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Biomedical subjects

A Eisenman

Publications and source records attributed to A Eisenman.

14 recordsLinked to original sources
PubMed2005

Are all troponin assays equivalent in the emergency department?

INTRODUCTION: Cardiac-specific troponins (cTn) are recently-introduced, sensitive and specific markers of myocardial injury, and their absence should allow to safely exclude a coronary event. Various assays are commercially available but the relative advantage of each is not clear. Our objective was to compare the reliability of the two most commonly used troponin assays (cTnI and cTnT), in the emergency department (ED) for clinical decision when myocardial infarction (MI) or acute coronary syndrome (ACS) is suspected. METHODS: This prospective study included all patients arriving at the ED over a six-month period with chest pain or symptoms suggesting MI or ACS, in which diagnosis could not be confirmed due to absence of characteristic ECG features. All patients were tested with at least one of the two troponin assays available at the ED. RESULTS: Of the 54 included patients, ten (19%) were eventually diagnosed with MI/ACS. Qualitative assays for cTnI and cTnT identified the MI/ACS patients by both assays (respective positive predictive values of 0.5 and 0.7, and negative predictive values of 1.0 and 0.9). However, these assays were only partially correlated (R equals 0.49) and differed significantly. The quantitative assay for cTnI, but not for cTnT, discerned those who had MI/ACS (group A) from those who had other condition (group B) by their troponin levels (MI/ACS - 17.2 plus or minus 23.8 ng/ml versus others - 0.37 plus or minus 0.91 ng/ml, p is less than 0.001). CONCLUSION: In the ED, bedside assays of troponins are invaluable tools for the clinician, and their use is cost-effective. However, in the recommended cutoffs levels, only troponin I but not troponin T allowed the safe discharge of patients not requiring acute hospital care.

Emergency Service, Hospital↗
PubMed1999

[Superficial skin necrosis--an uncommon manifestation of short bowel syndrome].

Short bowel syndrome causes a complex of symptoms due to compromise of small intestinal nutrient absorption. A 60-year-old woman underwent major resection of the small intestine due to a road accident 3 years ago. The sole manifestation of short-bowel-syndrome was superficial skin necrosis due to vitamin K deficiency. She was asymptomatic for a long time, until treatment with antibiotics further intensified initially subclinical malabsorption. It is not clear why there had been no other symptoms and why the main impact was on the fibrinolytic system rather than the coagulation system, as is usually the case. It is recommended that patients after major resection of the small intestine be closely monitored for coagulation function if an oral antibiotic is prescribed.

Accidents, Traffic↗
PubMed1999

Low-dose vasopressin restores diuresis both in patients with hepatorenal syndrome and in anuric patients with end-stage heart failure.

OBJECTIVES: The purpose of this study was to confirm earlier reports that low-dose vasopressin (LDVP) analogues promote urine output in patients with hepatorenal syndrome (HRS) and to check whether this mode of therapy could also be effective in renal shutdown due to nonhepatic conditions. DESIGN: A prospective, open, interventional study. SETTING: An intermediate-level (step-down) medical intensive care unit within a general medical ward of a large university-affiliated hospital. SUBJECTS: Eighteen successive hospitalized patients with HRS (mean age 65 +/- 13 years) and 11 patients with end-stage congestive heart failure (CHF) (mean age 81 +/- 5 years) who failed to restore urine output with conventional treatment (fluids, dopamine, and diuretics) given for at least 24 h. INTERVENTIONS: The patients received LDVP (1 IU h-1) continuously in addition to the conventional treatment. MAIN OUTCOME MEASURES: Urine output and creatinine clearance every 24 h. RESULTS: In the HRS group, before treatment the urine output was 155 +/- 9 mL 24 -1h (mean +/- SD). After treatment with LDVP for 24, 48, and 72 h, urine output improved to 1067 +/- 87, 1020 +/- 501, and 1311 +/- 988 mL 24 -1h, respectively (P < 0.0001 for all measures; two-tailed paired t-test). In the CHF group, before treatment the urine output was 99 +/- 99 mL 24 -1h. After treatment with LDVP for 24, 48, and 72 h, this improved to 1125 +/- 994 mL 24 -1h (P = 0.0028), 1821 +/- 1300 mL 24 -1h (P = 0.004), and 2920 +/- 2423 mL 24 -1h (P = 0.0012), respectively. The improvement in urine output was not accompanied by a parallel improvement in creatinine clearance. The overall outcome did not change, and all patients except two in each group succumbed to their end-stage disease, due to nonrenal causes. CONCLUSIONS: LDVP is effective in restoring urine output both in HRS and in CHF. This suggests that LDVP affects mechanisms not specifically related to liver disease. LDVP may be useful in critical patients with renal shutdown whilst awaiting liver or heart transplantation.

Aged↗
PubMed1998

Nitric oxide inhalation for paraquat-induced lung injury.

BACKGROUND: When ingested, concentrated paraquat can cause either rapid death from multisystem failure and cardiovascular shock or delayed death from progressive pulmonary fibrosis. Diquat ingestion does not usually cause pulmonary fibrosis, but produces early onset acute renal failure. CASE REPORT: A 52-year-old male ingested approximately 50 mL of a solution containing 13% paraquat and 7% diquat (about 6650 mg of paraquat and 3500 mg of diquat), and subsequently developed adult respiratory distress syndrome and pulmonary fibrosis. Survival prediction employing the criteria of Hart et al. for paraquat plasma levels was 30%. From the probable amount of paraquat ingested, severe toxicity was expected. The clinical course was not consistent with significant diquat toxicity. Treatment included oral Fuller's earth, forced diuresis, hemofiltration, N-acetylcysteine, methylprednisolone, cyclophosphamide, vitamin E, colchicine, and delayed continuous nitric oxide inhalation. The patient recovered and pulmonary function was subsequently normal. CONCLUSION: It is unclear which, if any, of the above treatments contributed to recovery, but the encouraging outcome suggests a possible benefit of nitric oxide inhalation in paraquat poisoning which deserves further study.

Administration, Inhalation↗
PubMed1995

[Cholestyramine for digoxin intoxication].

Cholestyramine, a bile acid sequestering resin, has been reported to bind digitalis in vitro. We gave 4 g every 6 hours to 3 patients with non-life threatening digoxin intoxication. In all 3 serum digoxin concentrations and digoxin half-life decreased: from 50 to 32 hours, from 50 to 10 hours and from 46 to 16 hours in the 3 cases, respectively. Cholestyramine is potentially useful and safe adjunct medication for non-life threatening digoxin intoxication.

Aged↗
PubMed1995

Blood exchange [correction of exchance]-a rescue procedure for complicated falciparum malaria.

Falciparum malaria is the most hazardous form of malaria. Its high degree of parasitemia interferes with vital functions of most organs and is directly responsible for its high rate of mortality and morbidity. Quinine and other antimalarial drugs are relatively slow acting and not always effective due to the growing resistance developed by Plasmodium toward these drugs. Another emergency modality, which would remove the parasitic burden quickly and effectively, is thus much needed. We present a case of a 51-year-old sailor, who was admitted to the hospital because of complicated falciparum malaria. His situation deteriorated rapidly into a desparate stage, despite the various intensive treatments and quinine. He soon developed a systemic inflammatory response syndrome manifested as cerebral malaria, renal failure, acute respiratory distress syndrome and disseminated intravascular coagulation. An emergency blood exchange reversed the situation dramatically, and the patient recovered completely. It is recommended that any doctor, both in endemic and in non endemic areas, dealing with blood transfusions or infectious diseases, should be acquainted with this lifesaving modality, regardless of the controversy still surrounding this subject.

Emergencies↗
PubMed1992

[A family outbreak of trichinosis acquired in Israel].

Trichinosis is a parasitic disease transmitted to man by ingestion of contaminated raw meat, usually pork, containing cysts of Trichinella spiralis. Formerly appearing as serious epidemics, it has now become uncommon due to public health control measures. Since the Jewish and Moslem religions forbid consumption of pork, the disease is even rarer in Israel. The literature indicates that all the cases of trichinosis hospitalized in Israel were contaminated abroad. We describe an Israeli family in which trichinosis following the eating of boar meat, hunted along Israel's northern sea coast (Hof HaCarmel). We believe that this is the first report of trichinosis acquired in Israel. Only family members who ate the meat raw became ill, while those who ate it well-cooked were spared. However, not all of our cases were symptomatic, some showing only laboratory evidence (eosinophilia and a rise in CPK). In accord with postmortem data in the USA, this indicates that trichinosis is probably more common than estimated due to the many asymptomatic cases (about 4% of all Americans).

Adult↗
PubMed1991

[Subcutaneous emphysema as a complication of colonoscopy].

A 71-year-old man underwent colonoscopy and multiple poly-pectomy. A few hours after the procedure he developed massive subcutaneous emphysema of the abdomen, chest, mediastinum, scrotum and both legs. Treatment was by conservative measures only. The emphysema gradually disappeared and he was discharged within a few days without sequelae. Subcutaneous emphysema is a rare complication of colonoscopy which has also been described after other endoscopic and radiological investigations of the gastrointestinal tract. It is due to a tiny laceration of the mucosal wall of the colon incurred during aggressive instrumentation, through which pass large quantities of air. The laceration is located underneath the peritoneal sac and the air flows into the retroperitoneum (closed or extraperitoneal perforation). The appearance of subcutaneous emphysema a few hours later, usually after leaving the hospital, is characteristic. In contrast to intraperitoneal perforation (open perforation), surgical intervention is not indicated and treatment is usually conservative. It includes complete cessation of oral alimentation, insertion of a nasogastric tube, IV drip, and correction of hydro-electrolytic or acid-base imbalances. The overall prognosis following such measures is excellent.

Aged↗
PubMed1985

Pheochromocytoma of the organ of Zuckerkandl presenting as shock.

A patient with unusual manifestations of pheochromocytoma, together with a relatively rare localization of the tumor in the organ of Zuckerkandl, is presented. There was a sharp fall in blood pressure to shock levels and transient severe cardiomyopathy, as evidenced by ECG changes, all of which disappeared postoperatively. We suggest several explanations for these unusual manifestations.

Adult↗