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Biomedical subjects

T J Iberti

Publications and source records attributed to T J Iberti.

At least 55 records · Page 3Linked to original sources
PubMed1987

Control of catecholamine-induced tachycardia with alinidine in the anesthetized dog.

Sinus tachycardia is a common complication of beta-adrenergic agonist therapy. A new selective bradycardic agent, N-allyl-clonidine, or alinidine, has been found effective against sinus tachycardia caused by a variety of stimuli. To determine whether it would also control catecholamine-induced sinus tachycardia, the effects of alinidine in two groups of anesthetized dogs treated with either dobutamine, 10 microg/ kg/min, or isoproterenol, 0.1 microg/kg/min, were studied. In both groups, alinidine significantly reduced the heart rate (P < .0001 in the dobutamine group, and P < .005 in the isoproterenol-infused dogs). The other hemodynamic effects of dobutamine were not adversely affected by alinidine, while the isoproterenol-infused dogs had a further afterload reduction when treated with alinidine. It is concluded that alinidine is effective against catecholamine-induced sinus tachycardia, possibly through mechanisms not related to beta-adrenergic receptors.

Adrenergic beta-Agonists↗
PubMed1987

Venous hypercarbia in canine hemorrhagic shock.

The venous-arterial PCO2 gradient may increase in certain low-flow states, such as CPR and canine endotoxemia. To determine whether venous hypercarbia also occurs in hemorrhagic shock, we studied 12 anesthetized, mechanically ventilated dogs. We performed laparotomies on the animals, inserting catheters into their renal, superior mesenteric, and external iliac veins. Flow in the corresponding arteries were determined using electromagnetic flow probes. The dogs were randomized into a control group (n = 6), and a hemorrhagic shock group (n = 6) which was bled to a mean arterial pressure of 45 to 50 mm Hg and maintained at this pressure for the 6-h study. The results demonstrated a significant (p less than .05) increase in lactate and venous-arterial PCO2 gradient systemically and in all three regional beds. A significant decrease of venous blood pH accompanied these changes which are consistent with our previous findings in low-flow, canine endotoxemia. We conclude that venous hypercarbia is a nonspecific phenomenon, common to low-flow states. The increased CO2 represents both an increased CO2 production and a decreased removal, secondary to low-flow.

Animals↗
PubMed1987

A simple technique to accurately determine intra-abdominal pressure.

The determination of intra-abdominal pressure (IAP) may be useful in a variety of clinical situations. Despite this, invasive IAP monitoring is seldom performed due to the risks involved. Using a standard canine model of increased IAP, we evaluated the accuracy of transurethral bladder catheter pressure in reflecting IAP. Throughout the range of IAP studied (10 +/- 5 to 70 +/- 10 mm Hg), bladder pressure did not differ significantly from the direct measurement of IAP. We conclude that the measurement of bladder pressure using a standard transurethral bladder catheter provides an accurate determination of IAP.

Abdomen↗
PubMed1986

Thrombocytopenia following peritonitis in surgical patients. A prospective study.

Thrombocytopenia is commonly found in patients with serious infection. To investigate this phenomenon, 14 consecutive patients (68 +/- 10 years) who underwent laparotomy for bowel perforation and culture-proven peritonitis were prospectively studied. Ten noninfected laparotomy patients served as a control group. None of the 10 control patients developed thrombocytopenia. Of the infected group, 12 of 14 patients (85%) developed thrombocytopenia (less than 100,000/mm3). One patient (9%) developed disseminated intravascular coagulation (DIC). Of the remaining 11 patients with thrombocytopenia, platelet counts fell from preoperative level of 350,000 +/- 166,000 to 54,000 +/- 30,000 (p less than 0.001) and reached this nadir 4.3 +/- 2 days after surgery. There was no statistically significant difference in prothrombin time, partial thromboplastin time, or fibrinogen levels before versus after operation in this group. Bleeding times in seven patients were 5.5 +/- 2 minutes, and bone marrow examination in five patients with platelet counts of less than 50,000/mm3 revealed normal or increased megakaryocytes. No patient in this group bled, had medications held, or received platelet transfusions. Platelet counts increased greater than 100,000/mm3 at a mean of 8.9 +/- 4.1 days after operation. It is concluded that thrombocytopenia is common following surgery for intra-abdominal infection, is not usually associated with DIC, clinical bleeding, or coagulation abnormalities, does not commonly result from bone marrow suppression, and is transient and does not require routine platelet transfusions.

Disseminated Intravascular Coagulation↗
PubMed1986

Use of constant-infusion verapamil for the treatment of postoperative supraventricular tachycardia.

The effects of constant-infusion verapamil were studied in ten postoperative ICU patients who developed supraventricular tachycardia (atrial fibrillation) with rapid ventricular response rates. A 5-mg iv bolus dose of verapamil was followed by a 5-mg/h infusion that continued for 8 h. Ventricular rates were significantly (p less than .005) reduced from a pretreatment mean of 156 +/- 14 (SD) to 104 +/- 9 beat/min on constant-infusion therapy. This therapy was well tolerated without observed side-effects. Moreover, constant-infusion verapamil might avoid the hypotension and wide range of ventricular rates frequently encountered with repeated bolus doses of verapamil.

Aged↗
PubMed1985

Ventricular arrhythmias during pulmonary artery catheterization in the intensive care unit. Prospective study.

The balloon-tipped, flotation pulmonary artery catheter is frequently utilized in the management of intensive care unit patients. Advanced ventricular arrhythmias (three or more consecutive premature ventricular contractions) have been reported in 25 to 68 percent of intensive care unit patients undergoing catheterizations. A group of 56 intensive care unit patients who received a pulmonary artery catheter were prospectively studied to determine the incidence of catheter-induced arrhythmias and the time required for catheterization. The mean age of the patients was 69.8 +/- 11 years. Indications for catheterization included septic shock (n = 10), congestive heart failure (n = 8), hypovolemia (n = 12), respiratory failure (n = 2), preoperative cardiac evaluation (n = 20), and miscellaneous (n = 4). Advanced ventricular arrhythmias were recorded in seven of the 56 patients (12.5 percent), the longest arrhythmia being a run of seven consecutive premature ventricular contractions. No patient required treatment with lidocaine for their arrhythmias and all arrhythmias resolved with catheter movement. The mean time of catheterization for the 56 patients was 175.9 seconds (SD 263.2), and was not significantly different for patients with or without arrhythmias. There was no statistical difference in catheterization times or incidence of arrhythmias between critically ill patients and the preoperative patients. It is concluded that pulmonary artery catheterization can be performed in critically ill patients with a lower incidence of arrhythmias than has previously been reported. The decreased incidence of arrhythmias may be secondary to the decreased catheterization times.

Aged↗
PubMed1985

American medical education. Has it created a Frankenstein?

The solutions to the problems cited and to many others regarding medical education in America are not simple ones. But it is clearly time to recognize that this system is failing to produce physicians that best meet the needs of the patient, society, and the medical field in general. It is essential for those of us involved in medical education to recognize these facts and to make major changes to help correct them. Failure to do so will only increase the severity of the problems.

Education, Medical↗
PubMed1985

Hemodynamic effects of verapamil in the beta-blocked dog.

The use of the calcium channel-blocking agent, verapamil, in beta-blocked patients has been the subject of intense investigation, particularly because both verapamil and the beta-blockers can produce negative inotropic effects. We studied the hemodynamic effects of verapamil in beta-blocked dogs to establish specific measurements that could be used clinically for early identification of combined negative inotropism. Seven anesthetized, mongrel dogs were beta-blocked with propranolol, and then given 2.5-, 5.0-, and 10.0-mg iv boluses of verapamil. The 2.5- and 5.0-mg boluses represent clinical doses, whereas the 10.0-mg bolus is a large pharmacologic dose. Hemodynamic measurements showed that verapamil was well tolerated at clinical doses; increases in stroke volume compensated for decreases in mean arterial pressure. At high doses of verapamil this response was not observed and left ventricular stroke work decreased. Cardiac and stroke indices were not useful indicators of combined drug toxicity in this dog model.

Animals↗
PubMed1984

Percutaneous catheterization of the brachial vein for central venous access.

A method of percutaneous central venous catheterization involving the brachial vein is described. A constant anatomic location and large diameter of brachial vein render a high chance of successful veinpuncture. The gradual increasing size of venous catheters with initial small needle puncture minimizes the possibility of a complication. This technique is recommended when usual percutaneous central venous access is not available.

Arm↗
PubMed1984

Prolonged bromide intoxication resulting from a gastric bezoar.

Bromide intoxication is now a relatively uncommon disease. We describe a critically ill patient who had an elevated chloride level and neurologic abnormalities. Bromide levels were also elevated, and remained so for several days. After more than 12 days of abnormally high serum bromide and chloride levels, endoscopy was performed. This procedure disclosed a gastric bezoar containing identifiable pill fragments. The gastric washings from these fragments contained high levels of bromide. We believe that the prolonged course of bromide intoxication secondary to a gastric bezoar makes this case unique.

Adult↗