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Biomedical subjects

J Ferber

Publications and source records attributed to J Ferber.

17 recordsLinked to original sources
PubMed2001

Arterial to end-tidal carbon dioxide difference during craniotomy in severely head-injured patients.

Clinical data suggest that cerebral blood flow (CBF) can be abnormally low within the first four to eight hours after severe head injury (SHI). An aggressive hyperventilation can additionally worsen CBF and provoke cerebral ischemia. Therefore an accurate PCO2 monitoring in SHI patients (pts) is necessary. PetCO2 failed to reflect PaCO2 in SHI pts treated in neurosurgical ICU. Up to now, the validity of PetCO2 monitoring in estimating PaCO2 during an acute posttraumatic craniotomy has not been studied. Forty five adult SHI pts operated on because of an acute intracranial posttraumatic haematoma within 8 hours after head trauma entered the study. The standard anaesthetic protocol included N2O/O2, fentanyl and pancuronium bromide anaesthesia, and mechanical ventilation with respiratory rate 10 divided by 12 bpm and tidal volume in mL = body weight (kg) x 10 - 100. After obtaining a stable PetCO2 arterial blood sample was taken for PaCO2 measurement and P(a-et)CO2 = PaCO2 - PetCO2 was calculated. P(a-et)CO2 ranged -9 divided by 20 mm Hg (5 +/- 6; mean +/- SD). P(a-et)CO2 between 2 mm Hg and 6 mm Hg was found in 17 (38%) patients only. A negative P(a-et)CO2 was stated in 20% of patients. No relationships between P(a-et)CO2 and pts age and mean arterial pressure were found. P(a-et)CO2 was higher in normocapneic pts than in hyperventilated ones and tended to decrease with an increase in heart rate. We can conclude that during an acute craniotomy in SHI pts, PetCO2 does not reflect accurately PaCO2 and the monitoring of adequacy of ventilation should be based on repeated or continuous measurements of an arterial PCO2.

Adult↗
PubMed2001

[The effect of small doses of 7.5% NaCl on brain bulk during elective craniotomies].

In 16 patients (ASA I i II) aged 16-76 years (48 +/- 15; mean +/- SD) operated on because of intracranial expanding mass, the effect of hypertonic saline (7.5%--1 ml/kg b.w.) on brain bulk (BB) was evaluated. Patients were anaesthetised with a slight hypocarbia (PaCO2 = 33.3 +/- 3.5 mmHg). BB was scored after opening the dura (T0) and 15 min. (T15) after hypertonic saline (HS) infusion. Five points BB scale was used. Brain bulk reduction (D BB) was calculated as a difference: BB15-BB0. Tomographic signs of intracranial expansion (TSIE) in preoperative CT were scored using the scale from 5 to 15 points assessing (1 to 3 points) the size of mass lesion, the size of perifocal oedema, midline shift, displacement of ventricles and basal cisterns compression. Systolic (SBP), diastolic (DBP) blood pressures and heart rate (HR) were monitored. Serum natrium (SNa), kalium (SK) and osmolarity (Sosm) were measured at T0, T15 and Tp0 (one hour after operation). Student's t-test, Wilcoxon test and Spearman correlation were used for statistical analysis. P < 0.05 was considered as statistically significant. HS caused significant decrease in BB (p = 0.002). In 12 patients with a solid brain tumor a negative correlation between BB and TSIE was found (r = -0.68). A slight but significant decreases in SBP and DBP at Tp0 and T15 as well as decrease in HR due to HS were stated. SNa and Sosm increased at T15 and reminded elevated at Tpo. We can conclude that 7.5% saline in a dose of 1 ml/kg b.w. reduces brain bulk during craniotomy in patients with supratentorial mass lesions. In patients with a solid brain tumor this effect correlates negatively with a size of expanding mass. A slight changes in blood pressure and heart rate due to HS as well as moderate decrease in SK are within limits of clinical acceptance.

Adolescent↗
PubMed2000

Tramadol for postoperative analgesia in intracranial surgery. Its effect on ICP and CPP.

An ideal analgesic for patients after craniotomy should neither cause respiratory depression, nor affect intracranial pressure (ICP) and cerebral perfusion pressure (CPP). The aim of the study was to evaluate the effect of Tramadol (T) on ICP and CPP, as well as to determine its analgetic efficacy in patients (pts) after craniotomy. Thirty five pts aged 16 divided by 78 years (mean 46) entered the study. Twelve had GCS (Glasgow Coma Scale) scores < or = 8 and 23 pts had scores > or = 12. Fourteen pts were mechanically ventilated and 21 pts were breathing spontaneously (BS). Tramadol was injected i.v. at a dose of 0.75 mg/kg over 3 minutes in 11 pts (Group 1), 1.0 mg/kg over 5 minutes in 13 pts (Group 2) and 1.0 mg/kg over 10 minutes in 11 pts (Group 3) PaCO2 was measured before T in all pts and at 8 minute after injection in 21 BS pts. Heart rate (HR), mean arterial blood pressure (MBP), ICP, CPP and respiratory frequency (f) were registered before and in the 1st, 3rd, 8th, and 15th minute after T. Analgetic effect was evaluated in 22 conscious pts by comparing the pain intensity before and 30 minutes after T using a five-point verbal response scale. Mean control ICP was 17 mmHg. ICP over 15 mmHg was diagnosed in 15 pts (mean ICP equal 26 mmHg). Mean CPP for all 35 pts was 85 mmHg. There were no statistically significant changes in HR, MBP, ICP, and CPP after T in any particular group, nor were there changes in ICP in subgroups with normal and elevated ICP. No significant changes in PaCO2 and f were found in BS pts. Satisfactory analgesia was obtained in 50% of pts of Group 1, and in 88% of pts of Groups 2 and 3. We conclude that tramadol in doses of 0.75 mg/kg and 1.0 mg/kg i.v. does not affect ICP and CPP in adult postcraniotomy patients and seems to be a safe and effective analgesic at a dose of 1.0 mg/kg for postcraniotomy pain control.

Adolescent↗
PubMed1999

A cure for the Blues: resolving nonprofit Blue Cross conversions.

This Article analyzes the issues involved in converting nonprofit Blue Cross organizations to for-profit status. These issues have arisen in the context of litigation regarding the "reorganization" of Blue Cross and Blue Shield of Missouri ("BCBSMo"). BCBSMo had reorganized by creating and transferring a majority of its business to a new for-profit subsidiary. Missouri consumer groups and state regulators characterized the "reorganization" as a conversion requiring BCBSMo to transfer its assets to a foundation dedicated to charitable health purposes. BCBSMo, however, denied that it had any obligation to leave behind its assets in the nonprofit sector. The BCBSMo litigation raises issues common to most conversions of nonprofit healthcare organizations, particularly conversions of nonprofit Blue Cross plans. This Article provides a road map for state regulators and the public to follow in ensuring that the public interest is fully protected in such conversions.

Blue Cross Blue Shield Insurance Plans↗
PubMed1997

Measurement of NO synthesis in humans by L-[15N2]arginine: application to the response to vaccination.

Induction of nitric oxide (NO) synthesis is a key element of the inflammatory response in humans. We describe a sensitive gas isotope ratio mass spectrometric (GIRMS) method for measuring urinary [15N]nitrate production during intravenous infusion of L-[guanidino-15N2]arginine and its application to investigate the effects of a controlled inflammatory stimulus, typhoid vaccination, on NO synthesis in humans. Intravenous infusion of L-[15N2]arginine at 5-12 mumol.kg-1.h-1 for 24 h in three subjects was used to determine arginine and nitrate pool kinetics. Eight subjects received primed constant infusion of 2.5 mumol.kg-1.h-1 of L-[15N2]arginine for 12 h once before and again after typhoid vaccination. NO synthesis was calculated from 15N enrichment of plasma arginine and urinary nitrate, measured by gas chromatography mass spectrometry and GIRMS, respectively, and total urinary nitrate excretion. Baseline NO synthesis was 298 +/- 44 nmol.h-1.kg lean body mass-1, representing 0.41% of arginine flux. After vaccination, NO synthesis (267 +/- 77 nmol.h-1.kg-1) was not increased (P = 0.18), despite demonstration of an acute phase response. Typhoid vaccination is not accompanied by accelerated NO synthesis.

Adult↗
PubMed1993

Childhood abuse and neglect among women outpatients with chronic mental illness.

OBJECTIVE: The purposes of the study were to determine the prevalence of childhood sexual abuse, physical abuse, and neglect among women outpatients with severe and persistent mental illness; to examine patterns of co-occurrence of the various types of abuse; and to explore the relationships between childhood abuse and adult psychiatric symptomatology. METHODS: Childhood histories of abuse and data on clinical characteristics of 78 women enrolled in a New York State outpatient clinic were elicited in face-to-face interviews using a structured questionnaire. RESULTS: Sixty-five percent of the women reported histories of some type of abuse or neglect during childhood. Forty-five percent of the sample had been sexually abused, 51 percent had been physically abused, and 22 percent had experienced neglect. Seventy-four percent of the sexually abused women, 70 percent of the physically abused women, and 94 percent of the women who experienced neglect reported at least one additional form of abuse or neglect. Respondents who had been abused in childhood had higher levels of depressive and psychotic symptoms and higher rates of sexual victimization in adulthood than those who had not been abused. Women who experienced neglect as children had higher rates of homelessness in adulthood. CONCLUSIONS: Chronic mentally ill women seem to experience higher rates of abuse and more types of abuse than the general population. Clinicians should try to determine whether chronic mentally ill women have histories of abuse and to develop interventions to meet their special needs.

Adolescent↗
PubMed1987

[An expert system of aiding decision making in breast pathology connected to a clinical data base].

The René Huguenin Cancer Center holds a medical file for each patient which is intended to store and process medical data. Since 1970, we introduced computerization: a development plan was elaborated and simultaneously a statistical software (Clotilde--GSI/CFRO) was selected. Thus, we now have access to a large database, structured according to medical rationale, and utilizable with methods of artificial intelligence towards three objectives: improved data acquisition, decision making and exploitation. The first application was to breast pathology, which represents one of the Center's primary activities. The structure of the data concerning patients is by all criteria part of the medical knowledge. This information needs to be presented as well as processed with a suitable language. To this end, we chose a language-oriented object, Mering II, usable with Apple and IBM 4 micro-computers. This project has already allowed to work out an operational model.

Breast Neoplasms↗
PubMed1976

Comprehensive evaluation of basic living skills.

In this paper a rationale is established for an evaluation of basic living skills for chronic psychiatric patients living in mental institutions, and a comprehensive evaluation is presented. The advantages of this battery of tests over currently used activities of daily living scales are: it is specifically designed for psychiatric patients, it tests a wide range of skills, the items are graded in complexity, it can be administered in full or in part, and it has a scoring system and a summary that indicates the patient's functional status. The information gained from the evaluation improves staff communication about patient care and aids in the planning of the patient's future placement or treatment situation.

Activities of Daily Living↗
PubMedDate not supplied

[Acute tension pneumocephalus as a complication of surgical procedures of the posterior cranial fossa in prone position].

The authors describe a case of acute tension pneumocephalus (TP) developing as a complication of an operation in the posterior cranial fossa, in a boy aged 3 years with a large cystic tumour of the vermis, operated on in prone position with flexed head. The authors discuss the circumstances leading to development of tension pneumocephalus.

Acute Disease↗