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Biomedical subjects

D Graber

Publications and source records attributed to D Graber.

27 records · Page 2Linked to original sources

Plasma exchange therapy in pediatric patients. Plasma filtration with a unipuncture technique.

Therapeutic apheresis in children is limited by technical considerations, such as circuit blood volume, venous access and hemodynamic instability. Here we report our experience with 310 plasma-filtration sessions in 44 children (aged 9 months-17 years). We used a miniaturized circuit with a unipuncture technique and a "balancing system" which assured a permanent fluid equilibrium. This procedure is well adapted to children and always made pediatric plasma exchange therapy easier and safer. The more common indications remain Guillain-Barré syndrome and acute severe glomerular diseases.

Adolescent↗

Sedation and analgesia.

The control of pain and the alleviation of anxiety are integral components in the management of soft tissue injuries in the Emergency Department. Pharmacologic agents utilized for analgesia and sedation must possess properties favorable for emergency department use. This article reviews the pharmacologic approach to patients who require sedation and/or analgesia for the management of a soft tissue injury in the Emergency Department.

Analgesia↗

[Dissection of the sylvian artery with resulting aneurysm in a 6 years old child].

BACKGROUND: Dissection of the walls of the cervical and cerebral arteries is rare in childhood. CASE REPORT: A 6 year-old girl suddenly suffered a loss of consciousness followed by a generalized tonic-clonic seizure 90 min after a non-traumatic fall. At admission, she had a massive right hemiplegia with aphasia. The CSF was not hemorrhagic. A CT-scan performed at H3 without infusion of radiopaque contrast material was normal, but a second CT-scan on day 4 showed a low density in the low area of the middle cerebral artery. An arteriogram taken on day 6 showed that the wall of the proximal part of this artery was irregular, with a discrete additive imaging. The child was treated with IV heparin for 3 weeks, then with aspirin. All investigations for the possible cause of thrombosis (protein C and S, antithrombin III, homocystinuria, etc...) were negative. Two further arteriograms, the last after a follow-up of 16 months, showed progressive disappearance of the wall irregularities and replacement of the additive imaging by a large aneurysm, suggesting a dissection. The hemiplegia persists under prolonged aspirin therapy. CONCLUSION: This case shows that dissection may occur in childhood without any apparent cause. It can result in the development of an aneurysm, a complication which is more frequent following dissection of the cervical rather the cerebral arteries.

Aortic Dissection↗

[Recurrent coxopathy, isolated manifestation of Gaucher's disease].

A case of Gaucher's disease is reported in a 12 year-old girl. Presenting signs consisted of relapsing hip arthritis, while no splenomegaly was detectable. The authors comment the inflammatory or moderately hemorrhagic nature of articular fluid and the diagnostic value of an early decreased uptake on bone scintiscan. The value of magnetic resonance imaging for evaluating bone involvement is emphasized.

Bone Diseases↗

[Hypoplasia of cartilage and hair with combined immune deficiency].

We report a case of cartilage-hair hypoplasia in a girl. The patient had short stature with short limbs and scalloped long bone metaphyses, sparse, poorly-pigmented hair, and increased susceptibility to infections. Several features of this case deserve attention: neutropenia, probably due to an autoimmune mechanism, was an initial manifestation; the immune deficiency (defective B and T cell immunity, autoimmune manifestations) was severe, and cytomegalovirus infection possibly aggravated the immune deficiency and hormone abnormalities. Whereas this patient's short stature is becoming more marked, prophylaxis of infections and administration of immune globulins have effectively prevented complications for the last two years.

Cartilage Diseases↗

Platelet-associated IgG in hepatitis and cirrhosis.

Increasing evidence is accumulating which indicates that immunological abnormalities contribute to the development of liver disease and its signs and symptoms. Platelet-associated IgG (PAIgG) levels were quantified in 42 patients with biopsy-proven liver disease of various etiologies to determine the relationship of thrombocytopenia to immunologic abnormalities in these disorders. Five of six nonthrombocytopenic patients with acute viral hepatitis B had elevated PAIgG. Six of ten patients with chronic active hepatitis had elevated PAIgG and thrombocytopenia. In contrast, only one of six patients with chronic persistent hepatitis had elevated PAIgG. Nine of ten patients with alcoholic hepatitis had elevated PAIgG; seven of the nine were thrombocytopenic. Seven of ten alcoholic patients with cirrhosis had elevated PAIgG; six of seven were thrombocytopenic. Thus the increase in PAIgG may be present without thrombocytopenia in acute liver injury, while patients with chronic persistent hepatitis do not usually exhibit this abnormality. Severe chronic active liver disease is accompanied by thrombocytopenia and an increase in PAIgG levels.

Biopsy↗

Ursodeoxycholic acid: a safe and effective agent for dissolving cholesterol gallstones.

Ursodeoxycholic acid, 250 to 300, 500 to 600, or 900 to 1000 mg/d, was given orally for 6 to 38 months to 53 patients with cholesterol gallstones and functioning gallbladders. Forty-two patients had greater than 50% reduction in gallstone volume, number, or both, without apparent dose dependence and 27 of these patients had complete gallstone dissolution. Results of laboratory studies including liver function tests were not affected adversely and biliary lithocholic acid concentration did not increase during therapy. Most biliary symptoms seemed to disappear within 3 months and no patient developed diarrhea. Large diameter and increased number of gallstones were found to hinder dissolution. The percentage of biliary ursodeoxycholic acid increased with increasing dose and reached a maximum of 50% to 60% of total bile acids at a dose of about 10 to 12 mg/kg body weight. d. Biliary lithogenic index was reduced significantly during treatment with ursodeoxycholic acid, 500 to 600 and 900 to 1000 mg/d. Thus, ursodeoxycholic acid appears to be a safe and effective alternative to surgery in selected patients with gallstones.

Bile Acids and Salts↗

[The antigenicity of various new chromatographically purified depot insulin preparations].

Four groups of adult diabetics who had never received insulin before were treated for 10--12 months with the following insulin preparations: 1. Insulin Lente, purified by conventional methods; 2. Insulin Lente, purified by gel-filtration; 3. Insulin Lente Monocomponent (MC); 4. Insulin Monotard. Insulin antibodies were measured in these four groups at regular intervals and compared. MC Lente is significantly less antigenic than conventional Lente insulin, but Monotard, a pure pork insulin preparation, is even less antigenic than MC Lente (all 3 Lente preparations contain 70% ox insulin). The average insulin requirement in the Monotard group is significantly lower than in the conventional Lente group.

Adult↗

Curriculum trends in nurse-midwifery education. Views of program directors.

The purpose of this study was to determine the extent to which nurse-midwifery education programs are addressing the practice competencies that have been recommended by the Pew Health Professions Commission and others as essential for effective practice in the 21st century. This study was part of a larger survey of eleven health professions education programs. The 56 nurse-midwifery program directors whose names and addresses were provided by the American College of Nurse-Midwives were surveyed by mailed questionnaire, with a response rate of 59% (n = 33). The study sought to identify current and ideal emphasis placed on 33 broad topics, most important curriculum topics, and barriers to curriculum change as perceived by respondents. Findings revealed that nurse-midwifery program directors would like to see greater emphasis placed on every topic except one (tertiary/quaternary care). Desired increases ranged from .04 to 1.36. The overall mean rating for all topics was 3.51 for current emphasis (5-point scale) and 4.18 for ideal emphasis, both of which were higher than any other survey group. The greatest desired increases (> 1.00) were for "primary care," "managed care," "use of electronic information systems," and "business management of practice." Respondents identified "primary care," "health promotion/disease prevention," and "accountability for cost-effectiveness and patient outcomes" as the most important topics. The top three barriers to curriculum change were identified as "already crowded curriculum," "inadequate funding," and "limited availability of clinical learning sites," the last being statistically significant compared with other survey groups. Findings indicate that nurse-midwifery program directors perceived that they are adequately addressing most of the curriculum topics, while continuing to focus on the need for curriculum change as the health care environment changes.

Curriculum↗