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Biomedical subjects

J Rosenberg

Publications and source records attributed to J Rosenberg.

At least 19 recordsLinked to original sources
PubMed1992

[Monitoring and oxygen therapy during gastrointestinal endoscopy].

Gastroenterological Societies in Britain and USA have published recommendations for sedation, monitoring and oxygen therapy during gastrointestinal endoscopy. No scientific basis for the introduction of recommendations such as these is, however, present as it has not yet been proved that hypoxaemia is responsible for morbidity and mortality on gastrointestinal endoscopy. The pathogenesis of the development of myocardial ischaemia during gastrointestinal endoscopy is considered by many to be the simultaneous arterial hypoxaemia but recent investigations suggest that tachycardia is a more important factor. The scientific data available at present in this field is not conclusive. Introduction of recommendations for monitoring and oxygen therapy during gastrointestinal endoscopy in Denmark should be delayed until elucidation of the mechanisms involved has been undertaken.

Coronary Disease↗
PubMed1992

[Exposure to asbestos and asbestos-related pulmonary changes among employees at a magnesium plant].

Prevalence of disease related to previous exposure to asbestos was investigated in a cohort of 394 men who had worked for more than a year at a magnesium plant before 1970. Radiography showed lung fibrosis in nine men (2.3%) and pleural plaques in 40 men (9.5%). Prevalence rates varied considerably between sub-groups subjected to different modes of exposure. For the whole cohort there was a positive correlation between prevalence rate of radiographic changes and duration of work entailing exposure to asbestos. Subjects with pleural changes had more dyspnoea than found in an external reference material. Vital capacity and forced expiratory volume in one second was significantly reduced for the whole cohort. A significant reduction in lung function was found among a larger proportion of subjects with pleural changes than among subjects with no radiographic indications of such changes. The results unveil a need for similar surveys among workers in other energy-intensive industries where a similar mode of exposure to asbestos may be assumed.

Adult↗
PubMed1992

Circadian variation in unexpected postoperative death.

Unexpected deaths still occur following major surgical procedures. The cause is often unknown but may be cardiac or thromboembolic in nature. Postoperative ischaemia, infarction and sudden cardiac death may be triggered by episodic or constant arterial hypoxaemia, which increases during the night. This study examined the circadian variation of sudden unexpected death following abdominal surgery between 1985 and 1989 inclusive. Deaths were divided into those occurring during the day (08.00-16.00 hours), evening (16.00-24.00 hours) and night (24.00-08.00 hours). Twenty-three deaths were considered to have been totally unexpected. Of 16 such patients undergoing autopsy, pulmonary embolism was the cause of death in five. In the remaining 11 patients, death occurred at night in eight (P < 0.005). Five of the seven patients without an autopsy died at night (P < 0.04); overall, 13 of 18 unexpected deaths occurred at night-time. These results suggest a need for further studies of sleep- and respiration-related effects on postoperative nocturnal cardiac function. The efficacy of monitoring during this apparent high-risk period should be evaluated.

Aged↗
PubMed1992

Pulse oximetry in severe anaemia.

Measurement of arterial oxygen saturation by pulse oximetry was performed in two patients with acute and chronic anaemia (haemoglobin concentrations: 2.9 mmol/l (4.7 g/dl) and 1.9 mmol/l (3.0 g/dl), respectively) using a Radiometer OXI and a Nellcor N-200 pulse oximeter. The two oximeters read alternating different values in the two patients. In conclusion, pulse oximeters are able to give a value for oxygen saturation even at extreme anaemia, and when a high value is given, it possibly reflects arterial oxygen saturation. The value of pulse oximetry in severe anaemia is discussed.

Aged↗
PubMed1992

Effect of oxygen therapy on late postoperative episodic and constant hypoxaemia.

As constant hypoxaemia itself may trigger development of apnoea and periodic breathing, we have studied the effect of oxygen therapy on the occurrence of late postoperative episodic hypoxaemia. Thirty-five patients without cardiopulmonary disease and undergoing elective total hip replacement were monitored with a pulse oximeter on the second night after operation (23:00 to 07:00), receiving either 21% or 37% oxygen by face mask in a randomized double-blind design. Mean oxygen saturation was greater in the group receiving 37% oxygen than in those having 21% oxygen (96% vs 92%, P less than 0.01). There was a weak correlation between mean oxygen saturation and the total number of hypoxaemic episodes (rs = -0.62, P less than 0.001), explained partly by the calculated (non-mechanistic) reduction in mean saturation by the episodes of hypoxaemia. There was no significant difference between the groups in the total number of sudden decreases in oxygen saturation, the duration of the events or number of patients with events to more or less than 80% oxygen saturation, although there was a trend towards fewer patients having events to less than 80% in the 37% oxygen group (nine of 17 patients vs five of 18 patients (ns); 95% confidence limits of median difference: -6 to 56%). We conclude that postoperative oxygen therapy with 37% oxygen by face mask increases mean oxygen saturation, but does not influence the basic mechanism leading to episodic hypoxaemia.

Aged↗
PubMed1992

Effect of thoracic epidural etidocaine 1.5% on somatosensory evoked potentials, cortisol and glucose during cholecystectomy.

The effect of thoracic (T7-8) epidural etidocaine 1.5%, 9 ml, and continuous per- and postoperative epidural infusion of etidocaine 1.5%, 4 ml/h, on early (less than 500 ms) somatosensory evoked potentials (SEPs), and cortisol and glucose in plasma during cholecystectomy, was examined in ten patients. Spread of analgesia (pin-prick) was T3 (T1-T3) to L2 (T11-L3) 35 min after injection of etidocaine, and T3 (T2-T4) to T12 (T8-L4) 3 h after surgical incision (median (range)). Before operation, epidural etidocaine had no significant effects on peak-to-peak amplitude of SEPs to electrical stimulation at the L1, T10 or T6 dermatomal level (P greater than 0.09). SEPs were abolished in only two patients at T6, and no patient had SEPs abolished at T10 or L1. The plasma concentrations of cortisol and glucose were significantly increased 20 min after surgical incision and remained increased throughout the study. No correlation was found between the block-induced decrease in the peak-to-peak amplitude at T6 or T10 and increase in plasma cortisol, except for a negative correlation at T10 and the initial increase in cortisol (Rs = 0.72, P = 0.03). In conclusion, thoracic epidural administration of 9 ml of etidocaine 1.5% does not provide total afferent somatic blockade assessed by SEP and the stress response to cholecystectomy.

Adult↗
PubMed1992

Effect of mental retardation and motor disability on testing with visual acuity cards.

The visual acuity of 77 children (aged between 1 1/2 and eight years) with cerebral palsy and mental retardation was tested using acuity cards. Results varied by no more than one octave in 79 per cent of the cases. The median acuity of children with severe motor disabilities was lower and the variability from test to test was greater than for those with mild motor disabilities. Grouping the children roughly according to degree of mental retardation, the more retarded group tended to be more visually disabled and vary more from test to test. In general, day-to-day variability was greater than within-day inter-observer variability. The use of acuity cards to evaluate visual acuity in severely disabled and mentally retarded children, whose acuity is difficult to evaluate with conventional acuity tests, is a useful alternative method.

Adolescent↗
PubMed1992

Clinical presentation of PTSD in World War II combat veterans.

Clinicians have increasingly recognized posttraumatic stress disorder (PTSD) among Vietnam veterans, but the disorder may be easily overlooked among World War II combat veterans. The authors review recent studies of PTSD in older veterans and describe five cases that illustrate the diverse clinical presentations of PTSD in this population. Symptoms included anxiety, cognitive and somatic complaints, depression, alcohol dependence, and amnestic periods. Despite the varied presentations, a fairly consistent patient profile emerged. Patients avoided reminders of war, showed an exaggerated startle response, and experienced restless sleep and chronic anxiety. Factors associated with exacerbations of symptoms were retirement and reminders of war experiences. Although past studies have emphasized resuppression of the trauma, the authors encourage a flexible approach to treatment, including exploratory techniques.

Adaptation, Psychological↗
PubMed1992

Practice parameters: strategies for survival into the nineties.

In an atmosphere of escalating medical costs, clinical practice guidelines have been proposed as a viable means of achieving cost containment. The approaches to developing standards of practice have historically been varied, and new methods of development have been proposed to incorporate current scientific knowledge and patient preferences for achieving optimal health outcomes. We review the historical, governmental, and health organization approaches to achieve scientifically sound and clinically relevant parameters. The mechanism and the mission of the American Academy of Neurology Quality Standards Subcommittee is reviewed. The Subcommittee has selected the term "practice parameter" in lieu of "practice policy" to be consistent with AMA terminology. Practice parameters may include one or more of the following types of recommendations: standards, guidelines, and options. These three terms reflect varying levels of clinical certainty as determined by the level of objective evidence.

National Institutes of Health (U.S.)↗
PubMed1992

Differential analgesic effects of low-dose epidural morphine and morphine-bupivacaine at rest and during mobilization after major abdominal surgery.

In a double-blind, randomized study, epidural infusions of low-dose morphine (0.2 mg/h) combined with low-dose bupivacaine (10 mg/h) were compared with epidural infusions of low-dose morphine (0.2 mg/h) alone for postoperative analgesia at rest and during mobilization and cough in 24 patients after elective major abdominal surgery. All patients in addition received systemic piroxicam (20 mg daily). No significant differences were observed between the groups at any assessment of pain at rest (P greater than 0.05), whereas pain in the morphine/bupivacaine group was significantly reduced during mobilization from the supine into the sitting position 12 and 30 h after surgical incision and during cough 8, 12, and 30 h after surgical incision (P less than 0.05). We conclude, that low-dose epidural bupivacaine potentiates postoperative low-dose epidural morphine analgesia during mobilization and cough. Evaluation of postoperative analgesic regimens should include assessment of pain during various activities as different analgesics may have differential effects on pain at rest and during mobilization.

Abdomen↗
PubMed1992

Hypoxaemia and myocardial ischaemia during and after endoscopic cholangiopancreatography: call for further studies.

Sixteen non-selected patients undergoing endoscopic cholangiopancreatography (ERCP) after diazepam premedication were monitored for oxygen saturation (SpO2) with a pulse oximeter and for myocardial ischaemia with a Holter tape recorder from 2 h before ERCP to 6 h after the procedure. One patient was excluded from data analysis because of oxygen therapy. Oxygen saturation was significantly decreased (p less than 0.05) both during endoscopy and in the postendoscopy recovery period. Heart rate was significantly increased (p less than 0.05) both during and after the procedure. ST depression occurred in no patients before endoscopy, in 10 patients during, and in no patients after endoscopy. Concurrent ischaemia and episodic hypoxaemia were found in 5 patients, isolated ischaemia in 7 patients, and isolated episodic hypoxaemia in 13 patients. Concurrent ischaemia and tachycardia were found in 10 patients, ischaemia without tachycardia in no patients, and isolated tachycardia in 1 patient. There was no significant correlation between diazepam dose and SpO2 during endoscopy. These results suggest tachycardia to be more important than hypoxaemia in the pathogenesis of myocardial ischaemia during upper gastrointestinal endoscopy. Cardioprotective measures other than oxygen therapy should soon be evaluated before the implications of the new standards of care in endoscopy have become generally adopted.

Adult↗
PubMed1991

Monoclonal anti-idiotypic antibodies to human melanoma-associated proteoglycan antigen: generation and characterization of anti-idiotype antibodies.

We have characterized a number of monoclonal anti-idiotype antibodies (mAb2s) made against a monoclonal antitumor antibody, MEM136. The monoclonal antibody 1 (mAb1) MEM136 recognizes an epitope on human melanoma-associated proteoglycan and blocks melanoma cell interaction with basement membrane components in vitro. The anti-idiotype antibodies (Ab2s) made against MEM136 each cross-inhibited, to varying degrees, their binding to MEM136. Thus, the mAb2s recognized overlapping idiotopes on MEM136. In an attempt to identify potential internal image candidates we set up a cell migration inhibition assay. In this assay, migration of melanoma-associated proteoglycan-positive Colo38 cells was determined through a membrane barrier impregnated with Matrigel, which is composed of extracellular matrix components, i.e., collagen type IV, heparan sulfate, and laminin. Interestingly, only Ab2s IM06 and IM32 inhibited melanoma cell migration. Additional studies indicate that of eight mAb2s tested, only IM32 and IM06 induced anti-MPG responses in rabbits. The possibility that IM32 and IM06 bear images of melanoma cell surface-associated proteoglycan epitopes is discussed.

Antibodies, Anti-Idiotypic↗
PubMed1991

[Peroperative and early postoperative hypoxemia].

Arterial hypoxaemia is observed during operation and also in the recovery room. Hypoxaemia during operation may be due to altered pulmonary mechanical conditions, drug-induced physiological changes and technical errors. Early postoperative hypoxaemia is frequently observed after general anaesthesia and may, among other things, be due to diffusion hypoxaemia, hyperventilation-induced hypoventilation, residual curarization, hypoventilation induced by sedatives or analgesics and ventilation/perfusion alterations. The clinical significance of peroperative and early postoperative hypoxaemia is not yet elucidated and treatment consists primarily of increasing the oxygen concentration in the inspired air.

Humans↗
PubMed1991

[Late postoperative hypoxemia].

Arterial hypoxaemia may be observed several days after an uncomplicated major surgical operation and may be of constant or episodic nature. Late postoperative constant hypoxaemia is mainly due to reduced pulmonary volume on account of reduced diaphragmatic function. The cause of late postoperative episodic hypoxaemia is probably opioid-induced alterations in regulation of respiration and alterations in sleep on account of pain and stress which cause intermittent hypoventilation and central and/or obstructive apnoea. The clinical significance of late postoperative hypoxaemia is not yet fully elucidated. The data available suggest, however, that it may be a contributory factor in the development of cardiac, cerebral and wound complications. The pathogenesis should, therefore, be elucidated and rational therapeutic principles against late postoperative hypoxaemia should receive higher priority.

Humans↗
PubMed1991

Jets over Labrador and Quebec: noise effects on human health.

OBJECTIVE: To determine whether the noise from low-level flights over Labrador and Quebec is harmful to human health. DATA SOURCE AND SELECTION: Search of MEDLINE for articles on the effect of noise, particularly impulse noise associated with low-level flights, and a search of the references from identified articles. DATA SYNTHESIS: The noise levels from low-level flights could affect hearing acuity. However, the more important consequences appear to be stress-mediated physiologic effects, especially cardiovascular ones, and psychologic distress, particularly in children. Subjective perception of control over the noise has been found to mitigate some physiologic effects. CONCLUSION: There is sufficient evidence to show that the noise from low-level flights is harmful to human health.

Adaptation, Physiological↗