PubMed Health⌕ Search

Biomedical subjects

A S Gervin

Publications and source records attributed to A S Gervin.

At least 19 recordsLinked to original sources
PubMed1992

Incidence of temporomandibular joint symptoms following whiplash injury.

Recently there has been considerable litigation involving the development of temporomandibular joint (TMJ) pain and dysfunction following cervical musculoskeletal injury (whiplash). The purpose of this investigation was to interview, examine, and follow up patients with a diagnosis of whiplash injury to determine the incidence of associated temporomandibular disorders. Patients were divided into two categories: those with and those without radiologic evidence of cervical skeletal injury. In the 63 patients with radiographic evidence of cervical skeletal injury (group 1), none had clicking at the time of initial examination. In the 92 patients without positive radiographs (group 2), only one had clicking. At 1 month follow-up by telephone, 2 of 51 available patients in group 1 had developed clicking, but no new TMJ symptoms were reported by the 78 patients in group 2 contacted by phone. Seventy percent of the initial follow-up group (44 patients) with radiographic evidence of injury were contacted by telephone at 1 year and none reported new symptoms of TMJ pain or clicking. Sixty-five percent of the initial follow-up group without radiographic evidence of injury (60 patients) were interviewed and also reported no new TMJ symptoms. These data indicate that the incidence of TMJ pain and clicking following whiplash injury is extremely low, and that patients who do not have clicking on resolution of their initial pain/dysfunction subsequently do not develop this problem.

Accidents, Traffic↗
PubMed1991

Seat belt injuries: radiologic findings and clinical correlation.

The seat belt syndrome consists of skeletal, soft-tissue, and visceral injuries associated with use of two- and three-point restraints in patients involved in motor vehicle accidents. Skin abrasions of the neck, chest, and abdomen--the classic seat belt sign--indicate internal injury in 30% of cases. Neck abrasions are associated with injuries to the carotid artery, larynx, and cervical spine; chest abrasions, with fractures of the sternum, ribs, and clavicles and injuries to the heart and thoracic aorta; and abdominal abrasions, with mesenteric tears, bowel perforation and hematoma, Chance fractures, and injuries to the abdominal aorta. The seat belt sign should prompt a diligent search for related injuries.

Abdominal Injuries↗
PubMed1991

Indications for radiography in patients with acute ankle injuries: role of the physical examination.

A prospective study was performed to test the hypothesis that a thorough physical examination can eliminate the need for a large number of radiographs obtained in patients with acute ankle trauma. Two hundred one patients were seen in the emergency department for acute ankle trauma and referred to the department of radiology for ankle radiographs. Radiology residents performed a brief but thorough physical examination of the ankle in all 201 patients. Solely on the basis of a strict set of physical examination criteria (examination for gross deformity, instability, crepitation, focal bony tenderness, severe soft-tissue tenderness, moderate or severe soft-tissue swelling, and ecchymosis), the radiologists determined whether or not the radiographs were indicated. All patients, irrespective of the physical examination, underwent ankle radiography, and the results were correlated with those of the physical examination. On the basis of the results of the physical examinations, 101 (50%) of the radiologic studies were not indicated. In only one of these patients was a fracture seen on radiographs. The radiograph in this case showed a small avulsion fracture of the dorsal aspect of the talus that was clinically insignificant (no cast or surgery was required). Our results suggest that a brief but thorough physical examination can eliminate the need for a large percentage of radiographs ordered in patients with acute ankle trauma.

Adolescent↗
PubMed1990

Biliary obstruction and cholestasis in AIDS: case report.

In summary, we have described a patient with AIDS and a previously unreported cause of biliary tract obstruction. The incidence of cryptococcal visceral lymphadenitis in patients with AIDS and disseminated cryptococcosis is unknown, but, if present, is probably clinically silent in most instances. However, in the differential diagnosis of abdominal pain and cholestasis in such patients, one should consider major biliary duct obstruction due to cryptococcal lymphadenitis.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Capnographic waveforms in esophageal intubation: effect of carbonated beverages.

Capnography is a useful tool in differentiating tracheal from esophageal intubation. It may be an especially useful tool in emergency airway management by rescue squads or in the emergency department. However, in clinical practice the question has arisen as to whether prior ingestion of carbonated beverages can generate false-positive capnographic evidence of endotracheal intubation when in fact esophageal intubation has occurred. To answer this question, we compared the difference between tracheal and esophageal capnographic waveforms in dogs in the setting of recent ingestion of carbonated beverages. Esophageal capnographic recordings from three of five dogs undergoing esophageal ventilation were strikingly positive for exhaled carbon dioxide; however, the waveforms were significantly different from waveforms of tracheal ventilation. We conclude that esophageal intubation, after recent ingestion of carbonated beverages, may give false-positive waveforms suggestive of tracheal intubation. Rapidly diminishing CO2 concentrations, however, help differentiate esophageal from tracheal ventilation in this setting.

Animals↗
PubMed1989

Case report: transthoracic retrograde venous bullet embolization.

The embolism of bullets in the venous system is an uncommon complication of penetrating missile injuries. Retrograde transthoracic venous bullet embolization is exceedingly rare. This report describes embolization of a small-caliber bullet from the left subclavian vein to a branch of the right popliteal vein. The patient was treated successfully without surgery.

Adolescent↗
PubMed1978

Fibrinolytic activator activity in human neoplasms.

The results of this study suggest that many malignant tumors contain low levels of fibrinolytic activator activity. Evidence is presented to suggest that this low activity may be due to the presence of an inhibitor of fibrinolysis. The presence or absence of measurable fibrinolytic activator activity, and/or inhibitor in neoplastic growths may enable one to predict the probability of viable metastases to a distant site.

Anticoagulants↗
PubMed1975

Surgical trauma and pericardial fibrinolytic activity.

Fibrinolytic activator activity was identified in canine pericardium by fibrin slide and fibrin slide and fibrin plate techniques and shown to be sighnificantly decreased following trauma. Cotton sponge abrasion, heating, drying and use of electrocautery and DC electro-shock significantly decreased pericardial fibrolytic activity. Operative decreases in pericardial fibrinolytic activator activity may be significant in the etiology of postoperative pericardial adhesions and constrictive pericardial syndromes.

Animals↗
PubMed1975

The source and removal of microaggregates in aged human blood and human blood components.

Microaggregates are formed during the storage of human blood and are composed largely of platelets and leukocytes. These microparticles reside in the buffy coat fraction of blood. The formation of microaggregates can be successfully prevented by removal of the buffy coat or by treatment of blood with drugs which inhibit platelet function prior to storage. Once formed, the volumes of microaggregates in aged blood can be significantly reduced by washing, centrifugation or treatment with urokinase or streptokinase. Glycerol frozen red blood cells and blood components--packed red blood cells and plasma--are free of microaggregates, and they can be infused without fear of embolic consequence.

Aspirin↗
PubMed1975

Complications of heparin therapy.

Currently, heparin therapy is rarely extended for periods required for the onset of chronic complications. Thus, alopecia and skeletal defects are infrequently encountered. However, during pregnancy, prolonged therapy with heparin may be used. Heparin does not cross the placental barrier, whereas the warfarin class of anticoagulants is freely transported across the barrier. Thus, if extended anticoagulation is required during pregnancy, heparin is preferred to provide maternal anticoagulation while protecting against fetal hemorrhage. Hemorrhage, the most frequent and most feared complication of heparin therapy, does not occur spontaneously in all patients receiving large doses of heparin. However, in certain populations, hemorrhage must be anticipated and appropriate modifications made in the heparin dosage. Elderly women, persons with thrombocytopenia or drug induced platelet dysfunction, or persons who have undergone recent surgical treatment or trauma are sensitive to standard heparin dosages and may bleed during heparin therapy. In these situations, the initial heparin dosage must be appropriately decreased and subsequent dosages carefully determined by frequently monitored coagulation studies. a well maintained, functional coagulation laboratory is imperative in these situations. By careful monitoring of coagulation parameters and by the selection of the smallest effective heparin dosage, complications can be minimized. The clinical cognizance of heparin induced thrombocytopenia is increasing. This disorder must be considered when hemorrhage and low platelet numbers appear during heparin therapy. Discontinuance of heparin therapy causes a rapid increase in platelet counts and diminution of bleeding. The indiscriminate use of protamine sulfate to neutralize heparin must be discouraged. One must resist the temptation to administer multiple extra doses of protamine to assure achievement of hemostasis. The precise dosage of protamine sulfate calculated to neutralize a given heparin dosage must be used. Additional doses of protamine must be determined by coagulation studies, such as whole blood clotting time, protamine titration test, or thrombin time with toluidine blue correction. If proper attention is directed to the dosage of protamine, relative to heparin, the complications of neutralization rarely will occur. Heparin is a basic drug in the armamentarium of the contemporary surgeon. Successful clinical use of heparin requires fundamental knowledge of coagulation mechanisms, the manner in which heparin alters these mechanisms, and the factors which predispose to complications. The complications of heparin therapy can be minimized by strictest attention to selection of initial dosage and by careful subsequent determination of the precise coagulation status of the patient.

Age Factors↗