Biomedical subjects
Publications and source records attributed to G Hirsch.
Considerable differences of opinion exist concerning the best treatment of anterior tibial spine fractures in children. In this retrospective study of 32 cases, residual symptoms and/or clinical instabilities were found in 16 instances. Open surgery is suggested for displaced fractures in patients 10 years and older.
The authors describe the use of a new catheter for barium enema examination that eliminates the hazards of the straight and balloon type catheters.
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Infrared-spectroscopic investigations of the water content of the stratum corneum after application of emulsions and wash solutions are reported. As a methodologic variation infrared spectroscopy is applied after stripping the skin to determine the hydration of various depths of the stratum corneum by ointments. Using soap as an example, a method of correcting the overlap effects between the ointment and skin spectrums is presented which expands the application possibilities of infrared spectroscopy. An o/w emulsion with plenty of water and a w/o emulsion containing less water produce to almost the same degree a hydration of the deeper layers of the stratum corneum which lasts for at least 40 min. The report in the literature that soap solutions produced a stronger hydration of the stratum corneum and surfactant solutions is not supported.
Thirty-nine bone scans were performed in children (1 week - 14 years of age), with symptoms and signs of acute osteomyelitis. All but two scintigrams were obtained within the first week of the disease. Nine scans showed locally increased isotope accumulation. The diagnosis of osteomyelitis was later confirmed by radiological examination or by positive cultures. Twenty-nine scans were reported negative. Nevertheless, four patients developed characteristic radiological signs of osteomyelitis. In one of these four cases a decreased uptake ("cold" lesion) in the scintigram was over-looked. In spite of surgical drainage the patient developed chronic osteomyelitis. It is concluded that bone scanning is a valuable adjunct in the early diagnosis of osteomyelitis. A negative scintigram, however, does not exclude this diagnosis. A "cold" lesion may indicate a high pressure abscess and a risk for sequestrum formation. Prompt surgical drainage is advocated when such lesions are encountered in the scintigram.
Sonographic and radiographic fidings were reviewed in 27 patients with hepatic amebiasis. Sonography usually demonstrated nonspecific, peripheral, hypoechoic lesions. The only diagnostic sonographic appearance was a combination of a hypoechoic lesion and diaphragmatic disruption, which was found in four patients. About 50% of the patients had accompanying radiographic abnormalities that were nondiagnostic. These included elvation of the right hemidiaphragm, basilar pulmonary infiltrates, and pleural effusions. Liver abscesses occasionally grew during the first 2 weeks of treatment even though the patients were responding well to medical therapy. Lesions frequently became more anechoic and better defined on follow-up examinations. Successfully treated abscesses may calcify rather than diminish.
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Self-monitoring combined with contingency contracting resulted in weight loss, modification of dysfunctional eating habits, and increased or sustained exercise rates for two obese, mentally retarded adolescent females with Prader-Willi syndrome. Contingency contracting between clients and their parents/caregivers was used to specify consequences for daily self-monitoring, reduced caloric intake, weight loss, and exercise. Punishment for food stealing was also employed. Results suggest that contingency contracting is an effective technique for producing long-term weight loss in obese mentally retarded adolescents. Further, these techniques offer an alternative to the clinician considering solely dietary restriction or surgical intervention.
Within less than one year, our hospital received three cases of malignant manifestation in case of multiple neurofibromatosis. If the histological findings and the neurogenic origin of the malignant tumor are evaluated very critically, the malignant suppression of the differentiation of one or more neurofibromas in case of multiple neurofibromatosis must be considered as occuring very rarely. If in case of a neurofibromatosis a malignant manifestation is found, it has to be examined very carefully by tissue specimens of numerous spots (Loehr and Willebrand), furthermore the neurogenic origin must be ensured (Zuelch). There are three clinical possibilities: 1. Sarcomatous degeneration of a neurofibroma with demonstrable neurogenic origin. 2. Histological appearence of a malignant suppression of the differntiation of a neurofibroma with benign clinical course. 3. Independent sarcoma as second disease without original connection to an existing multiple neurofibromatosis.--A critical evaluation of our cases showed that there was only one case of malignant tumor with neurogenic origin, namely a neurofibrosarcoma originating from a multiple neurofibromatosis.
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