Biomedical subjects
Publications and source records attributed to M Heim.
Three members of a family, the father and two children, present a primary empty sella. The only clinical symptom is headache. The ophthalmologic examen, and the pituitary function are quite normal. No other anomaly is associated. This type of cases has never been published.
A group of 27 men with early coronary disease (mean age: 52 years) with cholesterol levels below 6.45 mmol/l and triglycerides levels below 2.3 mmol/l, who underwent a coronary angiography, is compared with a control group of 18 men (CG) with normal angiography. The only significant differences between the two groups are: a triglycerides levels slightly higher in the CM group (1.55 + 0.4 mmol/l) vs 1.18 +/- 0.37 mmol/l, p 0.001), a HDL-cholesterol level slightly lower in the CM group (1.08 +/- 0.19 mmol/l vs 1.26 +/- 0.21 mmol/l, p 0.01) and an Apo AI/Apo B ratio slightly lower in the CM group (1.02 +/- 0.24 vs 1.18 +/- 0.17, p 0.005). In the CM group, 21 patients in 27 present a lipid abnormality requiring, according to the European consensus recommendations, the prescription of hygieno-dietetic measures. In the CM group, 10 patients in 18 present a minimal lipid abnormality, also requiring hygieno-dietetic measures. These results are compared with the recommendations of the European consensus.
A case in which 23 recurrent episodes of anterior dislocation of the shoulder occurred in a 76-year-old woman is presented. Du Toit and Roux staple capsulorrhaphy was used to achieve a stable, functioning shoulder. Recurrent dislocation of the shoulder is a problem of youth. Peak incidence occurs at age 20, after age 70, the incidence of recurrent dislocation of the shoulder is extremely low. The surgical treatment of a 76-year-old woman, who suffered 23 documented anterior dislocations of the right shoulder, is discussed and reviewed.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Type 2 diabetic patients are known to frequently have a high insulin level and were recently described as having high plasminogen activator inhibitor (PAI) activity, compared to normal controls. As we have shown in several clinical conditions (normal subjects, obese patients, angina pectoris patients) that plasma PAI activity was linked with plasma insulin, we have studied in 38 type 2 diabetic patients the relationship between PAI activity, insulin and other parameters. Patients showed higher level of PAI activity, as well as plasma glucose, insulin, triglyceride, cholesterol and Apolipoprotein B levels than normal controls; highest values were observed with diabetic patients also affected by coronary artery disease. A significant correlation was found between PAI activity and insulin (r = 0.60, p less than 0.001), body mass index (r = 0.32, p less than 0.05) and Apolipoprotein B (r = 0.33, p less than 0.05). The two latter correlations disappeared after adjustment for insulin. These results are in agreement with our previous report showing an in vitro effect of insulin on the synthesis of PAI by a hepatocellular cell line. Hyperinsulinemia presented by type 2 diabetic patients may increase the hepatic synthesis of PAI, inducing an hypofibrinolysis, which could play a role in the development of the vascular complications. Attempts to reduce hyperinsulinemia could have a favorable effect by lowering PAI activity.
Emergency wards are under pressure most of the hours of the day and night. When patients arrive during the working hours of outpatient clinics it is possible to divert some of them. Once the clinics are closed, all patients that arrive at the casualty department are examined. Families that have elderly disabled persons at home often then bring the disabled to the emergency ward on some pretext of acute distress and then disappear, leaving the elderly person in the care of the hospital. The responsibility of providing sufficient geriatric institutions rests with departments of health, municipalities, and medical aid societies. Until such provision is made, hospitals will remain overcrowded with people who only require good auxiliary nursing care.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The comparison of an experimental group of schizophrenic patients undergoing cognitive training with a control group was tested for significance over a total of 23 psychometric features, using the test known as t-distribution or "Students distribution". Cognitive training results in varying degrees of improvement in the various parameters. Uncharacteristic schizophrenic basic disorders remitted significantly, and there was improvement in activity of intention, BP/RS sum score, and the BP/RS factors of anxiety/depression, anergy, and activation. The NOSIE factors of manifest psychosis, irritability, and depression remitted, and social interest improved. From the psychological data it can be concluded that cognitive training can help improve, in particular, cognitive adjustment and adaptability, and the organisation of complex societal conditions.
51Cr-platelet kinetic studies were performed in 77 patients with idiopathic thrombocytopenic purpura. The sequestration site was splenic for 63, splenic/hepatic for 7 or hepatic for remaining 7 patients. In 20 patients platelet survival was extremely shortened to 0-3 h, whereas only 26 patients had a survival time of more than 24 h. Those patients with low platelet counts also had a very short platelet survival time, whereas patients with higher platelet counts (greater than 50 x 10(9)/l) had longer platelet survival times. 51 patients (66%) were splenectomized following the kinetic studies. 25 patients who had a splenic sequestration site had normalized platelet counts and 6 patients had platelet counts between 80-149 x 10(9)/l 12 months after splenectomy (i.e. in 92% of cases with splenic sequestration site a full or partial remission). Of the 11 patients with a hepatic or splenic/hepatic sequestration site, 2 patients had full remission, 1 partial remission, 3 patients had minimal improvement and 5 other patients were treatment failures in respect to the splenectomy.
Ultrasound evaluation of the hip joint was performed in 17 patients as part of the sonographic investigation of lower abdominal pain with referred symptomatology to the groin and thigh. Sonographic features consistent with hip joint effusion were detected in 12 of the patients. In four patients with positive arthrosonogram the possibility of hip joint involvement was not considered by the examining physician. In 11 other cases, hip pathology was included in the differential diagnosis. Of these, hip involvement was confirmed by sonography in eight patients and excluded in three. Sonography was found to be a useful objective method for the confirmation or exclusion of hip joint effusion. The examination had a significant influence on the patient management for shifting the attention of the clinician from the abdomen to the hip joint in four of the cases in this series.
A 72-year-old widowed woman known to have an organic brain syndrome was hospitalised owing to gangrene of her lower limbs. The gangrene had been caused by an adduction contracture of her hip resulting in pressure on the medial surface of her left leg. In addition she had pressure sores over both trochanters and the sacrum. The smell of putrefication could be sensed from a distance and on examination large white worms could be seen slithering in the decomposing tissue. The patient was pyrexial, oblivious of her surroundings, and without pain. Surgery--limb amputations--would not restore the patient to a cognitive state nor improve here quality of life, but abstinence posed an inherent threat of sepsis, and revulsion to the attendants. The sacral pressure sore was so large that surgical closure was impossible. The question of surgical intervention is discussed.
The availability of concentrated coagulation factor has dramatically changed the effects of hemophilia on the musculoskeletal system. Limb angular deformities, on the whole, can be prevented by intensive medical and surgical care, but hemarthroses result in constantly changing joint circumferences and ranges of movement. Orthoses provide little protection against hemarthrosis and the unstable configurations contraindicate the use of rigid orthotic devices. Modern treatment protocols call for early and adequate factor replacement and physiotherapy. As an adjuvant to this form of therapy, anatomically constructed elastic joint supports and/or transcutaneous electric nerve stimulation (TENS) have been used.
Thyroid autoantibodies have been found in 28 to 38 per cent of Sjögren's syndrome cases. In this study, we inversely investigated, the presence of Sjögren's syndrome antibodies in autoimmune thyroid diseases, ie rheumatoid factors, antinuclear soluble antigens SSB/La and SSA/RO, anti-salivary ducts. Results show no increased incidence of these antibodies in autoimmune thyroid diseases as compared to those of control subjects. So, no significant immune abnormality association is found between these two autoimmune disorders.
Four cases are described wherein massive centrifugal trauma caused a whirl-whiplash type injury to the spinal cord resulting in paralysis. Two patients became paraplegics and two quadriplegics. In three cases, there was a loss of one or more limbs associated with other concomitant injuries. Attention is focused on the problems facing patients with a combination of plegias and amputation.
In a preliminary crossover study, fifty patients with a cyclothymic axial syndrome were given bright-light treatment, while fifty other such patients were treated by means of partial sleep deprivation, 60% of the patients responded to bright-light treatment, as opposed to 50% of the patients partially deprived of sleep. The superior results of the bright-light treatment (Hamilton Depression Scale) are confirmed on the Nurses' Observation Scale for Inpatient Evaluation and the Profile of Mood States. Comparatively young patients with a not so extremely marked depression show the best response rates. Bright-light treatment is also effective against depressive disorders in non-seasonal depressions.
A total of 306 patients with small cell lung cancer (SCLC) were randomized to receive chemotherapy in a sequential or alternating mode. Sequential chemotherapy consisted of eight cycles of cyclophosphamide, Adriamycin (doxorubicin), and vincristine (CAV) and alternating chemotherapy consisted of three cycles (1, 3, 5) of etoposide, vindesine, and ifosfamide (EVI); three cycles (2, 4, 6) of cisplatin, Adriamycin, and vincristine (PAV); and two cycles (7, 8) of cyclophosphamide, methotrexate, and CCNU (CMC). Responsive patients received prophylactic cranial irradiation after three cycles and chest irradiation after eight cycles of chemotherapy. No maintenance therapy was applied to patients achieving complete remission. Minimum follow-up was 2 years. Of the 302 patients evaluable, overall response rate was 59% in the sequential arm and 70% in the alternating arm. Patients treated with CAV had a complete response rate of 21% in contrast to 36% for those receiving alternating therapy. The median survival for all patients was 9.8 versus 11.3 months, for limited disease 11.1 versus 13.4 months, and for extensive disease 8.9 versus 9.9 months, all in favor of the alternating treatment. Two-year survival rate for all patients was 6% versus 9%, for limited disease 11% versus 14%, and for extensive disease 3% versus 6%, all preferring the alternating treatment mode. Progression-free survival demonstrated a strong correlation to the extent of response irrespective of the treatment regimen applied. Toxicity included 11 lethal and 8 life-threatening complications with a higher frequency in the alternating treatment arm. These results suggest that alternating treatment of SCLC with different drug combinations is more effective than sequential application of CAV.