Other threats to health in the Persian Gulf region.
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Adult↗
Biomedical subjects
R Barish
Publications and source records attributed to R Barish.
War crimes during the Persian Gulf War.
Evidence of violations of the 1949 Geneva Conventions by Iraq's military personnel during Desert Shield and Desert Storm are described and adverse effects on the Kuwaiti health care delivery system are discussed. New diplomatic and military initiatives that include education and accountability are needed to ensure better compliance with international conventions designed to protect victims of war.
Hospitals, Special↗
Echocardiographic diagnosis of acute pericardial effusion in penetrating chest trauma.
Pericardial tamponade persists as a diagnostic challenge to the clinician. The immediate diagnosis is particularly difficult when the patient is well compensated hemodynamically. In contrast to the deceptively stable appearance, the patient is at increased risk due to delayed onset, recognition, and therapy. A case of penetrating thoracic trauma is presented in which the concern about pericardial tamponade was considerable. However, the elements of clinical assessment were inconclusive. Two-dimensional echocardiography was employed in the emergency department to detect a pericardial effusion and thus avoid delayed management. Pericardial tamponade and associated vascular injuries were confirmed at surgery.
Acute Disease↗
Lithium intoxication: manifestations and management.
The clinical diagnosis of lithium intoxication can be elusive because of the slow onset and diversity of toxic manifestations. Mental status and neurologic symptoms often predominate. After the diagnosis is made, management depends on the clinical presentation and serum lithium level. Hemodialysis is the treatment of choice for severe lithium intoxication. Two cases of lithium intoxication are presented that demonstrate that predisposing factors and drug interactions play major roles. A review is given of the pathophysiology, presenting signs, symptoms, and approaches to treatment of lithium intoxication.
Adult↗
Coronary artery spasm. Part 1: Overview.
The syndrome of coronary artery spasm is described. This phenomenon may occur in conjunction with, or in the absence of, fixed atherosclerotic coronary artery disease. ECG manifestations during an attack mimic those seen with acute myocardial injury, but normalization of the ECG following the resolution of the pain is usual. Intravenous ergonovine is a sensitive and specific test for confirmation of the diagnosis. Nitrates and calcium channel blockers are the mainstay of therapy, although other agents are of theoretical benefit. The role of surgery is unclear.
Angina Pectoris, Variant↗
The Wenckebach phenomenon.
The Wenckebach phenomenon, or type I AV block, refers to a progressive lengthening of impulse conduction time, followed by a nonconducted impulse, or dropped beat. It can occur in a variety of pathologic settings, especially inferior myocardial infarction. Although a temporary pacemaker may be required, full spontaneous recovery is the rule.
Diagnosis, Differential↗
Coronary artery spasm. Part II.
Coronary artery spasm can occur in several settings, often combined with coronary artery disease and thrombosis. Calcium channel blockers and beta-blockers are primary treatment modalities. The role of alpha-blocking agents remains unconfirmed.
Adrenergic beta-Antagonists↗
Interpretation and clinical significance of the QRS axis of the electrocardiogram.
The frontal plane QRS axis of the standard 12-lead electrocardiogram (ECG) is easily and accurately measured by the clinician. A simple method of estimating this axis is discussed. This axis is age-dependent. We reviewed the literature to determine if evidence exists of an association between an "abnormal" QRS axis and clinically significant myocardial disease. We also examined the literature for clinical correlation of a "normal" QRS axis with the absence of myocardial pathology. We found that although an abnormal QRS axis (falling outside the limits of +30 degrees and +90 degrees) occurs in a small number of normal individuals, its presence should prompt a thorough evaluation of all the parameters of the ECG to look for myocardial disease.
Cardiomyopathies↗
The electrocardiographic manifestations of cyclic antidepressant therapy and overdose: a review.
Cyclic antidepressants may cause changes in the electrocardiogram at therapeutic or toxic serum levels. The most serious complications of cyclic antidepressant toxicity are dysrhythmias, hypotension, and seizures. It is predominantly the cardiotoxic effects that cause mortality. Once cardiotoxicity is evident, the treatment of choice is serum alkalinization, preferably by sodium bicarbonate therapy. In order to predict which overdose patients are at high risk for complications, electrocardiographic criteria have been identified as reliable screens. For "first generation" tricyclic antidepressants, QRS prolongation (particularly greater than 100 msec) and a terminal 40-ms frontal plane axis greater than 120 degrees are the most sensitive. This article reviews antidepressant pharmacology, electrocardiographic manifestations of antidepressant cardiotoxicity, and approaches to treatment of antidepressant-induced conduction disturbances and dysrhythmias.
Antidepressive Agents, Tricyclic↗