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Biomedical subjects

L B Siegel

Publications and source records attributed to L B Siegel.

12 recordsLinked to original sources
PubMed1999

Adhesive capsulitis: a sticky issue.

The shoulder is a very complex joint that is crucial to many activities of daily living. Decreased shoulder mobility is a serious clinical finding. A global decrease in shoulder range of motion is called adhesive capsulitis, referring to the actual adherence of the shoulder capsule to the humeral head. Adhesive capsulitis is a syndrome defined as idiopathic restriction of shoulder movement that is usually painful at onset. Secondary causes include alteration of the supporting structures of and around the shoulder, and autoimmune, endocrine or other systemic diseases. The three defined stages of this condition are the painful stage, the adhesive stage and the recovery stage. Although recovery is usually spontaneous, treatment with intra-articular corticosteroids and gentle but persistent physical therapy may provide a better outcome, resulting in little functional compromise.

Bursitis↗
PubMed1999

Gout and hyperuricemia.

Gout is a condition characterized by the deposition of monosodium urate crystals in the joints or soft tissue. The four phases of gout include asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout and chronic tophaceous gout. The peak incidence occurs in patients 30 to 50 years old, and the condition is much more common in men than in women. Patients with asymptomatic hyperuricemia do not require treatment, but efforts should be made to lower their urate levels by encouraging them to make changes in diet or lifestyle. Acute gout most commonly affects the first metatarsal joint of the foot, but other joints are also commonly involved. Definitive diagnosis requires joint aspiration with demonstration of birefringent crystals in the synovial fluid under a polarized light microscope. Treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, corticosteroids and analgesics. In patients without complications, NSAID therapy is preferred.

Acute Disease↗
PubMed1999

Noninvasive positive-pressure ventilation facilitates tracheal extubation after laryngotracheal reconstruction in children.

Tracheal extubation after laryngotracheal reconstruction in children may be complicated by postoperative tracheal edema and pulmonary dysfunction. The replacement of a tracheal tube in this situation may exacerbate the existing injury to the tracheal mucosa, complicating subsequent attempts at tracheal extubation. We present two cases where noninvasive positive-pressure ventilation was employed to treat partial airway obstruction and respiratory failure in two children following laryngotracheal reconstruction. Noninvasive positive-pressure ventilation served as a bridge between mechanical ventilation via a tracheal tube and spontaneous breathing, providing airway stenting and ventilatory support while tracheal edema and pulmonary dysfunction were resolved. Under appropriate conditions, noninvasive positive-pressure ventilation may be useful in the management of these patients.

Child, Preschool↗
PubMed1996

Viral infection as a cause of arthritis.

Rheumatic complaints secondary to viral infections are usually brief, self-limited and nondestructive. They may accompany almost any type of viral illness, and the arthritic presentation is nonspecific. These manifestations are protean, ranging from arthralgia to vasculitis. Often the cause of the rheumatic complaint remains elusive because of the prompt resolution of the viral infection. Evaluation for autoimmune diseases should be postponed until the symptoms have been present for at least six weeks. However, some viral diseases, such as parvovirus, chronic hepatitis B virus and hepatitis C virus infections, can produce long-lasting rheumatic symptoms. Since the arthritis associated with hepatitis C infection has only recently been recognized, it is important to search for this association in patients who have atypical rheumatic complaints, risk factors for hepatitis and alterations in liver enzymes, so that an accurate diagnosis can be established and the pathophysiology can be better understood.

Arthritis, Infectious↗
PubMed1996

Initial postoperative serum lactate levels predict survival in children after open heart surgery.

OBJECTIVE: To evaluate the relationship between postoperative serum lactate levels and outcome in children undergoing open heart surgery. DESIGN: Prospective, noninterventional study. SETTING: Pediatric intensive care unit (PICU) of a university hospital. PATIENTS: 41 nonconsecutive children who had had cardiopulmonary bypass for repair of congenital heart disease. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Serum lactate levels were measured on admission to the PICU immediately after open heart surgery. Lactate levels were correlated with bypass and cross clamp times, estimated intraoperative blood loss, lowest temperature on bypass, admission Pediatric Risk of Mortality score, anion gap, and measures of postoperative morbidity. Mean lactate levels on admission to the PICU were 6.86 +/- 0.79 mmol/l for nonsurvivors (n = 7) and 2.38 +/- 0.13 mmol/l for survivors (n = 34) (p < 0.0001), and 4.87 +/- 0.7 mmol/l and 2.35 +/- 0.19 mmol/l, for patients with (n = 11) and without (n = 30) multiple organ system failure, respectively (p < 0.0001). Admission lactate levels correlated with all measurements of postoperative morbidity. A serum lactate level of greater than 4.2 mmol/l had a positive predictive value of 100% and a negative predictive value of 97% for postoperative death. CONCLUSIONS: Initial postoperative serum lactate levels after pediatric open heart surgery may be predictive of outcome. Lactate levels are also higher in patients who go on to develop multiple organ system failure. Elevated postoperative lactate levels may reflect intraoperative tissue hypoperfusion, and measures aimed at increasing oxygen delivery, with normalization of lactate, may improve patient outcome.

Adolescent↗
PubMed1994

Comparison of adrenocorticotropic hormone and triamcinolone acetonide in the treatment of acute gouty arthritis.

OBJECTIVE: To determine the best alternative therapy for acute gouty arthritis when nonsteroidal antiinflammatory drugs or colchicine are contraindicated. METHODS: Thirty-one patients with crystal proven gout presenting with an acute attack of < 5 days' duration were treated prospectively with either a single intramuscular injection of adrenocorticotropic hormone (ACTH) 40 IU or triamcinolone acetonide 60 mg. The patients were followed for 30 days. RESULTS: Resolution of all symptoms occurred at an average of 8 days for both groups. No adverse reactions were noted in either group; however, there were 11 reinjections in the ACTH group and 5 reinjections in the triamcinolone acetonide group. Two patients from the ACTH arm were transferred to the triamcinolone acetonide arm because of rebound arthritis. CONCLUSION: Although recent studies of ACTH and triamcinolone acetonide have demonstrated efficacy and safety comparable to indomethacin, in a direct comparison of the 2 at the doses used, triamcinolone acetonide resulted in fewer rebound attacks and treatment failures than ACTH and required fewer reinjections.

Acute Disease↗
PubMed1994

The concomitant expression of vasculitis and coagulopathy: synergy for marked tissue ischemia.

We describe 4 patients with coagulopathy and vasculitis that demonstrated marked tissue ischemia and necrosis. In the clinical setting of rapid evolution of vascular insufficiency, the possibility of combined vasculopathic processes should be considered. This is especially so in patients with underlying connective tissue disease such as systemic lupus erythematosus or rheumatoid arthritis, in which both vasculitis and antiphospholipid antibodies are frequently present. Treatment of both pathologic processes may be required to prevent progressive tissue ischemia and necrosis. The use of antiplatelet and/or anticoagulation should be given consideration in addition to immunosuppressive agents.

Adult↗
PubMed1993

Rheumatic manifestations of hepatitis C infection.

With the advent of serological testing for the hepatitis C virus (HCV) clinicians can better recognize disorders associated with a subset of non-A, non-B hepatitis. As with hepatitis A and B virus infections, HCV disease may be associated with arthritis. Three patients with atypical arthritis who were subsequently discovered to have HCV infection are described. HCV infection should be considered in the differential diagnosis in patients with atypical arthritis.

Adult↗
PubMedDate not supplied

Nonsteroidal anti-inflammatory drugs and aspirin: a comparison of the antiplatelet effects.

Antiplatelet effects of common analgesics were assessed in vitro. The Streck Platelet Aggregation Test Kit (Omaha, NE) was used to measure percent platelet aggregation in response to sodium arachidonate, collagen, adenosine diphosphate, and ristocetin in patients on various analgesics. In comparison with the control group, the response to arachidonate and collagen of ibuprofen (86% vs. 33% and 55% vs. 23%), naproxen (86% vs. 43% and 55% vs. 29%), indomethacin (86% vs. 26% and 55% vs. 17%), and aspirin (86 vs. 21% and 55 vs. 23%) all demonstrated a significant yet comparable reduction in platelet aggregation (p < 0.01). Because of the comparable antiplatelet effects of aspirin and NSAIDs, the additional benefits of daily aspirin in those patients on chronic and consistent NSAID therapy must be reconsidered.

Adult↗