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Biomedical subjects

R Raheja

Publications and source records attributed to R Raheja.

8 recordsLinked to original sources
PubMed1994

Malignant catatonia--a continuing reality.

A comprehensive review of the world literature confirms that malignant catatonia continues to occur and is reported and discussed in psychiatric community. It is associated with affective disorders as well as schizophrenia. The pathophysiology is still unclear but most reports suggest a hypodopaminergic state. Its reported mortality has declined from 75-100% in the preneuroleptic era to 31% during the review period (1986-1992). Bomocriptine, dantrolene, and benzodiazepines have been used with success but ECT has been found to be life-saving. The present review supports earlier reports that neuroleptics are frequently lethal in some patients with malignant catatonia.

Adult↗
PubMed1989

Continuous monitoring of mixed venous oxygen saturation in patients with acute myocardial infarction.

Continuous measurement of mixed venous oxygen saturation (SvO2) has been suggested as an adjunct in monitoring critically ill patients. We evaluated SvO2 monitoring in 24 patients suffering from complicated myocardial infarctions. Cardiac output and arterial lactate levels were measured when there were persistent 5 percent changes in SvO2, and otherwise, every 12 hours or as indicated clinically. Increases in SvO2 by 5 and 10 percent corresponded with an increase in cardiac index in 78.5 percent and 75 percent of measurements, respectively. Decreases in SvO2 by 5 and 10 percent corresponded with decreases in cardiac index in 45.5 percent and 61 percent of measurements. Twenty percent changes in cardiac index showed dissimilar directional changes with SvO2 in 62 percent of cases. Arterial blood lactate levels correlated poorly with SvO2. Survivors had significantly higher mean SvO2 and cardiac indices than nonsurvivors (p less than 0.01). The clinical management of patients with myocardial infarction may not be altered in view of the limitations of SvO2 in reflecting tissue hypoxia. We conclude that continuous monitoring of SvO2 may not be a sensitive measure of cardiac output after acute myocardial infarction.

Aged↗
PubMed1987

Extravascular lung water measurement by double indicator dilution in shock and respiratory failure.

Clinical quantitation of water accumulation in the lungs is imprecise. The technique of measuring extravascular lung water (EVLW) with double indicator dilution utilizing cold indocyanine green dye has become practical with the addition of a microprocessor. The technique, insertion of a special thermistor tipped arterial catheter and potential problems are described. Our studies with resuscitation of 27 patients in shock indicate little increase in EVLW at 24 hours. On the other hand 19 patients with Adult Respiratory Distress Syndrome (ARDS) had marked increases in EVLW from normal of 5-8 ml/kg to 10.7 to 14.4 ml/kg. No further increases in EVLW were observed in eight ARDS patients requiring fluid resuscitation for associated hypovolemia and hypoperfusion. We feel that measurement of EVLW in critically ill patients offers an opportunity to study the pathophysiology of pulmonary failure.

Catheterization↗
PubMed1987

Cardiopulmonary resuscitation in hospitalized patients: continuing problems of decision-making.

Disturbingly low survival rates after CPR prompted us to carry out a series of studies. Of 272 patients receiving CPR at our 600-bed community hospital in 1984, 102 (37.5%) patients survived initial resuscitation and 30 (11%) survived their hospitalization. Of the 102 initial survivors, only 15 patients had received full CPR including cardiac compression and/or defibrillation, endotracheal intubation, and cardiotonic drugs. These data were compared with those for 129 patients admitted to our critical care units in 1982 and 1983 in whom CPR was withheld. These patients had been designated "No CPR" primarily because of their poor response to therapy. There was an 11% survival rate for patients who had received CPR compared to a 16% survival rate for the "No CPR" group. These data suggest that criteria for administering CPR to hospitalized patients should be improved.

Adolescent↗
PubMed1986

Detection of right atrial mass by echocardiography in pulmonary thromboembolism.

An echodense mass in the right atrium was detected incidentally by two-dimensional echocardiography (ECHO) in a patient with clinical suggestions of cardiogenic shock. Autopsy revealed a cylindrical thrombus extending from the right atrium through a patent foramen ovale, and bilateral massive pulmonary thromboembolism (PTE). Pulmonary thromboembolism should be one of the differential diagnoses in patients with an echodense mass in the right heart.

Diagnosis, Differential↗
PubMed1986

Oxygen delivery and consumption and P50 in patients with acute myocardial infarction.

We investigated the relationship between oxygen delivery (DO2), oxygen consumption (VO2), and influence of oxyhemoglobin dissociation (P50) on VO2 in 40 patients with complicated myocardial infarction. A decrease in VO2 and an increase in P50 were observed as DO2 decreased due to pump failure. In a given range of DO2, VO2 was related to P50 in survivors (r values .472 to .647, p less than .01). Each millimeter of mercury increase in P50 was associated with a 5.2 to 6.5 ml/min X m2 increase in VO2 when DO2 was less than 450 ml/min X m2. No similar correlation was found for nonsurvivors. Lactate was higher in nonsurvivors despite the fact that DO2 and VO2 were similar in the two groups. The lack of compensatory increases in P50 may be pathologic in nonsurvivors. However, the value of VO2 as an indicator of tissue oxygenation or survival in patients with acute myocardial infarction is questionable.

Adult↗
PubMed1981

Shock due to profound hypothermia and alcohol ingestion: report of two cases.

Cardiovascular failure (shock) associated with acute alcohol ingestion and severe hypothermia (core temperature 23 and 21 degrees C) was studied in 2 patients. In each case, perfusion failure was associated with lactacidemia, severe bradycardia, and agonal respirations. Infusion of fluids and mechanical ventilation reversed shock and prevented a fatal outcome. One case, complicated by renal failure and volume overload with pulmonary edema, was managed with peritoneal dialysis. These findings suggest that perfusion failure associated with severe accidental hypothermia after acute alcohol ingestion is due to a combination of hypovolemia, bradycardia, and respiratory depression.

Adult↗