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Biomedical subjects

M Kleinfeld

Publications and source records attributed to M Kleinfeld.

At least 19 recordsLinked to original sources
PubMed1992

Fatal peritonitis due to group B beta-hemolytic streptococcus in a patient receiving chronic ambulatory peritoneal dialysis.

Peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients is rarely caused by group B beta-hemolytic streptococcus species. We describe a 52-year-old man with chronic glomerulonephritis who developed a fatal peritonitis due to streptococcus group B in the absence of predisposing factors such as diabetes mellitus, malignancy, human immunodeficiency virus (HIV) infection, or liver disease. This report suggests that although beta-hemolytic streptococcus is a rare cause of peritonitis, the severity of the infection may be overwhelming and may rapidly lead to serious consequences and death.

Humans↗
PubMed1990

Giant peptic ulcers in patients with chronic renal failure.

The clinical characteristics and outcome of patients with peptic ulcer disease (PUD) in association with chronic renal insufficiency were compared with those of patients who had PUD without renal impairment. The number of patients hospitalized with PUD was 150, which represented 1.3% of all hospital admissions to Kingsbrook Jewish Medical Center over the two-year period August 1986 to August 1988. The incidence of PUD among the patients with end-stage renal disease was 2.6%. Mortality was significantly higher in patients with serum creatinine greater than 264 mumol/L (Group A) than in patients with serum creatinine less than 264 mumol/L (Group B) (p = 0.02). A striking finding was the presence of giant (greater than 2 cm in width) gastric and duodenal ulcers and ulcers of the second portion of the duodenum in both groups. The difference in number of giant ulcers in Group A and Group B was statistically significant (p less than 0.001). Moreover, the patients in Group A had a higher incidence of upper gastrointestinal bleeding and mortality than those in Group B. Group A patients also had a greater need for surgery than Group B patients. Both groups were predominantly elderly with a mean age greater than 65 years, which may have contributed to the increased incidence of complications and mortality.

Age Factors↗
PubMed1989

The causes and frequency of acute hospitalization of patients with dementia in a long-term care facility.

A retrospective study of 81 patients with dementia in a long-term care facility was conducted to determine the causes and frequency of acute hospitalization and the cause of death in the patients who succumbed during the acute hospital admission. Pneumonia and urinary tract infections were the most frequent causes of acute hospitalization; septicemia and respiratory failure were the most frequent causes of death. These results suggest that patients with dementia are prone to acquire life-threatening infections. Preventive measures to decrease the incidence of these complications are discussed.

Adolescent↗
PubMed1987

Transient hypoglycemic paraparetic syndrome in an elderly patient.

An elderly diabetic patient sustained a transient hypoglycemic paraparetic episode that was attributed to inappropriate administration of glyburide. There were no other predisposing causes to account for the transient hypoglycemia. The predominant clinical signs were paraparesis of the lower extremities, with the right side more affected than the left. The patient's paraparesis cleared within two hours after administration of 50 mL of 50 percent glucose intravenously.The management of a paraparetic syndrome should include an appraisal of all the predisposing factors and their correction. The mechanism that was deemed responsible for the patient's transient hypoglycemic paraparetic syndome was loss of cerebrovascular autoregulation in a vulnerable area (the vertebral-basilar artery distribution). In the elderly patient tight control of blood glucose levels should be avoided in view of the potential development of hypoglycemia and brain injury.

Aged↗
PubMed1986

Physical therapy and dance in the surgical management of breast cancer. A clinical report.

This report describes a creative therapeutic exercise program that is part of a preoperative and postoperative regimen prescribed for patients with breast cancer surgery. Since August 1982, physical therapy has been offered as part of a multidisciplinary breast cancer program at our acute-care hospital. Our physical therapy department provides preoperative and postoperative evaluations and treatment for patients with breast cancer surgery. This treatment is offered on an outpatient basis and includes group dance sessions that are supervised by a licensed physical therapist and a licensed dance teacher. Physical therapy for patients with breast cancer surgery need not be limited to traditional wall-climbing exercises. Early physical therapy intervention should be directed at the unique emotional and physical problems encountered by these patients. Through dance, patients may experience the freedom of total body movement that enhances their adjustment to a new body image. An organized group setting provides a support mechanism that enables patients to share their experiences, fosters a positive attitude toward exercise, and facilitates psychological adjustment to the diagnosis of breast cancer.

Ambulatory Care↗
PubMed1984

Pacemaker alternans.

A 52-year-old man was implanted with a Gemini pacemaker for complete heart block which developed suddenly three months after coronary reconstruction and endocardial resection to treat chronic recurrent ventricular tachycardia. Pacemaker alternans, which is a rare phenomenon, occurred two days after pacemaker implantation and then disappeared 24 hours later. The patient was followed for a two-month period during which the pacemaker system functioned normally. Many of the possible mechanisms which may produce pacemaker alternans were explored. Our findings are presented in this report.

Arrhythmias, Cardiac↗
PubMed1982

Alternans of the ST segment of T wave. A sign of electrical instability in Prinzmetal's angina.

In an effort to determine the incidence of ventricular arrhythmias associated with ST segments alternans, the patterns of ST segment and T-wave electrical alternans (STEA) were analyzed in 93 patients during spontaneous Prinzmetal's angina. Twenty-eight of 93 patients, or 30% (Group I), showed STEA during episodes of ST segment elevation. SIxty-five of 93 patients, or 70% (Group II), showed no alternans during episodes of ST segment elevation. In Group I, ventricular arrhythmias, defined as all ventricular ectopic activity greater than 5 beats per minute and complex Lown grades III to V, occurred during 52 of 55 episodes, or 95%; whereas in Group II, ventricular arrhythmias occurred in only 51 of 125 episodes, or 41% (p less than 0.01). The difference in the incidence of ventricular fibrillation (VF) or ventricular tachycardia (VT) in the two groups was more striking. VT or VF occurred in 20 of 55 in Group I (36%) versus 5 of 125 in Group II (4%). Although there were no significant differences in age or sex between Group I and II patients, there was a significant difference in the magnitude of the maximum ST segment elevation (5 mm in Group I versus 3 mm in Group II, p less than 0.01). This study demonstrates that the occurrence of STEA and T wave alternans frequently heralds the onset of ventricular arrhythmias in Prinzmetal's angina. Both the arrhythmias and the alternans occur during the time of maximal ST segment elevation.

Angina Pectoris, Variant↗
PubMed1981

The mechanism of flutter electrical alternans.

We have had the opportunity to observe the occurrence of flutter electrical alternans in which two distinct populations of flutter waves are present and which alternate in 1:1 and 2:1 patterns. The flutter alternans whether 2: or 3:1, was concordant with the pattern of preceding ventricular conduction (ventriculophasic variation). This concordance occurred reproducibly and remained consistent. Our example of flutter alternans probably represents mechanical artefact caused by catheter movement during ventricular mechanical systole. We reproduced this pattern consistently at a slower rate during coronary sinus pacing. These findings appear to suggest an explanation for certain types of so-called atrial flutter electrical alternans.

Atrial Flutter↗
PubMed1980

TQ segment (baseline) alternans during Prinzmetal's variant angina.

In a study of 93 patients who met criteria for Prinzmetal's angina, alternans of the ST segment was observed in 28 of 93 patients (30%). In 8 of these 28 patients, a hitherto undescribed variant of alternans, namely alternation (larger than or equal to 1 mm shift in 2:1 pattern) in the amplitude of the baseline or TQ segment (TQ Alt) was observed. In all eight patients serious ventricular arrhythmias were noted, namely, ventricular fibrillation in two, ventricular tachycardia in four, and multiform or advanced ventricular ectopic activity in eight. The TQ Alt developed only after ST segment alternans occurred. It is postulated that the alternations of the ST and TQ segments are due to differences in current flows due to inhomogeneity of depolarization and repolarization of the action potential caused by ischemia. Furthermore, the associated arrhythmias observed are related to the inhomogeneous state initiated by the ischemia.

Action Potentials↗