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Biomedical subjects

K R Gabriel

Publications and source records attributed to K R Gabriel.

29 records · Page 2Linked to original sources
PubMed1990

Quantitation of venous clot lysis with the D-dimer immunoassay during fibrinolytic therapy requires correction for soluble fibrin degradation.

Plasma cross-linked fibrin-degradation products were analyzed using a D-dimer (DD) immunoassay in patients with deep vein thrombosis (DVT) or acute myocardial infarction (MI) treated with fibrinolytic therapy, and the results were correlated with clot lysis documented angiographically. In 13 patients with DVT, the mean DD concentration increased 10-fold (1,074 +/- 252 to 10,333 +/- 1,004 ng/ml) during therapy, but neither the peak level nor the DD concentration integrated over the course of therapy correlated with clot lysis. Since plasma DD can derive from degradation of soluble plasma fibrin as well as from thrombi, the contribution of the former was estimated by in vitro incubation of the pretreatment plasma with plasminogen activator. Subtraction of this value from the measured posttreatment DD concentration provided a "corrected" level that represented DD originating from lysis of thrombi. This modification resulted in improved correlation of DD levels with clot lysis. The mean corrected peak DD was higher in patients with successful thrombolysis (8,780 +/- 1,352 ng/ml) compared with patients without lysis (3,075 +/- 589 ng/ml, p less than 0.001). There was a moderate correlation between the volume of clot lysed and the corrected peak DD (r = 0.62) and a higher correlation with the corrected DD integrated over the course of treatment (r = 0.97). By contrast, the corrected DD concentrations were near zero in patients treated for MI with or without thrombolytic reperfusion, suggesting that fibrin in small coronary thrombi did not contribute significantly to total plasma DD during therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Prevention of venous thrombosis after total hip arthroplasty. Antithrombin III and low-dose heparin compared with dextran 40.

The anticoagulant action of heparin is mediated through antithrombin III, and the postoperative decrease in the plasma concentration of antithrombin III may contribute to the relative ineffectiveness of prophylaxis with low-dose heparin in preventing venous thrombosis after total hip arthroplasty. We conducted a prospective, randomized trial to compare the effectiveness of a regimen of antithrombin III, given intravenously once daily, and low-dose heparin with a regimen of dextran 40, given intravenously, in preventing venographically documented venous thrombosis after total hip arthroplasty. The results demonstrated an incidence of venous thrombosis of 4.9 per cent in patients who received antithrombin III and heparin; this was significantly lower than the incidence (28.6 per cent) in patients who received dextran 40 (p less than 0.005). Venous thrombosis occurred only in patients who had total hip arthroplasty with a cemented prosthesis (fourteen of fifty-seven patients, or 24.6 per cent); none of the twenty-six patients in whom a non-cemented prosthesis was used had venous thrombosis (p less than 0.01). Of the patients in whom a cemented prosthesis had been inserted, the incidence of venous thrombosis was lower in those who were treated with antithrombin III and heparin (7.4 per cent) than in those who were treated with dextran 40 (40 per cent) (p less than 0.005). Postoperative levels of antithrombin III were maintained at more than 90 per cent of the baseline level in patients who received it; this was significantly higher than in patients who received dextran 40.(ABSTRACT TRUNCATED AT 250 WORDS)

Antithrombin III↗
PubMed1987

Foot and ankle problems.

The most common reason for children presenting to the general or the pediatric orthopedist has to do with foot problems. The usual age group ranges from the neonate to preschool. The authors have made an attempt to present guidelines for our approach to foot problems other than clubfoot in these age groups and have rendered our recommendations for treatment. We feel that pediatric and general orthopedists will be able to utilize our methods in the management of the pediatric patient with the more commonly presenting foot disorders.

Ankle↗
PubMed1986

Cultural values and biomedical knowledge: choices in infant feeding. Analysis of a survey.

This paper presents a study of 313 parturient women and considers their choices to bottle or breast feed. It examines demographic and cultural factors statistically and focuses on the effect of knowledge or ignorance of benefits of either method of infant feeding. Most women are found to have some biomedical knowledge of the benefits of breast feeding. The choice of bottle or breast feeding is closely associated with several demographic factors and a number of cultural ideas. Women who bottle feed see some of their dietary and other health related practices as barriers to breast feeding. It recommends that health practitioners who decide that individual women and/or their infants may benefit from breast feeding, should engage in a dialogue with the women. Such a dialogue should focus, not so much on information, but on the woman's views about her dietary and other health practices. If the woman is given compelling health reasons she may see herself as capable of changing some practices long enough to breast feed.

Adolescent↗
PubMed1979

Do psychiatric patients fit their diagnoses? Patterns of symptomatology as described with the biplot.

Systems of psychiatric diagnosis have been regularly criticized for their low reliability and their inability to fit accurately the kinds of patients coming for treatment. To explore the reasons for these problems, this study utilizes a new method, the biplot, for defining groups of similar patients and the relationships of these groups to key symptom clusters. Using this technique to analyze data from a representative sample of first admissions for psychiatric disorder, results showed: a) symptom clusters representing the classical diagnostic categories, mania, schizophrenia, neurotic depression, and psychotic depression, were readily identified; b) however, only a few patients were clustered near these traditional syndromes. These findings suggest that although syndromes do exist that fit traditional diagnostic categories, the vast majority of patients fall between these syndromes, having characteristics from several of them. For most patients, forcing the diagnostician to choose among the categories requires an arbitrary decision that may contribute to dissatisfaction in the diagnostician who recognizes how misleading the diagnosis can be.

Adjustment Disorders↗
PubMed1977

HLA B27 and ankylosing spondylitis in the Israeli population.

The distribution of 24 HLA antigens of the A and B loci was investigated in 38 Israeli ankylosing spondylitis (AS) patients of various ethnic origins. This was compared with the distribution in rheumatoid arthritis (RA) and osteoarthritis (OA), as well as in 456 controls representing the Jewish population and 260 controls representing the Arab population. Included in the study were Ashkenazi Jews and non-Ashkenazi Jews, as well as Moslem and Christian Arabs. The frequency of HLA B27 among AS patients (79 per cent) was significantly greater (P less than 10(-10)) than among the controls (three per cent). Ashkenazi Jews showed a higher relative risk than non-Ashkenazi Jews and Arabs. Six of the AS patients were offspring of consanguineous marriages, but this was not higher than expected and therefore no indication for rare recessive genes contributing to the disease could be demonstrated. This study confirms the association between AS and B27, and extends our knowledge to the heterogeneous population of Israel not previously investigated. A significant but weak association of B27 with RA was noted. No correlation of other HLA antigens with RA or OA was observed.

Adult↗
PubMedDate not supplied

Identification of acute posttraumatic spinal cord cyst by magnetic resonance imaging: a case report and review of the literature.

Posttraumatic spinal cord cysts have traditionally been diagnosed late. The condition is usually considered after the neurological sequelae of spinal cord trauma have not resolved. The diagnosis has usually required invasive radiographic techniques, or even surgical exploration. Magnetic resonance imaging is a new, non-invasive diagnostic technique that appears to be more accurate than previous procedures. Moreover, it has the ability to delineate spinal cord parenchymal lesions much earlier than other methods. We present a case report and literature review of posttraumatic spinal cord cyst.

Axis, Cervical Vertebra↗
PubMedDate not supplied

Second operation for slipped capital femoral epiphysis: pin removal.

Pin removal procedures were retrospectively reviewed for 43 hips in 31 patients. Original treatment had included use of Knowles, Steinmann, Hagie, and cannulated steel pins. Time to pin extraction ranged from 5 to 70 months. Average operative time was slightly more than 1 h and average blood loss was 127 ml. Bone overgrowth and difficult extraction was encountered with all pin types. Pin breakage during extraction was recorded with Steinmann and Knowles pins. Delay in return to full activity postoperatively was a common complaint. This study shows that pin removal is not without certain costs and risks.

Adolescent↗
PubMedDate not supplied

Percutaneous epiphyseodesis.

The records of 29 patients who underwent epiphyseodesis of 56 physes in which a percutaneous (minimal incision) technique was used were reviewed. Length of surgery averaged 36 min per physis. Growth arrest was achieved in every instance. There were no cases of unplanned angular growth, no deep infections, and no difficulties in regaining full joint motion were reported. Epiphyseodesis of the proximal tibial physis was performed on 16 patients without epiphyseodesis of the proximal fibula, yet symptoms attributable to fibular overgrowth were not reported. Some technical variations that have evolved in our procedure are described.

Adolescent↗
PubMedDate not supplied

Minimally invasive anterior spinal exposure and release in children with scoliosis.

BACKGROUND: The early experience with thoracoscopy in children has involved the diagnosis and treatment of pleural and pulmonary diseases. Recent advances have allowed surgeons to perform more complex procedures through video-assisted thoracoscopic surgery (VATS), potentially decreasing the pain and pulmonary impairment associated with an open thoracotomy. The authors report their initial experience with thoracoscopic assisted anterior spinal exposure and release as part of the treatment for children with spinal deformities. METHODS: A retrospective chart review of five children who underwent VATS for anterior spinal surgery between June 1995 and January 1997 was performed. RESULTS: The ages of the patients ranged from 11 to 16 years with a mean of 13.4 years. All patients had an anterior spinal release with or without fusion and same-day posterior spinal fusion with instrumentation. VATS was successfully completed in all patients without major morbidity and no mortality. The average operative time for the anterior portion of the procedure was 305 minutes, and a mean of 7 disc levels were released. Mean length of chest tube drainage and hospitalization were 6.8 and 8.6 days, respectively. CONCLUSIONS: The objectives of anterior exposure for spinal surgery in children can safely and effectively be accomplished using minimally invasive surgery.

Adolescent↗