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Biomedical subjects

R Silbergleit

Publications and source records attributed to R Silbergleit.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1992

Absence of the carotid canals at skull base CT.

Congenital absence of one or both internal carotid arteries (ICAs) has a high association with circle of Willis aneurysm formation. Since the carotid canals in the skull base form secondary to the presence of the embryonic ICA, absence or hypoplasia of a carotid canal on a computed tomographic (CT) scan through the skull base should suggest a congenital ICA abnormality and prompt a search for associated intracranial vascular abnormalities. Of four patients with carotid canal underdevelopment evident at CT, two had associated circle of Willis aneurysms and a third had an extensive skull base rete mirabile supplying an abnormal tangle of vessels in the basal cisterns. Only two patients (one with an aneurysm, one with the skull base rete mirabile) presented with subarachnoid hemorrhage. One patient presented with monocular decreasing vision due to an enlarging aneurysm, and one patient was essentially asymptomatic. If asymmetry or absence of the carotid canals is evident on CT scans of the head, further evaluation to rule out a potentially life-threatening intracranial vascular abnormality such as those found in these patients should be seriously considered, even in a young or asymptomatic patient.

Aged↗
PubMed1991

Forces acting during air and ground transport on patients stabilized by standard immobilization techniques.

OBJECTIVE: Transportation, whether by air or ground, exposes the injured patient to mechanical shocks and vibrations. These forces and their hazardous potential remain largely unknown. The purpose of this study was to identify, characterize, and compare the forces generated during patient transport in helicopter and ground ambulances. METHODS: Forces generated during transport were measured using an instrumented, low mass triaxial accelerometer fixed to a standard backboard. Measurements were recorded in three axes with an adult subject immobilized on the board during experimental ambulance and helicopter trials. Acceleration waveforms were analyzed in each mode of transport. RESULTS: Forces for both ground and air transport ranged 0.07g to 0.19g root mean square, and 0.32g to 0.83g mean peak. The vibrational forces in the helicopter were fairly discrete, located at 6.6, 19.5, and 39 Hz, and axis dependent. Ground ambulance vibrations were more diffuse, occurring below 1 Hz and between 10 and 15 Hz. Crest factor analysis shows that shocks were more uniform in the helicopter than on the ground, especially in the anterior-posterior axis. CONCLUSION: These data suggest that transportation by helicopter subjects supine patients to greater lateral and vertical forces, but smaller head to toe forces, than ground transportation (P less than .05). In general, the forces to which a backboarded subject is subjected during transport range from 0.32g to 0.83g, vary by direction, and are more predictable for air than for ground transport. The clinical significance of these measurements requires further study.

Acceleration↗
PubMed1991

Accelerated intracranial occlusive disease, oral contraceptives, and cigarette use.

We report clinical and angiographic features of accelerated intracranial occlusive disease resembling moyamoya vasculopathy in five young women who used oral contraceptives (OCs) and smoked cigarettes, but generally had no other obvious risk factors for cerebrovascular disease. Three women had been on OCs for at least 4 years, one woman each had been on OCs for 3 months and for 2 weeks. All five women had smoked cigarettes for at least eight pack-years. Intermittent and progressive multifocal cognitive, visual, motor, or sensory hemispheric symptoms and signs developed in all. All patients developed strokes, four preceded by transient ischemic attacks. Cerebral angiography demonstrated bilateral supraclinoid internal carotid artery stenosis in four patients and proximal posterior cerebral artery stenosis in one. Additional features included rete mirabile, telangiectasias, prominent lenticulostriate collaterals, and multifocal distal cerebral branch occlusions. Three had mild abnormalities of serum fibrinogen, antinuclear antibody, erythrocyte sedimentation rate, or CSF IgG. After discontinuing OCs and reducing cigarette use, four women have not had further strokes over a mean follow-up of approximately 5 years. In certain young women, clinical and angiographic features resembling moyamoya may develop with the use of OCs and cigarettes. We speculate that an immunologically mediated vasculopathy may explain, in part, this unusual cerebrovascular syndrome in otherwise healthy young women.

Adult↗
PubMed1989

Idiopathic intracranial hypertension (pseudotumor cerebri): MR imaging.

Magnetic resonance (MR) imaging was performed on six patients with idiopathic intracranial hypertension (IIH). The patients were all women with a mean age of 27 years (range, 17-41 years). Six healthy women volunteers with a mean age of 33 years (range, 25-46 years) were studied for comparison. All six patients had elevated opening pressures at lumbar puncture. MR imaging demonstrated a partially empty sella in two patients, and one patient had signal aberration in the dural venous sinuses suggestive of slow flow. There were no white matter signal abnormalities, even in the periependymal space. Volumetric pixel analysis revealed significantly larger subarachnoid space volumes in patients than in control subjects, without a significant difference in ventricular volumes. No other intracranial abnormalities were found in any IIH patient or control subject. The results suggest that, in IIH, (a) although the subarachnoid spaces are enlarged, the wide range of normal values would limit the clinical use of these measurements and (b) the role of MR imaging, as with CT, is primarily in the exclusion of other diseases with clinical presentations similar to that of IIH.

Adolescent↗
PubMed1989

Intraoperative sonography in low-grade gliomas.

A retrospective study of intraoperative sonography and preoperative head computed tomography (CT) in 15 patients with low-grade brain gliomas was undertaken to determine whether areas of increased echogenicity without shadowing corresponded with areas of pathologic CT enhancement. Glioma echogenicity was considered increased if greater than or equal to adjacent sulcal echogenicity. Of the 15 lesions, 7 of 8 with pathologic CT enhancement showed areas of increased echogenicity without shadowing. Areas of increased echogenicity topographically correlated with areas of pathologic CT enhancement. One of eight lesions with pathologic enhancement had no areas of increased echogenicity; however, the enhancement in this lesion was minimal. Six of seven patients without pathologic CT enhancement had areas of echogenicity always less than sulcal echogenicity. Our results suggest that, in low-grade gliomas, regions of enhancement usually correspond to areas of increased echogenicity without shadowing. These findings differ from those found with high-grade gliomas.

Astrocytoma↗
PubMed1988

Streptomycin in the chick embryo: post-hatching vestibular behavior and morphology.

Developing chick embryos were exposed to streptomycin injected on days 5 through 13 of the 21 day developmental period. Histological and behavioral abnormalities were found almost exclusively in chicks exposed after day 7. The nature of the behavioral deficits included abnormal head posture, head tremor, and inability to compensate for applied vestibular stimuli. Head movement measurements showed that the head tremor had frequencies of oscillations from 10-35 Hz. The amplitude of the tremor was a large as 10 degrees. Histology showed damage to the secretory dark cells of the membranous labyrinth in those chicks that showed behavior changes. Even with increased dosages chicks exposed prior to day 7 rarely showed abnormal vestibular behavior but instead experienced increased mortality. Further tests examining tissue levels of streptomycin showed little or no streptomycin in embryos until day 10. These results are discussed in terms of their utility as an alternative model to surgical manipulation of the vestibular system in developing embryos. Behavioral consequences are compared to other work with drugs and to the effects of weightlessness and unusual environments on vestibular orientation and behavior.

Animals↗
PubMedDate not supplied

Lack of a neuroprotective effect from N-acetylcysteine after cardiac arrest and resuscitation in a canine model.

OBJECTIVE: Oxygen free radicals cause brain injury following resuscitation from cardiac arrest. In preclinical trials, some free radical scavenging drugs reduce oxidative neuronal damage after ischemia and reperfusion, but these drugs are generally not yet available for clinical testing or use. N-Acetylcysteine (NAC), a commonly used antidote in acetaminophen poisoning, is also a potent free radical scavenger that can ameliorate oxidative injury following ischemia and reperfusion in neuronal cell culture. We hypothesized that treatment with NAC would improve neurological outcome after cardiac arrest and resuscitation. METHODS: In 16 adult female beagles, 10 min of ventricular fibrillation was followed by 3 min of open-chest CPR, and defibrillation. Immediately following return of spontaneous circulation, animals randomly received either 150 mg/kg NAC (3% solution) (n = 8) or an equivalent volume of normal saline (n = 8). Twenty-three hours later, neurological deficit was scored (0 = normal, 100 = brain death). RESULTS: All animals were successfully resuscitated, and there were no apparent adverse effects to the administration of NAC in post resuscitative animals. There was, however, no significant difference in neurological deficit in the animals receiving NAC (40 +/- 12.9, mean +/- SD) compared to control animals (44 +/- 6.5, P = 0.73). CONCLUSION: No neuroprotective effect was found from the administration of NAC at currently used clinical dosages, to dogs subjected to 10 min of global cerebral ischemia from cardiac arrest and resuscitation.

Acetylcysteine↗
PubMedDate not supplied

Benign pneumoperitoneum associated with pneumomediastinum and pneumoretroperitoneum in ambulatory outpatients.

Perforation of a hollow viscus and other dangerous etiologies must always be considered in the evaluation of free peritoneal air. Pneumoperitoneum in the presence of pneumoretroperitoneum and pneumomediastinum, however, often results from air tracking from a pathologic source outside of the abdomen along the mesentery into the peritoneum. This syndrome is relatively benign, and should be considered when there are multiple sites of extraluminal air in order to minimize the risk of unnecessary exploratory laparotomy. Two cases of benign pneumoperitoneum associated with pneumomediastinum and pneumoretroperitoneum are presented.

Adult↗
PubMedDate not supplied

Management of sickle cell pain crisis in the emergency department at teaching hospitals.

The purpose of this study is to determine the frequency and variety of strategies being used in the Emergency Department (ED) management of sickle cell pain crisis (SCPC). One thousand randomly selected academic emergency physicians received a multiple-choice survey; 549 (55%) completed the survey. Forty-five percent of respondents treat patients with SCPC every week or almost every shift. Twenty percent use protocols for management of SCPC. Respondents consider pain refractory to outpatient treatment if it is persistent after two (23%) or three (53%) doses of parenteral analgesic. Meperidine or morphine is the most common initial analgesic. In the routine management of uncomplicated SCPC, i.v. analgesics, i.v. hydration, oxygen therapy, and complete blood counts are often or always used by 67, 71, 66, and 82% of respondents, respectively. Some patterns in the diagnostic and therapeutic management of patients with SCPC in the ED are identified, but overall practice is highly variable. Some popular elements of care are divergent from those suggested by the scientific literature.

Anemia, Sickle Cell↗
PubMedDate not supplied

Outcome of patients after air medical transport for management of nontraumatic acute intracranial bleeding.

INTRODUCTION: Patients with acute, intracranial bleeding (ICB), particularly from intracranial aneurysms, are believed to be at high risk for rebleeding or neurologic deterioration if subjected to noise, motion, or stress, but are transported by helicopter with increasing frequency. This study was undertaken to examine the characteristics, safety, and outcomes of air transport for patients with acute subarachnoid hemorrhage (SAH) or other forms of acute ICB in an air medical system. METHODS: Charts of all patients with spontaneous, acute ICB who were transported by air from 1986 through 1989 were reviewed. Age, gender, time of transport, transport management measures, pre- and post-transport Glasgow Coma Scale (GCS) score, intensive care unit (ICU) and hospital days, operations, and mortality were compiled for all patients and analyzed. RESULTS: Eighty-seven patients ranging in age from 2 to 83 years (mean: 47.5 +/- 18.5 years) met entry criteria. The source of bleeding was cerebral aneurysm in 37 patients; intraparenchymal hemorrhage in 29; an unidentified vascular source in 11; and arteriovenous malformation (AVM) in 10. Mean GCS score measured in 69 patients before and after transport was 10.5 +/- 4.5 Glasgow Coma Scale score did not change during transport in 61 patients (88%), improved in three (4%), and deteriorated in five (7%). Fifty-nine patients (69%) underwent operations, 36 (41%) within 24 hours of arrival. Mean ICU stay was 14 days (95% CI: 12-15); mean hospital stay was 36 days (95% CI: 27-45 days). Overall mortality was 25% (95% CI: 16-34 days). A GCS score of 3 to 8 at time of transport was associated with both increased hospital length of stay and higher mortality. Patients transported within eight hours of symptom onset had lower GCS scores, but outcome measures were not significantly different from those transported later. CONCLUSIONS: Emergency air medical transfer of patients with acute ICB for definitive neurosurgical care appears to be both safe and effective, and facilitates early definitive diagnosis and operative intervention.

Acute Disease↗
PubMedDate not supplied

Arteriovenous malformation simulating encephalocele: CT findings.

Congenital arteriovenous malformation (AVM) of the scalp is a rare lesion, which usually is easily diagnosed. A case of a newborn infant with a midline occipital soft tissue mass that clinically simulated an encephalocele is reported. Postcontrast CT was useful in ruling out encephalocele and suggesting the diagnosis of AVM.

Arteriovenous Malformations↗
PubMedDate not supplied

Intraventricular primary neuronal neoplasms: CT, MR, and angiographic findings.

Intraventricular primary cerebral neuroblastoma and the more differentiated intraventricular neurocytoma are primary neuronal tumors that share common radiological characteristics. This article describes the imaging characteristics of these rare tumors using CT, MR, and angiography. We present one case of each neoplasm.

Adult↗
PubMedDate not supplied

Persistent trigeminal artery detected with standard MRI.

The trigeminal artery is the most common of the primitive carotid-basilar anastomoses to persist into adulthood. Prior to the introduction of MRI, the diagnosis of persistent trigeminal artery (PTA) could only be made at cerebral angiography. This study compares angiography and standard brain MRI in 11 cases of PTA. Nine of the 11 PTAs were identified with MRI. Axial imaging gave the best definition of the course of the PTA.

Adult↗
PubMedDate not supplied

Hallervorden-Spatz disease with bilateral involvement of globus pallidus and substantia nigra: MR demonstration.

Hallervorden-Spatz disease presents with relentless mental and physical deterioration. Pathologically there is abnormal iron deposition in the globi pallidi, substantia nigra, and red nuclei. A spectrum of abnormal basal ganglia signal intensities have been described on MRI. A pediatric case with low signal intensity in the globi pallidi and substantia nigra is presented.

Child↗
PubMedDate not supplied

Imaging-guided injection techniques with fluoroscopy and CT for spinal pain management.

Local spinal pain and radiculopathy are common conditions that debilitate millions of Americans annually. Most cases are successfully treated conservatively with rest or physical therapy. Chiropractic manipulation or, in some cases, surgery may also be performed. Percutaneous injection has been used for spinal pain management for many years, but many of these procedures have historically been performed without imaging guidance. Recently, however, newer minimally invasive, imaging-guided percutaneous techniques have been added to the list of available treatment options for spinal pain. Imaging-guided techniques with fluoroscopy or computed tomography increase the precision of these procedures and help confirm needle placement. Cervical, thoracic, lumbosacral, and sacroiliac pain can be evaluated and treated safely and effectively with injections of local anesthetics or long-acting steroids into facet joints, sacroiliac joints, selective nerve roots, spondylolytic areas, and the epidural space. Because imaging-guided techniques appear to provide better results and reduce complication rates, they are becoming more popular despite controversy regarding their effectiveness. Controversy will continue to surround these imaging-guided techniques until large, double-blinded studies become available. In the meantime, there is an increased demand for these procedures from referring physicians, and it is important to be able to safely perform them with a minimum of patient discomfort.

Anesthetics, Local↗