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Biomedical subjects

J Braun

Publications and source records attributed to J Braun.

At least 469 records · Page 26Linked to original sources
PubMed1990

Omental pedicle flap used to treat a bronchopleural fistula after diaphragma--pericardio-pleuropneumonectomy.

In a 47-year-old male patient a bronchopleural fistula was apparent 22 days after extended right-sided diaphragma-pericardio-pleuro-pneumonectomy for pleuramesothelioma. The thoracic cavity was infected. Rethoracotomy was performed and the fistula was closed using an omental pedicle flap. The bronchial stump became tight and the cavity fluid became sterile. No abdominal complications were seen. The patient died 8 months later from malignant pericardial infiltration. The ability of greater omentum to revascularize ischemic tissue, to absorb fluid and to resist local infection is proved and used in several subspecialities of surgery. Nevertheless the use of the greater omentum in the management of bronchopleural fistula has been rarely published. The reported case shows that the closure of a large bronchopleural fistula is possible by using the attributes of the omental tissue.

Bronchial Fistula↗
PubMed1990

Learning needs of patients with angina: an extension study.

This study compares the learning needs of patients diagnosed with coronary artery disease who experience angina with ratings by the patients themselves and the nurses who care for them. Also compared are the rankings done on categories of select learning needs with rankings done on categories of actual or intended adherence to prescribed medical regimens, using data obtained from the patients. Samples consisted of 15 telemetry unit nurses, 15 inpatients with angina, and 15 postdischarge patients with angina. All participants responded to the Cardiac Patient Learning Need Inventory and a demographic data sheet. Patients also responded to the Educator Preference Tool and either the Health Intention or Health Behavior Scale. Data analysis indicated that similarities and differences existed between patients and nurses in what they believed is important for patients to learn. Patients expressed a greater preference for physicians, rather than nurses, to teach them cardiac information. The findings indicate that what patients believe is most important to learn, as indicated by select learning needs categories, is related to what they most intend to do or actually adhere to regarding their medical regimen.

Adult↗
PubMed1990

A comparison of four immunometric assays for myeloperoxidase using luminescent and colorimetric signal detection.

This communication presents four different assay systems for the determination of myeloperoxidase in body fluids. One is based on conventional chemiluminescence, two on luminescence-amplified enzyme measurement using either spiroadamantane-1,2-dioxetanes with alkaline phosphatase or luminol/peroxidase/4-iodophenol coupled with a peroxidase label. The assays covered the range 0-600 micrograms/l peroxidase. Established reference range for EDTA plasma from healthy volunteers gave an upper limit of 250 micrograms/l (95% confidence limits). Intra-assay coefficients of variation were less than 5% for all assays, as seen in compound precision profiles. Inter-assay variation was less than 10% throughout the whole concentration range. Kinetic curves for the light production were performed over a 2 hour period for the enhanced luminescence assays. Dynamic ranges of these assays were compared with the conventional colorimetric assay using 4-nitrophenyl phosphate--alkaline phosphatase. The assay was standardized using a commercially available myeloperoxidase preparation with defined enzymatic activity. The protein content was estimated and the laboratory standard compared and calibrated in mass units.

Adamantane↗
PubMed1990

Vision outside the focus of attention.

We investigated the relationship between focal attention and a feature-gradient detection that is performed in a parallel manner. We found that a feature gradient can be detected without measurable impairment of performance even while a concurrent form-recognition task is carried out. In spite of the fact that the form-recognition task engages focal attention and thus removes attentive resources from the vicinity of the feature gradient. This outcome suggests strongly that certain perceptions concerning salient boundaries and singularities in a visual scene can be accomplished without the aid of resource-limited processes, such as focal attention, and, by implication, that there may exist two distinct perceptual faculties (one attentive, the other not) that are able to bring complementary kinds of visual information simultaneously to our awareness.

Attention↗
PubMed1990

[Lung resection in arteriovenous fistula].

Arteriovenous fistulas of the lung occur as a disease limited to the lung, or as a pulmonary manifestation of hereditary Rendu-Osler-Weber's disease. Typical complications are haemoptysis, haemothorax and cerebral embolism. We report on 3 patients in whom arteriovenous fistulas of the lung were removed by wedge excision or lobectomy. One of them had already suffered cerebral infarction. The indication for operative removal of single lesions is always given with respect to the severe complications of this disease. Decrease of the right-to-left shunt volume can usually be achieved.

Adult↗
PubMed1990

Contrasting effects of interleukin 4 (IL-4) on the in vitro proliferation of human B cells is due to the presence of B cell subsets in different activation states.

Human tonsillar B lymphocytes proliferate in vitro after activation with immobilized anti-IgM antibodies in combination with interleukin 2 (IL-2) or interleukin 4 (IL-4). In addition to its proliferative effects, IL-4 is also able to inhibit B cell proliferation. An explanation for these different actions of the same protein is not as yet available. The susceptibility to the inhibitory action of IL-4 emerges at late time points after in vitro activation of the B cells, whereas IL-4 shows its growth promoting action during early stages of culture, indicating that activated IL-2 responsive B cells are the targets for IL-4 dependent inhibition. Freshly isolated tonsillar B lymphocytes also appear to be susceptible to IL-4 dependent suppression. Isotonic Percoll gradient centrifugation, that has been used by several groups as a standard procedure to isolate high density, resting used by several groups as a standard procedure to isolate high density, resting cells from tonsil B lymphocytes, does not result in separation of B cells with different in vitro proliferative response to IL-2 and IL-4. However, partial separation of cells with "resting" and "activated" phenotypes can be achieved by centrifugation in slightly hypotonic Percoll gradients. High-density fractions contain cells with a "resting" phenotype which after in vitro activation proliferate with IL-4 but not with IL-2. "Activated" B cells accumulate in the low-density fractions as concluded from the increased expression of transferrin receptors and HLA-DR molecules on these cells. However, these cells no longer proliferate in vitro with immobilized anti-IgM antibodies, possibly due to damage caused by the hypotonic treatment during centrifugation. Our data indicate that resting B cells when activated in vitro with immobilized anti-IgM antibodies proliferate primarily with IL-4 but not with IL-2. In contrast, about 15 hours after activation the cells become responsive to IL-2. At that stage, IL-4 becomes an inhibitory factor.

B-Lymphocytes↗
PubMed1990

[Surgical problems in AIDS].

A mortality of 41 percent has so far been recorded from 2.779 cases on the AIDS register. Surgical problems were found to arise only in the terminal stage, when gastro-intestinal, anorectal, pulmonary, neurological, and haematological manifestations have to be expected. Surgical intervention is indicated in situations of massive bleeding, perforations, and mechanical ileus. Opportunistic infections have proved to give rise to the development of gall-bladder empyema and CMV-induced ulcerations. The risk of infection run by medical personnel as well as prophylaxis against AIDS infection of people in contact with HIV infected individuals are described in great detail.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Wartime neurosurgical experience in Lebanon, 1982-85. I: Penetrating craniocerebral injuries.

The present report analyzes 116 penetrating wounds of the brain sustained during warfare in Lebanon during 1982-85. Two basic mechanisms of injury were encountered: high-velocity bullets, and shrapnel and stones from explosive devices; and in one case a radio antenna penetrated the head through the orbit. The site of impact was at the convexity in 87% of cases and at the base of the skull in the remaining 13%. Surgery was performed in 83% of the patients: debridement-craniotomy in 73%, burr hole for intracranial pressure monitoring only in 6% and scalp closure only in 4%. The remaining 17% did not require surgery because of transbasal penetration without intracranial mass (10%) or due to moribundity. Indriven bone or foreign body fragments were removed only if readily accessible. The mortality rate was highest among patients with a Glasgow Coma Scale of less than or equal to 4 on arrival, after high-velocity bullet wounds, when the intracranial path was multilobar or transventricular, and when associated lesions were accompanied by shock. A follow-up study of the 49 Israeli survivors for almost 6 years revealed intracerebral-retained bone fragments in 48%, but these did not result in increased immediate or late complications (e.g., infection, epilepsy). These results support our conservative approach. Since all victims of penetrating head injuries were evacuated from Lebanon to Rambam Medical Center, Haifa, our report can serve as an estimation of the incidence of penetrating brain wounds and their burden on a front-line hospital.

Brain↗
PubMed1990

Wartime neurosurgical experience in Lebanon, 1982-85. II: Closed craniocerebral injuries.

This report presents 64 patients who sustained military-related closed craniocerebral injuries during the Lebanon conflict of 1982-85, all of whom underwent CT scanning at the initial assessment. Of these, 59% required surgery for removal of hematomas, depressed fractures and for monitoring intracranial pressure, in addition to intensive care management of elevated intracranial pressure and associated insults. CT scan revealed brain concussion only in 23%, depressed fracture in 9%, brain contusion alone in 17%, extracerebral hematomas in 17%, intracerebral hematomas in 11%, and diffuse axonal injury in 22%. Overall mortality was 19%, and the outcome was good in 69%. Various factors affecting survival are discussed, and our findings are compared with those in the literature concerning closed head injuries among civilians. Attention is drawn to the high proportion of diffuse brain injury due to blasts caused by side mines. Despite continued efforts to hasten evacuation from the field and improve the management of warfare-related head trauma, the outcome is still far from satisfactory.

Blast Injuries↗
PubMed1989

Postoperative adaptation of the small intestine after total colectomy and J-pouch-anal anastomosis.

Twelve patients who underwent total colectomy and J-pouch-anal anastomosis were followed up to 3 years after surgery to evaluate the functional and morphologic changes of the small-bowel reservoir. Intestinal absorption was impaired for lactose in 18 percent, for D-xylose in 27 percent, and for 75SeHCAT in 83 percent. Morphologic changes in ileal-pouch specimens consisted of a marked flattening of the villi and augmentation in crypt number and length. The number of Paneth's cells was increased compared with normal ileum. Parameters, indicating neorectal function such as stool frequency, pouch volume, and intestinal transit, improved in time during the postoperative course. Because of impaired small-bowel function, which is not restricted to the pouch reservoir, the ileum acquires progressive colonic capacities in accordance with its morphologic transformation to a colonic type mucosa. None of our patients developed clinical malabsorption requiring regular therapeutic substitution beyond a well-balanced diet due to these morphologic and functional changes and postoperative acceptance was good or excellent in all but one case.

Adult↗
PubMed1989

Axon outgrowth along segmental nerves in the leech. I. Identification of candidate guidance cells.

We studied the development of the major extraganglionic components of the germinal plate in embryos of the glossiphoniid leech Helobdella triserialis to improve our understanding of the mechanism of segmental nerve formation. We examined the outgrowth of groups of axons from ganglionic neurons into the segmental nerves, the migration of peripheral neurons and epidermal specializations to their definitive sites, and the development of circular and longitudinal muscle fibers. We visualized axons, as well as neurons and epidermal specializations, by means of fluorescent cell lineage tracers injected earlier into blastomeres and muscle fibers by means of immunofluorescence. The development of cells in all groups was found to follow a stereotyped pattern. Axons of ganglionic neurons approach some identified peripheral neurons located along the segmental nerve paths but not, in general, epidermal specializations and muscle fibers. Near the somata of a subset of peripheral neurons they approach, axons cease or interrupt their growth. These findings identify a set of candidate guidance cells for axonal outgrowth in the leech, similar to those previously described in the developing nervous system of insects.

Animals↗
PubMed1989

Axon outgrowth along segmental nerves in the leech. II. Identification of actual guidance cells.

Some peripheral neurons, previously identified as candidate guidance cells for axonal outgrowth along the segmental nerves in embryos of the glossiphoniid leech Helobdella triserialis, were photoablated by laser illumination to ascertain whether their presence is necessary for generation of the normal axonal growth pattern. These experiments showed that focal photoablation of peripheral neurons nz3 or pz8 prevents normal axonal outgrowth along the ultraposterior nerve path or along the distal sector of the medial-anterior nerve path, respectively, in conformance with the inference that these two neurons do function as guidance cells. However, ablation of these neurons affects axon outgrowth only if the neurons are illuminated prior to the end of a sensitive period in segmental development. By contrast, photoablation of previously identified candidate guidance cells situated on the anterior-anterior and posterior-posterior nerve paths, among them peripheral neurons nz1, nz2, oz1, oz2, pz6, and LD1, does not prevent normal axonal outgrowth. It is possible that the guidance role, if any, of these neurons is facultative rather than necessary, since each of the several neurons that lies on either of these nerve paths may provide an alternative axon guidance cue.

Animals↗
PubMed1989

Physical restraints and agitation in nursing home residents.

An observational study was performed to determine whether the use of physical restraints in agitated nursing home residents leads to decreased or increased agitation. Results indicate that restraint use does not decrease agitation in nursing home residents. Residents exhibited either the same amount or more agitated behaviors when they were restrained than when they were not restrained, suggesting that the act of restraining may itself contribute to manifestations of agitation. The implications of the use of restraints in agitated nursing home residents are discussed, with particular reference to the prevention of falls.

Adult↗
PubMed1989

Non-tropical pyomyositis in children--with report of severe neurological complications.

Pyomyositis appears to occur rarely in temperate climate areas, compared with the incidence of the disease in the tropics. Three young adults with pyomyositis have previously been described in Israel, two of them were newly arrived Ethiopian immigrants. We report three Israeli children with pyomyositis, who presented initially with nonspecific abdominal pain; in one child the course was complicated by spinal cord compression due to extension of the infected mass into the spinal canal. All three patients attained full recovery after antibiotic therapy and surgical drainage. Computed tomography was most valuable in establishing the diagnosis and defining the extent of the process.

Abscess↗