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Biomedical subjects

J Margulies

Publications and source records attributed to J Margulies.

At least 19 recordsLinked to original sources
PubMed2000

Lack of t-PA use for acute ischemic stroke in a community hospital: high incidence of exclusion criteria.

Thrombolytic therapy with t-PA for acute ischemic stroke may provide benefit in long-term outcome. This retrospective study was undertaken to evaluate appropriateness of the National Institute of Neurological Disorders and Stroke (NINDS) protocol in the emergency department (ED). All patients with appropriate International Classification of Diseases, 9th revision (ICD-9) codes indicating stroke who presented to our 387-bed trauma-I community hospital during 1997 were included in the study. Of the nearly 35,000 patients screened, 201 patients satisfied our inclusion criteria. Mean age was 73.5 +/- 13.3 years. Men were evaluated and transported to computed tomography more rapidly and older patients more slowly. Nonwhites were more likely to arrive via emergency medical services (EMS). Average time from EMS arrival at scene to ED arrival was 22.7 minutes, and from ED arrival to triage was 8.4 minutes. The most common reason for exclusion from t-PA administration was delayed presentation (n = 188); this is the most serious barrier to use of t-PA for acute ischemic stroke. Extensive public education may combat this.

Adult↗
PubMed1999

Intracranial pressure during liver transplantation for fulminant hepatic failure.

During orthotopic liver transplantation (OLT) for fulminant hepatic failure (FHF), some patients develop cerebral injury secondary to intracranial hypertension. We monitored intracranial pressure (ICP) and cerebral perfusion pressure (CPP) before and during OLT in 12 FHF patients undergoing transplantation. All four patients who had normal ICP preoperatively maintained normal ICP/CPP throughout OLT. During OLT, four of the eight patients with pretransplant intracranial hypertension had six episodes of ICP increase. These episodes of intracranial hypertension occurred during failing liver dissection (n=3) and graft reperfusion (n=3). At the end of the anhepatic phase, the ICP was lower than the preoperative ICP in all patients, and was below 15 mmHg in all but one patient. These data suggest that in FHF patients who develop intracranial hypertension before OLT, dissection of the native liver and graft reperfusion are associated with a risk of brain injury resulting from intracranial hypertension and cerebral hypoperfusion.

Adult↗
PubMed1994

Extended duration of vertical position might impair bone metabolism.

Bone-remodelling is markedly influenced by vectors of gravitational forces. Sleep-deprivation, common during military training, involves a change in the normal balance between horizontal and vertical forces enacting on the skeleton. Stress fractures are likewise prevalent among army recruits. In order to investigate the impact of sleep-deprivation on bone-metabolism, three groups of young, healthy volunteers were selected to exercise the following: 63 h of sleeplessness (17 participants, group A); vertical sleep in a seated position for three consecutive nights (9 participants, group B); controls who slept 6 h a night horizontally (14 participants, group C). During periods of wakefulness, all participants were kept in an upright position. Twenty-four hours' urine collection was strictly observed from two days prior to the experiment until two days after it (1 week). Changes in levels of the most characteristic bone-metabolites, calcium and hydroxyproline indicate an increased bone-resorption in the two experimental groups, but not in controls. The calcium excreted in the fasting urine peaked significantly at 72 h after the beginning of the experiment (+ 170% in group A; + 68% in group B, relative to the basal level). Qualitatively, similar results were obtained with hydroxyproline. On an individual basis, approximately 40% of the participants in either group responded by exceeding urinary-calcium elevation. A comparison of pre-test bone-density between responders and non-responders, reveals a significantly lower bone-density (-5%) in calcium and hydroxyproline excretors. These results suggest a pre-disposition to bone-resorption associated with responsiveness to changes in the balance between gravitational forces.

Adolescent↗
PubMed1989

The effect of pretraining sports activity on the incidence of stress fractures among military recruits. A prospective study.

In a prospective study of stress fractures among Israeli infantry recruits, no correlation was found between the recruits' prior participation in sports activities or their aerobic physical fitness and the incidence of stress fractures during basic training. This finding discredits the concept that improving physical fitness prior to basic training can be a prophylactic means of limiting the incidence of stress fractures during subsequent training.

Adult↗