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M Hersch

Publications and source records attributed to M Hersch.

26 records · Page 2Linked to original sources
PubMed1990

Histologic and ultrastructural changes in nonpulmonary organs during early hyperdynamic sepsis.

Previous studies describing the histologic elements of multi-system organ failure caused by bacterial sepsis may have been complicated by a significant interaction on tissue injury from either a preterminal low-flow state or the effects of therapy immediately before death. Therefore we evaluated the nonpulmonary histologic findings of sepsis during a 3-day period that followed cecal ligation and perforation. In this septic model, mean arterial perfusion pressures remained unchanged from baseline, systemic flows rose by 54%, and laboratory evidence of organ dysfunction including an elevation of the serum bilirubin levels and a depression of the serum total protein values was considered mild. Concurrently, development of the hyperdynamic central circulatory septic state was associated with widespread histologic changes in myocardium, striated muscle, liver, gut, and pancreas. Lesions common to these organs included high-protein interstitial and intracellular edema, mitochondrial destruction, and patchy cell necrosis. Lesions within the pancreas were exaggerated over those noted in other organs. Of all organs examined, only the liver demonstrated microvascular neutrophil accumulation. Unlike models of shock caused by sepsis, fibrin thrombi were not seen in the microvasculature of any organ. We conclude that tissue injury characterized by the accumulation of protein-rich extravascular fluid and the development of reversible and irreversible cell injury antedated significant multiple-system organ failure in this animal model of normotensive sepsis.

Animals↗
PubMed1989

PEEP increases non-pulmonary microvascular fluid flux in healthy and septic sheep.

The potential for significant interaction between PEEP and the peripheral microcirculations is not as well appreciated as are its central circulatory effects. Therefore, we studied the effects of PEEP, 15 mm Hg, on microvascular fluid flux in the hindlimb of ten mature sheep. Changes in prefemoral lymph flow (QL) and in lymph to plasma [L/P] total protein (TP) ratios were measured following the application of PEEP for 2 h, before and during hyperdynamic sepsis. Sepsis was induced by cecal ligation and perforation (CLP). Although the onset of sepsis was not associated with an increase in prefemoral QL, the [L/P] ratio of iodinated 125I human serum albumin (125I-HSA) was significantly greater 72 h after CLP than during the nonseptic baseline study. Histologic examination of gastrocnemius muscle also demonstrated an increase in protein-rich interstitial edema during the septic studies. During the 2 h of PEEP, prefemoral QL increased equally (p less than 0.05) in three study periods: (1) baseline nonseptic, delta QL = +1.2 +/- 1.4 ml/h; (2) septic period 1, 24 to 48 h after CLP, delta QL = +1.3 +/- 1.2 ml/h; and, (3) septic period 2, 72 h after CLP, delta QL = 1.0 +/- 0.6 ml/h. Calculated microvascular hydrostatic pressures also rose significantly during PEEP therapy in all three study periods. We conclude that PEEP, 15 mm Hg, increased hindlimb microvascular fluid flux and may thereby increase interstitial fluid content in tissues drained by the prefemoral lymph node. These effects of PEEP were not aggravated by hyperdynamic sepsis, despite a presumed increase in systemic microvascular permeability at this time.

Animals↗
PubMed1989

Optic nerve enlargement and central retinal-artery occlusion secondary to retrobulbar anesthesia.

Optic nerve injury after retrobulbar injection of anesthetic agents may damage the optic nerve and vascular supply to the eye. We describe a case of documented orbital optic nerve injury with central artery occlusion after retrobulbar injection before cataract surgery. Early computed tomography documentation of optic nerve injury associated with retrobulbar injection is suggested to allow early consideration of optic nerve sheath decompression.

Aged↗
PubMed1986

Disseminated intravascular coagulation and hypopotassemia associated with blast lung injury.

Forty six people were injured by a large explosive charge detonated in a Jerusalem bus. Four were killed instantaneously and 22 needed hospital care. We describe our experience in five patients with blast lung injury (BLI), all of whom survived in spite of severe respiratory failure requiring mechanical ventilation. Disseminated intravascular clotting (DIC) developed in three of the five patients and significant hypopotassemia ranging from 2.2 to 2.9 mEq/L in four. These two complications have not been previously described in association with BLI. Both DIC and hypopotassemia responded to replacement therapy. Vigorous treatment of respiratory failure, early recognition, and prompt correction of hemostatic and electrolyte abnormalities may have contributed to the avoidance of fatalities among the five patients with severe blast injury.

Adult↗
PubMed1977

The effect of ascorbic acid supplementation on some parameters of the human immunological defence system.

We have investigated the effect of ascorbic acid (vitamin C) supplementation on some parameters of the human immune defence system in a group of 25 healthy, male university students. The subjects ingested 1 g ascorbic acid per day for a period of 75 days. Serum levels of IgA, IgG, IgM, C-3 complement component, cortisol and transcortin were measured before and after the ascorbic acid course. Corresponding measurements were performed on a control group of 20 healthy, male university students receiving no extra-dietary vitamin C. Our results showed that ascorbic acid supplementation caused a statistically significant increase in the serum levels of IgA, IgM and C-3 complement. Our study does not permit of conclusions regarding the mechanisms of action of ascorbic acid.

Adolescent↗
PubMedDate not supplied

Childhood asthma surveillance using computerized billing records: a pilot study.

OBJECTIVE: This paper describes a pilot project to develop and implement a low-cost system for ongoing surveillance of childhood asthma in Milwaukee County, Wisconsin. METHODS: The authors organized a planning workshop to solicit information and ideas for an asthma surveillance system, bringing together national experts with Milwaukee professionals and community representatives involved in the prevention and treatment of asthma. Based on recommendations from the workshop, a pilot surveillance project was implemented in Milwaukee County using records of emergency room visits and hospital admissions for asthma abstracted from the computerized billing records of the Children's Hospital of Wisconsin (CHW), retrospectively for 1993 and prospectively for 1994. Retrospective data were also sought from the other hospital emergency departments in Milwaukee County to evaluate the representativeness of the CHW data. Surveillance data were used to evaluate utilization of care by patient subgroups and to describe temporal patterns in emergency room visits. RESULTS: Of the emergency department visits for asthma in Milwaukee County in 1993, CHW accounted for 94% among infants less than 1 year of age, 89% among children ages 1 through 5 years, and only 59% among children between the ages of 6 and 18 years. In 1994, the 7% of asthmatic children with repeat hospital admissions accounted for 38% of all hospital admissions for asthma and the 20% with repeat emergency department visits accounted for 50% of all emergency visits. Emergency visits for asthma showed clear seasonality, with a peak in the fall and a smaller peak in the spring. CONCLUSIONS: Computerized medical billing data provide an opportunity for asthma surveillance at a relatively low cost. The data obtained are useful for tracking trends in exacerbations of asthma and the use of medical services for asthma care and should prove valuable in targeting interventions.

Adolescent↗