PubMed Health⌕ Search

Biomedical subjects

M Yablonski

Publications and source records attributed to M Yablonski.

12 recordsLinked to original sources
PubMed2001

Magnesium sulfate in the treatment of refractory ventricular fibrillation in the prehospital setting.

OBJECTIVE: To determine if magnesium sulfate (MgSO(4)) improves outcome in cardiac arrest patients initially in ventricular fibrillation (VF). METHODS: Randomized, prospective, double blind, placebo-controlled, multicenter prehospital trial using 2 g of MgSO(4). Eligible patients were non-traumatic cardiac arrest patients (> or =18 years of age) presenting in VF. The protocol included those patients refractory to three electroshocks. Epinephrine and either 2 g of MgSO(4) or placebo (normal saline) were then administered. The primary outcome variable was return of spontaneous circulation (ROSC) in the field and a perfusing pulse on arrival at the ED. Secondary endpoints included admission to the hospital (ADMT) and hospital discharge (DISC). IRB approval was obtained at all participating centers. RESULTS: Total 116 patients (58 MgSO(4), 58 placebo) were enrolled during the period from 4/1992 to 10/96 with 109 available. There were no significant differences between the groups in baseline characteristics and times to cardio pulmonary resuscitation (CPR), advanced life support (ALS), and first defibrillation, except for time to study drug administration. There was no significant differences in ROSC (placebo, 18.5%, and MgSO(4), 25.5%, P=0.38), ADMT (placebo rate=16.7%, MgSO(4)=16.4%, P=1.0) or DISC (placebo rate=3.7%, MgSO(4)=3.6%, P=1.0). CONCLUSIONS: We failed to demonstrate that the administration of 2 g of MgSO(4) to prehospital cardiac arrest patients presenting in VF improves short or long term survival.

Adolescent↗
PubMed2001

Neuroimaging studies in Rett syndrome.

Neuroimaging is a key instrument for determining structural and in vivo functional status of the brain, non-invasively. Multiple approaches can now determine aspects of anatomic and neurochemical changes in brain, and have been utilized effectively in Rett Syndrome patients to understand the biological basis of this neurodevelopmental disorder. Studies performed at our institute include volumetric analyses of MRI, magnetic resonance spectroscopy (MRS), diffusion tensor imaging (DTI), cerebral blood flow measurements with MRI, and positron emission tomography scans (PET). These studies have provided considerable insight into mechanisms underlying the clinical features of this disease. Volumetric analyses suggest that decreased brain volume in RS results from global reductions in both gray and white matter of the brain. A selective vulnerability of the frontal lobes is evidenced by the preferential reduction of blood flow, increased choline and reduced n-acetyl aspartate (NAA) by MRS, and increased glucose uptake in these same regions as shown by ((18)F)-fluorodeoxyglucose (FDG) PET scans. We hypothesize that the increased glucose uptake relates to increased glutamate cycling in synapses. The resulting neuroexcitotoxic injury to the developing brain contributes to the seizures, behavioral disturbance and respiratory irregularities commonly seen in phases 1 and 2 of this disorder.

Adolescent↗
PubMed1993

Four-week safety and efficacy study of dorzolamide, a novel, active topical carbonic anhydrase inhibitor.

OBJECTIVE: To investigate the activity and local and systemic safety of the topical carbonic anhydrase inhibitor, dorzolamide hydrochloride. DESIGN: Four-week, double-masked, randomized, placebo-controlled, parallel, three-center study. SETTING: Referral centers. PATIENTS: Forty-eight patients with bilateral open angle glaucoma or ocular hypertension and intraocular pressure (IOP) greater than 22 mm Hg entered the study. Two of 28 patients receiving dorzolamide and two of 20 patients receiving placebo were withdrawn due to adverse experiences. INTERVENTION: Dorzolamide (2%) or placebo to each eye three times daily for 4 weeks. MAIN OUTCOME MEASURES: Diurnal IOP curves; ophthalmologic evaluations including corneal ultrasound pachymetry and endothelial cell count; and systemic evaluations including vital signs, blood chemistries, complete blood cell counts, urinalysis, electrocardiogram, and drug and carbonic anhydrase activity levels in red blood cells. RESULTS: Mean IOP at morning trough (8 AM) decreased from 27.1 mm Hg at baseline to 23.5 mm Hg on day 29 with dorzolamide (-13.3%) compared with a decrease from 27.1 mm Hg to 26.4 mm Hg with placebo (-2.3%). Peak activity occurred 2 hours after administration, with IOP decreasing from 26.8 mm Hg at baseline to 21.8 mm Hg on day 29 with dorzolamide (-18.4%) vs 26.1 mm Hg to 25.5 (-2.4%) with placebo. Mean corneal thickness was slightly increased for the dorzolamide-treated group compared with the placebo-treated group (0.009 mm vs 0.001 mm, respectively, P < .05) and changes in endothelial cell counts were similar (-24 cells/mm2 vs -27 cells/mm2, respectively, P > .25). Mean carbonic anhydrase isoenzyme II activity in red blood cells decreased to 21% of baseline in dorzolamide-treated patients. There were no clinically significant differences in ocular or laboratory parameters between the dorzolamide and placebo groups. CONCLUSIONS: Dorzolamide demonstrated significant IOP lowering activity over 4 weeks. It was well tolerated and there were no clinically significant changes in ocular or systemic safety parameters.

Administration, Topical↗
PubMed1990

Combination regional therapy for extremity sarcoma. A tricenter study.

Patients with extremity sarcomas were treated with a neoadjuvant therapy protocol that had originated within the Southeastern Cancer Study Group. Major objectives were to determine tolerance of therapy and its effects on tumor control and survival. After undergoing biopsy, patients received intra-arterial infusion with doxorubicin hydrochloride (Adriamycin) (30 mg every 24 hours) for 3 days and were allocated by institution to receive irradiation of 30 or 35 Gy in 10 fractions or 46 Gy in 23 to 25 fractions. Surgery was done within 7 to 10 days or 30 days pending irradiation dose. Postoperative chemotherapy was given to 31 patients. There were 60 patients, 29 women and 31 men with a median age of 48 years, with 53 soft-tissue tumors and 7 malignant bone tumors. Stages (American Joint Committee on Cancer) included stage IB, 2 patients; stages IIA and IIB, 9 patients; stage IIIA, IIIB, or IIIC, 39 patients; and stages IVA or IVB, 10 patients. Limb salvage surgery was done in 57 patients, including radical resection in 23 with large extensive tumors, wide local excision in 30, excision with narrow margins in 7, primary amputation in 3, and delayed amputation in 2 because of wound complications. There was one local recurrence in the 57 patients who had limb salvage surgery. Disease-free and overall survival at 48 months were 47% and 56%, respectively. We conclude that combined therapy for extremity sarcomas in a multicenter setting resulted in excellent local control, good function, and reasonable long-term survival in patients having limb salvage surgery.

Adolescent↗
PubMed1990

Subtle variations in tubal anatomy in infertile women.

The frequency of tubal variations was recorded in 100 infertile and 100 fertile women at cesarean section. The infertile women had significantly more tubal/pelvic anatomical variation than did their fertile counterparts. Fimbrial agglutinations (25%), accessory tubes (13%), accessory ostia (10%), phimoses (13%), and sacculations (7%) were found more commonly in the infertile women. Paratubal cysts were found with equal numbers in both groups. There was no statistical difference in history of sexually transmitted disease/pelvic inflammatory disease (PID) or endometriosis. No significant relationship between a positive PID history and fimbrial agglutination was found; the majority of agglutinations were present with no associated adhesions.

Fallopian Tubes↗
PubMed1987

Use of therapeutic ultrasound to restore failed trabeculectomies.

We treated 20 recently postoperative eyes with nonfunctioning trabeculectomies at the site of the failed bleb with two to four ultrasound applications, each of five seconds duration, at an intensity level of 10 kW/cm2. Fifteen of the eyes demonstrated a long-term decrease in intraocular pressure to 21 mm Hg or below. The mean intraocular pressure of all patients fell from a preultrasound mean (+/- S.D.) of 32 +/- 8 mm Hg to 20 +/- 10 mm Hg at a mean time of 236 +/- 204 days postultrasound. Complications included an immediate postultrasound rise in pressure over 10 mm Hg in 13 eyes, and the immediate development of a cataract in one patient.

Combined Modality Therapy↗
PubMed1979

Multivariate analysis of the risk of glaucomatous visual field loss.

In a retrospective study, 92 patients with ocular hypertension, ie, intraocular pressure of 21 mm Hg or higher, and no evidence of glaucomatous visual field defects, were observed for five years. Visual field defects developed in one or both eyes of 33 patients during the five-year follow-up period, while none were detected in the remaining 59. Values for suspected risk factors, determined at the outset of the follow-up period, were subjected to a multivariate analysis with use of linear discriminant analysis and a multiple logistic function. Models of risk providing maximum separation of the two patient groups (visual field loss vs no visual field loss) found that the risk factors having the greatest significance for prediction of visual field loss included vertical estimates of cup/disc ratio, mean IOP during the period of observation, a positive family history of glaucoma, and age. Factors having the lowest predictive values included IOP response to topical dexamethasone, plasma cortisol suppression, and a history of systemic hypertension.

Glaucoma↗
PubMed1978

Quantitative visual field and optic disc correlates early in glaucoma.

A retrospective study was made of persons with ocular hypertension and normal initial visual fields. Seventy eyes were followed, and glaucomatous visual field defects developed in 25 of these eyes. In eyes with ocular hypertensio, the area enclosed by the central visual field isopter (I2e) was significantly smaller than that previously reported for an age-corrected group of eyes with normal intraocular pressure. In the absence of glaucomatous visual field defects, isopter areas were not releated to cup-disc ratios. Coincident with visual field loss, reductions in both peripheral (I4e) and central (I2e) isopter areas correlated linearly with increases in the cup-disc ratio. Prior to visual field loss, the I4e isopter area wassignificantly smaller among those eyes destined to lose visual field.

Adult↗
PubMed1978

Screening for lower extremity deep venous thrombosis. An improved plethysmographic and Doppler approach.

Noninvasive screening of the lower extremities for deep vein thrombosis was performed bilaterally on 1,118 patients. Impedance plethysmography alone was used in 868. Venography in 135 revealed an accuracy of 88%, with a false-negative rate of 5.3% and a false-positive rate of 18.6%. A combined ultrasonic Doppler and modified impedance technic was used in 250 patients. Venography in forty revealed an accuracy of 95%, with a false-positive rate of 10% and no undetected thrombi. The combined technic, emphasizing the more accurate modality in three anatomic areas, has proven sensitive, specific, and reliable as a screening test for deep venous thrombosis.

Doppler Effect↗