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Biomedical subjects

A Gelb

Publications and source records attributed to A Gelb.

At least 37 records · Page 2Linked to original sources
PubMed1992

Cardiovascular effects of human insular cortex stimulation.

Recent investigations indicate a site of cardiac representation within the left insular cortex of the rat. Moreover, the results of lesion studies suggest left-sided insular dominance for sympathetic cardiovascular effects. It is unclear whether similar representation exists within the human insular cortex. Five epileptic patients underwent intraoperative insular stimulation prior to temporal lobectomy for seizure control. On stimulation of the left insular cortex, bradycardia and depressor responses were more frequently produced than tachycardia and pressor effects (p less than 0.005). The converse applied for the right insular cortex. We believe this to be the first demonstration of cardiovascular changes elicitable during insular stimulation in humans, and of lateralization of such responses for a cortical site. In humans, unlike the rat, there appears to be right-sided dominance for sympathetic effects. These findings may be of relevance in predicting the autonomic effects of stroke in humans and in the explanation of sudden unexpected epileptic death.

Adolescent↗
PubMed1989

Isoflurane for refractory status epilepticus: a clinical series.

General anesthesia has been recommended to control convulsive status epilepticus that is refractory to conventional anticonvulsant therapy. Halothane has been the recommended agent, but without experimental justification. Isoflurane, which has no reported organ toxicity and produces electrographic suppression at clinically useful concentrations in normal humans, should be a better volatile anesthetic for this purpose. The efficacy and safety of isoflurane administered to control convulsive status epilepticus were assessed on 11 occasions in nine patients in seven North American hospitals. Isoflurane, administered for 1-55 h, stopped seizures in all patients and was able to be titrated to produce burst-suppression patterns on electroencephalograms. Blood pressure support with iv fluids and/or pressor infusions was required in all of the patients. Seizures resumed upon discontinuation of isoflurane on eight of 11 occasions. Six of the nine patients died. The three survivors sustained cognitive deficits. In one patient urine fluoride concentrations were elevated, although not to nephrotoxic levels. These cases suggest that isoflurane 1) is an effective, rapidly titratable anticonvulsant; 2) does not reverse underlying causes of the refractory seizures; and 3) usually necessitates hemodynamic support with fluids and/or pressors. Isoflurane may be administered for seizures, but only when iv agents in anesthetic doses are ineffective or produce unacceptable side effects.

Adolescent↗
PubMed1989

Angiostrongyliasis: a rare cause of gastrointestinal hemorrhage.

Angiostrongylus costaricensis is an intestinal nematode, endemic to Central and South America. Affecting mostly children, it causes an eosinophilic gastroenteritis with involvement of the appendix, distal small bowel, and right colon. We report a case of a 41-yr-old man, from a non-endemic area, with the unique presentation of recurrent gastrointestinal bleeding. The diagnosis was made after surgical exploration.

Adult↗
PubMed1988

Patient anesthesia and monitoring at a 1.5-T MRI installation.

This paper describes the facilities successfully used to provide patient monitoring and anesthesia support in a 1.5-T imaging installation. The requirements for the MRI site for anesthetic gases, shielded power, and radiofrequency ports are outlined. Specific modifications in anesthesia machines, anesthesia cart, laryngoscope, mercury sphygmomanometer, oximeter, and remote blood pressure devices are described. Additional aspects of patient monitoring and support, e.g., electrocardiogram and pressure infusion, are also discussed.

Anesthesiology↗
PubMed1985

Aminophylline increases the toxicity but not the efficacy of an inhaled beta-adrenergic agonist in the treatment of acute exacerbations of asthma.

We studied 40 patients with acute exacerbations of asthma to determine the efficacy of a 3-h intravenous infusion of aminophylline in patients who were already being treated with an inhaled beta-adrenergic agonist (metaproterenol). Each patient was treated with inhaled metaproterenol at hourly intervals for 3 h. In addition, patients were randomly assigned to therapy with either intravenous aminophylline or placebo. Neither the patient nor the house officers and nurses caring for the patient knew whether aminophylline or placebo was given. The FEV1 improved continually throughout the study to a similar extent in both treatment groups, but the patients treated with aminophylline had significantly more adverse effects (p less than 0.025, Mann-Whitney). There was no apparent benefit from aminophylline even in patients who presented to the emergency room with severe airway obstruction (FEV1 less than 0.8L) or with plasma theophylline levels less than 10 mg/L. We conclude that intravenous aminophylline adds to the toxicity but not the efficacy of inhaled metaproterenol in the treatment of acute exacerbations of asthma.

Adolescent↗
PubMed1984

Isospora belli in a patient with acquired immunodeficiency syndrome.

Isospora belli is a cause of protracted diarrhea in immunocompromised patients. Acquired immunodeficiency syndrome (AIDS), seen mostly in homosexual men and narcotic addicts, predisposes affected persons to a number of opportunistic infections. As Isospora belli has been reported only once in this group, we report Isospora belli in an AIDS patient with chronic diarrhea.

Acquired Immunodeficiency Syndrome↗
PubMed1984

An unusual case of malignant melanoma of the small intestine.

A 42-year-old woman presented with abdominal pain and diarrhea. Small bowel x-rays and endoscopy revealed a diffuse, infiltrating lesion of the small intestine, which on biopsy proved to be melanoma diffusely infiltrating the lamina propria. Because of marked hypoalbuminemia, protein-losing enteropathy was suspected. This is an unusual case, because melanoma of the small intestine usually does not produce diffuse involvement.

Adult↗
PubMed1983

Sedation and respiratory mechanics in man.

The effects of sedation with halothane, enflurane or midazolam on respiratory mechanics and lung volumes were studied in young healthy volunteers, in the supine position. Functional residual capacity increased with halothane sedation, but was unchanged with sedation produced by enflurane or midazolam. Sedation with halothane and enflurane, but not midazolam, tended to increase lung static recoil pressure. Total lung capacity was decreased during sedation with midazolam. No evidence was found that sedation with these three agents increased airway resistance. These findings imply that changes in respiratory mechanics induced by the residual effects of anaesthetic agents are unlikely to contribute significantly to the impairment in pulmonary gas exchange which may occur in the period immediately after operation.

Adult↗
PubMed1983

Virus-associated colitis in homosexual men: two case reports.

Two homosexual men with colitis are described. In each case there was evidence of viral infection of the colon. One patient developed toxic megacolon that responded to conservative therapy. The other patient had proctosigmoiditis and opportunistic infections that eventually led to his death. An intensive search for viruses should be made in all homosexual men with proctitis and/or colitis.

Adult↗
PubMed1983

Colitis due to Dientamoeba fragilis.

Clinical reports have suggested that the parasite Dientamoeba fragilis may be a cause of acute and chronic colitis in children and adults. The mechanism by which this parasite produces colitis has not been determined. The clinical findings in this case report suggest that D. fragilis causes colitis through an invasive ulcerating process.

Adult↗