PARTIAL THROMBOPLASTIN TIME TEST WITH KAOLIN. NORMAL RANGE AND MODIFICATIONS FOR THE DIAGNOSIS OF HAEMOPHILIA AND CHRISTMAS DISEASE.
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The partial thromboplastin time test provides a convenient and sensitive screening procedure for deficiencies of thromboplastic factors, especially factors VIII and IX. The test is carried out after preincubating the plasma for 10 minutes with kaolin, and Inosithin is used as a platelet substitute. The ;normal range' of the test has been estimated in terms of the differences encountered between random normal plasmas tested in pairs, because individual patients are usually tested against single control subjects. A patient's partial thromboplastin time should be regarded as abnormal if it is more than six seconds longer than the control time. In the diagnosis of haemophilia, patients' plasmas with concentrations of factor VIII as low as about 20% might be regarded as being within the range of normal, if the selected control subject's factor VIII happened to lie near the lower end of the normal range. When mild haemophilia is suspected, discrimination may be improved by diluting both the patient's and the control plasmas 1 in 20 in haemophilic plasma. With the test modified in this way the clotting time is prolonged, though the range of differences among normal subjects is unaltered, and plasmas with factor VIII concentrations below about 30%, i.e., in undiluted plasma, would be unlikely to be regarded as normal. The partial thromboplastin time may be similarly modified as a screening test for factor IX deficiency.Some clinical examples are reported. (+info)
TRAUMATIC INTRAUTERINE ADHESIONS. (THE FRITSCH-ASHERMAN SYNDROME).
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In contrast to the foreign literature, there are no large North American studies on the sequelae to trauma and infection in the recently pregnant uterus. For this reason, the present status of these sequelae was reviewed and re-evaluated. They constitute a long-recognized, well-established clinical syndrome comprising: (1) past history of puerperal or postabortal infection and/or curettage, followed by (2) amenorrhea or hypomenorrhea, (3) dysmenorrhea, (4) habitual abortion, and (5) sterility. Knowledge of the existence of the entity is of great importance for its prevention and treatment. Strict maintenance of aseptic technique during curettage, use of a dull or serrated curette, and proper use of antibiotics are essential preventive measures. Treatment measures for this condition are solely surgical and consist of (1) dilatation and curettage, (2) hysterotomy, (3) transplantation of living tissues, and finally (4) hysterectomy. (+info)
THE INFLUENCES OF GROUP AND INDEPENDENT GENERAL PRACTICE ON PATIENT CARE: A COMPARATIVE STUDY IN ONTARIO.
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When the practices of four general practitioners, members of multispecialist-general practitioner salaried groups (clinic doctors) were compared with those of four independent general practitioners (solo practitioners), it was noted that: group practice patients had more office laboratory investigation and greater in-hospital consultation and referral. On the other hand, independent practitioners' patients seemed to receive more personal attention from the doctor, a fuller explanation of diagnosis and treatment during office hours, more drug samples and more laboratory investigation in hospital.Group and independent practices are similar with respect to the rate of follow-up visits, the volume of preventive medicine, the number of radiographs and special procedures, the total number of drugs ordered, and the in-hospital formal written consultation rate and office consultation rate.The similarities between two types of practice may be a result of the interaction of group and independent practice in the same community.It is concluded that the team approach to medical care is not incompatible with independent practice. (+info)
MYASTHENIA GRAVIS: MEDICAL ASPECTS.
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The diagnosis of myasthenia gravis is often difficult and calls for a broader use of pharmacological and electrodiagnostic tests. The decamethonium-edrophonium test, which has proved superior to other procedures for this purpose, is based on neurophysiological principles and depicts the behaviour of the neuromuscular junction. A state of resistance to depolarizing agents in the limited form of myasthenia and a state of a non-depolarizing (competitive) block in advanced cases has been shown. This test has demonstrated that the neuromuscular defect exists throughout the skeletal musculature, including muscles clinically unaffected. It produced no false-positive results either in normal or neurasthenic persons or in patients with neurological diseases with myasthenic symptoms. In a patient with botulism and in a patient with ocular palsies from brain-stem encephalitis the edrophonium test gave a false-positive result, while the decamethonium-edrophonium test was negative.Diagnosis, treatment and management of myasthenic emergencies are described. (+info)
NEISSERIA GONORRHOEAE IDENTIFICATION IN DIRECT SMEARS BY A FLUORESCENT ANTIBODY-COUNTERSTAIN METHOD.
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Direct smears from female patients have been considered unreliable for the detection of Neisseria gonorrhoeae by fluorescent-antibody (FA) methods because of inadequate background contrast of the fluorescent-stained smears and a scarcity of organisms on the smear. Evans blue dye employed as a counterstain eliminated the nonspecific background staining and increased the reliability of the direct FA procedure. Direct smears demonstrating positive fluorescence were obtained from 86% of a group of culturally positive named female contacts. The FA-counterstain technique is as sensitive as the presently recommended cultural procedures. (+info)
HUMAN BOTULISM DUE TO COMMERCIAL PRODUCTS.
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Two cases of botulism occurred in Montreal following the ingestion of commercially canned liver paste. A toxigenic, proteolytic strain of Clostridium botulinum type B was isolated from the paste in which type B toxin was also demonstrated by animal protection tests. One patient died undiagnosed about 45 hours after eating several liver-paste sandwiches. The second developed diplopia, dysphagia, speech difficulty and weakness 18 hours after ingestion of three bites of a sandwich. All symptoms progressed until admission to hospital where he was treated with 160,000 units of divalent botulinum AB antitoxin over a 72-hour period. Recovery was complete. The need for readily available supplies of both diagnostic and therapeutic botulinum antitoxin to meet such an emergency is stressed. (+info)
SOME AIDS IN THE DIAGNOSIS OF GENETIC DISORDERS.
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Disorders of genetic origin may cause morphological or metabolic disturbances. A number of recognized screening procedures, e.g. palm printing, buccal smears and paper chromatography, are useful in the recognition of these disorders.Additional procedures for more detailed analysis of the genetic defects, e.g. aminoacid analysis, gas chromatography and chromosome analysis, have been developed and are employed in specialized centres. (+info)
ENTEROVIRUS INFECTIONS: ETIOLOGIC, EPIDEMIOLOGIC AND CLINICAL ASPECTS.
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The term enteroviruses was introduced in 1957 to bring together in one large family the polioviruses, Coxsackie A and B and echoviruses, all agents for which the human alimentary tract is the natural habitat. At present more than 60 distinct members are recognized: three polioviruses, 24 Coxsackie A, six Coxsackie B and 30 echoviruses. The list of new members, particularly in the echo-group, grows regularly. The viruses are frequently widely disseminated in the summer and fall of the year, circulating chiefly among young children, causing both apparent and inapparent infection. The enteroviruses are responsible for a wide spectrum of clinical manifestations, including non-specific febrile illness, sometimes with rash, aseptic meningitis, paralytic disease, respiratory infections, pericarditis and myocarditis. There is considerable overlap in biologic behavior, and the same syndrome can be induced by many different agents. In a few instances the clinical pattern is distinct enough to suggest the group of agents involved. Thus, herpangina is associated with the Coxsackie A viruses and epidemic myalgia (devil's grip) with the Coxsackie B group. Paralytic disease is caused primarily by the polioviruses, but recently it has been found that other members, particularly the Coxsackie B viruses and Coxsackie A7 can also cause "paralytic poliomyelitis."The ultimate potential of enteroviruses in terms of central nervous system disease and other manifestations is unpredictable. Great variety in terms of clinical and epidemiologic behavior of known and "new" viruses has been the pattern in the past, and is likely to continue. (+info)