1982 resident's essay award: the immunologic effects of lymphoid irradiation in human and non-human primates: cellular changes and the potential for renal transplantation.
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Adult↗
Biomedical subjects
G Haas
Publications and source records attributed to G Haas.
[Development and fate of premature infants--then and now].
New scientific results and progress in technology allow even premature infants with very low birth weight to survive today. A vehement discussion arouse about effectiveness and efficiency of intensive care programs for these infants. However, an appreciation of the results at present should not be made without taking note of those achieved in former decades. A. Ylppö was the first pediatrician in Germany at the beginning of the 20th century, who was working systematically for the survival of low birth weight infants. He achieved remarkable results even at that time. After World War II the chances for survival of low birth weight infants became worse because of dangerous therapeutic innovations. In the 60's the frequency of serious sequelae could be reduced by improved therapeutic approaches. Since then the mortality rate is decreasing, whereas the frequency of serious sequelae remains nearly stable during the last 15 years. We hope that clinical research and new technologies may also reduce the morbidity of surviving premature babies in the future.
Birth Injuries↗
[Mortality and neurological morbidity in prematurely born infants and low birthweight infants born at term].
In a follow-up study the fate and development of 245 prematures with a birthweight below 1,500 g and of 230 infants with a birth weight of 1,501-2,500 g are reported. The mortality of infants with a birthweight below 1,500 g was 29.8%, in the group of infants with higher birthweights 9.1%. The frequency of severe neurological sequelae in infants with very low birthweight was 8.2%, in the other group of infants 3.5%. Minor handicaps and developmental abnormalities were found in a frequency of 12.2%, and 4.7% respectively. These results meet the present international standard in centers for perinatal medicine. Prospective investigations are mandatory to recognize causal factors for later severe handicaps.
Attention Deficit Disorder with Hyperactivity↗
[Hemangiomatosis of the liver in an infant diagnosed by ultrasound and computed tomography (author's transl)].
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Female↗
The Philadelphia epidemic of Legionnaire's disease: clinical, pulmonary, and serologic findings two years later.
Clinical, pulmonary, and serologic findings in Legionnaires who attended the 1976 American Legion Convention in Philadelphia were studied 2 years after the Legionnaires' disease epidemic there. All 31 survivors of Legionnaires' disease studied became ill within 2 weeks after the convention, and 18 had not fully recovered 2 years after the epidemic. Twenty-five (28%) of 90 additional Legionnaires exposed at the convention but not diagnosed as having Legionnaires' disease became ill during the same time interval; five of these had symptoms during the next 2 years. Survivors had decreased diffusion capacities measured by the carbon monoxide single-breath method. These differences could not be accounted for by ventilation abnormalities or concurrent illness. Significant levels of IgG or IgM antibodies persisted in 94% of survivors of Legionnaires' disease and in 53% of Legionnaires exposed at the convention, which suggests a high prevalence of subclinical infection. Persistence of IgM antibody raises the question of latency or subclinical infection as part of the natural history of Legionnaires' disease.
Adult↗
A polygraphic study of bioelectrical brain maturation in preterm infants.
Bioelectrical brain maturation was studied in 26 low-risk preterm infants by serial polygraphic recordings. A modified method of visual EEG analysis was used, based on Parmelee's coding system, which allowed quantification. It gave the following results: (1) The main characteristics of EEG maturation in preterm infants were a progressive spatio-temporal differentiation, with an increase of rhythmic activities and a decrease of discontinuity. (2) A strong relationship was found between post-menstrual age of the infants and EEG maturity, but there were exceptions to this rule. (3) longer duration of extra-uterine life had a small accelerating influence on EEG maturation. (4) Certain basic types of EEG patterns were closely related to behavioural states, whereas EEG maturity was not state-dependent. (5) The relationship between EEG pattern types and behavioural states becomes more stable with increasing age.
Electroencephalography↗
Locus of desired control and positive self-concept of the elderly.
In two studies, positive self-concept correlated with belief in one's internal locus of desired control. Examining only institutionalized subjects, the first study found this relationship to be particularly prominent for male subjects (r = .68). In the second study, comparing institutionalized persons sampled from several homes for the aged and noninstitutionalized elderly, this relationship was once again most prominent for the institutionalized males (r = .53). Among these studies internality also correlated positively with nurses' rating of subject's happiness, self-ratings of contentment and happiness, and correlated negatively with length of residency in old age home and age. In response to concerns raised by Rotter (1975) over locus of control research and issues raised by Mischel (1968, 1973) and others concerning personality research in general, the present study used a more situationally specific locus of control measure specially designed to take into consideration the environmental circumstances as well as interests of the subject population being studied. Included in the measure is a desire of outcome index which added substantially to the validity coefficient.
Adaptation, Psychological↗
[Problems of role development and field of activity of the nurse specialist in psychiatry].
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Germany, West↗
Angiography in the management of musculoskeletal tumors.
The contribution to pretreatment evaluation and surgical planning of 200 angiograms of bone and soft tissue lesions, mostly tumors, was evaluated. Their accuracy was studied by careful post-operative examination of gross surgical specimens and histologic sections. The angiograms were helpful in delineating the anatomic extent of lesions and, therefore, in planning the appropriate resection or amputation. This was particularly true in lesions treatable by radical local resection, such as most malignant tumors of soft tissues, giant cell tumors of bone, parosteal osteosarcomas, chondrosarcomas and occasional small central osteosarcomas. The angiograms were of some help in confirming or detecting residual or recurrent tumor and prior resection. This was not true immediately after inadequate local resections because residual tumor was likely to be quite small and reactive vascularity secondary to operation was confusing. Angiography was not accurate or helpful in distinguishing benign from malignant lesions when the clinical presentation and roentgenographic findings were confusing. The surgeon relied on biopsy rather than angiography. Aso, although we saw lymph node blushes on several angiograms, we could not reliably interpret whether or not this represented tumor metastasis. The vascularity of pathologic fractures was also confusing. Pelvic angiograms were difficult to interpret because of the complex anatomy. We made most of our serious mistakes in delineating tumor extent in pelvic lesions. Angiography is valuable in planning operative treatment of tumors if radical local resection is considered or if physical examination and roentgenographic findings do not indicate the appropriate level of amputation.
Angiography↗
[Clinical and bacteriological studies of various corticoid preparations for the treatment of pulpitis].
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Administration, Topical↗
Is neuroleptic dysphoria a healthy response?
We examined the relationship between neuroleptic-induced extrapyramidal effects, subjective neuroleptic dysphoria, and clinical outcome in acutely psychotic inpatients. Thirteen of 50 consecutively admitted patients experienced severe neuroleptic dysphoria. Dysphoric patients were less likely to comply with neuroleptic, but nine did complete neuroleptic trials. The compliant dysphoric inpatients received significantly lower neuroleptic doses compared with nondysphoric patients, and yet had equivalent overall improvement of psychotic symptoms and less severe extrapyramidal effects. Despite having fewer physical signs of akinesia, dysphoric patients were significantly more distressed from akinesia than nondysphoric. We conclude that while some neuroleptic dysphoric patients become noncompliant, others benefit from dysphoria by negotiating for lower, less toxic, and yet effective neuroleptic dosages.
Adult↗
Increased tardive dyskinesia in alcohol-abusing schizophrenic patients.
Many schizophrenics have a diagnosis of substance abuse or dependence. We evaluated whether drug or alcohol abuse is an independent risk factor for tardive dyskinesia (TD) in schizophrenia. In a consecutive admission, clinical study of 75 hospitalized schizophrenics, drug or alcohol abusers had significantly higher TD scores than nonabusers. The association of alcohol abuse or dependence with TD seemed independent from other risk factors for TD.
Adult↗
Slow-wave sleep and symptomatology in schizophrenia and related psychotic disorders.
Deficits in slow-wave sleep (SWS), or delta sleep, are frequently seen in schizophrenia, but their relationship with schizophrenic symptomatology remains unclear. We examined the association between visually scored and automated measures of SWS and positive and negative symptoms in a series of unmedicated patients with schizophrenia and related psychotic disorders. Total and average automated delta wave counts were significantly inversely associated with negative symptoms overall, and the psychomotor poverty syndrome in particular. Total delta counts were also inversely related to the disorganization syndrome. No relation was seen between reality distortion or the Brief Psychiatric Rating Scale (BPRS) positive symptoms and SWS. These findings support the view that SWS deficits may be related to negative symptoms of schizophrenia and may perhaps be mediated by impaired functioning of frontothalamic neural circuits.
Adult↗
Assessment and therapy monitoring of Leigh disease by MRI and proton spectroscopy.
In a 2-year-old boy with Leigh disease, spasticity, dysarthria, and optic atrophy gradually developed. Computed tomography and magnetic resonance imaging disclosed progressive, symmetric basal ganglia lesions. In muscle tissue, a defect of pyruvate dehydrogenase complex was found. Magnetic resonance volume selective proton spectroscopy (MRVS) of the basal ganglia demonstrated an abnormal lactate peak. A ketonemic diet coincided with clinical stabilization and arrest of progressive brain lesions. Lactate could no longer be demonstrated by MRVS. It reappeared with a new brain lesion coinciding with discontinuation of the diet. MRVS, therefore, appears to be a sensitive tool to evaluate pathologic lactate production in metabolic brain disease with disturbed energy metabolism and allows noninvasive therapy monitoring.
Basal Ganglia↗
Becoming a patient with heart failure.
OBJECTIVE: The purpose of this study was to gain a better understanding of the process of becoming a patient with heart failure, a process of identity formation. Are there clues in the patients' stories about heart failure that might give us a better idea of how patients adjust to heart failure and what heart failure means to them? Meanings that individuals attach to events or situations are central to development of identity and subsequent behaviors. DESIGN AND SETTING: Qualitative methods involving detailed interviews and grounded theory method were used in an outpatient cardiology department of a large health care facility in northeast Ohio. PATIENTS: Twenty-one patients with a diagnosis of heart failure were conveniently selected and interviewed for this research. Patients were selected on the basis of having a left ventricular ejection fraction of 35% or less and New York Heart Association class II, III, or IV. Other possible selection criteria (eg, VO(2Max ), walk test, or dyspnea) were not available for all patients and thus did not constitute consistent selection criteria. A broad net was cast for patients with varying characteristics to see if common processes and experiences existed regardless of the differences in clinical indicators. METHODS: Patients were interviewed in the examining room as part of a regularly scheduled visit with their cardiologists. All interviews were tape recorded and fully transcribed. Field notes and relevant patient chart data (eg, age, sex, race, marital status, cause of heart failure, comorbidities, history of hospitalization, New York Heart Association functional class, left ventricular ejection fraction) were included in the transcribed interviews. The transcribed interview was read and responses were given initial conceptual codes. These coded passages were categorized according to more abstract categories or concepts and underlying processes that encompass them. This process continues until all relevant passages have been categorized and subsumed under higher-order (more abstract or general) categories. RESULTS: The process of becoming a patient with heart failure involves a gradual process of taking on a new identity. Five distinct phases of this process of identity formation emerged from the data: a crisis event, the diagnosis, the patient's and family's response to the diagnosis, their acceptance and adjustment to life with this condition, and making the decision to get on with life. CONCLUSIONS: Most research on heart failure has focused on patients or their families farther along in the trajectory of this condition. We know little about the psychosocial experience of the early phases of this condition. Becoming a patient with heart failure is a process of searching for a meaning to this condition (what is it? what does it mean for the future?) and a process of taking on a new identity and appropriate role behaviors. This process takes place over a period of time. This suggests that the formation of individual identities evolve as new information becomes available, as meanings are attached to the new circumstances, and as a process of negotiating new roles among family members (and among patient, family members, and clinicians) takes place. The findings of this study suggest possible interventions that may positively affect the patient's condition and the quality of family life.
Adaptation, Psychological↗
[Transitory neurologic findings in risk children in the first year of life].
During the first year of life many infants born "at risk" present neurological findings, which vanish by the end of the first year. These neurological symptoms are found by using a neurological examination, which employs the principles of Prechtl 's neurological examination of the newborn. Using this kind of neurological examination, the neurology of transitory findings was studied in 40 infants "at risk" during their first year of life. Only infants "at risk" were selected, who presented finally normal psychomotor development at the end of the first year of life.
Brain Damage, Chronic↗
[Pubertal status of pupils in orientation classes with reference to school sports].
Tanner scores of pubertal development were determined in 194 girls and 190 boys of the fifth and sixth grades. There was a wide scatter of Tanner scores both within and between sexes, reflecting considerable variability of pubertal development in these age cohorts. Physical performance depends on muscle mass and muscle strength. Since these variables are related to pubertal development, training programs and training goals must take the stage of pubertal development into consideration. A comparison of Tanner scores and sport ratings showed that the factor "pubertal development" is usually accounted for in daily practice.
Adolescent↗
Heart-lung xenotransplantation in primates.
Heart and heart-lung xenografts are a potential solution to the shortage of donors. Concern over the adequacy of conventional immunosuppression in prevention of xenograft rejection, however, has hindered their use. Cyclosporine has not been successful in suppressing the rejection process in cardiac xenotransplantation, and other methods of immunosuppression need to be investigated. Therefore we studied the effect of preoperative total lymphoid irradiation (TLI) in combination with cyclosporine in a primate heart-lung xenograft model using cynomolgus monkey donors and baboon recipients. Heart-lung grafts were harvested from donors and transplanted orthotopically in baboons with use of cardiopulmonary bypass. Recipients were treated in one of three groups: (1) cyclosporine and steroids (controls), (2) cyclosporine and steroids plus TLI 20 Gy, or (3) cyclosporine, steroids, antithymocyte globulin, and TLI 6 Gy. Mean survival time of the baboons treated with cyclosporine and steroids was 8 +/- 0.6 days. The group receiving 20 Gy TLI had prohibitive perioperative mortality; however, one baboon lived an additional 90 days, and at autopsy the heart showed minimal rejection. Treatment with TLI at 6 Gy in combination with cyclosporine, antithymocyte globulin, and steroids comparatively prolonged survival (16 +/- 7.8 vs 8 +/- 0.6 days; p less than 0.001), and all animals in this group died of infection, with only minimal evidence of heart rejection noted in animals surviving 30 days. We conclude that the addition of TLI and antithymocyte globulin to cyclosporine-based standard immunosuppression is a potent immunosuppressant in heart-lung xenotransplantation; nevertheless, infection remains a common complication.
Animals↗