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Biomedical subjects

D Wahl

Publications and source records attributed to D Wahl.

At least 19 recordsLinked to original sources
PubMed1992

Self-limited primary cytomegalovirus colitis in an immunocompetent individual.

Cytomegalovirus colitis in immunocompetent patients has rarely been reported without another severe illness. The prognosis is usually bad, leading to toxic megacolon or death due to multi-organ system failure. We report a case of a self-limited cytomegalovirus colitis in a young patient with no risk factor for CMV infection or associated disease. This suggests that self-limiting CMV colitis may be more frequent than is usually believed, and its prognosis may be better in young patients with normal immune functions. Therefore it should be sought systematically even in immunocompetent young patients.

Adult↗
PubMed1991

Outcome of treatment in alcoholic women.

One hundred and seventy-eight females (mean age 40.6 +/- 10.2 years) were retrospectively studied by questionnaires for a mean duration of 46 (17-75) months. Sixty-two percent were married or living maritally. One third were working. The mean alcohol intake was 157 +/- 76 g/day and 57.3% had alcohol dependence for less than 5 years. Twenty-seven patients (15%) were lost to follow-up; out of the 151 remaining patients, 7 (4%) refused to answer and 18 (12%) died. Suicide and alcoholism complications were a frequent cause of death. One hundred and twenty-six questionnaires were obtained. Twenty-eight women (22%) were abstinent. A good outcome determined by the state of alcoholization (abstinence or moderate consumption) and the improvement of quality of life, was found in 44% of patients. Absence of marital life and greater alcohol intake were related to a poor outcome, whereas enrollment in a fellowship of recovering alcoholics was more frequent in abstinent patients. The mortality rate was important in alcoholic females. A number of factors were related to the outcome.

Adolescent↗
PubMed1991

Angiofollicular lymph node hyperplasia (Castleman's disease) in an adolescent female. Clinical and immunologic findings.

Angiofollicular lymph node hyperplasia is a heterogeneous disorder of unclear etiology and has a wide spectrum of systemic symptoms. This report describes a case of this disorder in a 15-year-old girl and examines the response of the primary mass, systemic symptoms, and alterations of selected immune parameters at diagnosis, as a result of steroid therapy and radiation therapy (RT). The patient had a 1-year history of growth failure, delayed puberty, and refractory iron deficiency anemia. Computed tomography scan showed a posterior mediastinal mass. Biopsy revealed angiofollicular lymph node hyperplasia of mixed hyaline-vascular and plasma cell type histologic type. Immunoperoxidase studies showed polyclonal B-cells, predominance of T-helper cells (CD4) over cytotoxic/suppressor T-cells (CD8), and the presence of natural killer (NK) cells. Southern blot analysis demonstrated germ line gene configuration for the T-cell antigen receptor and Ig heavy chain. The patient clinically improved with RT after failing to respond to steroids. Immunophenotyping of peripheral blood lymphocytes before therapy revealed a CD4:CD8 ratio of 0.8 with decreased numbers of circulating T-cells; this increased to 1.4 after steroid therapy. The patient's T-lymphocytes had no proliferative response to phytohemagglutinin (PHA) or concanavalin A (Con A) before RT. After RT, a small but significant mitogenic response to these reagents was noticed. The proliferative response to recombinant interleukin-2 (rIL-2) remained similar to that of control lymphocytes. Induction of second messenger signals by activation of protein kinase C (PKC) and elevation of free cytosolic calcium through the use of the phorbol ester, phorbol 12, 13-dibutyrate (PDBu), and ionomycin (Io) resulted in a strong proliferative response at diagnosis and after RT. In vitro cytotoxicity assays revealed diminished NK activity before and after therapy. Lymphokine-activated killer (LAK) activity remained comparable with that of control cells and was not affected by therapy. Before RT patient lymphocytes maintained cytotoxic capabilities after coincubation with rIL-2 and PDBu plus Io, whereas coincubation with these reagents abrogated cytotoxic function of normal cells. This case demonstrates a clinical response to RT as well as improvement in immune parameters. Intact signal transduction mechanisms through PKC activation and elevation of cytosolic calcium were also demonstrated in the circulating lymphocytes.

Adolescent↗
PubMed1991

[Sedation with intranasal midazolam for endoscopy of the upper digestive tract].

Twenty-nine patients, ranked ASA 1 or 2, scheduled for diagnostic gastroduodenal fibroscopy were randomly allocated into three treatment groups: intranasal midazolam (IN) 0.15 mg.kg-1; intramuscular midazolam (IM) 0.15 mg.kg-1, and placebo (P). Sedation and the fibroscopy were all carried out by the same anaesthetist and fibroscopist. Efficiency and tolerance of the method were assessed by monitoring the heart rate, systolic and diastolic arterial blood pressure, arterial oxygen saturation (pulse oximetry), the degrees of sedation, anxiety, and anterograde as well as retrograde amnesia. The patient's and endoscopist's reactions were also considered. Patients in group P were older than those of the other two groups (p less than 0.01). Sedation was more important and patients less anxious in groups IN and IM than in group P. Three patients in group IM had retrograde amnesia. There were no significant differences between the degrees of anterograde amnesia in the three groups. At no time during the study were there any significant differences in SpO2 between and within groups. Four out of the 9 patients in group P had a bad opinion of their experience, as compared with two out of the 20 in the midazolam groups; the difference was not statistically significant. Three hours after the procedure, all patients were fully awake. Intranasal administration of midazolam therefore seemed to be an interesting alternative for gastroduodenal fibroscopy, because it was simple, non traumatic, well tolerated, and did not result in arterial desaturation.

Administration, Intranasal↗
PubMed1991

[Treatment of Monteggia fracture in children].

Described in this paper is a therapeutic concept by which to cope with Monteggia's fracture in childhood. It is based on experience obtained from 72 cases with injuries of that kind and their evaluation in a group study. Therapeutic approach to the individual case was determined by the following criteria: age of infant, localisation and shape of ulnar fracture, reducibility of capitulum radii, and accompanying injuries requiring treatment on the same arm. The need for surgical stabilisation of ulnar fracture was found to increase along with growing age of the affected child. High-stability anatomic reduction of the ulnar fracture proved to be a prerequisite for safe stabilisation of the radial capitulum. Close reduction has proved to be sufficient in many instances. Open reduction and internal fixation were found to be necessary in cases in which an ulnar fracture was irreducible or instable and/or a radial head was not reducible. Minimal osteosynthesis and plaster cast is considered to be an optional therapy for younger children, whereas ulnar stabilisation by means of plates is preferred for children in somewhat advanced age of childhood. The radial head may be fixed by trans-articular Kirschner's wire (WITT) or primary reconstruction of the annular ligament, using a strip of biceps or triceps tendon, or adaptation around the collum radii and ulna of the proximal radio-ulnar joint by means of a sling of Dexon or Vicryl suture.

Child↗
PubMed1989

[Acute thrombosis of mitral Starr prosthesis. Value of color coded two-dimensional doppler echocardiography].

In a case of acute thrombosis on mitral Starr valve two-dimensional doppler-echocardiography rapidly showed that parts of the transprosthetic jets had disappeared, while conventional continuous wave doppler ultrasound confirmed the presence of a severe haemodynamic obstacle. With colour-coded doppler ultrasound, there only remained a jet that was parallel to the posterior wall of the left ventricle. This jet was of unusual pattern, with the presence of turbulence and high velocities in aliasing colour. The effectiveness of a thrombolytic treatment was demonstrated by the reappearance of the missing diastolic jets with return to normal velocities. Comparison between a post-thrombolysis colour-coded doppler examination and a reference examination confirmed that the valve was now functioning normally. Thus, while conventional doppler recordings accurately quantify prosthetic dysfunctions leading to stenosis, two-dimensional doppler recordings rapidly provide an anatomical information. By showing changes in the transprosthetic jets they indicate the precise location and extent of valve obstruction.

Echocardiography, Doppler↗
PubMed1989

[Post-infarction anterior septal rupture. Aspects of the IVC flux on bidimensional Doppler with color coding].

In a case of anterior septal rupture complicating a transeptal myocardial infarction, the diagnosis of IVC is immediately confirmed by bidimensional Doppler with color coding. The abnormal flow and its three components are studied in multiple section planes. Incidences permitting the best visualization of the shunt are the longitudinal sections: left parasternal and apical-long axis. The parasternal short axis section only visualizes an abnormal intraventricular flow. Sweeping of the septum by caudal tilting of the probe, from an apical section of the 4 cavities, successively studies the three portions: left intraventricular, trans-septal, and right intraventricular of the abnormal flow. The size of the defect seems underestimated on bidimensional ultrasonograms as well as color Doppler. Speed, sensitivity and reliability of the color coded bidimensional Doppler, places it as the reference diagnostic test in this type of pathology. Catheterization still has a place in evaluating the severity of the shunt.

Aged↗
PubMed1979

[Lipids and phospholipids in the fluid of broncho-alveolar lavage. Value for the study of alveolar penetration of corticosteroids by aerosol (author's transl)].

Broncho-alveolar lavages from 13 control subjects have been studied for the following parameters : phospholipids, free fatty acids, total last parameter, through the depolarisation of Diphenylhexatriene, is independent of the recovered volume. An identical study has been performed for two bronchiolo-alveolar cancers. A treatment with hydrocortisone-containing aerosol has been associated with an increase in phospholipid amount and a drastic decrease in microviscosity. This observation suggests that the synthesis of tensio-active phospholipids is dependant of corticoids by an enzymatic induction. The effect of therapeutics given in aerosol can be monitored by the biochemical and physical modification in broncho-alveolar fluids thus obtained.

Adrenal Cortex Hormones↗
PubMed1978

[Instrumental technics of exploration of the mediastinum].

Several techniques can be used for the diagnosing of diseases pertaining to the mediastinum. The diagnosis can be made in 78% of cases by mediastinoscopy. When the lesion is situated beyond the reach of mediastinoscopy, needle biopsy and pleuroscopy can be used either alone or associated to mediastinoscopy. The histological diagnosis can be made in almost all cases. But a few precautions are necessary because this technique carries a certain risk for vessels. Therefore preoperative angiography of the superior vena cava or arteriography of the branches of the aortic arch should be performed to help for the diagnosis and ensure its safety.

Biopsy, Needle↗
PubMed1978

[Respiratory localizations of Launois-Bensaude symmetrical lipomatosis. Apropos of 3 cases].

The authors report 3 observations of cervico-facial lipomatosis with mediastinal localization. In the 3 cases the rather unusual localization of Launois and Bensaude's disease produced respiratory troubles which worsened a chronic respiratory insufficiency due to another cause. Once a tracheotomy had to be done because of tracheo-malacia. Another time there was a pharynged localization. This disease etiology always remains obscure, usually appearing in alcoholic addicts of about 50. Mediastinal localizations have been unfrequently described but must be searched for systematically. The evolution is chronic, without specific treatment. If there is already a chronic respiratory insufficiency in relation with a chronic obstructive bronchopneumopathy or a cardiac insufficiency, then the mediastinal localization becomes an aggravating factor.

Aged↗
PubMed1978

[Anuric tubular nephritis caused by rifampicin allergy].

Starting again a Rifampicin treatment gave rise to an acute renal insufficiency, reversible by hemodialysis. This incident resulted from an immunopathological conflict revealed by the presence of anti-Rifampicin antibodies. Renal needle biopsy did not show any immune deposits. The mechanism of these incidents is discussed. Authors draw attention to the necessity of avoiding discontinuous Rifampicin treatment.

Acute Kidney Injury↗