Biomedical subjects

J Blum

Publications and source records attributed to J Blum.

At least 19 recordsLinked to original sources

PubMed2007

[Parasites as a cause of urticaria. Helminths and protozoa as triggers of hives?].

Urticaria is one of the most prevalent disorders in dermatological practice. The disease can be incapacitating. There are clear pathophysiological and epidemiological hints that helminths and protozoa are rare but treatable causes of acute and chronic urticaria. Doctors and patients are often not aware that parasitic diseases are increasingly common even in industrialized countries due to a steep rise in migration and international travel. This review presents the most important parasitic causes of urticaria and provides relevant details regarding personal history, clinical presentation, diagnosis and therapy.

Animals↗

PubMed2006

MRI of bone marrow edema-like signal in the pathogenesis of subchondral cysts.

OBJECTIVE: To determine if a relationship exists between bone marrow edema-like signal and subchondral cysts on magnetic resonance imaging (MRI). DESIGN: Retrospective cohort of 32 patients with two sequential knee MRI. Patients with acute trauma, infection, neoplasm, or osteonecrosis were excluded. The degree of osteoarthritis was assessed using an adaptation of the Baltimore Longitudinal Study of Aging (BLSA) scale. Initial and follow-up exams were reviewed for presence, location, size and changes of marrow edema-like signal, subarticular cysts and cartilage abnormality. All locations in the knee were aggregated for analysis with descriptive statistics. RESULTS: The mean time interval between exams was 17.52 months (range 2.1-40.1 months). There were 23 cysts: 11 (47.8%) new, 6 (26.1%) increased size, 1 (4.4%) decreased size, and 5 (21.7%) no change in pre-existing lesions. Cysts always arose from regions of marrow edema-like signal. There were 68 subarticular areas of marrow edema-like signal: 16 (23.5%) new, 23 (33.8%) increased size, 17 (25%) decreased size, 11 (16.2%) resolved and 1 (1.5%) no change in pre-existing lesion. Marrow edema-like signal size always changed with cyst development: increased in 6/11 (54.5%), decreased in 2/11 (18.1%) and resolved in 3/11 (27.2%). Change in cyst size was always accompanied by a change in edema-like signal size. An MRI visible cartilage abnormality was adjacent to 87% (20/23) of cysts. The mean BLSA score changed from 2.6 to 3.6 indicating an overall progression of osteoarthritis. CONCLUSION: Subchondral cysts develop in pre-existing regions of subchondral bone marrow edema-like signal.

Adult↗

PubMed2005

[MRT-induced burns in tattooed patients. Case report of an traumatic surgery patient].

Skin burns to patients with tattoos during MRI procedures are reported but rare complications. MRI scans are being used more often also as diagnostic procedures in trauma patients. In this article we present the case of a patient after trauma of the vertebral column who experienced burning pain at the site of a tattoo on the distal femur during the MRI examination, necessitating cessation of this procedure. Based on this example we discuss possible pathomechanisms of MRI-induced skin burns to patients with tattoos. It becomes clear that patients have to be asked about possible tattoos before MRI scans and should be informed about possible pain development.

Burns, Electric↗

PubMed2005

[Operative strategies in the treatment of upper limb fractures in polytraumatized patients].

BACKGROUND: Optimal timing of operative treatment of upper extremity long bone fractures in polytraumatized patients depends on the type and location of the fractures, as well as on the cardiorespiratory stability of the patient, and should be early in diaphyseal fractures in order to optimize intensive care treatment. The timing of surgery in cases of upper limb fractures is secondary to life-saving therapies. The same applies to stabilization of fractures of the lower limbs, including fractures of the femur and tibial shaft. METHODS: The recommended operative procedure for adult polytraumatized patients with closed or open humeral shaft fractures of grade I or II is intramedullary nailing or plating. For closed or open lower arm fractures of grade I or II, plating is the best procedure, or alternatively nailing. For upper extremity epi- or metaphyseal fractures plating is preferred. Specific fracture situations require specific operative treatments, for example traction band for olecranon fractures, external fixation for distal radial multi-fragmentary fractures. The external fixator may be the optimal approach in grade III open fractures of the upper extremity long bones. The main difference in paediatric fractures is not the timing of the procedure, but the selection of the technique, which has to respect the epiphyseal growth plates. RESULTS: Additional vessel injuries require quick diagnosis and early vessel reconstruction in the presence of cardiopulmonary stability. Open fractures should have a higher therapeutic priority if they are associated with vessel/nerve lesions. The strategy in additional nerve injuries depends on the type of lesion. Nerve decompression should take place together with fracture stabilization; necessary nerve reconstruction should be performed secondarily. The primary phase should be limited to fracture fixation. If the fracture is combined with a compartment syndrome, decompression by fasciotomy together with fracture fixation ensuring cardiopulmonary stability has be performed. CONCLUSION: Amputations at the upper extremity in polytraumatized patients are only occasionally indicated in very severe injuries. In injuries involving total amputation, depending on the condition of the limb, immediate reattachment should be attempted if the cardiorespiratory situation of the patient is stable.

Arm Injuries↗

PubMed2005

Clinical and serologic responses to human 'apathogenic' trypanosomes.

We describe a female patient suffering from a benign self-healing febrile disease with strongly positive serology for Trypanosoma brucei. The patient showed a clinical picture with similarities to that of human African trypanosomiasis (HAT). HAT due to T. b. gambiense and T. b. rhodesiense were ruled out. We performed serologic tests because the patient was worried about HAT after receiving tsetse bites. The possibilities of an infection with human 'apathogenic' trypanosomes such as T. b. brucei, T. congolense or T. vivax are discussed.

Aged↗

PubMed2005

[The worm in the brain].

Cerebral signs of focalized infection or tumour with changing localisation or meningoencephalitis with a travel history should alert the clinician to consider the possibility of a worm infection. A detailed history of the stay abroad, of consumption of raw or with animal faeces contaminated food and of known preexisting helminthic disease gives further clues. The diagnostic approach compromises the check for eosinophilia in peripheral blood and CSF, serologic testing and CT scan or MRI examination. Anthelminthic treatment may induce a host reaction with inflammation and deterioration of the clinical picture and has to be performed cautiously and under protection with corticosteroids.

Anthelmintics↗

PubMed2005

The impact of immigration on health systems: a legal analysis from a three-country perspective.

The focus of this paper will be on how health care systems in three countries, Malaysia, South Africa and the United States, are responding to the health needs of immigrants with a strong focus on the legal aspects of the respective national responses. The Malaysia portion emphasizes legal immigration and analyses as to how the country's Ministry of Health and the delivery system itself is responding to the demands of immigrant's health. In the context of South Africa, the paper explores implications of the South African Constitution, which establishes a right to access health care, and explores whether such a right can be extended to non-citizens, or can be tempered by economic constraints. In the American discussion the focus is on whether publicly supported health care programs can be accessed to provide coverage for undocumented residents, and highlights recent constraints in using government monies in this area.

Delivery of Health Care↗

PubMed2004

Development of an optical trap for microparticle clouds in dilute gases.

Long-duration experiments with clouds of microparticles are planned for the ICAPS facility on board the International Space Station ISS. The scientific objectives of such experiments are widespread and are ranging from the simulation of aerosol behaviour in Earth's atmosphere to the formation of planets in the early solar system. It is, however, even under microgravity conditions, impossible to sustain a cloud of free-floating, microscopic particles for an extended period of time, due to thermal diffusion and due to unavoidable external accelerations. Therefore, a trap for dust clouds is required which prevents the diffusion of the particles, which provides a source of relative velocities between the dust grains and which can also concentrate the dust to higher number densities that are otherwise not achievable. We are planning to use the photophoretic effect for such a particle trap. First short-duration microgravity experiments on the photophoretic motion of microscopic particles show that such an optical particle-cloud trap is feasible. First tests of a two-dimensional trap were performed in the Bremen drop tower.

Journal Article↗

PubMed2004

Treatment of cutaneous leishmaniasis among travellers.

Leishmaniasis is endemic in 88 countries on five continents. There are 1-1.5 million cases of cutaneous leishmaniasis reported yearly worldwide. There has been a sharp increase in recorded cases over the last 10 years. Based on geographical distribution, cutaneous leishmaniasis is divided into Old World and New World leishmaniasis. In the past, species could be inferred from geographical setting or determined by performing culture and isoenzyme analysis. The recently developed and now widely available PCR technology allows a rapid diagnosis with determination of most species, and thus enables a species-orientated treatment. While the Old World species mostly cause benign and often self-limiting cutaneous disease, the American species cause a broad spectrum of conditions from benign to severe manifestations, including mucosal involvement. The response to treatment varies according to the species. Therefore, a species-specific approach is proposed. Drugs for systemic and topical treatment are presented and discussed with regard to their application, use and adverse effects. Indications for local or systemic treatment are proposed. Drugs under investigation are also mentioned. An overview of published treatment options and a treatment recommendation is given for each of the most important species. The level of evidence of the studies leading to these recommendations is given.

Administration, Topical↗

PubMed2004

[Treatment of humeral shaft and subcapital fractures in children. Consensus report of the child trauma section of the DGU].

The orthopedic treatment is the first choice in shaft fractures of the humerus in children. Angulations of more than 10 degrees need reduction, in that case anesthesia should be used for surgical stabilization. The preferred method is the elastic-stable intramedullary nailing (ESIN). In adolescents, even unreamed interlocking medullary nails are used. The primary paresis of the radial nerve is not an indication for nerve exploration in principle, but may be useful in special fracture situations. In subcapital fractures, more distinct angulations can be left untouched because of the highly potent epiphyseal plate. In severe displaced fractures, reduction and stabilization by ESIN is recommended in patients over the age of 10 years. The method is even applicable to pathological fractures in juvenile bone cysts. In adolescents after the start of epiphyseal plate closure, angle-stable implants are an alternative.

Adolescent↗

PubMed2004

Eosinophilic meningitis due to Angiostrongylus cantonensis in Switzerland.

Eosinophilic meningitis is a well-known disease in areas where the rat lung worm Angiostrongylus cantonensis is endemic, i.e. in Southeast Asia and in the Caribbean. We report a case of eosinophilic meningitis due to infection with Angiostrongylus cantonensis in a traveler returning from Cuba. The diagnosis was based upon symptoms of chronic meningitis associated with hyperesthesia and presence of eosinophilia in the cerebrospinal fluid. With increasing mobility rare infections like eosinophilic meningitis due to A. cantonensis may be encountered in the western hemisphere. A Giemsa stain of the cerebrospinal fluid is crucial for a prompt diagnosis that is confirmed by detection of specific antibodies.

Adult↗

PubMed2004

Medical treatment of missed abortion using misoprostol.

OBJECTIVE: To compare the efficacy of two routes of misoprostol administration (oral and vaginal) for treatment of missed abortion. METHODS: Two hundred women with confirmed missed abortion received 800 mcg misoprostol either orally or vaginally. All women returned for follow-up care 2 days later. If the pregnancy was not completely evacuated at this time, women could wait an additional 5 days or undergo immediate surgical completion. Efficacy was defined as the percent of women discharged from the study without need for surgical intervention. RESULTS: Efficacy was high in both groups and not statistically different (oral=89.0%, vaginal=92.9%). While the groups did not differ in terms of the completion rate by day 2 (oral=41.6%, vaginal=52.7%), the mean time to expulsion was longer (21.04 h) in the oral group than the vaginal group (13.47 h), p=0.041. Women in both groups were highly satisfied with the method. CONCLUSIONS: Medical management of missed abortion with either oral or vaginal misoprostol is highly effective and highly acceptable.

Abortifacient Agents, Nonsteroidal↗

PubMed2004

All-trans retinoic acid is increased in the acute phase-related hyporetinemia during Escherichia coli mastitis.

Blood vitamin A profiles, including concentrations of retinol and its active metabolite retinoic acid, were assessed during the peripartum period and during experimentally induced Escherichia coli mastitis in heifers. Serum retinol decreased in all animals in the immediate postpartum period and normalized within 1 wk after parturition. No significant changes were detectable in the concentrations of retinoic acid isomers during puerperium. Following intramammary E. coli infusion, all cows showed moderate symptoms of systemic disease besides the local signs of inflammation. The presence of a systemic acute-phase reaction was documented by fever, increase in serum amyloid A, and decrease in serum albumin. Retinol concentration in serum also decreased spectacularly during coliform mastitis, and the decline was clearly related to the timing of the acute-phase response. Moreover, a significant increase of all-trans retinoic acid, mirrored by a lowering of 13-cis retinoic acid, was detected during the same time period. The 9-cis isomer of retinoic acid was present in all samples, but it remained below the quantification limit. Results confirmed the decrease in serum retinol during the peripartum period of dairy cows. Furthermore, the study established that profound changes in vitamin A metabolism occur during the acute-phase reaction of coliform mastitis in heifers. The bovine infection model reproduced the acute phase-related hyporetinemia, as previously observed in humans and rats. In addition, all-trans retinoic acid was found to be the most abundant circulating acid isomer during mastitis, providing an indication for a possible key role of all-trans retinoic acid in the modulation of the immune response.

Acute-Phase Reaction↗

PubMed2003

Influence of food composition on splanchnic blood flow during digestion in unsedated normal dogs: a Doppler study.

The effect of dietary components in gastrointestinal blood flow was investigated non-invasively in dogs. Doppler ultrasound (US) waveform analysis of the celiac artery (CA) and the cranial mesenteric artery (CMA) of eight healthy dogs was performed both in the fasting state and at 20, 40, 60 and 90 min after feeding maintenance, high protein, high carbohydrate and high fat diets. Resistive index (RI), pulsatility index (PI) and the percentage differences between measurements were calculated. In fasted dogs, the CA showed significantly (p<0.05) lower resistance than the CMA. With all diets, post-prandial RI and PI values decreased significantly in both vessels (CA: RI=-12-13%; PI=-25-29%; CMA: RI=-13-15%; PI=-27-29% [p<0.05]), and in all cases significantly earlier in the CA than in the CMA (p<0.05). With all diets except high fat the maximum decrease in RI and PI was reached in the CA at 40 min and in the CMA at 60 min. High fat diets were unique in that the maximum decrease in RI and PI in the CMA occurred earlier (at 20 min) and values were slower to return to normal (p<0.05). We conclude that Doppler US can be used in dogs to quantify significant differences in the response of splanchnic blood flow to different dietary components.

Animals↗

PubMed2002

Treatment of late stage sleeping sickness caused by T.b. gambiense: a new approach to the use of an old drug.

Melarsoprol is the standard treatment of late stage trypanosomiasis. The development of treatment schedules was previously purely empirical. Generally melarsoprol is given in 3 series of three to four consecutive injections, given every 24 hours, with an interval of about one week between the series. Based on pharmacokinetic analysis, computer simulations and extensive literature research covering all schedules previously used and tested, a new schedule, consisting of ten daily consecutive doses of 2.16 mg/kg of the drug was suggested. The pharmacokinetic model was validated in uninfected vervet monkeys. No unexpected drug accumulation and no systemic toxic effects were observed. In a pilot clinical trial in Congo RDC a small group of T. b. gambiense patients (n = 11) was treated successfully with the new schedule. In an open randomised clinical trial conducted in 500 patients in Angola the clinical efficacy and safety of this new concise treatment were compared to those of standard protocol treatment. Parasitological cure 24 hours after treatment was 100% in both groups. Statistical analysis yielded no significant differences for adverse events between the two treatment protocols. The new schedule reduces the amount and cost for the drug by about one third, and those for hospitalisation by about half.

Animals↗

PubMed2002

[Proximal interlocking of humeral intramedullary nails and risk of axillary nerve injury].

QUESTION: Possible injuries to the axillary nerve are criticised in antegrade and retrograde endomedullary nailing of the humeral shaft during proximal interlocking. Clinical experience seems not to support the theory of a high risk of nerve injury. The real risk although remains unknown under anatomical-morphological aspects. MATERIAL AND METHODS: Eight complete human cadaveric shoulder-arm regions with original soft-tissue coverage had been used. Four times the unreamed humeral nail (UHN) had been inserted retrograde, and four times antegrade, distributed in each pair. Antegrade interlocking was performed after skin incision and spreading of soft tissues through the aiming devices. This involved one oblique bolt from lateral to medial. Retrograde proximal interlocking was performed under image intensifier. This involved triple interlocking, once dorso-ventrally and twice latero-medially. The incision paths have been marked. After preparation of the nerve stem in the lateral axillary portal the different branches have been searched and exposed. The spatial relations of bolts and nerve branches have been measured and the insertion path of the bolts has been revised, finally lesions of nerve structures have been documented. RESULTS: We found the latero-medially inserted bolt heads of the retrograde approach and the oblique bolt head of the antegrade approach being placed in a safe distance from the medio-dorsally positioned stem of the axillary nerve. On the other hand the dorsoventrally inserted bolt head (retrograde approach) showed in most cases a very tight relation to the nerve stem. Exploring the axillary nerve and its branches showed in no case a direct nerve lesion. CONCLUSIONS: We suggest to perform only a sharp cutaneous incision and then to prepare the muscle only by careful spreading until touching bone, with tissue retraction during drilling. In retrograde nailing the dorso-ventral bolt should only be used in extreme proximal fractures.

Axilla↗

PubMed2002

Misoprostol use in obstetrics and gynecology in Brazil, Jamaica, and the United States.

OBJECTIVES: To investigate current clinical use of misoprostol for the treatment of a range of reproductive health indications by providers in Brazil, Jamaica, and the United States. METHODS: Using a 'snowball' sampling technique, we surveyed 228 gynecologists and obstetricians in Brazil (n=123), Jamaica (n=52), and the United States (n=53). RESULTS: Providers use misoprostol for labor induction (46%), postpartum hemorrhage (8%), intra-uterine fetal death (61%), cervical priming (21%), missed abortion (57%), and incomplete abortion (16%) as well as first and second trimester abortion induction (27% and 13%, respectively). CONCLUSIONS: There is considerable variation in the regimens used; moreover, the regimens commonly used in clinical practice often differ from those recommended in the medical literature. While misoprostol is an appealing alternative for many reproductive health indications in developing countries, the varied regimens and lack of registration raise critical medical and policy questions.

Brazil↗

PubMed2002

[Canine panosteitis--an idiopathic bone disease investigated in the light of a new hypothesis concerning pathogenesis. Part two: Biochemical aspects and investigations].

The pilot study included serum analysis of ionized calcium, copper, zinc, various hormones and amino acid profiles from dogs affected with panosteitis, as well as protein electrophoresis performed on bone biopsies. Results of these analyses are as follows: ionized calcium, copper, zinc and hormones (parathyroid hormone, IGF-1, T3 and T4) were within reference ranges. Eleven of 23 serum amino acids from panosteitis-affected dogs were found to be significantly increased (P = 0.05). SDS-polyacrylamide gel electrophoresis performed on bone biopsies, which were pretreated with SDS, resulted in a double band of 39,000 D molecular weight in all panosteitis-affected dogs. Similar studies in control dogs resulted in a single band in this region. Attempts at amino acid sequencing from the N-terminal of the proteins in this double band region were unsuccessful. A chemical interference at the N-terminal end of these proteins was suspected. The composition of this double band is as yet unknown. The etiology of panosteitis could therefore not be definitively verified. However, it does appear that protein- or amino acid metabolism is affected in dogs with panosteitis.

Amino Acids↗