Biomedical subjects
Publications and source records attributed to J Wehner.
The authors give a survey of problems concerning the use of antibiotic aerosols in cystic fibrosis patients. They give recommendations when and how to use this form of treatment. The combination of inhaled antibiotics with the oral or intravenous antibiotic therapy can be recommended best for patients with a chronic lung infection with Pseudomonas aeruginosa.
Ankle fracture dislocations are a common entity in orthopaedic practice and their treatment is well documented. Dislocations of other joints are usually treated by closed reduction with a brief period of immobilization. This ankle dislocation without fracture is a rare injury which was treated similarly to other joint dislocations. An intact bony construct of an ankle following dislocation allows for subsequent joint stability when soft tissues have healed.
Peripheral, posttraining injection of substance P (SP) has been shown to facilitate the retention of aversive and appetitive learning tasks, suggesting that SP may play a role in information processing. In addition, SP may modulate the release of nigrostriatal monoamines, which have also been linked with avoidance learning. This paper examines the interaction between SP and nigrostriatal monoamines by observing the behavioral effects of neurochemical lesions on SP-induced avoidance retention, and by measuring changes in nigrostriatal monoamine activity and receptor regulation following avoidance training and SP injection. In Expt. 1, 5,7-dihydroxytryptamine lesions of the substantia nigra, but not the caudate, attenuated the retention-enhancing effects of posttraining SP injection. Further, 6-hydroxydopamine lesions of the substantia nigra produced a deficit in avoidance conditioning that was reversed by posttraining SP injection. Expts. 2 and 3 demonstrated that although passive avoidance training and posttraining SP injections did not significantly alter nigral 5-hydroxytryptamine (5-HT) activity, SP increased 5-HT1 receptor density. It was concluded that SP may affect avoidance retention by modulating nigral 5-HT activity.
Four patients with adult acquired spastic hemiplegic hand disorders had brachioradialis to extensor digitorum communis tendon transfer to establish motor balance and improve prehensile hand function. All of the patients had volitional control of the wrist and finger flexors without control of the finger extensors, producing a dynamic hand deformity in which the patients could initiate grasp without release. Dynamic electromyography in these patients revealed electrical activity of the brachioradialis muscle during active elbow extension, making a seemingly "out-of-phase" muscle available for "in-phase" tendon transfer. At follow-up, ranging from 26 to 36 months (average of 30.2 months), all four patients improved three functional levels. Translated to functional capacity all of the patients had no functional capacity before operation and good assistive prehension afterward.
From 1957 to 1987 altogether 206 cases of tracheobronchial foreign body aspiration were diagnosed. Two third of the patients were one or two years old. Boys prevailed with 57 per cent. 55 per cent of all foreign bodies were nuts. Only 10 per cent were radiopaque (screws, nails, needles or pieces of bones). The attempt to eliminate the foreign body via the bronchoscope was successful in 96 per cent and failed in seven cases. Six children had to undergo a thoracotomy. In one third of the cases the foreign body remained two weeks or longer in the bronchial tree. 66 children with such a "chronic" foreign body were later on examined by bronchography, which showed in 29 per cent severe deformations of the bronchial wall and in 14 per cent even bronchiectasis. An acute foreign body aspiration should always be considered and handled as an emergency.
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To determine whether or not the crankshaft phenomenon occurs after spinal fusion in patients with congenital scoliosis, we reviewed 23 curves in 21 patients who were operated on before age 10 years. Operative procedures consisted of various kinds of posterior fusions as well as anterior and posterior hemiepiphyseodeses. Seven of the 23 curves progressed greater than or equal to 10 degrees during the course of follow-up, and six of the seven demonstrated increased rotation and were believed to demonstrate the crankshaft phenomenon. No spines rotated without curve progression. The only statistically predictive factor was length of follow-up. No curve that underwent anterior and posterior hemiepiphyseodeses demonstrated the crankshaft phenomenon. Although the crankshaft phenomenon can occur in young patients operatively treated for congenital scoliosis, apparently it can be prevented by anterior fusion.
An iatrogenic intoxication with 300 mg phenobarbital (Lepinal) in a newborn is reported. Description is given about clinical course, blood levels of phenobarbital (maximum 507 mumols/l) and the therapy. The most important therapeutic interventions like alkalinization of urine, haemoperfusion or blood exchange are directed towards increase of elimination of phenobarbital. The phenobarbital blood level decreased from 349 mumols/l before to 242 mumols/l after the blood exchange transfusion in our case. The transfer to a pediatric intensive care unit should be made as early as possible because of the risk of respiratory failure.