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Biomedical subjects

J Wertheimer

Publications and source records attributed to J Wertheimer.

At least 37 records · Page 2Linked to original sources
PubMed1989

The relationship of conjunctival and arterial blood gas oxygen measurements.

Conjunctival oxymetry (CjO2) measures peripheral tissue oxygen at the conjunctival level. CjO2 changes can indicate pulmonary or circulatory conditions leading to shock. Literature review does not define 'normal' CjO2/ABG PaO2 ratios. We designed a study to measure these ratios. Twenty-two healthy patients undergoing cardiac catheterization had simultaneous PcjO2 and PaO2 measurements completed. The range of conjunctival oxygen measurements was from 34 to 68 mmHg with a mean of 50.5 mmHg. The PaO2 readings ranged from 65 to 93 mmHg with a mean of 77.1 mmHg. The average PcjO2/PaO2 ratio was 0.656 with a range of 0.47-0.93. Thus the PcjO2 is on average 66% of the arterial blood gas PaO2. This ratio of 0.66 can serve as a base for further clinical studies in which PcjO2 is looked at in patients with pulmonary or circulatory illnesses or injuries.

Adult↗
PubMed1987

Noninvasive evaluation of mid-left ventricular obstruction by two-dimensional and Doppler echocardiography and color flow Doppler echocardiography.

Three patients with midventricular obstruction resulting from three different pathophysiologic mechanisms and differing anatomic bases for the development of obstruction are presented. In the first patient, a membrane-like structure appeared to cause some fixed obstruction, but a superimposed dynamic component to the obstruction was also evident. Papillary muscle hypertrophy with approximation of the papillary muscles during systole was the mechanism in the second patient. In the third patient, apical infarction with hyperdynamic contraction of the mid- and basal portions of the myocardium appeared to be the pathophysiologic mechanism. Color flow Doppler echocardiography was particularly useful in localizing the site of obstruction and allowed further evaluations by pulsed and continuous-wave Doppler techniques to precisely determine pressure gradients.

Blood Pressure↗
PubMed1987

Prevalence of thyroid disorders in psychogeriatric inpatients. A possible relationship of hypothyroidism with neurotic depression but not with dementia.

Thyroid disorders are known to manifest occasionally as isolated psychiatric disorders. In order to determine whether thyroid dysfunctions could play a significant role in the pathogenesis of psychiatric disorders in the elderly, the prevalence of thyroid disorders was compared in a group of psychogeriatric patients and in a group of nonpsychiatric elderly patients. Thyroid function screening was performed in 157 patients consecutively admitted to a psychogeriatric unit, and the prevalence of hypothyroidism was determined in the different groups of psychiatric disorders (senile and multi-infarct dementia, organic brain syndrome of other etiologies, psychotic depression, neurotic depression, chronic delusional state, acute confusional state, and personality disorder). Thyroid function screening was performed similarly in 104 unselected elderly patients admitted to the medico-surgical admission unit of the University hospital to assess the prevalence of hypothyroidism in a general, nonpsychiatric, elderly population. Eight patients were diagnosed as hypothyroid based on an elevated basal thyrotropin (TSH) and on thyrotropin-releasing hormone (TRH) test in the total number of patients, two in the nonpsychiatric and six in the psychiatric group. Three had clinical hypothyroidism, with decreased total and free T4 and T3 plasma levels in addition to increased basal TSH, five had biochemical hypothyroidism, with normal T4 and T3 levels and an excess TSH response to oral TRH. The prevalence of hypothyroidism in the two groups did not differ significantly (1.9% in the nonpsychiatric versus 3.8% in the psychiatric group). The prevalence of hypothyroidism in a subgroup of 88 patients with senile and multi-infarct dementia was 2.3%.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Severe primary hyperparathyroidism in a neonate with two hypercalcemic parents: management with parathyroidectomy and heterotopic autotransplantation.

A neonate with severe primary hyperparathyroidism was successfully managed by parathyroidectomy and heterotopic autotransplantation (one third of one gland of the infant was implanted in the forearm). In vitro studies of parathyroid tissue from the infant revealed a severe defect in parathyroid suppressibility. Postoperatively, the infant had modest hypercalcemia, normal serum immunoreactive parathyroid hormone levels, hypermagnesemia, and relative hypocalciuria. The parents were related and both had asymptomatic hypercalcemia with mean serum immunoreactive parathyroid hormone levels that were within the normal range. Similar to the findings in the infant postoperatively, relative hypocalciuria in the presence of hypercalcemia was found in the mother; in contrast, the father had hypercalciuria. The presumed dominantly transmitted hypercalcemia in this kindred is consistent with familial hypocalciuric hypercalcemia with a confounding factor of ethanol possibly accounting for the hypercalciuria in the father.

Acute Disease↗
PubMed1985

[The use of low-dose amitriptyline in psychogeriatrics. A clinical, pharmacokinetic and pharmacogenetic study].

Two groups of six depressive psychogeriatric patients (age 69-93) have been treated for three weeks with either 25 mg or 50 mg of amitriptyline (AT) per day. Before the beginning of the treatment and after 8, 15 and 22 days of medication, the patients (7 outpatients and 5 hospitalized patients) underwent various psychopathological tests (Hamilton, Crichton) and biochemical investigations, i.e. clinical chemistry and hematology, analyses of AT and nortriptyline (NT), in the plasma. In some subjects the hydroxylated metabolites and the binding of these substances to plasma proteins were also measured. Except one patient, all responded favourably to the treatment. No difference between the two doses has been observed as regards their clinical efficacy and incidence of side effects. The plasma levels of AT and NT were below those generally recommended in the literature. The monitoring served to identify some cases of noncompliance and, in one patient, a deficiency of hydroxylation of AT, confirmed by the debrisoquine test. These results suggest that the "therapeutic window" needs redefinition and that low-dose medication with antidepressants is indicated in a psychogeriatric population.

Aged↗
PubMed1984

[Survival of patients with triple-vessel stenosing coronary atheroma].

This study analysed the survival rate of 179 patients with triple vessel coronary artery disease, 168 men and 11 women (mean age 54 years). Seventeen cases of left main stem disease were excluded. The patients presented with unstable angina (64 cases), stable angina (66 cases), recent myocardial infarction (26 cases) or chronic invalidating angina (23 cases). Coronary bypass surgery was undertaken whenever possible (64 cases, 34% of patients). Medical therapy (115 cases) was based on betablockers (61%), amiodarone (22%) and perhexiline (17%). The study was carried out by a double questionnaire sent to the patient and treating physician, 6 months to 76 months after coronary angiography (average 30 months). The response to these questionnaires was 100%. Survival rates were calculated by actuarial methods. Comparisons of survival graphs was made using the Log Rang test. The overall survival rate was 89% at 1 year, 84% at 2 years, 82% at 5 years and 71% at 6 years. There seemed to be a lower mortality in the surgical group (p less than 0,28). The 2 year survival rate in the group with cardiac failure was 40% compared with 88% in the group without cardiac failure (p less than 0,001). There was no statistically significant difference in mortality except in patients with ejection fractions lower than 0,30. Analysis of survival with respect to mode of presentation did not show any significant difference between patients with unstable angina, stable angina or chronic invalidating angina. Mortality was higher when triple vessel disease was discovered during myocardial infarction, reaching 33% at 4 years, compared to 15% in the other subgroups (p less than 0,05).(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1983

Surgical management of late prosthetic valve endocarditis.

Among 32 patients with late prosthetic valve endocarditis selected from two cooperative retrospective studies, ten had valve replacement: six men and four women, mean age being 48 years, ranging from 23 to 65 years old. An emergency reoperation was undertaken for refractory heart failure in seven out of ten cases, with an average delay of 6.6 days after the beginning of antibiotic therapy. In the other three cases, the operation was carried out at the end of 40 days of antibiotic therapy, once for recurrent endocarditis and twice for severe aortic insufficiency. The most common causative micro organism was the staphylococcus (7 out of 10 cases). The infected prosthetic valves were, in 8 out of the 10 cases, in the aortic position. The outcome was poor as the mortality rate was 60% (6 out of the 7 patients operated on in an emergency). Death was attributed to heart failure with conduction disturbances and severe aortic regurgitation (2 cases), cerebral emboli (2 cases), septicopyemia (2 cases). Four patients of the ten, after a mean follow up of 10 months, are cured without prosthetic valve dysfunction. The extreme gravity of prognosis seems related to the microorganism (staphylococcus), to the delay between the beginning of antibiotic therapy and the onset of the fever, and finally to the extension of destructive lesions under the prosthetic valve implantation base; the reimplantation of the prosthesis on frail and abscessed tissue implies a substantial risk of disinsertion. The indications for systematic early reoperation in cases of severe acute heart failure are discussed.

Adult↗
PubMed1983

The mechanisms of permanence time: support for a psychodynamic hypothesis of psychological aging.

We often observe in advanced age a degree of obsessionalization in behavior, attitudes, and interests. This phenomenon, seemingly the expression of unconscious defense mechanisms, may be explained in various ways: as a consequence of losses related to aging; as regression in the service of the self; as an expression of the "death instinct." Another level of reflection is concerned with the influence of the perception of time. Confronted by the curtailing of one's expectation of life, the aged person may unconsciously yearn for some kind of permanence, designed to conjure away the effect of passing time. We find such a process underlying rigidity, collecting, or hypochondria, which may be regarded as "mechanisms of permanence." These strategies, although constituting for the aged person a defense intended, in fantasy, to preserve life, in reality constitute a trap that excludes life.

Adaptation, Psychological↗