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Biomedical subjects

J L Bernat

Publications and source records attributed to J L Bernat.

At least 19 recordsLinked to original sources
PubMed1989

Ethical issues in brain death and multiorgan transplantation.

There is a consensus in Western society that "brain death" is the medical and legal standard for human death. Patients in persistent vegetative states may have lost their "personhood," but they are not dead. It may be desirable to maintain the physiologic processes of a brain-dead pregnant woman to permit the birth of her child. The determination of brain death and plans for multiorgan transplantation should be conducted independently. It is axiomatic that the multiorgan transplantation donor must be dead. Therefore, living anencephalic infants and patients in persistent vegetative states cannot be organ donors. It is permissable to temporarily maintain the physiologic processes of brain-dead patients in order procure their organs for transplantation. Society will have to decide if money spent on multiorgan procurement and transplantation is better spent in other areas of health care.

Brain Death↗
PubMed1989

Decisions to withhold or terminate treatment.

Decisions to withhold or terminate treatment are common clinical dilemmas in patients dying from diseases of the nervous system. Decision making for such patients must be based upon ethical principles. Under the doctrine of valid consent and refusal, competent patients have the right to refuse life-sustaining therapies. For incompetent patients, this right may be exercised through their previously executed advanced directives or through appointed proxy decision makers. Physicians have the duty to assess the potential benefits and harms of various treatment options and to clearly communicate this information to patients and their proxies in a supportive manner. The authors illustrate the application of ethical principles in neurologists' management of patients in persistent vegetative states, dementia, and end-stage neuromuscular disease.

Beneficence↗
PubMed1989

Neurologic disorders and respiration.

The impact of neurologic disorders on the respiratory system is considered as a functional-anatomic-pathologic sequence. Functional roles of the central, peripheral, and autonomic nervous systems in respiration are described. The effects of pathologic conditions are then discussed based on this functional-anatomic background.

Autonomic Nervous System↗
PubMed1987

A study of crying in medically and surgically hospitalized patients.

In a prospective study of hospitalized patients referred to a psychiatry consultation service, 46 patients were referred for a presumed diagnosis of depression because crying was a prominent symptom. Psychiatric consultation determined that 20% had a psychiatric disorder only, 33% had a neurological disorder only, 43% had both psychiatric and neurological disorders, and 4% had a previously undescribed entity, "essential" crying. The most common neurological disorder in these crying patients was bilateral hemispheric dysfunction associated with dementia or delirium; the most common psychiatric disorder was major depression. Effective therapy for patients who cry depends on proper identification of the cause of crying.

Crying↗
PubMed1987

Ethical and legal aspects of the emergency management of brain death and organ retrieval.

Patients brought to an emergency room with profound brain damage can be determined to be unsalvageable but usually cannot be declared brain dead. Most such patients should be admitted to the hospital for physiologic support and formal brain death determination. There are ethical and legal justifications, discussed in this article, for physicians to encourage the families of such patients to consent for them to be organ and tissue donors.

Apnea↗
PubMed1985

The neuroanatomy of vomiting in man: association of projectile vomiting with a solitary metastasis in the lateral tegmentum of the pons and the middle cerebellar peduncle.

Animal studies have indicated a "vomiting center" situated in the dorsal portion of the lateral reticular formation of the medulla at the level of the dorsal nucleus of the vagus. There is also a chemoreceptor trigger zone in the floor of the fourth ventricle in the area postrema which influences the vomiting center. A 63 year old man with a three year history of metastatic malignant melanoma presented with nausea, projectile vomiting, gait ataxia and diplopia associated with horizontal and vertical nystagmus. CT scan showed a solitary brainstem metastasis without hydrocephalus and he was treated with radiotherapy with resolution of his vomiting after four weeks. At post mortem three months later a metastasis was found in the right middle cerebellar peduncle and lateral tegmentum of the pons; there was no pathological change in the area of the vomiting center or area postrema. It is postulated that this lesion caused projectile vomiting because of involvement of either afferent projections to the vomiting center. The neuroanatomy of vomiting is discussed.

Brain Neoplasms↗
PubMed1979

Bilateral rhinocerebral phycomycosis.

A 51-year-old diabetic woman developed bilateral rhinoorbitocerebral phycomycosis. Successful treatment was accomplished by correction of the ketoacidosis, surgical debridement, and amphotericin B therapy. Rhinoorbitocerebral phycomycosis is a fulminant and frequently fatal disease most often seen in debilitated hosts. This survival suggests that aggressive therapy is indicated in patients with extensive fungal involvement.

Amphotericin B↗
PubMed1978

The benign lateral medullary syndrome.

Four young, otherwise healthy men developed the signs and symptoms of lateral medullary ischemia following extraordinary outdoor exercise. The syndrome was short-lived, with excellent long-term prognosis. We suggest that the designation "benign lateral medullary syndrome" is appropriate for this transient nonrecurring state.

Adult↗
PubMed1978

Muscle hypertrophy after partial denervation: a human case.

While undergoing long-term physiotherapy, a 41 year old woman with a chronic S1 radiculopathy developed progressive, painless enlargement of the weak calf. Gastrocnemius muscle biopsy disclosed changes of partial denervation and reinnervation, with small groups of type I and type II atrophic muscle fibres and abundant hypertrophic fibres of both types but mostly type II. It is postulated that, in addition to comprensatory work-induced type II muscle fibre hypertrophy, there was an element of (type I) stretched-induced hypertrophy of denervated fibres, a condition well recognised experimentally but not documented in man.

Adult↗