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Biomedical subjects

R S Cicala

Publications and source records attributed to R S Cicala.

12 recordsLinked to original sources
PubMed1992

Laryngotracheal trauma.

Laryngotracheal trauma (LTT) is a rare but clinically important injury that may be missed without a high index of suspicion. Forty patients with LTT admitted to the University of Tennessee, Memphis from 1984 through 1989 were retrospectively reviewed. Twenty-six patients sustained penetrating (P)-LTT and 14 had blunt (B)-LTT. Three patients with P-LTT and one with B-LTT arrived in full arrest. Sixty-five per cent of blunt injuries, and 100 per cent of penetrating injuries had neck tenderness or overlying evidence of trauma. A combination of angiography, barium swallow, esophagoscopy, CT scan, bronchoscopy and/or laryngoscopy was used for evaluation, depending on the mechanism. Twenty-two of the 23 surviving P-LTT patients underwent surgery; 11 (50%) had concomitant esophageal injury. All patients with complications from P-LTT were in the group with esophageal injury. B-LTT was classified as either mild5, moderate3, or severe6; all 6 severely injured patients had preoperative airway compromise. All complications of B-LTT occurred in the severely injured group. The following conclusions were reached: LTT usually presents with symptoms and/or signs, but they may be minimal and nonspecific. Emergency tracheostomy should not be delayed if ventilation is compromised. Concomitant esophageal injuries are frequent in P-LTT and predispose the patient to postoperative complications. Airway compromise frequently correlates with severity of injury in B-LTT and these patients are also at high risk for complications.

Emergencies↗
PubMed1991

A prospective evaluation of myocardial contusion: correlation of significant arrhythmias and cardiac output with CPK-MB measurements.

Over a nine-month period, patients with chest trauma were prospectively evaluated for myocardial contusion. Ninety-two patients with evidence of anterior chest trauma were entered into the study and had 1) an ECG on admission and daily for three days; 2) monitoring of the myocardial band fraction of creatine phosphokinase (CPK-MB) on admission and every eight hours for 24 hours; 3) continuous electrocardiographic Holter monitoring for three to five days; and 4) noninvasive pulsed-Doppler cardiac output measurements daily for three days. Twenty-three patients developed 25 significant arrhythmias (SARRs): 1 atrial fibrillation, 1 AV dissociation, 5 supraventricular tachycardias, and 18 paroxysmal ventricular tachycardias. Cardiac outputs were significantly higher in those patients without SARRs. The CPK-MB levels correlated with the SARRs but were neither sensitive nor specific. No patients required specific therapy and none developed adverse sequelae of the SARRs. We conclude that 1) CPK-MB monitoring should not be routinely used for screening and diagnosis; 2) continuous arrhythmia monitoring deserves further clinical investigation but not routine application; 3) stable patients at risk for myocardial contusion should be monitored for 24 hours; and 4) the Abbreviated Injury Score for "minor" myocardial contusion should be deleted for purposes of ISS tabulation.

Adolescent↗
PubMed1990

Methylprednisolone acetate does not cause inflammatory changes in the epidural space.

Few studies have examined the possible adverse effects that epidural injection of depot corticosteroid preparations may have on meningeal membranes and nervous tissue. Thirty-six healthy adult white rabbits received 0.3 ml/kg epidural injections of either lactated Ringer's solution (negative control group), 1% lidocaine containing methylprednisolone acetate (study group), or normal saline containing talc (positive control group). Animals were killed either 4 or 10 days after injection and stained sections of the spinal cord and meningeal membranes were examined by light microscopy. In all animals that received either lactated Ringer's solution or lidocaine with methylprednisolone acetate, microscopic examination of specimens taken from the L5-L6 interspace revealed no white cell infiltrates and no fibroblastic activity. All animals that received epidural injections of normal saline containing talc had marked infiltration of tissue macrophages in the epidural space. There was no thickening of the meningeal membranes or nerve roots in any animal. The complete lack of inflammatory changes and meningeal thickening demonstrated in this pilot study helps to confirm the safety of methylprednisolone acetate when injected into the epidural space.

Animals↗
PubMed1990

Effectiveness of alprazolam in the treatment of chronic pain: results of a preliminary study.

One hundred chronic pain patients were begun on alprazolam, 1.5 mg/day. No other medication changes or therapeutic interventions were made. Sixteen patients were lost to follow-up and 1 oncology patient died. Of the 83 patients who were evaluated at 12 weeks, 61 (73.5%) showed improvement, and only 5 had discontinued the medication because of side effects. The average score of all patients had decreased from 3.6 to 2.2 on a verbal analog scale that rated pain severity from 0 to 5. There was no difference in response among the various diagnostic groups represented in the study population.

Alprazolam↗
PubMed1990

Epidural analgesia in thoracic trauma: effects of lumbar morphine and thoracic bupivacaine on pulmonary function.

Changes in pulmonary function tests were compared in 14 thoracic trauma patients, of whom seven received thoracic epidural bupivacaine for analgesia and seven received lumbar epidural morphine. In both groups epidural analgesia decreased subjective pain levels when compared to parenteral narcotics which the patients received before epidural catheter placement. Patients in the bupivacaine group had statistically significant improvements in vital capacity and forced expiratory volume, and a decreased respiratory rate. Patients in the morphine group had no significant change in pulmonary function. The use of thoracic epidural bupivacaine for analgesia in post-traumatic chest injuries produced superior improvement in pulmonary function when compared to lumbar epidural morphine.

Analgesia, Epidural↗
PubMed1989

Side effects and complications of cervical epidural steroid injections.

Two hundred and four cervical epidural injections of corticosteroids were performed on 142 patients for the treatment of cervical pain over a 1-yr period. Injections were performed at the C7-T1 interspace with 10-15 mL of 0.5% lidocaine containing 1 mg per kg of methylprednisone acetate. Four complications occurred: two dural punctures without sequelae; one episode of upper extremity weakness, which resolved in 24 hr; and one episode of nausea and vomiting lasting 12 hr. In addition, two side effects were frequently reported: stiff neck lasting 12-24 hr occurred in 13.2% of patients, and a mild facial flushing with subjective (but not objective) fever lasting about 12 hr occurred in 9.3% of patients. In this large series, the procedure appears safe to use in an outpatient setting.

Adrenal Cortex Hormones↗
PubMed1989

Long-term results of cervical epidural steroid injections.

Fifty-eight patients undergoing cervical epidural injection of corticosteroids were followed for a 6-month period. Patients with 90% pain relief lasting 6 months were considered to have excellent results, those with greater than 50% pain relief lasting at least 6 weeks were considered to have good results, and all others were considered to have poor results. Six months after the injection, 41.4% of patients had excellent pain relief by our criteria. Twenty-nine percent of patients reported good results and 29.3% had poor results. Those patients with the diagnosis of cervical spondylosis and those with subacute cervical strain had statistically significantly (p less than 0.001, difference of proportions test) better results than patients with other diagnoses. The procedure of cervical epidural steroid injection may be most effective in patients with cervical degenerative joint disease as the etiology of their cervical pain.

Adrenal Cortex Hormones↗
PubMed1989

Outpatient treatment of patients with chronic pain: an analysis of cost savings.

To control costs, the University of Tennessee Center for Pain Management added an ambulatory pain rehabilitation program to its existing inpatient hospitalization program. The impact of this program was assessed by comparing the first 25 patients treated in 1985 (prior to the introduction of outpatient management) with the first 25 patients treated in 1987 (after outpatient management was established). Twenty of the 25 patients seen in 1985 required hospitalization, while in 1987 nine patients were hospitalized and 10 patients were placed in outpatient rehabilitation. The total cost for treating 25 patients in 1985 was $571,200 but decreased to $191,000 in 1987. Hospital charges were the greatest single cost factor in 1985 ($321,500) but were only $61,000 in 1987. Success rates as measured by a return to previous employment were not significantly changed (13 of 25 returned to work in 1985, and 11 of 25 returned to work in 1987).

Adult↗
PubMed1988

Evaluation of coagulation studies from heparinized arterial lines with use of Lab-Site high-pressure tubing.

Heparinized arterial catheters are commonly used in critically ill patients to monitor pressures and to collect blood for laboratory analysis. To remove the heparinized fluid used to keep these lines patent large volumes of blood are often withdrawn and discarded or calculations of tube volume must be made. Repeated violation of stopcocks may lead to contamination and infection of arterial lines. In addition, discarded blood has become an increasing concern as a source of infection for health care personnel. This study evaluates the efficacy of noncompliant arterial line tubing that contains two polymer sampling ports permanently placed at prefixed distances such that if blood is withdrawn to the distal port, undiluted arterial blood can then be withdrawn from the proximal port. Blood from arterial lines that consisted of 20-gauge catheters connected to Lab-Site tubing was withdrawn in the method suggested by the manufacturer with no removal or wasting of excess blood from the system. Prothrombin time (PT) and activated partial thromboplastin time (aPTT) studies performed on this sample were compared with those performed on a simultaneously drawn venous sample. Regression analysis showed a correlation coefficient of 0.966 for PT and 0.935 for aPTT, demonstrating an excellent correlation for the technique. The average arterial PT was 0.12 seconds less than venous control and the average arterial aPTT was 0.49 seconds greater than control. Neither of these differences was significant. We conclude that this type of high-pressure tubing allows accurate blood samples to be obtained from arterial lines without the necessity of precise calculations or blood wastage.

Blood Coagulation Tests↗
PubMedDate not supplied

Initial evaluation and management of upper airway injuries in trauma patients.

STUDY OBJECTIVE: To examine and compare the mechanism of injury, diagnostic findings, initial methods of airway management, and outcome of patients who had upper airway injuries. DESIGN: A retrospective review of hospital records. SETTING: A large metropolitan, university-affiliated trauma center. PATIENTS: Forty-six cases of upper airway injuries admitted between 1984 and 1988. INTERVENTIONS: Diagnostic methods included clinical examination, cervical and thoracic radiographs, bronchoscopy and computerized tomographic (CT) scan. Therapeutic interventions ranged from conservative management with or without endotracheal intubation to operative reconstruction. MEASUREMENTS AND MAIN RESULTS: Mechanism of injury was knife stab wound in 9 cases, gunshot wound in 17 cases, and blunt trauma in 20 cases. Location was the larynx in 13 cases, trachea in 24 cases, cricoid cartilage in 5 cases, and multiple sites in 4 cases. Diagnostic findings varied considerably according to the mechanism of injury, but radiographic evidence of soft tissue air and wounds opening into the airway were common findings. CT scan and bronchoscopy also were useful diagnostic tools. Overall mortality was 24%, which did not vary according to patient age or mechanism of injury. The airway injury itself was a primary or contributory cause of death in four cases, two of which were tracheal injuries and two injuries at the cricotracheal junction. CONCLUSIONS: In any patient with possible upper airway injury, plain radiographs of the chest and neck should be obtained to aid in the diagnosis. Elective intubation should be attempted only with a surgical team present and prepared for emergency tracheotomy. Fiber-optic bronchoscopy could be a valuable aid for both intubation and evaluation in such cases.

Cricoid Cartilage↗