98 results on '"Heller MB"'
Search Results
2. Novel Germline SDHB Mutation in a 35 Year-Old Male with Invasive Bladder Paraganglioma.
- Author
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Heller, MB, primary, Elaraj, DM, additional, Aleppo, G, additional, and Sturgeon, C, additional
- Published
- 2010
- Full Text
- View/download PDF
3. 28 Correlates of Emergency Department Analgesic Use by Race, Age, Gender, and Severity: Use of a National Database
- Author
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Salen, PN, Lucas, J, Arcona, S, and Heller, MB
- Published
- 2000
4. INTRAVAGINAL ALUM RESULTING IN MUCOSAL EROSIONS
- Author
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Hahn, I, O'Connor, J, Melville, L, Blancaflor, G, Heller, MB, Hoffman, RJ, and Hoffman, RS
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Alum -- Adverse and side effects ,Poisoning, Accidental -- Care and treatment ,Environmental issues ,Health ,Pharmaceuticals and cosmetics industries - Abstract
Background: Alum is any group of chemical compounds made up of water molecules and two kinds of salts, one of which is typically aluminum sulfate ([Al.sub.2][([SO.sub.4]).sub.3]). Therapeutically, alum is typically used for its astringent properties. We describe a pediatric patient who performed an ethnic healing practice improperly and subsequently sustained severe vaginal injury. Case Report: A 17-year-old nulliparous Haitian female presented to the emergency department complaining of severe vaginal pain. Two days prior, the patient had inserted alum 'crystals' to increase her vaginal tone. Her motivation for using intravaginal alum stemmed from a cultural practice of Haitian women, who use alum postpartum as a means to increase vaginal tone for enhanced sexual pleasure. The patient did not understand that this practice typically involves use of a dilute douche and instead inserted solid crystals. On presentation, the patient had normal vital signs. Intravenous conscious sedation was necessary in order to conduct an adequate pelvic examination, which was significant for vulvar edema and gray-yellow charring of the vaginal mucosa with areas of ulceration. There were no signs of vaginal perforation and there was no active bleeding. The remainder of the physical examination was normal. Laboratory investigations revealed a normal PT/PTT, normal CBC and a negative pregnancy test. Initial treatment consisted of vaginal irrigation with normal saline and administration of analgesics. The patient was observed for 24 hours and discharged. The crystals were identified using atomic absorption spectroscopy for aluminum sodium and barium sulfate precipitation and turbidometric analysis for the sulfate ion. Percentage composition determined after analysis was consistent with the theoretical composition of AlK[([SO.sub.4]).sub.2] [multiplied by] 12 [H.sub.2]O or aluminum potassium sulfate, otherwise known as alum. Conclusion: Intravesicular alum instillation is a common treatment for hemorrhagic cystitis. Aluminum sulfate is also used as an antiperspirant for its astringent properties. Rare complications associated with various different uses for alum include fistulas, encephalopathy and death. In certain ethnic groups, the alum douche is used in conjunction with sitz baths after postpartum to enhance healing in the perineal area. This case describes an ethnic practice that can cause severe injury. This practice should be recognized by physicians living in the multi-cultural urban environment because it may aid in diagnosis and management for an unusual cause of vaginal pain., Hahn I, O'Connor J, Melville L, Blancaflor G, Heller MB, Hoffman RJ, Hoffman RS. St. Luke's-Roosevelt Hospital Center, Kings County Hospital, New York City Department of Health, Bellevue Hospital Center, [...]
- Published
- 2001
5. Can Cardiac Ultrasound and End-Tidal [CO.sub.2] Be Used to Predict Resuscitation Outcomes?
- Author
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Salen, PN, O'Connor, RE, Passerello, B, Sierzenski, P, Pancu, DM, Arcona, S, and Heller, MB
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Echocardiography ,Cardiac resuscitation -- Methods ,Health - Published
- 2000
6. Lumbar Puncture First in Subarachnoid Hemorrhage? Not in My Back!
- Author
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Pancu, D, Roth K, Arcona, S, Patterson, J, and Heller, MB
- Subjects
Subarachnoid hemorrhage -- Diagnosis ,Spine -- Puncture ,CT imaging ,Health - Published
- 2000
7. Are Specialist Interventions Underutilized in the Care of Delirious Geriatric Patients Admitted From the Emergency Department?
- Author
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Salen, PN, Daoud, G, Arcona, S, Kinchen, D, and Heller, MB
- Subjects
Aged patients -- Care and treatment ,Delirium -- Care and treatment ,Health - Published
- 2000
8. Ultrasound Use in a Community Hospital Emergency Department: Adjunctive or Definitive Study?
- Author
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Pancu, D, Melanson, SW, Arcona, S, Pronchik, D, and Heller, MB
- Subjects
Ultrasound imaging ,Emergency medical services -- Equipment and supplies ,Health - Published
- 2000
9. Can an Emergency Department Ultrasound Screening Program Identify Abdominal Aortic Aneurysms in Asymptomatic Geriatric Patients?
- Author
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Melanson, SW, Salen, PN, Saracino, B, Buro, D, Heller, MB, and Patterson, J
- Subjects
Abdominal aneurysm -- Diagnosis ,Aged men -- Medical examination ,Emergency medical services -- Evaluation ,Health - Published
- 2000
10. Aeromedical FAST by Nonphysicians With a Miniature Ultrasound Unit
- Author
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Melanson, SW, McCarthy, J, Kostenbader, J, Greissinger, P, and Heller, MB
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Ultrasound imaging -- Equipment and supplies ,Abdomen ,Blunt trauma -- Care and treatment ,Health - Published
- 2000
11. Emergency Physician Bedside Ultrasound Decreases Length of Stay, Intravenous Usage, and Patient Charges in the Evaluation of Ureteral Colic Compared With Computed Tomography and Intravenous Pyelography
- Author
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Salen, PN, Hennelly, M, Kelleman, A, Sharp, T, Wloczewski, K, Arcona, S, and Heller, MB
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Colic -- Diagnosis ,Kidneys ,Ultrasound imaging ,Hospital utilization -- Length of stay ,Health - Published
- 2000
12. Correlates of Emergency Department Analgesic Use by Race, Age, Gender, and Severity: Use of a National Database
- Author
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Salen, PN, Lucas, J, Arcona, S, and Heller, MB
- Subjects
Analgesia -- Methods ,Pain -- Care and treatment ,Health - Published
- 2000
13. Preparing for chemical terrorism: stability of injectable atropine sulfate.
- Author
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Schier JG, Ravikumar PR, Nelson LS, Heller MB, Howland MA, and Hoffman RS
- Published
- 2004
14. Residency training in emergency ultrasound: fulfilling the mandate.
- Author
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Heller MB, Mandavia D, Tayal VS, Cardenas EE, Lambert MJ, Mateer J, Melanson SW, Peimann NP, Plummer DW, and Stahmer SA
- Published
- 2002
15. Are race, age, gender, and insurance status determinants in interhospital helicopter transport time and frequency?
- Author
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Furlong BR, Heller MB, and Auble TE
- Published
- 1993
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16. Severe headache: initial measures.
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Grossman RI, Heller MB, and Raskin NH
- Published
- 1993
17. Design of a resident in-field experience for an emergency medicine residency curriculum
- Author
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Stewart, RD, primary, Paris, PM, additional, and Heller, MB, additional
- Published
- 1985
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18. Effect of ethnicity on emergency department analgesia for low back pain and headache
- Author
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Patterson, JW, Hurst, KR, Heller, MB, and Arcona, S
- Published
- 1999
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19. How good are emergency physicians in predicting the results of shoulder X-rays?
- Author
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Silver, BE, Sexton, JD, McGinn, MA, and Heller, MB
- Published
- 1999
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20. Emergency medicine residents' perceptions of bioethical education
- Author
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Salen, PN, Siersenski, PR, and Heller, MB
- Published
- 1999
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- View/download PDF
21. Do age and gender affect β-blocker utilization in emergency department management of acute myocardial infarction?
- Author
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Pancu, DM, Lee, DC, Salen, PN, Roberts, SF, Rudolph, GS, Ryan, J, Heller, MB, and Arcona, S
- Published
- 1999
- Full Text
- View/download PDF
22. Is a clinical rule for predicting the need for shoulder X-rays feasible?
- Author
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Silver, BE, Sexton, JD, McGinn, MA, and Heller, MB
- Published
- 1999
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- View/download PDF
23. Bedside ultrasound education in emergency medicine residencies
- Author
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Melanson, SW, Panacek, EA, Wloczewski, KR, and Heller, MB
- Published
- 1999
- Full Text
- View/download PDF
24. Cost-Effectiveness of Drug-Coated Balloon Angioplasty versus Plain Old Balloon Angioplasty for Arteriovenous Fistula Stenosis.
- Author
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Zhou AL, Wu X, Youm J, Heller MB, and Lam A
- Subjects
- Aged, Humans, United States, Cost-Benefit Analysis, Constriction, Pathologic, Treatment Outcome, Medicare, Coated Materials, Biocompatible, Paclitaxel, Angioplasty, Balloon methods, Arteriovenous Fistula, Peripheral Arterial Disease therapy
- Abstract
Objective: To compare the cost-effectiveness of drug-coated balloon angioplasty (DCB) versus plain old balloon angioplasty (POBA) for treatment of arteriovenous fistula (AVF) stenosis., Methods: A Markov model was created to compare DCB versus POBA for AVF stenosis over a 2-year time horizon from a United States payer's perspective. Probabilities related to complications, restenosis, retreatment, and all-cause mortality were obtained from published literature. Costs were calculated using Medicare reimbursement rates and data from published cost analyses, inflation-adjusted to 2021. Health outcomes were measured with quality-adjusted life years (QALY). Probabilistic and deterministic sensitivity analyses were performed with a willingness-to-pay threshold of $100,000/QALY., Results: Base case calculation showed better quality-of-life outcomes but increased cost with POBA compared to DCB, with an incremental cost-effectiveness ratio of $27,413/QALY, making POBA the more cost-effective strategy in the base case model. Sensitivity analyses showed that DCB becomes cost-effective if the 24-month mortality rate after DCB is no more than 3.4% higher than that after POBA. In secondary analyses where mortality rates were equalized, DCB was more cost-effective than POBA until its additional cost reached more than $4213 per intervention., Conclusion: When modeled from a payer's perspective over 2 years, the cost utility of DCB versus POBA varies with mortality outcomes. POBA is cost-effective if 2-year all-cause mortality after DCB is greater than 3.4% higher than after POBA. If 2-year mortality after DCB is less than 3.4% higher than after POBA, DCB is cost-effective until its additional cost per procedure exceeds $4213 more than POBA., Level of Evidence Iv: HISTORICALLY CONTROLLED STUDY.: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)
- Published
- 2023
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25. Geniculate Artery Embolization: Role in Knee Hemarthrosis and Osteoarthritis.
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Heller DB, Beggin AE, Lam AH, Kohi MP, and Heller MB
- Subjects
- Arteries, Hemarthrosis etiology, Hemarthrosis therapy, Humans, Quality of Life, Arthroplasty, Replacement, Knee adverse effects, Osteoarthritis, Knee complications, Osteoarthritis, Knee diagnostic imaging, Osteoarthritis, Knee therapy
- Abstract
Roughly 37% of Americans 60 years of age and older experience chronic pain due to osteoarthritis (OA) of the knee. After conservative treatment (pharmacologic, physical therapy, and joint injections) fails, patients often require total knee arthroplasty to alleviate pain and regain knee function. Given the high economic burden of surgery paired with its invasive nature, many patients with this degenerative joint disease seek alternative treatment. Moreover, many patients with severe knee OA who also have comorbidities that preclude surgery-most often morbid obesity-are left without options. Geniculate artery embolization (GAE) is a minimally invasive intra-arterial intervention that was originally developed for the treatment of knee hemarthrosis that has recently been adapted for symptomatic knee OA. Through selective embolization of geniculate branches corresponding to the site of knee pain, GAE inhibits the neovascularity that contributes to the catabolic and inflammatory drive of OA. Preliminary trials over the past decade have demonstrated promising clinical results, including decreased pain and improved function and quality of life after treatment. Given such success, GAE provides another minimally invasive treatment option for knee OA to patients who feel reluctant to undergo or are ineligible for surgery. The authors review the radiographic manifestations and current standard of treatment of OA and hemarthrosis of the knee. Procedural technique, embolic selection, and clinical evidence for GAE in the treatment of OA and hemarthrosis of the knee are also explored. The online slide presentation from the RSNA Annual Meeting is available for this article.
© RSNA, 2021.- Published
- 2022
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26. Visceral Aneurysm Formation and Intraabdominal Hemorrhage Associated with Immune Checkpoint Inhibitor Therapy.
- Author
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Lee AY, Lam A, Hicks RM, Isikbay M, Heller MB, Sugi MD, Behr S, and Kohi MP
- Subjects
- Aged, Aneurysm diagnostic imaging, Aneurysm therapy, Embolization, Therapeutic, Female, Hemoperitoneum diagnostic imaging, Hemoperitoneum therapy, Hemorrhage diagnostic imaging, Hemorrhage therapy, Humans, Aneurysm chemically induced, Antibodies, Monoclonal, Humanized adverse effects, Antineoplastic Agents, Immunological adverse effects, Hemoperitoneum chemically induced, Hemorrhage chemically induced, Immune Checkpoint Inhibitors adverse effects
- Published
- 2021
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27. The Roots of Chronic Posttraumatic Stress Disorder: Childhood Trauma, Information Processing, and Self-protective Strategies.
- Author
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Crittenden PM and Heller MB
- Abstract
Background: Although childhood endangerment often precedes adult posttraumatic stress disorder (PTSD), the mechanism from danger to disorder is unclear. We proposed a developmental process in which unprotected and uncomforted danger in childhood would be associated with "shortcuts" in information processing that, in adulthood, could result in PTSD if the adult experienced additional exposure to danger. Information processing was defined as the basic associative, dissociative, and integrative processes used by all humans. Individual differences in parents' (or primary caregivers') protective and comforting behavior were expected to force unprotected children to use psychological shortcuts that linked early trauma to later vulnerability for PTSD., Method: We compared 22 adults with chronic PTSD to (a) 22 adults with other psychiatric diagnoses and (b) 22 normative adults without any diagnosis, in terms of information processing around childhood danger. The Adult Attachment Interview was used to derive information processing variables, including self-protective strategies, childhood traumas, and depression., Results: The two patient groups differed from the normative group on all variables. Adults with chronic PTSD differed from other psychiatric patients in having more childhood traumas and using more transformations of associative and dissociative processes. Within the PTSD group, there were three psychologically different subgroups., Conclusion: Our findings suggest that (1) prediction of risk for adult PTSD may be possible, (2) treatment might be facilitated by provision of a protective and supportive therapist, (3) who included a focus on correction of information processing errors and use of more adaptive strategies, and (4) subgroups of adults with PTSD may require different forms of treatment., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2017.)
- Published
- 2017
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28. Performance of an expedited rhythm control method for recent onset atrial fibrillation in a community hospital.
- Author
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White JL, Heller MB, Kahoud RJ, Slade D, and Harding JD
- Subjects
- Adult, Aged, Aged, 80 and over, Cohort Studies, Emergency Service, Hospital, Female, Humans, Length of Stay statistics & numerical data, Male, Middle Aged, Prospective Studies, Young Adult, Anti-Arrhythmia Agents therapeutic use, Atrial Fibrillation therapy, Clinical Protocols, Electric Countershock methods, Hospitalization statistics & numerical data, Hospitals, Community, Procainamide therapeutic use
- Abstract
Background: A standard approach to recent onset atrial fibrillation (AF) in the emergency department (ED) in the United States has not been established., Purpose: The purpose of this prospective clinical trial was to determine how an ED protocol emphasizing rhythm control for recent onset AF compared similar patients receiving standard therapy in the same facility., Methods: We enrolled consecutive patients presenting to our community hospital with recent onset AF into a protocol, which called for rhythm control with procainamide and if unsuccessful electrical cardioversion and discharge home. We compared this prospective cohort with matched historical controls. Primary outcome was admission rate. We also compared ED conversion rates and lengths of stay (LOS). We reported 30-day data on the study group including ED recidivism, recurrent AF, outpatient follow-up, and any important adverse events., Results: Fifty-four patients were enrolled in the study group with 4 being admitted compared with 30 of 50 in the historical control group. Ninety-four percent of the study group converted compared with 28% in the historical control. Both hospital and ED LOS were significantly shorter for the study group. Six patients had recurrent AF, and 4 of those returned to the ED., Conclusion: An ED protocol that uses rhythm control decreased hospital admission and LOS, and there were no adverse events at 30 days., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
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29. A mouse model of β-thalassemia shows a liver-specific down-regulation of Abcc6 expression.
- Author
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Martin L, Douet V, VanWart CM, Heller MB, and Le Saux O
- Subjects
- ATP-Binding Cassette Transporters metabolism, Animals, Blotting, Western, Calcinosis complications, Calcinosis pathology, Disease Models, Animal, Fluorescent Antibody Technique, Kidney metabolism, Kidney pathology, Liver pathology, Mice, Multidrug Resistance-Associated Protein 2, Multidrug Resistance-Associated Proteins genetics, Multidrug Resistance-Associated Proteins metabolism, Organ Specificity genetics, Phenotype, Promoter Regions, Genetic genetics, RNA, Messenger genetics, RNA, Messenger metabolism, Transcription Factors metabolism, beta-Thalassemia complications, beta-Thalassemia pathology, ATP-Binding Cassette Transporters genetics, Down-Regulation genetics, Liver metabolism, beta-Thalassemia genetics
- Abstract
β-Thalassemia and pseudoxanthoma elasticum (PXE) are distinct genetic disorders. Yet, a dystrophic mineralization phenotype similar to PXE has frequently been associated with β-thalassemia or sickle cell anemia patients of Mediterranean descent. These calcifications are clinically and structurally identical to inherited PXE. As we previously excluded the presence of PXE-causing mutations in the ABCC6 gene of β-thalassemia patients with PXE manifestations, we hypothesized that a molecular mechanism independent of gene mutations either altered the ABCC6 gene expression or disrupted the biologic properties of its product in the liver or kidneys, which are the tissues with the highest levels of expression. To test this possibility, we investigated Abcc6 synthesis in the liver and kidneys of a β-thalassemia mouse model (Hbb(th3/+)). We found a progressive liver-specific down-regulation of the Abcc6 gene expression and protein levels by quantitative PCR, Western blotting, and immunofluorescence. The levels of Abcc6 protein decreased significantly at 6 months of age and stabilized at 10 months and older ages at ∼25% of the wild-type protein levels. We studied the transcriptional regulation of the Abcc6 gene in wild-type and Hbb(th3/+) mice, and we identified the erythroid transcription factor NF-E2 as the main cause of the transcriptional down-regulation using transcription factor arrays and chromatin immunoprecipitation. The Hbb(th3/+) mice did not develop spontaneous calcification as seen in the Abcc6(-/-) mice probably because the Abcc6 protein decrease occurred late in life and was probably insufficient to promote mineralization in the Hbb(th3/+) mouse C57BL/6J genetic background. Nevertheless, our result suggested that a similar decrease of ABCC6 expression occurs in the liver of β-thalassemia patients and may be responsible for their frequent PXE-like manifestations., (Copyright © 2011 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2011
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30. DNA methylation and Sp1 binding determine the tissue-specific transcriptional activity of the mouse Abcc6 promoter.
- Author
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Douet V, Heller MB, and Le Saux O
- Subjects
- Animals, Cell Line, DNA Methylation, Mice, Multidrug Resistance-Associated Proteins, Organ Specificity, Tissue Distribution, ATP-Binding Cassette Transporters genetics, Kidney metabolism, Liver metabolism, Promoter Regions, Genetic genetics, Sp1 Transcription Factor metabolism, Transcriptional Activation genetics
- Abstract
The gene encoding the ABCC6 protein, an ABC transporter of the multidrug resistance-associated protein (MRP), is mainly expressed in liver and kidney. Mutations in ABCC6 are responsible for the development of the pseudoxanthoma elasticum (PXE) phenotype. PXE is a recessive disease characterized by the calcification of elastic fibers resulting in dermal, vascular, and ocular clinical manifestations. The physiological function of ABCC6 and the rodent orthologs Abcc6 is unknown and their precise relationship to elastic fibers is only a matter of speculation. Despite several studies focused on the transcriptional regulation of ABCC6/Abcc6, the molecular signals conferring the tissue-specificity to the ABCC6/Abcc6 expression are not well defined. In this report, we determined the level of the mouse Abcc6 promoter methylation in tissues with low level of expression (tail extremity and skin), intermediate (kidney), and high level of expression (liver). We observed that high and moderate levels of methylation correlated with low levels of Abcc6 expression. Moreover, we determined that CpG methylation of the Abcc6 proximal promoter region was interfering with the binding of the Sp1 transcription factor thereby inhibiting Sp1-dependent transactivation. Thus, our data provide the first direct evidence that an epigenetic mechanism regulates the binding of transcription factor Sp1 to the proximal promoter and participates in the tissue-specific expression control of the mouse Abcc6 gene.
- Published
- 2007
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31. The effect of IM droperidol on driving performance.
- Author
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Fulton J, Popovetsky G, Jacoby JL, Heller MB, and Reed J
- Subjects
- Adult, Cross-Over Studies, Double-Blind Method, Droperidol administration & dosage, Female, Humans, Injections, Intramuscular, Male, Middle Aged, Antipsychotic Agents adverse effects, Automobile Driving, Droperidol adverse effects, Psychomotor Performance drug effects
- Abstract
Objectives: Droperidol (DROP) is used in the emergency department (ED) for several indications, but its effect on psychomotor performance is unclear. The purpose of this study was to evaluate the effects of DROP, 2.5 mg intramuscular (IM), on driving performance., Methods: This was a randomized, double-blinded, two-period, placebo-controlled crossover trial that utilized a standard driver-training program with computerized scoring. We solicited 20 paid volunteers who were pre-screened with a 12-lead EKG to evaluate QT length. For the first driving simulation, subjects were randomly assigned to receive either 2.5 mg of DROP IM or an equal volume of normal saline (NS). At least 72 hours later, the same subjects participated in a second driving simulation. For the second driving simulation, the assignment of DROP, 2.5 mg IM, or normal saline was reversed: (If a subject received DROP, 2.5 mg IM, in the first simulation, the subject received normal saline in the second simulation; conversely, if a subject received normal saline in the first simulation, the subject received DROP, 2.5 mg IM, in the second simulation). Thirty minutes later, participants drove the 20-minute simulation and received an average score based on the errors made in 4 categories: accelerating, braking, steering, and signaling. Post-testing, participants evaluated their degree of drowsiness and driving impairment using a visual analog scale and compared their perception of impairment to that caused by alcohol ingestion. Data were analyzed using analysis-of-variance, Pearson chi-square and Fischer's exact test with alpha set at p = 0.05., Results: Twenty subjects (11 males and 9 females) completed the protocol. The mean age was 30 years with a range of 20 to 46 years, and the mean weight was 80 kg. The mean driving experience was 12 years. Participants who received DROP felt significantly drowsier (38.6 mm +/- 9.0) than those receiving NS (13.2 mm +/- 9.0), the mean difference was 25.4 mm p = .009. Subjects receiving DROP were also more likely to feel that their driving would be impaired as rated on the VAS (DROP: 34.6 +/- 5.2; NS: 3.2 +/- 5.2; p = .0005), and DROP subjects reported impairment equivalent to 1-4 drinks more frequently than those receiving placebo (61% vs. 16.7%, p < .001). These subjective feelings of impairment were confirmed by their driving performance on the simulator. The mean driving score, using the driving simulator, was 68.8% with DROP vs. 73.6% with NS; p = .013., Conclusions: Subjects receiving modest doses of IM DROP report increased perceptions of drowsiness, driving impairment, and intoxication; these perceptions are confirmed on objective testing.
- Published
- 2006
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32. HNF4alpha and NF-E2 are key transcriptional regulators of the murine Abcc6 gene expression.
- Author
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Douet V, VanWart CM, Heller MB, Reinhard S, and Le Saux O
- Subjects
- Animals, Base Sequence, Cloning, Molecular, DNA, Complementary genetics, Humans, Mice, Molecular Sequence Data, Multidrug Resistance-Associated Proteins, Promoter Regions, Genetic, Transcriptional Activation, ATP-Binding Cassette Transporters genetics, Hepatocyte Nuclear Factor 4 metabolism, NF-E2 Transcription Factor, p45 Subunit metabolism
- Abstract
Mutations in an ABC transporter gene called ABCC6 are responsible for pseudoxanthoma elasticum (PXE), a rare heritable disease characterized by elastic fiber calcification in skin, ocular and vascular tissues. The presumed function of this ABC transporter is to export metabolites from polarized cells. However, the endogenous substrate(s) are unknown and the exact relationship with elastic fibers is unclear. As ABCC6 is only expressed at high level in liver and kidneys, tissues seemingly unrelated to the PXE phenotype, we explored the transcriptional regulation of the murine Abcc6 gene to define the transcriptional signal conferring tissue specificity and to gather clues on its possible biological function. We cloned 2.9 kb of the mAbcc6 5'-flanking region and several deletion constructs linked to a luciferase reporter gene. We delineated a proximal promoter and a liver-specific enhancer region. We also demonstrated that the proximal region is a TATA-less promoter requiring an intact CCAAT-box and Sp1 binding for its basal activity. By using reporter assays and chromatin immunoprecipitations, we showed that HNF4alpha and surprisingly, NF-E2, enhanced the mAbcc6 promoter activity. The involvement of both HNF4alpha and NF-E2 in the mAbcc6 gene regulation suggests that Abcc6 might be involved in a detoxification processes related to hemoglobin or heme.
- Published
- 2006
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- View/download PDF
33. Intramuscular ziprasidone: an effective agent for sedation of the agitated ED patient.
- Author
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Fulton JA, Axelband J, Jacoby JL, and Heller MB
- Subjects
- Adult, Emergency Service, Hospital, Female, Humans, Injections, Intramuscular, Male, Pain Measurement, Prospective Studies, Antipsychotic Agents administration & dosage, Hypnotics and Sedatives administration & dosage, Piperazines administration & dosage, Psychomotor Agitation drug therapy, Thiazoles administration & dosage
- Published
- 2006
- Full Text
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34. Synchronized emergency department cardioversion of atrial dysrhythmias saves time, money and resources.
- Author
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Jacoby JL, Cesta M, Heller MB, Salen P, and Reed J
- Subjects
- Adult, Aged, Aged, 80 and over, Atrial Fibrillation therapy, Chi-Square Distribution, Electric Countershock methods, Female, Humans, Length of Stay economics, Male, Middle Aged, Patient Satisfaction economics, Retrospective Studies, Time Factors, Atrial Fibrillation economics, Electric Countershock economics, Emergency Service, Hospital economics
- Abstract
The strategy of elective synchronized cardioversion (EDCV) of new onset atrial fibrillation/flutter (AF/flutter) compares favorably to that of Emergency Department (ED) rate control and inpatient admission. This 1-year study comprised consecutive ED synchronized cardioversions performed on patients with new onset (< 48 h) AF/flutter; all were hemodynamically stable. A control group was obtained by chart review of all patients meeting the inclusion criteria admitted in the same year who were managed with rate control in the ED and inpatient admission. Thirty ED cardioversions were performed on 24 patients. Twenty-nine of 30 (97%) of ED cardioversions were successful. The mean hospital length of stay (LOS) for the EDCV group, including those admitted, was 22.8 h (95% CI: 1.7-44.0) compared to the control group: 55.6 h (all admitted) (95% CI: 41.6-69.6). Median LOS for the entire EDCV group was 4 h, compared with 39.3 h for the controls (p < 0.001). There was also a significant difference in median hospital charge, including ED care: EDCV group: $1598 vs. controls $4271 (p < 0.001). All of the study patients were contacted by telephone a minimum of 4 weeks after cardioversion to assess for complications, recidivism, and satisfaction. There were no complications in the EDCV group, and all expressed satisfaction with the procedure. Elective synchronized cardioversion in the ED is an effective strategy for management of new-onset AF/flutter and is associated with significant decreases in charges and length of stay as well as a high degree of patient satisfaction.
- Published
- 2005
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35. The emergent airway: what drugs and adjuncts do emergency physicians prefer?
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Jacoby JL, Fulton J, Melanson S, Reed J, and Heller MB
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- Conscious Sedation, Emergencies, Emergency Service, Hospital, Etomidate, Humans, Midazolam, Hypnotics and Sedatives, Intubation, Intratracheal, Practice Patterns, Physicians'
- Published
- 2004
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36. Scrubs versus professional attire: ED patients are indifferent.
- Author
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Jacoby JL, Fulton J, Pronchik D, Patterson J, Reed J, and Heller MB
- Subjects
- Chi-Square Distribution, Humans, Prospective Studies, Surveys and Questionnaires, Clothing psychology, Emergency Service, Hospital, Patients psychology, Professional Competence, Social Perception
- Published
- 2004
- Full Text
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37. Isolated case of bioterrorism-related inhalational anthrax, New York City, 2001.
- Author
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Holtz TH, Ackelsberg J, Kool JL, Rosselli R, Marfin A, Matte T, Beatrice ST, Heller MB, Hewett D, Moskin LC, Bunning ML, and Layton M
- Subjects
- Anthrax diagnosis, Anthrax drug therapy, Bacillus anthracis genetics, Bacillus anthracis isolation & purification, Ciprofloxacin pharmacology, DNA, Bacterial analysis, Disease Outbreaks statistics & numerical data, Environmental Exposure, Female, Humans, Middle Aged, New York City epidemiology, Postal Service, Spores, Bacterial isolation & purification, Women, Anthrax epidemiology, Anthrax etiology, Bioterrorism, Inhalation Exposure
- Abstract
On October 31, 2001, in New York City, a 61-year-old female hospital employee who had acquired inhalational anthrax died after a 6-day illness. To determine sources of exposure and identify additional persons at risk, the New York City Department of Health, Centers for Disease Control and Prevention, and law enforcement authorities conducted an extensive investigation, which included interviewing contacts, examining personal effects, summarizing patient's use of mass transit, conducting active case finding and surveillance near her residence and at her workplace, and collecting samples from co-workers and the environment. We cultured all specimens for Bacillus anthracis. We found no additional cases of cutaneous or inhalational anthrax. The route of exposure remains unknown. All environmental samples were negative for B. anthracis. This first case of inhalational anthrax during the 2001 outbreak with no apparent direct link to contaminated mail emphasizes the need for close coordination between public health and law enforcement agencies during bioterrorism-related investigations.
- Published
- 2003
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38. Laboratory response to anthrax bioterrorism, New York City, 2001.
- Author
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Heller MB, Bunning ML, France ME, Niemeyer DM, Peruski L, Naimi T, Talboy PM, Murray PH, Pietz HW, Kornblum J, Oleszko W, and Beatrice ST
- Subjects
- Algorithms, Bacillus anthracis isolation & purification, Epidemiological Monitoring, Information Management methods, Laboratories statistics & numerical data, Medical Laboratory Personnel, New York City epidemiology, Personnel Staffing and Scheduling, Risk Factors, Security Measures, Specimen Handling methods, Workforce, Workload, Anthrax diagnosis, Anthrax epidemiology, Bioterrorism, Environmental Monitoring methods, Laboratories organization & administration, Population Surveillance methods
- Abstract
In October 2001, the greater New York City Metropolitan Area was the scene of a bioterrorism attack. The scale of the public response to this attack was not foreseen and threatened to overwhelm the Bioterrorism Response Laboratory's (BTRL) ability to process and test environmental samples. In a joint effort with the Centers for Disease Control and Prevention and the cooperation of the Department of Defense, a massive effort was launched to maintain and sustain the laboratory response and return test results in a timely fashion. This effort was largely successful. The development and expansion of the facility are described, as are the special needs of a BTRL. The establishment of a Laboratory Bioterrorism Command Center and protocols for sample intake, processing, reporting, security, testing, staffing, and and quality control are also described.
- Published
- 2002
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39. A two-hour intervention using START improves prehospital triage of mass casualty incidents.
- Author
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Risavi BL, Salen PN, Heller MB, and Arcona S
- Subjects
- Humans, Disasters, Emergency Medical Services methods, Emergency Medical Technicians education, Triage methods
- Abstract
Objective: There are few data concerning the ability of prehospital providers to triage patients in a mass casualty incident (MCI). The authors evaluated the effectiveness of a brief educational intervention on MCI triage with a written scenario and test. The START method (simple triage and rapid treatment) was used., Methods: The authors enrolled and tested 109 prehospital providers consisting of 31 paramedics and prehospital registered nurses (PHRNs) and 78 emergency medical technicians (EMTs) and first responders. A written scenario of an MCI was used to test participants before, immediately after, and again at one month after a two-hour educational intervention consisting of a slide and video presentation utilizing START., Results: The 109 participants completed the pre-intervention and post-intervention test; 72 (66%) completed the one-month post-intervention as well. Mean work experience was 9 years (ranging from 1 to 27 years). The mean immediate post-test score (75% correct) was significantly improved compared with the mean pretest score (55% correct) for the 109 providers completing both tests (p < 0.001). Among advanced life support providers (EMT-Ps and PHRNs) completing all three surveys, the mean immediate post-test score (76% correct) and mean one-month post-test score (75% correct) were not significantly different. Among the basic life support providers completing all three surveys, a modest but statistically significant decay in mean scores from immediate post-test (74% correct) to one-month post-test (68% correct) was observed (p < 0.01). Prior training in MCI had no statistically significant effect on changes in mean test scores., Conclusion: The ability of prehospital providers of all levels of training and experience to triage patients in an MCI is less than optimal. However, this ability improved dramatically after a single didactic session, and improvement persisted one month later.
- Published
- 2001
- Full Text
- View/download PDF
40. Ultrasound interpretation of hydronephrosis is improved by a brief educational intervention.
- Author
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Morse JW, Saracino BS, Melanson SW, Arcona S, and Heller MB
- Subjects
- Clinical Competence standards, Curriculum, Humans, Hydronephrosis etiology, Observer Variation, Program Evaluation, Reproducibility of Results, Ultrasonography, Education, Medical, Graduate organization & administration, Emergency Medicine organization & administration, Hydronephrosis classification, Hydronephrosis diagnostic imaging, Internship and Residency organization & administration, Medical Staff, Hospital education, Severity of Illness Index
- Abstract
Nineteen emergency medicine (EM) physicians (14 residents and 3 attendings) from an EM residency program which teaches ultrasound as part of the curriculum, were asked to rate 40 ultrasound scans showing different degrees of kidney hydronephrosis, first solely on the basis of their prior knowledge and experience. One week later, after a brief 15 minute lecture on a new objective method to read degrees of hydronephrosis, the same EM physicians were again asked to rate the 40 ultrasounds. One month later, to assess retention of the method, the same physicians were asked to read the same scans using the objective method presented 1 month prior. The three readings were compared with each other, and then each with a gold standard established for the study. Agreement of the group regarding scan interpretation improved and was maintained after the educational intervention (multirater kappa + .19, .32, and .32 for the three tests administered). When the differences between each week's readings and the gold standard were assessed, differences decreased with each successive test, and were statistically significant with the third test (P = .029). We conclude that our brief educational intervention improves agreement among physicians in readings of ultrasound scans and also significantly increases accuracy in readings when compared with a gold standard.
- Published
- 2000
- Full Text
- View/download PDF
41. The focused abdominal sonography for trauma (FAST) examination: considerations and recommendations for training physicians in the use of a new clinical tool.
- Author
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Salen PN, Melanson SW, and Heller MB
- Subjects
- Animals, Clinical Competence, Humans, Models, Educational, Sensitivity and Specificity, Abdominal Injuries diagnostic imaging, Curriculum, Education, Medical, Graduate, Emergency Medicine education, Ultrasonography methods
- Abstract
Focused abdominal sonography for trauma (FAST) is being used by growing numbers of emergency physicians and surgeons because it has proven to be an accurate, rapid, and repeatable bedside test for evaluating abdominal trauma victims. Controversy exists about the optimal means of FAST education and the number of examinations necessary to demonstrate competency. Most FAST educators agree that FAST education should consist of three phases: didactic, practical, and experiential. This article summarizes options and preliminary recommendations suitable for developing a FAST curriculum.
- Published
- 2000
- Full Text
- View/download PDF
42. Rapid oral hydration results in hydronephrosis as demonstrated by bedside ultrasound.
- Author
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Morse JW, Hill R, Greissinger WP, Patterson JW, Melanson SW, and Heller MB
- Subjects
- Adolescent, Adult, Humans, Middle Aged, Prospective Studies, Ultrasonography, Fluid Therapy, Hydronephrosis diagnostic imaging, Hydronephrosis etiology, Kidney diagnostic imaging, Point-of-Care Systems
- Abstract
Study Objective: To determine whether vigorous oral hydration (20 mL/kg) causes hydronephrosis as determined by bedside ultrasound., Methods: We conducted a prospective laboratory trial in 35 healthy volunteers weighing less than 90 kg and between the ages of 18 and 50 years. The right kidney of the volunteers was scanned by emergency physicians at time 0 both before and after voiding, and the volunteers then drank 20 mL/kg of bottled water. The kidney was scanned in the transverse and sagittal planes both before and after voiding at 60 and 90 minutes after completion of the water load. The scans were interpreted by a physician trained and credentialed in emergency ultrasound, blinded to the volunteers' identity, the time of the scan, and the volume of urine voided by the subject. Images were rated as to the degree of hydronephrosis according to literature-established criteria, as follows: grade 0=no hydronephrosis, grade 1=mild, grade 2=moderate, and grade 3=severe hydronephrosis., Results: Hydronephrosis was present in 3 (8.6%) of the 35 subjects at time 0 (prehydration), 24 (68.6%) at 60 minutes, and 20 (57.1%) at 90 minutes. Overall, hydronephrosis occurred at least once in 28 (80%) of the 35 subjects after oral hydration compared with 3 (8.6%) of the 35 subjects before hydration. Hydronephrosis was found to be significantly related to forced hydration for all posthydration times (60 minutes, 90 minutes, and 60+90 minutes combined) versus prehydration time 0 (P <.001)., Conclusion: Without prior fluid intake, even mild degrees of hydronephrosis were relatively uncommon, and seen in only 8.6% of study patients. In the presence of vigorous oral hydration, however, mild or moderate hydronephrosis is a frequent occurrence seen at least once in 80% of our study of healthy volunteers after hydration. Caution is warranted in this setting when interpreting mild or moderate hydronephrosis found on bedside ultrasound by emergency physicians.
- Published
- 1999
- Full Text
- View/download PDF
43. Does wearing a necktie influence patient perceptions of emergency department care?
- Author
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Pronchik DJ, Sexton JD, Melanson SW, Patterson JW, and Heller MB
- Subjects
- Humans, Male, Prospective Studies, Clothing, Emergency Medicine, Patients psychology
- Abstract
We conducted a prospective study of discharged emergency department (ED) patients to determine the effect of wearing a necktie by emergency physicians (EPs) had on patients' impression of their medical care. All male EPs were assigned randomly by dates to wear a necktie or no necktie, and the attire worn was otherwise similar in all respects. The study was conducted at a community teaching hospital with an Emergency Medicine residency and an annual census of 40,000. A total of 316 patients were surveyed. There were no statistically significant differences between patient groups in any of the five areas surveyed, including patient perception of physicians' appearance. Nearly 30% of patients incorrectly identified their doctor as wearing a necktie when no necktie was worn, and the perception of tie wearing was correlated with a positive impression of physician appearance. Wearing or not wearing a necktie did not significantly affect patients' impression of their physician or the care they received. However, patients seemingly preferred the appearance of physicians who were perceived to wear neckties.
- Published
- 1998
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44. Nebulized glucagon in the treatment of bronchospasm in asthmatic patients.
- Author
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Melanson SW, Bonfante G, and Heller MB
- Subjects
- Administration, Inhalation, Adolescent, Adult, Bronchial Spasm chemically induced, Bronchoconstrictor Agents adverse effects, Bronchospirometry, Child, Cross-Over Studies, Double-Blind Method, Female, Humans, Male, Methacholine Chloride adverse effects, Time Factors, Treatment Outcome, Anti-Asthmatic Agents therapeutic use, Asthma drug therapy, Bronchial Spasm drug therapy, Glucagon therapeutic use
- Abstract
This study sought to determine if nebulized glucagon, a well-known smooth muscle relaxant, is effective in relieving asthmatic bronchospasm. Ten subjects, aged 12 to 26 years, with chronic stable asthma were studied in a pulmonary function laboratory under a randomized double-blind, placebo-controlled, crossover design. Bronchospasm was induced in each subject with progressive doses of nebulized methacholine until forced expiratory volume in 1 second (FEV1) had decreased at least 20% from baseline. Subjects then received either nebulized saline or 2 mg of nebulized glucagon. Spirometry was performed at 5, 15, and 30 minutes after treatment. Subjects then received 2.5 mg of nebulized albuterol and had spirometry 15 and 30 minutes thereafter. Each subject returned for testing with the alternative solution at least 1 week later. Treatment with nebulized glucagon resulted in a 58% +/- 15% improvement in FEV1 15 minutes after treatment compared with 36% +/- 7% after nebulized saline (P < .05). No adverse effects of glucagon treatment occurred. This study suggests that nebulized glucagon reduces methacholine-induced bronchospasm in asthmatic patients.
- Published
- 1998
- Full Text
- View/download PDF
45. Impact of emergency medicine residents on ancillary test utilization.
- Author
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Sexton JD, Heller MB, Patterson JD, Pronchik D, and Melanson SW
- Subjects
- Blood Chemical Analysis statistics & numerical data, Electrocardiography statistics & numerical data, Emergency Service, Hospital, Hospitals, Community, Humans, Pennsylvania, Prospective Studies, Radiography statistics & numerical data, Ancillary Services, Hospital statistics & numerical data, Internship and Residency, Medical Staff, Hospital
- Abstract
The effect of the addition of emergency medicine residency on the use of ancillary testing in a teaching hospital's emergency department (ED) staffed previously by emergency medicine board-certified physicians was studied. Prospectively, the utilization of three common ancillary tests (electrolyte levels, X-ray, or electrocardiogram) for four common chief complaints of patients eventually discharged from the ED was evaluated. A 12-month period before and a 15-month period after introduction of an emergency medicine residency program were compared. The mean number of ancillary tests utilized by the ED attending physicians working with residents was compared with the mean number of tests generated by the same physicians (all emergency medicine board-certified) for the same complaints in the year before the residents' arrival. There was no significant difference in test use before and after introduction of the residency (P = .66). Faculty use of tests was also unaffected by the concurrent presence of residents (P = .068). These results show that the use of testing for a sample of common ED complaints was not affected by the introduction of emergency medicine residents to a previously emergency medicine board-certified staff in one community teaching hospital.
- Published
- 1998
- Full Text
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46. Transnasal butorphanol in the emergency department management of migraine headache.
- Author
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Melanson SW, Morse JW, Pronchik DJ, and Heller MB
- Subjects
- Administration, Intranasal, Adult, Analgesics, Opioid administration & dosage, Butorphanol administration & dosage, Female, Humans, Male, Middle Aged, Narcotic Antagonists administration & dosage, Pain Measurement, Patient Satisfaction, Prospective Studies, Treatment Outcome, Analgesics, Opioid therapeutic use, Butorphanol therapeutic use, Migraine Disorders drug therapy, Narcotic Antagonists therapeutic use
- Abstract
Transnasal butorphanol (TNB) is a mixed agonist-antagonist opioid that has recently been released for the treatment of painful conditions. Patients with a history of migraine diagnosed in either of two emergency departments (EDs) with a moderate or severe migraine were eligible for this prospective study. Patients received 1 mg of TNB at time zero and again in 45 minutes if needed. Twenty-five patients were studied. Pain intensity was measured on a 10-cm visual analog scale. Mean pain intensity was significantly decreased at 15 minutes and declined from 7.9 +/- 1 cm initially to 2.5 +/- 3.3 cm at 90 minutes. Sixty percent of the patients required no further treatment. Thirty-six percent experienced side effects, with all but 1 being mild or moderate. Seventy-five percent rated the treatment as good, very good, or excellent, and 71% would prefer to receive TNB for future migraines over other treatment options. TNB offers rapid, effective pain relief to the majority of ED migraine patients.
- Published
- 1997
- Full Text
- View/download PDF
47. Treatment of toad venom poisoning with digoxin-specific Fab fragments.
- Author
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Brubacher JR, Ravikumar PR, Bania T, Heller MB, and Hoffman RS
- Subjects
- Adolescent, Adult, Amphibian Venoms analysis, Animals, Aphrodisiacs analysis, Bradycardia chemically induced, Bufanolides analysis, Bufanolides poisoning, Bufotenin analysis, Bufotenin poisoning, Digoxin poisoning, Fatal Outcome, Humans, Male, Materia Medica analysis, Ventricular Fibrillation chemically induced, Vomiting chemically induced, Amphibian Venoms poisoning, Aphrodisiacs poisoning, Bufonidae, Digoxin immunology, Immunoglobulin Fab Fragments therapeutic use, Materia Medica poisoning
- Abstract
Toxicity from toad venom poisoning is similar to digoxin toxicity and carries a high mortality rate. We report on six previously healthy men who developed vomiting and bradycardia after ingesting a purported topical aphrodisiac. Each patient had positive apparent digoxin levels and the first four patients died of cardiac dysrhythmias. The last two patients recovered following treatment with digoxin Fab fragments. We analyzed samples of the purported aphrodisiac and found that it was identical to Chan Su, a Chinese medication made from toad venom. To our knowledge, this is the first reported use of digoxin Fab fragments to treat toad venom poisoning.
- Published
- 1996
- Full Text
- View/download PDF
48. Deep vein thrombosis, pulmonary embolism, and the white clot syndrome.
- Author
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Melanson SW, Silver B, and Heller MB
- Subjects
- Adolescent, Amputation, Surgical, Anticoagulants therapeutic use, Female, Heparin therapeutic use, Humans, Pulmonary Embolism drug therapy, Syndrome, Thrombophlebitis drug therapy, Thrombosis complications, Thrombosis surgery, Anticoagulants adverse effects, Heparin adverse effects, Popliteal Artery, Pulmonary Embolism complications, Thrombophlebitis complications, Thrombosis chemically induced
- Abstract
Thromboembolic events such as deep vein thrombosis (DVT) and pulmonary embolism (PE) are very uncommon in the pediatric age group; even more rare is the white clot syndrome. We present the case of a 13-year-old girl who presented with no known risk factors for thromboembolic disease or cardiopulmonary complaints, yet was found to have extensive lower extremity DVT and PE. This patient also suffered the rare but potentially devastating complication of heparin therapy referred to as the white clot syndrome, resulting in amputation of the lower extremity. Greater awareness of both thromboembolic disease in children and the white clot syndrome may lessen the morbidity and mortality associated with these entities.
- Published
- 1996
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- View/download PDF
49. Use of practice tracks in the medical specialties.
- Author
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Melanson SW, Sexton JD, and Heller MB
- Subjects
- Data Collection, Education, Medical, Emergency Medicine history, History of Medicine, History, 20th Century, Humans, Internship and Residency, Medicine standards, Specialization, United States, Certification history, Specialty Boards history
- Abstract
Objectives: To evaluate the use of practice tracks by each of the 24 medical specialty boards and to compare this with the experience in emergency medicine (EM)., Methods: Scripted telephone surveys were conducted with representatives of each of the specialty boards., Results: Of 24 specialties currently recognized by the American Board of Medical Specialties (ABMS), 14 (58%) reported a history of a practice track. Eight boards reported never having a practice track and 2 were unsure. All practice tracks have been limited in duration, most commonly closing after a specified period. The mean duration of the practice tracks was 9.8 years, the median was 7.5 years, and the range was 3-27 years. The practice track in EM was open for 9 years., Conclusions: Practice tracks were common in the early years of most specialties and most were limited by duration. The history of the practice track in EM is not dissimilar to those of other specialties.
- Published
- 1996
- Full Text
- View/download PDF
50. Conscious sedation: we are getting sleepy, very sleepy....
- Author
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Heller MB and Melanson SC
- Subjects
- Emergency Medicine, Humans, Conscious Sedation adverse effects, Publishing
- Published
- 1996
- Full Text
- View/download PDF
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