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Biomedical subjects

R J Rothstein

Publications and source records attributed to R J Rothstein.

At least 19 recordsLinked to original sources
PubMed1992

Evaluation of patients with chest pain and nondiagnostic ECG using thallium-201 myocardial planar imaging and technetium-99m first-pass radionuclide angiography in the emergency department.

STUDY OBJECTIVE: The purpose of this study was to determine if thallium-201 myocardial planar imaging and technetium-99m first-pass radionuclide angiography, performed in the emergency department, could predict which patients with acute chest pain and nondiagnostic ECGs were more likely to have an acute myocardial infarction (AMI). DESIGN: Retrospective analysis. SETTING: Urban, county ED. TYPE OF PARTICIPANTS: Convenience sample of 47 patients with acute chest pain suggestive of myocardial ischemia and nondiagnostic ECG. INTERVENTIONS: Thallium-201 myocardial imaging and technetium-99m first-pass radionuclide angiography in the ED. MEASUREMENTS AND MAIN RESULTS: Four patients had an AMI (ie, CK-MB greater than or equal to 6% total CK). The combined scans had a sensitivity of 75%, (95% confidence interval [Cl], 19-99%), a specificity of 42% (95% CI, 27-58%), an accuracy of 45% (95% CI, 19-99%), a positive predictive value of 11% (95% CI, 2-29%), and a negative predictive value of 95% (95% CI, 75-100%) in predicting AMI. CONCLUSION: Thallium-201 myocardial planar imaging and technetium-99m first-pass radionuclide angiography performed in the ED do not appear to be useful in determining which patients with acute chest pain and nondiagnostic ECG are likely to have an AMI.

Adult↗
PubMed1988

Appendicitis: evaluation by Tc-99m leukocyte scan.

Diagnosing appendicitis may be difficult. We report the use of a new technetium-99m-albumin colloid white blood cell (TAC-WBC) scan in the evaluation of appendicitis. In a synthesis requiring 75 minutes, autologous neutrophils and macrophages from 40 mL of whole blood were labelled with technetium-99m-albumin colloid and administered to 100 patients with possible appendicitis. The entire process, from labelling the cells to completion of the scan took a maximum of 5 1/4 hours. Two patients had second scans on separate hospitalizations. Twenty-six patients had appendicitis; 12 had perforations, five of whom had an abscess. Eighty-five scans were read as either positive or negative for appendiceal pathology with a sensitivity of 89%, a specificity of 92%, and an accuracy of 92% in diagnosing appendicitis. Seventeen scans were indeterminant; eight of these patients had appendicitis. The value of the TAC-WBC scan in the evaluation of appendicitis lies in its ability to be used emergently, its high negative predictive value for men and women (NPV = 97%), and its high positive predictive value for men (PPV = 93%). At present, the scan does not appear to be reliable in diagnosing appendicitis in women (PPV = 43%). It is most useful in those patients in whom diagnosis is uncertain, and should not be used in patients with clear-cut appendicitis in whom its use will delay definitive surgical care.

Abscess↗
PubMed1987

Esophageal electrocardiography in acute cardiac care. Efficacy and diagnostic value of a new technique.

Esophageal electrocardiography can detect atrial electrical activity during tachyarrhythmias when P waves are not evident by surface electrocardiography. However, patient discomfort, the difficulty of accurately interpreting cardiac signals against a background of electrical noise, and the complexity of use have limited widespread application. In this study, esophageal electrocardiography was used in 48 acutely ill patients with a new "pill electrode" system, consisting of a bipolar electrode pair (3 by 20 mm) attached to 0.5 mm diameter Teflon wires contained in a standard gelatin capsule. The capsule with enclosed electrodes was voluntarily swallowed, and the recording electrodes were positioned posterior to the left atrium. A preamplifier system with a low-frequency filter and a standard three-channel electrocardiographic recorder were used. Esophageal "pill" electrocardiographic recordings were made in 48 of 50 eligible study patients (96 percent) with tachyarrhythmias and absent or equivocal atrial activity on surface electrocardiography. In these patients, a high-quality esophageal electrocardiographic recording was obtained within one to 10 minutes with minimal patient discomfort. In 25 of 48 study patients (52 percent), the original diagnosis, based on the surface electrocardiographic recording, was incorrect after review of the esophageal recording. Results of esophageal recording altered management in 19 of 48 (40 percent) patients. This new and simple technique facilitates diagnosis and management of perplexing tachyarrhythmias in acutely ill patients by physicians with minimal training in the technique.

Acute Disease↗
PubMed1986

Electrocardiographic criteria for tricyclic antidepressant cardiotoxicity.

To determine if electrocardiographic findings characterize tricyclic antidepressant (TCA) overdose and cardiotoxicity, 25 patients suspected of taking an overdose of TCA were studied. Toxicologic assays for a TCA were positive in 11 patients (+TCA, n = 11). Toxicologic study results for a TCA were negative in 14 patients (-TCA, control subjects). Patients with positive TCA results (+TCA) had a significantly greater heart rate (117 +/- 23 vs 100 +/- 22 beats/min, p less than 0.05), QRS duration (103 +/- 15 vs 87 +/- 10 ms, p less than 0.005) and corrected QT interval (449 +/- 38 vs 418 +/- 36 ms, p less than 0.05) than control patients (-TCA) on admission. Patients with positive TCA results also had a more rightward terminal 40-ms frontal plane QRS vector (195 +/- 51 degrees vs 54 +/- 64 degrees, p less than 0.001) than control patients. This observation has not been previously reported. A terminal QRS vector of 130 degrees to 270 degrees accurately discriminated between -TCA and +TCA patients (positive and negative predictive value = 1.00). Counterclockwise rotation (normalization) of the terminal frontal plane QRS vector was noted in +TCA patients during hospitalization. All +TCA patients had a sinus tachycardia, a corrected QT interval 418 ms or longer, and a terminal QRS vector between 130 degrees and 270 degrees. Using these values as selection criteria, a computer-aided search of 15,064 electrocardiograms (ECGs) recorded in our emergency department was performed. The likelihood of encountering such an electrocardiographic pattern in this population was 1.0%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Myocardial contusion diagnosed by first-pass radionuclide angiography.

Myocardial contusion, (traumatic myocardial dysfunction) is a relatively common complication of blunt trauma. The diagnosis is often elusive. Studies using clinical and laboratory parameters often fail to detect patients with significant myocardial injury. No constellation of clinical signs, electrocardiographic findings, or cardiac enzymes has been sensitive or specific enough to evaluate such patients accurately. Recently, radionuclide angiography was found to be a sensitive indicator of myocardial dysfunction. The authors studied ten patients with blunt thoracic or multisystem trauma who had myocardial dysfunction documented by first-pass radionuclide angiography. Follow-up study within five weeks demonstrated normalization or improvement in ejection fraction and wall motion abnormalities in all patients. Radionuclide angiography is cost effective, can be performed in the emergency department, and can assist in the management of patients with blunt thoracic or multisystem trauma.

Adult↗
PubMed1986

Varicella pneumonia in adults: a spectrum of disease.

Varicella (Chicken pox) is a contagious disease common in childhood but uncommon in adulthood. Pneumonia, however, is a relatively common complication of the disease in adults. Recognition of the potential for this complication in adult patients with varicella is essential for the emergency physician. Three cases of varicella pneumonia in adults are presented, representing the spectrum of disease. The first patient was a 58-year-old man without respiratory complaints who was managed successfully as an outpatient. The second patient was a 24-year-old woman who progressed from mild to marked respiratory distress over several hours, and was treated successfully with high-flow oxygen alone. The third patient was a pregnant 23-year-old woman who presented without respiratory symptoms but rapidly developed adult respiratory distress syndrome, resulting in death. Clinical assessment, patient management, and indications for hospitalization are discussed.

Adult↗
PubMed1986

NMB usage survey.

Explore the source record for details and available documents.

California↗
PubMed1985

Use of naloxone during cardiac arrest and CPR: potential adjunct for postcountershock electrical-mechanical dissociation.

Naloxone has been shown to increase arterial pressure in hemorrhagic and septic shock. To determine if naloxone has salutary effects during cardiac arrest with conventional closed-chest cardiopulmonary resuscitation (CPR), ten dogs were studied during 20 minutes of ventricular fibrillation (VF) and CPR and during a 30-minute postcountershock period. Central aortic (Ao) and right atrial (RA) systolic and end-diastolic (EDP) pressures, instantaneous Ao-RA pressure difference (coronary perfusion pressure), and electromagnetic Ao flow were measured. Ao and RA samples were analyzed during a control period and at five-minute intervals during CPR for PO2, PCO2, and pH. During VF, a piston-cylinder device was used to perform anteroposterior sternal depressions and positive pressure ventilations (100% O2) at standard rates and ratios. After 15 minutes of CPR, animals were randomized and given either naloxone (5 mg/kg) or epinephrine (1 mg). Defibrillation was attempted five minutes later using 1 J/kg and then, if necessary, 2, 4, 8, 12, and 16 J/kg until VF was terminated or the maximum energy dose was reached. If VF persisted or if countershock resulted in asystole or a nonperfusing rhythm (electrical-mechanical dissociation [EMD]), the alternate drug (naloxone or epinephrine) was then given. Measured systolic pressures, coronary perfusion pressures, aortic flow, and blood gases were not significantly different during the control period or at five, ten, and 15 minutes of VF and CPR between animal groups prior to drug administration. When compared to hemodynamic values measured at 15 minutes, naloxone had no significant effect on pressures or aortic flow measured five minutes after administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

Assessing severity of adult asthma and need for hospitalization.

Exacerbations of asthma requiring emergency treatment are common but, fortunately, asthma is rarely life threatening. In the course of treating acute asthmatics, however, the question of whether to admit the patient often is raised. With the current costs of hospitalization and morbidity associated with the disease, it is advantageous to be able to separate accurately those who require in-hospital treatment from those who can be treated as outpatients. The choice to hospitalize the asthmatic patient must be based on objective findings, including spirometry alone, spirometry plus history and physical signs, or index scoring (Figure). The best method awaits elucidation by prospective study. The most objective indicator of asthma severity is the indirect measurement of airways obstruction by spirometry, either by FEV1.0 or PEFR. FEV1.0 and PEFR yield comparable results. Simple, inexpensive devices for these measurements are available. An FEV1.0 less than 0.8 to 1.0 L (less than 25% predicted in women and men ages 25 to 65 years) or a PEFR less than 100 L/min (less than 20% predicted in women and men ages 25 to 65 years) accurately indicates a severe asthma exacerbation. The percentage predicted is utilized in those individuals who lack average stature. An increase in FEV1.0 to greater than 1.6 to 2.1 L (greater than 60% predicted) or a PEFR improvement to greater than 300 L/min (greater than 60% predicted) after therapy negates the need for hospitalization. In order to gain such improvement the patient may require approximately four to six hours of outpatient treatment. Some will treat patients for longer periods. Evidence of worsening obstruction or impending respiratory failure during this period mandates admission.(ABSTRACT TRUNCATED AT 250 WORDS)

Acidosis↗
PubMed1979

Emergency management of poisoning and overdose.

The management of the poisoned patient can be difficult and challenging. The task often demands the physician's entire resources in putting together pieces of history and significant physical findings to make a diagnosis. He must then carefully support and stabilize the patient under constant monitoring, while making efforts to prevent further absorption of the toxin, enhance excretion, and treat complications as they arise.

Adult↗
PubMed1978

Syphilis and pelvic inflammatory disease.

Since screening every patient in the emergency department for venereal disease is impractical, we hypothesized that patients with the clinical diagnosis of pelvic inflammatory disease (PID) might be at higher risk and a group that should be screened. Seventy women with a clinical diagnosis of PID treated in our adult emergency department from July to November 1976 were screened for syphilis using three separate serologic tests: Venereal Disease Research Laboratory, fluorescent treponemal antibody absorption, and treponema pallidum hemagglutination. The incidence of positive serologies in our study group was significantly higher (11.4%) than that of 100 controls (4%). All patients with a clinical diagnosis of PID should be screened for syphilis using both FTA-Abs and TPHA tests, as well as a VDRL.

Adult↗
PubMed1977

The effect of ochre suppression on meiosis and ascospore formation in Saccharomyces.

The effect of altered tyrosyl-tRNAs on the developmental process of sporulation was examined. Mutations in eight independent loci resulting in tyrosine-inserting nonsense suppressor were tested for their effects on sporulation. Different levels of inhibition were found ranging from SUP3-omicron, which caused the greatest reduction of sporulation (7-17% of wild type), to SUP11-omicron which caused no reduction in sporulation. Since the SUP3-omicron mutation exhibited the greatest effect, it was studied in detail. Although SUP3-omicron is a dominant nonsense suppressor, its effect on sporulation is recessive. Expression of the sporulation deficiency is dependent upon the stage of transfer from glucose growth medium (i.e., log, early stationary, etc.) to sporulation medium. SUP3-omicron/SUP3-omicron diploid cells transferred from log or early stationary phase are capable of sporulation, whereas cells transferred after early stationary phase (i.e., after adaptation to respiration) exhibit poor sporulative ability. Sporulation events were examined under restrictive conditions to observe those events completed by SUP3-omicron/SUP3-omicron diploids. The early events of sporulation occur in these cells. Later events are completed by progressively fewer cells. Premeiotic DNA synthesis occurred in approximately 40% of the cells, nuclear segregation occurred in 20%, and finally, only 2% formed asci. The fact that fewer late-sporulation events occur under restrictive conditions can be explained by increased efficiency of suppression.

Meiosis↗
PubMed1977

A genetic fine structure analysis of the suppressor 3 locus in Saccharomyces.

A meiotic fine structure map of a yeast tyrosine-inserting ochre suppressor, SUP3-omicron, was constructed. This was accomplished by examining ten intragenic suppressor-inactive revertants for their relationship to each other and to the original SUP3-omicron mutation. The second-site revertants map on both sides of the SUP3-omicron mutation. The meiotic map length based on the summation of short intervals is 45+/10(5) asci.

Chromosome Mapping↗