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At least 1,279 records · Page 71Linked to original sources
PubMed1995

Laryngeal reconstruction and survival after function-sparing laryngectomy for selected T3 and T4 lesions.

Most patients lost their vocal ability after ablative surgery for the laryngeal cancer. Total laryngectomy has a history of over 100 years, hence many surgeons are accustomed to the en bloc organ resection and the loss of ability for communication after surgery. The recent advance of surgery introduces the concept and technique of radical cure and functional preservation of the cancer-afflicted-organ at the same setting. For lesions of late T categories (T3, T4), the maintenance of normal function after wide resection to ensure radicality demands a special technique to repair the crippled larynx. For this purpose a local osteomuscular flap was designed to reconstruct a functioning larynx. The surgical manoeuvre was described and the result proved to be successful. The outcome of 138 patients with T3 and T4 laryngeal carcinomas following conservation laryngectomy was analyzed. The five-year survival rate was 69% for supraglottic type and 75% for glottic type. The quality of life was much improved.

Adult↗
PubMed1995

Ginger Jake and the blues: a tragic song of poisoning.

Prohibition, "The Noble Experiment", ushered in speakeasys, gangsters and bathtub gin in the 1920s. For many Americans, however, it led to a period of joblessness, hard times, and austerity. The story of Jamaican Ginger ("Jake") poisoning, in which batches of a cheap, alcoholic tonic were laced with tri-ortho cresyl phosphate (TOCP) is one of cynical despicable behavior on the part of those responsible and a tragic enduring legacy for the invisible group of Americans who were victimized. TOCP, a potent organophosphate, caused an axonal dying-back neuropathy affecting mainly large muscle groups. Jake poisoning struck about 50,000 adults, mostly poor middle-aged vagrants with little medical care or social standing. Their symptoms and stories were told not only in medical journals but also in song. Hillbilly jazzmen sang of the "Jake Leg Blues" with a resignation to the fate of their own undoing, brought on by the intemperance of a wasted life. The postscript is grim--those responsible received little punishment; many who drank "Jake" were left both uncompensated and crippled by irreversible paralysis.

Alcoholic Beverages↗
PubMed1995

Case of pulmonary alveolar proteinosis treated by sequential whole-lung lavages and a review of the condition.

We report our first local case of pulmonary alveolar proteinosis that required symptomatic therapy with whole lung lavage. This is a rare condition associated with the accumulation of phospholipid material in the alveoli. The presentation is usually insidious and the symptomatology varies from vague complaints to severe crippling dyspnoea. The diagnosis is often delayed and usually made after the exclusion of other conditions. While there is no definitive treatment apart from lung transplant, whole-lung lavage is a safe, repeatable procedure which offers the best prospect for symptomatic, physiological and radiological improvement in severe cases.

Adult↗
PubMed1994

[Transanal resection of the rectum].

A new method of an organ-preserving operation for the management of the initial forms of rectal carcinoma and benign tumors of the distal parts of the rectum has been elaborated and successfully used at the Scientific Research Institute of Proctology. It consists in transanal resection of the rectum with creation of a recto-anal anastomosis. Transanal resection of the rectum was performed on 34 patients. Sixteen patients had giant or recurrent villous tumours of the distal part of the rectum 6 of which had undergone malignant degeneration. In a group of 34 patients 14 had the initial forms of carcinoma of the inferoampular part of the rectum, 2 had a deep cystic colitis, and the other 2 patients were operated on for neurilemoma and teratoma. Recurrences were not revealed in patients with benign diseases in follow-up periods of 2 to 8 years. Recurrent carcinoma of the rectum in the region of the anastomosis was found in 2 patients in follow-up periods of 25 to 37 months. They underwent extirpation of the rectum. The new method enables stable recovery to be achieved and saves the patients from crippling abdomino-anal resections and extirpation of the rectum in the management of benign new growths and initial forms of carcinoma of the distal parts of this organ.

Adenoma, Villous↗
PubMedDate not supplied

Clinical and biological polymorphism of rheumatoid arthritis.

Rheumatoid arthritis (RA) is a frequent disease, leading in more than 50% of cases to severe disability within 5 years of evolution, and sometimes to the premature death of the patient. It is therefore of crucial importance to diagnose, evaluate, and treat this crippling disease as soon as possible. We need accurate clinical, biological, immunological and radiographic parameters which will permit both early diagnosis and evaluation of the patient's prognosis. However, RA is a very heterogeneous disease which is sometimes considered as a clinical syndrome. The clinical heterogeneity of RA is well known; some cases are very mild and self-limiting, while others are seriously progressive and include extra-articular manifestations which can be life-threatening. There is also a biological and immunological heterogeneity of RA, depending on the presence or absence of: rheumatoid factor, high levels of serum IgA, and antinuclear, anti-Ro, antiperinuclear, or anti-stratum corneum antibodies. The association between HLA DR antigens and the severity of RA has been demonstrated in recent studies including some by our group. HLA DRB1*0401 or 0404 homozygous, or HLA DRB1*0401/0404/0408 heterozygous, or HLA DRB1*04 + HLA DRB1*0101 are associated with severe and erosive RA. Extra-articular manifestations such as nodules, vasculitis or Felty syndrome are very often observed in patients homozygous for HLA DRB1*0401 or 0404. The presence of HLA DR4 seems to be correlated with the articular erosions and not with rheumatoid factor. There is a clear need for a 'staging' of RA in order to define more homogeneous clusters of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthritis, Rheumatoid↗
PubMed1994

Effects of NMDA receptor antagonists on the developing brain.

This overview describes two effects of N-methyl-D-aspartate (NMDA) receptor antagonists that are not strictly speaking toxic: There are no signs that cells are dying. Nevertheless, these antagonists, if applied for prolonged periods in young children, could permanently cripple normal brain function. Disturbing the function of the NMDA channel during development can severely disrupt the wiring of defined neural circuits. It also can disrupt the developmental upregulation of the receptor protein itself and possibly many other molecular components of the synapse.

Animals↗
PubMed1995

How to reduce the risk factors of osteoporosis in Asia.

Osteoporosis can be predicted to be a new burden to public health in Asia. Currently, the incidence of osteoporosis-related fractures is lower there than in most western communities. By the year 2050, however, 50% of the 6.3 million hip fractures which occur worldwide will be in Asians as a result of an aging population, a decrease in physical activity and westernization of lifestyles. The cost of treatment and cure of these patients will be enormous, a sufficient financial burden to consume current economic gain and cripple the future advancing development of Asian countries. Individual risk factors for osteoporosis have been identified by the extensive Mediterranean Osteoporosis Study (MEDOS). Fortunately, Asians, the rural population and farmers in particular, have the favorable lifestyle identified by the study, including high physical activity and exposure to sunlight. Strikingly, tea drinking, a daily habit in Asia, is also identified as a protective factor against osteoporosis. In addition, bioflavonoids and phytoestrogen-rich soybeans and vegetables are consumed in large quantities by Asians. A soy diet reduces mortality in breast and prostate cancer because it contains weak estrogens. The weakly estrogenic phytoestrogens require further study to demonstrate their pharmacological effect in reducing the rate of osteoporosis. Public health education, however, is needed to encourage the Asian population to maintain their traditionally good lifestyle and to reduce the risk factors for osteoporosis. In turn, these steps may reduce the public health burden by 2050.

Estrogens, Non-Steroidal↗
PubMed1995

[Clinical and psychometric findings in spasmodic torticollis].

In a previous study screening for psychopathological symptoms in a sample of 256 patients with spasmodic torticollis had resulted in 27% of patients, whose mean score of the GSI of the SCL-90-R was above the double standard deviation of the control group of normals (Scheidt et al. 1994). In this study the self-reported psychopathology of a subsample of 19 TS patients was controlled for its agreement with a clinical assessment in a psychiatric interview. The results of the study confirm the validity of the SCL-90-R as a screening instrument for psychological distress and psychopathology. However a tendency for social desirability in a subgroup of patients might lead to underestimate the degree of psychological distress in this patient group and might als account for some of the discrepant findings concerning psychological distress and psychopathology in TS in former studies. Furthermore the clinical assessment revealed a high psychiatric and psychosomatic morbidity prior to the onset of the spasmodic torticollis as well as a high frequency of traumatic life events (e.g. bereavement) in the patients premorbid history. In addition to coping with a crippling neurological condition concurrent psychopathology in TS therefore should be considered also in terms of the individuals premorbid psychological vulnerability.

Adaptation, Psychological↗
PubMed1994

[A study of children with cerebral palsy who were born between 1977 and 1985 in Kyoto City; a report from an institution for handicapped children].

First, we longitudinally analyzed 177 cerebral-palsied children (CP) who were born in Kyoto City between 1977 and 1985. They were all visited St. Joseph Hospital for Crippled Children in Kyoto during the period 1977 to 1991 in order to investigate the relationship between the prognosis of perinatal care and the changing panorama of CP in Kyoto. The average occurrence rate of CP per 1,000 live birth during the 9 years in Kyoto was 1.12. 177 CP were divided into 3 groups according to their birth years: 1977-1979 (47 CP); 1980-1982 (62 CP); and 1983-1985 (68 CP). Then we compared the distribution of birthweights and gestational periods among the 3 groups. We found a significant increasing trend in the percentage of CP in babies with birthweight less than 2,000 g. Second, we examined 162 CP; 15 born outside of Kyoto were excluded because of extraneous influences of perinatal care. 162 were divided into 3 groups according to their birth years: 1977-1979 (44); 1980-1982 (56); and 1983-1985 (62). We also compared the risk factors and prognosis according to the birthweights and gestational ages among the 3 groups. This study revealed a decreasing trend in the frequency of convulsions of full term CP, dyspnea and oxygen administration of premature CP in the neonatal period. At the same time, the motor development of CP without mental retardation had improved significantly in the later period. However, in the last 3 years the distribution of the severity of motor disturbance at 4 years of age among CP with birthweight of 1,000-2,000 g was either mild or severe.(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗
PubMed1994

[Treatment of complicated recurrent hypospadias].

Between January 1985 and December 1990, a total of 40 patients aged 2-40 years underwent surgical reconstruction for complicated failure of hypospadias repair. These included 19 patients with multiple previous operations, severely scarred skin, penile deviation, long urethral defects and scarred or cleft glans, who were classified as hypospadias cripples (group I). The remaining 21 patients had distal urethral defects and a scarred or cleft glans but better skin condition; this group was classified as having defects of the distal urethra and glans (group II). Island flaps were used in 17 patients, and transversal or axial random penile skin flaps in 18. In 4 patients the urethra was reconstructed with mesh graft and in 1 case, with a bladder mucosa graft. With the designed single-session procedure primary treatment was successful and free of complications in 52% of the patients in group I and 67% in group II. In each of 3 patients three further operations were required. In 15 patients revision surgery was confined to simple fistula closure, stricture incision or correction of scarred skin. Follow-up examination at 7-72 months showed that treatment had been successful in all patients.

Adolescent↗
PubMed1994

Excitotoxins in foods.

Evidence is reviewed pertaining to excitatory neurotoxins (excitotoxins) encountered in human food supply. The most frequently encountered food excitotoxin is glutamate (Glu) which is commercially added to many foods despite evidence that it can freely penetrate certain brain regions and rapidly destroy neurons by hyperactivating the NMDA subtype of Glu receptor. Hypersensitivity of NMDA receptors during development makes the immature nervous system especially sensitive to Glu excitotoxicity. On the other hand, elderly consumers are particularly sensitive to domoic acid, a powerful excitotoxic Glu analog that activates both NMDA and non-NMDA receptors. A high content of domoic acid in shell fish caused a recent food poisoning incident that killed some elderly victims and caused brain damage and memory impairment in others. Neurolathyrism is a crippling neurodegenerative condition associated with ingestion of a legume that naturally contains BOAA, an excitotoxic Glu analog that hyperactivates non-NMDA receptors. Thus, the human food supply is a source of excitotoxins that can damage the brain by one type of mechanism to which immature consumers are hypervulnerable, or by other mechanisms to which adult and elderly consumers are peculiarly sensitive.

Amino Acids, Diamino↗
PubMed1994

Advances in the diagnosis of human lymphatic filariases: a review.

The nematode parasites Wuchereria bancrofti, Brugia malayi and B. timori are the causative agents of human lymphatic filariasis. Of the estimated 90 million infections world-wide, W. bancrofti is responsible for over 80 million cases and is the only known aetiologic agent in the African Region. Numbers of infected persons are on the increase world-wide due to rural-urban migrations which result in mushrooming of shanty towns often encouraging formation of favourable mosquito breeding-sites. Development of insecticide resistance by the vector mosquitoes; the toxicity and high cost of available effective formulations, and the deteriorating global economy aggravate this situation. Human lymphatic filariasis is more of a morbidity than a mortality-causing disease but can be devastating and crippling at both the individual and community levels. Unlike many parasitic infections, lymphatic filariasis can easily be controlled. The success of any control programme depends on sensitive diagnostic techniques and this is the challenge. Identification of all true positive individuals in an endemic community can be problematic since filariasis is spectral and no single diagnostic technique can be expected to be uniformly sensitive in all situations. Availability of new biotechnologies has given impetus to formulations of several diagnostic tools. New diagnostic methods and improvements on the traditional ones is the topic of this review. Recommendations in view of their field applications are also discussed.

Africa↗
PubMed1994

Hip screening: are health visitors adequately prepared?

Developmental dysplasia of the hip is a crippling disorder, causing early arthritis if left undetected. In Northern Ireland health visitors routinely screen infants' hips at specific intervals up to pre-school age. The screening tests used appear simple but involve a high degree of skill in order to identify abnormality. A video study of three health visitors found that their performance was poor, but a marked improvement was noted after a period of specialised training. Bernadette Trainor et al suggest that more initial training and post-qualification update sessions are necessary to support health visitors in this role.

Child, Preschool↗
PubMed1994

Tachycardia and panic attacks.

This case taught me the importance of listening closely to the patient's history, and not just jumping in and accepting an old diagnosis. It also showed me how patients can effect change in their lives, that even when patients are seemingly crippled by panic, anxiety, stress, and with a history of sexual abuse as a child, that person can effect meaningful change in their life and reclaim their life from the effects of these problems.

Adult↗
PubMedDate not supplied

Dr. Cohen's myringotomy day at the Outpatient Care Center. Interview by Nancy L Zinner.

1. Seventy percent of children develop at least one bout of otitis media. Myringotomy is done whenever serous otitis media fails to resolve after medical therapy. 2. The Outpatient Care Center (OCC) at Jewish Hospital in Louisville, the Kentucky Commission for Handicapped Children, and the Indiana Crippled Children's Commission have collaborated to provide cost-effective middle ear ventilation tube surgery for children in the greater Louisville area and southern Indiana. 3. On a typical morning, the OCC's first patient arrives in the operating room at 7:30 AM. The 20th patient is usually out of the operating room by 11:00 AM. Teamwork in all areas allows the cases to flow smoothly.

Ambulatory Surgical Procedures↗
PubMed1994

[5 leprosy cases in the 20th century in Switzerland].

Leprosy had a great impact on everyday life during the Middle Ages, which is reflected in many works of art and also in some preserved buildings. Worldwide, leprosy is still an unsolved problem; this fact has led the World Health Organization to develop a specific strategy to fight the disease. For physicians in Europe, leprosy has lost its significance. In the archives of the Swiss Canton of Valais leprosy in the 20th century is documented by photographs and written records. It is deplorable to see how a young woman can become crippled, lose her eyesight and die within a couple of years. Probably a pocket of leprosy persisted since the Middle Ages in this remote mountain area. The limited contagiousness of the disease is astonishing, since only a few of the closest family members and inhabitants of the some house were infected, while others remained healthy. The social situation of these patients at the beginning of this century was pitiable. The federal laws on epidemics of 1886 did not mention leprosy, as no one seemed to believe in its existence in Switzerland. Even after the cases of leprosy in the Canton of Valais were revealed, the reaction of the political authorities was reserved. An engaged effort by the involved physicians was necessary to establish the appropriate hygienic measures. In the literature of the time there were regular reports of cases in people who emigrated from the endemic areas. Today, in Switzerland one case of leprosy is discovered per year; thus, leprosy is still a disease which physicians must cope with.

History, 19th Century↗
PubMed1994

[Obsessive-compulsive disorders].

Obsessive-compulsive disorder (OCD) is a psychiatric illness, until recently considered a rare, mainly neurotic condition with poor prognosis. However, epidemiologic studies have shown that the condition has a 25-50 times higher frequency than previously assumed. A review of occurrence, phenomenology and comorbidity is given. Newer theories of etiology are discussed, underpinning neurobiological aspects of the illness. In its most severe forms OCD is a condition with a socially crippling course, but with the introduction of anti-depressants acting on serotonin reuptake the therapeutic possibilities have increased, especially when these drugs are given in combination with behaviour therapy.

Adult↗
PubMed1993

[Accidents in children and adolescents].

Injury is the most important threat to health of children and the leading cause of death in children after the first year of life. The death of an otherwise normal child is a tragedy. Crippling injuries to a child and the need for rehabilitation have a greater effect on our health system; the child's image of himself as an incomplete individual is another tragedy during the whole life of a child. With this system's approach of continuum of care, of integrated prehospital treatment and transport, hospital resuscitation, intensive care, and rehabilitation of the injured child, optimal management of this most fatal disease of modern society can be attained; nationwide injury prevention programs contribute to diminish accident frequency and lead to improvement in child safety. Trauma management and injury control are a challenge for all emergency physicians, especially pediatric surgeons.

Accident Prevention↗