Biomedical subjects
Publications and source records attributed to M Heim.
A 14-year-old boy with severe hemophilia had a swollen immobile left shoulder joint. A roentgenogram showed a severely deformed humeral head that had interlocked onto the glenoid ring. After manipulation, the motion promptly returned. Incongruency of the shoulder in adolescence poses a serious therapeutic problem.
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A hemophiliac child with flexion contracture of the knee and symptoms of leg length difference was treated with a shoe lift on the affected side, which failed to aid the problem. Further investigation revealed that the affected limb was actually longer than the contralateral side. The chronic synovitis of the knee that had resulted in the contracture also caused supplementary bone growth around the distal femoral epiphysis, resulting in the lengthening of that leg.
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After a review of the literature dealing with pedophilia, the results of an analysis of 100 forensic psychiatric reports dealing with pedophile criminals are described. They show that, except for a few homosexual pedophiles, pedophilia is a pseudoperversion originating from different developmental conditions and, in individual cases, verifiable personality traits. The authors discuss problems involved in the forensic-psychiatric assessment of these delinquents. Attention is drawn to the necessity of purposeful, coordinated further education in this respect to enable the existing considerable discrepancies between forensic-psychiatric evaluation of these and other sexual deviants to be overcome.
The authors deal with the question as to whether the target symptom "disturbed time perception" is to be considered a basic schizophrenic symptom and whether therapeutical (neuroleptic) control possibilities exist. 135 schizophreniacs have given statistical evidence (intensity quotient, Wilcoxon comparison, Hotelling-Pabst test, exact probability test according to Fisher/Yates) that the disturbed time perception of schizophreniacs is accessible by a differentiated neuroleptic therapy but is not a basic schizophrenic disturbance.
Between October 1980 and March 1983 we explored 269 patients who had one or several thyroid nodules with low or normal technetium 99 uptake. Each palpable nodule was aspirated 1 to 3 times, using a fine 21 G2 needle, and the aspirates were immediately spread on glass-plates and kept in alcohol-ether. After staining by the Harris- Shor method, all plates were examined by the same cytologist. Biopsies were unassessable in 50 patients (18%), mainly because they were entirely made up of red cells. Sixty patients did not undergo surgery. In the 159 patients operated upon, cytology was compared with histology which showed 139 benign and 20 malignant nodules. In 5 histologically benign nodules, cytology had shown nuclear abnormalities or enlarged cells suggestive of malignancy (false-positive results: 3.5%). Among 5 nodules diagnosed as benign at cytology, there were 2 papillary microcarcinomas , 2 to 4 mm in diameter, the course of which is little known, 1 well differentiated vesicular cancer extremely difficult to distinguish from vesicular adenoma, and 2 papillary cancers. Fine needle biopsy cytology is a harmless procedure, but it requires considerable experience on the part of cytologists. We consider that it should be performed in all cases of thyroid nodule, either to help in deciding whether or not to operate, or to guide the surgeon in deceding whether or not to operate, or to guide the surgeon in his operative strategy.
Locally disseminated breast carcinoma after a simple or radical mastectomy and radiotherapy causes serious surgical problems. Excision of the chest wall obliterates the negative intrapleural pressure, and wound healing within a previously irradiated area is notoriously poor. A new method is described in which the diaphragm is mobilized and reinserted into the defect to allow final resurfacing with a skin graft or locally rotated skin flap. This simple surgical method is advocated when the prognosis is poor and breast reconstruction is not being considered.
Transfusion of frozen blood has become a routine method. As the cost is high, the method is restricted to autologus transfusion and storage of rare blood groups. Transfusion of frozen platelets will become a routine method in near future. Especially large pools of HLA-identical platelets should be of great advantage in many cases.
Eleven adults have been transplanted for various reasons between July 1979 and July 1982: 2 with aplastic anemia (AA), 1 with paroxysmal nocturnal hemoglobinuria (PNH), 8 with acute leukemia (AL). Four patients suffered from acute lymphocytic leukemia (ALL) and four from acute non-lymphocytic leukemia (ANLL). Two of them were transplanted in relapse, 1 in a partial remission, and 5 in complete remission. All patients were in their late stage of disease. The PNH-patient had an identical twin, 8 patients had an HLA- and MLC compatible sib, 1 an unrelated donor, and 1 was transplanted from his father. Four patients are alive, 2 more than 3 years: 1 with AA and 1 with ALL who was transplanted in relapse. Six patients died of infectious complications (4 of interstitial pneumonia, 1 of a candida sepsis, 1 of acute toxoplasmosis). Patients living more than 3 weeks had a take. Acute graft-versus-host (GvH) disease did not present a major problem. All patients received methotrexate for GvH-prophylaxis, in three instances the marrow was additionally pre-incubated with anti-T-cell globulin.
Patients who were scheduled for surgical release of their trigger fingers underwent an injection of the involved tendon sheath prior to surgery. In thirty-six patients the injection of methylene blue was undertaken in a proximal-distal direction and in forty-three the direction of the injection was reversed. The success rate of the injections was 61 per cent. in the proximal distal group and 37 per cent in the second group. There was no significant statistical difference with regard to age, but duration of the disorder and mode of injection regarding the different fingers did have statistical significance.
Among hundreds of spinal cord injured patients (SCIP) who have been rehabilitated in the Sir Ludwig Guttmann Spinal Cord Injury Unit at the Sheba Medical Centre, Tel Hashomer; we only found six patients who had lost one or more limbs (upper or lower limbs). Although many plastic and orthopaedic surgeons regard paralytic limbs as useless appendages, we cannot agree with this erroneous viewpoint and we find that the clinical and psychological effects of the absence of limb(s) are tremendous. The six case reports are given together with a brief review of the relevant literature.
Patients with a high level tetraplegia from a spinal injury have only been able to survive the critical initial period since the development of modern resuscitation techniques including artificial respiration. However, their lives are still threatened by many complications, such as decubitis ulcers, infections and respiratory failure. We describe four young tetraplegic patients who developed an unusual sepsis pattern several years after the injury. The sepsis was accompanied by hypothermia, leukopenia and mental deterioration. This peculiar 'silent' sepsis may also occur in elderly people who are not paralysed. The question arises, therefore, if the chronic spinal cord injured patient may become 'prematurely aged'.
Small solitary or multiple cystic lesions were found in the hemispheres of 3.6% of all patients suffering from cerebrovascular disorders, seizures, system degeneration or skull or brain injuries who were examined by PEG. Such lesions were especially frequent in patients in their forties to sixties. The absence of corresponding changes in the results of electroencephalographic, scintillation scanning and angiographic examination makes PEG an indispensable tool for prognosis in such cases.
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Pain around the hip joint and femoral neuropathy in a patient with a bleeding coagulopathy should alert the physician to the possibility of an iliopsoas haematoma. Unfortunately this diagnosis is often missed. Clinically, reduced hip motion, a mass in the iliac fossa and alteration in the motor and sensory function of the femoral nerve may be noted. If the pain is on the right side, appendicitis must be excluded. Ultrasound is the diagnostic aid of choice, being more sensitive than computerized tomography or radioisotope investigations. Treatment should be gradual, gentle and protracted to avoid recurrent bleeding episodes.
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