Search PubMed⌕ Search

Biomedical subjects

M Heim

Publications and source records attributed to M Heim.

At least 55 records · Page 3Linked to original sources
PubMed2000

Elbow joint, crutches and locomotion: special reference to persons with haemophilia.

A 52-year-old, trans-femoral amputee with haemophilia was hospitalized because of ambulatory problems arising from the osteo-arthropathic involvement of other major articulations. Reduced function in the upper limbs, caused by the effects of recurrent haemarthroses, resulted in additional problems concerning the usage of auxiliary ambulatory aids. The advantages and disadvantages of traditional and experimental crutches highlight the functional problems of ambulation in persons with concomitant upper limb pathologies.

Amputees↗
PubMed2000

Drug-induced and traumatic nail problems in the haemophilias.

Many persons with haemophilia suffer from HIV and receive highly active antiretroviral therapy. Three patients received indinavir and required surgery due to ingrown toenails. Two patients suffered from a traumatic subungual haematoma. The treatment protocol is described whereby the pressure exerted onto the germinal layer and the nail bed is relieved in order to alleviate pain and nail matrix damage.

Adult↗
PubMed2000

[Not Available].

Oncologists have been reluctant a long time to accept the existence of spontaneous remissions in cancer disease. The considerable number of patients whose cancer-disease has regressed without (adequate) treatment should have allayed these doubts. Such remissions could serve as a kind of natural experiments that may lead to greater insights in the biology of tumours and to more efficient therapeutic strategies. In the moment the discussion deals with the explanation of spontaneous remissions by the existing biological or psychosomatic theories. Whereas the fact of spontaneous remissions was denied on the one hand some people claim the occurrence of such remissions for themselves without justification. In order to obtain an epidemiological register of these cases it would be necessary to document all patients in question in a standardised manner. Such a set of data should include psychosocial variable as well since the psychosomatic approach seems to be even more in danger of speculations that resemble closely the causal attributions of the patients.

Causal attributions↗
PubMed1999

Gold-tagged RNA-A probe for macromolecular assemblies.

Ribonucleic acids (RNAs) play a key role in many fundamental life processes. These polymers are often found complexed with proteins in extremely large particles whose molecular mass may reach several millions of daltons (e.g., ribosomes, spliceosomes, and viruses). Structural studies of such RNA-protein complexes should help elucidate their mode of action. For the structural analyses of many macromolecular assemblies, electron microscopy (EM) has served an instrumental role. However, localization by EM of RNA within biological complexes is not yet a straightforward undertaking. Here we describe a methodology for the covalent tagging of RNA molecules with gold clusters, thereby enabling their direct visualization by microscopical methods. Our strategy involves transcription in vitro of RNAs that carry free thiol groups, using ribonucleoside triphosphate analogs containing a substituent with a terminal thiol group on their heterocyclic ring. This synthesis is followed by coupling of gold clusters to the thiolated transcript through a maleimido group. Visualization of such gold-tagged RNAs by transmission electron microscopy showed spots of gold clusters, with a diameter of 1-2 nm, arranged at nearly regular distances on an imaginary curve that presumably corresponds to the RNA chain. This assignment was corroborated by atomic force microscopy that exhibited images of RNA chains in which knob-like structures, whose height corresponds to the diameter of the gold clusters, were clearly seen. This study demonstrates the potential use of nucleic acids that are covalently labeled with gold clusters for the structural characterization of protein-RNA complexes.

Globins↗
PubMed1999

Expanding portal haematomata as a complication of knee arthroscopies in persons with haemophilia.

Recurrent haemarthroses stimulate the hypertrophy of synovial tissues that if left in situ will eventually cause joint destruction. Synovectomies have been the cornerstone of joint preservation and a number of different methods exist. We report two patients who suffered complications after an arthroscopic procedure. No previous complications of this nature have been reported in the literature.

Adult↗
PubMed1999

The role of orthoses in the management of elbow joints in persons with haemophilia.

The elbow joint is extremely prone to haemarthroses, and when these occur the elbow requires support and rest. Supporting the limb with a simple collar-and-cuff sling, a triangular bandage either with or without a shoulder immobilization device will provide an analgesic effect without adding an unnecessary heavy orthosis. As the swelling subsides and the pain lessens a dynamic orthosis aids in the support and compression. When considering functional branching of the elbow joints there are a number of basic principles to be followed. One requires to consider problems of orthosis suspension, two dimensional motion and stabilization in the functional range of motion. This article provides the rationale for the special needs of persons with haemophilia who suffer from involvement of their elbow joints.

Contracture↗
PubMed1999

Characteristics of septic arthritis in human immunodeficiency virus-infected haemophiliacs versus other risk groups.

The cases are presented of four haemophiliacs infected with human immunodeficiency virus (HIV) and with septic arthritis among the 340 patients followed at our centre. The data of these cases and 39 additional HIV-infected haemophiliacs with septic arthritis, identified in a literature search, are reviewed. The spectrum of bacterial pathogens is limited and somewhat different from that in other risk groups. The localization is exclusively to joints affected by haemophilic arthropathy. The laboratory picture is characterized by the absence of peripheral leucocytosis, varying CD4-helper cell counts, a high erythrocyte sedimentation rate and fever. The clinical picture mimics that of haemarthrosis, often causing a delay in diagnosis. Treatment with systemic antibiotics is often sufficient, obviating the need for arthrotomy and open drainage. Prognosis related to the joint function is relatively good, but poor when related to the medium- to long-term survival of the patient.

Adult↗
PubMed1998

Free plasma catecholamines in spinal cord injured persons with different injury levels at rest and during exercise.

Spinal cord lesion leads to an interruption of pathways from brain to the peripheral sympathetic nervous system, which results in pathological changes in sympathetic innervation. Free epinephrine (E), norepinephrine (NE) and dopamine (DA) were measured in 30 tetraplegics (TETRA), 15 high-lesion paraplegics (T1 and T4, HPARA), 15 paraplegics with injuries between T5 and T10 (MPARA), 15 low-lesion paraplegics (below T10, LPARA) and 16 non-handicapped control persons (C) at rest, at 60 and 100% of maximal oxygen consumption during graded wheelchair ergometry (WCE). The TETRA showed significant lower E and NE levels at rest and only slight increases during physical exercise. The E and NE concentrations of the paraplegics with a lesion below T5 were significantly higher than those of the high-lesion paraplegics, as well as those of the control persons at every point in the study. All paraplegics and the control persons showed, at submaximal and maximal exercise, a significant increase in NE. Only a slight increase in E in HAPRA was shown. No differences were found at rest and during exercise in E and NE levels in the MPARA and LPARA. No significant differences were found in the dopamine concentration at rest or during exercise for any of the groups. In summary, different levels of lesion and the resulting interruption to sympathetic pathways in the spinal cord are decisive factors in the degree of impairment of sympathetic innervation in SCI persons. Tetraplegics show less preganglionic resting activity because of interruption of impulses from central centers and no considerable stimulation of the sympathetic nervous system during maximal exercise. Individuals with high paraplegia have a partial impairment of catecholamine release, especially of epinephrine, at rest and during exercise. Paraplegics with a lesion level below T5 showed an augmented basal and exercise-induced upper spinal thoracic sympathetic activity in comparison to control persons.

Adult↗
PubMed1998

The management of a person with haemophilia who has a fixed flexed hip and intractable pain.

The clinical picture of a fixed flexed hip associated with pain in a person with haemophilia is suggestive of a haemorrhage in that area. Sonography facilitates differentiation between a haemarthrosis, intraperitoneal haemorrhage, subperiosteal bleed, a bleed into the soft tissue around the hip joint or a psoas haematoma. All these aforementioned causes may result in the same clinical presentation. Two cases are described in which coxhaemarthrosis resulted in a flexion contracture of the joint associated with severe intractable pain. Narcotic drugs failed to alleviate the severe pain. Joint aspiration produced dramatic pain relief and early joint rehabilitation.

Adult↗
PubMed1998

Functional kinesiology in haemophilia, an area yet to be explored.

UNLABELLED: In haemophilic arthropathy there is a progressive limitation of the range of motion (ROM) which may lead to disabilities in the activities of daily living (ADL). In the literature the pathology of haemophilic arthropathy is described extensively, but only one paper describing functional limitations caused by limited range of motion (LOM) in haemophilia was found. The aim of the pilot study was to estimate on theoretical grounds, how many patients with haemophilia might suffer from functional disabilities. MATERIAL: ROM of elbows, knees and ankles of 155 Haemophilia A and B patients. METHODS: Flexion and extension were measured with an ordinary goniometer. The ROM of joints of patients with haemophilia was compared with normal values. RESULTS: 39 of 155 patients had a normal ROM in both elbows; 22 in one elbow; 34 patients had disabilities in ADL with both arms; 14 with one arm; 18 were able to compensate; 89 had no problems; 79 of 155 patients had a near normal ROM of both knees; 38 patients could not ride an ordinary bicycle. CONCLUSION: Only limited data are available concerning the normal ROM needed for individual ADL. Until additional data are available, it is not possible to predict which patients will be disabled in their activities of daily living and individual counselling should be done during the yearly outpatient comprehensive care clinics. Conservative and surgical measures should be taken to ensure elbow flexion of at least 120 degrees and knee flexion of 100 degrees for Western societies. In Asian countries patients with haemophilia need maximum knee flexion and ankle dorsi flexion.

Adult↗
PubMed1998

Criteria for prosthetic provision: "he who pays the piper calls the tune".

Previously instituted policies regarding prosthetic limb provision had been deemed dependable. A follow-up home visit study showed that 18 of 60 patients that had been provided with prostheses, did not make use of them. Analysis showed that three categories of patients made up the large majority of the non-users; double amputees, blind persons and those with psychiatric disorders. In order to attempt to eliminate the wastage of prosthetic provision to non-ambulators a new policy decision was made. Doubtful ambulators and those from the three aforementioned categories will be initially provided with temporary prostheses. Only after a period of months of temporary prosthetic usage at home will a decision be made as to whether a permanent prosthesis will be issued.

Adult↗
PubMed1998

The will to walk--a partnership involving dual dynamics.

A case report is used as an example of how the will of a patient convinced an entire rehabilitation team to alter its assessment of the patient's ambulatory potential. The question of dual dynamics is discussed in the light of the realities of the honest desire and motivation to walk and regain independence.

Aged↗
PubMed1998

The changing needs of patients after primary rehabilitation: an overlooked entity.

PURPOSE: The need for rehabilitation should not be viewed as a single event that may occur during a lifetime. This theme is explored. METHOD: A case of a man who lost the distal portions of all four limbs, is reported. RESULTS: He was rehabilitated and spent many years as an active member of the community. The physical changes, owing to advancing age, were overlooked. CONCLUSIONS: Attention is drawn to the fact that long term re-evaluation of function is periodically required.

Amputees↗
PubMed1998

Why should a deformed, anaesthetic, functionless hand be wanted?

A 58-year-old woman presented at a disability assessment tribunal with a severely deformed left forearm. She had broken the arm 25 years previously and the infected open fracture had not healed. There were no sensory or motor functions in the hand, which the patient kept constantly hidden in her garments. The question of an amputation was raised and the advantages of modern prosthetics with respect to cosmesis and function failed to convince the patient that she might benefit from such surgery. One questions why a patient should want to retain this cumbersome, obviously embarrassing, burden and whether the question of surgery should have been raised.

Amputation, Surgical↗
PubMed1997

Hydration scanning tunneling microscopy of DNA and a bacterial surface protein.

Hydration scanning tunneling microscopy is based on the electrical conductivity of molecularly thin water layers which adsorb to the sample surfaces in a humid atmosphere. It allows reliable imaging of biological specimens and even insulators, provided they are hydrophilic. Here, we present results obtained with linearized plasmid DNA on mica and a bacterial surface protein layer (the HPI layer). A width of 3 nm was measured for the DNA molecules and a quasi-periodic structure along the molecules with a repeat distance of about 5 nm was observed. We show that-depending on the tunneling voltage-there are two different imaging modes for the DNA samples: at higher voltages, real tunneling or field emission is responsible for the charge transfer between tip and sample. In contrast, at lower voltages we found indications of a water meniscus between tip and surface. The HPI layer, however, seems to be imaged at most voltages without a water meniscus.

Aluminum Silicates↗