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Biomedical subjects

M R Kramer

Publications and source records attributed to M R Kramer.

At least 109 records · Page 6Linked to original sources
PubMed1991

Exertional sudden death in soldiers.

To address the problem of a significant rise in the incidence of exertional sudden death worldwide, the medical records and necropsy reports of all deaths that occurred in the Israel Defence Forces (IDF) during 1974-1986 were scrutinized. Twenty male soldiers, aged 18-29 yr, died suddenly and unexpectedly within 24 h of strenuous exercise. Necropsy results, available for 90% of the subjects, included underlying cardiac disease in 50% and noncardiac causes of death in 33.3%; the cause of death was unidentifiable in 16.7% of the subjects. Prodromal symptoms in 70% of the subjects are presented as a main focus of this investigation. The most frequently reported symptom was exertional or nonexertional syncope in 40% of the subjects. Chest pain, acute gastrointestinal symptoms, or febrile disease were reported in 30% of the cases. The findings of this research suggest that syncope is a major antecedent symptom of exertional sudden death. An attack of syncope in young conditioned individuals should be followed by thorough medical surveillance, and strenuous exercise should be avoided until this procedure is completed. Sports and military officials have the obligation to promote awareness that strenuous exercise should not be performed in the presence of acute gastrointestinal symptoms or febrile illness.

Adolescent↗
PubMed1990

Disseminated strongyloidiasis in AIDS and non-AIDS immunocompromised hosts: diagnosis by sputum and bronchoalveolar lavage.

In conclusion, disseminated strongyloidiasis is a fatal disease that commonly affects the lungs. The disease should be suspected in an immunocompromised host who came from an area endemic for S stercoralis even years before the onset of symptoms or in patients with unexplained gram-negative bacteremia or meningitis. Treatment should be started promptly and should be maintained for a long time.

Acquired Immunodeficiency Syndrome↗
PubMed1990

The radiographic appearance of pulmonary nocardiosis associated with AIDS.

Pulmonary nocardiosis is a well-described infection in immunocompromised patients; however, it is less well documented in patients with AIDS. The pulmonary manifestation in 21 HIV-positive patients who developed pulmonary infection with Nocardia asteroides is described. The radiographic picture included lobar or multilobar consolidation (52 percent [11/21]), solitary masses (24 percent [5/21]), reticulonodular infiltrates (33 percent [7/21]), and pleural effusion (33 percent [7/21]). Cavitation was common (62 percent [13/21]), and upper lobes were more commonly involved (71 percent [15/21]). Although the radiographic picture is variable, nocardiosis should be suspected in an HIV-positive patient who has subacute pulmonary disease with an unexplained lung mass or cavitary lesions.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Selection and evaluation of recipients for heart-lung and lung transplantation.

Heart-lung and lung transplantation is being successfully performed with increasing frequency in patients with end-stage cardiopulmonary and pulmonary disease. Transplantation must now be considered as a therapeutic option in selected patients, and physicians are required to understand the principles involved for determining suitable candidates and operative procedures of choice. Indications, contraindications, and choice of operation with respect to underlying disease are discussed herein, as are methods of evaluation and appropriate timing for transplantation. Special considerations regarding specific patient populations are also addressed. In properly selected patients, heart-lung and lung transplantation provide a viable therapeutic option in those with end-stage disease who are unresponsive to conventional management.

Contraindications↗
PubMed1989

End-tidal carbon dioxide in critically ill patients during changes in mechanical ventilation.

Values of end-tidal CO2 (PETCO2) approximate PaCO2 in spontaneous breathing normal subjects and in stable patients receiving mechanical ventilatory support (MVS). Because marked inequality of ventilation/perfusion ratios in critically ill patients might affect this correlation, we assessed changes of PETCO2 in predicting changes in PaCO2 (delta PaCO2) and changes in minute ventilation (delta Ve) in this patient population. Twenty consecutive intubated patients 38 to 89 yr of age (mean, 70 yr) with respiratory failure while receiving MVS with indwelling arterial lines were studied. Settings on the mechanical ventilator were varied for frequency and tidal volume, and after a minimum of 5 to 10 min equilibration, PaCO2 and PETCO2 were measured. Vt and Ve were recorded from the digital indicator of the pneumotachygraph within the mechanical ventilator and corrected for compression volume in the respirator circuit. A total of 116 simultaneous measurements were performed. PETCO2 correlated well with PaCO2 (r = 0.78, p less than 0.001). The 95% confidence interval for the mean difference in PaCO2-PETCO2 was 4.0 +/- 0.97 mm Hg. However, delta PETCO2 (measured from baseline) did not correlate as well with delta PaCO2 (r = 0.58, p = less than 0.001). In four patients, the trend in their PETCO2 during changes in mechanical ventilation were in the opposite direction from the trend in their PaCO2. Thus, many critically ill patients, who cannto be preidentified, have an inconstant PaCO2-PETCO2 gradient with changes of ventilation. Utilization of PETCO2 as a noninvasive monitoring substitute for trends in PaCO2 in critically ill patients may be misleading despite establishing an initial PaCO2-PETCO2 relationship.

Adult↗
PubMed1989

Sudden death in young Israeli soldiers. Analysis of 83 cases.

During the years 1974-86 in the Israel Defense Force (IDF), 83 soldiers aged 17-39 years died suddenly and unexpectedly. Cardiac causes accounted for 56% of the deaths, neurological causes for 19%, other diseases for 8% and in 17% the cause of death was unknown. Causes of death varied between soldiers younger and those older than 30 years of age. Ischemic heart disease accounted for 58% of deaths in soldiers greater than 30 years old but was an infrequent cause of death in subjects less than 30 years (4%). Congenital cardiac anomalies (27%) and myocarditis (15%) accounted for most deaths in subjects less than 30 years of age. Epilepsy was a common cause of sudden death (10%), occurring mainly during sleep, and was related to poor medical control. Effort-related deaths occurred in 25 cases (30%) and were mainly associated with cardiac causes. Syncope (18%) and chest pain (18%) were common symptoms prior to death. According to our data and previous reports, sudden death continues to be an unresolved medical problem in young adults. Preventive measures should include a more thorough evaluation of symptoms such as syncope and chest pain, particularly when occurring during or after exercise. Furthermore, early coronary artery disease should not be disregarded in subjects as young as 30 years of age.

Adolescent↗
PubMed1989

Mortality in elderly patients with thermoregulatory failure.

Fifty-four elderly patients with thermoregulatory failure were evaluated retrospectively. The most commonly associated cause was underlying sepsis, which occurred in 78% of cases. Underlying conditions that increased the incidence of hypothermia were hypoproteinemia (50%), cachexia (30%), and neuroleptic medications (21%), most commonly thioridazine. Digoxin toxicity was a common finding (20% of all cases). One third of the patients developed hypothermia in warm months and half of them developed it while in the hospital. Patients who presented with hypothermia from out of the hospital had lower temperatures, were more bradycardic and hemoconcentrated, and died more rapidly than the in-hospital group. This could be explained by lower outside temperature or delay in diagnosis and treatment of the underlying disease. The overall mortality rate was extremely high (74%) in both groups. The mortality rate was not affected by age, sex, or degree of hypothermia. We conclude that thermo-regulatory failure in the elderly can occur in warm as well as cold environments or climates. The development of hypothermia in elderly patients should be promptly treated as sepsis unless proven otherwise, in light of the poor prognosis of this condition.

Aged↗