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Biomedical subjects

J Blum

Publications and source records attributed to J Blum.

At least 73 records · Page 4Linked to original sources
PubMed1997

[Whole body spiral CT in primary diagnosis of patients with multiple trauma in emergency situations].

PURPOSE: The aim of this study was to evaluate the role of a fast whole body helical CT scanner for primary diagnosis in trauma patients. METHODS: 27 severely injured patients (9 women, 18 men; mean age 43 years) were first examined with a helical CT scanner allowing for digital radiograms up to a length of 1024 mm and continuous helical scans of up to 70 seconds (slice thickness 3 to 10 mm, pitch factor up to 2). The primary CT diagnosis was verified either by x-ray after the CT examination or during the subsequent days, by abdominal ultrasound, by additional CT scans in the following days, and by clinical follow-up. RESULTS: CT showed all clinically relevant injuries of the head, spine, chest, abdomen and pelvis. The diagnosis and classification of vertebral fractures was performed immediately. 4% of the fractures of the extremities and the ribs were not seen primarily. 6% of the injuries were outside the CT scan field. CONCLUSION: Helical CT is a reliable and fast method to obtain vital information and to improve management planning in severely injured patients. It reduces the number of conventional x-ray examinations. In certain cases, additional x-rays of extremity fractures may be required.

Abdominal Injuries↗
PubMed1997

The unreamed humeral nail--a biological osteosynthesis of the upper arm.

One hundred humeral shaft fractures have been treated by closed retrograde locked intramedullary nailing. The Russell-Taylor nail was used in 58, a Synthes prototype of an unreamed humeral nail in 42 cases. Excellent shoulder function after consolidation has been found in 90%, excellent elbow joint function in 86%. Among four cases of postoperative radial nerve palsy, three fully recovered within three months and one patient needed a secondary exploration. In three cases additional comminution at the fracture site occurred. Interlocking bolt breakage has been seen in three, slight nail migration with no adverse consequences in two cases, an additional supracondylar fracture in one case. Nine patients needed a secondary internal fixation because of disturbed fracture healing. Compared to complication rates and end results in shoulder and elbow function of plate fixation or anterograde nailing in the treatment of humeral shaft fractures, the retrograde locked humeral nail seems to present itself as the better implant for these fracture types. The number of radial nerve palsies is significantly lower than in plate osteosynthesis. A huge advantage compared to plate osteosynthesis is also the biological type of stabilization with minimal invasion of the soft tissues. There is also minimal damage to periosteal and endosteal blood supply.

Adolescent↗
PubMed1997

Surgical approaches to the humeral shaft.

Open fractures, transverse, short oblique and spiroid fractures of the humeral shaft, as well as comminuted fractures with radial palsy or vascular injury, mostly lead to bad end-results if treated conservatively. The same is valid in the case of bilateral humeral shaft fractures, multiple injuries, polytrauma, pathologic fractures and pseudarthrosis. Good end-results and a low rate of complications in the operative procedure require an adequate approach to the fractured limb as well as a meticulous care of the soft tissues. In plate osteosynthesis, the anterolateral approach for the proximal third of the shaft, the anterolateral approach with radial exposure for the middle third of the shaft and the posterior approach for the distal third of the shaft seem to offer the best pathway for reposition and fixation, respecting the biologic requirements for a successful osteosynthesis. The approaches for external fixation demand a thorough knowledge of the course of the axillary and radial nerves. Unreamed intramedullary nailing can be done in an anterograde and in a retrograde way. In anterograde nailing, damage of the rotator cuff must be avoided, in retrograde nailing, the elbow capsule should be left closed and untouched.

Bone Nails↗
PubMed1997

[Complications of endoscopic retinaculum dissection].

Reviewing the literature on endoscopic carpal tunnel release (biportal Chow-technique and uniportal Agee-technique), we found 31 different intra- and postoperative complications. Of these, 14 affected nerve structures, four vessel structures, two tendon structures, two bony structures, and nine surrounding tissues. The most common complications were analyzed taking anatomical and pathological variations of the carpal tunnel into consideration. In our own prospective series of 88 endoscopic releases of the carpal tunnel using the Agee technique, we had eleven complications: one patient suffered residual symptoms, five patients experienced transient ulnar neurapraxia, and one patient complained of intense pain in the middle- and ringfinger after the operation. In four cases, intraoperative change of technique from endoscopic to open became necessary, due to poor visualization.

Carpal Tunnel Syndrome↗
PubMed1996

Uncoupling of M-phase kinase activation from the completion of S-phase by heat shock.

Chronic exposure of asynchronous HeLa cell cultures to 41.5 degrees C leads to an accumulation of cells in the S-phase, spontaneous premature chromosome condensation, and loss of clonogenicity (M.A. Mackey, S. L. Anolik, and J. L. Roti Roti. Cancer Res., 52: 1101-1106, 1992). In this report, we show that increases in histone H1 kinase activity during 41.5 degrees C exposure occur coincidentally with the appearance of premature chromosome condensation. Furthermore, this kinase activity is shown to be associated with M-phase kinase complexes containing cyclin B1. These increases in the activity of M-phase kinase were found to occur concomitantly with an elevation in cyclin B1 mRNA and an accumulation of cyclin B1 protein. Because cyclin B1 transcription begins in the S-phase, it is probable that the heat-induced delay in the S-phase allows the accumulation of abnormally high cyclin B1 levels. Elevated cyclin B1 levels could then account for the observed abrogation of the cell cycle checkpoint, which usually assures that mitosis does not proceed until DNA replication is complete. This involvement of M-phase kinase in heat-induced cytotoxicity demonstrates the importance of the coordinate regulation of the processes of DNA replication and entry into mitosis.

Cell Cycle↗
PubMed1996

[Bilateral acetabulum fractures of the anterior column and vertebral body fracture after alcohol-induced seizure].

The case of a 54-year-old male with a compression fracture of the T 12 vertebral body and a bilateral anterior column fracture of the acetabulum is presented. The origin of this rare combination of fractures is explained by the action of the patient's own muscle force on bone of very poor quality. The treatment of these lesions is comparable to the treatment of similar fractures in bone of normal quality.

Acetabulum↗
PubMed1996

[Results of primary unreamed tibial nailing of tibial fractures with severe open or closed soft tissue injuries].

Primary stabilization was performed in 72 tibial fractures with sever open (n = 37) or closed (n = 35) soft tissue injury using unreamed interlocking nails. In 60 (83%) cases the fractures healed without additional procedures. There were 2 cases of osteitis, but both these fractures healed after removal of the nail or after reamed nailing. In 9 patients with delayed union reamed nailing (n = 8) or bone grafting (n = 1) led to healing. In 1 patient with hypertrophic pseudarthrosis, union was achieved after substitution of a reamed nail for the anreamed nail. The infection rate was similar to that observed with external fixation. More secondary procedures, such as bone grafting or a change of the osteosynthesis technique, are necessary with external fixation than with unreamed nailing. Further advantages of unreamed nailing are the internal treatment of the fracture and the patient's greater comfort. Therefore, unreamed nailing can be recommended for the primary treatment of tibial fractures with severe open or closed soft tissue trauma.

Adolescent↗
PubMed1996

Tissue engineering scaffolds using superstructures.

Here, scaffolds as cell and tissue carriers are approached from an engineering point of view, emphasizing material superstructuring in the design of supports. Superstructure engineering provides optimal spatial and nutritional conditions for cell maintenance by the arrangement of structural elements (e.g. pores or fibres) so as to vary the order of cell to cell contact. This approach is illustrated in the design of several scaffolds: knitted fabrics as three-dimensional superstructures for optimized osteosynthesis implants, a new injectable open porous implant system, an angiopolar non-degradable ceramic cell carrier, and an injectable or microsurgically implantable entangled carrier system. The implications for tissue engineering are discussed.

Anisotropy↗
PubMed1996

Detection of coccidioidal antibodies by 33-kDa spherule antigen, Coccidioides EIA, and standard serologic tests in sera from patients evaluated for coccidioidomycosis.

During a 9-month study of patients being evaluated for coccidioidomycosis, 1 or more serum samples were obtained from 138 patients with an illness suggestive of recent infection. In this group, standard immunodiffusion tests of unconcentrated sera were positive for 25; 49 additional patients had at least 1 reactive test result by newer enzyme-linked serologic tests. At least 11 of these 49 patients had coccidioidomycosis as determined by culture or subsequent standard serologic tests. Patients with coccidioidomycosis identified only by newer tests had fewer or milder clinical abnormalities than did patients in whom the disease was detected by standard tests. For 31 other patients with illness of a chronic or undetermined duration, newer tests detected only 10 more than the 18 identified by standard tests, suggesting that later in the course of illness, standard testing gains in sensitivity for coccidioidal infection.

Antibodies, Fungal↗
PubMed1996

Major histocompatibility complex class II molecules function as a template for the processing of a partially processed insulin peptide into a T-cell epitope.

Our understanding of how an autoantigen is processed and presented during the development of a major histocompatibility complex (MHC) class II-dependent and T-cell-mediated autoimmune disease, such as IDDM, is incompletely understood. We have used insulin as a model autoantigen in IDDM to address the question of whether MHC class II molecules play a role in the generation and/or preservation of an autoantigen peptide that stimulates T-cell activation. Analyses of the requirement of I-Ad class II molecules in the processing of the partially processed porcine insulin peptide A1-A14/B1-B16 demonstrate that the binding of this peptide to I-Ad is essential for it to be further processed and tailored into a T-cell epitope. Based on our observations, we propose a two-step model for insulin processing in which insulin is first processed by an enzyme(s) into an intermediate peptide that binds to class II and then class II functions as a template to guide the processing of this partially processed peptide by cathepsin D into a T-cell epitope. Our data further underscore the important realization that MHC class II-directed processing of an autoantigen (e.g., insulin) may regulate 1) the relative immunodominance of T-cell determinants in an autoantigen, 2) the self-reactivity to cryptic T-cell epitopes in autoantigens, and 3) the susceptibility to autoimmune disease.

Animals↗
PubMed1996

[Reference values of electrodiagnostic and laboratory studies in young Wallis Schwarzhals goats].

Laboratory testing in 10 "Walliser Schwarzhals"-goats included red and white blood cell count, electrolytes, liver enzymes, trace elements and urinalysis, protein determination and cell count of the cerebrospinal fluid (CSF) was also performed. Electrodiagnostic testing included electromyography (EMG) of the head and spinal muscles, motor nerve conduction velocity (MNCV) of the right and left peroneal nerve, brainstem auditory evoked potentials (BAEP) and electroencephalography (EEG). MNCV of the peroneal nerve was 72 +/- 9.24 m/s. Latency and amplitude of the BAEP for P1 was 2.15 +/- 0.08 ms respectively 2.23 +/- 0.7 microV and for P5 5.09 +/- 0.15 ms respectively 0.68 +/- 0.24 microV. P2 (3.2 +/- 0.14 ms/1.37 +/- 0.32 microV) and P3 (3.9 +/- 0.13 ms/0.84 +/- 0.14 microV) were equally distributed between P1 and P5. Whereas the results of EMG and BAEP were similar to those of other species, the electroencephalographic findings consisted of three different patterns depending on duration and depth of isofluran anesthesia. Pattern I had a rhythmic high amplitude (80 microV) and low frequency (1-2 Hz) pattern with aperiodic intervals of relative electric silence. Pattern II was characterized by increased duration of HALF (150 microV), associated with spindles of low amplitude (20-30 microV) and high frequency (10 Hz). Pattern III had generalized delta-activity of high amplitude (70-200 microV). All the results are discussed briefly.

Animals↗
PubMed1995

Long-term clinical and prostate-specific antigen follow-up in 500 patients treated with radiation therapy for localized prostate cancer.

During a 14-year period, 500 consecutive patients having localized prostate cancer were treated with external beam radiotherapy with curative intent. Patients were staged according to the Whitmore-Jewett and TNM systems. Median follow-up for all patients was 69 months. Local recurrence included failures detected by rectal examination and/or prostate biopsy. Progressively elevated prostate-specific antigen (PSA) values at follow-up with no evidence of systemic disease also was considered a local treatment failure. Overall 5- and 10-year survival rates were 65% and 37%, respectively. Cause-specific 5- and 10-year survival rates were 79% and 55%, respectively. Five- and 10-year local control rates for all patients were 72% and 52%, respectively. No patient with a T1 a tumor failed locally. When follow-up PSA data were included in control criteria, 10-year local control rates for patients with T1b, T2a, and T2b-T4 tumors were 66%, 55% and 44%, respectively. If only an abnormal rectal examination and/or a positive post-treatment biopsy was considered as evidence of local failure, control rates were significantly better. Approximately one third of the study patients had died of cancer or intercurrent disease before the PSA test was used routinely. Of the 244 patients (49%) for whom follow-up PSA values were available, 116 had a normal post-treatment PSA with no evidence of disease; 94 were alive and 22 died with no evidence of prostate cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Alternative application of melarsoprol for treatment of T. B. gambiense sleeping sickness. Preliminary results.

The protocols for treatment of human African trypanosomiasis (sleeping sickness) with the organoarsenical drug melarsoprol are based on empirical observations. Therapy is often accompanied by serious side effects and relapses. Additionally, the duration of treatment, which is up to forty days, is a major drawback in African countries. Based on pharmacokinetic investigations an alternative therapy protocol for T. gambiense sleeping sickness has recently been proposed which consists of ten consecutive injections of 2.2 mg/kg melarsoprol given at intervals of 24 hours. In a preliminary study, eleven patients were treated in Vanga, Zaire following this alternative protocol which reduces the duration of the treatment to ten days. The results indicate that the alternative schedule was as effective as the traditional protocol, showed similar adverse reactions but required a much shorter treatment period.

Adolescent↗
PubMed1994

[Erroneous tracks in the diagnosis of cutaneous and mucocutaneous leishmaniasis].

Cutaneous leishmaniasis is an uncommon finding among patients seen in Central Europe. We report on three patients with cutaneous leishmaniasis who were initially misdiagnosed. Case 1, a woman who had returned from South America, was first thought to have an ulcer due to immunosuppression. Spread of the lesions to the nasal mucosa and a cosmetically disturbing scar were partly caused by delayed diagnosis and treatment. Case 2 shows a patient who has developed red papules on both legs after a trip to Spain. The lesions were misinterpreted as a residual reaction to insect bites. In case 3, a patient who had travelled in Nicaragua, the diagnosis of leishmaniasis was delayed because of coexisting acne vulgaris. In all three patients the final diagnosis of cutaneous leishmaniasis was confirmed by culture of the parasite. The only case with positive serology was the patient with mucocutaneous involvement. Two patients were radically cured, and one patient showed a substantial improvement of the lesions. The importance of a broad history including previous travel is emphasized to avoid the fallacies of missing a rare, but important disease among people travelling to countries with endemic leishmaniasis.

Adult↗
PubMed1994

Mutagenicity of K-region oxides and imines of chrysene, benzo[c]phenanthrene and benzo[g]chrysene in Salmonella typhimurium.

The K-region oxides and imines of chrysene, benzo[c]phenanthrene and benzo[g]chrysene were investigated for mutagenicity in Salmonella typhimurium TA98 and TA100, using two different exposure media. All six compounds were mutagenic under all four experimental conditions. The imines were 17-3800 times more potent than the corresponding oxides. Omission of KCl (125 mM) from the exposure medium resulted in enhanced mutagenic effects. The enhancement was stronger in strain TA98 (3.1-5.2-fold) than in strain TA100 (1.3-2.5-fold), suggesting an influence on the bacteria rather than on the chemicals.

Aziridines↗
PubMed1994

The presence of KCl in the exposure medium strongly influences the mutagenicity of metabolites of polycyclic aromatic hydrocarbons in Escherichia coli.

Previous studies demonstrated that the ion composition of the exposure medium may strongly influence the mutagenicity of many compounds in the liquid preincubation modification of the reversion assay with his- Salmonella typhimurium strains. Similar influences were now observed in the reversion assay with trp- Escherichia coli strain WP2 uvrA. The exposure medium was 8 mM sodium phosphate buffer (pH 7.4), containing no other ions or 125 mM KCl. Omission of KCl resulted in an about 10-fold enhancement of the mutagenic activity of 7-methylbenz[a]anthracene 5,6-oxide, but in a strong decrease in the mutagenicity of 1-hydroxymethylpyrene sulphate, close to the limit of detection. The findings with these two representative mutagens are very similar to those previously observed in S. typhimurium, suggesting that unobtrusive medium components may exert strong influences on the results with many test compounds in various bacterial test systems.

Benz(a)Anthracenes↗