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Biomedical subjects

M Sagy

Publications and source records attributed to M Sagy.

At least 37 records · Page 2Linked to original sources
PubMed1994

Pediatric intrathoracic large airway obstruction: diagnostic and therapeutic considerations.

We describe seven patients who had intrathoracic airway obstruction resulting in severe respiratory distress. The patients were a four month old with bronchial cartilage hypoplasia presenting as congenital lobar emphysema; a one month old with segmental bronchomalacia; a one month old with tracheal bronchus; a two day old and a seven month old with aneurysmal distension of the pulmonary arteries secondary to tetralogy of Fallot, with absent pulmonary valve and atrioventricular canal with pulmonary poststenotic dilatation, respectively; a three year old with double aortic arch forming a vascular ring; and a three month old with tracheomalacia from tracheoesophageal fistula. The patients had various associated congenital defects, and all of them required one or more surgical procedures to repair the defects and relieve the airway obstruction. Five patients received endotracheal intubation with mechanical ventilation on their first admission, and three of them died postoperatively. The diagnostic workup to delineate the anatomic factors causing the obstruction, as well as to determine the therapeutic medical and surgical strategies to relieve it, are described. We conclude that the course of illness in most pediatric patients with intrathoracic airway obstruction is complex, is associated with high morbidity and mortality, and entails extensive multidisciplinary diagnostic and therapeutic efforts.

Airway Obstruction↗
PubMed1991

Reye's syndrome associated with acute myocarditis and fatal circulatory failure.

We describe an eight-month-old infant who had an unusually fulminant and fatal course of Reye's syndrome. The patient died 36 hours after admission because of irreversible circulatory failure not associated with clinical symptoms of increased intracranial pressure or cerebral herniation. Autopsy revealed the pathognomonic fatty degeneration of the liver and heart of Reye's syndrome, but the brain was normal. In addition, a marked inflammatory infiltration of the myocardium was also observed, which indicated that acute myocarditis had been the preceding underlying disease. This case report emphasizes the fact that the viral prodrome preceding Reye's syndrome may not be as benign as often observed with influenza and varicella. Acute myocarditis and Reye's syndrome are also a combination which may result in fatal cardiovascular collapse.

Acute Disease↗
PubMed1990

Management of upper airway obstruction in the Pierre Robin syndrome.

Eight patients with Pierre Robin syndrome (PRS), were treated according to our management protocol. All our patients initially were given a trial of conservative, positional treatment, with high caloric gavage feeding. In five patients this therapeutic approach resulted in a good weight gain, with no significant respiratory distress. The remaining three patients showed no improvement, failed to thrive and therefore underwent the tongue to lip adhesion (TLA) procedure. Two patients then improved dramatically; whereas one continued with respiratory distress and failure to thrive and required tracheostomy. We conclude that when symptoms of respiratory distress and failure to thrive coexist in patients with PRS despite conservative management, surgical intervention to the airway is mandatory. TLA should be the first surgical procedure considered and if the ultimate goals of weight gain and respiratory comfort are still not achieved then tracheostomy seems inevitable.

Airway Obstruction↗
PubMed1990

Calcium blocking agents in pediatric emergency care.

Blocking calcium ion entry into tissue cells appears to have therapeutic benefits in various diseases and symptoms. In the emergency department, as well as in the pediatric intensive care unit, the pediatrician often encounters life-threatening clinical episodes for which the safest, quickest, and most efficient treatment is required. Thus, being familiar with a large variety of emergency therapeutic options, including the use of CBAs, is important. In many medical centers, CBAs have already become the first line of drugs for converting PSVT into normal sinus rhythm (verapamil) and for ameliorating malignant hypertension (nifedipine). The increasing evidence that nimodipine effectively decreases the cerebral damage after head trauma and intracranial hemorrhage will also probably turn this compound into one of the drugs readily available in the emergency department. CBAs will continue to be thoroughly investigated, allowing more new therapeutic applications in pediatric emergency care.

Adolescent↗
PubMed1989

Myocardial response to alpha-agonist (phenylephrine) in relation to age.

We studied the inotropic effect of the alpha-agonist phenylephrine on human and rat myocardium in relation to age. Strips of human atrial myocardium, discarded during cardiac surgery, were obtained from pediatric (2 to 18 months) and adult (40 to 60 yr) patients, and their electrically driven contractions were studied. The inotropic response of pediatric myocardium to phenylephrine was five times larger than that of the adult myocardium (p less than .05). The beta-agonist, isoproterenol, was also administered to the same myocardial specimens, and the average pediatric myocardial response was three times larger than that of the adult myocardium (p less than .05). Strips of right ventricular myocardium were obtained from four age groups of rats: 14 days, 3 months, 6 months, and 18 months, and exposed to phenylephrine. We demonstrated two age-related phenomena: a) a biphasic response with an early short negative inotropic effect preceding a sustained positive inotropic effect was registered in most of the rats aged 3 months and older, but in none of the youngest age group. b) A high mean positive inotropic response (211% of basal response) was generated in the youngest age group, whereas the oldest age group of rats showed only a slight response (8% of basal response, p less than .05). We conclude that loss of myocardial responsiveness to alpha and beta-agonist with increasing age is a prominent feature. The pattern of the ventricular responsiveness to phenylephrine also changes during aging as it turns from monophasic to biphasic.

Adult↗
PubMed1989

Multifocal necrotizing fasciitis in varicella.

We describe a two-year-old patient who developed severe necrotizing fasciitis in three nonadjacent sites of his extremities during varicella. The recovery of purulent material by aspiration of deep soft tissues after seven days of fever, leukocytosis, and no response to antimicrobial therapy raised the suspicion of this diagnosis. The patient recovered following surgical drainage, debridement, and subsequent skin grafts. It is emphasized that early diagnosis of this severe complication is important since early surgical intervention decreases morbidity and facilitates recovery.

Chickenpox↗
PubMed1988

The admission cardiorespiratory performance in relation to outcome in pediatric ICU patients.

We tested the hypothesis that the admission cardiorespiratory performance determines the outcome in pediatric intensive care unit (PICU) patients. We studied 331 patients who were assigned to one of the three commonly encountered PICU clinical entities: respiratory disease, cardiovascular disease and head trauma. All patients were evaluated by a simple cardiorespiratory scoring system which we named "Rule of 60" (RO60), and their highest score within the first 24 h of arrival in the PICU was used for the study. This scoring system includes 6 cardiorespiratory parameters where a value of 60 represents a cut-off point above or below which 0 points (low risk) or 10 points (high risk) are assigned. The relationship between score and mortality rate revealed that the higher the score the higher is the mortality rate. We determined two categories of severity of illness in our patients. Patients at severity level A had scores ranging from 0 through 30 and the mortality rate in this category ranged from 2% to 5%. Patients at severity level B had scores ranging from 40 through 60 and had a higher mortality rate: 30% to 80%. The overall mortality rates for patients at severity level A and B were 2% and 54% respectively. Patients with respiratory disease at severity level B had the lowest mortality rate (20%), whereas patients with cardiovascular disease and head trauma had mortality rates of 52% and 80% respectively. We found that our cardiorespiratory scoring system was as good as the Glasgow Coma Scale for indicating prognosis and outcome in head trauma patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Variables affecting outcome from severe brain injury in children.

This study evaluates the outcome of 56 severely brain injured children (mean age 6.2 +/- 2.1 years) and relates the Initial Glasgow Coma Scale (IGCS), initial intracranial pressure (ICP int), maximal intracranial pressure (ICP max) and minimal cerebral perfusion pressure (CPP min) to quality of survival. Forty-one children sustained head trauma, five severe central nervous system infections and 10 were of miscellaneous etiology. Therapy consisted of mechanical hyperventilation, moderate fluid restriction, dexamethasone and diagnosis specific measures when indicated. Outcome was categorized according to the Glasgow outcome scale at discharge from the hospital. An IGCS of 3 was associated with 100% mortality, 7 and above resulted in 72% good recovery, 28% poor outcome and no mortality. ICP int of less than 20 torr was noted in (67%) of the patients, and did not correlate with ICP max or outcome. Conversely, ICP int in excess of 40 torr correlated well with ICP max and outcome. ICP max of less than 20 torr resulted in 57% good recovery, 36% poor outcome and 7% mortality. ICP max greater than 40 torr resulted in 7% poor outcome and 93% mortality (p less than 0.001). In head trauma, 32 patients (78%) were alive with mean ICP max 16.9 +/- 3.1 and CPP min 65.5 +/- 8.5 torr compared to 9 patients (22%) who died with mean ICP max 53.7 +/- 10.8 and CPP min 6 +/- 3.9 torr, (p less than 0.01). In children with infectious etiology 60% survived with mean ICP max 16 +/- 3 and CPP min 96 +/- 16 torr.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Injuries↗
PubMed1988

Computed tomography in children with esophageal and airway trauma.

Computed tomography (CT) was used in five children, four with esophageal and one with airway trauma. The examination contributed valuable information that aided in planning and evaluating therapy: (1) it assessed mediastinal and pleural cavity involvement prior to surgery or drainage; (2) it evaluated the efficacy of drainage; (3) it gave excellent information about the position of chest tubes; and (4) it demonstrated unsuspected pneumothoraces, pleural effusion, pulmonary infiltrates, and lung perforation by a chest tube. In the postoperative assessment of laryngotracheal fracture, neck radiographs were useless since the airways were obliterated by hematomas and edema. In this situation, CT showed the position and state of the laryngeal cartilages. However, CT findings were not pathognomonic for esophageal tears or airway fractures. The primary diagnosis was still made by conventional radiography. Esophageal tears were accurately demonstrated by gastrografin swallow and the tracheolaryngeal fracture was diagnosed by a lateral neck radiograph--the state of the child permitting no lengthy workup. CT and conventional radiography with contrast studies play a complementary role in esophageal and airway trauma in children.

Child↗
PubMed1988

The diagnosis and management of acid-base imbalance.

The ability to obtain an arterial blood gas analysis within a few minutes in most medical facilities enables the clinician to rapidly evaluate the acid-base status of his or her critically ill patients and to treat disorders as they appear. Although acid-base charts, graphs, and nomograms are available and can help to establish a diagnosis of acid-base disorders, the common practice is that most emergency and critical care clinicians tend to interpret acid-base data rapidly, usually without using any of these tools. The intent of this discussion is to provide the clinician with the pathophysiologic background of acid-base imbalance, the diagnostic criteria for acid-base disturbances, and the clinical approach to management. The standard arterial blood gas analysis, serum and urine electrolytes, and clinical assessment of the alveolar ventilation are the only data upon which this discussion is based.

Acid-Base Imbalance↗
PubMed1988

Pediatric cardiopulmonary resuscitation outcome.

In order to identify factors that influence the outcome from cardiopulmonary resuscitation (CPR) in children, we studied 69 children (mean age 2.5 +/- 0.4 years) who were apneic and pulseless prior to resuscitation, and treated in the Pediatric Intensive Care Unit (PICU) following CPR. Immediate success (restoration of spontaneous circulation and normal sinus rhythm) was noted in 54 (78%) patients. Forty-one (59%) were short-term survivors (greater than 24 h), and ten (14.5%) became long-term survivors (five recovered well, three moderately disabled, and two severely disabled). Fifty-nine (85%) died. Outcome was positively influenced by: 1) CPR duration; when less than five min., 54% were long-term survivors compared to 5% of patients resuscitated for more than five min (p less than 0.001). 2) Number of epinephrine doses: 38% of 24 patients receiving one dose became long-term survivors versus 0% of 26 receiving more than one dose (p less than 0.001). 3) Location of arrest; Fifty percent of patients resuscitated in the operation suite or catherization laboratory survived long-term compared to only 8% resuscitated in the PICU (p less than 0.03). Age, sex, cardiac rhythm, as well as metabolic and acid-base variables during resuscitation, did not significantly affect the outcome. Overall good neurologic survival was rare.

Acid-Base Imbalance↗
PubMed1987

Nonopiate effect of naloxone on cardiac muscle contractility.

To test the hypothesis that naloxone exerts a direct positive inotropic effect on the cardiac muscle, we employed two in vitro models. In one set of experiments we demonstrated that injection of 1 mg naloxone into an isolated perfused rat heart produced a significant increase in the amplitude of contraction. In another set of experiments we exposed an isolated and spontaneously contracting rat right atrium in a tissue bath to naloxone, and demonstrated that the amplitude of contraction increased significantly within a few minutes of naloxone administration. We showed that this effect of naloxone was not related to opiate receptors, since a similar effect was obtained with d-naloxone (the stereoisomer that is inactive as an opiate antagonist) and it was not affected by pretreatment with morphine. We also demonstrated that addition of alpha- and beta-adrenergic antagonists phentolamine and propranolol, in doses that effectively block alpha- and beta-adrenergic agonists, did not have any effect on naloxone's inotropic action. We validated our results in two electrically driven strips of human atrial myocardium in the tissue bath. A positive inotropic response to naloxone, measured as an increase of 80 and 50% in the amplitude of contraction, was noted. We postulate that naloxone's previously described cardiovascular pressor effect in states of shock may not only be related to reversal of the effects of endorphins but also to its direct inotropic action.

Animals↗
PubMed1985

Open- versus closed-chest cardiac compressions in a canine model of pediatric cardiopulmonary resuscitation.

Whether or not the principles of adult resuscitation apply to the pediatric population remains unknown. In order to study this issue, a pediatric animal model was developed using puppies 6-12 weeks of age and 2-8 kg in weight. Hemodynamic status was assessed using standard methods, and measured global cerebral blood flow was assessed using the nitrous oxide (Kety-Schmidt) technique after placement of a catheter in the sagittal sinus. In this initial study, five puppies resuscitated with closed-chest cardiac compression (CCCC) were compared with five receiving open-chest cardiac compression (OCCC). Although mean systolic arterial pressures were equal with both methods during resuscitation (40 versus 49 mm Hg, P = 0.19), OCCC produced a greater cardiac output and a higher cerebral blood flow (5 versus 18 ml/100 g/min, P = 0.008). Only one of five dogs treated with CCCC had a blood flow during resuscitation greater than 15 ml/100 g/min, as compared with four of five receiving OCCC. Finally, three of five dogs in the CCCC group experienced liver lacerations, while none who were resuscitated by OCCC sustained any gross visceral injuries.

Animals↗
PubMed1984

The renal effects of radiocontrast administration during cardioangiography in two different groups with congenital heart disease.

Renal effects of the administration of contrast media during cardiac catheterisation were compared in two groups of patients with congenital heart diseases. Group A consisted of 21 patients with cardiac malformations, characterised primarily by left ventricular volume overload and known to be associated occasionally with left heart failure, such as: left to right shunts and left ventricular valvular defects. Group B consisted of 23 patients with lesions affecting the right ventricle which are rarely associated with left heart failure, such as: Tetralogy of Fallot and Pulmonic stenosis. Patients in Group A showed a significant increment in both plasma creatinine and uric acid levels in the 24 h following heart catheterisation. This observation was significantly more prominent in the older age group (above the age of 5 years). In Group B no changes in these parameters were encountered. Plasma renin activity and fractional sodium excretion increased and decreased respectively, by a similar degree in both groups in the 24 h following contrast media administration. No difference in renal tubular handling of uric acid was observed between both groups, nor did any of the patients studied demonstrate any degree of proteinuria or abnormality in the urine sediment, prior to or following heart catheterisation. We suggest that chronic pre-existing left ventricular overload should be considered a risk factor among the other known risk factors which promote the incidence of acute renal failure after contrast media administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1981

Congenital lactic acidosis associated with pyruvate carboxylase deficiency.

Two cases of congenital lactic acidosis associated with pyruvate carboxylase deficiency are described. One 2-mo-old infant had a fulminant clinical course with extremely severe intractable acidosis and died after 48 h in hospital. The second infant, aged 2 1/2 mo, had a milder clinical course, characterized by moderate acidosis and frequent convulsive episodes. He died at the age of 3 mo due to respiratory arrest following prolonged status epilepticus. Pyruvate carboxylase activity in liver biopsy specimens obtained from the two patients was 1 and 50% of normal, respectively. Both patients failed to respond to treatment, including massive doses of thiamine and high serum levels of lactate and pyruvate were found throughout their illnesses. Cerebral autopsy performed in both cases was unremarkable. Absence of neuropathological findings ruled out the possibility of Leigh's disease.

Acidosis↗