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Biomedical subjects

A Frank

Publications and source records attributed to A Frank.

At least 145 records · Page 8Linked to original sources
PubMed1992

Effects of hypoglycemia on the cerebral circulation in awake goats.

We electromagnetically measured blood flow to one cerebral hemisphere and determined cerebrovascular reactivity to vasoconstrictor and vasodilator stimuli during normoglycemia and insulin-induced hypoglycemia in unanesthetized goats. Control blood glucose concentration was 84 +/- 4 mg, and insulin, injected intravenously, decreased glycemia with a concomitant increment in cerebral blood flow and reduction in cerebrovascular resistance in all the animals. When glycemia decreased to 60 to 65 mg/dl, the animals began to show signs of increased adrenergic activity, and when it decreased to less than 30 mg/dl, they showed signs of CNS depression. Cerebral blood flow began to rise significantly at a glycemia of 50 to 55 mg/dl, and progressively increased to reach an increment of 36% +/- 4% when glycemia was less than 30 mg/dl. Norepinephrine (0.3 to 9 micrograms), tyramine (50 to 500 micrograms), and 5-hydroxytryptamine (0.1 to 9 micrograms) reduced cerebral blood flow, and this effect was lower during severe hypoglycemia. Acetylcholine (0.01 to 1 microgram), isoproterenol (0.03 to 3 micrograms), diazoxide (0.3 to 9 mg), and inhalation of 10% CO2 in air increased cerebral blood flow, and this effect was also lower during severe hypoglycemia. The results show that insulin-induced hypoglycemia causes cerebral vasodilation and reduction of the capacity of cerebral blood vessels to constrict and dilate. They also show that the glycemic thresholds for increasing cerebral blood flow are near to, or slightly lower than, the thresholds for hypoglycemic symptoms. This experimental model of hypoglycemia closely resembles the conditions in hypoglycemic patients and permits serial evaluation of the cerebrovascular effects of hypoglycemia without using anesthesia.

Animals↗
PubMed1992

Emergency hospital admissions and readmissions of patients aged over 75 years and the effects of a community-based discharge scheme.

This paper reports the results of a retrospective review which analysed emergency admissions and readmissions of elderly patients to a district general hospital. All patients received standard after-care allocated by the community health and social services departments following referral by hospital staff. In addition, half of the cohort was randomly allocated to receive care attendant support for a maximum of 12 hours a week for two weeks following the first and any subsequent discharge from hospital. The effect of this additional community support on emergency readmissions was also reviewed. The findings show that the patients randomly allocated to receive the modest domiciliary after-care service were less likely to have another emergency readmission or multiple readmissions. The results suggest that patients over 75 years-of-age, living alone, or having two or more emergency admissions within six months, should have a domiciliary assessment and follow-up after hospital discharge.

Aftercare↗
PubMed1991

On methods of reporting clinical material.

The members of the Committee on Scientific Activities of the American Psychoanalytic Association are concerned about the paucity of clinical data in psychoanalytic reports and by the quality of what does exist. We have proposed a few standards for clinical reports that we believe will be reliable and clear and will have enduring usefulness. We recognize the need for maintaining confidentiality and, at times, for disguise; we also recognize the need to balance these requirements against the dangers of misleading the reader (or listener). These conflicting requirements have resulted in our concentrating on some general principles for clinical reporting. We have appended a tentative form, and examples, to be considered for that purpose.

Data Collection↗
PubMed1991

Community support for young physically handicapped people.

This study examined the cost of home and hospital care for individuals who are severely physically handicapped and who may have many years to live. In addition to quantifying the overall level of these services and their costs, factors which might influence the level of service were identified and their use related to the diagnosis, duration and severity of disability, and number of unpaid carers. Costs of health and social service community support increased with severity of disability, and were mostly incurred by individuals with a Barthel score of less than 50 (more severe handicap). Costs, except for those individuals with cerebral palsy, were independent of the number of careers, and for those of school and university age the costs of special educational facilities were significant.

Adult↗
PubMed1990

[Evaluation of respiratory muscle function (maximal respiratory pressures) in myasthenia gravis].

In myasthenia gravis (MG) the status of respiratory function has a paramount importance and a careful evaluation is recommended. The weakness of respiratory muscles has been demonstrated in several studies. However, a reliable simple method for the evaluation of this muscular group was lacking until recently, when the usefulness of the maximum respiratory pressures, expiratory (MEP) and inspiratory (MIP), was demonstrated. We evaluated with this method a series of 23 patients with a diagnosis of MG (16 females and 7 males), with a mean age of 46 years (22-68 years), clinically stable and without symptomatic dyspnea. They were distributed in: grade I (5), grade II A (12), and grade II B (6). All of them were evaluated with flow-volume curves, pletysmography, gas transfer, MEP and MIP. The resulting values were then correlated with the expected ones, a reduction greater than one SD being considered as abnormal. The results showed that respiratory function was normal without a restrictive pattern. However, the force of respiratory muscles was reduced in the following proportions of patients in the different groups: grade I: MIP 40%, MEP 60%; in grades II A and II B both MEP and MIP were reduced in 84% of patients. When a statistical comparison with the expected values was carried out it was found that MEP and MIP, considered as a group, were reduced to 53% of the expected values (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Wilson's disease: computed tomography and magnetic resonance imaging].

Wilson's disease is an autosomal recessive hereditary disease in which the capacity of biliary copper excretion is reduced, resulting in a toxic accumulation of this metal in the liver, brain and other organs. The neuroimaging techniques, computed tomography (CT) and nuclear magnetic resonance (NMR), have been incorporated to the diagnostic workup in patients with suspected Wilson's disease (WD). We report two patients with WD in whom CT and NMR were carried out for the evaluation of the central nervous system (CNS). The lesions appeared as hypodense areas in CT or signal abnormalities in NMR over the involved structures: putamen, caudate nucleus, cerebellar dental nucleus, red nucleus and subcortical white matter. In one of the patients, hypointense signal areas were found over both putamen nuclei in T-2 times of NMR, which might correspond to cavitary necrosis or copper deposition. The lesion distribution suggests that vascular lesions might play a role in the mechanisms of tissue damage. These findings show that CT and NMR are very helpful to evaluate WD. NMR images are quite characteristic of this disorder.

Adolescent↗
PubMed1989

Arthroscopic treatment of osteochondral lesions of the talar dome.

Nine osteochondral lesions of the talar dome were treated arthroscopically. Two patients (a 16-year-old boy) had two recent osteochondral fractures, anterior and superior lateral, with a free fragment detached in the joint. The lesions were treated with simple ablation of the loose body. Seven old lesions were found in four men and three women, aged 18-32 years, with an osteocartilaginous, partially loose body with necrosis of the underlying bone. The lesion was posterior medial in these seven cases. Technically, arthroscopy is usually performed using an anterior approach. However, it is sometimes necessary to place the foot in the talipes equinus position to achieve articular distraction for diagnosis and treatment of posterior lesions. Treatment consisted of removal of the loose body, with curettage of the necrotic bone. The nine patients were clinically and radiologically reviewed with a follow-up period of 10-24 months. For the two osteochondral fractures, clinical results following the removal of free loose bodies in the joint were spectacular, with complete pain relief and osseous rehabilitation almost radiologically complete after 2 years. In the seven patients with an old necrotic lesion, the result was very good or good in six cases, and poor in one case. Radiologically, osseous rehabilitation occurred progressively, but remained incomplete at 2 years. This technique provides multiple advantages: minimal morbidity, 48-h hospitalization, and rapid functional recuperation without immobilization. Our results confirm the recent data in the literature (1-4).

Adolescent↗