Biomedical subjects
Publications and source records attributed to M Blum.
Hepatomegaly was observed in most of the patients undergoing long-term hemodialysis treatment. This was confirmed and quantitated by isotope liver scanning. Liver size was normal in uremic nondialyzed patients. Common causes for liver enlargement were excluded in all reported cases, and there was no evidence for liver disease as judged by functional tests and liver histology.
M-mode echocardiography was performed in 20 asymptomatic patients undergoing chronic hemodialysis, in order to assess pericardial involvement. Six of the patients had small to moderate amounts of pericardial effusion. One of these patients and 5 others showed an echocardiographic pattern of pericardial thickening. No correlation was found between pericardial involvement and age, sex, secondary hyperthyroidism, serum levels of urea, creatinine or uric acid. The traditional diagnostic techniques commonly used for the detection of pericardial disease such as physical examination, chest X-ray and electrocardiography were not helpful in our patients. Our study demonstrates the high incidence of pericardial involvement in asymptomatic chronically dialyzed patients. Periodic echocardiographic evaluation is recommended for assessment of the presence and significance of these findings.
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A study was made of the cervical and upper vaginal flora in menopausal women, in an attempt to determine whether such women are predisposed to infections when undergoing gynecologic operations. The series comprised 72 women (age range, 44-80 years) classified as follows: a) 35 with a natural menopause, b) 18 with a surgical menopause induced by abdominal panhysterectomy, and c) 19 postmenopausal women after vaginal hysterectomy performed for genital prolapse. The vaginal flora of these menopausal women consisted predominantly of Gram-positive bacteria which, together with the Gram-negative bacteria, conformed to the normal pattern of microorganisms in the vagina. Such bacteria also are found in women of child-bearing age, but occasionally they can be pathogenic. Despite the inherent biohormonal changes of the memopause, expressed especially by the low estrogen level, 26.4 percent of the cultures in our study were sterile, even after major vaginal operations. Thus, the pattern of the vaginal flora, even though occasionally pathogen, should not be a contraindication to gynecologic surgical procedures in postmenopausal women. Even when vaginal cultures show the presence of these bacteria, it does not seem necessary to use prophylactic antibiotic and hormonal therapy routinely. Rather, it should be given selectively, depending upon the local state of the tissues and upon the postoperative course.
During a five-year period, from 1970 through 1974, 26.776 deliveries occurred in our department, of which 55 (0.6%) were in elderly primiparae (EP). This group was compared with two control groups. The first comprised 97 women aged 30--34 years, and the second one, 250 women between 20 and 29 years of age. The parameters investigated were: The gynecologic past history, the course of the present pregnancy, labor, delivery and fetal outcome. In most of the cases, no significant differences were found between the EP group and the control groups. A striking difference was observed in the rate of cesarean sections, which was 49.1% in the EP group, as against only 2.3% in the age group 20--29 years. It may be concluded that by more liberal use of cesarean sections, available means of antenatal care, and prompt intervention in cases of postmaturity and prolonged labor, one can reduce the maternal and fetal morbidity and mortality, and that the EP, although a group at risk, has nowadays a better outlook for both mother and fetus.
The discovery of multiple polypi in a small child does not necessarily indicate that this is a case of familial adenomatosis. Two cases of juvenile polyposis were confirmed by histological examinations, and their clinical and, more particularly, their radiological characteristics were studied. The only way to explore the full extent of the lesions in a satisfactory manner is by double-contrast examination of the whole colon. The authors stress the value of radiological examinations, though the frequency with which they should be carried out is open to discussion. Review of the published literature reveals that the association of true familial polyposis or adenocarcinomatosis exists in the same family or even in the same patient. Diagnostic difficulties are usually due to the fortuitons co-existence of a lymphoid hyperplasia, the significance of which is still not known.
Phosphate concentration was found to be significantly elevated in the saliva of uremic patients (dialyzed and non-dialyzed) when compared to normal subjects and to dialysis patients after parathyroidectomy. Salivary calcium concentrations were similar in all groups examined. As increased salivary phosphate was found also in primary hyperparathyroidism, we attribute our findings to the secondary hyperparathyroidism of the uremic state.
Discitis was diagnosed in 5 children under 3 years of age, the initial clinical manifestations being difficulty in walking and abdominal pains in one case. Diagnosis was not made before periods varying from 8 days to 3 months, and no etiological basis for the disease was discovered. Pinching of the disc was always present in the first radiographic image, and the vertebral plate was ill-defined in 3 cases. Repeat radiological examinations were carried out in 3 children after 6 months, 2 and 5 years respectively. There was partial restauration of the disc space in 2 cases; the last one presented signs of late collapse after early recuperation. Early perilesional bone sclerosis was noted in 2 cases, while it was posterior and late in one child. There were no sequelae (fusion, vertebra plana, scoliosis). Two investigations are essential if a disc lesion is suspected: -- radiography of the spinal column, even if there are no disturbances in walking or abdominal pains. -- scintigraphy with technitium 99, which is the only means of establishing an early diagnosis.
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The activity of erythrocyte uroporphyrinogen I synthetase has been measured in various cases of non-porphyric affections. The results indicate a diminution of this activity in some of the studied cases of chronic renal insufficiency and chronic polyarthritis. This modulation in activity mitigates against its use as a diagnostic criterion of acute intermittent porphyria. On the other hand, an increase in urosynthetase activity has been noted in acute and especially chronic hepatic affections. This increase seems to be connected with the severity of the hepatic affection. The relationship is illustrated particularly in the case of viral hepatitis associated to an AIP, where the increasing activity of the urosynthetase masks for many weeks the congenital deficiency peculiar to this AIP. Our study thus indicates that the diagnosis of AIP based on the activity of the urosynthetase must take into account the pathological context in which the investigation is realised.
Typical subungual splinter hemorrhages were found on routine medical examination in four of 20 patients receiving regular hemodialysis, with no apparent clinical cause.
Improved preoperative thyroid diagnosis and reduction of needless thyroid surgery are achieved by employing gray scale echography in patients whose solitary thyroid nodule is cold on scintillation scanning. It is highly useful in distinguishing solid tissue from a cyst, identifying degenerative changes, guiding needle biopsy, and monitoring changes in a nodule during suppressive therapy.
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