[Community nursing plan for patients with rheumatic fever and rheumatic heart conditions in Or-Yehuda].
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Comprehensive Health Care↗
Biomedical subjects
T David
Publications and source records attributed to T David.
Unusual finding during dermatoglyphic study.
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Dermatoglyphics↗
Assessing clot lysis strategies using a simplified mathematical model.
This paper attempts to describe lysis of a clot by infusion of lytic agent using a simple geometrical approach, in which the rate of clot lysis is assumed proportional to the exposed surface of the clot and the concentration of lytic agent. Six simple realizations (a)-(f) of this basic model are developed which account for the dependence of clot lysis time on five different clot geometries. In all six cases the clot is initially described as a uniform cylinder which totally occludes a vessel. In model (a) lysis proceeds as an advancing front at the proximal face of the clot. In model (b) lysis proceeds radially outwards from the central axis of the vessel while in model (c) lysis occurs radially inwards from the surface adjacent the wall, of the cylinder. In models (d) and (e) it is assumed that the clot breaks into a uniform spherical and cylindrical fragments, respectively, while model (f) uses the spherical fragment model combined with a lytic agent concentration which decreases with time. The validity of the models was assessed using previously published data from 76 patients in whom lysis time and clot size were recorded. Least squares linear regression analysis based on the six model equations yielded highly significant correlation coefficients r2 of 0.457, 0.412, 0.412, 0.495, 0.469, 0.663 for models (a)-(f), respectively. The results suggest that when a constant lytic agent concentration is assumed, no single geometry accounts for significantly more variation than any other, but that a combination of varying lytic agent concentration and clot geometry significantly influences clot lysis time and accounts for much of the observed variation.
Humans↗
Refractive results of radial keratotomy after 10 years.
BACKGROUND: We analyzed retrospectively the refractive and visual results of a cohort of patients who underwent radial keratotomy for myopia 10 years ago. METHODS: Radial keratotomies using centripetal incisions were performed by the same surgeon in 1986 and 1987 to correct myopia of -0.75 to -10.00 diopters (D). Refractive and visual results were evaluated at 1 month and on average 10 years after surgery. RESULTS: Thirty-nine patients (71 eyes) underwent radial keratotomy. Mean spherical equivalent refraction before surgery was -3.90 D and after surgery was -0.50 D at 1 month and +0.13 D at 10 years after surgery. At last examination, 41 eyes (43.7%) had a spherical equivalent refractive error within +/- 1.00 D of emmetropia (24 eyes [34%] +/- 0.50 D) and 32.4% of eyes were overcorrected by more than 1.00 D. Between 1 month and 10 years after surgery, a hyperopic shift greater than 1.00 D occurred in 34.1% of eves with a single procedure. Ten years after surgery, 59 eyes (83%) had uncorrected distance visual acuity of 20/40 or better (22 eyes [31%] with uncorrected visual acuity of 20/20 or better). CONCLUSION: This retrospective evaluation confirms that radial keratotomy is an effective procedure to correct myopic error, but the hyperopic shift produces an unstable, less predictable refraction in one-third of eyes at 10 years.
Adult↗
Primary angioplasty for cardiogenic shock complicating acute myocardial infarction.
To evaluate the role of primary percutaneous transluminal coronary angioplasty in cardiogenic shock, 53 patients admitted with the diagnosis of acute myocardial infarction and cardiogenic shock were studied. Thirty-five (66.0%) patients received intravenous thrombolytic therapy (streptokinase 15 lac units) and 18 (34.0%) underwent primary percutaneous transluminal coronary angioplasty. There was no significant difference in the mean age, risk factor profile, presence of prior myocardial infarction, site of myocardial infarction and cardiac enzyme levels at presentation between the two groups. More male patients were present in the group undergoing primary percutaneous transluminal coronary angioplasty (94.44% vs 68.57%; p = 0.04). The time delay between the onset of symptoms and presentation to the hospital did not differ significantly between the two groups (318.9 vs 320.0 minutes; p = NS). In the primary percutaneous transluminal coronary angioplasty group, 17 patients had a single infarct-related artery and one had both left anterior descending and right coronary artery occlusion. Thus in 18 patients, 19 vessels were attempted. Angiographic success (< 50% residual stenosis) was achieved in 15 (78.94%) vessels of which TIMI III flow was achieved in 10 (52.63%) vessels and TIMI II flow in five (26.31%). Intra-aortic balloon pump was needed in five (27.77%) patients undergoing coronary angioplasty. In-hospital mortality was 27.77 percent in patients undergoing primary percutaneous transluminal coronary angioplasty and 57.14 percent in patients receiving intravenous thrombolytic therapy (p = 0.04). In the thrombolytic therapy group, mortality was higher (85.91%) in patients presenting six hours or later after the onset of symptoms as compared to those presenting in less than six hours of the onset of symptoms (50%). In primary percutaneous transluminal coronary angioplasty group, mortality was 21.42 percent in patients with successful and 50 percent in patients with failed angioplasty. Thus, in patients with acute myocardial infarction and cardiogenic shock, an aggressive invasive strategy with primary percutaneous transluminal coronary angioplasty, as compared to intravenous thrombolytic therapy, is helpful in reducing in-hospital mortality.
Adult↗
Percutaneous retrieval of a broken catheter fragment from the left common carotid artery.
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Cardiac Catheterization↗
[The school for patients with chronic backache. Retrospective study of 93 severely handicapped patients with backache and their socio-occupational status].
A small percentage of low back pain sufferers are resistant to the various types of treatment tried and the problem becomes chronic. It is for this severely incapacitated group, threatened by socio-occupational misfortune, that we created: the School for Chronic Low Back Pain Sufferers. One hundred and five patients in whom treatment had failed were included after insurance programmes had agreed to provide cover. The system is of a multidisciplinary nature with hospitalisation for 5 days. The fate of 93 of these patients is known with a mean follow-up of 1 year. Quantified initial evaluation on an obstacle course confirmed that even severe low back pain sufferers were unaware of the basic rules for protection of the spine (mean score of 14/50 on admission). Socio-occupational fate analysed on the basis of a questionnaire showed: a high satisfaction index (90%) regardless of the subsequent outcome, and a correlation between follow-up time after the programme and the decrease in painful attacks (p less than 0.03, r = 0.23) or consumption of medications (p less than 0.01, r = 0.29). The relative simplicity of the system proposed, the situation of therapeutic impasse in which the patients for whom it is intended find themselves, the short time required and the results obtained confirm the importance of this multidisciplinary management approach being able to best envisage the possibilities of rehabilitation of the chronic low back pain sufferer, in particular when there are repeated periods off work.
Adult↗
Lamellar keratoplasty with the Barraquer microkeratome.
Lamellar keratoplasty was performed in 17 eyes: 6 with corneal opacities following epidemic keratoconjunctivitis, 3 with herpes keratitis, 2 with anterior corneal dystrophies, and 6 others. The Barraquer microkeratome was used for the resection in both the host and the donor. A technique is described to correct major disparities in diameter between the bed and the donor disc. In eyes with vision limited only by corneal diseases (11), the best postoperative spectacle corrected visual acuity was 20/25; the mean postoperative spectacle corrected visual acuity for the 11 eyes was 20/40.
Adolescent↗
[Hyponatremia and convulsions in the postoperative period in children].
Four children undergoing surgery presented with seizures and hyponatremia 12 hours after anesthesia. One child died with cerebral oedema, the others recovered. The respective roles of hypo-osmolar perfusions and ADH secretion are discussed. Ionogram before surgery, supervision of weight and diuresis and correct fluid management should prevent these postoperative complications.
Child, Preschool↗
[A case of 49 XXXXY gonadosomatic dysgenesis: clinical elements and biological consequences of polysomy X].
Discovery of 49 XXXXY syndrome in a six years young boy allows description of the main clinical characteristics of this disease: hypotrophy, facial anomalies, hypogenitalism, delayed speech development and oligophrenia. Radio-cubital synostosis is quite specific in this syndrome. The hypothesis of a correlation between clinical anomalies and excess of genes induced by polysomia has been suggested. We give results of five X-linked enzymatic activities: steroid sulfatase (STS) (located on the probably noninactivated segment), Hypoxanthine Guanine Phosphoribosyl Transferase (HGPRT), Glucose 6 Phosphate Déshydrogenase (G6PD), Phospho Glycerate Kinase (PGK), Alpha Galactosidase A (Alpha GAL A). Only STS activity seems to be significatively increased.
Child↗
Urinary uric acid excretion in patients with carcinoma of the cervix undergoing intracavitary radium therapy.
An attempt is made here to determine the pattern of urinary uric acid excretion in patients with carcinoma of the cervix undergoing intracavitary radium therapy. Eight patients from the Philippine General Hospital were studied using 24-hour urine collection method to study the uric acid level. Result showed a proportionate increased in uric acid excretion with increasing dose of radiation up to 4,800-5,400 rads, after which, uric acid excretion produced an unexpected downtrend even with continued radiation. Maximum uric acid excretion ranged from 680-1,500 mg% with a mean of 1,005 +/- 100 mg%.
Adult↗
[Coxal femoral fractures--surgical management and internal medicine-cardiologic concomitant therapy in geriatric patients. 1. Surgical procedure and postoperative follow-up].
246 patients (average age 82.4 years) with proximal femur fractures treated with bipolar endoprothesis, sliding lag screw or Ender nailing, related to the fracture type were analyzed in a retrospective study. Preexistent diseases, duration of operation, postoperative complications, transfusions, hospital stay, mobility achieved and mortality were noted. As a result, we found a high multimorbidity related to the age, the highest requirement of transfusions in patients undergoing Ender nailing, a long period to achieve postoperative mobility, a long hospital stay, and increasing mortality with average age and average hospital stay.
Aged↗
Correlation of Braunwald's clinical classification of unstable angina pectoris with angiographic extent of disease, lesion morphology and intra-luminal thrombus.
One hundred consecutive patients (81 male and 19 female) with unstable angina pectoris undergoing coronary angiography were divided according to Braunwald's clinical classification. Seventeen (17%) patients had new onset angina (class I), 68 (68%) sub-acute angina (class II) and 15 (15%) had acute rest angina (class III). Twenty-seven (27%) patients had secondary unstable angina pectoris (class A), 49 (49%) primary unstable angina (class B) and 24 (24%) had post-infarction unstable angina (class C). ST-T wave changes on ECG were present in 54 (54%) while absent in 46 (46%) patients. On coronary angiography, 26 (26%) patients had single vessel disease, 30 (30%) double vessel disease and 39 (39%) patients had triple vessel disease. Five (5%) patients were found to have normal coronaries. Classification of patients according to Braunwald's clinical classification showed single vessel disease to be higher in class I as compared to class II (47% vs 22%; p = 0.04) and classes III (47% vs 20%; p<0.01). Single vessel disease was found to be higher in class C as compared to class B (41.7% vs 16.4; p = 0.01). Double vessel disease was higher in class B as compared to class A (40.8% vs 18.5%, p = 0.04). Triple vessel disease incidence was not found to be significantly different among different clinical classes. Morphology of coronary artery lesions was classified according to Ambrose's classification. Out of the total of 248 lesions in the whole study group, there were 68 (27.42%) concentric lesions, 55 (22.18%) eccentric type I lesions, 23 (9.27%) eccentric type II lesions, 42 (16.94%) multiple irregularity lesions and 60 (24.19%) totally occluded lesions. Concentric lesions were found to be higher in class C as compared to class B (40% vs 19.8%; p = 0.014). Statistically significant difference was not present in the distribution of other morphological type of lesions among different clinical classes. In the whole study group, intra-luminal thrombus was found to be present in 17 (17%) of patients. Distribution of intra-luminal thrombus according to Braunwald's classification showed that none of the patients in class I had intra-luminal thrombus, while 13 (19.1%) patients in class II and 4(26.7%) in class III had intra-luminal thrombus. The difference in the occurrence of intra-luminal thrombus between class I and class II (p = 0.004) and class I and class III (p = 0 .03 was found to be significant. Thus, majority of patients undergoing coronary angiography had primary sub-acute rest angina. Single vessel disease was higher in new onset angina. Patients with unstable angina pectoris and ST-T changes on ECG had higher number of lesions per patient and higher eccentric type I lesions. Intra-luminal thrombus was more frequently encountered with acute rest angina. However, the distribution of different morphological type of lesions on coronary angiography did not differ significantly in different clinical classes of unstable angina pectoris divided according to Braunwald's classification.
Adult↗