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Biomedical subjects

R J Roberge

Publications and source records attributed to R J Roberge.

17 recordsLinked to original sources
PubMed1992

Whole bowel irrigation in an acute oral lead intoxication.

An 89-year-old man acutely ingested approximately three ounces of a ceramic glaze preparation with a 30% lead oxide content. A blood lead level of 18 micrograms/mL was reported from a sample drawn within 1 hour of ingestion and just prior to gastric lavage. Following lavage, an abdominal radiograph demonstrated lead throughout the small intestine. Whole bowel irrigation was then undertaken and subsequent x-rays demonstrated clearing of all lead in the small bowel. At 16 and 24 hours post-ingestion, blood lead levels rose to 39 micrograms/dL and 42 micrograms/dL, respectively, and the patient then underwent a 5-day course of chelation therapy. This is the first reported case of the use of whole bowel irrigation in an acute lead ingestion. The use of decontamination techniques in acute lead ingestions is reviewed.

Administration, Oral↗
PubMed1991

Cat-scratch disease.

Cat-scratch disease is a relatively common disorder that is the result of infection with a recently identified gram-negative bacillus. Although it is overwhelmingly a benign, self-limited illness requiring only supportive care, serious complications can occur and the disease may be life-threatening on occasion. Although randomized clinical trials of antibiotic therapy for CSD do not exist, CSD has demonstrated in vitro susceptibility to several antibiotics, and gentamicin has been reported beneficial in a few patients with systemic manifestations of the illness. Therefore, pending clinical trials, gentamicin may be worthy of consideration in CSD patients with serious manifestations of this illness. CSD is one of the most common causes of adenopathy and should be considered in all patients who present with unilateral or regional lymphadenopathy.

Cat-Scratch Disease↗
PubMed1991

Facilitating cervical spine radiography in blunt trauma.

The interpretation of cervical spine radiographs is an important facet of the evaluation of blunt trauma victims. The diagnostic accuracy of cervical spine films is dependent upon the technical adequacy of the radiographs and the clinician's diagnostic and interpretive skills. The anxiety inherent in cervical radiographic interpretation by the nonradiologist can be minimized by coupling the use of several simple techniques aimed at enhancing visualization of all cervical spine elements and optimizing bony definitions with an unhurried, methodical radiographic evaluation utilizing a number of radiologic "pearls" in those instances in which injury is less than readily apparent but still suspect.

Cervical Vertebrae↗
PubMed1989

Glossal abscess.

A 21-year-old man presented to our emergency department with a two-day complaint of painful swelling and protrusion of the tongue, odynophagia, dysphagia, and difficulty with speech. A nonfluctuant area of tongue swelling was identified; needle aspiration of this site produced 5 mL of pus, with considerable amelioration of symptoms. Culture of the aspirate subsequently grew Hemophilus parainfluenzae, the first such reported case of this pathogen in a glossal abscess. Glossal abscess is a rare clinical entity that may result in airway compromise and disseminated infection to other systems. The presence of a glossal abscess should be considered in all cases of tongue swelling.

Abscess↗
PubMed1988

Survival following massive arsenic ingestion.

A case of a 30-year-old man who ingested a massive quantity of arsenic (approximately 2,150 mg) in an apparent suicide attempt is presented. Aggressive initial therapy, including fluid resuscitation, chelation therapy, and hemodialysis, resulted in the patient's survival. The successful management of arsenic intoxication requires both prompt recognition and the initiation of specific and aggressive therapeutic modalities.

Adult↗
PubMed1988

Serum amylase levels in ectopic pregnancy.

Thirty-four women with abdominal complaints and a positive pregnancy test were evaluated for possible ectopic pregnancy (EP). Serum amylase levels were obtained as part of the diagnostic workup to note any correlation of enzyme levels with the presence of EP. Thirteen individuals (30%) were subsequently diagnosed as having an EP, and serum amylase levels in all of these patients were within normal limits, averaging 81 U/L. There was no statistically significant difference in amylase levels between the EP group and the non-EP group (P = .70). Serum amylase levels cannot reliably predict the presence of EP and should not be used as a screening or diagnostic test for this disorder.

Adolescent↗
PubMed1988

Popcorn primary colonic phytobezoar.

A compulsive popcorn eater presented with complaints of abdominal and rectal pain, abdominal distention, and obstipation of one week's duration. Physical examination revealed a large lower abdominal mass, and roentgenograms demonstrated a large bezoar in the rectosigmoid region. This case describes the first report of a primary colonic bezoar caused by the ingestion of raw popcorn kernels.

Adult↗
PubMed1988

Selective application of cervical spine radiography in alert victims of blunt trauma: a prospective study.

Four hundred sixty-seven adult victims of blunt trauma undergoing cervical spine radiography (CSR) were prospectively studied to identify any clinical parameters which would aid in the selective application of CSR. Eight persons (1.7%), six of whom were alert and two who presented comatose, sustained cervical spine injuries. In this study, persons injured in falls demonstrated a statistically significant greater risk of cervical spine injury compared to those injured in motor vehicle accidents (p = 0.001). In alert trauma victims, a statistical correlation with cervical spine injury was noted for individuals who had complaints of neck discomfort (p = 0.028) and for patients who manifested tenderness to neck palpation (p = 0.000039). No cervical spine injury was noted in any alert, not intoxicated, neurologically intact patient who had no complaints of neck discomfort upon questioning or palpation. We conclude that alert trauma victims with no complaints of neck discomfort upon questioning and with no tenderness on neck palpation need not undergo CSR.

Adolescent↗
PubMed1987

Quincke's disease of the uvula.

Upper airway compromise may be the result of numerous factors, among which a swollen uvula should be considered in the differential diagnosis. We present a case of a 21-year-old man who presented with complaints of throat discomfort, altered voice, and tachypnea secondary to acute uvular edema. The patient was treated with sympathomimetic drugs both by injection and by inhalation with complete resolution of the swelling and his symptoms within 30 minutes. The uvula is a potential cause of upper airway obstruction and should be examined in persons presenting with airway-related complaints.

Adult↗
PubMed1987

Nontraumatic subdural hematoma in a patient with osteogenesis imperfecta and renal failure.

Intracranial hematomas in patients with osteogenesis imperfecta rarely are reported despite an increased incidence of skull fractures. We present a case of a patient with osteogenesis imperfecta but without any history of trauma or chronic anticoagulation in whom a subdural hematoma occurred during hemodialysis. Despite operative intervention, the patient died. We could find no other cases in the medical literature of a patient with osteogenesis imperfecta who had an intracranial hematoma in the absence of a skull fracture. Patients with osteogenesis imperfecta may be at high risk for intracranial bleeding from coagulation abnormalities or otherwise trivial injuries.

Adult↗
PubMed1987

Facilitated intravenous access through local application of nitroglycerin ointment.

Thirty-four patients with diminutive peripheral veins requiring peripheral IV access (PIVA) in the emergency department setting were randomly assigned to one of two treatment groups. One group of patients (Group A) received application of a bland ointment to the dorsum of the hand prior to attempts at cannulation, while the other group (Group B) received application of 2% nitroglycerin ointment to the dorsum of the hand prior to cannulation attempts. Cannulation was achieved in all 34 patients in the study, but required significantly fewer attempts in Group B patients (P = .04). No side effects of the drug were observed in any patient or any staff member applying the ointments. We conclude that application of 2% nitroglycerin ointment to the dorsum of the hand is a safe, effective method of inducing local venodilation that will ensure PIVA with significantly fewer attempts at cannulation.

Adolescent↗
PubMed1987

Penetrating thoracic injuries: in-field stabilization vs. prompt transport.

One hundred patients who were in extremis and required Emergency Room Thoracotomy (ERT) after sustaining penetrating thoracic injuries were analyzed to compare the results of attempted stabilization in the field (n = 51) with those who had immediate transportation (n = 49). The clinical status of the patients in the field and in the E.R. was quantified by Trauma Score (TS) as well as Physiologic Index (PI), ranging in severity from 20 (clinically dead) to 5 (stable). The anatomic injury severity was expressed by Penetrating Trauma Index (PTI). Survival was analyzed according to the type of injuries: noncardiac and cardiac. The overall survival was 10%. There was only one survivor with noncardiac injuries. Sixty-nine patients had cardiac penetration, 33 in Group I (stabilization) and 36 in Group II (immediate transport). Despite attempts at stabilization, none of the patients in Group I showed an improvement in clinical status from the scene to the emergency room. There were a higher number of patients arriving at the E.R. with signs of life in Group II compared to Group I. In Group II patients, survival was significantly improved overall (p = 0.01), in patients with signs of life on arrival at the hospital (p = 0.02) and in patients with isolated right ventricular wounds (p = 0.01) compared with Group I. The anatomic injury severity (PTI) as well as the mode of injury in the two groups was similar.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Emergency department thoracotomy for penetrating injuries: predictive value of patient classification.

In 18 months, 44 patients underwent thoracotomy in an emergency department (ED) for penetrating thoracic injuries. Of 14 patients resuscitated, seven (50%) survived, and all were neurologically intact. Patients were classified according to the quality of signs of life in transit or upon arrival at the ED. Identical survival rates of 29% were noted for patients in Group I (profound shock) and in Group II (agonal), with survival at 14% for individuals in Group III ("dead" on arrival). There were no survivors among patients in Group IV ("dead" on the scene), and ED thoracotomy, in the authors' opinion, is fruitless in this group. In Groups I, II, and III, total salvage from cardiac injuries was six of 24 patients (25%), and for those with non-cardiac injuries, it was one of 11 (9%). The rate of survival from cardiac stab wounds in Groups I, II, and III, was five of 16 (31%) and one of eight (13%) for gunshot wounds. Five of the seven survivors (71%) arrived at the ED by rapid transport without the benefit of any pre-hospital life support. Patient classification appears to be a valuable tool in evaluating the benefit of ED thoracotomy. The neurological status of all survivors and pertinent transportation data should be included in all future studies of ED thoracotomy. "Scoop and run" in the urban setting with rapid transport capability may be superior to pre-hospital stabilization of victims of penetrating thoracic trauma.

Adolescent↗
PubMedDate not supplied

Evaluation of neck discomfort, neck tenderness, and neurologic deficits as indicators for radiography in blunt trauma victims.

Seventeen of 480 adult blunt trauma victims who sustained cervical spine injuries (CSI) were studied prospectively. In reliable patients, complaints of neck discomfort and tenderness demonstrated sensitivities of 86% and 79%, respectively, for CSI. A positive physical examination, defined as neurologic deficits, or cervical region discomfort or tenderness was noted in 13 of 14 reliable individuals sustaining CSI (sensitivity 93%, specificity 16%, positive predictive value 3.3%, negative predictive value 98.7%). Lack of absolute sensitivity of these studied clinical parameters, either singly or in concert, for CSI suggests that eliminating cervical spine radiography on the basis of the absence of neck discomfort, tenderness, or neurological deficits in reliable blunt trauma victims could result in missed CSI. An enormous prospective data base will be required to definitively address the sensitivity of all clinical parameters currently employed to determine the need for cervical spine radiography in reliable blunt trauma victims.

Adolescent↗