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Biomedical subjects

A Strauss

Publications and source records attributed to A Strauss.

At least 19 recordsLinked to original sources
PubMed1992

[Value of duplex sonography in diagnosis of renal artery stenosis and its value in follow-up after angioplasty (PTA)].

The assessment of the renal arteries is particularly important in the detection of a renovascular cause of the arterial hypertension. The purpose of the present study was twofold: to evaluate the accuracy of duplex scanning in non-invasively diagnosing renal artery stenoses in hypertensive patients, and to determine the results of transluminal angioplasty of renal artery stenoses as assessed by duplex scanning. In 76 patients with arterial hyertension, 170 renal arteries (18 kidneys supplied by two renal arteries) were examined by both duplex scanning and angiography (DSA in intraarterial and intravenous technique, and conventional arteriography). Peak systolic and end-diastolic flow velocity parameters as well as the Pourcelot-index were determined in the proximal renal artery and compared with the indendently performed angiography. In 102 angiographically proven normal renal arteries, mean +/- SD peak systolic and end-diastolic velocity values were 84.7 +/- 13.9 cm/s and 31.2 +/- 7.8 cm/s, respectively, with a Pourcelot-index of 0.66 +/- 0.07. For detecting renal artery stenoses greater than 50%, duplex scanning had a sensitivity of 86%, and a specificity of 83% for a systolic peak velocity of 140 cm/s and more in the renal artery. In 13 patients with 14 stenosed renal arteries, duplex scanning and intraarterial DSA densitometry were performed before and after transluminal angioplasty of the renal artery stenoses. There was fairly good agreement between transstenotic peak systolic velocities and densitometrically determined degrees of stenosis in the renal artery (r = 0.84). These results show that duplex scanning is an accurate noninvasive diagnostic tool in detecting proximal renal artery stenoses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Adrenal responsiveness in very-low-birth-weight infants treated with dexamethasone.

This study was designed to investigate the effect of steroid administration in ill premature neonates. Twenty high-risk very-low-birth-weight (VLBW) infants [birth weight (BW) < or = 1,300 g] with a mean BW 948 +/- 220 g, gestational age (GA) 27 +/- 1.7 weeks underwent 1-hour ACTH (Cortrosyn) stimulation tests and determination of 17-hydroxyprogesterone (17OHP)/dehydroepiandrosterone sulfate (DHEAS) at 23.6 +/- 15.9 days poststeroid treatment for bronchopulmonary dysplasia (BPD)/airway obstruction. Metyrapone tests were also obtained in 18 infants. Baseline (nonsteroid-exposed) values for pre-/post-ACTH cortisol, 17OHP, DHEAS, and pre-/post-metyrapone compound S values were obtained in 5 infants. Eight of 18 (44%) infants had evidence of secondary (hypothalamic-pituitary) adrenal suppression based on abnormal metyrapone tests. No difference was found in BW, GA, time on O2 or AV, steroid dose/kg, or neonatal/postneonatal mortality between the suppressed and nonsuppressed groups. Two of 4 infants with borderline ACTH tests had subnormal compound S levels postmetyrapone. No relationship was found between steroid dose/kg and cortisol response post-ACTH. Additionally, corrected GA was not related to change in cortisol, 17OHP, and DHEAS pre-/post-ACTH. Two infants exhibited recovery of adrenal suppression documented by repeated metyrapone testing at 63 and 186 days poststeroid treatment. In conclusion, this study documents the apparent high incidence of secondary adrenal suppression in VLBW infants treated with dexamethasone. Clinical significance of these findings deserves further investigation.

17-alpha-Hydroxyprogesterone↗
PubMed1991

A nursing model for chronic illness management based upon the Trajectory Framework.

The trajectory framework developed by Strauss and associates provides a conceptual basis for developing a nursing model that gives direction for practice, teaching, and research in the area of chronic illness. This paper presents an overview of the trajectory framework and shows how it can be used to generate such a nursing model.

Adaptation, Psychological↗
PubMed1990

Fluoride-induced fractures: relation to osteogenic effect.

The possible effects of fluoride in inducing fractures were studied in 61 patients treated with sodium fluoride (NaF), 40-60 mg daily in combination with calcium and vitamin D. Nine patients developed the fluoride-(F) related lower extremity pain syndrome. Four other patients had stress fractures associated with trauma. Seven of the 61 patients had 10 upper femur fractures of which 5 were stress fractures. The bone mineral mass of the central skeleton including the hips was measured by neutron activation and the results expressed as a calcium bone index (CaBI) which normalizes the results to that of young adults of the same body size (normal range 0.75-1.2). At the time of hip fracture, 4 patients with a minimal increase in bone mass (mean delta CaBI 0.01) had 4 femur fractures and 3 patients with a marked increase (mean delta CaBI 0.24) had 6. The 7 patients with upper femur fractures at 4 years had a significantly higher bone fluoride retention, 30 mg/g Ca compared with 23.9 mg/g Ca for the other 54 (p less than 0.02) and were older, 73.1 versus 64.2 years (p less than 0.01). Using all 61 fluoride-treated patients, femur fractures/patient were significantly correlated to bone fluoride (p less than 0.05) and to age (p less than 0.05). By partial correlation, only the correlation between hip fractures/patient and bone fluoride remained significant after controlling for the effect of age (p less than 0.05). These results suggest that fluoride therapy may be implicated in the pathogenesis of hip fractures which may occur in treated patients despite a rapid, marked increase in bone mass. The lower extremity pain syndrome is not frequently associated with stress fractures in this study.

Aged↗
PubMed1990

Bone mineral mass associated with postmenopausal vertebral deformities.

Vertebral morphometry on thoracic and lumbar spine radiographs and bone mass measurements were carried out on 215 patients investigated for postmenopausal osteoporosis. Bone mineral mass was measured on the central third of the skeleton by neutron activation analysis and the result, normalized for body size, expressed as a calcium bone index (CaBI). The normal CaBI value for females (20-40 years) is 0.97 (0.11) with a lower limit for these young, normal women, of 0.75. Vertebral compression deformity was defined as a mean height more than 15% lower than adjacent normal vertebrae. Thoracic and lumbar anterior wedge deformities and central compression were defined as anterior/posterior (A/P) or mid/posterior (M/P) height ratios of less than 0.75. For the 129 patients without vertebral deformities, the mean CaBI was 0.80 (0.12) (1 SD) and 32% of these patients had CaBI values below the normal young adult range (CaBI less than 0.75). In 20 patients, vertebral deformities were limited to 1 or 2 mid-thoracic vertebrae, and the mean CaBI values for these 20 patients was 0.81 (0.15), equal to that for patients without any vertebral deformity. For the remaining 67 patients, (i.e., patients with one or more vertebral deformities involving at least one distal thoracic or one lumbar vertebra) the mean CaBI value was 0.66 (0.10), 17% below the value for patients without vertebral deformities. Low CaBI values (CaBI less than 0.75) were observed in 87% of these patients, consistent with the diagnosis of osteoporotic fractures. Based on our CaBI results, however, mid-thoracic deformity was not associated with significant osteopenia and is not, therefore, diagnostic of osteoporotic fracture.

Adult↗
PubMed1990

Schizophrenia, schizotypal and delusional disorders (section F2): results of the ICD-10 field trial.

To determine whether the use of ICD-10 provides greater diagnostic reliability than ICD-9, a field trial of the ICD-10 draft (WHO, 1987) was carried out. A total of 1,778 diagnoses made on the basis of ICD-10, ICD-9 and, in part, DSM-III were established by 134 clinicians in 10 centres using case reports and interviews. The corrected reliability coefficients of schizophrenic disorders obtained with ICD-10, with kappa-coefficients of reliability of 0.69 for the 2-character category and 0.67 for the 3-character category are higher than those reported for the diagnosis of schizophrenia made without specified criteria, but lower than those reported for DSM-III. Despite the operationally defined diagnostic guidelines, diagnostic discrepancies still persist when organic disturbances, substance abuse or psychogenic features are additionally present. The diagnoses of each rater remain stable on change over from ICD-9 to ICD-10. Our data suggest that ICD-10 is suitable for worldwide use in diagnosing schizophrenia.

Adult↗
PubMed1989

Quantitative SPECT in radiation dosimetry.

Accurate and precise radiation dosimetry is critical for the successful therapeutic application of systemically administered radionuclides, including, of course, radionuclides in the form of radiolabeled antibody. This requires determination, based on discrete serial measurements, of the time-dependent concentrations and/or total amounts of radioactivity in situ in order to calculate source region cumulated activities. Based on extensive studies (with clinically realistic numbers of counts and accuracies of the order of 10%) in simple geometric phantoms, in complex anthropomorphic phantoms, in animal models, and in humans, quantitative rotating scintillation camera-based single-photon emission computed tomography (SPECT) now appears to be a practical approach to such measurements. The basis of the quantitative imaging capability of a three-dimensional imaging modality such as SPECT is the elimination in the reconstructed image of counts emanating from activity surrounding the source region. Subject to considerations such as the reconstruction algorithm, attenuation and scatter corrections, and, most importantly, statistical uncertainty, the counts in a pixel in a reconstructed image are therefore directly proportional to the actual counts emanating from the corresponding voxel in situ. Among intrinsic, pre-processing, and post-processing attenuation corrections, post-processing algorithms, the most widely used approach in current commercial SPECT systems, have proven adequate in uniformly attenuating parts of the body (eg, abdomen, pelvis), subject to accurate delineation of the body contour. Although a number of sophisticated scatter correction methods have been developed, the lack of explicit scatter correction has, in practice, not been a major impediment to reasonably accurate quantitative SPECT imaging, despite scattered radiation representing up to 50% of the counts in a large source region (eg, liver). Because of its mathematical propagation in the image reconstruction process, statistical uncertainty (ie, "noise") in SPECT is far greater than would be expected if it were distributed according to Poisson statistics, as in planar imaging. The low "single slice" sensitivity of rotating scintillation camera-based SPECT is therefore the principal limitation of practical quantitative SPECT. Accordingly, absolute quantitation of count-limited clinical images has been accomplished using a judiciously selected "non-ramp" filter function. In summary, reasonable quantitative SPECT imaging is now feasible clinically, even without sophisticated scatter corrections, at least in uniformly attenuating parts of the body.(ABSTRACT TRUNCATED AT 400 WORDS)

Humans↗
PubMed1989

Jejunal atresia with 'apple peel' deformity. A report of eight survivors.

Jejunal atresia with an "apple peel" deformity is one of the most severe forms of intestinal atresia. Until quite recently, neonatal mortality rates as a result of this anomaly were high. Early diagnosis, appropriate surgery, and prolonged parenteral nutrition have led to a spectacular improvement of the survival rates. We are reporting eight cases of apple peel atresia--all eight patients survived. The pathophysiology, diagnostic aspects, surgical approaches, and postoperative management are discussed.

Female↗