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Biomedical subjects

S L Brody

Publications and source records attributed to S L Brody.

12 recordsLinked to original sources
PubMed1992

Do-not-resuscitate orders in the emergency department.

PURPOSE: To evaluate the nature of the decision to write a do-not-resuscitate (DNR) order in the Emergency Department (ED). PATIENTS AND METHODS: This is a prospective evaluation of 37 consecutive patients for whom a DNR order was written by personnel assigned to the ED of a large inner-city teaching hospital. For each patient, information was collected including who was involved in the decision, the difficulty the family or patient had in agreeing to the DNR order, acute and chronic problems, how often the patient could enter into the process, and the ultimate outcome. RESULTS: DNR orders were usually initiated by house officers assigned to the ED (65%), and the family was usually involved (89%, mean of 1.4 family members per patient). There were no cases where significant resistance to the DNR order was exhibited by the family. The patients were generally elderly, demented, and debilitated with multiple chronic medical problems or young with malignancy or the acquired immunodeficiency syndrome and had become critically ill and unstable. Only five patients were able to enter into the decision. Discussion of DNR status had occurred previously in only 14% of patients. CONCLUSION: Because there remains considerable reluctance on the part of physicians to discuss the DNR issue before patients become critically ill, it is often necessary for ED physicians to write a DNR order. Although the ED is not an ideal setting for discussion of DNR orders and patients and families do not generally initiate this discussion, DNR orders can be written by ED physicians after consultation with the family.

Adult↗
PubMed1991

Respiratory tract gene transfer. Transplantation of genetically modified T-lymphocytes directly to the respiratory epithelial surface.

To evaluate the strategy for potentially treating respiratory disorders with genetically modified T-lymphocytes, the interleukin-2 (IL-2)-dependent murine T-cell line, CTLL2, was genetically altered with the Escherichia coli beta-galactosidase (beta-gal) gene (lacZ) in vitro with a retroviral vector and the modified T-cells were transplanted directly to the respiratory epithelial surface of syngeneic C57Bl/6 mice. Southern and Northern analyses confirmed that the neomycin-selected modified T-cells contained and expressed the lacZ gene. The fate of the modified T-cells (CTLL2/lacZ) was followed by flow cytometry with T-cell surface marker Thy1.2 and fluorescent beta-gal analysis. One day after transplantation (7.5 x 10(5) CTLL2/lacZ T-cells/g of body weight), 95 +/- 3% of the Thy1.2+ T-cells recovered from respiratory epithelial lining fluid (ELF) were beta-gal+. Importantly, the modified T-cells remained in the lung for some time; at 3 days, Thy1.2+ beta-gal+ T-cells represented 63 +/- 12% of ELF Thy1.2+ T-cells and 59 +/- 6% of Thy1.2+ T-cells recovered from the whole lung. At 7 days, 33 +/- 8% of the Thy 1.2+ cells in ELF and 75 +/- 6% of the Thy1.2+ cells in whole lung were Thy1.2+ beta-gal+. In contrast, the proportion of the Thy1.2+ beta-gal+ T-cells in the spleen, the major extrapulmonary lymphatic organ, never rose above 3 +/- 1% of the total Thy1.2+ cells. The number of Thy1.2+ beta-gal+ T-cells in the lung could be modified by the systemic administration of IL-2, with whole lung Thy1.2+ beta-gal+ T-cells increasing 4.6-fold 3 days after transplantation, compared with non-IL-2-treated animals. These studies suggest that direct transplantation of genetically modified T-cells into the lung is feasible and represents a viable strategy for lung-specific gene transfer.

Animals↗
PubMed1991

Experience with esmolol for the treatment of cocaine-associated cardiovascular complications.

The authors report their experience using esmolol, an ultra-short acting beta-adrenergic antagonist, for the treatment of seven patients with cocaine-associated cardiovascular complications. No consistent hemodynamic benefit was found with the use of this drug. Although there was a decline in mean heart rate of 23% (range 0% to 35%), they were unable to show a consistent antihypertensive response. Adverse effects occurred in three patients. This included one patient with a marked exacerbation of hypertension and one who became hypotensive. Another patient developed emesis and lethargy during esmolol therapy and required endotracheal intubation. They do not recommend the routine use of esmolol for cocaine cardiotoxicity.

Adrenergic beta-Antagonists↗
PubMed1990

Cocaine-related medical problems: consecutive series of 233 patients.

PURPOSE: Little information describing common cocaine-related medical problems is available. This study examined the nature, frequency, treatment, incidence of complications, and emergency department deaths of patients seeking medical care for acute and chronic cocaine-associated medical problems. PATIENTS AND METHODS: A consecutive series of 233 hospital visits by 216 cocaine-using patients over a 6-month period during 1986 and 1987 was studied. Medical records were retrospectively reviewed to determine patient characteristics, nature of complications, treatment, and outcome. RESULTS: Patients most commonly used cocaine intravenously (49%), but freebase or crack use was also common (23.3%). Concomitant abuse of other intoxicants, especially alcohol, was frequently seen (48.5%). The vast majority of complaints were cardiopulmonary (56.2%), neurologic (39.1%), and psychiatric (35.8%); multiple symptoms were often present (57.5%). The most common complaint was chest pain though rarely was it believed to represent ischemia. Altered mental status was common (27.4%) and ranged from psychosis to coma. Short-term pharmacologic intervention was necessary in only 24% of patients, and only 9.9% of patients were admitted. Acute mortality was less than 1%. CONCLUSION: Most medical complications of cocaine are short-lived and appear to be related to cocaine's hyperadrenergic effects. Patients usually do not require short-term therapy or hospital admission. Acute morbidity and mortality rates from cocaine use in patients presenting to the hospital are very low, suggesting that a major focus in the treatment of cocaine-related emergencies should be referral for drug abuse detoxification and treatment.

Adolescent↗
PubMed1990

Predicting the severity of cocaine-associated rhabdomyolysis.

STUDY OBJECTIVES: The syndrome of rhabdomyolysis associated with cocaine use has been recently described, but the incidence, severity, risk factors, and complications are unknown. This study sought to describe the spectrum of the syndrome and identify clinical features of patients at risk. DESIGN: Retrospective case series with analysis of common clinical features. SETTING: Medical emergency department of an urban teaching hospital serving an indigent population. TYPES OF PARTICIPANTS: ED patients with acute cocaine intoxication and a serum creatine kinase (all MM) of more than 500 U/L (8.3 ukat/L) who were admitted for in-hospital management. MEASUREMENTS AND MAIN RESULTS: Twenty-nine patients, representing 5% of cocaine-related patient visits, were identified over 20 months. Patients were divided into three groups: mild, characterized by anxiety, tachycardia, diaphoresis, dyspnea, or chest pain; moderate, characterized by delirium, agitation, fever, leukocytosis, or an elevated serum creatinine; and severe, characterized by seizure, coma, hypotension, arrhythmia, or cardiac arrest. There was a significant association between the rating system for level of intoxication and the severity of rhabdomyolysis and its complications (P less than .01). Patients at highest risk for complications of rhabdomyolysis were those in the moderate or severe groups. CONCLUSION: This classification system may be useful for the management of patients with acute cocaine intoxication, predicting those patients in whom aggressive therapy should be initiated in the ED to minimize the complications of rhabdomyolysis.

Adult↗
PubMed1988

Pneumomediastinum as a complication of "crack" smoking.

Three cases of pneumomediastinum related to smoking cocaine in the form of "crack" are presented. The patients complained of chest or neck pain occurring 1 to 6 hours after smoking crack. All three did not immediately divulge a history of cocaine use. There was spontaneous resolution of pneumomediastinum in every case, and the creation of pneumomediastinum appeared to be directly related to the route of drug use. The abuse of crack and the mechanism of spontaneous pneumomediastinum are discussed.

Adult↗
PubMed1987

Acute myocardial infarction temporally related to cocaine use. Clinical, angiographic, and pathophysiologic observations.

Ischemic chest pain syndromes and myocardial infarction occurred within minutes to hours of cocaine use in nine persons ages 23 to 39 years. Five developed symptoms after taking cocaine intranasally; three, after intravenous use; and one, after smoking cocaine. Four were habitual users and five were recreational users; eight also smoked cigarettes heavily. Ischemic syndromes recurred in five who continued to use cocaine. Coronary arteriography showed an abnormal infarct-related vessel (more than 50% stenosis, total occlusion, or intraluminal thrombus) in seven patients. The noninfarct-related vessels were normal in eight patients. The left anterior descending coronary artery and the anteroapical left-ventricular wall were involved in all patients. After three patients had successful thrombolysis of the obstructed infarct-related vessel, angiography showed a normal underlying vessel.

Adult↗
PubMed1978

Myocardial imaging using emission computed tomography.

Single-photon emission computed tomography (ECT) was evaluated during myocardial studies in dogs. Acute anterior and posterior infarcts were imaged following injection of 99mTc-pyrophosphate or 201Tl. In most cases, tomographic delineation of infarct location and extent correlated with tissue section. The 99mTc images were far superior to the 201Tl images. ECT improves delineation of tracer within the myocardium.

Animals↗
PubMed1978

Myocardial infarct quantification in the dog by single photon emission computed tomography.

Radionuclide techniques for sizing acute myocardial infarction have been hampered by the intrinsic limitations of the scintillation camera. Emission computed tomography can overcome these limitations. Single photon emission computed tomograms of the distribution of technetium-99m pyrophosphate in acute anterior and posterior infarcts were obtained in 16 dogs after death. Tomograms were also obtained in 10 dogs during life without gating. The size of the infarcts was determined by staining gross sections of the heart with nitro blue tetrazolium, dissecting out the infarcted tissue and weighing it. Infarct sizes were determined from the tomographic images and compared with the measured infarct sizes. Good images showing the location and three-dimensional extent of the infarcts were obtained in all dogs. The measured and calculated infarct sizes correlated well (r = 0.85). Comparison of the calculated sizes in the living (non-gated) and dead ("physiologically" gated) animals showed reasonable agreement (r = 0.87). Single photon emission computed tomography is a feasible and useful technique for localizing and sizing acute myocardial infarctions.

Animals↗
PubMedDate not supplied

Cassaine: mechanism of inhibition of Na+ +K+ -ATPase and relationship of this inhibition to cardiotonic actions.

The erythrophleum alkaloid cassaine shares many of the pharmacological actions of the cardiac glycosides but lacks the structural characteristics typical of cardiac glycosides. To further investigate the relationship between Na+ +K+ -ATPase inhibition and the cardiotonic actions of these drugs we investigated the interaction of cassaine with the Na+ +K+ -ATPase. Cassaine inhibited rat brain Na+ +K+ -ATPase with about one quarter of the apparent affinity of ouabain for this enzyme. This inhibition was non-competitive with respect to K+. Cassaine also inhibited this enzyme in the presence of Mg2+ and this inhibition was enhanced by Pi and antagonized by Na+. In the presence of Na+, Mg2+ and (gamma-32P)-ATP cassaine acted to stabilize the phosphorylated intermediate of Na+ +K+ -ATPase. Cassaine also acted to displace specifically bound (3H)-ouabain from this enzyme. These observations suggested that cassaine inhibited the Na+ +K+ -ATPase by interacting at the cardiotonic steroid binding sites of Na+ +K+ -ATPase. Consistent with this hypothesis, dog, guinea pig and rat heart Na+ +K+ -ATPase showed differing sensitivities to cassaine paralleling their differing sensitivities to ouabain. The principal difference between the interaction of cassaine and ouabain with Na+ +K+ -ATPase appeared to be the more rapid dissociation of cassaine from the cardiotonic steroid binding site(s) of Na+ +K+ -ATPase. In keeping with this the rates of offset of cassaine-induced inotropy in Langendorff perfused dog and guinea pig hearts were several times faster than those of ouabain-induced inotropy.

Abietanes↗