Levels of selenium in the skin of patients with chronic lymphedema.
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Biomedical subjects
Publications and source records attributed to G T Werner.
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In 361 patients with cerebral stroke a study of medical and neurological complications was undertaken. Among a total of 131 complications (36.2%) a striking incidence of urinary tract infections was seen: 83 cases (22.9%). Patients without complications had an average stay of 61.2 days in hospital, those with urinary tract infections had 77 days (p < 0.05). In patients with cerebrovascular accidents voiding dysfunctions are common. Great care must be taken to prevent complications: indwelling catheters should be used only over short periods of time. In case urinary drainage is needed over a long period of time, suprapubic catheterization should be preferred.
BACKGROUND: In paralysed limbs quite often edemas are seen, which might pose problems during rehabilitation. The origin of these edemas is not fully understood. METHODS: 48 patients with hemiplegia and edema of the paralysed arm were studied; in 40 patients lymphoscintigraphic studies (static and dynamic lymphography) were performed. RESULTS: In 80% of these cases lymphatic flow in the paralysed arm was increased compared to the healthy arm. If there was marked edema in the paralysed arm, the increase of lymph flow was considerable (p < 0.01). CONCLUSIONS: Edemas in hemiplegic extremities are not due to lymphedema, as in lymphedema the lymph flow usually is very slow. They most likely are caused by disorders of filtration and reabsorption, due to a dysfunction of the autonomic nervous system.
Edemas of the leg sometimes pose problems for diagnosis. Invasive procedures like lymphography or phlebography are either difficult to perform or might endanger the lymphatics. The value of magnetic resonance imaging was assessed in 20 patients with lymphedema, lipedema and phlebedema. Images of patients with lipedema showed homogenous enlarged subcutaneous tissue. In lymphedema a honeycomb pattern in the subcutaneous tissue was observed; in phlebedema there was an increase of fluid within the muscle. Magnetic resonance imaging is useful in differentiating lymphedema, lipedema or phlebedema.
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Immunity against tetanus in an urban population: gaps of immunity among elderly persons. In a sero-epidemiological survey we investigated the immunity against tetanustoxoid in an urban population. Children and adolescents born in Germany (n = 193) showed an excellent immunity, negative findings being the exception. Among soldiers of the army (n = 136), negative findings were rare too. In these both groups the antibody titiers averaged 4,5 IU/ml. It is generally agreed that an antibody titer of 0,01 IU/ml protects against tetanus. Adults born in Germany (n = 295) had a good immunity: 84% showed antibody - titers against tetanus. Among elderly persons, however, above 60 years of age (n = 1576) there was a striking incidence of negative findings: in 1043 persons (65%) no antibodies could be detected. The remaining 533 persons with positive findings (35%) had antibody-titers in the lower range (average 0,482 IU/ml). Also among foreigners and immigrant labourers from mediterrean countries (Greece, Turkey, Yugoslavia) the frequency of negative findings was high: 183 persons were examined, 70 (39%) were negative 113 (61%) were positive. The incidence of negative findings was highest among women from the mediterrean countries. Several small studies published in Switzerland show a similar tendency. Our paper will encourage further seroepidemiological studies.
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In a seroepidemiological study of the population of a rural area in northern Zaire, markers of hepatitis A and B were determined. Examinations of serum specimens (n = 142) showed that hepatitis A is acquired early in childhood; virtually all persons beyond 20 years of age are immune. Capillary blood dried on filter discs (n = 352) gave accurate results only in childhood; in older individuals a high percentage of positive results was missed (approximately 20%), presumably due to lower anti-HAV titers in older persons. The dried-blood method showed similar limitations regarding the detection of hepatitis B markers. In the 5-7 year age group there was already a high prevalence of anti-HBc (59%) as determined by the dried blood method. In the 10-19 year age group the prevalence was 94% as determined by examination of serum specimens. In all age groups the percentage of HBsAg positive persons was 20.7%, as demonstrated in capillary blood specimens and 31.7% in serum specimens.
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In a sero-epidemiological study, clinically healthy persons from a rural area of Zaire were tested for antibodies against hepatitis A, B and yellow fever. There was a high prevalence of antibodies to hepatitis A-virus in early life: 90% of all children at the age of ten had antibodies in their sera. Similarly up to the age of 19 years almost 90% of all persons investigated were positive for hepatitis B (anti-HBc). The incidence of the hepatitis B-surface antigen in all ages was high. According to the method used, it totalled to 21% (capillary blood) or 32% (serum specimens). All these persons were asymptomatic HBsAg carriers. A carrier-rate of 20-30% is extremely high; it has been reported only in a few studies in tropical countries. 138 serum specimens from all age groups were tested for antibodies to yellow fever virus; 59 of them (43,4%) were positive. None of these persons reported a history of yellow fever; evidently they had undergone subclinical infections. Our findings show that yellow fever still is endemic in Central Africa. It may be concluded that all persons visiting Central Africa should be vaccinated against hepatitis A (passive prophylaxis), yellow fever and, if possible, against hepatitis B.