Intraluminal radiation therapy for biliary tract malignancy--an endoscopic approach.
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Aged↗
Biomedical subjects
K Klein
Publications and source records attributed to K Klein.
Pace variation and control of work pace as related to cardiovascular, neuroendocrine, and subjective responses.
Two studies of paced and self-paced arithmetic performance are reported. Heart rate and blood pressure were recorded and ratings of subjective arousal obtained. In one of the studies, plasma levels of catecholamines and cortisol were determined. Under externally paced experimental conditions pace variation was found to be quantitatively related to changes in systolic and diastolic blood pressure, as well as to ratings of stress and irritation. This was not the case for heart rate or positively evaluated aspects of subjective arousal. Performance was better and ratings of stress and irritation were lower during self-paced than during paced work at a comparable work pace. In one of the studies the diastolic blood pressure increased less when subjects controlled the pace. Plasma catecholamines did not increase significantly during either externally or self-paced work, but adrenaline tended to increase during paced work. Our findings give partial support to the suggestion that personal control may attenuate sympathoadrenal activation and cardiovascular reactivity.
Adrenal Glands↗
Depression and hemispheric site of cerebral vascular accident.
In order to investigate the possible role of left and right hemisphere neural structures in the manifestation of depression, 50 left brain damaged and 50 right brain damaged stroke inpatients were administered the Zung Depression Scale (ZD S) during the course of the rehabilitation phase of their treatment. These subjects were randomly chosen from all stroke patients receiving rehabilitation services who could be administered the ZDS. Approximately 30% of these subjects, regardless of the site of lesion, were clinically depressed. The severity of depression was independent of demographic factors and time since injury. Right brain damaged patients reported significantly more sleep disturbance, psychomotor agitation and pervasive sense of sadness. These results were discussed in light of previous findings that damaged to the left hemisphere results in greater depression. A model of reactive depression that results from neurological disability was proposed to partially account for these findings.
Journal Article↗
Personal control over work pace--circulatory, neuroendocrine and subjective responses in borderline hypertension.
Cardiovascular and neuroendocrine reactivity during arithmetic task performance were studied in 24 patients with borderline hypertension and normotensive controls. Personal control (self-paced versus externally paced performance) resulted in an attenuated blood pressure (BP) response to task performance in normotensives but not in borderline hypertensives. In response to self-paced work, systolic blood blood pressure (SBP) reactivity was significantly greater in borderline hypertensives, but the heart rate (HR) reactivity was similar in borderline hypertensives and normotensives under the different pacing conditions. Task difficulty (pace variation during external pacing) did not differentially affect reactivity in borderline hypertensives and normotensives. Venous plasma noradrenaline and adrenaline were unaffected by task performance. At rest after the task performance plasma noradrenaline was elevated in both normotensives and borderline hypertensives. The latter group also showed a persistent elevation of diastolic blood pressure after task performance, suggesting a prolonged vasoconstrictor response. The present findings indicate that, in terms of circulatory responses, borderline hypertensives may profit less than normotensives from personal control over environmental demands.
Adult↗
Family observations of everyday cognitive impairment in dementia.
The observations made by family members of cognitive impairment and decline serve an important role in the description of dementia-related illnesses such as Alzheimer's disease. A common clinical practice is to interview the family and informally gather information about the severity and history of intellectual impairment such as memory disorder and aphasia. The present study introduces a method to formalize this information gathering using an inventory that allows a family member to rate the presence and severity of the everyday manifestations of dementia. Results of initial psychometric studies of the rating scale indicate that a family member can make reliable judgments of everyday cognitive impairment. Observér ratings such as these should significantly enhance diagnostic efforts when they are used in conjunction with neuropsychological tests and in cases in which the demented person cannot participate in a full neuropsychological evaluation.
Journal Article↗
The effect of cardiac autonomic blockade on ventricular response to changes in preload.
Echocardiographic (E) assessment of left ventricular response to increases (I) and decreases (D) in preload of 9 volunteer male subjects (mean age 25 +/- 2.0 years) was made during both control (C) and cardiac blocked (B) conditions. Cardiac autonomic blockade was produced by intravenous administration of atropine (0.04 mg/kg) and propranolol (0.2 mg/kg), while I was produced by 5 degrees head-down tilt (T) for 90 min and D by lower body negative pressure to -40 Torr. Increases in resting heart rate of 44% and diastolic blood pressure of 13% occurred after B, (P less than 0.05). During C, the alterations in preload produced mean changes in end-diastolic volume (EDV) ranging from 135 +/- 10 cm3 for I to 96 +/- 9.1 cm3 for D. Changes in stroke volume during condition C were significantly related to changes in EDV during preload alterations and conformed to a normal LV function curve and were described by SV = 0.6 EDV + 4.5 cm3 (r = 0.85; P less than 0.001). Similarly during B, SV = 0.43 EDV + 5.8 cm3 (r = 0.75; P less than 0.001). Comparison of the LV function curves produced during C and B showed that both slope of regression and r were significantly different (P less than 0.01). These data indicate that cardiac autonomic blockade produces a downward shift in the LV function curve indicating a depression in myocardial contractility. In addition, the data indicate that changes observed in LV function during wide variations in preload are independent of autonomic nervous system influences and are independent of the intrinsic heart rate.
Adult↗
Arthroscopic synovectomy in the treatment of hemophilic synovitis.
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Adolescent↗
The kinetics of bupivacaine (Carbostesin) plasma concentrations during epidural anesthesia following intraoperative bolus injection and subsequent continuous infusion.
Plasma levels of bupivacaine were measured in 25 patients undergoing major abdominal surgery. The pharmacokinetic analysis of these data shows: (1) under a short term treatment, i.e. in the initial phase where multiple injections are given, the kinetic properties are in accordance with linear kinetic theory. The data can best be fitted to a two-compartment-model. (2) under a longterm treatment, i.e. infusion for more than 50 h, a very high accumulation occurs in contradiction to this theory. Therefore, the calculation of plasma levels from initial kinetic data is not feasible.
Adult↗
Jejunal infection with Campylobacter.
A patient had common variable immunodeficiency, chronic malabsorption, and Campylobacter jejuni infection. Infection was diagnosed by jejunal aspiration. A follow-up jejunal aspirate was culture positive at the same time that a stool culture was negative. Infection resulted in worsening of chronic diarrhea, but it was not associated with clinical features of colitis or proctitis. The duration of infection was prolonged and initial antimicrobial therapy was ineffective. Single drug therapy with erythromycin ethylsuccinate and then chloramphenicol led to the emergence of resistant organisms. After five months of bacterial excretion, combination therapy with metronidazole and neomycin sulfate eliminated the organism. This case emphasizes that the clinical manifestations and response to therapy of C jejuni infection can be altered in immunodeficient patients.
Adult↗
[Vascular stress reaction in the aged].
Based on atraumatic measurements by means of dynamographical, sonometrical and echographical methods reaction patterns of the blood pressure and the cerebral arteries in 50 patients aged from 65 to 83 during and after conflict stress situations were qualified and quantified. Without exception impairments of already preexisting vascular-hemodynamic lesions resp. blood pressure slips caused by hyperreactive (sympathicogenic) or hyporeactive (vagotonic) disorders of the autoregulation appeared. These alterations being typical of vascular stress reactions in the age became (partly) reversible after the end of the psychotraumatic phases. Additional risks for the (cerebro) vascular system by stress induced cardiogenic troubles have to be simultaneously calculated. The consideration for these circumstances within the geriatric diagnosis and treatment strategy is an important contribution to the prevention of vascular catastrophes and to the stability and the improvement of the quality of life.
Aged↗
Pouch ileitis: report of a case with severe systemic manifestations.
A 28-year-old man with chronic ulcerative colitis had a proctocolectomy with creation of a continent ileostomy. Six months later, he developed a severe systemic illness characterized by malaise, 24-lb. weight loss, fever, night sweats, arthralgias, bloody diarrhea, and problems with ileostomy function. On endoscopy, the pouch showed erythema, edema, friability, and ulceration; on biopsy, there was severe mucosal disruption with ulceration into the submucosa. Features consistent with chronic ulcerative colitis were also present. Laboratory investigation ruled out other causes of the illness so that a diagnosis of pouch ileitis was made. The patient responded dramatically to a 10-day course of metronidazole and remains well 2 years later. In patients with continent ileostomy after proctocolectomy for chronic ulcerative colitis, inflammation of the pouch may be associated with a severe systemic illness. The pathogenesis is unclear, but may involve the interaction of colonic type bacterial flora with ileal mucosa in immunologically susceptible patients.
Adult↗
Role of Clostridium difficile and Campylobacter jejuni in relapses of inflammatory bowel disease.
Findings from recent studies on the role of Clostridium difficile and Campylobacter jejuni in exacerbations of inflammatory bowel disease are in conflict. We examined stool specimens from 32 patients who had inflammatory bowel disease in relapse for the presence of C difficile and C difficile cytotoxin. In the last 19 cases stool specimens were also cultured for C jejuni. C difficile was identified in one patient who was receiving antimicrobial therapy. In no patient was C difficile cytotoxin detected. All cultures for C jejuni were negative. Routine screening of stool specimens for C difficile cytotoxin and C jejuni was not clinically useful in our patients during exacerbation of their inflammatory bowel disease.
Adult↗
Effects of tendon transfer on the canine scapulohumeral joint.
Surgical techniques for correcting medial or lateral instability of the scapulohumeral joint in conditioned research dogs were evaluated. Lateral instability was created by severing the lateral joint capsule and the tendon of insertion of the infraspinatus muscle. In 4 dogs, the tendon of origin of the biceps brachii muscle was then transferred to a position lateral to the greater tubercle in an effort to improve lateral stability. In 3 control dogs, lateral instability was induced, but attempt was not made to stabilize the joint. Medial instability was created by severing the tendon of insertion of the subscapularis muscle and the medial joint capsule. In 3 dogs, the tendon of origin of the biceps brachii muscle was transferred to a position under the lesser tubercle. In 2 dogs, a portion of the tendon of insertion of the supraspinatus muscle was transferred to a medial location. In 3 control dogs, attempt was not made to stabilize the joint. The control dogs (n = 6) demonstrated mild-to-moderate weight-bearing lameness for 7 to 14 days after surgical induction of joint instability and thereafter had normal limb usage. Dogs having had tendon transfer procedures recovered normal limb usage in 4 to 6 weeks and thereafter behaved normally. At necropsy, all joints appeared stable, and the surgical repairs were intact. A variety of joint surface abnormalities consistent with degenerative joint disease was observed, but no consistent pattern was assignable to any given surgical manipulation.
Animals↗
[Calcitonin and prostaglandins].
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Adult↗
A convenient approximation of life expectancy (the "DEALE"). II. Use in medical decision-making.
We show how to use a bedside approximation of life expectancy in quantitative decision-making. This method, the declining exponential approximation of life expectancy (DEALE), enables the physician to collate various survival data with information on morbidity to determine a quality-adjusted expected survival for a potential management plan. The keystone in the DEALE approach is the approximation of survival by a simple exponential function. This approximation makes it possible to translate data from various literature sources (life expectancy tables, five-year survival rates, survival curves, median survival) into a single, unified mortality scale. In this paper, we use the DEALE method to obtain approximations of quality-adjusted life expectancy and illustrate the application of the method in a quantitative analysis of a clinical decision.
Aged↗
Correlation of circulating levels of a serum protein with triiodothyronine levels and hepatoma growth.
In this communication, we provide evidence that proliferation of transplantable Morris hepatoma 7777 might to some extent be regulated by triiodothyronine and/or a specific serum protein, the levels of which are correlated with levels of triiodothyronine. The protein has an estimated molecular weight of 80,000 and migrates as one band on polyacrylamide gel electrophoresis. In normal rats, this protein accounts for approximately 1% of the total serum protein. Both the circulating levels of the serum protein and proliferating of transplanted hepatoma cells were decreased in thyroidectomized rats. Elevated levels of the serum protein and increased cell proliferation were observed when animals had 70% of their lives removed prior to transplant, were given injections of triiodothyronine, or had a 10-day-old first transplant surgically removed. Some evidence is also provided suggesting that the synthesis of the serum protein is stimulated by thyroid hormone.
Animals↗