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Biomedical subjects

R Klein

Publications and source records attributed to R Klein.

At least 847 records · Page 47Linked to original sources
PubMed1979

Control, participation, and the British National Health Service.

The experience of Britain's National Health Service since 1948 suggests that there is a conflict between different social values and policy aims, and that progress toward achieving more community or worker control is constrained by the pursuit of other desired objectives. The egalitarian ideology of the NHS emphasizes central control to achieve a nationally equitable distribution of resources. Emphasis on coordination between the NHS and other social services limits freedom of action. Democracy as accountable policy-making on a national scale may therefore be incompatible with democracy as direct control, whether by community or workers. To encourage participation means accepting diversity in the provision of health care and the multiplication of small, self-governing units. Similarly, worker control is professional autonomy writ large and may therefore conflict with community control.

Community Health Services↗
PubMed1979

Sex-linked retinitis pigmentosa: ultrastructure of photoreceptors and pigment epithelium.

An ultrastructural study of a postmortem donor eye from a 24-year-old male patient with sex-linked retinitis pigmentosa showed abnormalities in all remaining cones and rods. Central foveal cones were reduced in number by about 50% and had shortened and severely distorted outer segments. Cones from the parafovea through the midperiphery gradually decreased in density and had no organized outer segments. In the far periphery, cones and rods had only slightly shortened outer segments. Photoreceptors equidistant from the fovea in all quadrants showed similar changes. The virtual absence of organized cone outer segments from the parafovea through the midperiphery was conspicuous in that this patient had full visual fields with large test lights 3 weeks prior to death. The pigment epithelium contained abnormally large numbers of melanolysosomes and few free melanin granules from the fovea through the midperiphery and few melanolysosomes and many free melanin granules in the far periphery. Whether or not these observations in the pigment epithelial cells represent a primary defect in this disease or reflect changes secondary to a defect in the photoreceptor cells remains to be defined.

Adolescent↗
PubMed1978

[T-lymphocytes in the peripheral blood. Study on 113 patients with malignant melanoma].

In the present study, we determined the absolute and the percental numbers of T-lymphocytes in 113 patients with malignant melanomas, of whom 50 had metastases and 63 did not. The findings were compared to those in a control group of 22 persons. The patients with melanomas were divided up into clinical stages: stage I (primary tumour), II (metastases in the local lymph nodes), and stage III (systemic metastases). There was a statistically significant reduction of T-lymphocytes in all patients with melanomas, but there were no significant differences between the three stages. Therapy with DTIC did not lead to any major reduction in T-lymphocytes, possibly because of subsequent treatment with BCG. We found no clear correlation between the reduction of T-lymphocytes and an unfavourable prognosis.

Adolescent↗
PubMed1978

Abnormal chloroidal circulation: association with arteriovenous fistula in the cavernous sinus area.

Abnormalities in the choroidal circulation developed in two patients with arteriovenous fistulae in the area of the cavernous sinus. Fluorescein angiography in both patients revealed delayed filling of their choroidal circulation. In the first patient, this was associated with a central serous detachment of the retina secondary to a retinal pigment epithelial defect. In the second patient, a large choroidal detachment and serous retinal detachment, which resolved spontaneously developed. High venous pressure, low mean arterial pressure, and subsequent tissue hypoxia are postulated to be the cause of the altered choroidal circulation. The possibility of occult dural arteriovenous fistulae should be considered in the differential diagnosis in patients with a choroidal detachment, proptosis, and a red eye.

Aged↗
PubMed1978

Subretinal neovascularization associated with fundus flavimaculatus.

Hemorrhagic disciform degeneration centered in the fovea with serous detachment of the overlying neuroepithelium developed in two patients with fundus flavimaculatus. Fluorescein angiography disclosed the presence of subretinal neovascular membranes. There was no evidence of other diseases associated with subretinal neovascularization. Fundus flavimaculatus must be added to the growing list of diseases associated with subretinal neovascularization.

Adolescent↗
PubMed1978

Fibrinogen turnover in progressive systemic sclerosis.

Large amounts of fibrin are seen in the intima of the renal arterioles in progressive systemic sclerosis (scleroderma). The half-life or half disappearance time of plasma fibrinogen in 15 patients with scleroderma was studied using 125I fibrinogen to find whether there is an increased turnover of plasma fibrinogen paralleling this morphologic abnormality. Patients had a more rapid fibrinogen turnover than normal controls (60.7 versus 90.6 hours); the subgroup of patients with "progressive" scleroderma had a more rapid fibrinogen half-life than those with "stable" scleroderma (56.5 versus 73.2 hours). The mean fibrinogen half-life of 8 patients given intravenous heparin increased to within one standard deviation of normal, a finding that suggested that the fibrinogen molecule in these patients was capable of normal survival. There was a considerable variation of normal survival. There was a considerable variation of fibrinogen half-lives in individual scleroderma patients over time (not seen in the normal controls) which may be the result of intermittently increased fibrinogen consumption.

Adult↗
PubMed1978

Unplanned extracapsular cataract extraction in postvitrectomy eyes.

A 70-year-old man, a 59-year-old woman, and a 57-year-old woman underwent pars plana vitrectomy. In all three cases, cataracts developed in the eyes that had been operated on. During cataract extraction, which included massage of the globe after retrobulbar anesthesia and a conventional ab externo incision, loss of lens material into the vitreous cavity occurred in all three postvitrectomy eyes.

Aged↗
PubMed1978

Criteria for selective positive end-expiratory pressure and independent synchronized ventilation of each lung.

Respiratory failure of different origins often requires therapy with mechanical ventilation and positive end-expiratory pressure (PEEP). These supports are occasionally inadequate if the damage to one lung is significantly more pronounced than that to the other lung. Technical means exist to ventilate each lung independently or to provide a different PEEP to each lung. The findings from nine patients in whom one of these techniques was applied are presented, and advantages and disadvantages are discussed.

Adult↗
PubMed1978

Treatment of chronic childhood asthma with beclomethasone dipropionate aerosols: II. Effect on pituitary-adrenal function after substitution for oral corticosteroids.

The effects of beclomethasone, dipropionate aerosol (DBA) (400 microgram/day) on clinical course, pulmonary function, and pituitary-adrenal function was studied in 34 steroid-dependent asthmatic children. Asthma severity was assessed by daily symptom and medication scores, peak flow measured three times a day, and weekly spirometry. Pituitary-adrenal function was evaluated by diurnal cortisol levels, cortisol responses to intravenous (IV) corticotropin (ACTH), and steroid responses to IV metyrapone. After 12 weeks of BDA therapy, 30 of 34 patients no longer required prednisone. Mean weekly symptom and medication scores and the number of attacks decreased significantly (P less than .01)). A significant improvement was demonstrated in the patients' peak flow (P less than .01), forced expiratory volume in one second, and maximum midexpiratory flow rates (P less than .01). Thirty of the 34 patients initially had abnormal metyrapone responses, 28 had abnormal diurnal cortisol levels, whereas only 14 had abnormal IV ACTH response tests. Although significant improvement was noted in the mean metyrapone and diurnal cortisol tests, only partial recovery of pituitary-adrenal function was observed in 20 patients, complete recovery in 5, and no change in 9. BDA was found to be therapeutically superior to oral steroids in the group of steroid-dependent asthmatic children and produced no serious adverse effects.

Administration, Oral↗
PubMed1978

Septic choroiditis with serous detachment of the retina in dogs.

The present study describes a model of multifocal septic choroiditis with serous retinal detachment after intracarotid injection of Staphylococcus aureus or Streptococcus faecalis. The fundus lesions occurred mainly in the tapetal area and, on ophthalmoscopic examination, were more extensive after S. aureus than after S. faecalis injection. On histopathologic examination there were microabscesses in the inner choroid and subretinal space, disrupting the outer retina but sparing the inner retina.

Animals↗