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Biomedical subjects

R J Stine

Publications and source records attributed to R J Stine.

12 recordsLinked to original sources
PubMed1995

Perirectal abscess.

STUDY OBJECTIVE: To review clinical features of perirectal abscesses and to determine appropriate management. DESIGN: Retrospective analysis of medical records. SETTING: Urban teaching hospital. PARTICIPANTS: Ninety-two patients with the discharge diagnosis of perirectal abscess over a 4-year period. RESULTS: Perirectal pain was the most common presenting symptom, being present in 98.9% of cases. External perianal and digital rectal examination identified an abscess in 94.6% of patients. A variety of aerobic and anaerobic bacteria from skin, bowel, and, rarely, vagina were identified as causative agents, with mixed infections common. The major complications of perirectal abscesses included formation of extensive abscesses and urine retention. Abscess resolution occurred in all patients after adequate drainage. Antibiotics appeared to be useful only as adjunct therapy. CONCLUSION: Effective management of perirectal abscess involves early, adequate drainage, with antibiotics in an adjunct role.

Abscess↗
PubMed1989

Aminophylline loading in asthmatic patients: a protocol trial.

We tested an aminophylline loading-dose protocol in which asthmatic patients presenting to an emergency department were given a half (3 mg/kg) IV loading dose based on total body weight (TBW) if they had taken a short-acting or sustained-release theophylline preparation within 12 or 24 hours, respectively, prior to arrival: otherwise, a full (6 mg/kg) loading dose was administered. Of the 28 patients given a full loading dose, 20 (71.4%) achieved a postload therapeutic level (10 to 20 micrograms/mL), and none developed a toxic level (greater than 20 micrograms/mL). Although 34 (60.7%) of 56 patients given a half loading dose attained a postload therapeutic level, 13 patients (23.2%) entered the toxic range. We were able to predict that loading doses of 7.6 mg/kg and 3.8 mg/kg based on ideal body weight (IBW) would have yielded very similar results. The mean change in theophylline level per mg/kg TBW of administered aminophylline was 2.01 micrograms/mL. When calculated on the basis of IBW, the mean change in theophylline level was 1.58 micrograms/mL. Evaluation of the change in theophylline level resulting from aminophylline loading doses based on either TBW or IBW revealed that each dosing method produced changes in blood level with similar variability that were not independent of obesity, indicating that neither dosing method is superior to the other. Thus, patients who report not having taken a theophylline preparation within the above time limits can be given a full aminophylline loading dose of either 6 mg/kg based on TBW or 7.6 mg/kg based on IBW. Other patients, however, require a preload blood level determination to optimize therapy and avoid toxic levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Diagnostic and therapeutic urologic procedures.

Urologic procedures useful to the emergency physician in the diagnosis and management of urinary tract disorders are presented in this article. Discussed are urinalysis, diagnostic radiologic modalities (KUB film, intravenous pyelography, retrograde cystourethrography, computerized tomography, angiography, ultrasonography, and renal scintigraphy), and urologic procedures (urethral catheterization, percutaneous suprapubic cystostomy, suprapubic bladder aspiration, dorsal-slit procedure, and meatotomy). Where appropriate, indications, contraindications, method, and complications are presented for the various procedures.

Angiography↗
PubMed1987

Clinical predictors of theophylline blood levels in asthmatic patients.

To determine the usefulness of clinical information in predicting theophylline levels, 21 parameters were studied in 204 asthmatic patients. The best single parameter for predicting theophylline levels was the last outpatient level (r = 0.484), which was within +/- 5 micrograms/mL of the presenting theophylline level in 62.5% of cases. However, there was considerable variability in theophylline levels in the other 37.5% of cases. The best combination of predictors was the last outpatient level and time since the last dose in patients taking a short-acting preparation. Even with this combination, however, 20.8% of predicted levels fell outside a range of +/- 5 micrograms/mL of the presenting theophylline levels. The only patients in whom a theophylline level could be predicted reliably were those who reported taking a sustained-release or short-acting preparation more than 15 or 8 hours prior to evaluation, respectively. In these patients, all presenting theophylline levels were in the subtherapeutic range (ie, less than 10 micrograms/mL), with 92% of the levels less than 5 micrograms/mL. Except for these patients, readily available theophylline determinations are necessary in order to optimize theophylline therapy with minimal risk of toxicity.

Adolescent↗
PubMed1987

Perforation of the gall bladder following blunt abdominal trauma.

A 66-year-old man presented after having been involved in a motor vehicle accident. He was not wearing his seatbelt, and his vehicle had a deformed steering wheel after the incident. In the emergency department, his only complaint was mild right lower quadrant abdominal pain without signs of rebound or guarding. His laboratory and radiologic evaluations were unremarkable and he was observed in the intensive care unit. Nine hours after the accident, he developed an acute abdomen; exploratory laparotomy revealed a perforation of the gall bladder. Gall bladder injuries secondary to blunt trauma are infrequent events.

Abdomen, Acute↗
PubMed1980

Hypertension: spectrum of problems and guidelines for management.

Hypertensive patients may present to the emergency department with one of three general problems: high blood pressure due to labile hypertension, chronic hypertension, accelerated hypertension, or a hypertensive emergency; side effects from antihypertensive drugs; or acute medical or surgical illness whose management may be affected by hypertension or by drugs taken for hypertension. We describe these problems and recommend an approach to each that is appropriate in the emergency department.

Antihypertensive Agents↗
PubMed1979

Hiccups: an unusual manifestation of an abdominal aortic aneurysm.

A patient with hiccups was found to have an abdominal aortic aneurysm that subsequently ruptured. We believe that a leaking abdominal aortic aneurysm led to an ileus-induced distention of the splenic flexure of the colon with consequent diaphragmatic irritation and phrenic nerve stimulation. This led to persistent hiccups as a result of repetitive stimulation of the reflex arc mediating hiccups. Persistent hiccups require investigation for an underlying organic etiology, and a leaking abdominal aortic aneurysm should be included in the differential diagnosis.

Aged↗
PubMed1979

Heat illness.

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Acclimatization↗
PubMed1977

Accidental hypothermia.

Accidental hypothermia is an acute medical emergency with a high mortality rate. Physiologic derangements include hypoxemia, hypotension, acidosis, and arrhythmias. Management consists of careful monitoring rewarming, vigorous supportive care, and treatment of underlying and complicating disorders. Active core rewarming is recommended for hypothermia with associated cardiovascular insufficiency or instability and rapid core rewarming for hypothermia with cardiovascular collapse. Otherwise, passive or active external rewarming may be used. Good supportive care with correction of physiologic disturbances and vigorous treatment of underlying and complicating disorders are important in improving the survival rate.

Acidosis↗
PubMed1976

Caffeine intoxication: a case of paroxysmal atrial tachycardia.

Caffeinism is a syndrome resulting from the excessive ingestion of caffeine and characterized primarily by cardiovascular and central nervous system manifestations. A variety of tachyarrhythmias and extrasystoles are believed to reflect the toxic, cardiotonic effects of caffeine. A case of paroxysmal atrial tachycardia (PAT) related to caffeine abuse is PAT. The importance of considering this and other less frequent conditions as potential causes for this arrhythmia is stressed.

Adult↗
PubMed1976

Hydrogen sulfide intoxication. A case report and discussion of treatment.

The toxicity of hydrogen sulfide is thought to be due primarily to reversible inactivation of the respiratory enzyme, cytochrome oxidase, with resultant inhibition of aerobic metabolism. A patient with severe hydrogen sulfide poisoning and consequent profound metabolic acidosis was treated successfully with nitrites and oxygen. The nitrite-induced methemoglobin, by competitively binding the toxic hydrosulfide anion until detoxified, presumably reactivated and protected cytochrome oxidase and therby aided the patient's recovery by enhancing aerobic metabolism. His rapid recovery adds clinical support to the efficacy of nitrite therapy in sulfide poisoning. Therefore, we recommend that severe cases of sulfide poisoning be treated with nitrite-induced methemoglobinemia in addition to vigorous supportive care.

Accidents, Occupational↗