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Biomedical subjects

P C Ferrera

Publications and source records attributed to P C Ferrera.

At least 19 recordsLinked to original sources
PubMed1999

Outcomes of anticoagulated trauma patients.

Patients on warfarin are at high risk for potentially life-threatening hemorrhage even after relatively minor trauma. Outcomes of these patients and the potential complications of reversing the effects of anticoagulation have received little attention. This study was performed to determine the overall outcome of orally anticoagulated patients who sustained injury as well as to determine any untoward effects of reversing their anticoagulated states. A retrospective study of injured patients on warfarin was conducted on patients admitted to an urban, university, tertiary-referral, level I trauma center between 1/1/93 and 12/31/96. Surviving patients were followed for a period of at least 1 month. Injuries were grouped by anatomic site. Charts were reviewed for degree of anticoagulation on admission (ie, initial international normalized ratio [INR]), survival, adverse effects of reversal of anticoagulation, and reinstitution of warfarin therapy. Discharged patients were contacted at home for follow-up. Thirty-five consecutive patients, 18 men and 17 women, on warfarin therapy at the time of their injuries were reviewed. The mean age was 75 years, with a range of 39 to 96. The mean follow-up period was 12.7 months. Reasons for anticoagulation included atrial fibrillation, prosthetic heart valves, revascularized limb, hypercoagulable state, deep venous thrombosis, pulmonary embolism, phlebitis, and aortic stenosis. Mean admission INR was 3.2, with a range of 1.6 to 10.0. There were 8 in-hospital deaths. Intracranial hemorrhages accounted for the majority of injuries. Ten patients were not given reversal therapy. Four complications were attributable to reversal therapy (upper extremity hemiplegia, transient ischemic attack, deep venous thrombosis, arterial thrombosis). Twenty-one patients had their warfarin reinstituted. Follow-up of surviving patients ranged from 1.5 to 42 months. Patients on warfarin are at high risk for intracranial hemorrhage following trauma. Patients on warfarin may be reversed during the acute period following injury, but transient complications may arise. Further prospective studies need to be conducted to determine which anticoagulated trauma patients may not require reversal therapy.

Adult↗
PubMed1998

Injuries distracting from intraabdominal injuries after blunt trauma.

While most conscious patients with severe intraabdominal injuries (IAI) will usually present with either abdominal pain or tenderness, there is a small group of awake and alert patients in whom the physical examination will be falsely negative because of the presence of associated extraabdominal ("distracting") injuries. We sought to define the types of extraabdominal injuries that could lead to a false negative physical examination for potentially severe IAI in adult victims of blunt trauma. This study was prospectively performed on consecutive blunt trauma patients over a 14-month period in our level I trauma center. Inclusion criteria were as follows: (1) Glasgow Coma Scale score of 15; (2) age 18 years or older; and (3) computed tomography (CT) of the abdomen or diagnostic peritoneal lavage (DPL) performed regardless of initial physical examination findings. Patients were questioned specifically about the presence of abdominal pain and the initial abdominal examination was documented in addition to other extraabdominal injuries. Abdominal injuries were considered to be present based upon either abdominal CT findings or a positive DPL. Patients with and without abdominal pain or tenderness were compared for the presence of IAI. A total of 350 patients were enrolled. There were 142 patients with neither abdominal pain nor tenderness (group 1) and 208 patients with either or both (group 2). Ten of the 142 patients (7.0%) in group 1 had IAI compared with 44 of the 208 patients (21.2%) in group 2 (P = .0003). Presence of pain and/or tenderness had a sensitivity of 82%, a specificity of 45%, a positive predictive value of 21%, and negative predictive value of 93%. All 10 patients in group 1, and 36 of the 44 group 2 patients, had associated extraabdominal injuries. Although the presence of abdominal pain or tenderness was associated with a significantly higher incidence of IAI, the lack of these findings did not preclude IAI.

Abdominal Injuries↗
PubMed1998

Disseminated herpes simplex virus infection in a neonate.

The emergency department (ED) evaluation of the neonate with sepsis or symptoms suggesting sepsis usually includes a complete blood count, catheterized urinalysis with culture, blood cultures, cerebrospinal fluid analysis and culture, and possibly a chest radiograph. Admission for observation for neonates at high risk for sepsis is universal. Depending on the patient's presentation and the preference of the admitting physician, intravenous antibiotics are started. Typically, ampicillin and either an aminoglycoside or cefotaxime are chosen because they cover the likely pathogens in this age group, ie, group B streptococci, Escherichia coli and other gram-negative enterics, and Listeria monocytogenes. Coverage for viral infection, most notably herpes simplex virus (HSV), is only rarely instituted in the ED and is usually considered if the patient has obvious ulcerative lesions or if the mother has known HSV infection. Unfortunately, antiviral therapy with acyclovir or vidaribine has to be started in the early stages of infection to be effective. If antiviral therapy is started after viral entry into cells, morbidity is severe and mortality approaches 80%. Neonates who survive are usually severely disabled. Broadening the indications for initiating antiviral therapy to include the neonate whose mother has any history of a sexually transmitted disease may prevent the sequelae of untreated or inadequately treated HSV infection. A case is reported of an 8-day-old girl who developed disseminated HSV infection and died as a result of hepatic failure.

Acyclovir↗
PubMed1998

Sagittal sinus thrombosis after closed head injury.

Superior sagittal sinus thrombosis (SSST) is an unusual disorder, most often attributed to hematological abnormalities, oral contraceptive use, or association with the puerperium. Although SSST secondary to trauma has been reported, it still remains an extremely rare entity. Antemortem diagnosis of SSST is made by findings on computed tomographic scanning, cerebral angiography, or magnetic resonance imaging. Prognosis is variable and spontaneous resolution has been reported. Successful treatment options of spontaneous cases include systemic anticoagulation and thrombolytic therapy along with supportive measures. There are currently no guidelines for the management of SSST associated with traumatic brain injury. This report describes a case of SSST in a man who sustained a closed head injury.

Adult↗
PubMed1998

Coincident meningitis and intracerebral hemorrhage in an unresponsive adult.

Intracerebral hemorrhage is an unusual complication of central nervous system infection. A 54-year-old man presented to our emergency department unresponsive following an acute intracerebral hemorrhage that likely occurred as a complication of pneumococcal meningitis. Although the simultaneous presence of meningitis and intracerebral hemorrhage is rare, prompt identification and treatment of each is essential to maximize the outcome. The intracranial complications and various presentations of bacterial meningitis in adults are reviewed.

Cerebral Hemorrhage↗
PubMed1997

Neonatal fever: utility of the Rochester criteria in determining low risk for serious bacterial infections.

The purpose of this study was to test the utility of the Rochester criteria in determining which febrile neonates are at low risk for serious bacterial infections (SBI). This was a retrospective study over a 5-year period of 134 patients younger than 29 days old with fever without a source evaluated in the emergency department. Results of urinalysis, lumbar puncture, peripheral white blood cell count, and cultures of blood, urine, cerebrospinal fluid, and stool were recorded. Of the 134 neonates, 71 were high-risk, 48 low-risk, and 15 were not classifiable by the available data. Nineteen of the 71 high-risk patients (26.8%) had SBI (2 patients had 2 SBI). Three of the 48 low-risk neonates (6.3%) had SBI (1 patient had 2 SBI). None of the 15 nonclassifiable patients had SBI. Employing the Rochester criteria to the fully cultured neonates who could be risk-stratified, the sensitivity, specificity, positive predictive value, and negative predictive value were 86.4%, 46.4%, 26.8%, and 93.8%, respectively. Although outpatient management of febrile neonates may be feasible, a small percentage of neonates meeting low-risk criteria will have a SBI.

Age Factors↗
PubMed1997

Third ventricle colloid cyst.

A 65-year-old man presented with an episode of loss of consciousness associated with a fever and headache. His history was significant for 1 year of short-term memory loss. Computed tomographic scanning showed a third ventricular mass that was ultimately resected and pathologically confirmed as a colloid cyst. The patient's postoperative course was complicated by a dense left hemiparesis. A brief discussion of colloid cysts of the third ventricle is presented.

Adenocarcinoma, Mucinous↗
PubMed1997

Ductus diverticulum interpreted as traumatic aortic injury.

A 50-year-old woman was the victim of a motor vehicle accident. An aortogram obtained for suspicion of an aortic injury was interpreted as an intimal disruption at the level of the aortic isthmus. At thoracotomy the patient was found to have only a ductus diverticulum. A brief discussion of the angiographic appearance of a ductus diverticulum and its significance in the setting of trauma is presented.

Aorta, Thoracic↗
PubMed1997

Traumatic carotid-cavernous sinus fistula with spontaneous resolution.

A 77-year-old woman presented with unilateral ocular pain, exophthalmos, vascular tinnitus, and chemosis several weeks after a minor closed head injury. Cerebral angiography showed a carotid-cavernous sinus fistula. One week later the patients's symptoms abruptly ceased. A brief discussion of the presentation and management of these fistulas is presented.

Aged↗
PubMed1997

Nonconvulsive status epilepticus.

A 49-year-old man presented with dizziness and altered behavior associated with a nonconvulsive seizure. He had a long history of well-controlled tonic-clonic seizures and daily episodes of 10-second staring spells. Despite normal neurological and laboratory examinations, an emergent electroencephalogram showed changes consistent with nonconvulsive generalized status epilepticus.

Anticonvulsants↗
PubMed1997

Initial management of the patient with altered mental status.

Primary care physicians may encounter patients with altered mental status or neurologic deficit. Because the differential diagnosis for altered mental status includes conditions with significant morbidity and mortality, care of these patients must be rapid and thorough. The resources required to ensure and maintain cardiopulmonary stabilization and to perform the initial workup are often unavailable in the primary care office setting. Therefore, these patients often require immediate referral to an emergency department. Proper evaluation and initial management include evaluation of metabolic factors, assessment for toxic ingestions and a thorough neurologic assessment.

Brain Diseases↗