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Biomedical subjects

S Gelb

Publications and source records attributed to S Gelb.

6 recordsLinked to original sources
PubMed1997

Stroke associated with cardiac surgery. Determinants, timing, and stroke subtypes.

OBJECTIVE: To determine the nature of strokes complicating cardiac surgery. DESIGN: A medical record review was undertaken of all patients who underwent cardiac surgery (either coronary bypass, valvular surgery, or both) between January 1990 and July 1995. Univariate and multivariate analyses were done using odds ratios (ORs) and logistic regression. RESULTS: A total of 2211 patients underwent cardiac surgery. A total of 44 patients (2%) had postoperative strokes. They were compared with 104 surgical controls. Univariate analysis revealed that the patients with stroke were significantly older and had significantly higher rates of transient ischemic attack, congestive heart failure, and peripheral vascular disease by history. A multivariate logistic regression revealed the significant variables associated with stroke were congestive heart failure (OR, 6.8) and transient ischemic attack (OR, 1.2). Analyses of surgical variables revealed that bypass pump time of more than 120 minutes (OR, 1.40) was the only significant predictor. The majority of strokes (61%) had occurred by postoperative day 2, but 39% occurred between postoperative days 3 to 9. Hemispheric syndromes occurred in 70%, brain stem and cerebellar syndromes in 14%, and lacunar syndromes in 16%. Computed tomographic scans revealed that 29 patients had new infarcts, of which 20 (69%) were territorial, 5 (17%) were small deep, and 4 (14%) were border zone. Hemorrhagic infarction was found in 2 cases (5%). One patient (2.5%) had a cardiorespiratory arrest while undergoing computed tomography. Discharge disposition was good in 88% of patients with stroke (12% with poor outcomes) vs 97% of controls with good outcomes (3% with poor outcomes) (P = .04). CONCLUSIONS: Strokes may be delayed following cardiac surgery perhaps because of ongoing risk of embolism or a hypercoagulable state. A surprisingly high proportion of patients have lacunar syndromes or small-deep infarcts shown on computed tomography. Early computed tomographic imaging may be useful to exclude hemorrhage if anticoagulation is considered, but is not without risk in these potentially unstable patients. Greater understanding of risk factors for stroke, timing, and subtypes may ultimately allow identification of patients at particularly high risk for perioperative stroke.

Aged↗
PubMed1997

The problem of typological thinking in mental retardation.

Despite the acceptance of evolutionary theory in the biological and social sciences, typological thinking--the belief that individual differences diverge around an underlying type or essence--has persisted. The most egregious example is J. H. Langdon Down's "ethnological classification of idiocy," taken seriously in the field for almost 80 years after its origin in 1866. Past and present controversies over the definition of mental retardation have turned on an unacknowledged typological axis. Some contemporary research on Down syndrome indicates that the allure of typology is still an obstacle to the appreciation of individual differences and human dignity in the field of mental retardation.

Humans↗
PubMed1989

Ibuprofen and acetaminophen in the relief of acute pain: a randomized, double-blind, placebo-controlled study.

To determine the relative analgesic efficacy of ibuprofen 400 mg and acetaminophen 1000 mg, we conducted a single-dose, double-blind, placebo-controlled, randomized clinical trial using a standard assay for analgesic agents, the dental pain model. At regular intervals over 6 hours, 184 patients who had undergone dental impaction surgery rated pain intensity and relief on categorical scales and pain half-gone on a dichotomous nominal scale; a categorical overall evaluation was completed at the end of 6 hours. Both active agents were effective compared to placebo. Ibuprofen 400 mg was more effective than acetaminophen 1000 mg for Sum Pain Intensity Difference (SPID), Total Pain Relief (TOTPAR), sum pain half-gone, and overall evaluation (P less than .05 to P less than .001). The time-effect curves demonstrated a greater peak effect and longer duration of action for ibuprofen 400 mg compared to acetaminophen 1000 mg. Side effects were reported in five ibuprofen patients, 11 acetaminophen-treated patients, and seven placebo patients. Based on the results of this clinical study, we conclude that ibuprofen 400 mg is a safe and more effective analgesic than acetaminophen 1000 mg for patients with acute pain.

Acetaminophen↗
PubMed1988

Spirometric abnormalities among asbestos insulation workers.

We studied the prevalence of spirometric changes among asbestos insulation workers to investigate when functional abnormalities appear during the course of asbestos employment and the influence of cigarette smoking. Of 1,249 eligible asbestos insulation workers in the New York-New Jersey metropolitan area, 1,117 (89.4%) were examined in the year 1963 to provide baseline pulmonary function status for long-term prospective observation. Forced vital capacity (FVC) was measured in all 1,117 workers and forced expiratory volume in 1 second (FEV1) in 613 workers (55%). Of 353 workers examined in the first 10 years after onset of exposure, 26 (7.4%) had FVC below 70% of predicted, a prevalence similar to that reported in nonexposed general populations. Prevalence increased with time from onset of exposure. Of the 117 workers examined 40 or more years after onset of exposure, 76 (55%) had FVC below 70% of predicted. A similar trend with time was shown for FEV1 and FEV1/FVC. Cigarette smoking had little influence on the prevalence of pure restrictive impairment. Cigarette smokers and non-cigarette smokers had much the same prevalence (28%) of moderate to severe reduction of FVC while the FEV1/FVC was normal. None of the non-cigarette smokers and five of the cigarette smokers had a predominantly obstructive pattern. One non-cigarette smoker and eight cigarette smokers showed reduction of both FVC and FEV1/FVC, consistent with a mixed ventilatory abnormality. The data demonstrate that asbestos alone without the additional effect of cigarette smoking has no measureable effect on the function of the large airways.

Adult↗
PubMed1984

Comparative efficacy of fenoprofen calcium and zomepirac sodium in postsurgical dental pain.

The relative analgesic efficacy of zomepirac sodium 100 mg and fenoprofen calcium 200 mg was evaluated in patients with pain due to surgical removal of dental impactions. This is the first study to make a direct comparison of their effectiveness. This study is especially important since zomepirac sodium was recently removed from the market as an analgesic for acute pain. Zomepirac sodium was extremely popular among clinicians and was considered the most effective of the peripherally acting analgesics. Patients were requested to take a single dose of study medication when they had moderate to severe pain. The study medications were identical in appearance and randomly allocated under double-blind conditions. The medication was evaluated over the next 4 hours according to subjective analgesic measurement scales. The primary measures of efficacy included total pain relief ( TOTPAR ), sum pain intensity difference ( SPID ), overall evaluation, and time to remedication . Of the 136 patients entered, 117 were included in the efficacy analysis. Both active agents demonstrated marked superiority to placebo (p less than 0.001) for all efficacy measures but were inseparable from each other. The mean analgesic efficacy values for both zomepirac sodium and fenoprofen calcium were almost identical. The nineteen subjects who reported side effects were evenly distributed among the three groups. No serious side effects occurred. The results of this study indicate that fenoprofen calcium 200 mg and zomepirac sodium 100 mg are equally efficacious, with similar onset, peak, and total analgesic effects.

Adult↗