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Biomedical subjects

J S Goldberg

Publications and source records attributed to J S Goldberg.

At least 19 recordsLinked to original sources
PubMed1992

MR imaging of the juvenile temporomandibular joint: preliminary report.

Thirty-two children were evaluated by means of medical history and physical examination for signs and symptoms of internal derangement (ID) of the temporomandibular joint (TMJ) and mandibular dysfunction. These children also underwent magnetic resonance (MR) imaging of the TMJs. The study was double blind. At clinical examination, 19 patients (59%) had at least one positive finding of ID of the TMJ and/or mandibular dysfunction. MR images of the TMJ obtained in 60 of the 64 TMJs demonstrated 57 normal joints (95%) and three abnormal joints (5%). Two of these three joints had a mild anterior-lateral disk displacement, and one joint had an anterior dislocated disk. There were no false-positive MR examinations. MR imaging failed to depict abnormalities in 16 patients who had positive findings at history and/or physical examination. Although MR imaging may fail to depict ID of the TMJ in some patients, clinical techniques commonly used in population surveys probably overstate the prevalence of ID of the TMJ in children.

Adolescent↗
PubMed1992

Use of patient-controlled analgesia to compare the efficacy of epidural to intravenous fentanyl administration.

Fentanyl, unlike morphine, is highly lipophilic and rapidly diffuses out of the epidural space. Respiratory depression is, therefore, unlikely when fentanyl is given epidurally. However, much of fentanyl's analgesic effect is mediated by systemic rather than spinal receptor binding. To test this hypothesis, we performed a prospective, double-blind, cross-over study comparing epidural and intravenous (IV) administration of fentanyl in 16 patients for the first 12 h after lower abdominal or lower extremity surgery. To allow direct comparison of these two routes of administration, patient-controlled analgesia was used so patients could self-titrate their analgesia. Patients were randomized to receive fentanyl initially by an epidural (group A, n = 8) or IV (group B, n = 8) catheter for 6 h, after which they were crossed-over to the alternate route by means of a hidden three-way stopcock. The degree of analgesia was subjectively evaluated by a visual analogue scale, and by an observer rating patient's comfort and sedation. Cumulative dosage of fentanyl was recorded, and plasma fentanyl concentrations were measured. The onset of analgesia and increase in plasma fentanyl concentrations were more rapid with intravenous fentanyl. However, after 60 min, analgesia (visual analogue scale 2-4 cm) or plasma fentanyl concentrations (0.3-0.7 ng/mL) did not differ between the two routes of administration. There were also no significant differences in the cumulative dosage of fentanyl within each group (epidural vs IV) or between the groups. Thus, the analgesic effects of epidural fentanyl appear largely mediated by systemic absorption. Intravenous fentanyl achieves a similar degree of analgesia and a more rapid onset of effect without the need for epidural catheterization.

Aged↗
PubMed1992

Postoperative hypertension: a multicenter, prospective, randomized comparison between intravenous nicardipine and sodium nitroprusside.

OBJECTIVE: To compare the efficacy and safety of iv nicardipine with sodium nitroprusside in the treatment of postoperative hypertension after both cardiac and noncardiac surgery. DESIGN: Multicenter, prospective, randomized, open-label study. SETTING: Six tertiary referral medical centers (recovery rooms and surgical ICUs). PATIENTS: A total of 139 patients with postoperative hypertension: i.v. nicardipine (n = 71), sodium nitroprusside (n = 68). INTERVENTION: Administration of i.v. nicardipine or sodium nitroprusside. MEASUREMENTS: Vital signs (BP, heart rate), hemodynamic variables, medication dosage, total number of dose changes, and time to achieve BP control were recorded. MAIN RESULTS: Both medications were equally effective in reducing BP in both the cardiac and noncardiac surgical groups. Under the conditions of the study, i.v. nicardipine controlled hypertension more rapidly than sodium nitroprusside (i.v. nicardipine 14.0 +/- 1.0 mins and sodium nitroprusside 30.4 +/- 3.5 mins, p = .0029). The total number of dose changes required to achieve therapeutic BP response was significantly less in the i.v. nicardipine-treated patients (i.v. nicardipine 1.5 +/- 0.2 vs. sodium nitroprusside 5.1 +/- 1.4, p < .05). Adverse effects were observed with both drugs (i.v. nicardipine 7% [5/71] and sodium nitroprusside 18% [12/68] [NS]). CONCLUSIONS: Intravenous nicardipine is as effective as sodium nitroprusside in the therapy of postoperative hypertension. Specific advantages have been identified. The use of i.v. nicardipine should be considered in the therapy of postoperative hypertension.

Aged↗
PubMed1990

Effects of unilateral premature fusion of the zygomaxillary suture on the growth of nasomaxillary complex.

Unilateral premature fusion of the zygomaxillary suture was produced in 2-week-old guinea pigs by immobilization with methyl-cyanoacrylate adhesive. The effects of sutural fusion on the growth of the nasomaxillary complex were evaluated by radiographic cephalometry with implants, and histologic assessment. The immobilization successfully constrained the anteroinferior displacement of the maxilla and zygomatic bone on the fused side. Compensatory responsive remodeling at adjacent sutures and in certain regions of the nasomaxillary complex was observed. Developmental asymmetry was found when the fused side was compared with the nonfused side. No gross anatomic asymmetry of the facial complex as a whole, however, was detected. Adaptive compensation involving periosteal bone deposition occurred at the junction of the lower maxillary process and the maxilla proper on the fused side. This, together with periosteal bone resorption in corresponding areas on the nonfused side served to offset any developmental asymmetry that might have occurred, thus leading to a compensatory preclusion of gross anatomic asymmetry.

Analysis of Variance↗
PubMed1990

Labetalol for the control of elevated blood pressure following coronary artery bypass grafting.

In a multicenter study, the efficacy and safety of intravenous (IV) labetalol for the control of elevated blood pressure were studied in the intensive care unit (ICU) in 65 patients within 4 hours following coronary artery bypass grafting (CABG). Patients with pre-existing ventricular dysfunction, bradycardia, bronchospastic disease, or postoperative complications were excluded. All patients were monitored with a thermodilution pulmonary artery catheter. Entry criteria were a systolic blood pressure (SBP) greater than 140 mm Hg or diastolic blood pressure (DBP) greater than 90 mm Hg for at least five minutes. Intravenous labetalol was loaded incrementally (5, 10, 20, and 40 mg at 10-minute intervals) to a maximum cumulative dose of 75 mg, until either SBP decreased 10% or DBP decreased 10% and was less than 90 mm Hg. Responders were entered into a 6-hour maintenance period, and received 5 to 40 mg of IV labetalol every 10 minutes as needed for blood pressure control. Hemodynamic data and temperature were recorded at baseline, just before each dose of labetalol during the loading period, and at the end of the maintenance period. Alternative therapy was given in the case of nonresponse or adverse events. Intravenous labetalol successfully controlled post-CABG hypertension in 55 of 65 patients (85%); of these, 46 responded to 35 mg or less. Although 28 patients required no further labetalol in the maintenance period, in the others dosage varied from 5 to 400 mg. Reductions in SBP and DBP were associated with moderate reductions in pulse pressure (SBP-DBP) and heart rate (HR). Cardiac index decreased by 18.5%, with a 12.5% decrease in stroke index and 8.1% decrease in HR. Systemic vascular resistance did not increase significantly. Four patients (6%) developed hypotension related to IV labetalol. There was one death due to perioperative myocardial infarction, which was unrelated to labetalol use. The mechanism of action of IV labetalol in controlling hypertension after CABG surgery seems to be moderate negative inotropy and chronotropy. Its alpha-blocking effects seem to be important in preventing reflex vasoconstriction. This is directly opposite to the primary vasodilator effect found when IV labetalol is used to control nonsurgical hypertension. Because of these actions, labetalol should be avoided or used with caution in patients with preoperative and postoperative cardiac dysfunction. In patients with normal left ventricular function, IV labetalol appears to be a safe, effective agent in controlling post-CABG hypertension, with the added potential benefit of enhanced myocardial oxygen balance.

Analysis of Variance↗
PubMed1990

Temporomandibular synovial fluid pressure response to altered mandibular positions.

Hydrostatic synovial fluid pressure within the superior aspect of the temporomandibular joint space of the growing pig, Sus scrofa domesticus, was examined in response to various acute and chronic alterations of mandibular position. Bilateral measurements of pressure were recorded with chronically implanted wick catheters in three 8-week-old pigs before and at the time of appliance placement and then at 2-day intervals until the animals were 20 weeks old. Besides confirming the observations of a previous study, we noted that forward positioning of the mandible caused an increase in synovial fluid pressure that decayed to baseline levels within 2 hours. Posterior positioning of the mandible effected a larger increase in pressure that partially decayed over 2 hours but did not return to baseline levels over the entire course of the experiment. These results may have significance in the understanding of the physiology of the temporomandibular joint, local control mechanisms involved in the normal and treatment-aided growth of the mandible, and disorders of the temporomandibular joint.

Animals↗
PubMed1990

Nicardipine infusion for postoperative hypertension after surgery of the head and neck.

The therapy of postoperative hypertension (POH) after head and neck surgery was evaluated in a prospective, randomized, double-blind trial. Nicardipine hydrochloride, a Ca channel-blocker for iv use, was compared with placebo. Patients were initially randomized to receive nicardipine infusion or placebo. Those not responding to placebo were given nicardipine infusion on an open basis. Hypertension was significantly better controlled in patients treated with nicardipine infusion compared with placebo (83% vs. 22%, p less than .002). Subsequently, six (86%) of seven of the placebo failures were successfully treated with nicardipine. There were no significant complications in either group. We conclude that the titratable infusion of nicardipine is an effective and safe method for the control of POH after surgery of the head and neck. Further studies are now warranted comparing nicardipine with other drugs currently used to treat this condition.

Blood Pressure↗
PubMed1990

Colorimetric end-tidal carbon dioxide monitoring for tracheal intubation.

We evaluated a colorimetric end-tidal carbon dioxide (ETCO2) detector (FEF end-tidal carbon dioxide detector, Fenem, New York, N.Y.) during 62 intubations in anesthetized patients who were hemodynamically stable. The intubations were performed during a drill that simulates difficult tracheal intubation and therefore is associated with an increased risk of esophageal intubation. Each intubation attempt was monitored by two anesthesiologists and a research assistant who together used chest auscultation, colorimetric ETCO2, and capnography to confirm tracheal intubation and detect esophageal intubation. The reliability of the monitors was compared with capnography. Colorimetric ETCO2 confirmed tracheal intubations and detected esophageal intubations 100% of the time, as judged by capnography. There were no false-positive or false-negative decisions based on endotracheal tube position; however, one equivocal color change occurred, which was caused by failure to inflate the endotracheal tube cuff. Colorimetric ETCO2 monitoring confirmed tracheal intubation more rapidly than did chest auscultation (P less than 0.001) or capnography (P less than 0.05), and detected esophageal intubation more rapidly than did chest auscultation (P less than 0.05) and as rapidly as capnography did. Confirmation of tracheal intubation was achieved earlier than detection of esophageal intubation with all three monitors (P less than 0.05). We conclude that colorimetric ETCO2 monitoring is a safe, reliable, rapid, simple, and portable method for determining endotracheal tube position for patients who are hemodynamically stable and should be recommended where capnography is not available.

Carbon Dioxide↗
PubMed1989

Migration of Kirschner wires used for rigid noncompressive fixation of the mandibular sagittal split osteotomy: report of four cases.

Four instances of migration of Kirschner wires have been reported in patients in whom bilateral mandibular sagittal splits were stabilized with rigid noncompressive pin fixation. Three of these cases demonstrated gross pin migration, and the fourth showed significant symptoms due to the loosening and extrusion of the Kirschner wires. Although this technique produces good clinical results, migration of the pins is a problem.

Adolescent↗
PubMed1979

Tropical pyomyositis: a case report and review.

Tropical pyomyositis is a disease of skeletal muscle characterized by single or multiple abscesses. The infective organism is most often penicillin-resistant Staphylococcus aureus. Only recently have case reports appeared in the literature from temperate zones; however, this disease is common in the tropics. This report reviews the literature and describes a child from rural North Carolina in whom tropical pyomyositis developed after incision and drainage of a furuncle.

Abscess↗