PubMed Health⌕ Search

Biomedical subjects

J Lipman

Publications and source records attributed to J Lipman.

At least 109 records · Page 6Linked to original sources
PubMed1991

Failure of early electrocardiogram to predict successful thrombolysis. Effect of stunned myocardium?

We investigated the value of the modified Selvester QRS score in predicting reperfusion in 74 patients with an acute myocardial infarction who were treated with intravenous streptokinase. Coronary angiography and time to peak creatine kinase level were used to determine the success of thrombolytic therapy. At 6 weeks a significant difference was seen between the QRS score of the patients in whom thrombolysis was successful compared with those in whom there was no reperfusion. There was, however, no difference between the QRS score of these groups of patients at 1 week. The ejection fraction at 1 week was 60% and 51%, respectively. The failure of the early electrocardiogram to predict reperfusion and improved left ventricular function may be a consequence of the stunned myocardium.

Coronary Thrombosis↗
PubMed1990

Clinical predictors of early death in acute myocardial infarction. A prospective study of 233 patients.

Patients who suffer acute myocardial infarction are heterogeneous and prognosis differs widely. High-risk patients are likely to derive the greatest benefit from treatment in an intensive care unit and from early thrombolytic therapy. A study was undertaken to determine those clinical parameters, available on admission to hospital, which would predict early death (within the first 30 days) and in this way to define high-risk patients. From July 1985 to December 1987, 233 patients admitted to J. G. Strijdom Hospital with acute myocardial infarction were prospectively evaluated. A total of 30 variables, including clinical, ECG and biochemical parameters, were recorded for each patient on admission. During the study period 36 patients (15.5%) died. The following variables were significantly associated with early mortality: age, Killip class, infarct location, height of ST-segment elevation and raised blood urea level. Using data readily available on admission to hospital, patients at highest risk of early death can be identified.

Age Factors↗
PubMed1990

Coronary embolism causing myocardial infarction.

Two cases of myocardial infarction due to coronary embolism arising from bacterial endocarditis are reported. The importance of this condition in the differential diagnosis of myocardial infarction from non-atheromatous coronary artery disease is highlighted and the literature on the subject is reviewed.

Adult↗
PubMed1990

Acute preload effects of furosemide.

Acute preload effects (as reflected by the pulmonary capillary wedge pressure [PCWP]) of an intravenous furosemide bolus were studied in 33 patients. In those patients receiving no vasoactive drug and in those receiving predominantly preload reducing agents, there was an initial rise in PCWP up until 15 minutes followed by a diuresis-induced fall in PCWP below baseline levels at 1 h. Patients who were receiving preload and significant afterload reduction showed an immediate drop in PCWP which was sustained. This trend is independent of underlying pathology or dose of furosemide used. It is postulated that furosemide causes an early deleterious release of endogenous vasoconstrictors which may be blocked by combined preload and afterload reduction.

Adult↗
PubMed1988

Catheter related infection. A plea for consensus with review and guidelines.

Although there has been a proliferation of catheter related infection literature there is still little consensus regarding infection statistics and optimal catheter management techniques. This paper analyses the various factors that have contributed to these inconsistencies and thereby attempts to provide a standardised framework for future research and communication on the subject. An attempt has also been made from available data to provide management guidelines that are practicable in the intensive care environment.

Bacterial Infections↗
PubMed1988

Fatal infection caused by a multiply resistant type 3 pneumococcus.

The most virulent pneumococcal serotype (type 3) has not to date been associated with multiple antimicrobial resistance. We report an unusual gastrointestinal presentation of fatal septicemia caused by a multiply resistant type 3 pneumococcus in a setting of increasing prevalence of multiple resistance, including resistance to erythromycin, clindamycin, and tetracycline.

Adolescent↗
PubMed1987

Invasive vascular catheterisation in the critically ill.

In order to identify potential problems and thereby minimise the risk of invasive vascular catheterisation, we conducted an analysis of these procedures in our medical intensive care unit with the aid of a computer database. During the 9-month study period 114 patients underwent 247 invasive vascular catheterisations, including pulmonary arterial (PA), central venous (CV) and arterial catheter insertions. Complications unique to PA catheterisation included burst catheter balloons (6%) and one serious episode of arrhythmia. The incidence of pneumothorax (2.8%) and inadvertent arterial puncture (2.2%) with PA and CV lines and our sepsis rate of 3.6% for all types of catheters are consistent with other studies. Arterial catheterisation proved to be relatively free of complications. Our study confirmed the safety of invasive vascular catheterisation. However, we review the precautions needed to limit potential complications.

Arteries↗
PubMed1987

Carbamate toxicity. A case report.

The type of poisoning which inhibits acetylcholinesterase (AChE) most often encountered in an intensive care unit is that of organophosphates (OP). Carbamates also inhibit AChE but for a much shorter duration and they do not cause the same degree of central nervous system effects as OP. A case of carbamate poisoning is described, in which the pharmacological differences between carbamates and OP are stressed. The therapeutic and diagnostic differences between the two are also discussed.

Adult↗
PubMed1987

Subarachnoid haemorrhage. A report of 2 cases.

Two patients admitted to the medical intensive care unit with subarachnoid haemorrhage, one with the provisional diagnosis of 'sick sinus syndrome' the other as having an acute myocardial infarction complicated by ventricular tachycardia, are described and the arrhythmias associated with this condition are reviewed.

Adult↗
PubMed1987

Autonomic dysfunction in severe tetanus: magnesium sulfate as an adjunct to deep sedation.

We studied the use of continuous iv magnesium (Mg) infusion to control the sympathetic crises in a patient with severe tetanus characterized by pronounced autonomic nervous system instability. Our results suggested that Mg is a useful adjunct to the CNS depressants traditionally used. This therapy controlled the sympathetic crises and also suppressed the release of catecholamines, although Mg infusions alone appeared to be inadequate therapy.

Adult↗
PubMed1986

A comparison between right atrial and pulmonary arterial oxygen tensions.

Oxygen tensions of 50 simultaneously withdrawn blood samples from the right atrial orifice of a triple-lumen pulmonary artery catheter and from the pulmonary artery lumen were compared. Mixed venous oxygen tensions ranged from 21 mmHg to 44.9 mmHg. The correlation coefficient was 0.96 (t = 2.09; P = 0.01). The benefits and drawbacks of intermittent right atrial oxygen tension monitoring are discussed.

Cardiac Catheterization↗
PubMed1985

Pitfalls in the interpretation of pulmonary capillary wedge pressure.

The measurement and interpretation of pulmonary capillary wedge pressure (PCWP) is often vital to the correct management of patients. In this article some pitfalls associated with PCWP measurement are discussed. The physiology of PCWP preload and the Starling curve are described. PCWP indirectly measures left ventricular end-diastolic volumes: the interpretation of this correlation is altered under certain circumstances, and these are described.

Heart Valve Diseases↗
PubMed1984

A guide to the rational use of dopamine, dobutamine and isoprenaline in patients who need inotropic support.

Which inotropic agent to use to the patient's greatest advantage is a common problem in hospital practice. Sympathetic nervous system physiology is outlined to explain the actions of dopamine, dobutamine and isoprenaline. The following suggestions are made: Where a low-dosage inotropic effect is required, dopamine should probably be used because of the unique benefit of increased renal blood flow. Where there are no tachyarrhythmias, dopamine should be the drug of choice. In dosages greater than 5 - 10 micrograms/kg/min, dopamine should be combined with nitroprusside. If further inotropic activity is required, the effect of dopamine can be increased with the concomitant use of isoprenaline. In the presence of tachyarrhythmias dobutamine may be of benefit.

Autonomic Nervous System↗
PubMed1984

Vitamin B12 levels in the prolonged use of sodium nitroprusside.

Long-term (greater than 48 h) sodium nitroprusside (SNP) infusion significantly reduced cobalamin (vitamin B12) levels in 23 patients treated in a CCU after myocardial infarction. There was no evidence of vitamin B12 deficiency or SNP toxicity. Low vitamin B12 levels should not limit the use of SNP, because prolonged infusion of SNP at maximum doses of 2.5 micrograms/kg X min did not adversely affect hemodynamic stability.

Blood Pressure↗