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Biomedical subjects

R E Schneider

Publications and source records attributed to R E Schneider.

At least 19 recordsLinked to original sources
PubMed1999

Rapid-sequence intubation at an emergency medicine residency: success rate and adverse events during a two-year period.

OBJECTIVES: Rapid-sequence intubation (RSI) is an active airway intervention used frequently in emergency medicine (EM). The authors hypothesized that RSI can be performed safely in the setting of an EM training program at a tertiary care center. METHODS: Observational study of RSI at an urban ED/Level 1 trauma center with annual census of 100,000 patients. Consecutive patients who underwent RSI during a two-year period were studied. Data included age, gender, type of patient (medical/trauma), indication for intubation, number of intubation attempts (laryngoscope passes), training level of operator, and major immediate adverse events (clinical deterioration within 10 minutes of RSI). RESULTS: RSI was used in 417 of 596 (70%) critically ill patients requiring emergent intubation. The patient demographic distribution was the following: adults 89.7%, male 58%, and trauma 44%. Primary indications for intubation among RSI patients were as follows: mechanical ventilation 57.4%, airway protection 41.3%, and cardiac arrest 1.3%. Distribution of intubations by level of EM training was PGY1, 5%; PGY2, 52%; PGY3, 40%; and attendings, 3%. Intubations were successfully completed within two attempts in 97% of the patients. Major immediate adverse events were encountered in six patients (1.4%) (hypotention=2, hypoxemia=1, dysrhythmia=3). There was no death attributable to RSI. The rate of intubations requiring two or fewer attempts and without major immediate adverse events was 96%. Three patients required cricothyrotomy. CONCLUSION: In the setting of an EM residency at a tertiary care ED, RSI can be performed successfully with few major immediate adverse events.

Adult↗
PubMed1998

Innervation pattern of the temporalis muscle.

The purpose of this article is to describe the neural anatomy of the temporalis muscle as dissected along the intramuscular temporal fascial plane. This sagittal plane is a natural cleavage plane of the muscle, which is explored along with its relationship to the deep temporal nerve. Eight temporalis muscle specimens were removed in their entirety from 8 preserved cadavers. The muscles were selected based on whether they were grossly intact prior to procurement for processing. The muscle specimens were then processed over a 3-month period using Sihler's staining technique. Muscle dissection was performed along the intramuscular fascial plane under an operating microscope, taking care to preserve the underlying nerve and arterial anatomy. Dissections demonstrated an anterior and posterior division of the deep temporal nerve running within the deep portion of the muscle below the intramuscular fascial plane. This fascial layer provided a natural dissection plane to expose and evaluate the underlying nerve and arterial anatomy. In all specimens the deep temporal artery originated with the anterior temporal nerve and then branched into an anterior and posterior division. The innervation density and nerve caliber of the anterior portion of the muscle was much greater than that of the posterior, correlating with a greater anterior muscle bulk. This may have implications in differences in fiber type and functional regionalization of the muscle. The results of this anatomic study support the finding of an anterior and posterior division of the deep temporal nerve within the deep portion of the temporalis muscle. In addition, differences in the innervation density and muscle bulk lend credence to the possibility of regional muscle specialization. The natural cleavage plane of the intramuscular temporal fascia may have clinical ramifications for temporalis myofascial flaps while preserving the underlying neural anatomy to allow for normal residual temporalis muscle function.

Dissection↗
PubMed1997

Wurzburg lag screw plate versus four-hole miniplate for the treatment of condylar process fractures.

PURPOSE: The purpose of this study was to compare the biomechanical stability of rigidly fixed condylar neck fractures using either a conventional four-hole miniplate system or the Wurzburg lag screw plate system. MATERIALS AND METHODS: Ten identical synthetic mandibles were used for this study. Simulated bilateral condylar neck fractures were fixed with the lag screw plate system on one side and the miniplate system on the other. The mandibles were loaded with an MTS servohydraulic testing machine at a rate of 1 cm/min until failure was reached. Data for resistance to motion and ultimate strength for each fixation device were compared by paired Student t-tests. RESULTS: The mean resistance to motion for the four-hole miniplate was 64.0 kg/mm (SD = 10.1; range = 52-94) and for the lag screw system was 80.2 kg/mm (SD = 24.0; range = 55 to 126). The mean failure strength was 4.0 kg (SD = 0.9) (range = 2.6 to 5.5) for the miniplate system and 5.0 kg (SD = 2.5; range = 3.4 to 7.2) for the lag screw system. The lag screw system was significantly (P < .05) better than the miniplate for both parameters measured. CONCLUSION: In laboratory testing using synthetic mandibles, the Wurzburg lag screw-plate fixation system proved superior to a four-hole miniplate system in regard to resistance to motion and failure strength. Clinical trials are necessary to substantiate these laboratory data and determine whether the system can be effectively applied by the surgeon.

Bone Plates↗
PubMed1997

Using fenestration technique to treat a large dentigerous cyst.

Dentigerous cysts are commonly encountered in the practice of dentistry and oral and maxillofacial surgery. Treatment modalities range from enucleation to marsupialization, and are based on the premise that the pathological process can be controlled locally with minimal injury to the adjacent host structures. In a child, however, loss of permanent tooth buds in the management of a large dentigerous cyst can be devastating. This article describes the technique of fenestration, which removes this entity and preserves the developing dentition.

Child↗
PubMed1997

Intramuscular temporalis fascia: a guide to procurement of temporalis myofascial flaps.

The purpose of this study is to demonstrate an intramuscular fascial layer within the temporalis muscle. This can be used as an inferior plane when developing a temporalis myofascial flap for temporomandibular joint reconstruction. The advantages of using this plane include relatively bloodless zone, adequate thickness of flap for reconstructive purposes, and residual temporalis muscle to prevent the temporal concavity deformity. Cadaveric and clinical examples are presented.

Humans↗
PubMed1994

Outcome of carotid endarterectomy performed at a community medical center.

From 1990 to 1992 there was a 43% increase in the number of carotid endarterectomies (CEAs) performed at our institution. Not coincidentally the North American Symptomatic Carotid Endarterectomy Trial study was published in August 1991. To determine whether CEAs could be performed safely at community medical centers, records of 181 consecutive CEAs performed during a 30-month period at a suburban community medical center were reviewed. CEAs were performed by 14 surgeons: six vascular, three thoracic, and five general surgeons. Among all patients 87% had lesions with > or = 70% stenosis. Seventy percent of CEAs were performed on symptomatic patients, 84% of whom had stenoses > or = 70%. Among asymptomatic patients 96% had stenoses > or = 70%. There were five instances of neurologic complications in the perioperative period--two transient ischemic attacks, two reversible ischemic neurologic deficits, and one permanent neurologic deficit. One patient died. The mortality rate was 0.6%, the combined major stroke/mortality rate was 1.2%, and the any stroke/mortality rate was 2.2%. There were five patients with nonfatal major complications--one with myocardial infarction, one with pulmonary edema, one with congestive heart failure, and two with postoperative arrhythmia. Thirteen minor complications included eight cases of cranial nerve dysfunction. These data demonstrate that CEAs can be performed safely at community medical centers.

Aged↗
PubMed1993

Genitourinary trauma.

Evaluation of genitourinary trauma can be confusing. This article discusses identifying the significant injuries, those patients at risk for developing these injuries, and the radiographic procedures that will effectively stage these injuries so that appropriate management can be proposed.

Female↗
PubMed1992

Limitations of pulse oximetry.

Pulse oximetry is a noninvasive, accurate, and safe method for the measurement of oxygen saturation during intravenous sedation or general anesthesia. Several factors should be considered with its use, since these variables will either alter the accuracy of the readings or may cause harm to the patient. These factors include changes in the strength of the arterial pulse, body movements, dyshemoglobinemias, plasma lipids and bilirubin, color interferences, venous pulsations, and several physical factors. Awareness of these variations will help the clinician become more knowledgeable in the use of the pulse oximeter.

Anesthesia, Dental↗
PubMed1990

Effect of temperature on the lactose hydrolytic capacity of a lactase derived from Kluyveromyces lactis.

In vitro studies of lactose hydrolysis in milk with 20-125 neutral lactase units (NLUs) carried out at 38.0 degrees C for 15 min with a beta-galactosidase derived from Kluyveromyces lactis (Lactaid, Lactaid Inc, Pleasantville, NJ) resulted in 85-95% of the hydrolysis observed with standard incubation conditions (24 h at 4-5 degrees C with 1000 NLU/L). Thirty-three lactose-maldigesting Guatemalan subjects, 16 children and 17 adults, were challenged with oral doses of lactose in milk (children aged less than 12 mo, 2 g/kg body wt; children aged 12-24 mo, 15 g/kg body wt; older children and adults, 18 g/kg body wt) preincubated for 20 min at 38 +/- 0.5 degrees C with 50-125 NLU Lactaid. Under these conditions the subjects consumed milk without presenting any signs of intolerance. Furthermore, their breath-hydrogen excretion showed a 91-93% reduction when compared with a similar load of milk containing nonhydrolyzed lactose.

Adult↗