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Biomedical subjects

D Grob

Publications and source records attributed to D Grob.

At least 127 records · Page 7Linked to original sources
PubMed1988

Transfusion-associated-graft-vs-host disease in a presumed immunocompetent patient.

Since the advent of bone marrow transplantation, a vexing clinical problem is that of acute graft-vs-host disease (GVHD). A less well-recognized disorder is that of GVHD in patients receiving blood products containing immunocompetent lymphocytes. Transfusion-associated (TA)-GVHD has a lower incidence and higher mortality (greater than 90%) than bone marrow transplantation-GVHD and until now has been limited to patients with hereditary or acquired immunologic deficits and to patients immunocompromised by chemotherapy for malignant neoplasms. We presently describe a patient who underwent coronary artery bypass graft surgery and who suffered what we believe was TA-GVHD. This diagnosis is supported by considering the chronology of events (in particular, blood transfusion), clinical features (fever, rash, abnormal results of liver function tests, diarrhea, and pancytopenia), and a skin biopsy specimen that revealed basal cell vacuolation and lymphocyte satellitosis that are considered characteristic for this disorder. We believe TA-GVHD can occur in previously immunocompetent patients who receive transfusions of blood products containing functioning lymphocytes and that this awareness will lead to the discovery of additional cases and a better understanding of this disorder.

Acute Disease↗
PubMed1988

Determination of left ventricular wall thickness and muscle mass by intravenous digital subtraction angiocardiography: validation of the method.

Left ventricular (LV) wall thickness and muscle mass are important measures of LV hypertrophy. In 24 patients LV end-diastolic wall thickness and muscle mass were determined (two observers) by digital subtraction angiocardiography (DSA) and conventional LV angiocardiography (LVA). Wall thickness was determined over the anterolateral wall of the left ventricle according to the technique of Rackley (method 1) or by planimetry (method 2). Seventeen patients were studied at rest and seven during dynamic exercise. Wall thickness correlated well between LVA and DSA; the best correlations were obtained by a combined subtraction mode using either method 1 or 2 (method 1, r greater than or equal to 0.80; method 2, r greater than or equal to 0.75). The standard error of estimate of the mean (SEE) was slightly lower for method 2 (less than or equal to 10%) than for method 1 (less than or equal to 13%). DSA significantly overestimated wall thickness by 5-7% with method 1 and underestimated by 12-14% with method 2. Muscle mass correlated well between LVA and DSA; the SEE was less than or equal to 15% for method 1 and less than or equal to 12% for method 2. Overestimation of muscle mass by DSA was 7-11% with method 1 and underestimation was 13-15% with method 2. It is concluded that LV wall thickness can be determined accurately by DSA with an SEE ranging between 10 and 13%. Determination of LV muscle mass is slightly less accurate and the SEE is slightly larger ranging between 13 to 17%. With method 1, wall thickness and muscle mass were overestimated and with method 2 underestimated.

Adult↗
PubMed1987

Adverse cardiovascular effects of anticholinesterase medications.

Anticholinesterase medications (anti-ChEs) play a significant role in the diagnosis and treatment of myasthenia gravis (MG). The primary effect on the heart produced by a surfeit of ACh is bradyarrhythmias with consequent fall in cardiac output and hypotension; yet, adverse cardiac reactions to these agents have been reported relatively infrequently. The authors describe 12 patients with MG from a pool of more than 1,000 who suffered hypotensive episodes related to use of anti-ChEs. The 12 patients (seven male, five female) had a mean age of 62.6 years; of these, eight adverse reactions occurred after edrophonium, two after neostigmine, and two after pyridostigmine. Seven patients had a recent increase in anti-ChEs and none had a decrease in dosage. Nine patients suffered either from severe sinus bradycardia, (20 beats/min), junctional bradycardia, or complete AV dissociation. Two patients had paradoxic sinus tachycardia and all had syncopal or near-syncopal episodes. Evidence for cholinergic stimulation of other organs was generally lacking. No recurrence appeared with reduction of the dose of anti-ChEs or discontinuation of the drug. The authors believe that these agents should be given with caution to patients with inflammatory, infiltrative, or degenerative disease of the conduction systems, patients being treated with digitalis, calcium-channel antagonists or beta blockers, patients with myocardial ischemia, and elderly patients. Appropriate resuscitative equipment should be readily available.

Adult↗
PubMed1987

The course of myasthenia gravis and therapies affecting outcome.

The course of 1,487 patients with myasthenia gravis followed between 1940 and 1985 for a mean of 18 years provides further evidence that the distribution, severity, and outcome of the disease are determined during the first 1 to 3 (occasionally 5) years after onset, suggesting that injury to acetylcholine receptors occurs mainly during this time. In 14%, the disease remained clinically localized to the extraocular muscles, and in the remaining 86% became generalized, in 87% within a year, with the disease reaching maximum severity within the first year after onset of symptoms in 55%, during the first 3 years in 70%, and during the first 5 years in 85%. Male patients tended to have more rapid progression of disease, higher mortality, and lower rates of remission and improvement than females. From 1940 to 1957, when management relied on anticholinesterase compounds, endotracheal intubation or tracheostomy and negative pressure assisted ventilation for respiratory failure, and thymectomy in 26% of patients and thymomectomy in 8%, 31% of patients with generalized myasthenia gravis died of the disease (29% of these during the first year after onset, 27% during the second and third years, and 17% during the fourth and fifth years), 32% improved, 23% remained unchanged, 10% went into remission, and only 5% were worse during the last year seen than during the worst of the first 3 years (or 5 years in the minority of patients who reached maximum weakness after 3 years). From 1958 to 1965, during which time the management of respiratory failure was improved by positive pressure and volume controlled ventilation and improved intensive care, mortality fell to 14% (p less than 0.005), and a higher proportion remained unchanged (p less than 0.005). From 1966 to 1985, when over half the patients received adrenal cortical steroids, mortality fell to 7% (p less than 0.005) and the proportion who improved rose to 47% (p less than 0.05). Even though the patients who received steroids usually had more severe myasthenia, they had a higher rate of improvement than those who received no steroid, 54% compared to 39% (p less than 0.005). Thymectomy was performed in one-fourth of patients with generalized myasthenia gravis, more frequently in young females and those with more severe weakness, and less often in older males and those with less severe weakness.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1987

[Surgical stabilization of C1 and C2 fractures].

We present operative procedures for the stabilization of fractures of C1 and C2. As is the case for fractures of the extremities, a direct approach to the injury should be attempted in order to avoid the inclusion of intact segments in the spondylodesis. The aim of the three presented techniques - direct screw fixation of fracture of the dens axis and traumatic lysis of C2 - is to active anatomical reconstruction by optimal stabilization. The new technique of transarticular screw fixation of C1-2 developed by Magerl allows unisegmental three-dimensional stabilization in cases in which at least a three-level fusion would have previously been considered necessary.

Bone Screws↗
PubMed1987

[Dorsal spondylodesis of the cervical spine using a hooked plate].

The hook plate is a new device for achieving dorsal fusion of the lower cervical spine (C2-T1). Using the dorsal approach, this technique guarantees independent stability that is sufficient even in cases without anterior stabilization. It satisfies the three main requirements for dorsal implants, i.e. a tension band, independent stability and the possibility of distraction. Except in cases with direct anterior compression of the neural structures (such as herniated discs) the dorsal approach allows, in most cases, direct repair of the injury or luxation. The technique and the results obtained are described and discussed.

Bone Plates↗
PubMed1987

[Refractures].

Explore the source record for details and available documents.

Adult↗
PubMed1987

[Reinterventions in postoperative instability of the lumbar spine].

Among the many reasons for reinterventions in the lumbar spine, postoperative instability was chosen as the subject for investigation. Abnormal mobility can be described more precisely in terms of pathological, segmental movement than in terms of instability, as such movement not only represents a greater range of motion of one vertebra towards the adjacent one, but also movement with a restricted (or normal) amplitude of a pathological pattern. Three conditions create pathological postoperative movement: (1) nonunion after attempted fusion; (2) pathologically increased movement because of removal of important weight-bearing structures; (3) compensatory movement of the segment next to a fusion. At the Wilhelm Schulthess Clinic in Zürich, 26 patients underwent one or more operations on the lumbar spine because of persisting pain as a result of postoperative pathological movement. In accordance with the results reported in the literature, good results were rare in reoperations on the lumbar spine (only 8 patients were completely free of pain); 14 patients had intermittent or continuous lumbar pain and 4 patients became worse. The indications for several interventions are carefully analyzed. Better results could probably have been obtained by more stable fixation techniques (transpedicular fixation, combined ventral and dorsal fusions), but the best means of avoiding reoperation is to observe the following guidelines: first, in disectomy cases, the osseous, weight-bearing structures (lamina, facet joint) should remain untouched. If even partial removal seems to be inevitable, fusion should be added done as well.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1986

High-dose intravenous immunoglobulin in the management of myasthenia gravis.

Intravenous immunoglobulin, 400 mg/kg, was administered daily for five days to 12 patients with exacerbation of generalized myasthenia gravis. Degree of weakness, duration of illness, use of prednisone, and history of thymectomy or thymoma did not affect the response to intravenous immunoglobulin. Eleven patients improved, beginning 3.6 +/- 2.7 (mean +/- SD) days after the start of treatment and becoming maximal in 8.6 +/- 4.6 days, with sustained improvement lasting 52 +/- 37 days. Vital capacity increased from 1748 +/- 510 to 2700 +/- 614 mL at peak effect. Decreases in strength occurred in four patients beginning on day 3.2 +/- 2.5, lasted 1.5 +/- 0.6 days, and were mild in three patients. Other effects were minimal. There was no significant change in acetylcholine receptor antibody titers, which were elevated in all patients. Immunoglobulin seemed to produce a more rapid improvement than corticosteroids and is recommended as an adjunct in the management of myasthenia gravis exacerbations.

Adult↗
PubMed1985

High-dose intravenous methylprednisolone in myasthenia gravis.

Corticosteroids have been useful in the management of myasthenia gravis (MG), but their efficacy has been limited by the slow onset of improvement, initial worsening of MG, refractoriness of some patients, and side effects of large daily doses. High-dose intravenous methylprednisolone pulses have been reported to produce rapid improvement in several immunologic disorders. In this study we administered 2 g of methylprednisolone intravenously every five days to 15 consecutive patients who had exacerbation of generalized MG. Satisfactory improvement occurred in ten of 15 patients after two courses and in two of five patients after a third course. Onset of improvement began a mean (+/- SD) of 3 +/- 1.1 days after the first infusion, 2.1 +/- 1 days after the second, and 2.4 +/- 1 days after the third, and reached its maximum level 8.9 +/- 6.1 days after the last infusion. A decrease in strength occurred in three patients 1.43 +/- 1.30 days after each infusion, was not marked, and lasted three days, following which improvement generally occurred. Side effects were minimal. After improvement, a daily dose of prednisone (30 mg) was used to maintain improvement. Use of pulse therapy at five-day intervals for the management of severe MG seems to have an advantage in that it produces less initial worsening and more rapid improvement in MG, enabling smaller daily maintenance doses to be employed, with fewer side effects.

Adult↗
PubMed1985

Operative treatment of displaced talus fractures.

The talus is a bone with unique biomechanical features and vascular supply. Displaced fractures of the talus, therefore, frequently create problems of proper management. Forty-one severe talar fractures were treated operatively. The incidence of avascular necrosis was relatively low in this series (16%), and all of these were of Type III and IV fractures of the Marti-Weber classification. Type IV fractures were successfully treated by arthrodesis per primam, and suggested that fusion may be the indicated method of treatment in these severe injuries. Fusion of the tibiotalar joint has been used to encourage revascularization and to preserve the important function of the subtalar joint. In all other fracture types with dislocation, anatomic reduction is performed to restore joint congruity and encourage maintenance of talar dome viability. Painstaking postoperative management is important for the complete restoration of function.

Adolescent↗
PubMed1982

Urinary incontinence following prostatectomy in patients with myasthenia gravis.

An unusual incidence of urinary incontinence was observed in patients with myasthenia gravis who required transurethral resection of the prostate for relief of obstruction secondary to benign prostatic hypertrophy. This urinary incontinence was not observed in patients who had open prostatectomies (suprapubic and retropubic). The urinary incontinence did not appear to be related to the control of the underlying muscular disorder. It is suggested that the external sphincter in patients with myasthenia gravis may be more vulnerable to thermal changes that occur when a blended current is used during transurethral resection. If prostatectomy is required in a patient with myasthenia gravis, open surgery should be the procedure of choice. If a TURP is used, then a high frequency current is advised with prudent resection in the area of the prostatic apex.

Aged↗
PubMed1982

Neuromuscular transmission in neonatal mice injected with serum globulin of myasthenia gravis patients.

Neuromuscular transmission was studied in neonatal mice following injection with serum globulin of patients with myasthenia gravis (MG). Compared to controls, these mice showed significant reduction in successive muscle action potentials evoked by repetitive nerve stimulation, amplitude of miniature endplate potentials, and postjunctional sensitivity to acetylcholine. There was no change in evoked isometric tension, quantal content of endplate potentials, or input resistance of the endplate membrane. These results confirm earlier reports of neuromuscular block in animals following injection of globulin of myasthenic patients, and demonstrate that decrease in amplitude of evoked potentials and of miniature endplate potentials is due to reduction in sensitivity to acetylcholine rather than in input resistance of the postsynaptic membrane. These findings are compatible with a postsynaptic defect in MG caused by a humorally mediated autoimmune mechanism.

Adult↗