Biomedical subjects
Publications and source records attributed to D Manzi.
A young woman with an occult bronchogenic carcinoma presented with secondary amenorrhea and an elevated beta subunit of human chorionic gonadotropin that was mistakenly attributed to pregnancy. Physicians should be aware that this carcinoma may present solely with an elevated beta human chorionic gonadotropin value, and the potential exists for confusion with a pregnancy state in women of childbearing age.
Most colonic varices are attributable to portal hypertension. Intra-abdominal adhesions have been incriminated as the cause of intestinal varices only in association with portal hypertension. We present the first well-documented occurrence of adhesion-related colonic varices in the absence of portal hypertension or other known associated conditions. It is important to delineate the mesenteric vascular anatomy in order to select the appropriate surgical procedure.
STUDY OBJECTIVE: To test the hypothesis that alkalinization of lidocaine decreases the pain of skin infiltration in surgical patients. DESIGN: Double-blind, randomized, prospective study. SETTING: Preoperative holding units, Brigham and Women's Hospital. PATIENTS: 184 adult surgical patients. INTERVENTIONS: We compared the efficacy of 1% lidocaine with and without 0.1 mEq/ml of sodium bicarbonate (NaHCO3) for relief of pain of (1) skin infiltration and (2) intravenous (i.v.) catheterization prior to surgery. MEASUREMENTS AND MAIN RESULTS: Patients evaluated the intensity of pain using a 100 mm visual analog scale (VAS). There were no differences between study groups (lidocaine with NaHCO3, n = 89; lidocaine alone, n = 95) with respect to site of catheterization or catheter gauge used. Lidocaine plus NaHCO3 caused significantly less pain on skin infiltration (median VAS = 4; range = 0 to 51) than did lidocaine alone (VAS = 8; range = 0 to 48; p < 0.008). Pain of i.v. catheterization also did not differ between groups. There was a weak correlation between catheter gauge and pain of i.v. catheterization (r = -0.19; p = 0.01). CONCLUSIONS: Pain resulting from skin infiltration of lidocaine solutions can be diminished by adding NaHCO3. However, catheter size is more important than the presence or absence of NaHCO3 in determining the pain of i.v. catheterization.
A stress test was performed before and after by-pass grafts in 83 patients. Post-operatively, the number of painful stress tests fell from 68 to 28. Whatever the initial clinical picture (stable angina, anterior or inferior infarct), the improvements is significantly better when all of the lesions have been by-passed. Furthermores, there was no significant change in the maximal performance, but the appearance of pain occurred at much higher values, reflecting the improvement in coronary perfusion and the displacement of the point of appearance of ischaemia.