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Biomedical subjects

S Bursztein

Publications and source records attributed to S Bursztein.

At least 37 records · Page 2Linked to original sources
PubMed1985

Rupture of splenic abscess through the diaphragm.

Splenic abscess is an uncommon disease that has a high mortality rate if not treated surgically. With the aid of new diagnostic tools, such as ultrasonography, scanning and computerized axial tomography, it is possible to diagnose the entity antemortem. Even though it often has a nontypical clinical course, it may overlap other systemic diseases. We describe an unusual case of splenic abscess with rare complications, the operation and the outcome.

Abscess↗
PubMed1984

Management of crush syndrome.

Our experience in treating seven patients with severe crush injury of the lower limbs is described. They were brought to hospital 12 h after rescue and had no treatment until then. All seven developed acute renal failure due to myoglobinuria and dehydration. Five were anuric and three non-oliguric. All developed severe sepsis and two had also acute respiratory failure. No bleeding tendency was observed. They were treated along the following lines: early extensive fasciotomy and removal of dead tissues; early fluid challenge; early peritoneal dialysis and/or hemodialysis; high caloric, high protein nutrition; vigorous antibiotic therapy when infection was evident. There were no deaths in our patients. Our management and results are discussed and compared with those in the literature.

Adolescent↗
PubMed1984

Prevention of acute renal failure in traumatic rhabdomyolysis.

Following the collapse of a building, seven subjects (aged 18 to 41 years) were released from under the rubble within one to 28 hours. All seven suffered from extensive crush injuries with evidence of severe rhabdomyolysis and were treated by the induction of an alkaline solute diuresis immediately on their extrication from the debris. The leakage of muscle constitutents was estimated by quantifying the net total body potassium losses, which averaged 395 mEq (SD, +/- 198) over the first 60 hours of therapy. In the past, injuries of similar severity have been associated with a high incidence of acute renal failure and a high mortality rate, yet none of our patients had azotemia or renal failure. We attribute this success to the unprecedented early institution of appropriate therapy.

Acid-Base Equilibrium↗
PubMed1984

Crush syndrome: experience from the Lebanon War, 1982.

Eight patients with crush syndrome were treated in our department during the Lebanon War, 1982. They arrived after having been trapped under fallen masonry for 4 to 28 h. They all had injuries of the lower limbs, with neurological deficiency and myoglobinuria. The local and general aspects of the syndrome are presented and discussed and a successful treatment protocol outlined.

Crush Syndrome↗
PubMed1983

Computerized medical reasoning in diagnosis and treatment of acid-base disorders.

A system is described for aiding the clinician in the management of acid-base disorders. The medical knowledge required for interpretation of blood gas measurements, etiologic diagnosis, and treatment selection for acid-base disorders is structured into decision pathways consisting of a series of inferences. Each inference is defined by a medical logic module which specifies the different combinations of criteria, patient data and/or previously confirmed inferences, sufficient for confirming or rejecting the inference. A method is provided for converting numerical observations to the appropriate logical statement used in the modules. Patient data are compared to the medical logic and a status report lists the input data, acid-base diagnosis, and the suggested therapy. After initial testing on patient data, the medical logic was updated to express the medical policy of our clinical specialists. The system was applied to 54 patients and the system's conclusions were in full agreement with our staff in 93% of the cases, and in partial agreement in the other cases. The modular structure of the system's medical knowledge allows full expression of all the nuances of medical policy in our unit and facilitates updating to encompass the latest developments in acid-base management. The system can be integrated readily into existing computerized patient monitoring systems.

Acid-Base Imbalance↗
PubMed1983

Energy metabolism rate equation for fasting and postabsorptive subjects.

The energy metabolism rate, an important parameter in severe clinical polytrauma and burns, is evaluated here using mass conservation law and simple thermodynamic considerations. The expressions for the energy and fat metabolism rates are evaluated utilizing easily measurable quantities: oxygen consumption, CO2 production, and nitrogen excretion rates. The derived equations are identical for the fasting and postabsorptive states, independent of feed composition. A new criteria for distinguishing between the fasting and postabsorptive states is suggested. These equations should help in evaluating energy metabolism rate for patients receiving continuous parenteral nutrition.

Calorimetry↗
PubMed1983

Saturation recompression therapy in a diving accident.

We report a case of cerebral air embolism caused by pulmonary barotrauma in a diver. Severe neurological symptoms, deterioration during decompression, and a prolonged, complicated, initial pressure profile indicated the need for saturation therapy. Few clinical cases treated by saturation recompression therapy (SRT) have been reported since its introduction in 1978 (1,5). SRT is an effective alternative for the management of complicated and persistent accidents involving intravascular bubbles.

Adult↗
PubMed1982

Effects on respiratory patterns during bronchoscopy by the Sanders attachment technique.

The purpose of this study was to rationalize the choice of injector and bronchoscope sizes during bronchoscopy under general anesthesia using the Sanders attachment technique. Arterial Po2 and Pco2, FIo2, and peak inspiratory pressure at the tip of the bronchoscope were plotted against the ratio (RI/B) of the internal diameters of the injector and the bronchoscope in seven dogs undergoing bronchoscopy under general anesthesia. Peak inspiratory pressure, FIo2, and PaO2, increased, and PaCO2 decreased with an increase in RI/B. A working table is proposed to predict the optimal RI/B.

Anesthesia, General↗
PubMed1981

Analysis of error in the determination of respiratory gas exchange at varying FIO2.

On-line gas exchange monitors have been based on the measurement of both inspired and expired flows (method A) or on the measurement of expired flow only (method B). In both methods, the cancellation of systematic errors is appreciable if calibration errors in the inspiration variables are matched with calibration errors in the corresponding expiration variables. The determination of oxygen consumption (VO2) results in a considerable amplification of random measurement error, which becomes larger as the inspired oxygen fraction (FIO2) is made larger. For example, when in method A all gas compositions and flows are in error by +/- 0.01, the computed value of VO2 will be in error by +/- 0.16 when FIO2 = 0.21 and by +/- 0.40 if FIO2 = 0.50. When air is breathed, method B creates smaller errors than method A, but as FIO2 is increased the error in method B increases sharply and eventually overtakes that of method A. Even at high FIO2 values, the random error in VO2 may be reduced to an acceptable value by estimating it from a sequence of 100 measurement samples requiring a minimum of 5 min to acquire. There is no error amplification in the computation of carbon dioxide production.

Carbon Dioxide↗
PubMed1980

Utilization of protein, carbohydrate, and fat in fasting and postabsorptive subjects.

Energy expenditure, carbohydrate, protein, fat utilization, as well as metabolic water production were evaluated in ten healthy adult volunteers in fasting and postabsorptive states. The values of the nonprotein respiratory quotient established whether the fasting or postabsorptive relationship was used in the computer program. After ingestion of a 900 kcal mixed meal, significant increases were observed for energy metabolism (P less than 0.01), carbohydrate utilization (P less than 0.001), and water production (P less than 0.001). The calculated lipid values suggested that fat was being synthesized in the postabsorptive state (P less than 0.001). No significant changes in protein utilization were found.

Adult↗
PubMed1980

Influence of varying inspired oxygen tensions on the pulmonary venous admixture (shunt) of mechanically ventilated patients.

Pulmonary venous admixture (shunt) was measured in 10 mechanically ventilated patients with respiratory failure at varying oxygen tensions. All patients manifested a drop in pulmonary shunt as FIO2 was increased from 0.21 to 0.4. Further increase in FIO2 led to a gradual increase in the calculated venous admixture. The clinical significance of the conventional measurements of pulmonary shunt at FIO2 = 1.0 is questionable because of the marked effect of FIO2 on pulmonary shunt. Consequently, shunt measurements should be performed with the clinically useful FIO2.

Humans↗
PubMed1980

Effect of positive end-expiratory pressure on intrapulmonary shunt at different levels of fractional inspired oxygen.

In 10 patients undergoing ventilation, venous admixture was measured at different values of positive end-expiratory pressure (PEEP). The measurements were performed at the level of fractional inspired oxygen (FIO2) at which each patient was ventilated, and at FIO2=1. In patients ventilated at FIO2 between 0.21 and 0.3 venous admixture was not modified by PEEP, while in patients ventilated with FIO2 between 0.4 and 0.6, venous admixture decreased significantly (p less than 0.01). With FIO2=1, increased PEEP produced a reduction in venous admixture in all cases (p less than 0.05). These observations suggest that in patients similar to ours, PEEP does not reduce venous admixture at low levels of FIO2 (0.21--0.3), and the observed reduction with PEEP at FIO2=1 may be misinterpreted.

Adult↗