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Biomedical subjects

J Grossman

Publications and source records attributed to J Grossman.

At least 109 records · Page 6Linked to original sources

Comparison of three treatments for fractures of the diaphysis of the femur.

Sixty-eight patients with fractured femurs were studied who, in terms of personal characteristics, associated injuries and type of fracture, could have been treated by intramedullary nailing or traction followed by the application of either a spica cast or fracture brace. Twenty-eight patients actually underwent intramedullary nailing, while 18 were treated with a spica cast and 22 with a fracture brace. Multiple outcome factors were studied and, based upon every comparison, intramedullary nailing was found superior. Among those patients treated by non-operative techniques, fracture bracing permitted earlier independent ambulation and increased the probability of normal knee motion at the conclusion of treatment.

Absenteeism↗

Early operative intervention for complications of acute myocardial infarction.

Cardiac operations were performed on 21 patients for treatment of complications of acute myocardial infarction unresponsive to vigorous drug therapy. There were six hospital deaths (28.5 per cent) and 15 survivors 3 to 50 months postoperatively. Fourteen of the 15 survivors are asymptomatic (Class I N.Y.H.A.); one patient remains in Class III. The average time from infarction to operation was 7 days; operative mortality rate was unrelated to the time from infarction to operation. Five of six deaths were in patients with preoperative cardiogenic shock who were not supported by an external cardiac assistance device. The two survivors of cardiogenic shock, treated preoperatively with the intraaortic balloon pump (IABP), are now asymptomatic. Early operative intervention is recommended to decrease the mortality rate in patients with complications of acute myocardial infarction unresponsive to conventional medical therapy. Preoperative treatment with the IABP is advised for the patient in cardiogenic shock.

Adult↗

Unusual cardiac reaction to chemotherapy following mediastinal irradiation in a patient with Hodgkin's disease.

A 27 year old man with Hodgkin's disease experienced three separate episodes of chest pain, each occurring on the sixth day of a cycle of mustargen, oncovin, procarbazine, prednisone (MOPP) combination chermotherapy. The first episode appeared to represent a myocardial infarction, whereas the next two were less serious. Numerous studies were performed including coronary angiography, cardiac catheterization and open pericardial biopsy. It is suggested that the patient represents an example of a previously undescribed syndrome due to chemotherapy administered after cardiac irradiation.

Adult↗

The occurrence of arrhythmias in hospitalized asthmatic patients.

Twenty-four hour continuous ECG monitoring was performed on 20 patients hospitalized for asthma to evaluate the occurrence of potentially dangerous arrhythmias. Most patients (19/20) had sinus tachycardia on admission; premature ventricular contractions (PVCs) were present in 4; 1 had angina associated with runs of increased sinus tachycardia. With improvement in PaO2 and FEV1, the heart rate decreased in 17 patients and fewer PVCs were present in 2. Arrhythmias were not a serious problem in the patients studied.

Adolescent↗

Systemic lupus erythematosus in a 1-year-old child.

An 11-month-old girl had systemic lupus erythematosus with a widespread skin rash. She manifested five of the criteria necessary for the diagnosis: oral ulcerations, alopecia, positive lupus erythematosus preparations, convulsions, and thrombocytopenia with leukopenia. Direct immunofluorescence showed deposits of IgG and C3 at the dermoepidermal junction of both abnormal and clinically uninvolved skin, and in subepithelial deposits along the glomerular basement membrane.

Age Factors↗

The effect of aging and acute illness on delayed hypersensitivity.

A group of standard antigens (monilia, mosquito, mumps, purified protein derivative [PPD], staphylococcus toxoid, streptokinase-streptodornase [sk-sd] and trichophyton) were applied to 321 normal volunteers, 60 patients admitted to a medical ward, and 41 patients in an intensive care unit (ICU) to evaluate their delayed hypersensitivity skin test response. Eighty-eight per cent of the normal subjects reacted with at least 5 mm. induration to one or more skin tests without any decrease in reactivity occurring with increasing age. In the hospitalized group, only 62 per cent of the ward and 63 per cent of the ICU patients reacted to the same skin tests. All (8/8) anergic ICU patients tested after discharge regained normal reactivity. Acute illness but not increasing age will impair the delayed hypersensitivity skin test response.

Acute Disease↗

Small airway obstruction in allergic rhinitis.

Applying newer techniques to assess the reactivity of small peripheral airways, we studied the effects of saline and methacholine inhalation in patients with allergic rhinitis. The maximum midexpiratory flow rate (MMF) and the maximum terminal flow (MTF) were used to assess the degree of small airway obstruction. Four rhinitis patients (13 per cent) had abnormal baseline MMF and/or MTF and 12 patients (38 per cent) developed a decrease in MMF and/or MTF after saline inhalation. Twenty-one patients (66 per cent) responded to methacholine inhalation with a greater than 20 per cent fall in the MMF and/or MTF. This response was significantly different from that of the control subjects (p less than 0.01). The patients' hyperresponsiveness appears to be similar to that of asthmatic patients except that the obstruction is primarily limited to the airways.

Adolescent↗

Effects of a procaine preparation (Gerovital H3) in hospitalized geriatric patients: a double-blind study.

The effects of Gerovital H3 (a specially stabilized form of procaine hydrochloride) on geriatric psychiatric patients were assessed in a double-blind study at Bronx State Hospital. The mean age of the subjects was 73 years and the average rating for the severity of organic symptoms was "moderate." During the first six weeks of study, the patients were each given a 5-ml injection of either Gerovital or placebo (saline) intramuscularly three times a week. This dosage was doubled to 10 ml per injection during the second six weeks. Nine Gerovital and 10 control subjects completed the first six weeks; and 6 Gerovital and 7 control subjects completed the entire 12-week study. Objective rating scales were used to evaluate patients on measures of interpersonal functioning, cognitive ability, psychiatric symptoms, and urine and blood chemical findings. All subjects were assessed before treatment and at six weeks and twelve weeks of the study. Side effects were recorded at two-week intervals. On most measures the variability between subjects was quite large, whereas differences between average scores for the two groups usually were small The few significant differences showed no systematic pattern and would be expected to occur by chance alone when so many statistical comparisons are made. The overall results of this double-blind study strongly indicated that, among these hospitalized geriatric patients with organic symptoms, Gerovital H3 had no ameliorative effect on either psychologic or physiologic functioning.

Aged↗

Lymphangitic pulmonary metastases secondary to breast cancer with normal chest x-rays and abnormal perfusion lung scans.

Three patients with advanced breast cancer are described who developed lymphangitic pulmonary metastases with normal chest x-rays and abnormal perfusion lung scans. The abnormal lung scans can probably be attributed to embolization of the pulmonary vasculature, first described in association with lymphangitic pulmonary metastases in 1903. The importance of recognizing this condition in patients with breast cancer is shown by their frequently good responses to combination chemotherapy.

Adult↗

Hemodynamic effects of edrophonium chloride (Tensilon) infusion.

The hemodynamic effects of a 10 mg bolus of edrophonium chloride followed by a continuous infusion of 0.25 to 1.0 mg per minute, were determined in unanesthetized patients with significant myocardial disease. The effect on heart rate of the drug was negated by studying a group of nine patients with complete heart block and permanently implanted ventricular pacemakers. After the 10 mg bolus, two of the nine patients experienced dizziness, nausea and abdominal cramps associated with a mild decrease in peripheral vascular resistance. There was no significant change in cardiac index, mean blood pressure, brachial artery upstroke time, corrected ejection time, or left ventricular systolic ejection time. This study demonstrated that the continuous infusion of 0.25 to 1.0 mg per minute of edrophonium chloride following a 10 mg loading dose, had no significant effect on myocardial function.

Aged↗