[Extending mortality statistics in the 1st year of life using birth weight-related mortality and standard growth curves].
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Biomedical subjects
Publications and source records attributed to M Fuchs.
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To study teratogenicity of cocaine in humans, we studied three groups of pregnant women and their offspring: group 1, 50 women who abused cocaine only; group 2, 110 women who were polydrug abusers; and group 3, 340 who were drug free. All three groups were similar for socioeconomic status, cigarette smoking, and ethnicity. Maternal age of group 1 was similar to that of group 3, but group 2 mothers were significantly older. Gravidity was significantly higher in groups 1 and 2 compared with group 3. No statistical difference was found in spontaneous abortion rate among the three groups, but the stillbirth rate was significantly higher in group 1 (chi 2 = 6.89, P less than or equal to 0.01). All stillbirths were related to abruptio placentae. Birth weight, length, and head circumference were significantly decreased in infants in groups 1 and 2 compared with group 3 (P less than or equal to 0.0001), but no statistical difference was found between groups 1 and 2. The congenital malformation rate was significantly higher in group 1 compared with group 3 (chi 2 = 7.07, P less than or equal to 0.01). We conclude that cocaine abuse in humans significantly reduces weight of the fetus, increases the stillbirth rate related to abruptio placentae, and is associated with a higher malformation rate.
Five cases of Down syndrome in association with fetal alcohol syndrome (FAS) are described. Four of the babies were full term, one was premature. Phenotypically these babies (3M:2F) had manifestations of both Down syndrome and FAS; growth deficiency was more pronounced than is expected in Down syndrome. All measurements, birth weight, length and head circumference were below -2 SD. All had congenital heart disease. Chromosome analysis confirmed 21 trisomy in every case. Down syndrome and FAS may occur together, at random, in 1 in 525,0000 newborns in United States but 1 in 200,000 in our institution. Estimated incidence of FAS and Down syndrome in our institution was 1 in 6,600, a 30-fold increase over the chance occurrence of these two conditions together. Mean age of mothers at delivery was 29.6 +/- 9.3, statistically similar to the mean ages of mothers who delivered Down syndrome and FAS babies in our two hospitals, but was significantly higher than the mean age of mothers in our general population (p less than 0.001). All study cases had chronic alcoholic mothers as well as maternal grandmothers, suggesting that there is an increased incidence of trisomy 21 in children of second generation of alcoholic mothers.
This study was designed to compare manifestations of FAS in the offspring of lower and upper middle class chronic alcoholic mothers, and to compare these offspring with those of nonalcoholic controls. There was highly significant difference in the incidence of FAS offspring between upper middle and lower class alcoholic mothers, 4.5% versus 70.9% respectively. Mean weight, length, and head circumference at birth in children of upper middle class alcoholic women was -ISD, those of lower class alcoholic women fell into -2SD. All other parameters, congenital malformation rate, failure to thrive, mental retardation were also significantly greater in children of lower class alcoholic women (p less than or equal to .01). Attention deficit disorder was found in 21% of upper middle class offspring of alcoholic women as compared to 71% in the children of the lower socioeconomic group (p less than or equal to .01).
Intermediate filament keratin is regarded as a good marker for epithelial and mesothelial tumors. In the intracranial and intraspinal spaces keratin has been demonstrated only in the endocrine cells of the adenohypophysis, squamous epithelial islands in the pars tuberalis of the hypophysis and in the choroid plexus epithelium. Since gliomas and meningiomas do not express keratin, this marker provides an additional help for differentiating between primary and secondary CNS tumors. Indirect immunofluorescence using an anti-keratin serum was used in a retrospective search for keratin in 80 tumors of the cranium and intraspinal space. Of the primary CNS tumors keratin positivity occurred in craniopharyngiomas, epidermoid tumors, pituitary adenomas, chordomas, a plexus papilloma as well as in the majority of germ cell tumors. Only 3 renal cell carcinoma metastases of 21 metastatic epithelial cell tumors (7 bronchial carcinomas, 6 breast cancers, 6 renal carcinomas, 1 rectum carcinoma, 1 cervix carcinoma) were keratin-negative. Similar findings were made in two melanoma metastases which we examined, whereas in a seminoma metastasis a few keratin expressing cells were found. Primary CNS tumors such as myxopapillary ependymomas, medulloepitheliomas, malignant meningiomas and paragangliomas which are often difficult to distinguish from these metastases proved to be keratin negative.
In the pathogenesis of infectious diseases, great importance is attached to the problem of adhesion of bacteria to cells. In 100 urine specimens from normal test persons, patients with infections of the lower urinary tract, with chronic pyelonephritis and glomerulonephritis were studied. The adhesion of strains of Escherichia coli to human uroepithelial cells depended on the concentration of single urinary factors. While increased concentrations of urea and creatinine favored the adhesion process, a statistically significant negative influence was found with regard to potassium, immunoglobulins and pH value. Considering the multifactorial effects of the urinary constituents, we found in a multivariate comparison that none of the studied physiological features alone exerts a fundamental influence upon adhesion, but in their entirety they determine the environmental conditions for the adhesion of bacteria to cells in the urine.
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The hypothesis is promoted that the arterial vessel can modulate the response to atherogenic factors. Patients with the same index of atherogenic factor may have different degrees of arteriosclerosis. The verification of this thesis needs a prospective study. The second fact described is the diminished experimental arteriosclerosis after treatment with the calcium antagonist Nifedipine (Corinfar).
In twelve patients with coronary heart disease and hemodynamically significant coronary artery stenoses (LAD: 11, LAD plus RCA: 1) the effect of intracoronary nifedipine, 0.2 mg, on PTCA-related myocardial ischemia was evaluated. The severity of angina pectoris during balloon inflation was not significantly reduced by nifedipine, whereas the sum of ST segment alterations in Einthoven and Goldberger leads on inflation was significantly decreased by the drug. Before inflation intracoronary nifedipine lowered the systolic arterial blood pressure significantly, whereas diastolic and mean aortic pressure and heart rate remained unchanged. At the end of the inflation period heart rates were significantly faster after nifedipine, and the heart rate-blood pressure product higher with nifedipine. No significant correlations could be calculated between the extent of ST segment alterations and any of the hemodynamic parameters. From our results we conclude that, besides the possibility of ventricular afterload reduction, the beneficial cardioprotective effect of intracoronary nifedipine may mainly be attained by the local "cardioplegic" action of this substance.
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72 patients with supraglottic carcinomas were stratified into two groups with similar cancerological data. 36 underwent horizontal and 36 total laryngectomy. Both groups were radiated postoperatively. In N0, elective neck dissection was omitted. Superior survival was achieved in patients after total laryngectomy. Recurrence rate in the neck for both groups was 6%. There was considerable morbidity after horizontal laryngectomy with aspiration being the main factor. 30.6% of the patients were unable to swallow at all and 30% had a permanent tracheostomy because of laryngeal stenosis. Technical modifications of horizontal laryngectomy including a change in postoperative radiotherapy as described seem to provide better functional results.
The influence of adenoidectomy, myringotomy and lavage of the middle ear was studied in children suffering from secretory otitis. The children were controlled by audiograms and tympanograms over a one-year period of time. 89 percent of all children showed normal values one year following surgery, 11 percent had still high negative middle ear pressures and conductive hearing loss. We think that these children only are candidates for ventilating tubes (grommets).
In 17 anaesthetized open-chest pigs, experiments were performed to determine if a myocardial protective effect can be obtained by intracoronary perfusion through the dilatation catheter during balloon inflation for percutaneous transluminal coronary angioplasty. Placement of the catheter such that the balloon lay in the middle third of the left anterior descending coronary artery caused a significant deterioration in haemodynamic status prior to balloon inflation, and on 5 occasions led to the development of ventricular fibrillation (VF). Balloon inflation without perfusion for periods of up to 5 min produced further haemodynamic deterioration, and culminated in VF in 4/14 cases. Simultaneous perfusion during balloon inflation (proximal perfusion pressure 900-1200 mmHg), with flow rates of 14.5 ml min-1 for arterial whole blood and 21 +/- 7 ml min-1 for blood diluted with 0.90% NaCl (haematocrit approx. 25%), not only prevented the haemodynamic deterioration but resulted in an improvement compared with values obtained with the catheter in position prior to balloon inflation. In no case did VF occur during 5 min of balloon inflation plus perfusion. The use of diluted blood as the perfusate was not associated with intracatheter thrombus formation, which was sometimes seen as a complication of whole blood perfusion.