A literature search at Indiana University, Bloomington, Indiana
The following MEDLINE items were compiled using SilverPlatter and are presented here with their generous co-operation and permission. (See SilverPlatter's Worldwide Library for bibliographic search information.)
MEDLINE EXPRESS (R) 10/97-11/97 1 of 44
TI: From "The ethical treatment of patients in a persistent vegetative state" to a philosophical reflection on contemporary medicine.
AU: Lamau-ML; Cadore-B; Boitte-P
AD: Centre d'Ethique Medicale, Universite Catholique de Lille, France.
SO: Theor-Med. 1997 Sep; 18(3): 237-62
ISSN: 0167-9902
PY: 1997
LA: ENGLISH
CP: NETHERLANDS
AB: The reflections put forward in this text concern the clinical and practical difficulties posed by the existence of patients in PVS, and the essential ethical issues raised, combining these ethical questions with practical and theoretical experience. Section 1 presents the methodology of the ethical reflection as we see it. Section 2 describes the clinical condition of patients in PVS. Section 3 develops the ethical difficulties relative to PVS from the French point of view. Section 4 illustrates the relevance of debating the ethical significance of such problematic situations, whilst defending a practical position based on a philosophical conviction. Section 5 points out the limits of ethical reflection in a biomedical context, and calls for reflection closer to the source of the problems described. For a comprehensive appraisal of biomedical rationality, the final section suggests combining the bioethical debates with traditional philosophical ethical reflection so as to get a clearer understanding of the real, if limited, relevance of these debates.
MESH: Attitude-of-Health-Personnel; Caregivers-psychology; Coma-rehabilitation; Culture-; France-; Morals-; Pain-; Physician-Patient-Relations
MESH: *Ethics,-Medical; *Persistent-Vegetative-State-therapy
TG: Human
PT: JOURNAL-ARTICLE
AN: 97417858
UD: 9711
MEDLINE EXPRESS (R) 10/97-11/97 2 of 44
TI: alpha, beta-Arteether for the treatment of complicated falciparum malaria.
AU: Mohanty-S; Mishra-SK; Satpathy-SK; Dash-S; Patnaik-J
AD: Department of Internal Medicine, Ispat General Hospital, Rourkela, India.
SO: Trans-R-Soc-Trop-Med-Hyg. 1997 May-Jun; 91(3): 328-30
ISSN: 0035-9203
PY: 1997
LA: ENGLISH
CP: ENGLAND
AB: alpha, beta-Arteether is an ethyl ether derivative of artemisinin which is an efficient schizontocidal drug in mild falciparum malaria. The present study reports the efficacy of the drug in severe falciparum malaria. Fifty patients with severe falciparum malaria were given intramuscular arteether, 150 mg, once daily on 3 consecutive days. The median fever clearance time was 72 h (range 12-120 h) and the median parasite clearance time was 2 d (range 1-4 d). Rapid recovery from coma was observed in cerebral malaria patients (after a median of 18 h, range 6-72 h). The recovery from other complications was also faster and complete. Two patients died; both had cerebral malaria and haemolytic jaundice, one had respiratory distress needing ventilatory support and the other had severe anaemia. Recrudescence within 28 d was observed in 7 patients. Drug toxicity or significant side effects were not noticed in any patient.
MESH: Coma-therapy; Fever-therapy; Injections,-Intramuscular; Malaria,-Cerebral-drug-therapy; Malaria,-Falciparum-parasitology; Time-Factors; Treatment-Outcome
MESH: *Antimalarials-therapeutic-use; *Malaria,-Falciparum-drug-therapy; *Sesquiterpenes-therapeutic-use
TG: Human
PT: CLINICAL-TRIAL; CLINICAL-TRIAL,-PHASE-III; JOURNAL-ARTICLE
RN: 0; 0; 109716-83-8
NM: Antimalarials; Sesquiterpenes; arteether
AN: 97374761
UD: 9710
MEDLINE EXPRESS (R) 10/97-11/97 3 of 44
TI: Brain tissue pO2-monitoring in comatose patients: implications for therapy.
AU: Kiening-KL; Hartl-R; Unterberg-AW; Schneider-GH; Bardt-T; Lanksch-WR
AD: Virchow-Medical Center, Department of Neurosurgery, Humboldt-University of Berlin, Germany.
SO: Neurol-Res. 1997 Jun; 19(3): 233-40
ISSN: 0161-6412
PY: 1997
LA: ENGLISH
CP: ENGLAND
AB: Monitoring of brain tissue partial pressure of O2 (ti-pO2) is a promising new technique that allows early detection of impending cerebral ischemia in brain-injured patients. The purpose of this study was to investigate the effects of standard therapeutic interventions used in the treatment of intracranial hypertension in comatose patients on cerebral oxygenation. In the neurosurgical intensive care unit ti-pO2, arterial blood pressure, intracranial pressure (ICP), cerebral perfusion pressure (CPP) and jugular bulb oxygen saturation (SjvO2) were prospectively studied (0.1 Hz acquisition rate) in 23 comatose patients (21 with severe traumatic brain injury, 2 with intracerebral hematoma) during various treatment modalities: elevation of CPP with dopamine (n = 35), lowering of the head (n = 22), induced arterial hypocapnia (n = 13), mannitol infusion (n = 16), and decompressive craniotomy (n = 1). Ischemic episodes ('IE' = ti-pO2 < 10 mmHg for > 15 min) within the first week after the insult were always associated with unfavorable neurological outcome. Elevation of CPP from 32 +/- 2 to 67 +/- 4 mmHg significantly improved ti-pO2 by 62% (13 +/- 2 to 21 +/- 1 mmHg) and reduced ICP indicating intact cerebral autoregulation. Further raising CPP from 68 +/- 2 to 84 +/- 2 mmHg did not alter ti-pO2. Mannitol-induced ICP reduction from 23 +/- 1 to 16 +/- 2 mmHg did not affect ti-pO2, nor did lowering of the head from 30 degrees to 0 degree. Hyperventilation from an endtidal pCO2 of 29 +/- 3 to 21 +/- 3 mmHg normalized ICP and CPP, but significantly reduced ti-pO2 from 31 +/- 2 to 14 +/- 3 mmHg. Decompressive craniotomy in a 15-year old patient with refractory intracranial hypertension instantly restored ti-pO2. Based on the present data, our understanding of many interventions previously believed to improve brain oxygenation might have to be re-evaluated. A CPP > 60 mmHg emerges as the most important factor determining sufficient brain tissue pO2. Any intervention used to further elevate CPP does not improve ti-pO2, to the contrary, hyperventilation even bears the risk of inducing brain ischemia.
MESH: Adolescence-; Adult-; Aged-; Brain-blood-supply; Brain-metabolism; Brain-surgery; Brain-Injuries-complications; Brain-Injuries-metabolism; Cerebral-Anoxia-etiology; Cerebrovascular-Circulation; Coma-etiology; Coma-metabolism; Data-Interpretation,-Statistical; Decompression,-Surgical; Head-Down-Tilt; Hyperventilation-complications; Hypocapnia-complications; Intracranial-Pressure-drug-effects; Mannitol-administration-and-dosage; Middle-Age; Monitoring,-Physiologic; Partial-Pressure; Respiration,-Artificial-adverse-effects; Treatment-Outcome
MESH: *Brain-Chemistry; *Brain-Injuries-therapy; *Coma-therapy; *Oxygen-analysis
TG: Female; Human; Male; Support,-Non-U.S.-Gov't
PT: JOURNAL-ARTICLE
RN: 69-65-8; 7782-44-7
NM: Mannitol; Oxygen
AN: 97335706
UD: 9710
MEDLINE EXPRESS (R) 10/97 4 of 44
TI: alpha, beta-Arteether for the treatment of complicated falciparum malaria.
AU: Mohanty-S; Mishra-SK; Satpathy-SK; Dash-S; Patnaik-J
AD: Department of Internal Medicine, Ispat General Hospital, Rourkela, India.
SO: Trans-R-Soc-Trop-Med-Hyg. 1997 May-Jun; 91(3): 328-30
ISSN: 0035-9203
PY: 1997
LA: ENGLISH
CP: ENGLAND
AB: alpha, beta-Arteether is an ethyl ether derivative of artemisinin which is an efficient schizontocidal drug in mild falciparum malaria. The present study reports the efficacy of the drug in severe falciparum malaria. Fifty patients with severe falciparum malaria were given intramuscular arteether, 150 mg, once daily on 3 consecutive days. The median fever clearance time was 72 h (range 12-120 h) and the median parasite clearance time was 2 d (range 1-4 d). Rapid recovery from coma was observed in cerebral malaria patients (after a median of 18 h, range 6-72 h). The recovery from other complications was also faster and complete. Two patients died; both had cerebral malaria and haemolytic jaundice, one had respiratory distress needing ventilatory support and the other had severe anaemia. Recrudescence within 28 d was observed in 7 patients. Drug toxicity or significant side effects were not noticed in any patient.
MESH: Coma-therapy; Fever-therapy; Injections,-Intramuscular; Malaria,-Cerebral-drug-therapy; Malaria,-Falciparum-parasitology; Time-Factors; Treatment-Outcome
MESH: *Antimalarials-therapeutic-use; *Malaria,-Falciparum-drug-therapy; *Sesquiterpenes-therapeutic-use
TG: Human
PT: CLINICAL-TRIAL; CLINICAL-TRIAL,-PHASE-III; JOURNAL-ARTICLE
RN: 0; 0; 109716-83-8
NM: Antimalarials; Sesquiterpenes; arteether
AN: 97374761
UD: 9710
MEDLINE EXPRESS (R) 10/97 5 of 44
TI: Brain tissue pO2-monitoring in comatose patients: implications for therapy.
AU: Kiening-KL; Hartl-R; Unterberg-AW; Schneider-GH; Bardt-T; Lanksch-WR
AD: Virchow-Medical Center, Department of Neurosurgery, Humboldt-University of Berlin, Germany.
SO: Neurol-Res. 1997 Jun; 19(3): 233-40
ISSN: 0161-6412
PY: 1997
LA: ENGLISH
CP: ENGLAND
AB: Monitoring of brain tissue partial pressure of O2 (ti-pO2) is a promising new technique that allows early detection of impending cerebral ischemia in brain-injured patients. The purpose of this study was to investigate the effects of standard therapeutic interventions used in the treatment of intracranial hypertension in comatose patients on cerebral oxygenation. In the neurosurgical intensive care unit ti-pO2, arterial blood pressure, intracranial pressure (ICP), cerebral perfusion pressure (CPP) and jugular bulb oxygen saturation (SjvO2) were prospectively studied (0.1 Hz acquisition rate) in 23 comatose patients (21 with severe traumatic brain injury, 2 with intracerebral hematoma) during various treatment modalities: elevation of CPP with dopamine (n = 35), lowering of the head (n = 22), induced arterial hypocapnia (n = 13), mannitol infusion (n = 16), and decompressive craniotomy (n = 1). Ischemic episodes ('IE' = ti-pO2 < 10 mmHg for > 15 min) within the first week after the insult were always associated with unfavorable neurological outcome. Elevation of CPP from 32 +/- 2 to 67 +/- 4 mmHg significantly improved ti-pO2 by 62% (13 +/- 2 to 21 +/- 1 mmHg) and reduced ICP indicating intact cerebral autoregulation. Further raising CPP from 68 +/- 2 to 84 +/- 2 mmHg did not alter ti-pO2. Mannitol-induced ICP reduction from 23 +/- 1 to 16 +/- 2 mmHg did not affect ti-pO2, nor did lowering of the head from 30 degrees to 0 degree. Hyperventilation from an endtidal pCO2 of 29 +/- 3 to 21 +/- 3 mmHg normalized ICP and CPP, but significantly reduced ti-pO2 from 31 +/- 2 to 14 +/- 3 mmHg. Decompressive craniotomy in a 15-year old patient with refractory intracranial hypertension instantly restored ti-pO2. Based on the present data, our understanding of many interventions previously believed to improve brain oxygenation might have to be re-evaluated. A CPP > 60 mmHg emerges as the most important factor determining sufficient brain tissue pO2. Any intervention used to further elevate CPP does not improve ti-pO2, to the contrary, hyperventilation even bears the risk of inducing brain ischemia.
MESH: Adolescence-; Adult-; Aged-; Brain-blood-supply; Brain-metabolism; Brain-surgery; Brain-Injuries-complications; Brain-Injuries-metabolism; Cerebral-Anoxia-etiology; Cerebrovascular-Circulation; Coma-etiology; Coma-metabolism; Data-Interpretation,-Statistical; Decompression,-Surgical; Head-Down-Tilt; Hyperventilation-complications; Hypocapnia-complications; Intracranial-Pressure-drug-effects; Mannitol-administration-and-dosage; Middle-Age; Monitoring,-Physiologic; Partial-Pressure; Respiration,-Artificial-adverse-effects; Treatment-Outcome
MESH: *Brain-Chemistry; *Brain-Injuries-therapy; *Coma-therapy; *Oxygen-analysis
TG: Female; Human; Male; Support,-Non-U.S.-Gov't
PT: JOURNAL-ARTICLE
RN: 69-65-8; 7782-44-7
NM: Mannitol; Oxygen
AN: 97335706
UD: 9710
MEDLINE EXPRESS (R) 1992-1996 6 of 44
TI: Emergency! Myxedema coma.
AU: McMorrow-ME
AD: Department of Nursing, College of Staten Island, NY, USA.
SO: Am-J-Nurs. 1996 Oct; 96(10): 55
ISSN: 0002-936X
PY: 1996
LA: ENGLISH
CP: UNITED-STATES
MESH: Aged-; Coma-diagnosis; Coma-nursing; Coma-therapy; Emergencies-; Hypothyroidism-complications; Hypothyroidism-drug-therapy; Levothyroxine-therapeutic-use
MESH: *Coma-etiology; *Myxedema-complications
TG: Case-Report; Female; Human
PT: JOURNAL-ARTICLE
RN: 51-48-9
NM: Levothyroxine
AN: 97017038
UD: 9701
SB: AIM; NURSING
MEDLINE EXPRESS (R) 1992-1996 7 of 44
TI: Post-traumatic apallic syndrome following head injury. Part 2: Treatment.
AU: Grossman-P; Hagel-K
AD: Arzt fur Neurologie und Psychiatrie, Neurologische Klinik Elzach/Schwarzwald, Postfach, Germany.
SO: Disabil-Rehabil. 1996 Feb; 18(2): 57-68
ISSN: 0963-8288
PY: 1996
LA: ENGLISH
CP: ENGLAND
AB: There is no doubt that vegetative patients need the appropriate medical and nursing procedures as well as family involvement, education and counselling. Additional structured stimulation programmes are used for the treatment of coma and vegetative state. The theoretical foundation is derived from animal studies. The relevance of the results for the rehabilitation of head-injured human patients remains questionable, because all animal studies involve the use of cerebral lesions different from those found in human head-injured patients. The studies of human sensory stimulation give more an orientation than a definitive statement. Very recently, hypotheses concerning sensory regulation have begun to be evaluated. Further investigations are required to provide a more definite conclusion.
MESH: Arousal-physiology; Brain-Injuries-physiopathology; Coma-physiopathology; Evoked-Potentials-physiology; Haplorhini-; Persistent-Vegetative-State-physiopathology; Rats-
MESH: *Brain-Injuries-rehabilitation; *Coma-rehabilitation; *Persistent-Vegetative-State-rehabilitation; *Physical-Stimulation-methods
TG: Animal; Human
PT: JOURNAL-ARTICLE; REVIEW; REVIEW,-TUTORIAL
AN: 97023147
UD: 9701
MEDLINE EXPRESS (R) 1992-1996 8 of 44
TI: Indications and contraindications in emergency acupuncture treatment.
AU: Zhang-X
AD: Anhui College of Traditional Chinese Medicine.
SO: J-Tradit-Chin-Med. 1996 Mar; 16(1): 70-7
ISSN: 0254-6272
PY: 1996
LA: ENGLISH
CP: CHINA
AB: This essay suggests the indications and relative contraindications in the emergency treatment and cure by acupuncture and moxibustion based on an analysis of the characteristics and principles of treatment in emergency cases and the many-sided regulating effects of acupuncture and moxibustion. It also introduces, case by case, methods of acupuncture and moxibustion treatment in 22 frequently encountered emergency situations, and stresses the fact that emergency treatment with acupuncture and moxibustion must be based on the various new achievement and experience and strictly observe rules of operation. It states that only by doing so can the therapeutic effect be enhanced and adverse reactions prevented.
MESH: Acupuncture-Therapy-contraindications; Emergencies-
MESH: *Acupuncture-Therapy; *Coma-therapy; *Convulsions-therapy; *Fever-therapy
TG: Human
PT: JOURNAL-ARTICLE
AN: 96335950
UD: 9611
MEDLINE EXPRESS (R) 1992-1996 9 of 44
TI: Brian's world.
AU: Brennan-L
SO: Rehabil-Nurs. 1996 May-Jun; 21(3): 152-3
ISSN: 0278-4807
PY: 1996
LA: ENGLISH
CP: UNITED-STATES
MESH: Adult-
MESH: *Coma-rehabilitation; *Medical-Futility; *Nurse-Patient-Relations
TG: Case-Report; Human; Male
PT: JOURNAL-ARTICLE
AN: 96345103
UD: 9611
SB: NURSING
MEDLINE EXPRESS (R) 1992-1996 10 of 44
TI: Can healthcare providers obtain judicial intervention against surrogates who demand "medically inappropriate" life support for incompetent patients? [see comments]
CM: Comment in: Crit Care Med 1996 May;24(5):730-2
AU: Cantor-NL
AD: Rutgers University School of Law, Newark, NJ 07102, USA.
SO: Crit-Care-Med. 1996 May; 24(5): 883-7
ISSN: 0090-3493
PY: 1996
LA: ENGLISH
CP: UNITED-STATES
AB: OBJECTIVE: This article analyzes, from a legal perspective, a recent phenomenon involving a clash between the values of attending medical personnel and the instructions of surrogate decision-makers acting on behalf of incompetent patients. Some hospitals have gone to court to challenge decisions by surrogates to continue life support for permanently unconscious or other gravely debilitated patients. Their claim has been that continuation of life support would be medically inappropriate and that the surrogates' decisions ought to be overridden. These petitions have thus far been rejected. The objective here is to explain those decisions and to predict the outcome of future, similar litigation. DATA SOURCES: The primary data are the judicial decisions and legislation accumulated since the Quinlan case in 1976, regarding the medical handling of dying medical patients. CONCLUSIONS: Judicial rejection of healthcare providers' claims in the decided cases is explainable under traditional guardianship principles. The explanation lies in surrogates' authority to make decisions in the best interests of incompetent patients, and in judicial reluctance to brand life preservation of nonsuffering patients as abusive or contrary to patient interests. At the same time, the author anticipates a change in judicial posture, as courts acknowledge the widespread antipathy of people toward being indefinitely preserved in a noncognitive status. Because the judicial approach to the handling of dying persons often seeks to replicate what the patient would have wanted, there is room to consider consensus preferences where the particular patients has never indicated any deviation from those preferences. Courts will eventually override surrogate decisions that do not conform to widely shared preferences for avoiding the indignity of permanent unconsciousness or other gravely debilitated states.
MESH: Ethics,-Medical; Family-psychology; Health-Care-Rationing; United-States
MESH: *Coma-therapy; *Decision-Making; *Legal-Guardians-legislation-and-jurisprudence; *Life-Support-Care-legislation-and-jurisprudence; *Medical-Futility; *Mental-Competency; *Patient-Advocacy-legislation-and-jurisprudence
TG: Human
PT: JOURNAL-ARTICLE; REVIEW; REVIEW,-TUTORIAL
AN: 96320671
UD: 9611
SB: AIM
MEDLINE EXPRESS (R) 1992-1996 11 of 44
TI: Withdrawal of nutritional support: a family's choice.
AU: Kowalski-S
SO: Gastroenterol-Nurs. 1996 Jan-Feb; 19(1): 25-8
ISSN: 1042-895X
PY: 1996
LA: ENGLISH
CP: UNITED-STATES
AB: Facilitating the death of a loved one through the withdrawal of nutritional support is a difficult choice. This case study illustrates the ethical principles used by a family and a health team during the decision to terminate tube feeding and hydration for a patient. Patient autonomy, beneficence, justice, and professional integrity are discussed. Also addressed are use of ordinary versus extraordinary means of treatment, futility of treatment, and quality of life. Nursing interventions used to assist the family with their fears and concerns during the decision-making process, and eventually the dying process, of their husband and father are described.
MESH: Aged-; Decision-Making; Ethics,-Nursing; Grief-
MESH: *Coma-therapy; *Enteral-Nutrition; *Euthanasia,-Passive; *Family-psychology
TG: Case-Report; Human; Male
PT: JOURNAL-ARTICLE
AN: 96345327
UD: 9611
SB: NURSING
MEDLINE EXPRESS (R) 1992-1996 12 of 44
TI: CSF neurotransmitter metabolites in comatose head injury patients during changes in their clinical state.
AU: Markianos-M; Seretis-A; Kotsou-A; Christopoulos-M
AD: Athens University Medical School, Psychiatric Clinic, Eginition Hospital, Greece.
SO: Acta-Neurochir-Wien. 1996; 138(1): 57-9
ISSN: 0001-6268
PY: 1996
LA: ENGLISH
CP: AUSTRIA
AB: The main metabolites of noradrenaline, serotonin, and dopamine, methoxyhydroxyphenylglycol (MHPG), 5-hydroxyindole-acetic acid (5HIAA), and homovanillic acid (HVA), respectively, were assessed in CSF samples of patients in coma after severe head injury, the first days after the accident and again after an improvement (13 patients) or deterioration (7 patients) in their clinical state, evaluated by the score on the Glasgow Coma Scale. Improvement was accompanied by significant decreases in HVA and 5HIAA. In the patients who deteriorated, the levels of the three metabolites remained high. The results show that the increased turnover of CNS neurotransmitters in severe head injury normalizes during recovery. The use of noradrenaline, dopamine, and serotonin antagonists in brain injury experimental models may clarify the role of the increased biogenic amine turnover in the processes that lead to recovery. We propose relevant pharmacological intervention influencing neurotransmission in severe head injury.
MESH: Adolescence-; Adult-; Aged-; Brain-Damage,-Chronic-diagnosis; Brain-Damage,-Chronic-rehabilitation; Brain-Injuries-diagnosis; Brain-Injuries-rehabilitation; Coma-diagnosis; Coma-rehabilitation; Homovanillic-Acid-cerebrospinal-fluid; Hydroxyindoleacetic-Acid-cerebrospinal-fluid; Methoxyhydroxyphenylglycol-cerebrospinal-fluid; Middle-Age; Neurologic-Examination; Prognosis-; Treatment-Outcome
MESH: *Brain-Damage,-Chronic-cerebrospinal-fluid; *Brain-Injuries-cerebrospinal-fluid; *Coma-cerebrospinal-fluid; *Neurotransmitters-cerebrospinal-fluid
TG: Female; Human; Male
PT: JOURNAL-ARTICLE
RN: 0; 306-08-1; 534-82-7; 54-16-0
NM: Neurotransmitters; Homovanillic-Acid; Methoxyhydroxyphenylglycol; Hydroxyindoleacetic-Acid
AN: 96268816
UD: 9610
MEDLINE EXPRESS (R) 1992-1996 13 of 44
TI: Effect of L-carnitine supplementation on acute valproate intoxication.
AU: Murakami-K; Sugimoto-T; Woo-M; Nishida-N; Muro-H
AD: Nakano Children's Hospital, Osaka, Japan.
SO: Epilepsia. 1996 Jul; 37(7): 687-9
ISSN: 0013-9580
PY: 1996
LA: ENGLISH
CP: UNITED-STATES
AB: We analyzed urinary valproate (VPA) metabolites and carnitine concentrations in a child who accidentally ingested 400 mg/kg VPA. The concentration of 4-en VPA, the presumed major factor in VPA-induced hepatotoxicity, was markedly increased, without liver dysfunction or hyperammonemia. The other major abnormality was decreased beta-oxidation and markedly increased omega-oxidation. After L-carnitine supplementation, VPA metabolism returned to normal. The level of valproylcarnitine was not increased and therefore was not affected by L-carnitine. L-Carnitine may be useful in treating patients with coma after VPA overdose.
MESH: Ammonia-blood; Carnitine-analogs-and-derivatives; Carnitine-metabolism; Carnitine-pharmacology; Carnitine-pharmacokinetics; Coma-drug-therapy; Coma-metabolism; Epilepsy-drug-therapy; Infant-; Overdose-blood; Overdose-drug-therapy; Oxidation-Reduction-drug-effects; Valproic-Acid-metabolism; Valproic-Acid-pharmacokinetics
MESH: *Carnitine-therapeutic-use; *Valproic-Acid-poisoning
TG: Case-Report; Human; Male; Support,-Non-U.S.-Gov't
PT: JOURNAL-ARTICLE
RN: 541-15-1; 7664-41-7; 95782-09-5; 99-66-1
NM: Carnitine; Ammonia; valproylcarnitine; Valproic-Acid
AN: 96305092
UD: 9610
MEDLINE EXPRESS (R) 1992-1996 14 of 44
TI: Level of care options for the low-functioning brain injury survivor.
AU: Walker-WC; Kreutzer-JS; Witol-AD
AD: Department of Rehabilitation Medicine, Medical College of Virginia, Richmond, Virginia, USA.
SO: Brain-Inj. 1996 Jan; 10(1): 65-75
ISSN: 0269-9052
PY: 1996
LA: ENGLISH
CP: ENGLAND
AB: During the early stages of recovery from severe brain injury many patients are comatose or minimally responsive. Rehabilitation for these low-functioning survivors traditionally includes acute medical care and transfer to a skilled nursing facility or acute rehabilitation. Concerns have been expressed that customary treatment options are ineffective, costly, or both. In response, 'intermediate'-level programmes designed to provide effective, cost-efficient rehabilitation have emerged. The purpose of this paper is to provide information regarding outcome of severe brain injury and the early rehabilitation needs of survivors. Common characteristics, advantages, and disadvantages of various intermediate programmes, including 'subacute' and 'transitional' rehabilitation, are discussed and contrasted.
MESH: Brain-Damage,-Chronic-economics; Brain-Injuries-economics; Coma-economics; Coma-rehabilitation; Cost-Benefit-Analysis; Long-Term-Care-economics; Patient-Care-Team-economics; United-States
MESH: *Brain-Damage,-Chronic-rehabilitation; *Brain-Injuries-rehabilitation; *Intermediate-Care-Facilities-economics; *Rehabilitation-Centers-economics
TG: Comparative-Study; Human; Support,-Non-U.S.-Gov't; Support,-U.S.-Gov't,-P.H.S.
PT: JOURNAL-ARTICLE; REVIEW; REVIEW,-TUTORIAL
CN: G0087CO219CONCI
AN: 96268898
UD: 9610
MEDLINE EXPRESS (R) 1992-1996 15 of 44
TI: Empiric use of flumazenil in comatose patients: limited applicability of criteria to define low risk.
AU: Gueye-PN; Hoffman-JR; Taboulet-P; Vicaut-E; Baud-FJ
AD: Reanimation Toxicologique, Hopital Fernand Widal, Paris, France.
SO: Ann-Emerg-Med. 1996 Jun; 27(6): 730-5
ISSN: 0196-0644
PY: 1996
LA: ENGLISH
CP: UNITED-STATES
AB: STUDY OBJECTIVE: To develop clinical rules for the safe and effective use of flumazenil in suspected benzodiazepine overdose. METHODS: We assembled a retrospective series of 35 consecutive comatose patients admitted between October 1992 and July 1993 to a toxicologic ICU with the presumptive diagnosis of drug overdose. These patients were divided into two groups. Group A (low-risk) patients had a clinical picture compatible with uncomplicated benzodiazepine intoxication (calm, without abnormalities in pulse or blood pressure, lateralizing signs, hypertonia, hyperreflexia, or myoclonus) in the absence of predefined electrocardiographic or clinical signs of tricyclic antidepressant or other proconvulsant overdose, and absence of an available history of long-term benzodiazepine treatment or an underlying seizure disorder. Group B ("non-low risk") comprised all other patients. Efficacy of flumazenil was categorized as complete awakening (with normal level of alertness), partial awakening, or no change in alertness level. The safety of flumazenil was defined on the basis of the absence of seizures or death. RESULTS: In group A (n=4), flumazenil was associated with complete awakening in three patients and partial awakening in one. No seizures were observed. In group B (n=31), flumazenil was associated with complete awakening in 4 patients, partial awakening in 5, and no response in 22. In group B, five seizures occurred. CONCLUSION: Comatose patients with clinical or ECG criteria thought to contraindicate the use of flumazenil have a reasonably high risk of seizures after administration of this drug. Low-risk patients may be able to receive flumazenil safely, but they may be only a small portion of comatose patients with suspected overdose.
MESH: Adolescence-; Adult-; Aged-; Aged,-80-and-over; Flumazenil-administration-and-dosage; Middle-Age; Overdose-drug-therapy; Psychotropic-Drugs-blood; Psychotropic-Drugs-poisoning; Retrospective-Studies; Seizures-chemically-induced
MESH: *Antidotes-therapeutic-use; *Coma-drug-therapy; *Flumazenil-therapeutic-use
TG: Female; Human; Male
PT: JOURNAL-ARTICLE
RN: 0; 0; 78755-81-4
NM: Antidotes; Psychotropic-Drugs; Flumazenil
AN: 96240172
UD: 9609
SB: AIM
MEDLINE EXPRESS (R) 1992-1996 16 of 44
TI: Outcome of patients admitted for severe coma in an intensive care unit.
AU: Bruneel-MF; Legendre-C; Thervet-E; Kreis-H
AD: Service de Transplantation, Paris, France.
SO: Transplant-Proc. 1996 Feb; 28(1): 280
ISSN: 0041-1345
PY: 1996
LA: ENGLISH
CP: UNITED-STATES
MESH: Brain-Death; Coma-mortality; Coma-therapy; Intensive-Care-Units-statistics-and-numerical-data; Organ-Procurement-organization-and-administration; Retrospective-Studies; Treatment-Outcome
MESH: *Coma-classification; *Tissue-Donors
TG: Human
PT: JOURNAL-ARTICLE
AN: 96218406
UD: 9609
MEDLINE EXPRESS (R) 1992-1996 17 of 44
TI: Long-term intravenous and oral flumazenil treatment of acute diazepam overdose in an older patient [letter]
AU: Weinbroum-A; Rudick-V; Sorkine-P; Fleishon-R; Geller-E
SO: J-Am-Geriatr-Soc. 1996 Jun; 44(6): 737-8
ISSN: 0002-8614
PY: 1996
LA: ENGLISH
CP: UNITED-STATES
MESH: Administration,-Oral; Aged-; Coma-chemically-induced; Glasgow-Coma-Scale; Infusions,-Intravenous
MESH: *Antidotes-therapeutic-use; *Coma-drug-therapy; *Diazepam-poisoning; *Flumazenil-therapeutic-use
TG: Case-Report; Female; Human
PT: LETTER
RN: 0; 439-14-5; 78755-81-4
NM: Antidotes; Diazepam; Flumazenil
AN: 96237947
UD: 9609
MEDLINE EXPRESS (R) 1992-1996 18 of 44
TI: Persons found in their homes helpless or dead [see comments]
CM: Comment in: N Engl J Med 1996 Jun 27;334(26):1738-9
AU: Gurley-RJ; Lum-N; Sande-M; Lo-B; Katz-MH
AD: Robert Wood Johnson Clinical Scholars Program, University of California, San Francisco 94102, USA.
SO: N-Engl-J-Med. 1996 Jun 27; 334(26): 1710-6
ISSN: 0028-4793
PY: 1996
LA: ENGLISH
CP: UNITED-STATES
AB: BACKGROUND: Health care providers and providers of emergency services are sometimes called to help with people who are found alone in their homes either helpless or dead. It is not known who is at risk for being found helpless or dead, what the mortality rates are among those found alive, or how frequently this situation occurs. METHODS: We conducted a population-based study of patients who were found in their homes either helpless or dead. Over 12 weeks, paramedics employed by the city of San Francisco identified 387 such events involving 367 persons. We obtained information on these patients from the emergency-medical-services department or the hospitals to which they were taken and determined their outcomes. RESULTS: The median age of the persons found helpless or dead was 73 years; 51 percent were women. The frequency of such incidents increased sharply with age, from a rate of 3 per 1000 per year among those 60 to 64 years of age to 27 per 1000 per year among those 85 years of age or older. The highest rate was among men 85 years and older who were living alone (123 per 1000 per year). In 23 percent of the cases, the person was found dead; an additional 5 percent died in the hospital. Thus, total mortality was 28 percent. Of the patients found alive, 62 percent were admitted to the hospital. The average hospital stay was eight days, and 52 percent of those admitted required intensive care. Of the survivors, 62 percent were unable to return to living independently. The total mortality was 67 percent for patients who were estimated to have been helpless for more than 72 hours, as compared with 12 percent for those who had been helpless for less than 1 hour. CONCLUSIONS: For elderly people who live alone, becoming incapacitated and unable to get help is a common event, which usually marks the end of their ability to live independently.
MESH: Accidental-Falls-mortality; Accidental-Falls-statistics-and-numerical-data; Adult-; Aged-; Aged,-80-and-over; Asthenia-rehabilitation; Coma-epidemiology; Coma-rehabilitation; Frail-Elderly; Hospitalization-statistics-and-numerical-data; Length-of-Stay; Mental-Disorders-epidemiology; Mental-Disorders-rehabilitation; Middle-Age; Prognosis-; Prospective-Studies; San-Francisco-epidemiology; Social-Isolation; Treatment-Outcome
MESH: *Asthenia-epidemiology; *Death-; *Emergencies-epidemiology
TG: Female; Human; Male; Support,-Non-U.S.-Gov't
PT: JOURNAL-ARTICLE
AN: 96240533
UD: 9609
SB: AIM
MEDLINE EXPRESS (R) 1992-1996 19 of 44
TI: Letter to an ethicist: resuscitative interventions.
AU: Quinlan-JJ; Cook-WA
SO: Can-Med-Assoc-J. 1996 Mar 15; 154(6): 887-8
ISSN: 0008-4409
PY: 1996
LA: ENGLISH
CP: CANADA
AB: Few issues raise more questions for physicians than the resuscitation of seriously ill patients. In the following exchange of letters, Dr. John Quinlan discusses two difficult cases involving patient resuscitation, while Dr. William Cook responds by referring to the Joint Statement on Resuscitative Interventions that was approved last year by the CMA and several other health care organizations.
MESH: Adult-; Aged-; Coma-therapy; Heart-Arrest-therapy; Palliative-Care; Postoperative-Complications; Suicide,-Attempted
MESH: *Cardiopulmonary-Resuscitation; *Ethics,-Medical
TG: Human; Male
PT: JOURNAL-ARTICLE
AN: 96258165
UD: 9609
SB: AIM
MEDLINE EXPRESS (R) 1992-1996 20 of 44
TI: Prediction of outcome in patients with anoxic coma: a clinical and electrophysiologic study.
AU: Chen-R; Bolton-CF; Young-B
AD: Department of Clinical Neurological Sciences, University of Western Ontario, Victoria Hospital, London, Canada.
SO: Crit-Care-Med. 1996 Apr; 24(4): 672-8
ISSN: 0090-3493
PY: 1996
LA: ENGLISH
CP: UNITED-STATES
AB: OBJECTIVE: To evaluate and compare the predictive powers of clinical examination, electroencephalography (EEG), and studies of short-latency somatosensory evoked potentials in determining the prognosis in anoxic coma. DESIGN: Prospective case series of patients in anoxic coma, whose prognoses were uncertain based on previously established clinical criteria. The clinical features, EEG, and somatosensory evoked potentials results were correlated with outcome. SETTING: A 40-bed intensive care unit in a university teaching hospital. PATIENTS: Thirty-four consecutive patients admitted over a 2-yr period with anoxic coma as the principal diagnosis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Twenty-seven (79%) patients never recovered consciousness and seven (21%) patients made a good recovery. One of six patients whose pupillary reflexes were present but whose other cranial nerve reflexes were absent on day 1 recovered, but none of the seven patients with these features still present on day 3 survived. None of the patients with motor responses of extension to painful stimuli or worse on days 1 or 3 recovered. The EEGs were classified into benign, uncertain, and malignant categories. The results of both EEG and somatosensory evoked potentials studies were strongly associated with outcome. With malignant EEG, the sensitivity was 74%, the specificity was 71%, and the positive predictive value was 9% for prediction of no recovery (death or persistent vegetative state). However, two patients with an initially malignant EEG eventually made a good recovery. The sensitivity for low amplitude or absent somatosensory evoked potentials for prediction of no recovery was 66%. There were no falsely pessimistic predictions with somatosensory evoked potentials, as all 18 patients with absent or low-amplitude responses had no recovery (specificity and positive predictive value were 100%). EEG and somatosensory evoked potentials studies were complementary to clinical examination in the determination of prognosis. Using a combined clinical and electrophysiologic approach, 63% of patients who had no recovery could be identified by day 3. Repeat EEG and somatosensory evoked potentials studies were of value in patients whose prognoses were uncertain, as their evolution invariably correlated with outcome. CONCLUSIONS: Based on the present data and a literature review, we propose that clinical examination combined with the results of EEG and somatosensory evoked potentials can be used to establish an early, definitive prognosis in a significant proportion of patients in anoxic coma. On day 3 or thereafter, patients with motor response of extension to pain or worse and malignant EEG, or those patients with flexor posturing or worse and bilaterally absent cortical somatosensory evoked potentials invariably have poor outcome. However, some patients with initially malignant EEG and normal somatosensory evoked potentials may recover and should be supported until their prognoses become more definitive.
MESH: Adolescence-; Adult-; Aged-; Cerebral-Anoxia-physiopathology; Cerebral-Anoxia-therapy; Coma-physiopathology; Coma-therapy; Electrodes-; Electroencephalography-classification; Electroencephalography-instrumentation; Electroencephalography-methods; Evoked-Potentials,-Somatosensory-physiology; Middle-Age; Prognosis-; Prospective-Studies; Sensitivity-and-Specificity; Time-Factors; Treatment-Outcome
MESH: *Cerebral-Anoxia-mortality; *Coma-mortality
TG: Comparative-Study; Female; Human; Male
PT: JOURNAL-ARTICLE
AN: 96197559
UD: 9608
SB: AIM
MEDLINE EXPRESS (R) 1992-1996 21 of 44
TI: Use of flumazenil in the treatment of drug overdose: a double-blind and open clinical study in 110 patients.
AU: Weinbroum-A; Rudick-V; Sorkine-P; Nevo-Y; Halpern-P; Geller-E; Niv-D
AD: Department of Anesthesiology and Critical Care Medicine, Tel-Aviv-Elias Sourasky Medical Center, Israel.
SO: Crit-Care-Med. 1996 Feb; 24(2): 199-206
ISSN: 0090-3493
PY: 1996
LA: ENGLISH
CP: UNITED-STATES
AB: OBJECTIVES: To assess the efficacy, usefulness, safety, and dosages of flumazenil required when flumazenil is used in the diagnosis of benzodiazepine-induced coma (vs. other drug-induced coma), and to reverse or prevent the recurrence of unconsciousness. DESIGN: A two-phase study: a controlled, randomized, double-blind study followed by a prospective, open study. SETTING: An 800-bed, teaching, university-affiliated hospital. PATIENTS: Unconscious patients (n = 110) suspected of benzodiazepine overdose, graded 2 to 4 on the Matthew and Lawson coma scale, were treated with flumazenil, the specific benzodiazepine receptor antagonist. The first 31 patients were studied in a double-blind fashion, while the rest of the patients were given flumazenil according to an open protocol. INTERVENTIONS; All patients received supplemental oxygen; endotracheal intubation was performed, and synchronized intermittent mandatory ventilation was initiated whenever it was deemed necessary. A peripheral intravenous cannula was inserted, as were indwelling arterial and urinary bladder catheters. Blood pressure, electrocardiogram, respiratory rate, end-tidal CO2, and core temperature were continuously monitored. The first 31 double-blind patients received either intravenous flumazenil (to a maximum of 1 mg) or saline, while the rest of the patients were given flumazenil until either regaining consciousness or a maximum of 2.5 mg was injected. Patients remaining unconscious among double-blind patients or those patients relapsing into coma after the first dose were later treated in the open phase of the study. Treatment continued by boluses or infusion as long as efficacious. MEASUREMENTS AND MAIN RESULTS: Fourteen of 17 double-blind, flumazenil-treated patients woke after a mean of 0.8 +/- 0.3 (SD) mg vs. one of 14 placebo patients (p < .001). Seventy-five percent of the aggregated controlled and uncontrolled patients awoke from coma scores of 3.1 +/- 0.6 to 0.4 +/- 0.5 (p < .01) after the injection of 0.7 +/- 0.3 mg of flumazenil. These patients had high benzodiazepine serum blood concentrations. Twenty-five percent of the patients did not regain consciousness. These patients had very high serum concentrations of nonbenzodiazepine drugs. Sixty percent of the responders who had primarily ingested benzodiazepines remained awake for 72 +/- 37 mins after flumazenil administration; 40% relapsed into coma after 18 +/- 7 mins and various central nervous system depressant drugs were detected in their blood in addition to benzodiazepines. Seventy-one percent of the patients had ingested tricyclic antidepressants. Seventy-eight percent of the responders were continually and efficaciously treated for < or = 8 days. Fourteen (25%) of the intubated patients were extubated safely while 12 patients, who had shown increased respiratory insufficiency, resumed satisfactory respiration after flumazenil injection. Five cases of transient increase in blood pressure and heart rate were encountered. There were 27 mildly unpleasant "waking" episodes, such as anxiety, restlessness, and aggression, but no patient had benzodiazepine withdrawal signs, convulsions, or dysrhythmia, most noticeably absent in tricyclic antidepressant-intoxicated patients. CONCLUSIONS: Flumazenil is a valid diagnostic tool for distinguishing pure benzodiazepine from mixed-drug intoxication or nondrug-induced coma. Flumazenil is effective in preventing recurrence of benzodiazepine-induced coma. Respiratory insufficiency is reversed after its administration. Flumazenil is safe when administered cautiously, even in patients with coma caused by a mixed overdose of benzodiazepine plus tricyclic antidepressants.
MESH: Adult-; Aged-; Antidepressive-Agents,-Tricyclic-poisoning; Barbiturates-poisoning; Benzodiazepines-blood; Benzodiazepines-poisoning; Coma-blood; Diagnosis,-Differential; Double-Blind-Method; Middle-Age; Prospective-Studies; Recurrence-; Reproducibility-of-Results
MESH: *Antidotes-diagnostic-use; *Antidotes-therapeutic-use; *Coma-chemically-induced; *Coma-drug-therapy; *Flumazenil-diagnostic-use; *Flumazenil-therapeutic-use
TG: Female; Human; Male; Support,-Non-U.S.-Gov't
PT: CLINICAL-TRIAL; CONTROLLED-CLINICAL-TRIAL; JOURNAL-ARTICLE; RANDOMIZED-CONTROLLED-TRIAL
RN: 0; 0; 0; 0; 78755-81-4
NM: Antidepressive-Agents,-Tricyclic; Antidotes; Barbiturates; Benzodiazepines; Flumazenil
AN: 96189878
UD: 9607
SB: AIM
MEDLINE EXPRESS (R) 1992-1996 22 of 44
TI: Life-sustaining treatment decisions by spouses of patients with Alzheimer's disease.
AU: Mezey-M; Kluger-M; Maislin-G; Mittelman-M
AD: Division of Nursing, New York University, New York 10012, USA.
SO: J-Am-Geriatr-Soc. 1996 Feb; 44(2): 144-50
ISSN: 0002-8614
PY: 1996
LA: ENGLISH
CP: UNITED-STATES
AB: OBJECTIVE: To examine the anticipated decisions to consent to or to forgo life-sustaining treatment by spouses of patients with Alzheimer's disease and to describe the relationship of spouse and patient characteristics to predicted decisions. DESIGN: Prospective quantitative study. SETTING: The Aging and Dementia Research Center (ADRC), part of an Alzheimer's Disease Center Core Grant, at New York University Medical Center. PARTICIPANTS: Fifty spouse caregivers of Alzheimer's disease patients, evaluated at the ADRC, who had a minimum Stage 4 on the Global Deterioration Scale. MEASUREMENTS: Spouses were presented with two conditions (critical illness and irreversible coma) and rated their agreement with, certainty of, and comfort with four treatments (resuscitation, breathing machine, feeding tube, and antibiotics). Data were also obtained as to patients' current quality of life, spouses' standard of decision-making, and spouse burden. RESULTS: Eighteen of 50 patients had a durable power of attorney for health care, 20 of 50 had a living will, and 26 of 50 had neither. In the face of critical illness, almost equal numbers of spouses would consent to or forgo CPR, 28 of 50 would forgo a breathing machine, 21 of 50 a would forgo a feeding tube, and 5 of 50 would forgo antibiotics. Five of 50 would forgo all four treatments, and 12 of 50 all but antibiotics. Spouses were significantly more likely to forgo treatment in the face of coma than for critical illness (P < .001). Spouses were more certain about decisions related to coma than to critical illness (P < .001), and there was a positive and significant correlation between certainty and comfort (P = .001). Those consenting to treatment were more comfortable than those forgoing treatment (for CPR and antibiotics P = .001). Spouses of patients with Stage 7 AD were more likely to forgo CPR than those with Stages 4 to 6 AD (P < .001). Only two of 50 spouses selected descriptors congruent with a purely substituted judgment standard of decision-making. An equal number of spouses rated patient quality of life as good, fair, or poor. For critical illness, the poorer the quality of life rating, the more likely the spouses were to forgo feeding tubes (P < .001). There was a trend for highly burdened spouses to consent to treatment. CONCLUSIONS: The results provide evidence that spouses of patients with AD anticipate forgoing life-sustaining treatments in the face of coma but are less sure about choices for critical illness. Although preliminary in nature, findings suggest that doctors, nurses, and social workers need to provide additional support to spouses choosing to forgo rather than consent to treatment and need to inquire as to what spouses perceive as the factors that are important to them in making a decision.
MESH: Advance-Directives; Aged-; Coma-therapy; Critical-Illness-therapy; Cross-Sectional-Studies; Prospective-Studies; Questionnaires-; Resuscitation-Orders
MESH: *Alzheimer's-Disease-therapy; *Decision-Making; *Life-Support-Care; *Patient-Advocacy; *Spouses-psychology
TG: Female; Human; Male; Support,-Non-U.S.-Gov't
PT: JOURNAL-ARTICLE
AN: 96165293
UD: 9605
MEDLINE EXPRESS (R) 1992-1996 23 of 44
TI: Living wills: not just for the elderly.
AU: Germain-H
SO: RN. 1996 Jan; 59(1): 72
ISSN: 0033-7021
PY: 1996
LA: ENGLISH
CP: UNITED-STATES
MESH: Adult-; Age-Factors
MESH: *Coma-therapy; *Family-psychology; *Living-Wills
TG: Case-Report; Human; Male
PT: JOURNAL-ARTICLE
AN: 96153340
UD: 9604
SB: NURSING
MEDLINE EXPRESS (R) 1992-1996 24 of 44
TI: Limiting treatment in nursing homes: knowledge and attitudes of nursing home medical directors.
AU: Ghusn-HF; Teasdale-TA; Skelly-JR
AD: Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
SO: J-Am-Geriatr-Soc. 1995 Oct; 43(10): 1131-4
ISSN: 0002-8614
PY: 1995
LA: ENGLISH
CP: UNITED-STATES
AB: OBJECTIVE: To determine nursing home medical directors' knowledge about cardiopulmonary resuscitation outcome and their support of treatment limitation requests and policies. DESIGN: Mailed questionnaire, followed by telephone interview. PARTICIPANTS: Forty-six medical directors of 70 community nursing homes in Harris County, Texas. MEASUREMENTS: Medical directors were asked to estimate the CPR survival rate to discharge of all nursing home residents and that of two case scenarios. They were asked to indicate on a Likert scale their support for mandatory Do-Not-Resuscitate orders and for requests by nursing home patients to withhold other life support measures. RESULTS: Responses were received from 33 directors. Overall CPR survival rate of older nursing home residents after cardiac arrest was thought to be 10.7%. The average CPR survival rate for healthy older people with witnessed arrests was believed to be 13.8%. The perceived rate for unwitnessed arrests in terminal patients was 4.6%, significantly lower than estimates for healthy older people (P = .003) and estimates of the overall survival rate (P = .02). Medical directors were split regarding mandatory Do-Not-Resuscitate orders for patients in vegetative states, with terminal illness, with an unwitnessed arrest, or in those older than 90 years of age. Mandatory use of Do-Not-Resuscitate orders for all nursing home residents was strongly opposed. Assuming a 2% survival rate did not significantly influence medical directors' opinions about mandatory DNR orders in these groups. Medical directors were more willing to support requests by stable nursing home residents to withhold resuscitation, mechanical ventilation, or hospitalization than requests to withhold antibiotics, intravenous fluids, or tube feedings (P < .005). The majority of medical directors were willing to withhold all such measures for terminal patients. CONCLUSIONS: Health care professionals who are responsible for educating patients about the efficacy of cardiopulmonary resuscitation in nursing homes overestimate its benefit and may benefit from further education about its outcome. Although mandatory Do-Not-Resuscitate orders were favored for terminal or vegetative patients, medical directors are not supportive of such orders across the board. Medical directors are more willing to honor requests for treatment limitation by terminal patients than others.
MESH: Age-Factors; Aged-; Aged,-80-and-over; Cardiopulmonary-Resuscitation-mortality; Cardiopulmonary-Resuscitation-utilization; Coma-therapy; Physician-Executives-education; Physician-Executives-psychology; Questionnaires-; Survival-Rate; Terminal-Care; Texas-; Treatment-Outcome
MESH: *Cardiopulmonary-Resuscitation; *Knowledge,-Attitudes,-Practice; *Nursing-Homes; *Physician-Executives-statistics-and-numerical-data; *Resuscitation-Orders
TG: Human
PT: JOURNAL-ARTICLE
AN: 96003678
UD: 9601
MEDLINE EXPRESS (R) 1992-1996 25 of 44
TI: Emergent evaluation of the comatose patient.
AU: Smith-MC
AD: Department of Neurosciences, Rush Memorial College Chicago, USA.
SO: Lijec-Vjesn. 1995 Jun; 117 Suppl 2: 54-6
ISSN: 0024-3477
PY: 1995
LA: ENGLISH
CP: CROATIA
MESH: Coma-classification; Coma-therapy; Glasgow-Coma-Scale
MESH: *Coma-diagnosis
TG: Human
PT: JOURNAL-ARTICLE
AN: 96214248
UD: 9609
MEDLINE EXPRESS (R) 1992-1996 26 of 44
TI: Coma.
AU: Smith-MC
AD: Department of Neurosciences, Rush Memorial College Chicago, USA.
SO: Lijec-Vjesn. 1995 Jun; 117 Suppl 2: 46-9
ISSN: 0024-3477
PY: 1995
LA: ENGLISH
CP: CROATIA
MESH: Coma-etiology; Coma-physiopathology; Coma-therapy; Prognosis-
MESH: *Coma-
TG: Human
PT: JOURNAL-ARTICLE; REVIEW; REVIEW,-TUTORIAL
AN: 96214246
UD: 9609
MEDLINE EXPRESS (R) 1992-1996 27 of 44
TI: Evolving brain lesions in the first 12 hours after head injury: analysis of 37 comatose patients.
AU: Servadei-F; Nanni-A; Nasi-MT; Zappi-D; Vergoni-G; Giuliani-G; Arista-A
AD: Division of Neurosurgery, Ospedale Maurizio, Bufalini, Cesena, Italy.
SO: Neurosurgery. 1995 Nov; 37(5): 899-906; discussion 906-7
ISSN: 0148-396X
PY: 1995
LA: ENGLISH
CP: UNITED-STATES
AB: From January 1, 1990, to April 30, 1994, 412 patients were admitted to our intensive care unit in coma after head injuries. Our study group consisted of 37 patients who were retrospectively identified as harboring lesions or developing new lesions within a 12-hour period from the time of admission. We defined the evolution of a lesion as an increase or decrease in the size of an already present hematoma or as the appearance of a totally new lesion. There were 25 male and 12 female patients (mean age, 34.9 yr), and the cause of trauma was road traffic accidents in 32 patients. Nine patients presented with shock, and six had evidence of abnormal coagulation at admission. Patients were divided into two different groups. In Group 1, 15 patients harbored lesions that evolved toward reabsorption. In Group 2, 22 patients harbored hematomas that evolved toward lesions requiring surgical removal. Fifteen of these patients had initial diagnoses of diffuse injury that evolved in this manner, whereas the remaining seven patients had already been operated upon and had developed second, noncontiguous, surgical lesions. Patients with lesions that required surgical evacuation had their computed tomographic (CT) scans obtained earlier and had a higher incidence of clinical deterioration. There was a significant difference in the evolution of the different lesions (P < 0.001), with subdural hematomas being more prone to reabsorption and intracerebral and extradural hematomas being more likely to increase in size or to appear as new lesions. Second CT scans were obtained because of clinical deterioration in 10 patients and because of increase in intracranial pressure in 5 patients. Scheduled CT scans were obtained in 13 patients, whereas in the remaining 9 patients, the diagnosis emerged from a combination of scheduled CT scans and intracranial pressure monitoring. There was a trend toward a poorer result among the patients with clinical deterioration, which, however, was not significant. A significant proportion of post-traumatic patients, particularly those who are unconscious, harbor early evolving intracranial lesions. When the first CT scan is performed within 3 hours after injury, a CT scan should be repeated within 12 hours.
MESH: Adolescence-; Adult-; Aged-; Cerebral-Hemorrhage-surgery; Child-; Coma-surgery; Glasgow-Coma-Scale; Head-Injuries,-Closed-surgery; Hematoma,-Epidural-radiography; Hematoma,-Epidural-surgery; Hematoma,-Subdural-radiography; Hematoma,-Subdural-surgery; Middle-Age; Postoperative-Complications-radiography; Retrospective-Studies
MESH: *Cerebral-Hemorrhage-radiography; *Coma-radiography; *Head-Injuries,-Closed-radiography; *Tomography,-X-Ray-Computed
TG: Female; Human; Male
PT: JOURNAL-ARTICLE
AN: 96131470
UD: 9605
MEDLINE EXPRESS (R) 1992-1996 28 of 44
TI: The feisty family.
AU: Brock-G; Gurekas-V; Thomas-JE
AD: Temiscaming Centre de Sante, Que.
SO: Can-Fam-Physician. 1995 Sep; 41: 1483, 1485
ISSN: 0008-350X
PY: 1995
LA: ENGLISH
CP: CANADA
MESH: Adenocarcinoma-complications; Adenocarcinoma-secondary; Aged-; Colonic-Neoplasms-complications; Colonic-Neoplasms-pathology; Coma-etiology; Ethics,-Medical; Terminal-Care
MESH: *Adenocarcinoma-therapy; *Colonic-Neoplasms-therapy; *Coma-therapy; *Family-psychology; *Family-Practice; *Patient-Advocacy
TG: Case-Report; Human; Male
PT: JOURNAL-ARTICLE
AN: 96087445
UD: 9603
MEDLINE EXPRESS (R) 1992-1996 29 of 44
TI: Myxedema coma in the elderly [published erratum appears in J Am Board Fam Pract 1995 Nov-Dec;8(6):502]
AU: Olsen-CG
AD: Department of Family Medicine, Wright State University School of Medicine, Dayton, Ohio 45408, USA.
SO: J-Am-Board-Fam-Pract. 1995 Sep-Oct; 8(5): 376-83
ISSN: 0893-8652
PY: 1995
LA: ENGLISH
CP: UNITED-STATES
AB: BACKGROUND: Myxedema coma in the elderly, although uncommon, is frequently overlooked and has a high mortality rate. Signs and symptoms are many and are often insidious. Nearly every organ system is involved. Prompt recognition and treatment are mandatory for a successful outcome. METHODS: A case study is presented. Using the key words "myxedema" with the word "aged," MEDLINE files were searched from 1989 to present. Articles dating before 1989 were accessed from the reference lists of the more recent articles. RESULTS AND CONCLUSIONS: This review describes the signs and symptoms of myxedema coma in the elderly. Epidemiology and histopathology of the disorder are discussed. Prompt recognition and emergency medical treatment are essential for a successful outcome. Prevention requires screening of elderly patients at risk for hypothyroidism and assuring thyroid hormone replacement therapy.
MESH: Aged-; Aged,-80-and-over; Coma-diagnosis; Coma-epidemiology; Coma-therapy; Myxedema-diagnosis; Myxedema-epidemiology; Myxedema-therapy; Sex-Factors
MESH: *Coma-; *Myxedema-
TG: Case-Report; Female; Human; Male
PT: JOURNAL-ARTICLE; REVIEW; REVIEW,-TUTORIAL
AN: 96054481
UD: 9602
MEDLINE EXPRESS (R) 1992-1996 30 of 44
TI: Team development and memory training in traumatic brain injury rehabilitation: two birds with one stone.
AU: Finset-A; Krogstad-JM; Hansen-H; Berstad-J; Haarberg-D; Kristansen-G; Saether-K; Wang-MD
AD: Department of Behavioural Sciences in Medicine, University of Olso, Norway.
SO: Brain-Inj. 1995 Jul; 9(5): 495-507
ISSN: 0269-9052
PY: 1995
LA: ENGLISH
CP: ENGLAND
AB: The need for developing team cooperation procedures when treating patients with traumatic brain injury (TBI) is stated. One approach in promoting team cooperation is to combine team development with a specific training programme. A memory training programme used in a subacute TBI rehabilitation unit is described. A combination of a team development procedure and memory training programme was performed in the unit. A questionnaire to assess team members' attitudes to team cooperation was administered before and after team development, and memory training procedures were implemented. The post-training questionnaire administration indicated a more positive perception among team members of how the team functioned. The efficacy of memory training showed variable results. The programme described may illustrate the advantages of combining a specific treatment programme with efforts to promote team development.
MESH: Adult-; Coma-rehabilitation; Follow-Up-Studies; Middle-Age; Neuropsychological-Tests; Treatment-Outcome
MESH: *Anomia-rehabilitation; *Brain-Damage,-Chronic-rehabilitation; *Brain-Injuries-rehabilitation; *Patient-Care-Team; *Staff-Development
TG: Case-Report; Human; Male
PT: JOURNAL-ARTICLE
AN: 96053761
UD: 9601
MEDLINE EXPRESS (R) 1992-1996 31 of 44
TI: Perioperative management of thyroid disease. Prevention of complications related to hyperthyroidism and hypothyroidism.
AU: Pronovost-PH; Parris-KH
AD: Section of General Internal Medicine, Temple University School of Medicine, Philadelphia, USA.
SO: Postgrad-Med. 1995 Aug; 98(2): 83-6, 96-8
ISSN: 0032-5481
PY: 1995
LA: ENGLISH
CP: UNITED-STATES
AB: Patients with underlying thyroid disease who are in need of surgery present a particular challenge to the surgeon responsible for their care and to the medical consultant who must offer clinical guidance. Often, underlying thyroid disease is difficult to detect clinically, because signs and symptoms of disease are varied or subtle. Furthermore, those with known disease who are receiving a seemingly stable medical regimen may still be at risk for associated complications. Only heightened clinical awareness, early and appropriate treatment, and delay of elective surgery results in an improved patient outcome.
MESH: Adrenergic-beta-Antagonists-therapeutic-use; Antithyroid-Agents-therapeutic-use; Coma-prevention-and-control; Comorbidity-; Glucocorticoids-therapeutic-use; Hyperthyroidism-prevention-and-control; Hypothyroidism-prevention-and-control; Iodine-therapeutic-use; Myxedema-prevention-and-control; Risk-Factors; Thyroid-Crisis-prevention-and-control
MESH: *Postoperative-Complications-prevention-and-control; *Thyroid-Diseases-surgery
TG: Human
PT: JOURNAL-ARTICLE; REVIEW; REVIEW,-TUTORIAL
RN: 0; 0; 0; 7553-56-2
NM: Adrenergic-beta-Antagonists; Antithyroid-Agents; Glucocorticoids; Iodine
AN: 95357288
UD: 9511
SB: AIM
MEDLINE EXPRESS (R) 1992-1996 32 of 44
TI: The teaching of bioethics to the health care team: the neurologist's role.
AU: Pasetti-C
AD: Division of Neurology, Medical Centre of Rehabilitation, Veruno, Novara, Italy.
SO: Med-Law. 1995; 14(1-2): 87-91
ISSN: 0723-1393
PY: 1995
LA: ENGLISH
CP: SOUTH-AFRICA
AB: The term 'bioethics' connotes not only the complexity of the subject but also the importance of adopting an interdisciplinary approach to it. Any given bioethical issue should be considered from a biological as well as anthropological and social perspective. Treating and evaluating ethical ideas without regard for these three aspects means diminishing and limiting them. Owing to the progress in intensive care and thanks to our increased sensitivity towards patients affected by irreversible diseases, many ethical problems have emerged relating to new conditions (for instance persistent vegetative state) or to already known ones (for example the later stages of amyotrophic lateral sclerosis or dementias). In future, it is likely that neurologists will be called upon to address an increasing number of ethical concerns, as primary care givers, consultants or members of ethics consultative teams, given that they are the most qualified to throw light on individual cases with regard to their diagnostic and prognostic, as well as on ethical, rational and emotional aspects. Neurologists are eminently suitable to play a crucial part in medical decision making regarding issues such as the administration or withdrawal of life-sustaining treatment. Furthermore, neurologists have much to contribute to the education of the health care team. This is because they are used to formulating judgments grounded on their professional experience in dealing with problems both physical and psychological. On the basis of these considerations, the author believes that neurologists are among the most qualified to bridge the gap between the two major components of bioethics: natural and human science. These components should find their synthesis and completeness in the bioethical debate.
MESH: Coma-therapy; Decision-Making; Intensive-Care; Life-Support-Care; Patient-Care-Team
MESH: *Ethics,-Medical-education; *Neurology-; *Physician's-Role
TG: Human
PT: JOURNAL-ARTICLE
AN: 95396197
UD: 9512
MEDLINE EXPRESS (R) 1992-1996 33 of 44
TI: A pediatric right to die?
AU: George-JE; Quattrone-MS; Goldstone-M
SO: J-Emerg-Nurs. 1995 Aug; 21(4): 341-2
ISSN: 0099-1767
PY: 1995
LA: ENGLISH
CP: UNITED-STATES
MESH: Child-; Michigan-
MESH: *Child-Advocacy-legislation-and-jurisprudence; *Coma-therapy; *Right-to-Die-legislation-and-jurisprudence
TG: Female; Human
PT: LEGAL-BRIEF
AN: 95387573
UD: 9512
SB: NURSING
MEDLINE EXPRESS (R) 1992-1996 34 of 44
TI: The gulf between: surrogate choices, physician instructions, and informal network responses.
AU: Koch-T
AD: David See-Chai Lam Centre for International Communications, Simon Fraser University, Vancouver, Canada.
SO: Camb-Q-Healthc-Ethics. 1995 Spring; 4(2): 185-92
ISSN: 0963-1801
PY: 1995
LA: ENGLISH
CP: UNITED-STATES
MESH: Attitude-of-Health-Personnel; Decision-Making; Legal-Guardians-psychology; Life-Support-Care-legislation-and-jurisprudence; Quality-of-Life; Social-Values; United-States
MESH: *Coma-therapy; *Computer-Communication-Networks; *Ethics,-Medical; *Legal-Guardians; *Life-Support-Care-standards; *Professional-Family-Relations
TG: Human
PT: JOURNAL-ARTICLE
AN: 95384406
UD: 9512
MEDLINE EXPRESS (R) 1992-1996 35 of 44
TI: Continuous use of neuromuscular relaxants in the management of head injured patients [letter; comment]
CM: Comment on: J Neurosurg Anesthesiol 1994 Apr;6(2):136-8. Comment on: J Neurosurg Anesthesiol 1994 Apr;6(2):139-41
AU: Beretta-L; Citerio-G; Gemma-M
SO: J-Neurosurg-Anesthesiol. 1995 Apr; 7(2): 127
ISSN: 0898-4921
PY: 1995
LA: ENGLISH
CP: UNITED-STATES
MESH: Neuromuscular-Blocking-Agents-adverse-effects; Positive-Pressure-Respiration; Pseudotumor-Cerebri-prevention-and-control; Respiration,-Artificial
MESH: *Coma-therapy; *Head-Injuries-therapy; *Neuromuscular-Blocking-Agents-administration-and-dosage
TG: Human
PT: COMMENT; LETTER
RN: 0
NM: Neuromuscular-Blocking-Agents
AN: 95290944
UD: 9509
MEDLINE EXPRESS (R) 1992-1996 36 of 44
TI: Early restructuration of consciousness after traumatic coma.
AU: Van-de-Kelft-E; Candon-E; Couchet-P; Frerebeau-P; Daures-JP
AD: Department of Neurosurgery, Universitair Ziekenhuis Antwerpen, Belgium.
SO: Acta-Neurol-Belg. 1995; 95(2): 88-91
ISSN: 0300-9009
PY: 1995
LA: ENGLISH
CP: BELGIUM
AB: Recovery of consciousness after acute brain injury is a remarkable phenomenon, yet, not completely understood. We describe the early clinical stages of recovery of consciousness in 48 selected patients by means of different items of the Glasgow Coma and Liege Coma Scales. Arousal, expressed by the stimulated opening of the eyes (E2) was correlated with the appearance of the localizing pain response (M5), with the capacity to obey commands (M6), with the opening of the eyes (E4) and with the blink reflex (R5). This study confirms the classical clinical sequence of arousal and recovery of consciousness characterized by the consecutive appearance of E2, R5, E4, M5 and M6. When the appearance of E2 and R5 are considered separately, we noticed a significant difference, suggesting different structural and functional brain recovery processes.
MESH: Adolescence-; Adult-; Aged-; Aged,-80-and-over; Arousal-physiology; Blinking-; Brain-Injuries-psychology; Coma-diagnosis; Coma-psychology; Glasgow-Coma-Scale; Middle-Age; Pain-
MESH: *Coma-rehabilitation; *Consciousness-physiology
TG: Female; Human; Male
PT: JOURNAL-ARTICLE
AN: 95343713
UD: 9510
MEDLINE EXPRESS (R) 1992-1996 37 of 44
TI: Myxedema coma.
AU: Tsitouras-PD
AD: Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, USA.
SO: Clin-Geriatr-Med. 1995 May; 11(2): 251-8
ISSN: 0749-0690
PY: 1995
LA: ENGLISH
CP: UNITED-STATES
AB: Myxedema coma is a rare, hard-to-diagnose condition with a very high mortality rate. Prompt diagnosis and aggressive treatment are essential because they can greatly improve survival risks.
MESH: Aged-; Coma-diagnosis; Coma-therapy; Middle-Age
MESH: *Coma-etiology; *Myxedema-complications
TG: Human
PT: JOURNAL-ARTICLE; REVIEW; REVIEW,-TUTORIAL
AN: 95330703
UD: 9510
MEDLINE EXPRESS (R) 1992-1996 38 of 44
TI: A comatose woman who fears hospitals.
AU: Fuller-J; Somerville-K; Bliss-M
AD: Charing Cross Hospital, London.
SO: Practitioner. 1995 May; 239(1550): 291-4, 296
ISSN: 0032-6518
PY: 1995
LA: ENGLISH
CP: ENGLAND
MESH: Aged-; Dehydration-therapy; Professional-Family-Relations
MESH: *Coma-therapy; *Fear-; *Home-Care-Services; *Hospitalization-
TG: Female; Human
PT: JOURNAL-ARTICLE
AN: 95288200
UD: 9509
MEDLINE EXPRESS (R) 1992-1996 39 of 44
TI: Pentoxifylline as a supportive agent in the treatment of cerebral malaria in children.
AU: Di-Perri-G; Di-Perri-IG; Monteiro-GB; Bonora-S; Hennig-C; Cassatella-M; Micciolo-R; Vento-S; Dusi-S; Bassetti-D; et-al
AD: Institute of Immunology, University of Verona, Italy.
SO: J-Infect-Dis. 1995 May; 171(5): 1317-22
ISSN: 0022-1899
PY: 1995
LA: ENGLISH
CP: UNITED-STATES
AB: In an open, randomized, controlled therapeutic trial, 56 children with cerebral malaria (CM) were randomly assigned to receive standard quinine regimen with or without pentoxifylline (10 mg/kg/day by continuous intravenous infusion). Pentoxifylline exerted an inhibitory effect on the synthesis of tumor necrosis factor (TNF), a possible mediator of CM. The 26 children who received pentoxifylline had significantly shorter comas than controls (median, 6 vs. 46 h; P < .001) Pentoxifylline recipients showed a trend toward a lower mortality, with a borderline significant difference (P = .055). The better outcome in the pentoxifylline group was associated with a decline in TNF serum levels on the third day of treatment in a few subjects that was not seen in controls. While alternative or concurrent mechanisms of action may be of some relevance, larger double-blind trials are needed to determine whether pentoxifylline has a therapeutic role in CM.
MESH: Adolescence-; Burundi-; Child-; Child,-Preschool; Coma-drug-therapy; Drug-Therapy,-Combination; Malaria,-Cerebral-mortality; Quinine-therapeutic-use; Survival-Rate; Tumor-Necrosis-Factor-analysis
MESH: *Malaria,-Cerebral-drug-therapy; *Pentoxifylline-therapeutic-use
TG: Female; Human; Male; Support,-Non-U.S.-Gov't
PT: CLINICAL-TRIAL; JOURNAL-ARTICLE; RANDOMIZED-CONTROLLED-TRIAL
RN: 0; 130-95-0; 6493-05-6
NM: Tumor-Necrosis-Factor; Quinine; Pentoxifylline
AN: 95271072
UD: 9508
SB: AIM
MEDLINE EXPRESS (R) 1992-1996 40 of 44
TI: Withholding nutrition and hydration revisited [comment]
CM: Comment on: Nurs Manage 1994 Oct;25(10):81-2, 85-9
AU: Daly-BJ
SO: Nurs-Manage. 1995 May; 26(5): 30, 33, 37-9
ISSN: 0744-6314
PY: 1995
LA: ENGLISH
CP: UNITED-STATES
AB: The concerns Hall raises in her article, "Caring for Corpses or Killing Patients" (October 1994) are reasonable points to consider but careful examination suggests that this form of treatment limitation is not prohibited by moral, legal or professional principles. In fact, in situations in which we have reliable information about what the patient's preferences were, we may have a very strong obligation to cease this unwanted intervention. In situations of uncertainty because of lack of data, lack of confidence in the information or sincere philosophical differences, we must hesitate before acting, calling upon whatever ethical, legal and professional resources can shed light on the issues at hand and lead us to consensus.
MESH: *Coma-therapy; *Enteral-Nutrition; *Ethics,-Nursing; *Fluid-Therapy; *Terminal-Care; *Treatment-Refusal
TG: Human
PT: COMMENT; JOURNAL-ARTICLE
AN: 95265391
UD: 9508
SB: NURSING
MEDLINE EXPRESS (R) 1992-1996 41 of 44
TI: Survey of critical care management of comatose, head-injured patients in the United States.
AU: Ghajar-J; Hariri-RJ; Narayan-RK; Iacono-LA; Firlik-K; Patterson-RH
AD: Aitken Neurosurgery Laboratory, Department of Surgery, Cornell University Medical College, New York, NY 10021.
SO: Crit-Care-Med. 1995 Mar; 23(3): 560-7
ISSN: 0090-3493
PY: 1995
LA: ENGLISH
CP: UNITED-STATES
AB: OBJECTIVE: This survey was designed to study current practices in the monitoring and treatment of patients with severe head injury in the United States. DATA SOURCES: The collected data represent answers to telephone interviews of nurse managers, clinical specialists, and staff nurses specializing in neurotrauma care at 277 randomly selected hospitals from a total pool of 624 trauma centers. Overall, 261 (94%) centers participated in the survey. Of the participating centers, 219 (84%) were providers of care for severely head-injured patients. In order to assess reliability and account for differences among respondents, personnel from 40 (15%) centers were resurveyed 6 months later and a different nursing professional was interviewed, although the questions remained the same. DATA EXTRACTION: The largest group of respondents came from level I centers (49%), followed by level II (32%) and level III (2%). Thirty-four percent of the surveyed hospitals had a designated neurologic/neurosurgical intensive care unit, and 24% of all units surveyed were under the direction of either a neurosurgeon or a neurologist. Twenty-eight percent of the centers routinely performed intracranial pressure monitoring, while 7% of the centers reported never using this technique. The use of ventriculostomy catheters for intracranial pressure monitoring was employed in 72% of the centers, but cerebrospinal fluid drainage was utilized by only 44% of the hospitals. The percentage of patients who had their intracranial pressure monitored was significantly higher in level I trauma centers and at hospitals that treated larger numbers of severely head-injured patients (15 to 30 patients per month, which represented 15% of the hospitals surveyed). Hyperventilation and osmotic diuretics were used in 83% of centers to reduce intracranial hypertension. The administration of barbiturates was reported in 33% of the units as a treatment for intracranial hypertension. Corticosteroids were used more than half of the time in 64% of trauma centers. Twenty-nine percent of the centers reported aiming for PaCO2 values of < 25 torr (< 3.3 kPa). CONCLUSIONS: The survey data indicate that there is a considerable variation in the management of patients with severe head injury in the United States. The establishment of guidelines for the management of head injury based on available scientific data and moderated by practical and financial considerations may lead to improvement in the standard of care.
MESH: Adrenal-Cortex-Hormones-therapeutic-use; Barbiturates-therapeutic-use; Cerebrospinal-Fluid-Shunts; Coma-therapy; Combined-Modality-Therapy-standards; Diuretics,-Osmotic-therapeutic-use; Head-Injuries-physiopathology; Intracranial-Pressure; Monitoring,-Physiologic-methods; Quality-of-Health-Care; Sampling-Studies
MESH: *Critical-Care; *Head-Injuries-therapy
TG: Human; Support,-Non-U.S.-Gov't
PT: JOURNAL-ARTICLE; MULTICENTER-STUDY
RN: 0; 0; 0
NM: Adrenal-Cortex-Hormones; Barbiturates; Diuretics,-Osmotic
AN: 95179982
UD: 9506
SB: AIM
MEDLINE EXPRESS (R) 1992-1996 42 of 44
TI: Transient unresponsiveness in the elderly: possible episodes of idiopathic recurring stupor [letter; comment]
CM: Comment on: Arch Neurol 1992 Jan;49(1):35-7. Comment on: Arch Neurol 1994 Jul;51(7):644
AU: Tinuper-P; Montagna-P; Plazzi-G; Lugaresi-E
SO: Arch-Neurol. 1995 Mar; 52(3): 232
ISSN: 0003-9942
PY: 1995
LA: ENGLISH
CP: UNITED-STATES
MESH: Aged-; Carrier-Proteins-blood; Coma-blood; Flumazenil-therapeutic-use
MESH: *Coma-drug-therapy
TG: Human
PT: COMMENT; LETTER
RN: 0; 0; 78755-81-4
NM: diazepam-binding-inhibitor; Carrier-Proteins; Flumazenil
AN: 95177747
UD: 9506
SB: AIM
MEDLINE EXPRESS (R) 1992-1996 43 of 44
TI: Myxedema coma. Pathophysiology, therapy, and factors affecting prognosis.
AU: Jordan-RM
AD: Department of Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City.
SO: Med-Clin-North-Am. 1995 Jan; 79(1): 185-94
ISSN: 0025-7125
PY: 1995
LA: ENGLISH
CP: UNITED-STATES
AB: Myxedema coma is a fatal condition when left unrecognized. With the advent of intensive supportive therapy and the use of intravenous thyroxine, however, mortality for this disorder is declining. Further insights into the pathophysiology of hypothyroidism should lead to more rational approaches to therapy and result in improved survival.
MESH: Coma-therapy; Emergencies-; Myxedema-diagnosis; Myxedema-physiopathology; Myxedema-therapy; Prognosis-; Thyroid-Hormones-therapeutic-use
MESH: *Coma-etiology; *Myxedema-complications
TG: Human
PT: JOURNAL-ARTICLE; REVIEW; REVIEW,-TUTORIAL
RN: 0
NM: Thyroid-Hormones
AN: 95106903
UD: 9504
SB: AIM
MEDLINE EXPRESS (R) 1992-1996 44 of 44
TI: Old age does not negate good cerebral outcome after cardiopulmonary resuscitation: analyses from the brain resuscitation clinical trials. The Brain Resuscitation Clinical Trial I and II Study Groups.
AU: Rogove-HJ; Safar-P; Sutton-Tyrrell-K; Abramson-NS
AD: Department of Anesthesiology, University of Pittsburgh Medical Center, PA. 15260.
SO: Crit-Care-Med. 1995 Jan; 23(1): 18-25
ISSN: 0090-3493
PY: 1995
LA: ENGLISH
CP: UNITED-STATES
AB: OBJECTIVE: To assess survival after cardiac arrest and to determine whether age is an independent determinant of late mortality or poor neurologic outcome. DESIGN: Analyses using results of Brain Resuscitation Clinical Trial I (1979 to 1984) and Brain Resuscitation Clinical Trial II (1984 to 1989), two randomized, double-blind studies of outcome following cardiac arrest. SETTING: A multicenter study in 12 acute care hospitals in nine countries (Brain Resuscitation Clinical Trial I), and 24 hospitals in eight countries (Brain Resuscitation Clinical Trial II). PATIENTS: A total of 774 patients who were initially comatose after successful resuscitation from cardiac arrest. The analyses include both in- and out-of-hospital cardiac arrests. RESULTS: The 6-month mortality rate for the entire group was 81%. Mortality rate was 94% for the oldest group (> 80 yrs) compared with 68% for the youngest group (< or = 45 yrs) (p < .01). Other independent predictors of mortality were history of diabetes mellitus, inhospital arrests, arrest time of > 5 mins, history of congestive heart failure, a noncardiac cause of arrest, and cardiopulmonary resuscitation time of > 20 mins. Of the 774 patients, 27% recovered good neurologic function. There was no statistically significant difference in neurologic recovery rates by age. Multivariate analysis showed that independent predictors of good neurologic recovery were: no history of diabetes mellitus, a cardiac cause of arrest, short arrest time, and short cardiopulmonary resuscitation time. CONCLUSION: Increasing age was a factor in postresuscitation mortality, but was not an independent predictor of poor neurologic outcome.
MESH: Age-Factors; Aged-; Aged,-80-and-over; Cardiopulmonary-Resuscitation-mortality; Coma-etiology; Coma-mortality; Double-Blind-Method; Glasgow-Coma-Scale; Heart-Arrest-complications; Heart-Arrest-mortality; Lidoflazine-therapeutic-use; Middle-Age; Neurologic-Examination; Prognosis-; Risk-Factors; Thiopental-therapeutic-use
MESH: *Cardiopulmonary-Resuscitation; *Coma-therapy; *Heart-Arrest-therapy
TG: Female; Human; Male; Support,-U.S.-Gov't,-P.H.S.
PT: CLINICAL-TRIAL; CLINICAL-TRIAL,-PHASE-I; CLINICAL-TRIAL,-PHASE-II; JOURNAL-ARTICLE; MULTICENTER-STUDY; RANDOMIZED-CONTROLLED-TRIAL
CN: NS15295NSNINDS
RN: 3416-26-0; 76-75-5
NM: Lidoflazine; Thiopental
AN: 95094522
UD: 9503
SB: AIM
web contact: pietsch@indiana.edu
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