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Biomedical subjects

N A Lemak

Publications and source records attributed to N A Lemak.

At least 19 recordsLinked to original sources
PubMed1999

Ondansetron/promethazine combination or promethazine alone reduces nausea and vomiting after middle ear surgery.

STUDY OBJECTIVES: To determine the incidence of postoperative nausea and vomiting when a combination of ondansetron and promethazine is given prophylactically, and to ascertain the effect of postoperative nausea and vomiting on recovery room duration and patient satisfaction. DESIGN: Prospective, randomized, placebo-controlled, double-blind study. SETTING: University-affiliated tertiary-care hospital. PATIENTS: 87 ASA physical status I and II adult patients scheduled for middle ear surgery. INTERVENTIONS: Patients were randomly assigned to receive one of the following interventions intravenously: ondansetron 4 mg (Group 1), promethazine 25 mg (Group 2), ondansetron 2 mg plus promethazine 12.5 mg (Group 3, combination), or placebo (Group 4). MEASUREMENTS AND MAIN RESULTS: Independent, study blinded observers recorded complaints of nausea and number of episodes of vomiting for 24 hours following the patient's first response to commands. All patients were contacted the day after discharge to inquire about nausea and vomiting. The awakening time, postanesthesia care unit and day surgery unit durations, opioid use, and side effects were recorded. At the end of the 24-hour period, the study blinded observers asked patients for an overall assessment of their global anesthesia experience using an 11-point scale. During the 24-hour period, the incidence of postoperative nausea and vomiting was reduced from 74% (placebo) to 39% (promethazine; p = 0.03) and 29% (combination; p = 0.003). Compared with placebo, the severity of vomiting was significantly less in the combination group (p = 0.04). The number of very satisfied patients correlated negatively with the incidence of postoperative nausea and vomiting (p < 0.0001) and with the severity of vomiting (p = 0.003). CONCLUSION: The prophylactic use of an antiemetic with middle ear surgery may reduce postoperative nausea and vomiting over 24 hours, and the ondansetron/promethazine combination or promethazine alone are cost-effective choices. Finally, the combination reduced significantly the severity of vomiting.

Adolescent↗
PubMed1999

Endobronchial intubation causes an immediate increase in peak inflation pressure in pediatric patients.

UNLABELLED: Our purpose was to determine whether endobronchial intubation always causes an immediate increase in peak inflation pressure and, if so, the magnitude of the increase. Fourteen children scheduled for central line placement for prolonged antibiotic administration comprised the study group. After routine premedication and induction of anesthesia (halothane in oxygen), an endotracheal tube was inserted, and its position was verified by auscultation and fluoroscopy. Children were mechanically ventilated using a preset volume pressure-limited ventilator with a 5-L fresh gas flow. All children received a constant tidal volume using a similar circuit, similar tubing, and a similar compression volume. The lowest peak inflation pressure to deliver a tidal volume of 15 mL/kg was used. After adjusting the respiratory rate (end-tidal CO2 30 mm Hg) and anesthetic level (halothane end-tidal 1.2%), the peak inflation pressure at this endotracheal position was recorded. The endotracheal tube was advanced into a bronchus, the position was verified as above, and peak inflation pressure was recorded. The endobronchial tube was then pulled back into the trachea, and placement of the central line proceeded. The peak inflation pressure at the endobronchial position was significantly greater than the peak inflation pressure at the endotracheal position (P < 0.0001). The increase was instantaneous at the endobronchial position. Monitoring peak inflation pressure while inserting an endotracheal tube and during anesthesia can help to diagnose endobronchial intubation. IMPLICATIONS: Monitoring peak inflation pressure while inserting an endotracheal tube and during anesthesia can help to diagnose endobronchial intubation.

Anesthetics, Inhalation↗
PubMed1998

Nerve growth factor in normal and psoriatic skin equivalent models.

Our objective was to determine the pattern and time course of nerve growth factor expression in an established skin equivalent model that we have used in the past to study wound healing and psoriasis phenotypes. Skin equivalents were constructed in triplicate using normal neonatal foreskin keratinocytes plated on collagen gels containing fibroblast lines. These lines were derived from five specimens of psoriatic lesions, three specimens of normal skin from patients with psoriasis, and three specimens of eyelid skin from normal donors. Immunohistochemistry and a monoclonal nerve growth factor-b antibody were used to determine the pattern of protein staining over 2 weeks. We looked at the wound healing phenotype using the skin equivalent model for 7-14 days. When keratinocytes invaginate into the dermis of skin equivalents (beginning at around 7 days of growth), dark staining of nerve growth factor was seen under the basal membrane zone, suggesting that nerve growth factor serves in the development of the basal membrane zone and the epidermis, and may influence the migration of nerves through the basal membrane zone into the regenerated skin.

Cells, Cultured↗
PubMed1998

Sublingual midazolam premedication in children: a dose response study.

The purpose of this study was to evaluate various doses of sublingual midazolam premedication in children. In our prospective, double-blind, placebo-controlled trial, children (n = 102, age range 12 to 129 months) scheduled for day surgery were randomized to receive either midazolam in one of three doses (0.25, 0.5, or 0.75 mg.kg-1) or placebo. Injectable midazolam was mixed with a thick grape syrup and placed under the tongue; the patient was asked to hold it as long as possible before swallowing. Children readily accepted the mixture. Analysing all patients randomized, none of the children receiving placebo vs 28% receiving 0.25 mg.kg-1 (P = 0.02), 52% receiving 0.5 mg.kg-1 (P < 0.001), and 64% receiving 0.75 mg.kg-1 (P < 0.001) of midazolam showed satisfactory sedation (drowsy) at 15 min after administration. Children receiving the two higher doses of midazolam (0.5 and 0.75 mg.kg-1) accepted mask induction willingly, while the group receiving 0.25 mg.kg-1 resembled the placebo group (P < 0.05).

Adjuvants, Anesthesia↗
PubMed1998

Artificial skin equivalent differentiation depends on fibroblast donor site: use of eyelid fibroblasts.

Our objective was to construct and explore human skin equivalents from several normal and pathologic donor skin sites to determine if the fibroblast origin influences epidermal differentiation. Also, we wanted to find out if fibroblasts from some donor sites produced epidermis of superior quality for plastic surgery repairs. Skin equivalents were constructed from 15 normal skin specimens, 9 normal eyelid specimens, 15 lesional skin specimens taken from patients with psoriasis, and 4 specimens from keloid scars. Results show that the tissue origin of the donor fibroblasts determines epidermal differentiation and the time period for regeneration. Eyelid fibroblasts were very dependable in establishing well-differentiated skin equivalents in all nine specimens. Our findings contribute to the accumulated knowledge of wound healing and should also be of value in skin grafting, especially when large areas are denuded as in burns, severe trauma, or cancer ablation.

Adolescent↗
PubMed1998

Absence or presence of a leak around tracheal tube may not affect postoperative croup in children.

To prevent postoperative croup in children, many anaesthesiologists use a tracheal tube that allows a leak when tested with 20 to 25 cm of water pressure. We studied the correlation of postoperative croup with leak, duration of anaesthesia, and a recent cold in 159 healthy outpatient children who had strabismus correction by the same surgeon and the same anaesthesiologist. We found no correlation between the presence or absence of a leak and the incidence or severity of postoperative croup. There was a strong trend toward significance when postoperative croup and duration of anaesthesia were compared (P = 0.056) and a significant, positive correlation between severe croup (requiring racemic epinephrine) and duration of anaesthesia (P = 0.005). Patients having a recent cold did not have an increased incidence of postoperative croup. A leak around the tracheal tube at 20 to 25 cm of water pressure may not be required for a healthy child who undergoes surgery lasting less than 2 h if the child has no history of croup.

Adolescent↗
PubMed1996

Combined modality therapy for cutaneous T-cell lymphoma.

BACKGROUND: Cutaneous T-cell lymphoma (CTCL) may respond to many therapies, but long-term disease-free survival is uncommon. Patients with advanced disease have a median survival of approximately 3 years. OBJECTIVE: Our purpose was to combine known effective agents sequentially to determine whether we could achieve remission in more patients or for longer duration. METHODS: Patients with mycosis fungoides (n = 23) or Sézary syndrome (n = 5) were treated with 4 months of recombinant interferon alfa together with isotretinoin, followed by total skin electron beam therapy alone (for stage I to II disease) or preceded by chemotherapy (for stage III to IV disease). Maintenance therapy consisted of interferon for 1 year and topical nitrogen mustard for 2 years. RESULTS: Twenty-eight patients were treated. The overall response rate (complete and partial remissions) was 82%. Although the median duration of remission was 5 months in patients with stage III to IV disease, two patients remain in complete remission at 39 + and 46 + months. In patients with stage I to II disease the median duration of remission has not been reached at a median follow-up of 18 months. Five patients, all with stage III to IV disease, have died. Overall, the regimen was well tolerated with one treatment-related death from neutropenic sepsis. CONCLUSION: Combined modality therapy may be effective for the treatment of CTCL with similar response rates to other current therapies.

Administration, Cutaneous↗
PubMed1996

A randomized trial of minoxidil in chemotherapy-induced alopecia.

BACKGROUND: Hair loss is a side effect of many chemotherapeutic agents, and patients have even refused possibly palliative or lifesaving drugs because they could not accept temporary or prolonged baldness. Topical minoxidil has been shown to be effective for androgenetic alopecia and alopecia areata. OBJECTIVE: Our purpose was to investigate the value and safety of minoxidil in chemotherapy-induced hair loss. METHODS: Twenty-two women who were facing adjuvant chemotherapy after breast surgery were registered in a protocol that used a 2% minoxidil topical solution or a placebo in a randomized double-blind trial. RESULTS: There was a statistically significant difference (favoring minoxidil) in the interval from maximal hair loss to first regrowth. Thus the period of baldness was shortened (mean, 50.2 days) in the minoxidil group. CONCLUSION: Minoxidil decreased the duration of alopecia caused by chemotherapy. There were no significant side effects.

Administration, Cutaneous↗
PubMed1996

Photopheresis therapy for cutaneous T-cell lymphoma.

BACKGROUND: Cutaneous T-cell lymphoma is a chronic peripheral lymphoma in which aggressive combined therapy elicits high response rates but does not improve survival. Photopheresis therapy has reportedly induced remissions and prolonged survival in patients with advanced disease. OBJECTIVE: We studied all patients who began photopheresis treatment between February 1988 and July 1994 to determine whether we could confirm the remission rates of previous studies, to evaluate variables that might predict a response, and to discover whether an accelerated delivery system would improve the remission rate or response time. METHODS: After an oral dose of methoxsalen was administered, a leukocyte-enhanced quantity of blood was exposed to UVA radiation for 1.5 hours and returned to the patient. With our accelerated system, 6 x 10(9) cells were irradiated in nine cycles. Treatments were given on 2 consecutive days once a month. RESULTS: Among 34 patients whose results could be evaluated, the overall response rate (complete and partial remissions) was 50%; most patients had mild side effects. All responders except one had erythroderma. Responders had a decrease of 75% in mean skin scores, whereas nonresponders had an increase of 21%. CONCLUSION: Photopheresis appears to be effective for selected patients with erythrodermic cutaneous T-cell lymphoma, although we did not achieve as high a remission rate as previously reported by others.

Adult↗
PubMed1996

Systemic lupus erythematosus diagnosed during interferon alfa therapy.

We describe a patient who had clinical manifestations of several autoimmune disorders: Sjögren's syndrome, benign hypergammaglobulinemic purpura of Waldenström, and systemic lupus erythematosus (SLE). The SLE was diagnosed during therapy with interferon alfa. Testing for anti-Ro and anti-La antibodies was negative until the serum was diluted to eliminate a possible prozone phenomenon of antibody excess.

Female↗
PubMed1995

Werner's syndrome.

Werner's syndrome is a rare autosomal recessive disorder that affects connective tissue throughout the body. The genetic basis is not yet known, although many laboratory abnormalities have been reported. The manifestations are widespread, and many organs may prematurely undergo changes usually associated with aging. The disease generally becomes apparent around puberty, with growth arrest and thinning and graying of hair. Rapidly progressing bilateral cataracts typically occur when patients are in their 20s and 30s. A dermatologist may be consulted because of the scleroderma-like appearance of the skin, lower-extremity ulcers or calluses, thinning and graying of hair or baldness, nail dystrophy or loss, wrinkling and aging of the face, or skin cancers. Patients should have a thorough clinical and laboratory work-up, keeping in mind their elevated risk for neoplasms.

Adult↗
PubMed1986

Controlled trial of aspirin in cerebral ischemia: an addendum.

Patients (303) who had had carotid territory transient ischemic attacks were randomly assigned to aspirin or placebo treatments. Patients with amaurosis fugax responded as well to aspirin as those with hemisphere events. Patients with lesions of the appropriate carotid artery responded better to aspirin therapy than patients with no lesion or an occlusion. The aspirin effect was the same across all risk-factor groups. Smoking had no effect on clinical outcome.

Aspirin↗
PubMed1986

Thoracic outlet syndrome: review and reference to stroke in a major league pitcher.

The thoracic outlet compression syndrome is reviewed. It should be considered in all neurologic and vascular complaints of the upper extremity. Symptoms are related to arm position and use and are aggravated by sustained activity that stresses the shoulder. A participant in any sport that requires a repetitive violent throwing motion is a potential candidate for this condition. A detailed report of a major league pitcher illustrates the importance of early diagnosis and appropriate treatment, inasmuch as delay can be catastrophic, as in the case of this career athlete. A thorough history is the best aid in arriving at a diagnosis. When the symptoms are mild or moderate, conservative therapy may suffice. When surgery is indicated, the object is to create adequate space for passage of the brachial plexus, subclavian artery, and subclavian vein. Patients with thrombosis and occlusion of a major artery supplying the upper extremity require an additional arterial reconstructive procedure plus a cervicothoracic sympathectomy.

Adult↗
PubMed1985

Does platelet antiaggregant therapy lessen the severity of stroke?

Data from the Aspirin in Transient Ischemic Attack (AITIA) study, an ongoing study of two platelet antiaggregant drugs, and other published therapeutic trials were reviewed to determine whether the severity of stroke is reduced in patients taking platelet antiaggregants. Data from three of four studies suggest that strokes in treated patients are less severe than those in untreated patients. Further studies evaluating platelet antiaggregant therapy should include assessment of the severity as well as the incidence of stroke.

Aspirin↗
PubMed1980

Controlled trial of aspirin in cerebral ischemia.

The findings from a double-blind multicenter clinical trial of aspirin for treatment of cerebral ischemia are reviewed. Of 303 patients who had carotid transient ischemic attacks (TIAs), 125 were selected for carotid reconstructive surgery and were then randomly assigned treatment with aspirin or placebo. The remaining 178 patients were also randomly assigned to an aspirin or placebo regimen. Analysis of the first 6 months of follow-up showed a differential in favor of aspirin when death, nonfatal cerebral or retinal infarction and the occurrence of TIAs were grouped and considered together as end points. Restriction of end points to death or nonfatal cerebral or retinal infarction yielded no statistically significant differential between the aspirin and placebo groups. After these results were published, a study group from Canada reported that aspirin was effective in preventing threatened stroke, but that this effect was limited to males. Review of our nonsurgical group with respect to sex shows findings consistent with those of the Canadian study for the end points of stroke or death. Inclusion of the occurrence of TIAs in the group of end points, however, revealed that aspirin is effective in females as well as males.

Actuarial Analysis↗