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Biomedical subjects

M Wolff

Publications and source records attributed to M Wolff.

At least 397 records · Page 22Linked to original sources
PubMedDate not supplied

Functioning lipoadenoma of a supernumerary parathyroid gland in the mediastinum.

A patient underwent reexploration for a parathyroid adenoma; following identification of four normal glands in the cervical region, the mediastinum was entered, and an intrathymic lipoadenoma was excised. These very rare tumors have been associated with hypercalcemia in approximately half of the previously reported cases; however, none has previously been described as occurring entirely in the mediastinum.

Adenoma↗
PubMedDate not supplied

Analysis of pain management in critically ill patients.

We analyzed the adequacy of pain control for 17 trauma patients during the initial part of their stay in the intensive care unit, and assessed reasons for inadequate analgesia, if it occurred. Patients, and physicians, and nurses were interviewed. A verbal pain intensity scale was used to determine whether patients received adequate analgesia. Patients were asked if the pain hindered their activities, and whether they requested pain medication from their caregivers. Caregivers were questioned whether patients received adequate analgesia. Prescribed morphine regimens and the amount of narcotic administered were analyzed. Twenty-seven percent of patients rated pain intensity as moderate and 47% as severe. Ninety-five percent of housestaff and 81% of nurses reported the patients received adequate pain control. Forty-seven percent of the patients who had moderate or severe pain asked their physician for more pain medication, and 65% asked the nurse. Thirteen residents did not order a larger dose of morphine due to concern about respiratory depression or hypotension. Morphine dosages ranged from 1-8 mg intravenously every 1-2 hours as necessary. Nurses administered less than the maximum amount ordered 58% of the time. The mean dosing interval was 2.3 hours. Barriers to adequate pain management were disparity in the perception of pain between patients and caregivers; patients not requesting more analgesia despite despite the presence of moderate to severe pain; and physician and nurse concerns about patients' adverse physiologic response to increased dosages.

Adult↗
PubMedDate not supplied

Upper limb nerve entrapments in elite wheelchair racers.

The prevalence of upper limb nerve injuries has been reported to be as high as 73% in individuals who rely on manual wheelchairs for mobility. Many authors hypothesize that the repetitive trauma to carpal canal structures caused by propelling a wheelchair is the reason for this high prevalence. The purpose of this study was to determine the prevalence of nerve conduction abnormalities in a group of elite wheelchair racers whose wrists are exposed to additional propulsion-related trauma during training and competition. We performed bilateral upper limb nerve conduction studies on each athlete (n = 12). The racers pushed their chairs an average of 56 miles a week for training purposes. Fifty percent of the athletes (n = 6) had evidence of median mononeuropathy by nerve conduction. Of these 6 racers, 5 had evidence of mononeuropathy bilaterally, making a total of 11 positive hands of the 23 tested. Twenty-five percent of the athletes had evidence of ulnar mononeuropathy at the wrist, and 25% had evidence of ulnar mononeuropathy at the elbow. Seventeen percent of athletes had evidence of radial nerve injury. Years with a disability accounted for a significant amount of the variance in the mean median sensory amplitude (R2 = 0.511; P = 0.020) and the mean ulnar palmar amplitude (R2 = 0.605; P = 0.008). Variables not correlated with nerve conduction studies include age, hours per day in a wheelchair not spent training, years competing, and number of miles pushed in training. Despite the amount of time spent training these wheelchair athletes have a similar or lower prevalence of median mononeuropathy then reported in the general wheelchair-using population.

Adult↗
PubMedDate not supplied

CT demonstration of "ectopic" thymoma.

Computed tomography of a large pedunculated "ectopic" thymoma clearly demonstrated an elongated pedicle, thus establishing the mediastinal origin of the mass.

Adult↗
PubMedDate not supplied

Mycobacterium tuberculosis versus nontuberculous mycobacterial infection of the lung in AIDS patients: CT and HRCT patterns.

PURPOSE: The aim of this study was to determine discriminating CT and HRCT features between mycobacterial pulmonary tuberculosis and nontuberculous mycobacterial (NTMB) pulmonary infections in patients with AIDS. METHOD: CT and HRCT scans of 52 AIDS patients with culture-proven mycobacterial infection [29 with Mycobacterium tuberculosis (MTB) and 23 with NTMB] without concomitant pulmonary infection were reviewed by two observers. RESULTS: Nodular opacities, mainly centrilobular in distribution, were the most common finding, seen in 21 (72%) and 15 (65%) of patients with MTB and NTMB, respectively. A lower lobe predominance of centrilobular nodules was seen more commonly in NTMB (p < 0.03). Ground-glass attenuation was seen in 5 (17%) and 11 (48%) of patients with MTB and NTMB, respectively (p = 0.03). Ground-glass opacities and bronchial wall thickening affected a larger number of lobes in NTMB (p < 0.01), while centrilobular nodules involved more lobes in MTB (p < 0.01). A higher prevalence of unilateral lung involvement was seen in MTB (12 patients, 44%) than NTMB (1 patient, 5%) (p < 0.01). Enlarged lymph nodes were more frequent in patients with MTB than in those with NTMB (22, 76% vs. 10, 43%, respectively) (p < 0.02). CONCLUSION: NTMB infection and pulmonary tuberculosis display different CT and HRCT patterns in AIDS patients, but there is considerable overlap in CT findings.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Calibration and use of the Wisconsin kVp test cassette.

The Ardran-Crooks kVp test cassette is widely used in diagnostic radiology to provide a rapid, simple, noninvasive measurement of x-ray tube potential. A modified version of this cassette called the Wisconsin kVp Test Cassette was introduced commercially in the U. S. in 1972. Since then, the method of calibration of these cassettes has changed significantly. Wisconsin kVp Test Cassettes calibrated by the manufacturer prior to August 1982 may yield underestimates of kVp measurements, particularly when using the 90-110 and 110-130 kVp regions with single-phase units. In August 1982 significant improvements in the calibration methods were implemented. The resultant change in calibration is demonstrated by data from the Centers for Radiological Physics. Present calibration methods are believed to be accurate within the greater of +/- 2 kVp or 2% of actual peak tube potential. Proper use of the cassette is necessary to achieve this level of accuracy.

Biophysical Phenomena↗
PubMedDate not supplied

Multiple macroregenerative nodules in liver cirrhosis due to Budd-Chiari syndrome. Case reports and review of the literature.

Clinical, radiological, histological and immunohistochemical methods were used to define the nature of multiple rapidly growing hepatic nodules in 2 young patients with Budd-Chiari syndrome due to myeloproliferative diseases. In one patient, the arterial hyperperfusion of large nodules was demonstrated by dynamic computed tomography and angiography. The explanted livers of these patients showed multiple well-demarcated nodules up to 3 cm in diameter on the background of liver cirrhosis resulting from chronic hepatic congestion. Histologically, these nodules covered a spectrum ranging from adenoma-like lesions to nodules resembling focal nodular hyperplasia. They consisted of essentially normal hepatocytes, and variably contained fibrous septa including neoductules and large, mostly dysmorphic arteries. Sometimes, they were located close to still patent or recanalized veins. These rapidly growing hepatic nodules are best defined as macroregenerative nodules. The knowledge of this entity may help the physician to avoid misinterpretation of such nodules as carcinomas.

Adolescent↗
PubMedDate not supplied

A senior elective: promoting health in underserved communities.

OBJECTIVES: A fourth-year service-learning elective was developed to teach medical students about the social, economic, and culturalfactors that affect health and health-seeking behavior DESCRIPTION: The elective provides students with didactic material and educational experiences in public housing sites in the community. Students work closely with community members to implement a community health care intervention. EVALUATION: Students respond to 10 reflection questions that assess their understanding of the important community factors that affect health. CONCLUSIONS: Reflection responses demonstrate that the course has challenged assumptions, dispelled stereotypes, and enhanced awareness of the role of socialfactors in maintaining health.

Adult↗
PubMedDate not supplied

[Adult cerebral malaria. Actual experience of the Infectious Diseases Intensive Care Department at the Claude Bernard Hospital].

22 cases of adult cerebral malaria were observed between July 1987 and June 1989, either associated or not: parasitemia 5%, consciousness disorders, acute renal failure, thrombocytopenia. Two patients died (9%). Increased frequency of attacks is underlined. They are due to chloroquino-resistant parasite strains, even polychemoresistant, occurred in French speaking Tropical Africa since 1985. Therapeutic strategy is described. The necessity to use increased doses of quinine has been admitted, correlatively underlining importance of strict monitoring of the patients because, in first instance, the risk of hypoglycemia (eased by injecting too quickly high doses of quinine) and of acute pulmonary oedema (eased by too quick perfusions and/or transfusions).

Adult↗
PubMedDate not supplied

Immunohistochemical demonstration of immunoglobulins and albumin in human brain tumors.

Routinely processed biopsy material, including 56 gliomas of varying malignancy, 10 meningiomas, 10 brain metastases and 12 brain abscesses, was examined for the presence and distribution of IgG, IgA, IgM, IgD and albumin using the unlabeled antibody peroxidase-antiperoxidase technique. In all specimens the deposition of stained immunoglobulins (Ig) was strictly associated with that of albumin even on cell surfaces. Thus there was no evidence for specific membrane binding or cytotoxicity. The interstitial proteins demonstrated are most likely derived from the plasma by blood-brain barrier breakdown which occurs in nearly all tumors and abscesses. Obvious intracellular staining for Ig and albumin was seen in glioma cells and astrocytes only. This is suggested to be due to active protein uptake as a specific feature of astrocyte differentiation which decreases with malignancy and is lost in glioblastomas. Evidence for local Ig production was found in 8 out of 10 metastases with striking IgG- and IgA-positive plasma cells within lymphocytic infiltrations and in one meningioma showing conspicuous plasma cells components. No glioma contained Ig-bearing plasma cells, though round cell infiltrations were present in 64% of the unselected cases. The significance of these findings regarding the immunological situation in brain tumors is briefly discussed.

Astrocytoma↗