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Biomedical subjects

C V Pollack

Publications and source records attributed to C V Pollack.

At least 55 records · Page 3Linked to original sources
PubMed1992

Recognizing an index case of type 1 neurofibromatosis.

Neurofibromatosis is a relatively common autosomal dominant disorder with variable penetrance. The disorder usually presents in childhood. Hallmarks of type 1 neurofibromatosis are café-au-lait macules and neurofibromas. Neurologic complications include mental retardation, learning disabilities and seizures. Tumors of the eighth cranial nerve, as well as other intracranial and spinal neoplasms, are the typical lesions in type 2 neurofibromatosis. Both forms of neurofibromatosis have a highly variable course and may result in progressive neurologic deterioration, disfigurement and impingement syndromes. In the 50 percent of cases that represent new mutations, diagnosis may be delayed if the physician is not familiar with the salient features of the disorder. Thorough initial evaluation, genetic counseling and close follow-up are important aspects of management.

Bone Diseases↗
PubMed1991

Benign cystic mesothelioma presenting as acute abdominal pain in a young woman.

Benign cystic mesothelioma is a rare tumor that, due to compressive effects, presents with abdominal pain and distention and other mass symptoms such as early satiety. Although diagnostic modalities such as plain radiography, ultrasonography, and computed tomography (CT) scan can suggest the diagnosis, confirmation can be accomplished only at surgery. The differential diagnosis includes any benign or malignant cystic abdominal or pelvic tumor. Management consists of surgical excision, which unfortunately is not always curative, since there is a recurrence rate of 50%. The clinical features, work-up, and course of a 15-year-old female with benign cystic mesothelioma are presented, followed by a brief review of the literature.

Abdominal Pain↗
PubMed1991

Intraosseous administration of antibiotics: same-dose comparison with intravenous administration in the weanling pig.

STUDY OBJECTIVES: To assess the reliability of the intraosseous route of administration for delivery of a loading dose of broad-spectrum antibiotics in a pediatric animal model. DESIGN: Serum levels achieved within 90 minutes of equivalent intraosseous (IO) and IV bolus dosing of ceftriaxone, cefotaxime, and a combination of ampicillin and gentamicin were compared in the weanling pig. SUBJECTS: Twelve female weanling pigs were studied in the Animal Facilities Laboratory at the University of Mississippi Medical Center. INTERVENTIONS: Through a proximal tibial IO catheter, each anesthetized animal received one of the following: 50 mg/kg ceftriaxone, 50 mg/kg cefotaxime, or 300 mg/kg ampicillin followed immediately by 2.5 mg/kg gentamicin. Venous blood was obtained for antibiotic assay at 15, 30, 45, 60, and 90 minutes after IO injection. The animals were allowed to recover, and, after a one-week washout period, each received the same antibiotic and dose as before through a peripheral IV. Levels were assayed at the same intervals and IO versus IV were compared. MEASUREMENTS AND MAIN RESULTS: Comparable serum levels of all four antibiotics were achieved by the two routes. Gentamicin levels were statistically indistinguishable IO versus IV at all assay intervals. Ampicillin and cefotaxime levels achieved by the two routes were equivalent within one hour of dosing. Serum levels of ceftriaxone after IO administration paralleled those after IV dosing but remained significantly lower at all time intervals. CONCLUSIONS: In the weanling pig model, the IO route was used to deliver serum levels of broad-spectrum antibiotics comparable to those attained after IV administration. The data support the use of standard parenteral doses for IO administration. To overcome potential avid protein binding of ceftriaxone in the bone marrow, we recommend using ceftriaxone at its highest recommended IO loading dose. Consistent with many other medications that have been similarly tested, these data indicate that initial or empiric antibiotic coverage in hypodynamic and shock states in infants and young children need not await the establishment of traditional IV access.

Ampicillin↗
PubMed1991

Hemorrhagic shock and encephalopathy syndrome.

Hemorrhagic shock and encephalopathy syndrome (HSES) is a devastating symptom complex that affects previously healthy infants and is associated with significant mortality and neurologic morbidity. The syndrome was first reported less than ten years ago, and there continues to be debate regarding whether HSES actually represents a distinct clinical entity or instead is a manifestation of heat illness, occult sepsis or endotoxic shock, or perhaps toxic ingestion. Nevertheless, the signs and symptoms described as HSES present in a typical fashion in the emergency department with sudden onset of shock, encephalopathy, seizures, and coagulopathy. Even with the initiation of intensive support in the ED, the outcome is probably dismal. We describe a case of HSES and review the presentation, proposed etiologies, and management of this catastrophic illness.

Central Nervous System Diseases↗
PubMed1991

Usefulness of empiric chest radiography and urinalysis testing in adults with acute sickle cell pain crisis.

STUDY OBJECTIVE: To determine the usefulness of obtaining routine chest radiographs and urinalyses on adults presenting to the emergency department in acute sickle cell pain crisis. The hypothesis tested is that in some adult sickle cell patients, sickle cell pain crises are precipitated or accompanied by acute infection that may be clinically occult and that routine screening for pulmonary or urinary tract infection would identify some of these precipitating illnesses. DESIGN: Prospective clinical study. SETTING: A university hospital ED. PATIENTS: All patients more than 14 years old with S-S, S-C, or S-beta-thalassemia sickle hemoglobinopathies who presented to the ED with acute nontraumatic painful complaints during a six-month period. INTERVENTIONS: All patients underwent posteroanterior and lateral chest radiography, routine urinalysis, and CBC count with reticulocyte count. A standard questionnaire for localizing symptoms of systemic, pulmonary, and urinary tract infection was completed for each patient. Urine cultures were ordered on all patients with voiding symptoms, flank pain, and/or more than 5 WBCs or RBCs per high-power field on urinalysis. Physical examination for evidence of pulmonary and urinary tract infection was carefully performed and recorded for subsequent analysis. RESULTS: Seventy-one patients with 134 ED presentations were studied over a six-month period. Eight diagnoses of acute pneumonia were made. Four of these patients complained of chest pain (50% vs 48% overall) and three had shortness of breath (38% vs 21%). None of these patients complained of fever or symptoms of upper respiratory illness. Ten diagnoses of urinary tract infection were made. Four of these patients complained of dysuria and frequency; three complained of flank pain. Eleven of the 18 infections (61.1%) did not have a typical history for or suggestive physical or laboratory findings of bacterial infection. CONCLUSION: In sickle cell disease patients with pain crisis, routine chest radiography and urinalysis may be clinically useful and cost effective in the early diagnosis of crisis-related infection.

Acute Disease↗
PubMed1991

Intraosseous administration of digoxin: same-dose comparison with intravenous administration in the dog model.

Intraosseous access has become the method of choice for venous access in critically ill and injured children when more traditional methods are not immediately available. However, there is a paucity of information concerning drug levels achieved via the intraosseous route. We report initial data on the comparison of serum digoxin levels after administration of the drug to dogs through both the intraosseous and intravenous routes. These data indicate that intraosseous infusion of digoxin results in similar serum levels to those attained after IV administration, and may therefore afford a reliable means of initial digitalization.

Animals↗
PubMed1990

Chylous drainage from a stab wound to the neck.

A 24-year-old man was assaulted and sustained a stab wound to the left lower neck. When he arrived at the emergency department, he was hemodynamically stable. Although the wound had penetrated the platysma, on initial evaluation the patient did not appear to have sustained significant injury. Closer examination of the wound revealed chylous drainage, indicating injury to the cervical portion of the thoracic duct. The patient was taken to the operating room for exploration of the wound, during which an injury to the left internal jugular vein was identified and repaired. The thoracic duct, which had been severed, was ligated. The remainder of the patient's hospital course was unremarkable. The consistent association between penetrating injury to the cervical portion of the thoracic duct and injury to neighboring vascular structures is discussed.

Adult↗
PubMed1990

Injury Severity Scores in desert recreational all-terrain vehicle trauma.

A retrospective analysis of 1,259 patients injured in all-terrain vehicle accidents over a 2-year period was performed. All patients presented to the same community hospital Emergency Department, located near a major desert off-road vehicle recreational area. The patients were characterized by demographics and Injury Severity Scores. There were 2,149 recorded injuries. Mean ISS +/- standard deviation for all patients was 5.07 +/- 4.93; among patients admitted for inpatient care, 9.83 +/- 6.46. Injury Severity Scores were independent of vehicle type (two, three, or four wheels). In this setting, injuries sustained by children were not disproportionately more severe than those sustained by adults. Where documented, alcohol use was associated with higher ISS, and the use of helmets was associated with less severe head and facial injuries. The most common diagnoses in this series were integumental injuries and fractures, frequently involving the face and extremities.

Adolescent↗
PubMed1990

Hemobilia presenting as lower gastrointestinal hemorrhage without pain or jaundice: a case report.

Hemobilia is a rare source of gastrointestinal (GI) hemorrhage. When hepatobiliary bleeding presents as GI bleeding, a history of preceding blunt abdominal trauma is reported in approximately 50% of cases. Often three to four weeks have elapsed between the injury and presentation, and as long as twelve weeks has been reported. Symptoms may suggest either upper or lower GI blood loss. Traumatic hemobilia is commonly associated with cavitary injuries to the liver, and is classically characterized by a triad of findings: GI bleeding, biliary colic, and jaundice. This report describes a patient with traumatic hemobilia, who had neither a significant hepatobiliary injury, nor the classic triad of findings.

Adult↗
PubMedDate not supplied

Use of diphenhydramine for local anesthesia in "caine"-sensitive patients.

Emergency physicians regularly encounter patients who require local or topical anesthesia in the course of their emergency department (ED) treatment for lacerations, abrasions, or mucosal surface pain. Rarely, patients disclose a history of allergy to lidocaine and its chemical analogues, and the physician is faced with the problem of achieving adequate anesthesia without the use of these drugs. Research studies and anecdotal reports have suggested that diphenhydramine hydrochloride (Benadryl) may be useful as a substitute. We describe three cases of patients with histories of "caine" allergy who required local anesthesia for laceration repair. Infiltration with a 1% diphenhydramine solution provided adequate anesthesia without noticeable adverse effects. We feel that diphenhydramine has a place in emergency medicine practice as a second-line local anesthetic agent.

Adult↗
PubMedDate not supplied

Cough-variant asthma in children and adults: case reports and review.

Two cases of cough-variant asthma are presented, one in an adult and one in a child. We discuss the diagnosis, treatment, and course of this common, yet often unrecognized entity. The keys to diagnosis are a typical history, clinical suspicion, and subsequent response to bronchodilator therapy. Treatment of cough-variant asthma is no different from that of classic asthma.

Adult↗
PubMedDate not supplied

Sialolithiasis: case studies and review.

Three cases of sialolithiasis are presented, each representative of acute and chronic presentations of this problem. The evaluation and treatment of salivary gland and duct stones are outlined. The primary axiom is, "Treat the gland, not the stone," and the essential aspects of emergency medical management are antibiotics, sialogogues, warm compresses, mechanical stimulation, and appropriate referral to an otolaryngologist.

Adult↗
PubMedDate not supplied

Emergency department analgesia without narcotics for adults with acute sickle cell pain crisis: case reports and review of crisis management.

Vaso-occlusive crises are one of the most debilitating features of sickle cell disease. There appears to be no standardization of care for adults with pain crisis, and some commonly utilized regimens, such as those employing intramuscular meperidine, are pharmacologically unsound. Parenteral narcotic use may be associated with respiratory compromise acutely and with dependence over the long term, but nonopioid preparations are often unsatisfactory in relieving pain. We have recently enjoyed success with a combination of a parenteral nonsteroidal anti-inflammatory medication and an oral tricyclic antidepressant. We report four representative cases and review the salient points of the management of pain crisis in adult patients in the emergency department.

Acute Disease↗
PubMedDate not supplied

Unusual cases of intussusception.

Intussusception occurs most commonly in the first five years of life and is classically associated with intense intermittent abdominal pain, vomiting, bloody mucoid diarrhea, and a palpable abdominal mass. These cardinal findings are frequently not present, however, particularly outside the usual age range. The emergency physician must therefore be vigilant in considering intussusception as a potential cause for intestinal obstruction in all patients, if ischemic complications are to be avoided. We present three cases of "unusual" intussusception, and provide a review of this entity and a guide to its consideration and work-up in the emergency department.

Adult↗