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Biomedical subjects

L Solomon

Publications and source records attributed to L Solomon.

At least 91 records · Page 5Linked to original sources
PubMed1990

[Clinical and therapeutic concepts in ischemic femur head necrosis].

Bone ischaemia can result from four mechanisms: (1) interruption of arterial inflow (e.g. after femoral neck fracture), (2) occlusion of venous outflow (possibly due to capsular distension), (3) intravascular arteriolar occlusion (as in sickle cell disease); (4) extravascular sinusoidal tamponade (e.g. in Gaucher's disease). Osteonecrosis following high-dosage corticosteroid administration or alcohol abuse could, theoretically, be due to either intravascular fat embolism or sinusoidal tamponade resulting from the marked fat deposition in the marrow. It is proposed here that, except in traumatic osteonecrosis, vascular insufficiency is part of a cycle of events resembling the familiar soft tissue compartment syndrome of the forearm or leg; no matter whether it started with venous stasis, arteriolar occlusion or capillary tamponade, the result is a diffuse and self-enhancing ischaemia involving all three haemodynamic abnormalities in a vicious circle. The very earliest stage of "idiopathic" osteonecrosis is characterised chiefly by marrow changes; for some (undetermined) period the ischaemic effects are potentially reversible-provided the vicious circle is broken by relieving the high intraosseous pressure. Effective management involves: (a) early diagnosis by MR imaging, measurement of intraosseous pressure and venography: (b) decompression of the bone, and (c) elimination of the etiological factor. Later stages of osteonecrosis cannot be treated by decompression and will need realignment osteotomy, prosthetic replacement or arthrodesis.

Adolescent↗
PubMed1990

Kaposi's sarcoma in transfusion-associated acquired immunodeficiency syndrome. A case report and review of the literature.

Kaposi's sarcoma in transfusion-associated acquired immunodeficiency syndrome is rare; to our knowledge, only four previous cases have been reported. We report a unique case of transfusion-associated acquired immunodeficiency syndrome in a 74-year-old woman. At autopsy, both lungs were extensively affected by Kaposi's sarcoma, Pneumocystis carinii, and cytomegalovirus infection. These three processes led to respiratory failure and accounted for her death.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Aluminum induced anemia: pathogenesis and treatment in patients on chronic hemodialysis.

The baseline hematologic status of 27 patients with modest degrees of aluminum overload was examined. In addition, hematologic data were evaluated in 19 of these patients during and after treatment with DFO. Although neither severe anemia nor microcytosis was observed pretreatment, there was a significant correlation between hemoglobin level and degree of aluminum burden as determined by bone surface aluminum staining (r = -0.58; P less than 0.007). Following treatment with DFO, hemoglobin concentration increased dramatically by 1.3 to 4.4 g/dl in eight patients but did not change in the remaining eleven. Responders and nonresponders were similar with regard to the degree of aluminum overload both before and after chelation therapy but differed with regard to baseline levels of erythropoietin (higher in responders) and degree of iron overload (greater in nonresponders). Pretherapy levels of red cell ALA dehydratase were depressed in all patients (32 +/- 4 vs. 56 +/- 5 U/g Hb in normals) but did not correlate with the degree of aluminum overload and did not change with chelation therapy. Pretherapy levels of red cell protoporphyrin were elevated in 15 of 24 patients (62%) and were higher in responders than in nonresponders. Following DFO therapy, levels fell by 25 to 50% in 7 of 8 patients with elevated pretherapy values, despite the tendency in several patients to develop iron deficiency with treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Aluminum↗
PubMed1989

The patient-analyst match and the outcome of psychoanalysis: a pilot study.

This paper presents a pilot study in which we explore the possibility that the match between analyst and analysand is a factor of central importance in the analytic situation. It is an attempt to look at the issue of match across a large number of patients. The data we used were not collected for studying this topic; thus, the study has serious limitations. Nevertheless, certain patterns emerged which support our thesis that patient-analyst match plays a significant role in the outcome of psychoanalysis. We present this work as a first step in developing concepts and methods which will be pursued in a more systematic and rigorous fashion in a later study.

Adaptation, Psychological↗
PubMed1987

Osteopenia of the pelvis associated with Mseleni joint disease. Radiological aspects.

Mseleni joint disease, an endemic form of osteoarthritis (OA), is associated with osteopenia (OP). In a detailed investigation of the disorder, the degree of OP was assessed in 593 radiographs of the pelvis which were taken during surveys of four populations: rural blacks from Mseleni, rural blacks from Manguzi (a similar population to Mseleni), a black control group of rural Tswanas and a white control group from Johannesburg. Only females were included because the number of males in the rural populations was too small. The radiographic trabecular pattern was assessed at four sites: sacrum, ilium, pubis and ischium. Four grades were used: O = normal bone, 1 = minimal OP, 2 = definite OP, 3 = severe OP. The sum of the grades at the four sites made up the OP score for the individual. The OP scores increased with age in all groups, the age-specific mean OP scores did not differ in the non-OA subgroups of all four populations, and subgroups with OA had significantly higher age-specific mean OP scores than those without OA.

Adolescent↗
PubMed1987

Pubertal development in black and white Johannesburg girls.

A study of the sexual maturation of 362 black and 355 white girls was conducted in Johannesburg in 1976 and 1977. It was found that the first sign of breast development occurs at the same mean age of 11.5 years for both groups, but that white girls develop pubic hair and experience menarche some 9 months earlier than black girls. The menarche in black girls occurs at a younger age than that recorded in the 1960s. The average black girl reaches full maturity later and has a longer maturational period than her white contemporary. In addition the time-span between maturational events in black girls differs from that in white girls.

Adolescent↗
PubMed1987

Disseminated adenovirus infection in an immunocompromised host. Pitfalls in diagnosis.

In this report, a bone marrow transplant recipient with rapidly fatal gastroenteritis is presented. The presence of intranuclear inclusions on postmortem light microscopic examination of liver, lung, and small bowel tissue was considered diagnostic of cytomegalovirus infection. However, electron microscopic examination of liver tissue demonstrated adenovirus infection. This was confirmed by isolation of an adenovirus type 2 with unusual laboratory features from liver, lung, colon contents, serum, esophageal swab, and oral ulcerations. Results of a complement fixation test for antibodies to adenovirus performed on postmortem serum samples were negative, and a titer of 1:4 was noted for antibody against cytomegalovirus. This case illustrates the diagnostic pitfalls that may be encountered in establishing a specific viral diagnosis in severely ill patients.

Adenoviridae Infections↗
PubMed1987

Androgen therapy in hemodialysis patients: I. Effects on red cell oxygen transport.

Measures related to red cell oxygen transport were evaluated in 17 hemodialysis patients receiving androgen therapy, 15 untreated hemodialysis patients and 15 normal subjects. Hemoglobin levels were higher in androgen-treated patients than in the untreated population and were directly related to the reticulocyte index. Hill coefficients were normal, and in vivo P5O values were increased to the same degree in both dialysis groups. However, DPG and serum phosphate explained 70% and 12%, respectively, of the variance in P5O in untreated patients but only 2% and 5% in androgen-treated subjects. In contrast, sample pH explained 34% of the variance in P5O in the androgen-treated group and less than 1% in the untreated dialysis population. Despite the relative importance of pH as a determinant of P5O in patients on androgen therapy, the Bohr coefficient in this group was only about half of that in untreated dialysis subjects. Androgen-treated patients also had lower red cell ATP levels. Finally, the expected correlation of MCHC with pH was noted in untreated dialysis subjects but not in patients receiving androgens. We conclude that androgen therapy in hemodialysis patients in addition to increasing red cell production, directly alters red cell metabolism. Moreover, although the androgen regimens used did not change the net oxygen transport characteristics of hemoglobin, they decreased the responsiveness of hemoglobin-oxygen affinity to changes in pH, DPG and phosphate. Thus, red cell adaptation to changes in oxygen supply and/or demand may be limited in androgen treated patients, and the improvement in clinical performance expected from androgen-stimulated erythropoiesis may not be realized.

Androgens↗
PubMed1987

Orthopaedic undergraduate assessment.

The multiple choice, viva voce and consultant marks from 327 students in the Orthopaedic Undergraduate Course at the University of Bristol were compared. The assessments were based on 84 questions in the multiple choice questionnaire, 30 questions in the viva voce and four questions in the consultant assessment. The consultant assessment correlated least well with the other two marks. It is suggested that in short courses consultant grades be supplemented by objective examinations.

Education, Medical, Undergraduate↗
PubMed1987

Changes in the level and quality of object relations in psychoanalysis: followup of a longitudinal, prospective study.

As part of a prospective, longitudinal study of suitability for and outcome of psychoanalysis, 22 patients were evaluated for changes in the level and quality of their object relations. These patients had been accepted for supervised analysis with candidates in training by senior analysts who had diagnosed them as neurotic. The majority of these patients reported difficulties in relationships as at least one of their reasons for originally seeking psychoanalytic treatment. Prior to beginning analysis, each patient was given a battery of psychological tests. One year after the termination of analysis, the test battery was readministered and a followup interview was conducted separately with each patient and analyst. Ratings of change based on patient and analyst interviews and comparisons of psychological tests before and after treatment all showed statistically significant improvement in the level and quality of object relations for this patient group. The results of this study support what is often observed in clinical practice, that psychoanalysis has a positive effect on the level and quality of a patient's object relations.

Adult↗
PubMed1987

The role of reality testing in psychoanalysis: followup of 22 cases.

As part of a prospective, longitudinal study of psychoanalytic outcome, 22 patients were evaluated for changes in their level of reality testing. These patients had been accepted for supervised psychoanalysis with candidates in training by senior analysts who had diagnosed them as neurotic. Psychological tests given prior to the beginning of analysis indicated, however, that more than one third of our sample demonstrated serious distortions in their perceptions of reality. When psychological tests administered one year after the completion of analysis were compared with these pretreatment tests, no significant improvement was found in the level of reality testing for the group as a whole. However, when excluding two patients who had suffered major traumas in the year following psychoanalysis, significant improvement in reality testing was found for the remaining 20 patients. Post-treatment interviews with the treating analysts revealed that in the course of analysis itself, approximately one third of these patients showed some disturbance in reality testing; only three of these patients showed significant improvement in the level of their reality testing during treatment. These findings suggest that while patients may not present clinically with evidence of impaired reality testing, such evidence may be available in psychological testing, and may become apparent in the course of the treatment.

Ego↗
PubMed1986

A longitudinal study of height and weight in black and white Johannesburg children.

A 2-year longitudinal survey of height and weight was conducted on 2,058 Johannesburg children aged 3.5 - 18.5 years. The principal findings were that both height and weight increased more rapidly in white than in black children, and that attained height and weight were significantly greater in whites. The ponderal index (a measure of weight-for-height) was greatest in black females and lowest in black males. Comparison with a survey carried out 12 years previously suggests that there has been an increase in the mean weight of the black population over this period.

Adolescent↗