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PubMed2003

Historical review: concept of acid-base balance in medicine.

This paper attempts to illustrate historically how important developments in the comparatively new field of physical chemistry during the second half of the 19th century made possible the understanding of ions and acid-base phenomena in clinical and laboratory medicine. Primarily based upon the revolutionary concept of ionization by Svante Arrhenius, it was the studies of two Americans, Lawrence Joseph Henderson and Donald Dexter van Slyke, during the first two decades of the 20th century that resulted in the elucidation and clinical laboratory evaluation of two major diseases, diabetes and nephritis, and the resulting recognition of the phenomena of acidosis and alkalosis.

Acid-Base Equilibrium↗
PubMedDate not supplied

[Persistence of the right valve of the sinus venosus with partial division of the right atrium].

A case of persistent right valve of the sinus venosus (the so-called cor triatriatum dexter) is described. There were associated severe pulmonary valve stenosis and probe patent foramen ovale. The patient survived to the age of 25, without complaints. His death was due to complications of pulmonary thromboembolism. The anomaly was detected prior to death by echo-doppler-cardiogram. The postmortem findings of the heart are described in detail.

Adult↗
PubMed1992

[The effect of monotherapy on concentration of selected blood serum hormones and upon cognitive function of children with epilepsy].

The studies included 64 children with newly diagnosed epilepsy, aged from 6 to 15 years of life. In 25 children with partial and secondary generalized seizures monotherapy with carbamazepine was introduced; in 19 children with primary generalized seizures--with phenobarbital, and in patients with both types of seizures--with primidone. Monotherapy was controlled by means of blood serum drug concentration level monitoring; the therapy was successful in all the children. The group did not include patients with mental retardation, and epilepsy was idiopathic. Prior to the institution of treatment, a single determination of blood serum triiodothyronine, thyroxine, TSH, prolactin, cortisol, LH and testosterone was made. Psychological test were carried out employing Wechsler's scale, Bender-Santucci test, rhythmic structures developed by Mira Stambak and test of manual dexterity (card display). In order to evaluate short-term effects of the employed drugs upon the blood serum concentration values of the studied hormones, a repeated determination was made one month after the initiation of therapy. The third determination was made one year after the onset of treatment in order to assess the long-term effects. The effect of drugs upon their cognitive functions was assessed in a follow-up psychological testing performed after one year of therapy. The studies combined with statistical analysis led to a conclusion that after one month of monotherapy there occurred a significant drop in thyroxine concentration levels, still augmented after one year. Patients treated with carbamazepine showed a significant decrease of T3 levels after one month and one year, whereas treatment with phenobarbital and primidone did not result in significant changes of T3 concentration. Yet, T3 and T4 concentration values did not exceed normal limits. No type of monotherapy resulted in significant long-term changes of TSH concentration levels. No clinical signs of hypothyroidism nor goiter were observed in the studied children. After one month of monotherapy with carbamazepine and phenobarbital there was observed a significant increase of prolactin and cortisol levels, which was absent after one year. The values observed did lie within normal limits. No significant changes were observed with respect to the effect of the studied drugs upon blood serum LH and testosterone levels. After a one-year monotherapy with primidone the children revealed a significant improvement of results measured on performance scale and by means of a full Wechsler scale. Carbamazepine and phenobarbital did not affect the intelligence quotient of the studied children.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1992

Studies of bone marrow progenitor cells in lupus-prone mice. I. NZB marrow cells demonstrate increased growth in Whitlock-Witte culture and increased splenic colony-forming unit activity in the Thy-1-, lineage- population.

Previous studies have demonstrated that NZB marrow can transfer features of autoimmunity. Therefore, we undertook a study of NZB marrow to determine whether it demonstrated any phenotypic abnormalities. In Whitlock-Witte cultures, NZB marrow cells generated nonadherent cells at low seeding densities, densities at which marrow from other strains did not generate nonadherent cells. In contrast, NZB marrow grew less well than controls in Dexter cultures. Inasmuch as the latter favor growth of granulocyte-macrophage precursors and the former B cells, these results suggest a possible skewing of NZB marrow cells toward lymphocyte production. Unfractionated marrow cells from NZB mice were found to produce 10-fold more splenic colonies in lethally irradiated recipients than marrow cells from control mice. This result was independent of the genotype of the recipient. When the progenitor Thy-1lo, Lin- marrow subpopulation was studied, NZB mice did not differ substantially from controls regarding splenic CFU. Therefore, Thy-1-, Lin- marrow cells were studied as a possible source of the excess splenic CFU in NZB mice. Indeed, the NZB Thy-1-, Lin- population contained 30-fold more splenic CFU than did the Thy-1-, Lin- population from control mice. These results suggest that NZB mice have unusual marrow progenitor cells; such cells may play a role in their autoimmune disease.

Animals↗
PubMed1976

Predictive tests in Huntington's disease.

HD is a dominantly inherited disorder that affects mental and motor systems and includes a rigid form as well as the better known choreic form. Many articles have been devoted to predicting the future onset of the disease in patients who are at risk, but none of the suggested predictors is currently considered completely reliable. Members from individual families do tend to show a similar age of onset, and similar intellectual and motor abnormalities do develop within a single family; but the presence or absence of this dominant gene of high penetrance is not usually certain until the obvious physical signs appear. Predictive tests are of importance not only to decide which person may develop the disorder, but they may also offer a clue to associated or causal features of the disease. This chapter is a review of reported predictive tests in HD, emphasizing the rationale for their use. Psychological testing has often been abnormal early in the course of the disease of some patients, particularly when motor dexterity or apraxia is tested. Family members often insist that various psychological traits enable them to predict which members are affected by the gene. These opinions are summarized. Neurophysiologic tests are briefly reviewed, including new data on increased liklihood of H-reflexes in HD. Electroencephalography was once touted as a possible predictive test but, although there is frequently an association of a low voltage EEG activity with HD, this change is too variable for certainty in prediction. Pneumoencephalography with specific measurements of caudate atrophy is of clinical interest, but a pneumoencephalogram is rarely needed for diagnosis and caudate atrophy may not actually be an early sign. Metabolic changes in HD include the biochemical effects of hypothalamic dysfunction, changes in growth hormone, and reported change in GABA levels in the CSF or brain. Provocative tests have utilized numerous drugs in an attempt to predict the onset of the disease, including particularly physostigmine and L-DOPA. All of the tests elucidate peculiarities of the disease, and all are of ethical as well as neurological interest. Many of the provocative tests utilize quantification of known neurologic features of the disease, such as reduction in saccadic movements of the eye, increased reflexes, or patterns of movement. The ethical problems in predictive tests, especially tests intended to provoke features of the disease, have been a matter of quiet controversy. Should a nontreatable disease be overtly diagnosed? And if so, will it benefit the patient? Can any of the tests tend to accelerate the patient's decline, either by physical or by psychological trauma? This chapter reviews the various predictive tests and their rationale and concludes that none of the tests are totally reliable. Many offer interesting insights into the effects of HD and do broaden the overall significance of this fascinating disorder of basal ganglion function.

Age Factors↗
PubMed1992

[Laparoscopic cholecystectomy].

Laparoscopic cholecystectomy has been accepted clinically in a very short time. Following an intensive training-course for manual dexterity clinical experience should be achieved in carefully selected cases. After a certain number of cholecystectomies the majority of cholecystectomies can be performed laparoscopically. The complication rate of laparoscopic cholecystectomy in the hand of a well trained surgeon seams to be comparable or even smaller than in conventional procedure. The patients have significantly less pain and bodily activity starts early. The postoperative time in hospital in our clinic is two to three days. The rehabilitation-time could be shortened.

Cholecystectomy↗
PubMed1965

CAROTID "THROMBOSIS" AND "FIXED NEUROLOGICAL DEFICIT". TWO CASES SURGICALLY TREATED.

Chronic "fixed" neurological deficits do not appear to be entirely beyond amelioration by surgical operation even in the presence of considerable intracranial disease. Improvement in the particularly important spheres of verbal communication and mental dexterity may be anticipated in some patients. The presence of multiple vessel involvement is additional stimulus to operative intervention. Failure to carry out arteriographic examination in cases of "chronic" stroke, or relying too much on the results of such an examination as an indication of local inoperability may lead to errors in treatment. Likewise, exploration of the "occluded" carotid artery in patients with multiple vessel disease may show patent distal vessels in a worthwhile number of cases.

Angiography↗
PubMed1992

[Studies of human bone marrow stromal cells--effects of antimetabolites on the growing dynamics of human bone marrow cells and their support of hemopoietic cells].

The effects of antimetabolites on the growing dynamics of human bone marrow stromal cells and their support of hemopoietic cells were tested by using a modified version of Dexter's culture system. Cytosine arabinoside (ara-C) was found to suppress neither the growing dynamics nor the supportability. On the other hand, methotrexate (MTX) suppressed the supportiveness, even though it hardly suppressed the growing dynamics. The recognition of injury to marrow cells could be of potential importance in cancer chemotherapy. Our in vitro evidence may provide clinical insights for cancer chemotherapy including prolonged marrow suppression or pretreatment of bone marrow transplantation.

Adult↗
PubMed1990

Memory disturbances following chronic, low-level carbon monoxide exposure.

Neuropsychiatric sequelae are a common feature of acute carbon-monoxide (CO) poisoning-particularly when the patient has experienced an episode of CO-induced unconsciousness. In this case report, we present neuropsychological test data demonstrating the presence of mild cognitive impairments following a chronic (3-year) history of low-level CO exposure that never produced loss of consciousness. Deficits were limited to concentration and memory; performance on measures of general intelligence, visuospatial functioning, and speed and dexterity were well within the normal range.

Journal Article↗
PubMed1992

Pesticide exposure and neuropsychological impairment in migrant farm workers.

The chronic, long-term effects from exposure to many frequently used pesticides have yet to be fully documented. Migrant Hispanic farm workers who are the frequent victims of such exposures are rarely studied. A neuropsychological test battery was administered to 21 migrant farm workers acutely exposed to Phosdrin, Lannate and Maneb on two occasions, and to 11 controls matched for age, sex, education, socioeconomic status, and ethnicity. Results revealed that two years after the pesticide exposures, the exposed group was significantly more impaired than controls on tests of psychomotor speed, dexterity, and visuospatial memory. Disturbing emotional symptoms were reported with significantly greater frequency by the exposed group in comparison to controls. Results are consistent with the previously reported constellation of symptoms and neuropsychological deficits associated with pesticide exposure.

Journal Article↗
PubMed1987

Progression of neuropsychological deficits following toluene diisocyanate exposure.

Three wharf workers were acutely exposed to toluene diisocyanate (TDI) during an accidental chemical spill. Toluene is neurotoxic as a solvent, while cyanates can cause nervous tissue injury or death by hypoxia. Chronic symptoms which occurred following the incident included headache, fatigue, concentration problems, irritability, depression, sleep disturbance, memory and sexual dysfunction. Compared with two months post-exposure, at 16 months post-exposure Full Scale IQ dropped an average of 23 points. Results from additional neuropsychological testing at 16 months post-exposure indicated severe deficits in all three subjects in memory, manual dexterity, visuomotor tracking, mental flexibility, ability to detect figure-ground relationships, and word fluency. Nerve conduction velocity testing indicated abnormal peripheral nervous system function in two of the three workers; however, its etiology is not certain. These results may be relevant to the neurotoxicity of methyl isocyanate exposure, such as occurred in Bhopal, India, where an increasing magnitude of depression, anxiety, fatigue, restlessness, and headaches 18 months post-exposure have been reported. In general, continuing decrement in mental function without concomitant environmental exposure should be considered in neuropsychological assessment of chemical toxicity.

Journal Article↗
PubMed2003

Dependent seniors at home--formal and informal help.

OBJECTIVES: This article documents the number of hours of help that seniors living in private households received from formal and/or informal sources in 1996. DATA SOURCE: Data are from Cycle 11 of the General Social Survey, conducted in 1996. This analysis focuses on 1,089 respondents aged 65 or older who, because of a long-term health problem, required assistance to remain in their homes and who indicated the source of assistance and the amount of help time received. ANALYTICAL TECHNIQUES: Analysis of variance, followed by Tukey's HSD test, was used to examine differences in help time received from each source. Medians are presented using an independent medians test. Linear regression was used to model associations between the amount of help time received from each source and certain characteristics. MAIN RESULTS: In 1996, dependent seniors living in the community received a median of 3 hours of help a week. Most of this assistance came from informal sources. Living arrangements and age were the major influences on hours received from informal sources. Having no surviving children and being disabled in terms of dexterity or mobility/flexibility were associated with increased hours of formal care. For those getting both types of help, increased hours from formal sources did not significantly reduce the hours received from informal sources.

Activities of Daily Living↗
PubMed2002

Compression under a mechanical counter pressure space suit glove.

BACKGROUND: Current gas-pressurized space suits are bulky stiff shells severely limiting astronaut function and capability. A mechanical counter pressure (MCP) space suit in the form of a tight elastic garment could dramatically improve extravehicular activity (EVA) dexterity, but also be advantageous in safety, cost, mass and volume. The purpose of this study was to verify that a prototype MCP glove exerts the design compression of 200 mmHg, a pressure similar to the current NASA EVA suit. METHODS: Seven male subjects donned a pressure measurement array and MCP glove on the right hand, which was placed into a partial vacuum chamber. Average compression was recorded on the palm, the bottom of the middle finger, the top of the middle finger and the dorsum of the hand at pressures of 760 (ambient), 660 and 580 mmHg. The vacuum chamber was used to simulate the pressure difference between the low breathing pressure of the current NASA space suits (approximately 200 mmHg) and an unprotected hand in space. RESULTS: At ambient conditions, the MCP glove compressed the dorsum of the hand at 203.5 +/- 22.7 mmHg, the bottom of the middle finger at 179.4 +/- 16.0 mmHg, and the top of the middle finger at 183.8 +/- 22.6 mmHg. The palm compression was significantly lower (59.6 +/- 18.8 mmHg, p<0.001). There was no significant change in glove compression with the chamber pressure reductions. CONCLUSIONS: The MCP glove compressed the dorsum of the hand and middle finger at the design pressure.

Adult↗
PubMed2003

Testing the effectiveness of techniques for reducing heat strain in Royal Navy nuclear, biological and chemical cleansing stations' teams.

Nine personnel simulating the work of an NBC cleansing station (CS) in conditions expected in Middle Eastern waters had a limited work duration due to incapacitating heat strain. When the subjects were allowed five minutes rest periods after every 10 minutes of work, the endurance of seven of the subjects was limited to between 75-105 minutes due to heat strain and heat illness. By the point of withdrawal mean (SD) rectal temperature (Tre) had risen by 1.8 degrees C (0.4 degree C). The other two subjects were withdrawn earlier because they reached cardiac safety limits. When the hands were immersed (HI) in 10 degrees C water during the five minute rest periods heat strain was significantly lower (P < 0.01) and work endurance times were increased. One subject was withdrawn early on reaching cardiac safety limits, two on reaching Tre limits (39 degrees C) at 105 minutes, and six subjects completed the 180 minute exposure with a final Tre of 38.4 degrees C (0.3 degree C). Using 'iced' (0 degree C) rather than 10 degrees C water for HI further reduced heat strain (P < 0.01) and increased endurance times. Three subjects were withdrawn early on reaching cardiac safety limits, the remaining six completing the 180 minute exposure, with a final Tre of 38.3 degrees C (0.5 degree C). Using an ice-vest (IV) in conjunction with HI further reduced heat strain (P < 0.01) and increased endurance times. Two subjects were withdrawn early on reaching cardiac safety limits, the remaining seven completing the 180 minute exposure, with a final Tre of 38.2 degrees C (0.8 degree C) when 10 degrees C HI water was used, and Tre 38.0 degrees C (0.4 degree C) when 0 degree C HI water was used. There were no reports of finger numbness or loss of dexterity due to HI, and all personnel were able to remove their own individual Protective Equipment (IPE) without difficulty. It is expected that using HI will not reduce the ability to decontaminate or undress others. The HI technique and IV equipment should be introduced into the Fleet. 'Iced' water should be used in preference to 10 degrees C, although any water colder than 25 degrees C will provide some benefit. The IVs increased torso girth and personnel should try them on (with frozen ice packs inserted) prior to their use and ensure that their protective clothing still fits, or obtain a larger size.

Body Temperature↗
PubMed2003

Identifying and treating reversible causes of urinary incontinence.

Urinary incontinence can be a symptom of a variety of reversible conditions. Common and reversible causes of urinary incontinence include polyuria, exposure to irritants (including concentrated urine), infection, urinary retention, use of pharmaceuticals, stool impaction or constipation, atrophic urethritis or vaginitis, restricted mobility or dexterity, psychological conditions, and delirium or acute confused state. Healthcare professionals can use existing assessment strategies, tools, and parameters to guide decisions and treatment options to manage these conditions. First-line assessment tools are reviewed, including the use of a voiding and bowel diary, simple dipstick urinalysis, catheterization for post-void residual, the Folstein Mini Mental Status evaluation, and the Geriatric Depression Scale. Guidelines for estimating normal ranges of urine output, the influence of irritants, the risk of incontinence caused by stool impaction, and urinary retention are discussed. Primary care providers are well positioned to rule out or treat many of the reversible causes of urinary incontinence using simple assessment tools and pragmatic guidelines.

Causality↗
PubMed2003

Urinary incontinence in older persons: a simple approach to a complex problem.

Urinary incontinence is a major geriatric syndrome with significant morbidity and even mortality. However, it is under-recognised and inadequately managed despite its impact and cost. Continence in the older person is maintained by the fine balance between the integrity of the lower urinary tract, the cognitive ability and motivation to keep dry, and adequate mobility and dexterity to void; impairment of any of the three can result in incontinence. The management of older persons with urinary incontinence involves, i) identifying and reversing transient incontinence, ii) excluding urinary retention, iii) deciding on the need of special tests (imaging, screening for malignancy, magnetic resonance imaging [MRI] for spinal cord, urodynamic assessment) to exclude sinister causes, and iv) deciding on the need to refer the specialist. With careful evaluation, continence in the older persons can be restored in most cases.

Aged↗
PubMed2003

Coordination dynamics in Parkinson's disease patients and healthy subjects quantified by the coordination dynamics recording method and sEMG.

Coordination dynamics were measured in Parkinson's disease patients to quantify central nervous system (CNS) dysfunction. The low-load coordination dynamics in the patients were impaired by 56% for forward and 44% for backward moving in comparison to a control group of similar age. Exercising at higher load was only partly possible. When the disease preferentially affected one side of the body, the coordination dynamics were worse for the affected side. A dexterity test showed that coordination of hand and arm movements could be improved in the short-term memory when exercising on the special coordination dynamics recording and therapy device. Simultaneously taken surface EMG (sEMG) showed that the motor pattern was impaired in the Parkinson's disease patients. sEMG recordings showed further that the fast fatigable muscle fibre activation was impaired. FF-type muscle fibres were already activated for low load in one and not at all in another muscle. In conclusion, coordination between motoneuron firings and between arm and leg movements were found to be impaired in Parkinson's disease patients.

Aged↗