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Biomedical subjects

R Silbergleit

Publications and source records attributed to R Silbergleit.

At least 19 recordsLinked to original sources
PubMed2000

The persistent stapedial artery.

The persistent stapedial artery is a rare congenital vascular anomaly that may present as a pulsatile middle ear mass or that may appear as an incidental finding. Five cases of persistent stapedial artery are presented. The CT findings include the absence of the ipsilateral foramen spinosum and a soft-tissue prominence in the region of the tympanic segment of the facial nerve. Three cases were associated with an aberrant internal carotid artery. Imaging identification of this variant may obviate unnecessary surgery and may help in planning surgical or endovascular interventions.

Adolescent↗
PubMed2000

Viral myocarditis presenting with seizure and electrocardiographic findings of acute myocardial infarction in a 14-month-old child.

Acute viral myocarditis is an uncommon but potentially fatal illness in children. Patients with myocarditis may present with nonspecific symptoms or atypical findings that make diagnosis in the emergency department difficult. We describe a previously healthy 14-month-old child with difficulty breathing and a tonic-clonic seizure who was subsequently found to have ECG changes and cardiac marker elevation consistent with acute myocardial infarction. The patient was immediately transferred from our community hospital ED to our tertiary care children's hospital. Shortly after admission, the patient developed intractable nonperfusing ventricular arrhythmias necessitating extracorporeal membrane oxygenation. Cardiac function did not recover, and the patient required heart transplantation before cessation of bypass. Serology and anatomic pathology confirmed coxsackievirus B myocarditis. This case illustrates (1) the nonspecific presentation of myocarditis as dyspnea and seizure, (2) the manner in which myocarditis can mimic myocardial infarction, and (3) the importance of early diagnosis in the ED and transfer to a tertiary care facility.

Cardiopulmonary Resuscitation↗
PubMed1999

Sarcomas of the head and neck.

Sarcomas are rare malignancies of mesenchymal origin. Computed tomographic and magnetic resonance imaging characteristics, as well as histologic findings and epidemiology, of sarcomas of the head and neck are reviewed. The sarcomas discussed include rhabdomyosarcoma, fibrosarcoma, osteosarcoma, chondrosarcoma, malignant fibrous histiocytoma, leiomyosarcoma, alveolar soft part sarcoma, Ewing's sarcoma, and synovial sarcoma. The imaging findings of these entities frequently are nonspecific. Imaging, particularly magnetic resonance imaging, has a major role in defining the extent of these tumors. This is important because complete surgical excision is the preferred method of treatment. Imaging also is useful in planning radiation therapy and determining prognosis.

Head and Neck Neoplasms↗
PubMed1998

Imaging of spinal intradural arachnoid cysts: MRI, myelography and CT.

Imaging studies in eight patients with surgically-confirmed spinal arachnoid cysts were analyzed retrospectively. All patients had preoperative MRI of the spine and seven preoperative myelography with postmyelographic CT. In all cases the correct diagnosis could be made preoperatively on the basis solely of MRI. The diagnosis could also be established from myelography and postmyelographic CT in six of the seven cases. In one case myelography and CT simply demonstrated an intradural extramedullary mass.

Adult↗
PubMed1998

Hypothermia from realistic fluid resuscitation in a model of hemorrhagic shock.

STUDY OBJECTIVE: To correlate changes in core body temperature with changes in mean arterial pressure (MAP) and cardiac output (CO) and with the administration of room-temperature intravenous fluids in a clinically relevant large-animal model of uncontrolled hemorrhage. METHODS: Ten swine were subjected to uncontrolled hemorrhage through a flow-monitored shunt placed between the femoral artery and the peritoneal cavity. Animals were randomly assigned to a treatment or a control group. The control group (n=5) received no intravenous fluids. The treatment group (n=5) received 80 mL/kg (3:1 crystalloid/blood loss) ambient-temperature lactated Ringer's solution over a 10-minute resuscitation phase initiated 10 minutes after injury. CO and core body temperature, measured with the use of a pulmonary artery catheter, and MAP were the primary outcomes. We analyzed differences between groups with the use of repeated-measures ANOVA. Change of temperature was analyzed against the change in CO, and against fluid infusion for each interval, by means of regression analysis. RESULTS: The unresuscitated control animals had no change in core temperature despite profound hemorrhagic shock and hypotension. The animals treated with fluids had a mean 2.6 degrees C decrease in core temperature during fluid resuscitation (95% confidence interval [CI], 1.8 to 3.5). A 1.5 degrees C decrease in core temperature (95% CI, .1 to 2.0) persisted at the end of 60 minutes (40 minutes after fluid resuscitation was discontinued). Core temperatures in control animals were 2.8 degrees C lower than those in treated animals after fluid resuscitation (95% CI, .8 to 4.8). Decreases in core temperature correlated with fluid infusion (beta=-35.2 mL/kg x degrees C, R2=.75) and increases in CO (beta=-1.46 L/min x degrees C, R2=.69). CONCLUSION: Ambient-temperature crystalloid resuscitation in a clinically relevant large-animal model of hemorrhagic shock causes small decreases in core body temperature. Resuscitation rather than shock is the main cause of decreased body temperature in this model.

Analysis of Variance↗
PubMed1997

MR of spinal meningeal melanocytoma.

We report an unusual case of meningeal melanocytoma, a rare pigmented lesion of the leptomeninges, that occurred within the leptomeninges of the thoracic spinal canal. The lesion showed increased signal intensity on T1-weighted MR images relative to gray matter, was isointense with gray matter on T2-weighted images, and enhanced mildly but homogeneously after administration of contrast material.

Aged↗
PubMed1997

Primary intraosseous hemangioma of the orbit: CT and MR appearance.

An 8-year-old girl had acute onset of blurred vision, proptosis, and lateral and vertical gaze palsies on the right. CT and MR examinations showed an expansile mass involving the greater wing of the right sphenoid bone. Pathologic analysis of the surgical specimen revealed a capillary hemangioma. The lesion was inhomogeneous but predominantly isointense with gray matter on T1-weighted images. On T2-weighted images the lesion was inhomogeneous with areas of both high and low signal intensity. The rim enhanced uniformly, and there was inhomogeneous enhancement of the bulk of the lesion.

Child↗
PubMed1996

Sudden severe barotrauma from self-inflating bag-valve devices.

Self-inflating bag-valve devices are commonly used for the ventilation of intubated patients, especially during resuscitation and transport. These devices are generally safe, but minor deviations in their recommended use can expose patients to airway pressures greater than 135 cm H2O. We present a patient in whom a sudden tension pneumothorax developed during ventilation with a bag-valve device. We believe that this complication resulted from high airway pressures generated in the bag-valve device. The ability of the device in question to cause barotrauma was confirmed by bench-top measurements of the peak airway pressures generated by minor deviations from proper use of the device.

Barotrauma↗
PubMed1996

A new model of uncontrolled hemorrhage that allows correlation of blood pressure and hemorrhage.

OBJECTIVE: To compare hemodynamics, mortality rates, and bleeding rates at 3 severities of hemorrhage in a new model of uncontrolled intra-abdominal bleeding that uses an injury of varying severity and geometry unfavorable to thrombosis. METHODS: Ten swine were bled through a flow-monitored shunt placed between the femoral artery and the peritoneal cavity. The shunt was connected to catheters of varying diameters placed in the femoral artery to create 3 rates of hemorrhage. Blood flow through the shunt was measured with an in-line Doppler probe. Arterial pressures, cardiac output (CO), and ECGs were monitored. Survival and blood loss were calculated. RESULTS: The model successfully produced 3 hemorrhage severities. At all 3 rates of bleeding, blood flow was linearly related to mean arterial pressure, with R2 > 0.72. Bleeding was continuous in all groups. The mean numbers of minutes until death were 53, 45, and 25, respectively, at the increasing shock severities. Blood pressure (BP) and CO decreased continuously in all groups, but did so more rapidly with increasing severity of hemorrhage. CONCLUSIONS: In this model of uncontrolled hemorrhage, bleeding was continuous and linearly related to BP. The hemodynamic response to uncontrolled bleeding in this model differs markedly from those in previous wire aortotomy models where wound geometry is favorable to thrombosis. Hence, when injury geometry is favorable to thrombosis (as in aortotomy), thrombosis formation affects hemorrhage rates and hemodynamic responses.

Analysis of Variance↗
PubMed1996

Effect of permissive hypotension in continuous uncontrolled intra-abdominal hemorrhage.

OBJECTIVE: To determine the effects of aggressive fluid administration vs permissive hypotension on survival, blood loss, and hemodynamics in a model of uncontrolled hemorrhage in which bleeding has been shown to be continuous. METHODS: In this porcine model, 10 animals were bled through a flow-monitored shunt placed between the femoral artery and the peritoneal cavity. The animals received either no fluid (n = 5) or 80 mL/kg lactated Ringer's solution (n = 5) during a resuscitation phase between 10 and 20 minutes postinjury, followed by a 40-minute evaluation phase. Arterial pressures, cardiac output (CO), and hemorrhage rate were measured. Survival and blood loss were calculated outcome measures. RESULTS: The difference in survival between the animals left hypotensive (40%) and those receiving normotensive resuscitation (20%) was not significant (p = 0.49). In the animals receiving fluid resuscitation, mean arterial pressure (MAP) and CO increased during the resuscitative phase, but all the animals suffered the same pattern of hemodynamic deterioration in the evaluation phase. Rate of hemorrhage during the resuscitative phase was 20 +/- 5 mL/min in the animals not receiving fluid and 56 +/- 9 mL/min in the animals receiving fluids. Total blood loss was subsequently 20 mL/kg greater in the animals receiving fluids than in the animals without fluid resuscitation. CONCLUSIONS: In this model of continuous uncontrolled hemorrhage, the difference in survival between the animals left hypotensive and the animals receiving fluid resuscitation was not statistically significant. Increases in MAP and CO with fluid resuscitation were transient and were offset by larger volumes of blood loss. In contrast to the aortotomy model (where thrombosis is likely and hypotensive resuscitation has proven beneficial), this model suggests that in continuous bleeding avoiding fluid resuscitation has a much smaller effect on outcome. Much of the benefit from hypotensive resuscitation may depend on having an injury that can stop bleeding.

Animals↗
PubMed1996

Neuroradiology.

Explore the source record for details and available documents.

Humans↗
PubMed1995

Thoracic radicular symptoms in amyotrophic lateral sclerosis.

We report 4 patients with amyotrophic lateral sclerosis (ALS) complaining of thoracic radicular symptoms. We postulate that in some patients paraspinal muscle weakness can result in an increased thoracic kyphosis, possibly producing traction on the thoracic roots.

Aged↗
PubMed1995

Efficacy of gadolinium administration in magnetic resonance imaging screening of patients with complex partial seizures and results of a normal neurologic examination.

RATIONALE AND OBJECTIVES: Magnetic resonance imaging has become a standard screening tool in the evaluation of patients with complex partial seizures. This study prospectively addresses the efficacy, if any, of routinely adding gadolinium-enhanced images to routine T2-weighted images in patients with a normal neurologic examination. METHODS: One hundred consecutive patients with electroencephalogram and clinical evidence of complex partial seizures and no other neurologic abnormalities were examined prospectively with axial and coronal T2-weighted spin-echo images, followed by axial and coronal gadolinium-enhanced T1-weighted scans. RESULTS: The scans in 73 patients were interpreted as normal, 14 had nonspecific white matter lesions, 5 had asymmetry of the temporal horns, and 2 had asymmetric signal intensity in the temporal lobes, and the scans in 6 showed abnormal gadolinium enhancement. Of the lesions in the six patients whose scans showed abnormal enhancement, four were seen well on the T2-weighted images. Of the remaining two, one was a small cerebellar venous angioma, and the other, a probable tiny convexity meningioma. One temporal lobe glioma seen on the T2 scans did not enhance with gadolinium. CONCLUSIONS: Routine administration of gadolinium does not appear to be of benefit in imaging patients with complex partial seizures who are otherwise neurologically normal.

Adult↗
PubMed1995

Effect of gender on the emergency department evaluation of patients with chest pain.

OBJECTIVE: To assess chest pain evaluation as reflected in the documentation of the evaluation process for women vs men in one emergency department (ED). METHODS: In this retrospective case series, patient charts were reviewed for documentation in accordance with a clinical policy for chest pain evaluation. Patient demographics and the frequencies of inclusion of the following items were determined: five descriptors of chest pain, associated symptoms, risk factors for coronary artery disease, receipt of physical examination, and receipt of ECG. RESULTS: Over a three-month period, 132 men and 150 women were evaluated for chest pain and entered in the study. There was no significant difference in age between men and women overall, but in the subgroup of patients who were admitted to the hospital, the women were significantly older than the men by an average of five years (p = 0.04). Fifty-five percent of all the patients were admitted to the hospital. The men were admitted to the hospital significantly more often than were the women (p = 0.01), with a relative risk of admission for women vs men 0.76 (95% CI = 0.62-0.94). There was no significant difference between the men and the women for any of the process of evaluation items in the overall group or in the hospital-admission and release-home subgroups. CONCLUSION: The authors' findings do not support the existence of a gender difference in ED chest pain evaluations, as reflected by documentation of the evaluation process. However, men were more likely to be admitted to the hospital for evaluation of coronary artery disease than were women.

Adult↗