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Biomedical subjects

P Singer

Publications and source records attributed to P Singer.

At least 55 records · Page 3Linked to original sources
PubMed1999

Parenteral selenium supplementation in extremely low birth weight infants: inadequate dosage but no correlation with hypothyroidism.

OBJECTIVE: Selenium is an essential trace element, known to be important in thyroid metabolism. We speculated that parenteral selenium supplementation is inadequate in preterm infants and may contribute to the development of hypothyroidism. STUDY DESIGN: Serum selenium and thyroid function were evaluated on day 10 of life in extremely low birth weight infants. Selenium intake provided by parenteral nutrition was prospectively evaluated. RESULTS: Selenium intake was close to the recommended 2 micrograms/kg per day. Serum selenium values were 0.54 +/- 0.13 microM (mean +/- SD, n = 29). Selenium serum levels were low in 26 of 29 infants. In infants with subnormal serum selenium levels, free T4 was transiently low in 10 of 26 infants but was normal in 16 of 26 infants. No significant correlation was found between serum selenium levels and hypothyroidism. CONCLUSION: Current selenium supplementation guidelines may be inadequate in extremely low birth weight infants. However, selenium deficiency does not seem to play a major role in neonatal hypothyroidism.

Birth Weight↗
PubMed1999

Gastric emptying after elective abdominal aortic aneurysm surgery: the case for early postoperative enteral feeding.

OBJECTIVE: To assess gastric emptying with a view to early postoperative enteral nutrition after elective abdominal aortic aneurysm (AAA) surgery. METHODS: The paracetamol absorption test was used to assess gastric emptying in 13 consecutive patients at 6, 18 and 32 h following elective AAA surgery. All patients received postoperative analgesia with marcaine given via an epidural catheter during the first 48 postoperative hours. Normal emptying was defined as an area under the plasma paracetamol concentration curve at 60 min (AUC-60) of > 600 mg/min/l. RESULTS: The median time to normal gastric emptying was 18 +/- 7.7 h. One patient (7.6%) had normal emptying at 6 h, nine (69%) at 18 h and 12 (92%) at 32 h. The nasogastric tubes were removed at a median of 3.2 days after surgery, and enteral feeding was commenced on day 4. CONCLUSIONS: Gastric emptying was normal 18 h post-AAA surgery as assessed by the paracetamol absorption test. In view of the importance of maintaining an intact gastrointestinal mucosa, enteral nutrition may be commenced on the second postoperative day.

Absorption↗
PubMed1999

Cadaveric organ donation in Israel: the facts and the perspectives.

OBJECTIVES: Transplantation is limited worldwide by the shortage of organs. The main reasons are a low detection rate of potential donors and a poor motivation and qualification of health care professionals to request for family authorization for organ donation. The aim of our study was divided into two parts: to evaluate the potential and effective organ donor rate in Israel, and to assess the effects of an education program on the knowledge and attitudes of health professionals in regard to organ donation. METHODS: Part 1: We collected data on all potential and effective cadaveric donors from 1991 to 1998. We compared these figures to those obtained from European or American organizations. Part 2: We conducted 7 seminars for a total of 167 health professionals from 10 hospitals. A questionnaire was completed before and after the seminar, and differences in knowledge and attitude were compared. Pearsons correlation and students t-test were used for statistical analysis. RESULTS: Potential organ donors varied from 77 to 201 per year and effective organ donors increased from 4.8 to 14.1 pmp. Multiorgan donation increased from 1991 to 1998 reaching 60% of the cases. Knowledge on brain death, legal and religious aspects, protocols and approach to the family improved significantly (p<0.001) after 2 days of an intensive workshop. CONCLUSIONS: The rate of potential and effective organ donors is low in Israel, in comparison with other developed countries. These results are explained by problems encountered at every step of transplant procurement. We believe that a model, involving experts in brain death determination, maintenance of the donor, family approach and organ procurement could reach results close to other developed countries.

Brain Death↗
PubMed1998

Outcome after elective infrarenal aortic aneurysm surgery.

We conducted a prospective case series study to investigate the causes of and factors influencing morbidity and mortality in 102 consecutive patients after elective infrarenal abdominal aneurysm (AAA) surgery between 1992 and 1995. Preoperative factors (demographics, risk factor indexes, electrocardiographic findings, ejection fraction, and stress imaging scans were indicated) and intraoperative factors (duration of surgery, size of aneurysm, complications, units of blood transfused, and additional procedures performed) were recorded. Patients were admitted to the intensive care unit (ICU) for at least 24 hours and followed for 30 days postoperatively. The mortality rate was 4.9%, due in all cases to multiorgan dysfunction syndrome (MODS). Death was preceded by colon ischemia (two patients), intraabdominal bleeding (two patients), or sepsis (one patient). Only the preoperative blood urea nitrogen correlated with mortality (p = 0.042). Complications occurred in 59% of patients in the ICU and involved the cardiovascular system in 83% of them (heart rate > 90 bpm in 49%). On multivariate analysis, only duration of surgery was associated with ICU complications (p = 0.018). No complication resulted in mortality. Ward complications occurred in 13%, and 5% of these patients required readmission to the ICU. Although cardiac complications are considered the major cause of mortality after infrarenal AAA surgery, all five deaths in the present series were due to MODS. Preoperative screening should be more selective, and intraoperative and postoperative care should be stressed.

Aged↗
PubMed1998

Massive spontaneous hemothorax as a presenting sign of aneurysmal rupture of the internal thoracic artery. A case report.

Massive spontaneous hemothorax is a very uncommon, life-threatening situation. Acute dissection and ruptured aorta can be one of the differential diagnoses, but usually the clinical feature is completely different, and very few patients have survived this event and received medical attention. Among other causes of spontaneous bleeding, some are extremely rare, demanding precise diagnosis and judicial and immediate intervention. We describe a patient who presented with a massive hemothorax. There was no immediately apparent cause. Emergent angiography revealed active bleeding from an extremely unusual source: aneurysmal dilatation of the internal thoracic artery.

Adult↗
PubMed1997

End-of-life decisions in Australian medical practice.

OBJECTIVE: To estimate the proportion of medical end-of-life decisions in Australia, describe the characteristics of such decisions and compare these data with medical end-of-life decisions in the Netherlands, where euthanasia is openly practised. DESIGN: Postal survey, conducted between May and July 1996, using a self-administered questionnaire based on the questionnaire used to determine medical end-of-life decisions in the Netherlands in 1995. PARTICIPANTS: A random sample of active medical practitioners from all Australian States and Territories selected from medical disciplines in which there were opportunities to be the attending doctor at non-acute patient deaths, and hence to make medical end-of-life decisions. MAIN OUTCOME MEASURE: Proportion of Australian deaths that involved a medical end-of-life decision, using ratio-to-size estimation based on the sampled doctors' responses to the questionnaire. The response rate was 64%. RESULTS: The proportion of all Australian deaths that involved a medical end-of-life decision were: euthanasia, 1.8% (including physician-assisted suicide, 0.1%); ending of patient's life without patient's concurrent explicit request, 3.5%; withholding or withdrawing of potentially life-prolonging treatment, 28.6%; alleviation of pain with opioids in doses large enough that there was a probable life-shortening effect, 30.9%. In 30% of all Australian deaths, a medical end-of-life decision was made with the explicit intention of ending the patient's life, of which 4% were in response to a direct request from the patient. Overall, Australia had a higher rate of intentional ending of life without the patient's request than the Netherlands. CONCLUSIONS: Australian law has not prevented doctors from practising euthanasia or making medical end-of-life decisions explicitly intended to hasten the patient's death without the patient's request.

Adult↗
PubMed1997

Bioethics for clinicians: 8. Confidentiality.

Physicians are obliged to keep information about their patients secret. The understanding that the physician will not disclose private information about the patient provides a foundation for trust in the therapeutic relationship. Respect for confidentiality is firmly established in codes of ethics and in law. It is sometimes necessary, however, for physicians to breach confidentiality. Physicians should familiarize themselves with legislation in their own province governing the disclosure of certain kinds of information without the patient's authorization. Even when no specific legislation applies, the duty to warn sometimes overrides the duty to respect confidentiality. The physician should disclose only that information necessary to prevent harm, and should reveal this information only to those who need to know it in order to avert harm. Whenever possible any breach of confidentiality should be discussed with the patient beforehand.

Adult↗