PubMed Health⌕ Search

Biomedical subjects

B Page

Publications and source records attributed to B Page.

13 recordsLinked to original sources
PubMed1992

Correction of severe secondary hyperparathyroidism in two dialysis patients: surgical removal versus percutaneous ethanol injection.

Two chronic hemodialysis patients had recurrent, severe secondary hyperparathyroidism. The first had no sonographically visible parathyroid gland in the neck. Computed tomography (CT) scan indicated the existence of a parathyroid mass in the upper mediastinum, which was removed surgically. The second patient had two intracervical, hyperplastic parathyroid glands visible on ultrasound examination. He volunteered for nonsurgical removal via sonographically guided percutaneous injection of ethanol. In both patients, serum total calcium concentration decreased dramatically to values near 1.5 mmol/L 24 hours after treatment. In patient 1, serum immunoreactive parathyroid hormone (iPTH) (1-84) decreased from 1,582 pg/mL before surgery to 34 pg/mL after 24 hours (normal range, 10 to 65 pg/mL). In contrast, serum iPTH (1-84) decreased only progressively in patient 2, from 1,680 pg/mL before ethanol injection to 865 pg/mL after 24 hours and to 378 pg/mL after 72 hours to reach 30 pg/mL after 14 days. Thus, patient 2 had a striking decrease of plasma calcium immediately after parathyroid gland destruction, even though circulating iPTH was still very high. The reason for such a discrepancy remains unexplained at present, and further study will be necessary to solve this issue.

Adult↗
PubMed1992

Decrease of tumor-like calcification in uremia despite aggravation of secondary hyperparathyroidism: a case report.

Extraskeletal pseudotumoral calcifications generally develop in uremic patients with a high calcium x phosphorus (Ca x P) product and severe secondary hyperparathyroidism. In the present case report we describe a chronic hemodialysis patient presenting with a massive calcification of the left shoulder region, severe aluminum (Al) intoxication and moderate hyperparathyroidism. Her initial serum Ca x P product was only slightly elevated: 5.01 mmol2/l2. Under deferoxamine treatment during the subsequent 4 months, Al overload decreased. On the other hand, parathyroid overfunction worsened, as reflected by an increase of the serum immunoreactive parathyroid hormone [1-84] level from initially 690 to 1052 pg/ml (normal, 15-60 pg/ml) and an increase of alkaline phosphatase activity, and plasma calcitriol increased from undetectable to a low-normal value. Predialysis serum total Ca levels decreased rapidly from 2.9 to 2.5 mM but serum P concentrations remained elevated: 1.6-2.5 mM. Unexpectedly, the extent of the periarticular calcification diminished considerably during the same time period. The present observation shows that in a subset of uremic patients with Al overload, pseudotumoral calcifications may regress during Al chelation therapy despite progression of hyperparathyroidism. Since Al may predispose collagen to develop dystrophic or metastatic calcification, it is suggested that this process is reversible by correcting Al intoxication.

Aluminum↗
PubMed1992

[Aseptic osteonecrosis of the knee induced by corticoids. MRI aspects].

Authors report the results of a series of 29 knees examined by magnetic resonance imaging in 16 patients subjected to a long-term corticosteroid therapy (6 systemic lupus erythematosus and 10 kidney transplanted people). Abnormal signals of condyles or tibial plateaus were observed in 12 patients (19 knees). Lesions, which were asymptomatic in 37% of the cases studied, mostly showed (12/24 condyles) a fatty signal area marked out by a hypointense signal strip in T1 edged with a hyperintense signal in T2. Some developed lesions were hypointense whichever the sequence. Our study confirmed the frequency of the lateral condyle involvement (60%) and the bilateral aspect of the lesions (50%) in osteonecrosis of the condyles following the corticosteroid therapy. The associated lesions of articular surfaces (3 cases) could be well assessed through magnetic resonance imaging on T2 or T2* weighted images. In two cases, the abnormal signals of the condyles suggesting a medullary edema (hypointense signal in T1 and hyperintense signal in T2) spontaneously disappeared 6 and 9 months after their discovery. Abnormal signals related to medullary infarcts (10 knees) were always associated with abnormal condyles. Most time their aspect in magnetic resonance imaging, except old calcified lesions, was characteristic: serpiginous hypointense signal isolating areas of fatty signal edged with a hyperintense signal strip in T2. In risk patients, magnetic resonance imaging allows early detecting knee necroses, precising the extent of epiphyseal and metaphyso-diaphyseal lesions and their impact on articular surfaces.

Adult↗
PubMed1991

Treatment of strabismus after retinal detachment surgery with botulinum neurotoxin A.

Thirty-one consecutive patients were treated with injections of Botulinum Neurotoxin A to rectus muscles for strabismus following retinal detachment surgery. In 14 cases the presenting problem was diplopia and in 17 cases the presenting problem was cosmetic appearance. A total of 67 injections was given. Twenty-seven cases had nine months or more follow-up. Of these, four of 11 cases with diplopia had fusion restored, four were shown to have no fusion potential, and three had temporary improvement only. In 16 cases with a primary cosmetic problem there was no useful effect in two, three had surgery as an alternative, three were realigned long-term, and eight had continuing maintenance therapy with toxin. Over half the series had undergone multiple detachment surgery, often for giant tears and other complex pathology.

Adult↗
PubMed1990

Behaviour of small children before induction. The effect of parental presence and EMLA and premedication with triclofos or a placebo.

The effect of the prescription of triclofos 70 mg/kg orally 90 minutes before operation on the behaviour of 263 children aged 1 to 5 years was studied in a blind, randomised, placebo-controlled trial. EMLA was applied to the dorsum of one hand when the premedication was administered, and all the children were accompanied by a parent during induction of anaesthesia. The frequency of satisfactory behaviour was significantly higher in the triclofos group (p less than 0.02), but the time spent in the recovery ward was increased.

Age Factors↗
PubMed1990

Effects of chewing behavior and ruminal digestion processes on voluntary intake of grass silages by lactating dairy cows.

Four primiparous Holstein-Friesian cows (518 kg average BW) with ruminal and duodenal cannulas were used to examine voluntary intake of direct cut (DC) or wilted (W) grass silage in relation to ruminal characteristics and chewing behavior. Dry matter content of the silages was 17.0 and 38.1%, concentrate DM intake was restricted to 5.0 and 5.3 kg/d, and voluntary DM intake from silages averaged 7.4 and 9.5 kg/d (P = .008), respectively. The acetate/propionate ratio in ruminal fluid decreased from 4.0 on DC to 3.3 on W silage (P = .021). The protein content in milk increased from 26.3 to 27.5 g/liter (P = .042) and the protein yield from 469 to 574 g/d (P = .038). The distribution of concentrates (38% of DM intake) with a mean particle size of .04 cm reduced differences in fecal mean particle size between diets. There was a shift from eating to ruminating on W silage with regard to daily duration (min/d) and number of jaw movements (no./d). However, ruminating index (no./kg DM intake) remained unchanged, irrespective of wilting and chop length of the silages or physiological state of the animals. These results are interpreted to indicate that the time lag for functional density of feed particles in the reticulorumen to increase, as affected by ruminating activity, not rate of reduction of the particle size, limits voluntary intake of grass silage by cattle.

Animals↗
PubMed1976

Multifactor evaluations of surgical trainees and teaching services.

Surgical education has been exposed to increasing challenges as students have moved from the highly structured environment of a university hospital into a variety of clinical settings within the community. Presented with a general surgical service that uses ten relatively autonomous teaching services in seven hospitals, we have developed a computer-based evaluation system designed to provide quality control and a feed-back loop for trainee, teacher, and service. Trainees were rated by comparing them to their peers, with the chief resident as a reference standard. Profiles of each teaching service also were developed and compared one to the other. The results of both studies over a one year period are presented.

Educational Measurement↗