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Biomedical subjects

D Geva

Publications and source records attributed to D Geva.

At least 19 recordsLinked to original sources
PubMed1999

Use of cuffed oropharyngeal vs laryngeal mask airway in elderly patients.

PURPOSE: This study was designed to compare the new cuffed oropharyngeal airway (COPA) to the laryngeal mask airway (LMA) in elderly patients. METHODS: In a randomized, controlled study, 80 patients, age > or = 65, ASA I-III, undergoing urology procedures, were managed with either COPA or LMA. Propofol requirements for insertion of the devices, ease of insertion and removal, airway manipulations, mean arterial pressure, heart rate, P(ET)CO2, SpO2, peak inspiratory pressure, selection of the appropriate size of the device and leaks, fibreoptic visualization of larynx and complications were studied. RESULTS: There were more airway manipulations in the COPA group than in the LMA group (40% and 5% respectively) whereas P(ET)CO2 was higher in the LMA group (P < 0.05). In 60% of COPA patients the vocal cords could not be visualized but ventilation was adequate in all but two cases. Postoperative sore throat occurred in 20% of patients with LMA vs 10% with COPA). Bloody secretions on the device were present in two patients managed with LMA. CONCLUSION: In elderly patients COPA required more airway manipulations than the LMA. Laryngeal mask airway caused more sore throats, but was better for fibreoptic visualisation of the larynx. Both are excellent options when intubation is not indicated/desired.

Aged↗
PubMed1999

Evaluation of a new immunochromatographic test for Helicobacter pylori IgG antibodies in elderly symptomatic patients.

AIM: To determine the diagnostic value of a new serum and whole blood serological IgG antibody test, FlexPack HP, for the diagnosis of Helicobacter pylori in elderly symptomatic patients. METHODS: 94 consecutive symptomatic patients who underwent upper endoscopy were studied (mean age, 62.6 years). On endoscopy, the presence of H. pylori infection was examined by biopsies from gastric antrum and body for rapid urease test and histologic examination. Blood was drawn prior to endoscopy and both blood and serum were immediately analyzed for human IgG antibodies to H. pylori by a new commercially available qualitative immunochromatographic method, FlexPack HP. This test incorporates high-molecular weight cell-associated proteins (HM-CAP), which are highly specific for H. pylori IgG antibodies. RESULTS: Overall agreement for FlexPack HP whole blood vs FlexPack HP serum was 100%, and agreement with biopsy results was 71%. The gold standard (detection of H. pylori by histology or urease test) identified H. pylori in 61 patients (65%). Complete agreement was observed between the gold standard test and the serology kit in 72% (68/94) of sera (51 positive and 17 negative). Disagreement was found in sera of 26 patients; 16 sera were negative by the gold standard and positive by FlexPack HP and 10 patients were found negative by serology. The sensitivity of FlexPack HP was 84% and the specificity 52% when compared with the gold standard. CONCLUSIONS: FlexPack HP serum and whole blood test is a simple and reliable method for the detection of H. pylori antibodies, with 100% agreement between the serum and blood results. In the elderly symptomatic patients the sensitivity of FlexPack HP was similar to that of other serologic tests, but the specificity was relatively low, limiting its use in this population.

Aged↗
PubMed1998

Cerebrospinal fluid magnesium level as a prognostic factor in ischaemic stroke.

Magnesium has been reported to have a dilatatory effect on cerebral arteries. Reduction of extracellular Mg+2 has been shown to be directly correlated with the intensity of cerebral spasm. A neuroprotective effect of magnesium in stroke has also been hypothesized. The aim of our study was to examine the Mg+2 levels in serum and cerebrospinal fluid (CSF) in the early stage of stroke and to evaluate the correlation between Mg+2 levels and the development of neurological deficits. Between 1986 and 1994, 96 patients who had a stroke of 24- to 48-h duration were enrolled in the study. Serum and CSF levels of magnesium were checked on admission, 2448 h after the onset of stroke. Using a neurological score, the neurological deficit was assessed on the 1st day, 1 and 4 weeks later. Computed tomography (CT) was performed after 1 week, and the volume and location of infarction were calculated and measured. Statistical analysis was performed for cortical and subcortical patients separately, using Spearman correlation and multiple linear and logistic regression analyses. Significant correlation was found between CSF Mg+2 and the size of the infarct (P < 0.0001). There was no correlation between serum Mg+2 and CSF Mg+2 levels. Regression analysis demonstrated an increase in the values of the Mathew Neurological Score with higher CSF Mg+2 levels. This association remained true after other factors such as age, associated heart disease, diabetes and infarction size had been taken into account by the regression model. The results confirm that there is a relationship between a low Mg+2 concentration in CSF during the first 48 h after onset of ischaemic stroke and the intensity of the neurological deficit. The therapeutic consequence of this finding may have some importance.

Adult↗
PubMed1998

Labetalol-induced hypotension decreases blood loss during uncontrolled hemorrhage.

In a model of uncontrolled hemorrhagic hypotension (UCHH) in rats, we examined whether blood loss or blood chemistry were affected by (1) deliberate, controlled hypotension induced with labetalol (L) or sodium nitroprusside (SNP) and (2) intravenous (iv) fluid therapy. Two hours of UCHH was induced by resecting the distal 25% of the tail. L or SNP was infused with the aim of decreasing MAP to 50 mmHg. In the groups receiving iv fluid, 3 ml of 0.9% saline was given for each 1 ml of blood loss. L decreased blood loss (2.8+/-2.0 and 3.0+/-1.9 ml, respectively, in the groups not receiving and receiving iv fluid) compared to the groups not given hypotensive drugs (6.3+/-4.1 and 13.5+/-6.6 ml). SNP did not decrease blood loss (5.7+/-4.7 and 11.0+/-6.2 ml), increased serum potassium (5.0+/-0.6 and 5.8+/-0.4 mEq l(-1)), and with accompanying iv fluid administration decreased hematocrit, worsened acidosis, and increased mortality. In this model of 2 h of UCHH in rats, hypotension to MAP of 50 mmHg with L but not with SNP decreased blood loss.

Animals↗
PubMed1998

High rate of asthma among immigrants.

Articles dealing with the epidemiological aspects of asthma were carefully reviewed in order to support or reject our clinical impression of increased rate of asthma among immigrants. Particular emphasis was put on data on very high or very low rates of asthma. The proposed theories to explain these differences were critically examined. The prevalence of asthma in China and in Africa is 1-2% and 0.5-5%, respectively. The prevalence of the disease in other indigenous populations ranges between 0.5% and 12%. On the other hand, asthma is much more frequently seen in Australia and in New Zealand (approximately 20-25%), where peoples' ancestors immigrated from distant areas. Statistical meta-analysis found a significant difference between the rates of asthma in the two groups of populations (P < 0.001). Immunoglobulin E levels of immigrants in Sweden are higher than those of native Swedes. Similarly, cord blood immunoglobulin E concentrations are more elevated in neonates whose mothers emigrated to Germany from Eastern countries than in those of native German mothers. There is an increased rate of IgE-mediated asthma among immigrant populations.

Asthma↗
PubMed1998

Effects of prenatal substance exposure: altered maturation of visual evoked potentials.

We investigated the effects of prenatal substance use on visual evoked potentials (VEPs). Seventy-four children were tested at birth and 1 month of age with binocular flash VEPs and at 4, 8, and 18 months of age with binocular pattern VEPs. Regressions were run by trimester to assess the independent effects of substance exposure. Variables included in the regression model were alcohol, marijuana, tobacco, other drug use for each trimester, maternal age, education, income, race, marital status, infant sex, birthweight, and Dubowitz score. Changes in specific components of the binocular VEP were both substance- and trimester-specific. First trimester alcohol use was associated with prolonged P1 wave latencies at 1 month of age. Prolonged P1 wave latencies at birth and 18 months were associated with tobacco use during each of the three trimesters, at 1 and 18 months with third trimester marijuana use, and at 1 and 18 months with first trimester other illicit drug use. Although these women were moderate substance users during pregnancy, their offspring exhibited maturational changes in components of the VEP in the absence of neonatal behavioral disturbances.

Aging↗
PubMed1998

Oral clonidine premedication does not prolong analgesia after herniorrhaphy under subarachnoid anesthesia.

STUDY OBJECTIVE: To determine the effect of oral clonidine premedication on duration of sensory and motor block, postoperative analgesia, hemodynamic stability, sedation, and respiratory parameters after subarachnoid anesthesia (SA). DESIGN: Prospective, double blind, randomized, placebo-controlled study. PATIENTS: 80 ASA physical status I patients were randomized into four equal groups to receive oral premedication with either clonidine 5 mcg/kg (C5), clonidine 2.5 mcg/kg (C2.5), diazepam 100 mcg/kg (D), or placebo (PL). MEASUREMENTS AND MAIN RESULTS: The following parameters were measured: duration of motor and sensory block, requirement for postoperative analgesia; systolic (SBP), diastolic (DBP), and mean (MBP) blood pressures; heart rate (HR); sedation and anxiolysis scales; respiratory rate (RR); oxyhemoglobin saturation; and complications. (1) The duration of sensory and motor block did not differ significantly among the groups. (2) There were no differences in the time to first request for analgesia and in requirements for analgesia in the first 24 postoperative hours. (3) Clonidine premedication before SA did not produce episodes of significant hypotension. HR did not differ significantly among the groups. Baseline SBP was significantly higher (p = 0.037) in group PL than in groups C5 and C2.5. Three minutes after SA significant decrease in the following parameters was observed: SBP in group PL compared with the other three groups (p = 0.004), DBP in group PL vs. groups C5 and C2.5 (p = 0.002), and MBP in group PL vs. groups C5 and C2.5 (p = 0.003). (4) Sedation and anxiolysis were more pronounced (p = 0.0001) in groups C5 and C2.5 than in groups D and PL and in group C5 than in group C2.5. (5) RR was significantly lower (p = 0.0024) in group C5 than in groups D and PL. (6) Complications consisted of three episodes (15%) of bradycardia in the C5 group and two of bradypnea (10%) in the same group. CONCLUSIONS: In healthy patients, premedication with oral clonidine provided useful sedation and anxiolysis and stable hemodynamics, without prolongation of sensory and motor block. Side effects occurred only with clonidine 5 mcg/kg. Thus, a dose of 2.5 mcg/kg is recommended.

Administration, Oral↗
PubMed1998

Ovarian carcinoma associated thrombocytosis. Correlation with prognostic factors and with survival.

OBJECTIVE: To assess the prevalence of thrombocytosis (platelets > or = 400,000 microliters) in ovarian cancer of epithelial origin as compared to benign controls consisting of benign ovarian cysts of epithelial origin and to correlate it with prognostic factors of ovarian cancer and survival. METHOD: Hospital records of 82 consecutive patients with ovarian carcinoma, 12 with low malignant potential tumors and 70 with invasive carcinoma, and of 32 patients with benign cysts of epithelial origin were reviewed. The clinical data and preoperative platelet counts were recorded. RESULTS: The prevalence of thrombocytosis in invasive ovarian carcinoma of epithelial origin was significantly higher than in benign controls (24.3% vs 2.9%; p = 0.006). No statistically significant correlation was found between thrombocytosis with age, grade and residual disease. A statistically non-significant excess of thrombocytosis was found among patients with advanced disease, but the survival of patients with thrombocytosis was significantly less favorable (p = 0.04). CONCLUSIONS: Thrombocytosis is significantly more prevalent in ovarian cancer patients than in benign controls and has a statistically significant correlation with poorer survival. The prevalence of thrombocytosis in ovarian carcinoma and its significance in various studies is inconsistent and should be elucidated in large prospective studies.

Adolescent↗
PubMed1997

Brain edema, hemorrhagic necrosis volume, and neurological status with rapid infusion of 0.45% saline or 5% dextrose in 0.9% saline after closed head trauma in rats.

We previously reported that in rats with closed head trauma (CHT), intravenous (IV) administration of 0.25 mL/g of 5% dextrose solution (D5W) increased blood glucose (G), decreased blood sodium (Na), caused no change in blood osmolality (Osm), increased brain edema (BE), and worsened neurological severity score (NSS) and mortality rate (MR). D5W in 0.9% saline (D5NS) is isonatremic and hyperosmolar with respect to blood and may avoid the problems reported with D5W. The present study compared the effects of 0.25 mL/g of D5NS or 0.45% saline (0.45 S) after CHT in rats. In 11 groups of rats, the three experimental variables were CHT (yes or no), IV fluid (none, D5NS, or 0.45 S), and time of death (4 or 24 h). D5NS or 0.45 S was given IV at 1 h after surgical preparation with or without CHT, and experimental values were determined at 1, 2, 4, and 24 h. D5NS decreased BE at 4 h compared with the untreated group, increased Osm (380 +/- 2 mOsm/kg) and G (1278 +/- 199 mg/dL), decreased Na (131 +/- 2 mEq/L) in blood, and caused no significant change in hemorrhagic necrosis volume (HNV), NSS, or MR. 0.45 S increased MR (50%) at 24 h, decreased Osm (270 +/- 5 mOsm/kg) and Na (123 +/- 1 mEq/L) in blood, and caused no significant change in G, BE, HNV, or NSS. We conclude that after CHT in rats, D5NS decreased BE without changing NSS or MR. 0.45 S increased MR and significantly altered blood chemistries.

Animals↗
PubMed1997

Spinal anesthesia speeds active postoperative rewarming.

BACKGROUND: Redistribution of body heat decreases core temperature more during general than regional anesthesia. However, the combination of anesthetic- and sedative-induced inhibition may prevent effective upper-body thermoregulatory responses even during regional anesthesia. The extent to which each type of anesthesia promotes hypothermia thus remains controversial. Accordingly, the authors evaluated intraoperative core hypothermia in patients assigned to receive spinal or general anesthesia. They also tested the hypothesis that the efficacy of active postoperative warming is augmented when spinal anesthesia maintains vasodilation. METHODS: Patients undergoing lower abdominal and leg surgery were randomly assigned to receive general anesthesia (isoflurane and nitrous oxide; n = 20) or spinal anesthesia (bupivacaine; n = 20). Fluids were warmed to 37 degrees C and patients were covered with surgical drapes. However, no other active warming was applied during operation. Ambient temperatures were maintained near 20 degrees C. After operation, patients were warmed with a full-length, forced-air cover set to 43 degrees C. Shivering, when observed, was treated with intravenous meperidine. RESULTS: The mean spinal analgesia level, which was at the sixth thoracic level during surgery, remained at the T12 dermatome after 90 min after operation. Core temperatures did not differ significantly during surgery and decreased to 34.4 +/- 0.5 degrees C and 34.1 +/- 0.4 degrees C, respectively, in patients given spinal and general anesthesia. After operation, however, core temperatures increased significantly faster (1.2 +/- 0.1 degrees C/h vs. 0.7 +/- 0.2 degrees C/h, mean +/- SD; P < 0.001) in patients given spinal anesthesia. Consequently, patients given spinal anesthesia required less time to rewarm to 36.5 degrees C (122 +/- 28 min vs. 199 +/- 28 min; P < 0.001). CONCLUSIONS: Comparable intraoperative hypothermia during general and regional anesthesia presumably resulted because the combination of spinal anesthesia and meperidine administration obliterated effective peripheral and central thermoregulatory control. Vasodilation increased the rate of core rewarming in patients after operation with residual lower-body sympathetic blocks, suggesting that vasoconstriction decreased peripheral-to-core heat transfer after general anesthesia.

Adult↗