Biomedical subjects
Publications and source records attributed to H G Haas.
The external mini-fixator of Jaquet is a new way for external stabilization in hand surgery. The technique of applying the external mini-fixator is described and the results in the treatment of 23 cases of infected non-unions, non-unions with defect and arthrodeses are reported.
In bone and soft tissue infections surgical treatment is often indicated. Gentamycin-containing plastic beads permit an additional, highly effective local antibiotic therapy. Beads of smaller caliber have been developed for the use in hand surgery.
Case report of a 35-year-old female patient who was admitted in Addisonian crisis and in whom primary adrenal, ovarian and thyroid failure was detected. Antibodies against the adrenals and the thyroid were found, together with dinished serum IgA levels. The patient had been treated for 20 years with diphenylhydantoin, a drug known to induce immunological disturbances, e.g. depression of serum IgA levels. The IgA deficiency and pluriglandular failure may be due to prolonged therapy with diphenylhydantoin. The coincidence of IgA deficiency and autoimmune diseases is well known. As far as is known this is the first case of IgA deficiency associated with autoimmune polyendocrinopathy.
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258 fresh and old navicular fractures and pseudarthroses are analysed with regard to conservative and operative treatment. Fracture healing occurred in 97.2% of conservatively treated cases. The method described by Matti-Russe using an iliac graft has given good results in old fractures and pseudarthroses, causing 95% fracture healing in old fractures and 76% in pseudarthroses.
Cyproteroneacetate, an antiandrogenic and gonadotropin-inhibiting steroid, has a marked ACTH suppressive effect. In rats, adrenal atrophy and severe impairment of ACTH and corticosterone responses to stress are induced by a 10-day treatment with 3-0.75 mg/100 g BW cyproteroneacetate/day. Two weeks after cessation of treatment, the ACTH adrenal system has not yet recovered. The ACTH suppression is evident 6 h after a single dose. In 25 human volunteers, a single dose of 200 mg cyproteroneacetate impaired their ACTH and 11-deoxycorticosteroid response to 1 g metyrapone. A similar impairment was seen in 12 women on sequential treatment with cyproteroneacetate and ethinyl estradiol. In 4 out of 11 children treated for precocious puberty, random plasma ACTH and cortisol measurements, cortisol responses to ACTH, and ACTH and cortisol responses to insulin-induced hypoglycemia revealed severely impaired ACTH adrenal function. Questionable impairment was found in 2 out of 11 and normal function in 5 out of 11 children. In 10 patients with endogenous elevated plasma ACTH, 10 days of treatment with cyproteroneacetate, in addition to the steroid substitution, diminished the morning plasma ACTH levels. It is concluded that cyproteroneactate has a pronounced ACTH-suppressive effect. The individual susceptibility of treated patients varies and the effect is dose dependent. A cortisol-like effect must be assumed, because cyproteroneacetate-treated animals and patients under therapy can withstand stress situations without signs of adrenal insufficiency. ACTH adrenal function must, however, be closely watched in treated patients and steroid cover must be considered in conditions of stress. Great care has to be taken when the drug, with its own "stress-protective" effect, is withdrawn. The recovery of ACTH adrenal function may take several months.
In 258 patients with fractures and pseudarthroses of the carpal scaphoid the cause and type are given and the results of treatment are presented. It is verified that the majority of fresh fractures are united by plaster immobilisation. In fractures with delayed healing and in cases with non-union the best results are achieved by autologous bone grafting.
In normocalciuric and in hypercalciuric renal stone formers tubular calcium reabsorption (TRCa) was studied before and during an intravenous calcium infusion. In addition two patients with proven primary hyperparathyroidism (pHPT) were studied. TRCa was decreased in hypercalciuric stone formers whereas an increase was noted both in pHPT and in normocalciuric subjects. It is concluded that normocalciuric nephrolithiasis may be a manifestation of mild and/or early pHPT.
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In double sucrose gap voltage clamp experimetns on frog atrial bundles the configuration of membrane current and contraction was used to estimate the quality of voltage control. Attention was focused on possible action potential activity along the test segment in response to depolarizing clamps. At low depolarizations large Na+ inward currents were observed while any tension response was missing. Transmembrane potential threshold for generation of a mechanical response was evaluated from conditioned (attenuated) action potentials. The mechanical threshold determined from action potential measurements was only slightly higher than that determined from step-clamp depolarizations. With clamp potentials below the threshold, then, any action potential activity induced by the inward current phase is expected to be rudimentary.
1. The extent to which skeletal involvement in hyperparathyroidism can be detected by X-ray remains an unsolved issue. The present investigation, aimed at resolving this problem, was carried out in 44 patients with primary (PHPT) and 57 subjects with secondary hyperparathyroidism (SHPT) due to terminal renal insufficiency. For comparison, 49 age-matched controls were included in this series. Subperiostal resorption of the phalanges of the hand was considered pathognomonic and graded according to a semiquantitative system using a magnifying lens. The data were compared with the serum calcium and alkaline phosphatase values. 2. Pathological subperiostal resorption was detected in 38.5% of the PHPT and in 56% of the SHPT patients while the controls showed 4% (false) positive results. A highly significant correlation between the extent of bone resorption and alkaline phosphatase was found (PHPT: r=0.80, SHPT: r=0.71, p less than 0.001). No correlation of the X-ray findings to the serum calcium could be detected. Compared to the degree of skeletal involvement demonstrated by X-ray, the alkaline phosphatase was significantly lower in SHPT than in PHPT. In PHPT on the other hand, subperiostal resorption was prominent among female patients aged over 40 years, while no prevalence for sex and age was found in the SHPT group. 3. These results demonstrate that a clinically relevant degree of bone involvement in hyperparathyroidism may be easily and reliability assessed by evaluating X-rays of the hands by means of a magnifying lens. Increased bone resorption in hyperparathyroidism appears to be paralleled by an increase of osteoblastic activity as assessed by elevation of alkaline phosphatase. In SHPT due to chronic renal failure, however, a relative osteoblastic insufficiency seems to exist. In PHPT, the prevalence of subperiostal bone resorption in women aged over 40 years may be compatible with a skeletal protecting effect of intact ovarian function (estrogens).
The extent to which histomorphometric analysis of bone biopsies correlates with Ca kinetic and biochemical parameters to reflect true bone formation and resorption in adult man remains an unsolved issue. Two groups of patients with either low (osteoporosis), (n = 15) or high (Paget's disease, n = 6) bone turnover were studied before and after sodium fluoride (NaF) and diphosphonate (EHDP) treatment, respectively. Histomorphometry of iliac crest biopsies permitted precise quantitation of the osteoblast layers (SVab), osteoid seams (SVos), the number of osteoclasts (NAocl) and the Howship's lacunae (SVhl). These determinations were correlated with serum alkaline phosphatase (aPh), urinary hydroxyproline (HyPro), Ca accretion rate (Vo+), and Ca mobilization rate (Vo-). In both patient groups bone formation indices were significantly correlated: SVob/Vo+, r = 0.85; SVos/Vo+, r = 0.83; and aPh/Vo+, r = 0.97. Provided that bone matrix formation and mineralization progess at the same rate, bone formation may be assessed by measuring either aPh, Vo+, SVob, or SVos. From these correlations it is not possible to draw any conclusions regarding the absolute "true" value of bone formation, be it in terms of Ca kinetics, alkaline phosphatase, or histomorphometry. However, since Vo+ retains its proportionality to all the other bone formation parameters tested, the so-called "slow exchange," which refers to pure physicochemical Ca exchange processes in the bone mineral, does not perturb Vo+ in an unsystematic way. Vo+ as well as aPh and histomorphometric indices are thus reliable, though not absolute indices of bone formation. Bone resorption indices correlated less well than bone formation indices: NAocl/Vo-, r = 0.68 and SVhl/Vo-, r = 0.63 with both groups. In the osteoporotic group, a negative correlation existed between the empty Howship's lacunae SVhe and Vo+, r = -0.62. Consequently, the overall extent of Howship's lacunae SVhl is influenced both by bone resorption and bone formation. On the other hand, the best correlation of HyPro was with the sum of Vo+ and Vo-, r = 0.97, confirming that HyPro is a sensitive index for the change of bone turnover.
15 cases with pain in the shoulder girdle following an operation in supraclavicular brachial plexus anesthesia are reported. The pain developped after an interval of several days. According to the neurological findings the diagnosis is regarded as neuralgic amyotrophy. Possible causes are discussed.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.