Impact of music therapy on the communication skills of toddlers with pervasive developmental disorder.
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Child Development Disorders, Pervasive↗
Biomedical subjects
J Nagler
Publications and source records attributed to J Nagler.
Meckel's diverticulitis in an elderly man diagnosed by computed tomography.
Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. Complications most frequently arise in children younger than 2 years who present with gastrointestinal bleeding. The diagnosis is usually made via radionuclide scintigraphy or intraoperatively. The authors report a 71-year-old man who developed a sudden onset of right lower quadrant abdominal pain, without bleeding, and was diagnosed as having Meckel's diverticulitis via computed tomography. The presence of Meckel' s diverticulitis was confirmed at surgery. Complications of a Meckel's diverticulum must be considered at any age. Computed tomography is another modality that may be helpful in the preoperative diagnosis.
Acute Disease↗
Single drug therapy for Helicobacter pylori infection.
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Bismuth↗
National Committee for the Coordination of Antibiotic Policy in Belgium: the next step in the fight against antimicrobial resistance.
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Anti-Bacterial Agents↗
Self-organized criticality in a nutshell.
In order to gain insight into the nature of self-organized criticality (SOC), we present a minimal model exhibiting this phenomenon. In this analytically solvable model, the state of the system is fully described by a single-integer variable. The system organizes in its critical state without external tuning. We derive analytically the probability distribution of durations of disturbances propagating through the system. As required by SOC, this distribution is scale invariant and follows a power law over several orders of magnitude. Our solution also reproduces the exponential tail of the distribution due to finite size effects. Moreover, we show that large avalanches are suppressed when stabilizing the system in its critical state. Interestingly, avalanches are affected in a similar way when driving the system away from the critical state. With this model, we have reduced SOC dynamics to a leveling process as described by Ehrenfest's famous flea model.
Journal Article↗
Erythropoietin response is blunted in critically ill patients.
OBJECTIVES: Critically ill patients often develop anaemia which can be related to a number of factors. However, the exact causes of anaemia in many patients remain unexplained. We hypothesized that the relationship between erythropoietin (EPO) and haematocrit may be altered in critically ill patients. DESIGN: Serum concentrations of EPO were serially determined by the ELISA method in 36 critically ill, non-hypoxaemic patients who stayed more than 7 days in the Intensive Care Unit, including 22 patients with sepsis and 14 without. Eighteen ambulatory patients with iron-deficiency anaemia served as a control group. SETTING: Two University Hospital Intensive Care Departments. RESULTS: A significant inverse correlation between serum EPO and haematocrit levels was found in the control patients (r = -0.81, p < 0.001), but not in the critically ill patients (r = -0.09, NS), except in a subgroup of non-septic patients without renal failure (r = -0.61, p < 0.01). CONCLUSIONS: EPO levels can be inappropriately low in critically ill patients, so that EPO deficiency may contribute to the development of anaemia in these patients. This phenomenon is observed not only in the presence of acute renal failure, but also in the presence of sepsis.
Acute Kidney Injury↗
Escherichia coli endocarditis of a native mitral valve with paravalvular pseudoaneurysm formation and fatal hemopericardium.
Until recently only few cases have been described of acute infective endocarditis with E. Coli limited to a normal native mitral valve. Furthermore, mechanisms of so called abcess formation and rupture are still uncompletely understood. We report the case of an E. Coli endocarditis developing a rapidly progressive pseudoaneurysm of the mitral annulus. At necropsy diffuse infectious tissue weakening with pseudoaneurysm formation of the mitral ring and dissection into an hemorraghic pericard were seen. The authors further discuss the changing pattern of infectious agents causing acute infective endocarditis of the native mitral valve, transesophageal echocardiographic characteristics of paravalvular cavities and insights in mechanisms of pseudoaneurysm formation and dissection from clinicopathological findings.
Aged↗
The pedagogic characteristics of a clinical conference for senior residents and faculty.
OBJECTIVE: To determine the pedagogic characteristics of a clinical conference for senior pediatric residents and selected faculty. PARTICIPANTS AND SETTING: Nineteen senior pediatric residents and 14 selected faculty members participated in a daily clinical conference at Children's Hospital, Boston, Mass. DESIGN: Qualitative research design using videotapes of nine consecutive hour-long sessions to generate pedagogic topics to be investigated using a questionnaire administered to participating residents and faculty. Narrative responses were analyzed to find pedagogic themes. RESULTS: Analysis of videotapes generated the following three topics: What facilitated learning? What was learned? What makes the process of teaching and learning effective? In the questionnaire residents indicated that learning was facilitated by resident-faculty interactions (19/19), faculty participation (19/19), and information resources (12/19). Content learned included information (16/19), approach to diagnosis (11/19), management strategies (14/19), and different perspective (14/19). An effective process of teaching and learning was attributed to case-based resident initiated discussion (19/19), facilitation by the chief resident (16/19), and non-competitive discussions in which expert faculty played a nondominant role (19/19). Faculty identified identical factors relating to all three themes. The mean rating of the conference was 4.5/5 (SD, +/- 0.50) and 4.7/5 (SD, +/- 0.45) by residents and faculty, respectively (Likert scale, 1 to 5). CONCLUSIONS: The pedagogic effectiveness of this conference was attributed to a resident-centered, case-based learning format and a discussion process characterized by noncompetitive interactions among faculty and residents, strong group facilitation by the chief resident, and participation of faculty experts in a nondominant role.
Faculty, Medical↗
Guanidino compound levels in brain regions of non-dialyzed uremic patients.
Guanidino compounds have been suggested to contribute to the complex neurological complications associated with uremia. Several of them have previously been reported to accumulate in physiological fluids of renal insufficient subjects. We report on guanidino compound levels in 28 brain regions in control and uremic brains. In all brain regions studied, in controls as well as in uremic patients, concentrations of alpha-keto-delta-guanidinovaleric acid, alpha-N-acetylarginine and beta-guanidinopropionic acid remained below detection limits. Creatine, guanidinoacetic acid, argininic acid, gamma-guanidinobutyric acid, arginine and homoarginine were not increased in uremic patients. Argininic acid and homoarginine were detectable in some brain regions only. Creatine concentrations varied from 2500 +/- 2100 nmol/g tissue in hypophysis to 10500 +/- 1200 nmol/g tissue in cerebellar cortex. Even more pronounced regional differences were found for gamma-guanidinobutyric acid with the lowest concentration in the caudate nucleus (0.6 +/- 0.3 nmol/g tissue) and highest in substantia nigra, pallidum and cerebellar dentate nucleus (8.3 +/- 2.8 nmol/g tissue). The guanidinosuccinic acid levels were below detection limit in controls in the majority of brain regions. Taking into account the detection limit of guanidinosuccinic acid for a certain amount of tissue applied to the analytical system, important increases (approx. up to > 100 fold) were observed in all brain regions of uremic patients. Accumulation of guanidinosuccinic acid increased with increasing degree of renal failure with levels up to 65 nmol/g tissue in the hypophysis. Creatinine concentrations were also found to be increased in uremic brain regions but increases seemed to be less strictly related to serum urea levels. Guanidine and methylguanidine were found only occasionally in brain regions of controls while respectively 100- and 30-fold increases were found in brain regions of uremic subjects. Levels of guanidinosuccinic acid and creatinine in uremic brain were comparable to those previously observed in brain of experimental animals displaying convulsions following intraperitoneal injection of the respective compounds. Our findings further establish guanidino compounds as probable uremic toxins contributing to the neurological complications in uremia.
Aged↗
Tracheal aspirate cultures in long-term ventilated patients who have clinical pneumonia.
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Acute Disease↗
Asymptomatic metachronous metastatic renal cell adenocarcinoma to the gallbladder. Report of a case and guidelines for evaluation of intraluminal polypoid gallbladder masses.
A case of asymptomatic metachronous metastatic unilateral renal cell adenocarcinoma to the gallbladder detected five years after resection of the primary renal neoplasm is reported here. The lesion was diagnosed by contrast enhancement of a gallbladder mass on abdominal computerized tomography scan and by color Doppler sonographic study of the gallbladder, both of which demonstrated the vascular supply to the intraluminal gallbladder mass. The biological behavior of renal cell adenocarcinoma is reviewed. Guidelines for the evaluation of intraluminal gallbladder masses are suggested.
Aged↗
Blastocystis hominis in inflammatory bowel disease.
We retrospectively examined the hospital course of 12 patients with exacerbated inflammatory bowel disease (IBD), who also had stool specimens positive for Blastocystis hominis to determine the effect of B. hominis on their disease. Bloody bowel movements were common with ulcerative colitis patients and watery diarrhea with Crohn's disease; other findings included abdominal pain, fever, nausea, and vomiting. All patients responded favorably to medical therapy. Three responded to treatment with corticosteroids alone, and one patient improved with bowel rest without medications. Five patients failed to improve on metronidazole; four of them responded to a subsequent course of corticosteroids, whereas the fifth patient became asymptomatic after erythromycin treatment for concomitant Campylobacter jejuni. Finally, three patients responded to treatment with metronidazole alone, which is known to eradicate B. hominis but may also have a beneficial effect on IBD. In no case did corticosteroid treatment worsen the condition. Our findings indicate that B. hominis is not a significant pathogen in IBD and treatment must be directed toward the underlying illness.
Adult↗
[Potassium-sparing effect of triamterene in a 3-component combination preparation for the therapy of hypertension].
A new fixed-dose combination drug, Minotensin (1 film-coated tablet contains 120 mg bupranolol, 2.5 mg bendroflumethiazide and 25 mg triamterene) was tested in a long-term study. 20 patients with mild to moderate primary hypertension were treated for 6 months. Items of investigation were: influence on low range serum potassium, influence on serum magnesium concentration, blood pressure lowering effect, tolerance and side effects. Initial dosage of 1 tablet b.i.d. could be reduced to 1 tablet in the morning in 4 patients. The mean serum potassium concentration rose from 3.79 +/- 0.3 mmol/l to 4.15 +/- 0.55 mmol/l (p less than 0.01) after 4 weeks, and to 4.26 +/- 0.37 mmol/l (p less than 0.001) after 6 months of treatment, all single values remaining within normal limits. The serum magnesium concentration rose to a small, insignificant extent. Systolic and diastolic blood pressure were lowered highly significantly from 177 +/- 12/103 +/- 7 mm Hg by 19/11 mm Hg. The mean values were within normal limits (less than 160/95 mm Hg) after treatment. Heart rate fell simultaneously by 11 beats per minute, on average (p less than 0.01). Atrioventricular conduction time was slightly prolonged in 2 cases. Serum levels of sodium, BUN and creatinine rose slightly, but remained within the normal range during treatment. Uric acid and lipids were not influenced significantly. 1 patient complained of transient gastrointestinal discomfort. Generally the drug was tolerated very well.
Bendroflumethiazide↗
[Intraoperative infusion therapy. Evaluation of the rate of administration and assessment of the effectiveness of infusion warmers].
A look at the efficiency of infusion warmers from the clinician's point of view must be based on the infusion rates usually necessary in the operating room. Therefore a retrospective evaluation of 1,510 anesthesia records was made in order to register the flow rate of every infusion. As a general rule the flow rate did not exceed 1.5 1/h. Our past warming apparatus was found not very effective in this range under the standard conditions of a cold operating room with laminar air flow. A new in-line warmer, fast and easy to handle, proved superior in daily use.
Blood Proteins↗
Pacemaker endocarditis: contribution of two-dimensional echocardiography.
A case of pacemaker endocarditis is presented. Electrode vegetations could be diagnosed by two-dimensional echocardiography. Prolonged antibiotic therapy failed. Only when the entire pacing system had been removed by cardiotomy with cardiopulmonary bypass, the infection cleared.
Echocardiography↗
Nonexudative diarrhea after gold salt therapy: case report and review of the literature.
A case of fulminant watery diarrhea after therapy with 485 mg of gold thioglucose in a 78-yr-old woman suffering from rheumatoid arthritis is presented. Evaluation failed to reveal evidence of infection, malabsorption, or mucosal inflammation. Treatment, after stopping therapy, was supportive over several months and the patient recovered completely. A comparison with other presentations of gold induced diarrhea is made through a review of all known cases reported in the literature. Although these cases have many points in common, it is apparent that there is a spectrum of disease from fatal hemorrhagic diarrhea to nonexudative diarrhea. Any diarrhea in a patient receiving gold salt therapy must be thoroughly investigated before continuing therapy.
Aged↗
Combined hemoperfusion-hemodialysis in organophosphate poisoning.
We report on a patient treated with combined prolonged hemoperfusion (HP, Adsorba 300 C, Gambro, Sweden) and hemodialysis (HD, C-DAK 1.2, Cordis Dow, USA) for severe dimethoate poisoning. This procedure was adopted since the combination of dialysis and adsorption may improve overall drug removal. Combined HP-HD was performed during 24 h using the same charcoal column and dialyser. Adequate heparinization was obtained by monitoring the whole blood activated partial thromboplastin time. The patient (a 34-year-old female) ingested approximately 10 g of dimethoate (Teletox 10) in a suicide attempt, 30 min before admission to the hospital. On admission, serum level of dimethoate (analysed by gas chromatography) was 2340 ng ml-1. She received conventional treatment and combined HP-HD was started within 2 h after admission. At this time serum levels had risen to 3110 ng ml-1. However, they declined constantly during the epuration and after 18 h no more dimethoate could be detected in the serum. She was discharged 3 days after treatment. During the 24 h of HP-HD treatment, 110.8 mg dimethoate entered the epuration system via the plasma. 55.3 mg were extracted by the charcoal column and 25.3 mg by hemodialysis.
Adult↗