Bernard Dannenberg

Journal Articles

• Tension pneumoperitoneum after intussusception pneumoreduction PEDIATRIC EMERGENCY CARE Sohoni, A., Wang, N. E., Dannenberg, B. 2007; 23 (8): 563-564

  Abstract

  Intussusception is the most common cause of intestinal obstruction in infancy. Presentation, diagnostic workup, and treatment are well understood and noncontroversial. Complications of bowel perforation are also well documented. We discuss a case of tension pneumoperitoneum after intestinal perforation during intussusception pneumoreduction in a 5-month-old child and review initial presentation, diagnosis, and management of this disease. It is important to recognize this rare complication of pneumoreduction and promptly treat the ensuing tension pneumoperitoneum.

  View details for Web of Science ID 000248777100009

  View details for PubMedID 17726417

• Pulse oximetry in discharge decision-making: a survey of emergency physicians. CJEM Brown, L., Dannenberg, B. 2002; 4 (6): 388-393

  Abstract

  Our primary objective was to describe the pulse oximetry discharge thresholds used by general and pediatric emergency physicians for well-appearing children with bronchiolitis and pneumonia, and to assess the related practice variability.This mail-in survey was conducted in August and September 2001 and included the 281 active members of the Pediatric Emergency Medicine Section of the American College of Emergency Physicians. The survey consisted of 2 case scenarios of previously healthy, well-appearing children: a 2-year-old with pneumonia and a 10-month-old with bronchiolitis. Respondents were asked about their years of experience, teaching load, percentage of children in their practice, whether they currently have a written departmental guideline at their institution, and the lowest pulse oximetry reading that they would accept and still discharge the patient directly home.One hundred and eighty-two (65%) physicians answered the survey and met the inclusion criteria. The respondents' median oximetry value and interquartile range (IQR) for the pneumonia and bronchiolitis cases were 93% (92%-94%) and 94% (92%-94%) respectively. With the exception of the 3 physicians practising >1000 metres above sea level, the responses by subgroups were similar.There does not yet exist a safe, clinically validated pulse oximetry discharge threshold. Emergency physicians from this study sample have a modest degree of practice variability in a self-reported pulse oximetry discharge threshold. Emergency physicians may use this data to compare their own practice with that reported by this group.

  View details for PubMedID 17637155

• Does adjunctive midazolam reduce recovery agitation after ketamine sedation for pediatric procedures? A randomized, double-blind, placebo-controlled trial ANNALS OF EMERGENCY MEDICINE Sherwin, T. S., Green, S. M., Khan, A., Chapman, D. S., Dannenberg, B. 2000; 35 (3): 229-238

  Abstract

  Despite widespread use of adjunctive benzodiazepines during ketamine sedation, their efficacy in reducing recovery agitation in children has never been studied. We wished to characterize the nature and severity of recovery agitation after ketamine sedation in children treated in the emergency department and to determine whether the addition of adjunctive midazolam reduces the magnitude of such recovery agitation.The study was a randomized, double-blind, clinical trial of adjunctive midazolam versus placebo during ketamine sedation. We enrolled 104 children aged 12 months to 15 years (median age, 6 years) at a combined university medical center and children's hospital. Subjects received either intravenous midazolam (0.05 mg/kg up to 2 mg) or placebo after intravenous administration of a ketamine loading dose (1.5 mg/kg). Treating physicians and nurses independently noted the presence of crying, hallucinations, and nightmares during recovery and graded recovery agitation by using a 100-mm visual analog scale. Preprocedure agitation and external stimulation during recovery were also graded. The time from ketamine injection until each subject met the recovery criteria was recorded.Fifty-three subjects received midazolam, and 51 received placebo. Potentially confounding variables were similar between the groups. Sedation efficacy, adverse effects, and recovery time were also similar between groups. Interobserver agreement between physician and nurse assessments was substantial. Median physician assessment of recovery agitation was 4 mm (interquartile range, 2 to 19) in the midazolam group and 5 mm (interquartile range, 3 to 14) in the placebo group (difference -1; 95% confidence interval -3 to 2; P =.705). Recovery agitation was moderately correlated with preprocedure agitation (rho=0.486) but not with external stimulation during recovery (rho=0.147).Recovery agitation is common but generally of very low magnitude after ketamine sedation in children in the ED. We observed a median physician rating of 5 mm on a 100-mm visual analog scale, a score that we believe to be clinically insignificant. The degree of recovery agitation after ketamine sedation is significantly related to the degree of preprocedure agitation. In this study, concurrent midazolam did not diminish such agitation and had no measurably beneficial effect. Use of adjunctive benzodiazepines in pediatric ketamine sedation appears unnecessary.

  View details for Web of Science ID 000085774700004

  View details for PubMedID 10692189

• OCCURRENCE OF IGE-BEARING EPIDERMAL LANGERHANS CELLS IN ATOPIC ECZEMA - A STUDY OF THE TIME COURSE OF THE LESIONS AND WITH REGARD TO THE IGE SERUM LEVEL JOURNAL OF INVESTIGATIVE DERMATOLOGY Bieber, T., Dannenberg, B., Prinz, J. C., Rieber, E. P., Stolz, W., BRAUNFALCO, O., Ring, J. 1989; 93 (2): 215-219

  Abstract

  Uninvolved and lesional skin of untreated and treated patients with atopic eczema has been investigated immunohistochemically to determine the conditions in which IgE-bearing CD1a+ Langerhans cells/indeterminate cells (LC/IC) occur in this disease. IgE-bearing epidermal dendritic cells were present in patients with elevated IgE serum level (greater than 300 UI/ml) and the staining pattern was stronger in lesional skin. On double immunostaining, a subpopulation of CD1a+ LC/IC was found not to bear IgE molecules as determined by the ratio IgE+/CD1a+ cells on serial sections as well. The ratio IgE+/CD1a+ cells decreased in patients who underwent a local therapy with glucocorticosteroids. These results suggest that the expression of IgE receptors and/or binding of IgE molecules on epidermal LC/IC in atopic eczema may be controlled by a complex network of mediators from the epidermis or the inflammatory infiltrate, or both, and that this phenomenon could be down regulated by glucocorticosteroids.

  View details for Web of Science ID A1989AJ16000005

  View details for PubMedID 2474029

• KERATINOCYTES IN LESIONAL SKIN OF ATOPIC ECZEMA BEAR HLA-DR, CD1A AND IGE MOLECULES CLINICAL AND EXPERIMENTAL DERMATOLOGY Bieber, T., Dannenberg, B., Ring, J., BRAUNFALCO, O. 1989; 14 (1): 35-39

  Abstract

  Apparently normal, and lesional skin from patients with atopic eczema were investigated immunohistochemically with anti-HLA-DR, -CD1a and -IgE antisera. A CD1a+ intercellular pattern was observed in uninvolved skin in the majority of the patients whereas an HLA-DR+/CD1a+ network, mostly localized in basal and supra-basal areas, was shown in lesional skin of virtually all of them. Moreover, an HLA-DR+/CD1a+IgE+ intercellular pattern was observed in some of the patients only and was predominantly localized in those areas characterized by lymphocyte exocytosis, spongiosis or vesicle formation. Whether keratinocytes are able to synthesize CD1a antigen and Fc epsilon R or if these molecules are only produced and shed by CD1a+/IgE+ epidermal dendritic cells remains unclear.

  View details for Web of Science ID A1989T083100008

  View details for PubMedID 2478318