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Biomedical subjects

A Elman

Publications and source records attributed to A Elman.

32 records · Page 2Linked to original sources
PubMed1976

Chloroquine retinopathy in patients with rheumatoid arthritis.

270 consecutive patients with rheumatoid arthritis who had received chloroquine therapy were examined ophthalmologically for toxic retinal lesions. The total annual dose of chloroquine was 70-75 g. The maximum total dose given was 1330 g. The duration of treatment ranged up to 15 years. The primary material was divided into four groups according to total chloroquine dose received: greater than 100 g, 101-300 g, 301-600 g, and less than 600 g. Each dose group was arbitrarily split into two age groups, one with patients under 63 years of age and the other with patients over 63, in order to analyse the effect of age upon the ocular findings. In the present study, slight macular changes were included in the concept of maculopathy and were not thought to contra-indicate chloroquine therapy. Macular changes were found in about 25% of the patients, regardless of age in the lowest dosage group. The frequency of maculopathy increased with increasing total dose only in the older age group. It was also shown that the frequency of maculopathies and other eye diseases also increased with increasing age. This was evident even from the age of 50. The only patient with chloroquine retinopathy was an inadequately controlled 74-year-old woman. Chloroquine treatment of rheumatoid arthritis in the absence of any other disease which may cause retinopathy implies negligible risks in adult patients under 50 years of age. These patients could be less frequently checked. Older patients require regular ophthalmological checks. It is important to use the smallest effective dose possible, and never higher than 4 mg of chloroquine phosphate/kg body weight and day for 10 months annually; in elderly patients, preferably even lower doses.

Age Factors↗
PubMed1976

Psoriasis, sacro-iliitis and peripheral arthritis occurring in patients with the same HLA haplotype. A preliminary family report and a hypothetical explanation of the interaction between MHS products.

The present family investigation has shown that genes within the MHS are mainly responsible for the development of psoriasis or psoriasis-associated arthritic lesions (peripheral arthritis and sacroiliitis). We have hypothetically discussed the possibility that multiple genes, all located within the MHS, act in concert to increase the risk of developing disease to very high levels. This implies that at least two MHS linked genes act in complementary fashion for the development of disease, these genes seem to be able to operate both in the cis and in the trans position. One of these genes would be situated in the chromosomal portion of the MHS which carries the HLA-D locus. Families with a high incidence of disease would show inheritance according to the cis position of genes, when it can be shown that most of the carriers of the specific disease-associated haplotype are affected by disease, whereas in other families, complementarity between two distinct HLA haplotypes with genes acting in the trans position would result in disease.

Adolescent↗
PubMed1975

Complications of transrectal aspiration biopsy of the prostate.

Four cases of coli-sepsis, one with a fatal outcome have been observed after more than 14 000 transrectal aspiration biopsies (TAB) of the prostate performed at Karolinska Sjukhuset with Franzén's apparatus. A few cases of transient febrile reaction and urinary contamination after TAB of the prostate have also been recognised. One of the patients with sepsis and two with febrile reactions belonged to a relatively small group of patients referred from the Department of Rheumatology. These observations prompted the present study. The records of all the patients referred for TAB of the prostate from the Department of Rheumatology were reviewed. Four complications (three patients with febrile reaction and growth of E. coli in the urine and one case of sepsis) were observed after 63 biopsies in 51 patients (6.3%). The patient with sepsis and two other patients with complications belonged to a group of 32 patients with proven rheumatic disease (chronic polyarthritis): 42 biopsies had been performed in this particular group of patients, bringing the incidence of complication to 7.1%. For comparison the records of 294 patients from the Department of Urology submitted to TAB of the prostate were also reviewed. Complications in the form of transient febrile reactions were found in five cases after 508 biopsies (1.0%). In addition, three cases of coli-sepsis not belonging to the above-mentioned groups are briefly described as case reports. Patients with rheumatic disease (chronic polyarthritis) seem to run a higher risk of complications after TAB of the prostate. Sepsis from E. coli is a rare but serious complication which can develop into, often fatal, endotoxin shock. TAB of the prostate should therefore be restricted to cases with clinical suspicion of prostatic malignancy.

Adult↗
PubMedDate not supplied

Interpleural analgesia with bupivacaine following thoracotomy: ineffective results of a controlled study and pharmacokinetics.

STUDY OBJECTIVE: To evaluate intrapleural analgesia with bupivacaine following partial pulmonary resection and to determine pharmacokinetic parameters of bupivacaine with epinephrine. DESIGN: Prospective, randomized study. SETTING: Thoracic surgical clinic of a university-affiliated general hospital. PATIENTS: Eighteen consecutive patients (13 men, 5 women) scheduled for pulmonary surgery by posterolateral thoracotomy. INTERVENTIONS: Bupivacaine was administered through an intrapleural catheter as a bolus dose of either 40 ml of 0.25% bupivacaine with epinephrine (0.5 mg per 100 ml of solution) (n = 10) or 20 ml of 0.5% bupivacaine with epinephrine (0.5 mg per 100 ml of solution) (n = 8) up to three times daily for a maximum time of 4 days. MEASUREMENTS AND MAIN RESULTS: Subjective evaluation of pain was performed using the visual analog scale (VAS) before and after each injection by response to spontaneous pain, coughing, deep breathing, and incision palpation. Maximum peak concentration (C Max) and maximum time to reach the peak concentration (T Max) were assessed after the first and last injections. Although VAS pain score decreased significantly, pain relief was not sufficient. C Max and T Max after the first and last injections were not significantly different between the two groups. In each group, C Max after the last injection was significantly higher than after the first injection. CONCLUSIONS: Intrapleural analgesia conducted with 40 ml of 0.25% bupivacaine with epinephrine or 20 ml of 0.5% bupivacaine with epinephrine was insufficient for pain, despite high plasma bupivacaine concentration.

Acetaminophen↗
PubMedDate not supplied

[Hypoglycemia].

After vagal collapsus, hypoglycemia is the emergency most often seen in the dental office. It usually happens among the treated diabetic population; there are approximately one million diabetics in France. Its sudden appearance requires an emergency treatment with oral or IV intake of glucose, or the injection of glucagon. Hypoglycemia is defined by a drop of the blood glucose level below the normal values. Of sudden onset, the clinical signs of hypoglycemia can vary, specially the neurological and psychiatric manifestations, and they can lead to a coma. The objective diagnosis relies on the blood glucose level.

Dental Offices↗
PubMedDate not supplied

[Carotid surgery under cervical plexus block. 405 consecutive operations].

There is controversy over the choice of anaesthesia for carotid surgery. The aim of this retrospective study was to report the early results of carotid surgery performed with loco-regional anaesthesia by blockade of the cervical plexus. From 1987 to 1992, 405 consecutive operations on the carotid bifurcation were performed using this technique. Among these patients, 202 (50%) were asymptomatic, the indication being carotid narrowing of 80% or more, while clinical signs were observed in the other 203 patients (50%). According to the Sundt classification, 360 patients (89%) had a medical risk and 45 (11%) had a neurological risk. Occlusion of the controllateral internal carotid was present in 47 patients (12%). The deep blocade affected roots C2-C3-C4 followed by a superficial block using 0.5% Bupivacaine. An endarteriectomy was performed in 96% of the cases. In 10 (2.5%), there were complications or the cervical plexus blocade was insufficient: 6 caused the operation to be postponed and/or use of general anaesthesia, but none of these led to postoperative complication. In 35 patients (8.6%) neurological events during clamping required establishing a shunt (6.1% and 27.6% in cases with permeable or occluded controlateral carotids respectively). Neurological recovery was rapid and complete except in 4 cases. There were 8 central neurological complications which persisted or appeared postoperatively: 5 regressive ischaemic events, 2 persistent ischaemic events and one which led to the patient's death. No cardiac complications were seen. We conclude that blocade of the cervical plexus is a simple and effective technique for surgery of the carotid bifurcation. With this method, detection of clamp intolerance is more reliable and it gives enough time for endarteriectomy. The risk of coronarian complications is low due to good haemodynamic stability. This method is a low-cost technique and is better adapted to understanding the mechanisms of neurological complications.

Adult↗