Biomedical subjects
Publications and source records attributed to P J Hirsch.
It is important to design an exercise program that provides an adequate amount of activity to attain maximal benefits at the lowest risk to the participant. Permanent lifestyle changes in eating and activity habits should be included in the primary goals of all programs.
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A sprain/strain syndrome or "whiplash injury" is the most common cervical injury associated with rear-end impact motor vehicle accidents. This results in a complex injury, often associated with extensive soft tissue injury in the cervical spine. There is additional potential for long term alteration in neurologic, muscular, and skeletal function. Evaluation and treatment should follow standard orthopedic principles.
The computer has become an important tool in orthopedic practice. Indeed, it is now invaluable and will soon be essential. It is still possible to run an orthopedic office without a computer--just as it is still possible to perform meniscectomy by arthrotomy--but that is not what most of us would do. The computer enhances efficiency, can improve business practice, assists in marketing, and helps store and retrieve medical information. The ultimate impact is not only on "business" functions but also on the quality of care.
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A prospective study was carried out to see whether a small fixed dose of warfarin (1 mg daily) given before operation (mean 20 days) would prevent deep vein thrombosis in patients having major gynaecological surgery. One hundred and four patients were randomised into three groups: fixed minidose warfarin; full dose oral anticoagulation; and no treatment (controls). There was a significantly lower incidence of deep vein thrombosis in the minidose warfarin and full dose anticoagulant treatment groups (9% (3/32) and 3% (1/35) respectively) than in the controls (30%; 11/37) but no significant difference between the two anticoagulant treatment groups. Prothrombin time and the activated partial thromboplastin time were normal on the day of surgery in the warfarin treatment group, whereas times were prolonged in the group given full dose anticoagulation. Mean haemoglobin concentrations fell in all three groups after operation but the fall was significantly less in the minidose warfarin treatment group than after full dose anticoagulation. The benefit from full dose oral anticoagulant prophylaxis, based on a preoperative international normalised ratio of 1.5-2.5 with rabbit brain Manchester reagent, was similar to the protection achieved in an oral anticoagulant treatment group controlled with human brain Manchester comparative reagent at a similar level of anticoagulation. The lack of disturbance of normal haemostasis at the time of operation together with a significant reduction in deep vein thrombosis may encourage surgeons to introduce minidose prophylaxis with warfarin.
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We retrospectively reviewed the medical records on all cases of acute epiglottitis in adults from each of the hospitals in Rhode Island and from the state medical examiner's office over an eight-year period (1975-1982). We found 56 cases--an annual incidence of 9.7 cases per million adults. A significant increase occurred in the last two study years. Indirect laryngoscopy proved to be more reliable in making a diagnosis than did x-ray films of the neck; all of 41 indirect examinations were performed without complications. Twenty-three percent (6 of 26) of patients in whom blood cultures had been obtained had bacteremia, all with Hemophilus influenzae. Bacteremia was associated with a high risk of airway obstruction. Four patients died, all from acute airway obstruction, for a mortality rate of 7.1 percent--a rate significantly higher than the current rate among children. Two deaths occurred after admission, while the patients were being observed without an artificial airway. We conclude that the incidence of epiglottitis in adults is higher than previously believed and may be increasing. Fatal airway obstruction can occur without warning, indicating a need for early protection of the airway in adults as well as in children.
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Separation of human endometrium into its epithelial and stromal components has been achieved through collagenase digestion and has permitted a study of these two cell populations under specific experimental culture conditions. The stromal cell populations showed a progesterone response, were easily handled in culture, and displayed a limited in vitro life span typical of human diploid fibroblasts. In contrast, epithelium only survived in short-term primary culture and showed no clear hormone response. High-density epithelial cultures remained viable for longer periods in culture. Comparisons between resurfacing endometrial epithelial cells in vivo and epithelial cells migrating from explants in vitro suggested that this initial epithelial migration in vitro was the counterpart of the repair response in vivo.
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Haematological indices were obtained by Coulter Counter analysis from 325 women in the first stage of labour, and from the cord blood of their newborn babies. The mean maternal haemoglobin concentration was 12.49 g/dl and the mean cord haemoglobin 16.18 g/dl. The mean corpuscular volume measured directly was 89.00 fl from maternal blood and 106.73 fl from the cord blood; the two ranges barely overlapped and it should be possible by automated analysis to differentiate between fetal and maternal blood obtained at amniocentesis or artificial rupture of the membranes at term.
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