

INTRODUCTION: Full-scale disaster drills are complex, expensive, and may involve hundreds or thousands of people. However, even when carefully planned, they often fail to manifest the details of medical care given to the casualties during the drill. OBJECTIVE: To assess the feasibility of integrating physicians among the simulated casualties of a hospital disaster drill. METHODS: A total of 178 physicians graduating an Advanced Trauma Life Support (ATLS) course participated in eight hospital disaster drills during 1994 as "Smart Victims." The participants were given cards with descriptions of their injury and detailed instructions on how to manipulate their medical condition according to the medical care provided in the hospital. They also were given coded questionnaires to fill out during the process of the drill. Conclusions were drawn from analysis of the questionnaires and from a roundtable discussion following each drill. RESULTS: The "smart casualties" made comments on the following topics: 1) triage (over-triage in 9%, and under-triage in 4%); 2) treatment sites; 3) medical equipment usage (i.e., shortage of ventilators and splinting devices); 4) medical knowledge and care rendered by the hospital staff; 5) evacuation and escorting of the wounded; 6) management of patients with post-traumatic stress disorder; and 7) medical documentation. Their comments contributed valuable information on the quality of medical care and organization, and identified obstacles that otherwise would have been overlooked. The "smart casualties" were very cooperative and indicated that their participation in the drill contributed to their understanding of disaster situations in hospitals. CONCLUSION: Integrating physicians among the simulated casualties in a hospital disaster drill may contribute to achieving the objectives of hospital disaster drills and add to disaster management education of the simulated casualty physicians.

Adult↗