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Biomedical subjects

L Weinberg

Publications and source records attributed to L Weinberg.

At least 19 recordsLinked to original sources
PubMed2006

Children presenting to hospital with acute alcohol intoxication.

AIMS: To investigate the problem of children presenting to hospital with alcohol intoxication. METHODS: An observational study was conducted over 18 months profiling children who presented to hospital with acute alcohol intoxication, proved by laboratory tests on blood alcohol levels (BALs). The study was part of a multicentre-funded injury prevention project based on the widely accepted Canadian Hospital Injury Reporting and Prevention Programme. RESULTS: 62 children (31 boys), mean age 14.5 years, presented with alcohol intoxication proved by BALs. The mean BAL was 203 mg/dl (standard deviation (SD) 80.7). As a point of reference, 56 (90%) children had BAL above the UK legal driving limit of 80 mg/dl. The most common type of alcohol consumed was spirits, in the form of whisky, gin, vodka and tequila. No significant association was seen between age and BAL. Children with high alcohol levels were much more likely to have lower Glasgow Coma Scores (p<0.001), but in contrast with conventional teaching, there was no association between blood glucose levels and BALs. The median Glasgow Coma Score on admission to the emergency department was 12. 15 (24%) children had a score < or = 8/15. Injuries were present in 21 (34%) children, most of which were minor injuries. Minor head injury was most common, accounting for 42% of the injuries. The most common cause of injury was a fall. DISCUSSION: The results of this study confirm the heavy use of alcohol by some young children. This highlights a definite problem, which needs to be dealt with by a variety of measures, giving particular consideration to the ease of access to alcohol by children.

Adolescent↗
PubMed2006

Pneumothorax from intrapleural placement of a nasogastric tube.

Nasogastric tube insertion is a commonly performed procedure that can be associated with significant morbidity and even mortality. There is no universally accepted technique to confirm correct placement. Most confirmatory methods are performed after placement, therefore misplacement and potential complications may have already occurred. We report a case where a commonly used bedside confirmatory test gave false reassurance that the nasogastric tube was properly positioned, but a plain chest X-ray revealed a massive pneumothorax due to inadvertent intrapleural placement of the tube. Due to the deficiencies of traditional confirmatory bedside techniques, and the limitations of modern and more sophisticated confirmatory methods, the plain chest X-ray remains the gold standard test to confirm correct nasogastric tube placement. We appraise the methods commonly employed to confirm nasogastric tube placement, and discuss factors that may increase the risk of misplacement.

Adult↗
PubMed2006

Postoperative changes in prothrombin time following hepatic resection: implications for perioperative analgesia.

Disorders of coagulation may occur after uncomplicated hepatic resection in patients who have normal preoperative coagulation profiles and liver function tests. We present a retrospective study performed in a tertiary care university teaching hospital examining changes in liver function tests and coagulation profiles in patients undergoing hepatic resection. Data were obtained for 124 patients. When compared to the preoperative values, prothrombin times were significantly increased throughout the postoperative period. Prolongation of the prothrombin time was related to both duration of surgery and hepatic resection weight. There was no relationship between prothrombin time and patient age. Disorders of coagulation occur after hepatic resection even in patients who have normal preoperative coagulation and liver function tests. This has implications for anaesthetic practice, particularly when considering the use of an indwelling epidural catheter in patients undergoing hepatic resection.

Analgesia↗
PubMed2005

The pregnant trauma patient.

Trauma is the leading non-obstetric cause of maternal death. Optimal management of the pregnant trauma patient requires a multidisciplinary approach. The anaesthetist and critical care physician play a pivotal role in the entire continuum of fetomaternal care, from initial assessment, resuscitation and intraoperative management, to postoperative care that often involves critical care support and patient transfer. Primary goals are aggressive resuscitation of the mother and maintenance of uteroplacental perfusion and fetal oxygenation by the avoidance of hypoxia, hypotension, hypocapnia, acidosis and hypothermia. Recognizing and understanding the mechanisms of injury, the factors that may predict fetal outcome, and the pathophysiological changes that can result from trauma, will allow early identification and treatment of fetomaternal injury. This in turn should improve morbidity and mortality. A framework for the acute care of the pregnant trauma patient is presented.

Cesarean Section↗
PubMed2002

Post-operative paraplegia following spinal cord infarction.

Thoracic epidural analgesia is a frequently utilised technique. Neurological complications are uncommon, but of grave consequence with significant morbidity. Spinal cord infarction following epidural anaesthesia is rare. We present a case where a hypertensive patient underwent an elective sigmoid colectomy under combined general/epidural anaesthesia for a suspected malignant abdominal mass. An epidural infusion was used for intra-operative and post-operative analgesia. During surgery, the blood pressure was labile and she was hypotensive. Postoperatively, the patient became confused, pyrexial and tachycardic and developed systemic inflammatory response syndrome requiring intensive care management. She developed a flaccid paralysis at L3 level with areflexia, analgesia and impaired sensation. A spinal cord infarct in the region of the conus extending into the thoracic cord was diagnosed. Complications of epidural anaesthesia are easily recognised when they develop immediately; their relationship to the anaesthesia and the post-operative period may be misjudged or underestimated when they appear after a delay, if neurological signs are masked by lack of patient cooperation and drowsiness or if the epidural anaesthesia is prolonged by long-acting drugs. New neurological deficits should be evaluated promptly to document the evolving neurological status and further testing or intervention should be arranged if appropriate. The association with epidural anaesthesia as a cause of paraplegia is reviewed. The aetiological factors that may have contributed to this tragic neurological complication are discussed.

Anesthesia, Epidural↗
PubMed2001

Use of anti-D immunoglobulin in the treatment of threatened miscarriage in the accident and emergency department.

BACKGROUND: The UK guidelines for the use of anti-D immunoglobulin for rhesus prophylaxis have been revised. Anti-D immunoglobulin is no longer recommended for Rh D negative women after a threatened miscarriage less than 12 weeks gestation. These patients are at risk of rhesus immunisation, and there should be a policy for their treatment in the accident and emergency (A&E) department. DESIGN: A retrospective study over a 17 month period was conducted looking at women less than 12 weeks gestation who presented to an A&E department with a threatened miscarriage. OBJECTIVES: To determine how many of these patients presented with heavy or repeated bleeding, or abdominal pain, and whether the guidelines for the use of rhesus prophylaxis were followed. RESULTS: 112 women fulfilled the criteria for inclusion. Nineteen patients were Rh D negative. Eighty three patients (74.1%) presented with either abdominal pain or heavy or recurrent bleeding. Rhesus status was recorded in the A&E notes in only 15 patients (13.3%). Ninety seven patients (86.6 %) were discharged without rhesus status being checked. Fifteen Rh D negative patients were discharged without being offered anti-D immunoglobulin. CONCLUSION: Many women who present to the A&E department with a threatened miscarriage of less than 12 weeks gestation have heavy or recurrent bleeding or associated abdominal pain. These patients have an increased risk of fetomaternal haemorrhage and the consequent development of haemolytic disease of the newborn is possible. It should be mandatory for the A&E department to record rhesus status. In the context of A&E medicine, anti-D immunoglobulin should still be offered to all non-immune Rh D negative women presenting with a threatened miscarriage less than 12 weeks gestation.

Abdominal Pain↗
PubMed2000

Cost-effective management of benign positional vertigo using canalith repositioning.

OBJECTIVE: The misdiagnosis and inappropriate treatment of benign positional vertigo have resulted in significant costs to the medical system. In the current medical-economic climate, there is an increased emphasis on cost control. Recent studies have shown that the canalith repositioning procedure (CRP) is effective; the next step is to show the impact of CRP in cost-effective management of benign positional vertigo. METHODS: Forty-six of 100 patients who underwent CRP for benign positional vertigo responded to a survey regarding the financial impact of their disease. They were asked to subjectively estimate the sum of all disease-related expenses. Objective substantiation of this number was estimated by tabulating physician data, laboratory data, and failed treatment costs. RESULTS: The subjective figure totaled $2684.74 per individual. Summation of the tangible objective figures yielded $2009.63 per patient, corroborating the subjective figure. CONCLUSIONS: Because CRP is a relatively simple procedure that can obviate many wasted expenses in most patients, we believe that it is very cost-effective and should be incorporated into routine practice.

Cost of Illness↗
PubMed1986

Effects of ouabain on calcium paradox in rat hearts.

The effects of ouabain (10(-7) to 10(-5) M) on the interrelationship between cell-cell contacts, resting tension, and creatine phosphokinase (CK) leakage owing to myocardial cell injury during Ca2+ paradox were studied in isolated perfused rat heart preparations. After perfusing for 15 min with Ca2+ -containing medium, hearts were perfused for 5 min with Ca2+ -free medium followed by a reperfusion with Ca2+ -containing medium for 5 min. This resulted in a transient increase in resting tension and a substantial release of CK into the perfusate during the calcium reperfusion period. These changes were accompanied by extensive structural damage in the myocardial cell, including formation of contraction bands, swelling of the mitochondria, and cell-cell separation. Inclusion of 10(-5) M ouabain for 5 min in the Ca2+ -containing perfusion medium prior to the start of Ca2+ -free perfusion resulted in a higher and sustained resting tension that was accompanied by a reduced loss of CK from the heart during Ca2+ reperfusion. In a histological examination of these ouabain exposed hearts, most of the structural changes owing to calcium paradox were apparent, but the cell-cell contacts were maintained. The results are consistent with the hypothesis that the loss of cell-cell contacts in the intercalated disc during the occurrence of Ca2+ paradox may be the cause of the delayed decline in the resting tension and is only partially responsible for the loss of CK. These differences in myocardial changes during Ca2+ paradox with or without ouabain may be due to the retention of calcium at certain crucial sites under the influence of ouabain.

Animals↗
PubMed1984

Acute liver biopsy lesions in early autoimmune ("lupoid") chronic active hepatitis.

We studied two female patients with autoimmune ("lupoid") chronic active hepatitis whose liver biopsies at initial presentation showed the unusual features of an acute hepatitis. Centrilobular hepatocyte swelling and multinucleation, acidophilic degeneration, cholestasis, mild fatty change and bile duct damage in one case resembled lesions of non-A, non-B hepatitis. Lobular and portal infiltrates of plasma cells with piecemeal necrosis suggested transition to chronicity as well as an autoimmune component. This was additionally supported by the presence of hypergammaglobulinemia and auto-antibodies in both patients. We conclude that liver biopsy features in the acute presentation of lupoid hepatitis may be difficult to distinguish from those seen in acute hepatitis due to virus or drugs.

Adult↗
PubMed1984

Wound infection caused by Kanagawa-negative Vibrio parahaemolyticus.

Kanagawa-positive Vibrio parahaemolyticus strains are considered to be human pathogens and are most commonly associated with summer diarrhea. Kanagawa-negative strains are most frequently isolated from the environment and are generally considered to be nonpathogens. We report a wound infection caused by a Kanagawa-negative V. parahaemolyticus strain. The infection occurred in October, an unusual time of the year for a V. parahaemolyticus infection to occur in the mid-Atlantic region of the United States.

Adult↗
PubMed1983

The cutaneous R-pulse interval: its application as a clinical measure of neonatal cardiovascular function.

The time interval from the onset of the R wave of the ECG to the onset of the cutaneous capillary pulse wave, i.e., cutaneous R-pulse interval or RPIc, was evaluated in 21 full-term and 22 preterm infants as a measure of cardiovascular function. RPIc showed a significant linear relationship with birth weight (r = .58, p less than .001) and gestational age (r = .62, p less than .001) for healthy infants. At similar gestational ages, the sick infants showed a significant prolongation of RPIc when compared to their healthy counterparts (mean prolongation 18.5 msec, p less than .01). The infusion of calcium gluconate, an inotropic agent, consistently and significantly shortened the RPIc from its preinfusion value (p less than .01). In 7 infants, simultaneous measurement of intra-aortic R-pulse interval accompanied parallel changes in RPIc. These preliminary observations suggest that continuous monitoring of RPIc may provide a reliable noninvasive measure of neonatal cardiovascular function.

Calcium Gluconate↗
PubMed1982

Effect of biliary diversion on rat mesenteric lymph apolipoprotein-I and high density lipoprotein.

The effect of biliary diversion on intestinal apolipoprotein (apoA)-I and high density lipoprotein formation was studied in mesenteric lymph fistula rats. Bile diversion was produced by an exteriorized catheter that allowed interruption and reconstitution of the enterohepatic circulation. Bile diversion reduced lymph cholesterol output from 0.47+/-0.05 mumol/h to 0.17+/-0.03 mumol/h (P < 0.025), and lymph triglyceride output from 3.6+/-0.3mumol/h to 0.6+/-0.05 mumol/h (P < 0.025) after 24 h. This was due to depletion of lymph chylomicrons and very low density lipoprotein (VLDL). Despite the reduced lipid outputs, lymph apoA-I output was maintained during biliary diversion (basal: 119+/-15 mug/h; diverted 140+/-20 mug/h, n = 12). During biliary diversion, high density lipoprotein (HDL) were maintained in mesenteric lymph as shown by lipoprotein and immunoelectrophoresis. Bile diversion altered the lipid composition of lymph HDL. Bile-diverted lymph HDL was depleted in total cholesterol and has a greater phospholipid/cholesterol ester ratio than basal lymph HDL. Lymph HDL contained discoidal particles when examined by negative stain electron microscopy. Bile diversion was associated with a reduction in the size of discoidal HDL particles (basal, nondiverted, 165+/-7A (n = 112) compared with diverted 126+/-5A (n = 98, P < 0.025). Experiments were then carried out to determine the source of the apoA-I and HDL found in lymph from bile-diverted animals. The transfer of HDL from plasma into lymph was determined by the intravenous infusion of (125)I-apoA-I labeled HDL into lymph fistula rats. In both nonbile-diverted and diverted rats, the specific activity of apoA-I in the HDL fraction of lymph was 23% of the specific activity of apoA-I in plasma HDL, indicating that the major portion (75%) of mesenteric lymph apoA-I did not come from plasma filtration. In other experiments the intraduodenal infusion of [(3)H]leucine to bile fistula, lymph fistula rats resulted in relative fivefold increase in the specific activity in apoA-I in lymph HDL when compared with the specific activity of apoA-I in plasma HDL from the same animal. We conclude that intestinal apoA-I secretion is maintained during biliary diversion and that synthesis of this apoprotein occurs in the absence of chylomicron formation. We also conclude that discoidal HDL are present in mesenteric lymph despite reduced triglyceride absorption and secretion into lymph.

Animals↗
PubMed1980

Transport of ova transferred to rabbit oviducts at varying intervals after human chorionic gonadotropin injection.

Ova obtained from donors were transfered to the oviducts of New Zealand White rabbits at various times after injection of human chorionic gonadotropin. The rabbits were killed at varying intervals after transfer. The genital tracts were removed, divided into segments (ampulla, isthmus, uterus, and vagina), and flushed to recover the ova. The experiments demonstrated the following: (1) A mechanism is present that retains some of the transferred ova above the ampullary-isthmic junction (AIJ). This mechanism is most efficient 60 hours after hCG injection. (2) Transferred ova that succeed in negotiating the AIJ are found in locations appropriate to the time elapsed from ovulation, rather than from transfer; i.e., they "catch up" to the endogenous ova.

Animals↗