[The tabor stapes replacement prosthesis].
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Adolescent↗
Biomedical subjects
M Levy
Publications and source records attributed to M Levy.
Bronchoscopy and bronchography in children. Experience with 110 investigations.
The results of 92 bronchoscopic examinations and 18 bronchograms in infants and children performed during a two-year period were reviewed. Of 62 patients with suspected foreign-body aspiration, the diagnosis was confirmed in 36 (58%); of 18 patients mainly suspected of having congenital anomalies, a positive diagnosis was made in 12 (66%); but of nine patients with lobar atelectasis only two had abnormal findings. In three patients a transbronchial biopsy specimen did not provide diagnostic material. Bronchography for suspected localized bronchiectasis was performed in 11 patients and a positive diagnosis was made in seven. In all seven patients suspected of having congenital anomalies, bronchography provided a definitive diagnosis. There was no mortality and morbidity was minimal but three patients died of their primary disease. Nearly 60% of the investigations yielded abnormal results, but many of the normal findings were of equal clinical value.
Bronchiectasis↗
Primary adenocarcinoma of the appendix with bilateral Krukenberg ovarian tumors.
An unusual case of a 22-year-old white female with known chronic ulcerative colitis presented with a several-day history of lower abdominal pain and a pelvic mass. Laparotomy revealed a primary carcinoma of the appendix with Krukenberg metastasis to both ovaries. Pathologically this tumor appeared to arise from an appendix which showed no evidence of chronic ulcerative colitis and therefore could not be associated with the above-mentioned entity.
Adenocarcinoma↗
A technique for fabrication of polydimethylsiloxane-acrylic resin obturators.
A flexible silicone obturator is an alternative to the acrylic resin obturator. It can be useful for patients with severe trismus who cannot insert a large prosthesis, as the flexibility of the hollow silicone section allows easy placement and removal (Fig. 9). Other patients cannot tolerate an unyielding substance against sensitive nasal tissues. Silicone can provide the necessary comfort without compromising retention. Silicone obturator sections can often be modified when further surgery is needed and result in a savings of time and expense (Fig. 10). For patients who can be reevaluated only twice a year, several silicone obturator sections can be made initially. One can be used while another is being cleaned or duplicated.
Acrylic Resins↗
Stapes-replacing prosthesis (S.R.P.).
Any chronic inflammatory condition of the middle ear may bring about bone destruction. Today, in the antibiotic era, this destruction concerns mostly the ossicular chain. Any one of the ossicles or all of them together may be partially damaged or completely destroyed (Sadé et al, 1981). Hearing is usually impaired if the stapes or the incus or both of them are damaged. To overcome the resulting hearing deficit, various surgical techniques, using various materials, have been introduced, with various degrees of success. The most problematic situation encountered surgically is the one in which the stapes is missing, and it is with this situation that the present study deals. The surgical solution so far advocated has been in the form of a surgical bridge or columella between the mobile footplate and the drum. The columella (Fig. 1) is made out of bone or some non-organic biocompatible material. Often, however, this solution is not very successful, for two reasons: A. Instability of the columella (prosthesis) is often unavoidable because of its slim attachment to the footplate; B. Biologically, an incompatibility between the drum and the prosthesis is all too often present, when the latter is made of plastic materials. These columellas have been found, sooner of later, to extrude. It is the purpose of this communication to report a new technique and a new concept, which tries to overcome the above shortcomings, using a different type of stapes-replacing prosthesis.
Hearing Loss↗
Caffeine metabolism and coffee-attributed sleep disturbances.
In six healthy subjects with a history of caffeine-induced wakefulness caffeine kinetics were compared to with those in six subjects not affected by caffeine. The data indicated that the former have a longer plasma t 1/2 (mean 7.4 and 4.2 hr) and slower plasma clearance (mean 1.2 and 1.7 ml . min-1 . kg-1) of caffeine. Plasma caffeine concentration at midnight, 8 hr after afternoon coffee, is higher in those with caffeine-attributed insomnia. Those reporting "coffee wakefulness" also tend to drink less coffee. We conclude that the rate of caffeine metabolism is a determinant of individual variation in the effect of drinking coffee on sleep.
Adult↗
Risk factors for breast cancer.
Since 1976, data were collected to evaluate risk factors for breast cancer in a hospital-based case-control study of 1185 women with breast cancer and 3227 controls. The risk of breast cancer increased with increasing age at first birth; this effect was not accounted for by parity. An early age at first birth appeared to reduce the risk relative to no pregnancy, whereas a late age at first birth was associated with a higher risk than not having a full-term pregnancy. High parity was associated with a reduction in the risk that was independent of that of age at first birth: for parity greater than or equal to 5, compared with parity 1-2, the relative risk estimate was 0.7 (95% confidence interval, 0.5-1.0). Late age at menarche was associated with a lower risk among premenopausal women but not among postmenopausal women. The relative risk decreased with increasing obesity among premenopausal women. Among postmenopausal women, the risk was higher among those who were obese, but there was no evidence of a trend with increasing body mass index. Risk did not vary materially according to history of abortion when gravidity was controlled. Risk was lower among postmenopausal women than among premenopausal women of the same age and increased with increasing age at menopause; bilateral oophorectomy reduced the risk more than hysterectomy alone. A positive history of benign breast disease, a positive family history of breast cancer, Jewish religion, and 12 or more years of education were each independently associated with an increased risk of breast cancer.
Adult↗
The effect of long-term colchicine therapy in patients with recurrent polyserositis on the capacity of blood platelets to synthesize thromboxane A2.
Thromboxane B2 (TXB) production during platelet activation was measured in 13 patients with recurrent polyserositis on long-term colchicine therapy and 10 healthy controls. Plasma colchicine concentration in patients ranged between 0.8-7.8 ng/ml (2.0-19.5 X 10(-9) M). Thromboxane production induced during aggregation by arachidonic acid or collagen and serum TXB2 levels (clotted blood, 37 degrees C, 1 h) did not differ among patients and controls. Previous studies reporting platelet function defects including anomalous TXB2 production, were performed in vitro using colchicine concentrations markedly exceeding the therapeutic range.
Adolescent↗
Duration of action of sodium cromoglycate on exercise induced asthma: comparison of 2 formulations.
Thirteen asthmatic children aged 9-14 years participated in a double blind randomised trial to compare the effectiveness and duration of action of 2 formulations of sodium cromoglycate; one a 20 mg capsule of powdered sodium cromoglycate delivered by turbo inhaler (spinhaler), and the other 1 mg of aerosolised sodium cromoglycate delivered by pressurised cannister inhaler (aerosol). The children performed exercise tests on each of 3 days in a 10 day period--15 minutes, 2 hours, and 6 hours after inhalation of powder, aerosol, or a placebo. Two patients were not protected from exercise induced asthma by either formulation of sodium cromoglycate. Among the remaining patients both formulations gave good protection from exercise induced asthma 15 minutes after inhalation, and the effect of both wore off steadily over the next 6 hours. The spinhaler gave appreciably better protection than the aerosol at 15 minutes after inhalation, and was the only formulation to provide good protection at 2 hours and 6 hours. The more limited effectiveness of the aerosol may be explained by the lower dose of sodium cromoglycate and the more complicated inhalation technique required.
Adolescent↗
Failure of delta-aminolaevulinic acid and porphobilinogen to alter renal salt and water excretion in the dog.
We tested the hypothesis that the hyponatremia commonly observed in patients with acute hepatic porphyria is mediated by the presence of aminolaevulinic acid (ALA) and (or) porphobilinogen (PBG) at the level of the renal tubule to alter water handling, or at the level of the nervous system to release antidiuretic hormone (ADH). When these substances were infused intravenously into hydropenic dogs, there was no effect on systemic hemodynamics or renal function. Neither ALA or PBG, when infused directly into the renal circulation of water-loaded dogs, could effect a decrease in urinary flow, osmolar clearance, or renal perfusion. Similar results were obtained when these substances were infused directly into the renal circulation of hydropenic dogs. When ALA was administered directly into the carotid artery of nine water-loaded dogs and eight hydropenic dogs, there was again no effect on systemic hemodynamics or renal function. These data suggest that ALA (and PBG) have no effect on the renal excretion of sodium or water, and ALA does not cause the release of ADH. The hyponatremia of porphyria may be related to factors other than the elevated plasma levels of ALA and PBG.
Aminolevulinic Acid↗
Renal blood flow in normal dogs and in dogs with experimental liver cirrhosis following the acute continuous infusion of endotoxin.
The purpose of this study was to determine if the renal circulation of normal and cirrhotic dogs behave similarly in response to an acute endotoxin infusion. Endotoxin was administered as a slow continuous infusion (13-26 micrograms/min) to a total of 20 normal dogs through the femoral vein, portal vein, or into the left renal artery. In each case, there was an initial increment in renal blood flow, of the order of 46%, while arterial blood pressure was actually declining. After 8-20 min, blood flow fell as perfusion pressure declined further. The initial increment in renal perfusion was not due to a hyperthermic response following the endotoxin. When similar doses were given to five dogs with chronic biliary cirrhosis and ascites, the biphasic response in renal perfusion was not observed, rather blood flow declined as perfusion pressure declined. When normal dogs were infused with bilirubin, bile salts, noradrenaline, and angiotensin in pressor doses, the subsequent infusion of endotoxin still produced the usual biphasic response in renal perfusion. Chronic elevation of portal pressure (but not acute elevation), volume contraction by diuresis or hemorrhage, and the infusion of bile intravenously, all abolished the biphasic response in renal perfusion and reproduced in normal dogs the response to endotoxin observed in cirrhotic dogs. Investigation of the factors causing the initial decrease in intrarenal vascular resistance in normal dogs following the endotoxin infusion implicated a role for histamine, kinins, and prostaglandins. We conclude there is a fundamental difference in the response of the renal circulation of normal and cirrhotic dogs to an endotoxin infusion, which may depend on failure of this latter group to release one or more humoral agents. This difference may be due to elevated portal pressure, a decreased effective arterial blood volume, or the products of bile having access to the circulation in cirrhotic dogs.
Animals↗
Renal response to four hours of biliary obstruction in the dog.
Clearance studies were performed in anesthetized dogs before and 4 h after the acute obstruction of the common bile duct (ABDL). ABDL was not associated with any change in systemic hemodynamics or plasma volume. Glomerular filtration rate (GFR) rose by 15.3%, PAH clearance by 13.3%, and renal blood flow by 13% (all values significant at P less than 0.05). Fractional excretion rates of water and sodium rose from 0.29 to 1.1 and from 0.21 to 0.76%, respectively (P less than 0.05). These changes in renal function were associated with a failure of bile excretion rather than distension of the biliary tree or failure of bile to enter the duodenum. They did not depend on intact hepatic nerves, alteration of hepatic perfusion, or the release of gastrointestinal vasoactive peptides. The increment in renal perfusion was maintained for 2-3 days before returning to baseline levels. Several lines of evidence suggested that factors influencing the renal tubule and the renal microcirculation might be separate in nature: e.g., urinary sodium excretion (UNaV) could increase without a change in GFR; if ABDL was relieved, delta UNaV and delta GFR returned to base line with different time courses; and controlling perfusion to the left kidney during ABDL reduced but did not abolish the increase in UNaV. Both effects could be transferred to recipient dogs by cross-perfusion. We have demonstrated, therefore, that 4 h of ABDL may significantly influence renal function through the appearance of humoral factors in the circulation.
Acute Disease↗
Renal perfusion in dogs with experimental hepatic cirrhosis: role of prostaglandins.
Increased renal production of prostaglandins are thought to be important for the maintenance of kidney blood flow in advanced cirrhosis. In alert, unanesthetized dogs with chronic cirrhosis and ascites, produced by bile duct ligation, we measured inulin and p-aminohippurate (PAH) clearance before and after the intravenous administration of 2 mg/kg indomethacin, an inhibitor of prostaglandin production. Inulin and PAH clearance declined by 42 and 43%, respectively. This decline in renal perfusion was not associated with changes in blood pressure or cardiac output. If portal hypertension was prevented by creating an end-side portacaval anastomosis at the time of bile duct ligation, indomethacin was without effect on renal perfusion whether or not the dog had ascites. If ascites was completely mobilized in cirrhotic dogs with portal venous hypertension with the aid of a LeVeen valve, indomethacin depressed inulin and PAH clearance as usual during the steady-state period once all ascites had been removed. An attempt was made to determine some of the factors mediating the apparent increase in renal prostaglandin synthesis by administering various pharmacological antagonists. The inhibition of angiotensin effect with saralasin and the inhibition of kallikrein with aprotinin prevented the usual indomethacin effect. It is concluded that portal hypertension, but not a "sick liver per se, in cirrhosis activates the renin-angiotensin system to both produce renal vasoconstriction and stimulate prostaglandin synthesis, thereby normalizing renal perfusion. Renal kallikrein also appears to play a role, probably by augmenting renin release.
Animals↗
The cardiovascular action of oxygen breathing: effect on adrenergic stimulation.
20 anesthetized mechanically ventilated dogs received an infusion of epinephrine, 2 micrograms/kg/min, for 4 h. 10 dogs were ventilated with air for the entire 4-hour period and 10 were ventilated with oxygen for the first hour and then air for 3 h. During the first hour of the epinephrine infusion in the group ventilated with oxygen, as compared to the group ventilated with air, the heart rate decreased (it increased in the dogs ventilated with air); the cardiac output increased less; the systemic vascular resistance decreased less; the pulmonary vascular resistance decreased more; and the pulmonary artery wedge pressure increased (it decreased in the dogs ventilated with air). During the next 3 h when the animals were ventilated with air, the effects of oxygen on the hemodynamic changes induced by epinephrine persisted for variable periods. The epinephrine-induced pulmonary arteriovenous shunt was significantly less at all times in the group ventilated with oxygen, not only during the oxygen breathing but following it for 3 h. Oxygen breathing has been known to exert powerful effects on the heart, and the pulmonary and systemic circulations in normal man and animals and in patients with pulmonary hypertension and acute respiratory failure. This study demonstrates that oxygen breathing significantly alters the cardiovascular effects of epinephrine during oxygen breathing and reduces the epinephrine-induced pulmonary shunt during and for several hours after oxygen is discontinued. These finding add further evidence that hyperoxia affects, by unknown mechanisms, the autonomic regulation of the cardiovascular system.
Animals↗
Dogs with experimental cirrhosis of the liver but without intrahepatic hypertension do not retain sodium or form ascites.
Dogs with portal cirrhosis but without portal hypertension (end-to-side portacaval anastomosis) retain sodium and expand plasma volume before ascites formation. In our study, dogs were subjected to bile duct ligation and simultaneous side-to-side portacaval anastomosis (PCA) in order to create a canine model of hepatic cirrhosis without intrahepatic or portal hypertension. The effect of normalizing intrahepatic pressures in the face of venous outflow block on sodium handling was studied. 13 dogs survived the surgical procedures and were followed. Two dogs developed sodium retention and ascites at 5-6 wk (livers were cirrhotic) when the PCA spontaneously closed. 11 dogs were free of sodium retention and ascites for as long as 12 wks after surgery, while ingesting 35 meq/d of sodium. In this group glomerular filtration rate remained normal throughout the period of observation and there was no expansion of plasma volume. Nine of these dogs were then fed 85 meq/d of sodium; eight remained in sodium balance and one retained sodium and went on to develop ascites. When 10-15 mg i.m. of desoxycorticosterone acetate (DOCA) was given daily, five dogs developed sodium retention and ascites, while four escaped from DOCA. Dogs who developed ascites had either a partially occluded PCA (4/5) or a patent PCA, but with a significant portacaval pressure gradient of 9.5 cm H2O (1/5). In all four dogs who escaped from DOCA, the PCA was widely patent and the mean pressure gradient was only 1.6 cm H2O. Both groups were equally cirrhotic, as judged by histological and biochemical parameters. We conclude that normalizing intrahepatic pressure by providing an outflow tract for the cirrhotic liver will abolish that component of early renal tubular sodium retention not due to portal venous hypertension or ascites sequestration.
Animals↗
Important gaps in patients' knowledge prior to chemotherapy.
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Aged↗
Adverse drug reactions.
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Agranulocytosis↗
[Influence of new aphakia glasses on the visual field and field of the gaze].
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Aphakia, Postcataract↗