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Biomedical subjects

D Gross

Publications and source records attributed to D Gross.

At least 163 records · Page 9Linked to original sources
PubMed1982

Clinical manifestations of inspiratory muscle fatigue.

Twelve patients exhibiting difficulties during discontinuation of artificial ventilation permitted us to investigate physical examination techniques used in diagnosing inspiratory muscle fatigue. Diaphragmatic and intercostal electromyographic tracings, arterial blood gases, rate and depth of ventilation, and thoracoabdominal motion were monitored during spontaneous breathing. Six patients showed electromyographic evidence of inspiratory muscle fatigue. A sequence of events leading to respiratory acidemia emerged--namely electromyographic evidence of fatigue, accompanied or followed by an increased respiratory rate, in turn followed by alternation between abdominal and rib cage breathing (respiratory alternans), paradoxical inward abdominal motion during inspiration (abdominal paradox), and finally an increase in PaCO2 associated with a fall in minute ventilation and respiratory rate, and worsening of respiratory acidemia. The abnormalities of respiratory movements may be reliable clinical signs of inspiratory muscle fatigue, particularly when accompanied by tachypnea and hypercapnia.

Adult↗
PubMed1981

Thallium myocardial perfusion scans for the assessment of right ventricular hypertrophy in patients with cystic fibrosis. A comparison with other noninvasive techniques.

The incidence of right ventricular hypertrophy in 32 patients with cystic fibrosis was studied using thallium 201 (TI-201) myocardial perfusion scans, and compared with other noninvasive techniques including electrocardiography, vectorcardiography, and M-mode echocardiography. The patients (mean age, 17.3 yr; range, 7 to 33) had a wide range of clinical and pulmonary abnormalities (mean Shwachman-Kulczycki score, 66.6). In the total study group, TI-201 scans, like the vectorcardiograms and the M-mode echocardiograms, gave a surprisingly high proportion of positive predictions for right ventricular hypertrophy (RVH) (44%). The correlations with all other noninvasive methods were uniformly poor, so caution must be exercised in using this technique to predict early RVH in order to follow the natural history of cor pulmonale in cystic fibrosis. At the time of the study, 6 patients had clinical evidence of right ventricular failure, and in this disease setting must have had RVH. In 3 patients, RVH was confirmed at autopsy, and it was successfully predicted by TI-201 scans in 5 of the 6 patients. The false negative scan may have been due to regional myocardial ischemia secondary to severe right ventricular failure. In contrast, the vectorcardiogram, using Fowler's new criteria, made a successful prediction of RVH in all 6 patients, and the electro cardiogram in only 3. Although the M-mode echocardiogram was abnormal in all patients, it would have predicted RVH (with increased right ventricular anterior wall thickness) in only 1 patient. We concluded that TI-201 myocardial perfusion cans are good at confirming RVH in cases with established right ventricular failure, but have no advantage over vectorcardiographic assessments, which are logistically easier to perform and carry no radiation risks.

Adolescent↗
PubMed1981

Myocarditis in legionnaires' disease.

A case of Legionnaires' disease is described in which the characteristic features of multilobar pneumonia, rhabdomyolysis, renal failure, hepatic and CNS involvement are accompanied by the previously undescribed complication of myocarditis. Clinical and laboratory findings of myocardial involvement included overt heart failure, a new gallop, an abnormal ECG, elevated myocardial specific enzymes and an abnormal thallium scan. All of these abnormalities resolved completely after recovery.

Electrocardiography↗
PubMed1980

[Diflunisal in the treatment of coxarthrosis and gonarthrosis. A comparative double-blind study with acetylsalicylic acid].

A double-blind study comparing the efficacy and safety of diflunisal (Unisal), a new derivative of salicylic acid, and acetylsalicylic acid (Aspirin) was conducted in the rheumatology clinics of the Cantonal Hospital Beau-Séjour, Geneva, and the Triemli City Hospital, Zurich. A total of 38 patients with established osteoarthritis of the hip and/or knee were studied for 12 weeks. The daily dose of diflunisal was 500-750 mg and that of acetylsalicylic acid 2000-3000 mg. After 12 weeks diflunisal was judged superior to Aspirin by both patients and investigators. Among the most important clinical symptoms evaluated were pain and limitation of motion. Side effects, particularly gastro-intestinal symptoms, of sufficient severity to cause discontinuation of therapy were more frequent in the acetylsalicylic acid-treated patients than in the group receiving diflunisal.

Adult↗
PubMed1980

The effect of training on strength and endurance of the diaphragm in quadriplegia.

The diaphragmatic electromyogram was used to detect fatigue of the diaphragm in six chronic quadriplegics while they breathed for 10 minutes against a variety of inspiratory resistances. The maximum static inspiratory mouth pressure was measured at functional residual capacity (Pmmax) and from the electromyogram the critical inspiratory mouth pressure that developed in each inspiration (Pmcrit) below which electromyographic changes of diaphragmatic fatigue do not develop was estimated. The measurements were repeated after 8, 12 and 16 weeks of inspiratory muscle training consisting of inspiring for a period of 30 minutes daily, six days a week, against a resistance just sufficient to produce the electromyographic changes of fatigue. A significant and progressive increase in Pmmax and Pmcrit was found during the training. It was concluded that (1) quadriplegics are predisposed to the development of inspiratory muscle fatigue due to reduced muscle strength and reduction in endurance, and (2) in these patients inspiratory muscle training increases both strength and endurance, and protects against fatigue.

Adolescent↗
PubMed1980

[Unilateral post-fracture ankylosis and facial growth in infants: therapeutic considerations (author's transl)].

Ankylosis of this type should be treated as early as possible. Resection of the ankylosed block should be avoided, and all that is required is reconstruction of a new condyle, subjacent to meniscal remnants that are usually present. As large as possible an inter-fragment space is obtained by forced lowering of the vertical branch, which is maintained in position by a blocking apparatus with a maximal molar gap. The validity of these principles is supported by the results in the case reported, after a lapse of 5 years.

Adolescent↗
PubMed1979

[Sympathalgia of the cervicobrachial region (author's transl)].

Pain syndromes in the cervicobrachial region may be an expression of irritation of the periarterial autonomic nervous system. They show a vasal, arterial topography (here of the subclavian artery). If the cervical sympathetic chain is involved in the irritation, the area supplied by the carotid artery, i.e. the homolateral half of the head is also affected. Characteristics of these disturbances are their abnormal topography, which cannot be classified either as a radicular nor a segmental pattern. In this region the perception of pain is delayed. The quality of pain is protopathic (dull, intense, burning). In the sympathalgia region there is lowering of the pain threshold (dysesthesia), vasomotor disturbance (dyskinesia) local homeostatic disorders (dyscrasia), in certain circumstances trophic disturbances (dystrophy) which are usually accompanied by marked depression (dysthymia).

Adjustment Disorders↗