Biomedical subjects
Publications and source records attributed to A Langer.
It is possible to define a group of prospective parents who are at risk of producing offspring with disability due to chromosomal abnormalities. Such individuals should have evaluation of the 15 or 16 week fetus by karyotype of amniotic fluid cells. The techniques and problems of such diagnostic procedures are discussed.
A look in the patient's mouth can give clues to his overall health. For instance, atrophic glossitis--or breakdown of the tongue's papillary structure--reveals that there may be incomplete absorption of vitamin B complex or some other nutritional deficiency. Tenderness and impaired motion in the jaw can mean any of a number of problems related to other joints of the body. Osteoarthritis is often to blame. Or the disablement may be due to rheumatoid arthritis or to sclerosis of joint surfaces. Atrophy of the alveolar bone, which progresses slowly during normal aging, is speeded up in persons with osteoporosis. Even after all teeth are gone, bone loss continues. It's likely to be excessive and uneven, and the resultant sharp ridges and spicules sometimes cause so much pain and irritation that the patient can't tolerate dentures.
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The relation of human placental lactogen (hPL) levels to pregnancy outcome was studied in normal and preeclamptic pregnancies, hPL determinations were performed between 38 and 44 weeks of gestation, and the results were compared with birthweight and Apgar scores in three groups. The results of hPL determinations permitted prediction of intrauterine growth retardation in all except 2 patients. The value of hPL measurement as a screening test in pregnancy is noted.
Use of dermal graft for a urethral sling in treating urinary stress incontinence is described. This tissue has potential advantages of availability, strength, and freedom from side effects.
An evaluation of the possible etiologic factors in hyperextension of the fetal head in breech presentation and a discussion of management are presented. Our seven cases plus a review of the literature led to the conclusion that hyperextension of the aftercoming head is a dangerous malpresentation that should not be underestimated. For this reason, we strongly suggest an x-ray of all breech presentations in early labor, not only to evaluate pelvic adequacy but also to determine the attitude of the head. In persistent hyperextension, cesarean section is the management of choice.
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One hundred and eight preplanned cesarean hysterectomies have been evaluated in an effort to determine that advisability of prophylactic bilateral hypogastric artery ligation when there is anticipated heavy bleeding associated with surgery. The data indicates that prophylactic bilateral internal iliac artery ligation is of questionable value in reducing operative bleeding, which can be controlled by more conventional means. However, when used therapeutically, it may be a lifesaving operation. Familiarity with the procedure is necessary for all those performing operative obstetrics and gynecology.
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The influence of denture changes, occurring during a period of use ranging from one to 15 years, was studied in a group of 35 complete denture subjects. Clinical and electromyographic data were collected. N0 correlation was found between denture serviceability on the one hand and masticatory performance and muscular coordination during chewing of test food on the other. However, a significant correlation was found between a subject's satisfaction and his masticatory performance, as well as his muscular coordination during chewing of test food. It appears that, as soon as the time-linked and insidious imperfections of complete dentures are compensated for by feedback-controlled neuromuscular adaptation, the subject's adjusted pattern of function does not affect his performance and comfort and consequently his satisfaction. Despite the obvious differences among the respective subjects, the number of masticatory strokes in the same individual was rather constant. Obviously, a subject's satisfaction may easily camouflage lack of denture fit, including its potential concomitant pathologic sequelae. Therefore, periodic examinations and adequate corrections are essential to successful complete denture treatment.
Thiamin, biotin, B12, folate, pantothenate, riboflavin, nicotinate, B6, vitamins A, E, C, and beta-cartene was estimated in the blood of 174 mothers and in the cord blood of their neonates at parturition. A vitamin profile of normal preganancy was established for mother and neonate. This was based on values obtained from 95 percent confidence limits in 74 mothers not taking oral vitamins and 133 mothers ingesting various vitamin supllements. Circulating vitamin levels in 38 neonates born to mothers with no laboratory evidence of hypovitaminemia was persented. The higher incidence of hypobitaminemia in gravidas not taking vitamins was folate, thiamin, vitamins A, C, B12, BL and nicotinate in descending order. Ingestion of vitamins supplements reduced the incidence of hypovitaminemia. A similar relationship held for neonates from these mothers. However, despite vitamin ingestion thiamin, folate, vitamins C, A, B6, B12 and nicotinate hypovitaminemia was evident. There was an approximate 1:2-5 ratio between mother and neonate blood vitamins; vitamins A, B6, E, and beta-carotene were exceptions. Vitamin B6 ran parallel, while vitamins A, B6, E, and beta-carotene ratios reversed in favor of the mother at an approximate ratio of 2:1, 4:1 and 7:1, respectively. It is concluded that vitamin profile for mother and neonate, taking into account values established from a lorge gravid population, should now permit an evaluation of the effects of hypoviteminemia on the outcome of pregnancy and infant health.
Survival of natural dentition was studied in a multicultural group of 826 elderly people living in sheltered conditions in three old-age homes. It was found that the ratio of dentate subjects decreased progressively with age. The proportion of dentate men was significantly higher than that of women. The ratio of dentate subjects among the immigrants from Afro-Asian countries was significantly higher than among the European group. As the number of denture wearers among the elderly of European origin greatly exceeded that of Afro-Asian extraction, the assumption was made that the more advanced cultural background of the Europeans motivated them to take more advantage of dental services and as a result they had more teeth extracted due to preprosthodontic preparations. The mandibular teeth showed a higher survival rate than the maxillary. Most remaining dental units (teeth and roots) were found in the front region in both jaws, with definite persistance of canines and a clear tendency towards diminishing numbers of posterior tooth types. Studies on tooth survival may provide useful information for assessing needs and planning services for the aged in modern society and may contribute to better understanding of prosthodontic problems encountered in practice.
A gravid patient presented with gross hematuria in the last trimester of pregnancy but did not permit diagnostic measures. After delivery a large abdominal mass, which proved to be renal cell carcinoma, was found. Previously reported cases are reviewed, and the importance of adequate workup of hematuria during pregnancy is emphasized.
During a 5-year time span, 118 addicted women gave birth to viable infants. These patients were subject to an increased incidence of complicating medical problems as well as many obstetric problems leading to maternal or fetal risk. The obstetrician should be aware of the possibility of addiction and its effects on pregnancy, and when possible, appropriate management should be initiated. Intensive care of the neonate must be begun as soon as possible.
A comparison was made between sterilization by hysterectomy and by tubal ligation at the time of cesarean section and as an interval procedure. All operations were done at one institution and, essentially, by the same physician population, allowing for promotion within the residency program. The major deterrent to hysterectomy was the associated high incidence of necessary blood transfusion. However, a hysterectomy does offer the benefits of a permanent and completely effective procedure and the removal of an organ which ultimately may be the source of other problems. If another pathologic condition exists, making ultimate hysterectomy likely, it is the procedure of choice for sterilization, avoiding risks, costs, and the inconvenience of another operation. Methods of elective sterilization must be individualized. If the patient is appraised of the increased risk of hysterectomy and desires this more definitive procedure on the basis of informed consent, the incidence of complications is not prohibitive. These should not deter the well trained surgeon but should mandate use of all available skills, intensive evaluation of the patient, and concerned recognition of the potential adverse consequences.
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Explore the source record for details and available documents.