Showing papers by "Rambam Health Care Campus published in 1986"
TL;DR: It is suggested that inexperienced physicians should first attempt central vein catheterizations in unconscious and mechanically ventilated patients, whereas in conscious patients these rates were 70.5% and 13.8%, respectively.
Abstract: • We prospectively studied the results of 714 attempts at central venous catheterization during an eight-month period in our intensive care department. We compared the rates of failure of catheterization and early complications among three percutaneous approaches: subclavian, anterior jugular, and posterior jugular veins. The procedures were performed by experienced staff or resident physicians and inexperienced interns and residents under teaching supervision. Overall rates of failure and complication were similar for each percutaneous approach within each group of physicians. Overall failure rate was 10.1% for the experienced group and 19.4% for the inexperienced. The complication was 5.4% for experienced and 11% for inexperienced. Among inexperienced physicians, the success rate was 86.7% and the complication rate 7.6% in unconscious patients, whereas in conscious patients these rates were 70.5% and 13.8%, respectively. The inexperienced physicians caused fewer complications in mechanically ventilated than in spontaneously breathing patients. We suggest that inexperienced physicians should first attempt central vein catheterizations in unconscious and mechanically ventilated patients. (Arch Intern Med1986;146:259-261)
621 citations
TL;DR: It is suggested that inexperienced physicians should first attempt central vein catheterizations in unconscious and mechanically ventilated patients, whereas in conscious patients these rates were 70.5% and 13.8%, respectively.
Abstract: • We prospectively studied the results of 714 attempts at central venous catheterization during an eight-month period in our intensive care department. We compared the rates of failure of catheterization and early complications among three percutaneous approaches: subclavian, anterior jugular, and posterior jugular veins. The procedures were performed by experienced staff or resident physicians and inexperienced interns and residents under teaching supervision. Overall rates of failure and complication were similar for each percutaneous approach within each group of physicians. Overall failure rate was 10.1% for the experienced group and 19.4% for the inexperienced. The complication was 5.4% for experienced and 11% for inexperienced. Among inexperienced physicians, the success rate was 86.7% and the complication rate 7.6% in unconscious patients, whereas in conscious patients these rates were 70.5% and 13.8%, respectively. The inexperienced physicians caused fewer complications in mechanically ventilated than in spontaneously breathing patients. We suggest that inexperienced physicians should first attempt central vein catheterizations in unconscious and mechanically ventilated patients. (Arch Intern Med1986;146:259-261)
389 citations
Journal Article•
TL;DR: The cardiodepressor effect of cholemia may explain the increased tendency of patients with obstructive jaundice to postoperative shock and renal failure and support a previously published in vitro study from the laboratory showing that Cholemia blunts the myocardial contractile response to sympathomimetic agents.
69 citations
Journal Article•
TL;DR: Assessment of phagocytosis and killing of Candida albicans by cultured monocyte-macrophages and granulocytes exposed to vit D and retinoic acid demonstrated that treated cells had the same capability to phagsocytose and kill C.A. as did untreated cells.
55 citations
Journal Article•
TL;DR: Assessment of phagocytosis and killing of Candida albicans by cultured monocytes-macrophages exposed to ARA-C demonstrated that treated cells had the same capacity to phagocytetose and kill CA as did untreated cells.
12 citations
TL;DR: The patient partially responded to craniospinal irradiation but succumbed to rapidly progressive myeloma 20 weeks following diagnosis of meningeal involvement.
Abstract: Concomitant occurrence of meningeal involvement and thoracic plasmacytoma was observed in a patient with IgA lambda myeloma. Cerebrospinal fluid analysis revealed IgA-lambda paraprotein and pathological plasma cells. CT scan of the chest and lumbar myelogram excluded spinal cord compression. The patient partially responded to craniospinal irradiation but succumbed to rapidly progressive myeloma 20 weeks following diagnosis of meningeal involvement.
10 citations
Journal Article•
TL;DR: P pokeweed mitogen-stimulated human spleen cells are determined to support the growth and proliferation of hemopoietic progenitors from normal and myelodysplastic syndrome patients, in the presence and absence of the maturation-inducing agents 13-cis-retinoic acid (RA) and 1,25-dihydroxyvitamin D3 (vit D).
Abstract: We determined the ability of pokeweed mitogen-stimulated human spleen cells to support the growth and proliferation of hemopoietic progenitors from normal and myelodysplastic syndrome (MDS) patients, in the presence and absence of the maturation-inducing agents 13-cis-retinoic acid (RA) and 1,25-dihydroxyvitamin D3 (vit D). The addition of various concentrations of vit D or RA to culture plates containing MDS patients' marrow cells stimulated myeloid colony growth. A higher number of myeloid colony-forming units-cell was noted in cultures containing vit D or RA in addition to pokeweed mitogen spleen-conditioned medium compared to these substances and placenta conditioned medium. When colony-forming units-cell from MDS patients was incubated with 2 X 10(-8) M vit D the percentage of monocyte-macrophage colonies was increased and the number of granulocyte colonies was decreased. Neither vit D nor RA affected the number of cells per colony. Our findings suggest that pokeweed mitogen spleen-conditioned medium provides a more potent source than placenta-conditioned medium for humoral factors that stimulate the growth of hemopoietic progenitors from MDS patients and that the use of pokeweed mitogen spleen-conditioned medium may improve studies of hemopoiesis in MDS patients.
5 citations
Journal Article•
3 citations
TL;DR: The patient had no abnormality that could be related to a known allcrgic disease, and no relationship to drug hypersensitivity could be established, which may suggest a linkage between EFHBM and the monoclonal gammopathy.
Abstract: We describe a 63-year-old male patient with severe osteoporosis, multiple lytic bone lesions, and monoclonal gammopathy (IgG lambda). Whereas the tentative diagnosis in this case was multiple myeloma, bone marrow trephine biopsies of the iliac crest and from an osteolytic lesion of the tibia both showed a peculiar infiltrate consisting of numerous elongated mast cells, eosinophils, and some plasma cells and lymphocytes. The bone marrow lesions fit the diagnosis of eosinophilic fibrohistiocytic lesion of bone marrow (EFHBM). The patient had no abnormality that could be related to a known allergic disease, and no relationship to drug hypersensitivity could be established. The features of the bone marrow infiltrate and its association with monoclonal gammopathy may suggest a linkage between EFHBM and the monoclonal gammopathy.
3 citations
TL;DR: Two patients with agnogenic myeloid metaplasia and refractory hemolytic anemia in whom pericardial effusion appeared a few days after splenectomy are described and the possible pathophysiologic mechanism is discussed.
Abstract: • Self-limited sympathetic pleural effusion is a well-known nonspecific sequela following any upper abdominal surgery, including splenectomy. However, to our knowledge, there is no report in the literature on sympathetic pericardial effusion immediately following splenectomy. We describe two patients with agnogenic myeloid metaplasia and refractory hemolytic anemia in whom pericardial effusion appeared a few days after splenectomy. The possible pathophysiologic mechanism is discussed. ( Arch Intern Med 1986;146:600-601)