Biomedical subjects
Publications and source records attributed to S Dally.
There is no evidence to support the suggestion that a widespread programme of vision screening at age 3 1/2 should be instituted. Some of the practical problems and defects of such a programme are outlined. If the issues raised are to be resolved by further research, identification of preschoolchildren who have visual problems will be facilitated by a screening procedure involving refraction and possibly a cover test.
Spectacle correction of unusually hypermetropic refractions from age 1 year did not reduce the incidence of squint or amblyopia, nor did it lead to a reduction in the severity of residual amblyopia after subsequent occlusion.
The authors report the evolution over an 11 months period of a case of subacute intoxication with arsenic in a 30 years old woman. In addition to the classical peripheral neuropathy, we observed impairment of the superior neurological functions which improved together with the neuropathy. These malfunctions are rarely described in the literature although arsenic seems to cross the blood-brain barrier easily. There is no other explanation, and we believe arsenic to be responsible for these disturbances. We suggest systematic testing of the superior neurological functions in cases of arsenic intoxication.
Vitamin B1, Folic acid Vitamin B12, whole blood Lead level, and plasma Zinc level were determined in 82 patients admitted to an alcoholism rehabilitation program. Each patient was examined for an optic neuritis. Thirty-two of the patients had sub-clinical abnormalities suggestive of optic neuritis like dyschromatopsias and/or field visual defects. No differences were found in the blood levels of Vitamin B1, Folic acid, and Vitamin B12 between the 32% affected and the 68% unaffected subjects. Moreover vitamins blood levels were found to be within the limits of normal values in both groups. A negative correlation between whole blood Lead levels and plasma Zinc levels was found. When an optic neuritis occurs the lead level tends to be higher and the Zinc lower. Abnormalities of the more usual alcoholism tests: gamma glutamyl Transpeptidase (gamma GT), mean red cell volume (V.G.M.) and glutamic Oxaloacetic transferase (T.G.O.), were more pronounced in alcoholics with optic neuritis.
A monoclonal antidigitalin antibody was obtained following the immunization of BALB/mice with digitalin coupled to BSA, and the fusion of lymphocytes from these mice with murin myeloma 8653. The supernatants were screened by a radioimmunoassay in which the supernatant was incubated with digitalin coupled to I125. This monoclonal antibody "Dig 278" has an antigen binding ratio of 95%; is an IgGl; has a titre of 1/1000 and its affinity constant, as determined by a Scatchard plot, was 1,20(9) L/M. By experimenting with the monoclonal antibodies on 15 rabbits, we have obtained the reversal of heart rhythm disorders and the survival of animals injected with a lethal dose of digitalin. All the controls died. This antibody could prove useful in treating advanced cases of digitalin intoxication and for which no satisfactory treatment is available at present.
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Since a mouthfull of the herbicidal compound Paraquat usually results in death from caustic burns, renal tubular necrosis, circulatory failure of pulmonary fibrosis, the fact that 11 out of 28 people poisoned in the period 1972-1980 survived deserves consideration. The most significant prognostic factors appear to be: (1) the mode of penetration: all 4 patients poisoned through the skin and/or the respiratory tract survived; (2) the volume of Paraquat absorbed: death from circulatory failure occurs within less than 72 hours with more than 50 mg/kg, while 35 to 50 mg/kg produce progressive pulmonary fibrosis; (3) the content of the stomach at the time of ingestion: food can neutralize the compound; (4) the finding of gastric lesions on early endoscopy; (5) evidence of acute renal failure; finally and mostly (6) Paraquat blood levels during the first 24 hours, as measured by radioimmune assays; lethal levels are 2.0, 0.6, 0.3, 0.16 and 0.10 mg/l at 4, 6, 10, 16, and 24 hours respectively. There is no overlapping between values obtained in patients who died and survivors. In this series, the course of the intoxication, as predicted from the initial prognostic factors, was unmodified by the treatments applied (Fuller's earth, dialysis, charcoal haemoperfusion, furosemide, immediate hypooxygenation). The survival of two patients with restrictive respiratory pathology seems to be ascribable to the circumstances of poisoning rather than to the treatment.
The results of biochemical tests used for the supervision of factory workers exposed to lead (notably lead serum levels, urinary aminolevulinic acid (ALA) and punctuated red cells) were compared in 90 patients. The reference test used to evaluate the sensitivity and specificity of these examinations was EDTA-induced lead urinary excretion. Lead serum levels and urinary ALA were about equally effective in providing information. However, these two tests were more sensitive when performed simultaneously than when performed separately. It is suggested that both should be requested when trying to prevent lead poisoning.
The prognostic significance of various clinical and biochemical factors was investigated in 179 patients who had ingested more than 2 mg digitoxin. The mortality rate in this series was 17%. Supraventricular arrythmias had no influence on prognosis, but the death risk was higher in males and in patients with AV block. It increased with age, with digitoxin and potassium serum levels and even more with persistent hyperkalemia. Two other factors--previous heart disease and vomiting--were also significant in patients without heart block. Calculated on the basis of 4 clinical factors, the mortality rate varied from 2 to 74%. The death risk in acute digitalis poisoning can therefore be easily assessed simply from clinical criteria.
Paraquat poisoning is very severe. When it is ingested, this herbicide may be responsible for causative lesions of the digestive tract, cytolytic hepatitis, renal tubular necrosis, circulatory failure, and/or pulmonary fibrosis. Since a very low dose (as little as one mouthful) is potentially lethal, it is important to understand why 11 of our 28 patients who entered our department for paraquat poisoning survived. The main prognostic factors appear to be the following: Route of administration. Of four patients who had inhaled paraquat aerosols and/or contaminated their skin with the herbicide, all survived. Ingested amount. Above 50 mg/kg, patients died of circulatory failure within 72 h; between 35 and 50 mg/kg, a progressive pulmonary fibrosis occurred. Delay between ingestion and the last meal. Paraquat is adsorbed and neutralized by foodstuffs. Caustic gastric lesions revealed by early endoscopic examination. The occurrence of an organic renal failure. The plasma paraquat concentrations within the first 24 h. Patients whose plasma concentrations do not exceed 2.0, 0.6, 0.3, 0.16, and 0.1 mg/L at 4, 6, 10, 16, and 24 h, respectively, are likely to survive. The different treatments that have been tested (fuller's earth, forced diarrhea, furosemide, hemodialysis, hemoperfusion, artificial ventilation with hypoxic breathing mixtures) did not modify the initial prognosis. The 11 survivals are only linked to the circumstances of the poisonings (route of administration, ingested amount, delay between ingestion and the last meal, etc.). The treatments did not modify the outcome.
A massive retroperitoneal hemorrhage found to be due to a renal abscess in a previously healthy kidney was treated successfully by nephrectomy. This type of lesion occurs fairly infrequently, but it is quite exceptional to observe presenting signs as in the case reported, and recovery is not mentioned in the published literature. Therapy for renal abscess involves either urgent nephrectomy in cases of associated hemorrhagic or septic shock, or medical treatment under close supervision in the absence of major signs of severity, which may, however, develop at any moment making surgery inevitable.
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The prognostic significance of various clinical and biochemical factors was investigated in 179 patients who had absorbed more than 2 mg of digitoxin. The mortality rate in this series was 17%. Supraventricular arrythmias had no influence on prognosis, but the death risk was higher in males and in patients with A-V block. It increased with age, with digitoxin and potassium serum levels and even more with persistent hyperkalemia. Two other factors, previous heart disease and vomiting, were also significant in patients without heart block. Calculated on the basis of 4 clinical factors, the mortality rate varied from 2 to 74%. The death risk in acute digitalis poisoning can therefore be easily assessed from simple clinical criteria.
The symptoms include, by ascending order of severity: nightmares and insomnia, nausea and vomiting, muscular weakness or tremor, postural hypotension, hyperthermia, muscle twitching, convulsions, confusional state or psychosis. Prominent features are the late onset of these symptoms, several days after treatment has been discontinued, and the sometimes difficult diagnosis, since patients are usually unaware of their dependence on these drugs. Reinstituting benzodiazepine treatment, then withdrawing it progressively are the best curative measures. Prevention is easy if treatment is gradually rather than abruptly withdrawn in all patients who receive the compound in high dosage for more than one month.
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Clinical, immunological, and functional investigations were conducted to study possible specific factors involved in the etiology of asthma in adults. The authors emphasize the frequency of positive skin, radio-immunologic and bronchial provocation tests for domestic pneumallergens in patients with common asthma, even those over 40 years of age. These cases improve in a protected environment and may benefit from immunotherapy. In patients with clinical manifestations suggesting possible occupational etiological factors the same tests can be used to diagnose the presence of a wide variety of vegetable or animal allergens. Tests involving exposing the bronchi to various chemical compounds used during working conditions (antibiotics, plastic precursors, metals, hair preparations) show that there exists a wide variety of causes. Systematic search for etiological factors is essential when investigating asthma in adults.