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Biomedical subjects

D Jackson

Publications and source records attributed to D Jackson.

At least 73 records · Page 4Linked to original sources

Malignant pleural mesothelioma. Report of 19 cases.

Malignant pleural mesothelioma may be composed of sarcomatous, epitheliomatous or mixed cell types. They can be differentiated from localized, benign mesothelioma. Malignant pleural mesothelioma is a rapidly fatal tumor that poses serious diagnostic and therapeutic problems. A series of 19 cases was compiled at the North Carolina Baptist Hospital, and data from these cases were compared to those of other series. The average survival time was 10 months. The most common symptoms were dyspnea, chest pain, pleural effusion, and weight loss. Three patients had a definite history of exposure to asbestos; in 6 more there was a questionable exposure. The most helpful investigative screening tool was the chest roentgenogram, in that it demonstrated an intrathoracic abnormality; however, mesothelioma could not be differentiated from inflammatory reaction or bronchogenic carcinoma with pleural effusion. Sputum cytology as well as pleural effusion cytology was only suggestive of malignancy. Bronchoscopy was not helpful. Needle biopsy yielded malignant cells in 3 of 8 patients. Exploratory thoracotomy was the most accurate means of diagnosis but was frequently followed by seeding into the incision and severe, intractable incisional pain. Therapy proved to be palliative at best. Thoracotomy did not alter the course of the disease; in fact, the production of severe incisional pain was deleterious to the patient's well-being. Cordotomy done in 3 patients brought no relief. Neither radiation therapy nor chemotherapy had a significant effect on survival time or palliation.

Adult

Sleep physiology at high altitude.

All night sleep EEG, EKG, and respiration were recorded from six young men during 2 nights at sea level and 4 nonconsecutive nights at high altitude (14.110 ft., 4301 m). Sleep at high altitude was chraacterized initially by a significant decrease in Stages 3 and 4, a significant increase in the number of arousals, and a trend towards more time spent awake. In terms of actual time spent sleep, however, a relatively good night's sleep was obtained, which suggests that the objective sleep disturbance was not commensurate with the marked subjective complaints of sleeplessness. Periodic respiration during sleep was frequent at high altitude, was quickly terminated by oxygen administration, was not clearly related to the increased number of arousals, and usually was not seen during REM periods. Heart rate was increased during sleep at high altitude. All measures tended to return towards sea level means during 12 days at altitude. We suggest that the marked increase in the number of arousals may account for the disparity between the subjective reports and objective measures of sleep disturbance at high altitude. Although the objective sleep disruption is probably related in some fashion to hypoxemia, it is unclear whether hypoxemia itself or the alkalosis commonly present shortly after arrival at altitude is the major factor.

Adult

Primary malignant melanoma of the oral cavity.

The natural history of malignant melanoma of the oral cavity is discussed with reference to the findings of previous writers, and six additional cases are reported. These demonstrate the considerable variations in detail of the course of the disease while confiriming the difficulty of treatment and the inexorable nature of the condition.

Aged

Thyrotrophin estimation in diagnosis and treatment of childhood thyroid disorders.

Serum thyrotrophin (TSH) was estimated by double-antibody radioimmunoassay in 200 children aged 2 months to 16 years with normal thyroid function. There was no apparent variation in TSH with age or sex and only 4 children had TSH levels greater than 5 muU/ml. High TSH values were obtained in 9 children with primary hypothyroidism, in 3 children with thyroiditis, and in one girl with a lingual thyroid. Moderately raised TSH was found in 3 girls with thyroiditis, 2 brothers with goitres due to enzyme defect, and a girl with an ectopic thyroid. In one girl with a defect of iodine organification and in 3 boys with thyroxine binding globulin deficiency the TSH levels were normal despite very low serum thyroxine values. Serum TSH was also estimated in 20 children during treatment for primary hypothyroidism. 3 of these children showed slightly raised TSH levels despite apparently adequate replacement therapy with L-thyroxine. One girl showed a very high TSH level 3 weeks after treatment had been temporarily withdrawn.

Adolescent

Human middle ear corpuscles -- A light and electron microscopic study.

The human middle ear corpuscles originally described by von Troeltsch are examined by means of light microscopy in 124 subjects, and electron microscopy in 27 subjects. While the corpuscles are not observed in all 19 individuals under age six, and in all 20 adults who had a history of suppurative otitis media, an average of six corpuscles per temporal bone is found in 98 percent of 83 adult subjects who had no history of middle ear disease. Two-thirds of the corpuscles are located in the mastoid, and the remainder in the middle ear. Often, they become bifurcated or trifurcated. Although light microscopy shows that the corpuscle is formed by lamellar capsules and a central core resembling pacinian corpuscles, electron microscopic study failed to confirm that this structure is a typical pacinian corpuscle. Subsequently, possible physiological significance of this corpuscle is discussed.

Adolescent

Preformed cytotoxic antibody in patients subjected to thoracic duct drainage.

1. Patients subjected to TDD prior to transplantation had a 4-yr graft survival rate of 65% compared to a comparably HL-A-matched group in which the survival rate was 35%9 2. Patients classified as non-responders to tissue antigens have a much higher graft retention rate than responders. Responders subjected to TDD have a 1 yr graft survival rate of 62% compared to a comparably HL-A-matched group with a survival rate of 28%. 3. Individuals with a positive crossmatch or receiving second or third transplants and subjected to TDD do much better than such individuals not subjected to TDD.

Cytotoxicity Tests, Immunologic

Effects of large doses of intravenous atropine on heart rate and arterial pressure of anesthetized patients.

A bolus of 3 mg. of atropine was given intravenously (I.V.) TO 123 ANESTHETIZED PATIENTS. Increases in heart rate were seen in 109 patients (88 percent), while 7 patients (5.7 percent) had no change. A mean increase in systolic arterial blood pressure of 14 mm. Hg was noted. A certain pattern in increases in heart rate and systolic blood pressure was observed. Ninety-six percent of the patients under cyclopropane, fluroxene, ether, ketamine, or regional (spinal or epidural) anesthesia had heart-rate increases, compared with only 77 to 89 percent of the patients anesthetized with halothane, enflurane, or neuroleptanalgesics. Rise in systolic blood pressure was seen in 40 to 50 percent of the former, but only in 31 to 40 percent of the latter group. The arrhythmias observed were transient A-V junctional tachycardias in three instances and bigeminal rhythm in one patient under cyclopropane anesthesia, The administration of a vagolytic dose of atropine to anesthetized patients appears not to be as arrhythmogenic as previously considered.

Adolescent

Randomized, prospective comparison of cefoxitin and gentamicin-clindamycin in the treatment of acute colonic diverticulitis.

In a randomized, prospective study, single-drug antibiotic therapy with cefoxitin (CFX) was compared to combination therapy with gentamicin and clindamycin (G/C) as definitive treatment for acute colonic diverticulitis. Excluding individuals requiring immediate operation, 51 patients with a clinical diagnosis of diverticulitis, who were hospitalized at five different medical centers, were randomized to receive CFX (30 patients) or G/C (21 patients). Age, sex, and the severity of diverticulitis were similar in the two groups. The cure rates of 90% and 85.7% observed for CFX and G/C, respectively, did not differ significantly. Leukocytosis resolved in a shorter time period in patients treated with CFX than in those treated with G/C (2.5 +/- 0.4 vs 4.1 +/- 0.6 days, respectively) (P = 0.03, Student's t test, unpaired data). Two cases of possibly antibiotic-related toxicity occurred in the CFX group versus three cases in the G/C group. The average cost of a course of CFX therapy was $417 compared with $488 for G/C. In this study, cefoxitin demonstrated efficacy and tolerability similar to that of gentamicin-clindamycin in the treatment of acute colonic diverticulitis and may be preferred in view of its narrower antimicrobial spectrum and lower cost.

Acute Disease

5-Fluorouracil and recombinant interferon alfa-2a: review of activity and toxicity in advanced colorectal carcinomas.

Improved response rates in metastatic colorectal carcinoma recently have been observed for the combination of 5-fluorouracil (5-FU) and recombinant interferon alfa-2a (rIFN), compared to those obtained in historical trials of single-agent 5-FU. The mechanism of interaction between these agents has not been explored adequately but may relate to biochemical modulation of 5-FU by rIFN. Toxicities resulting from this combination have included fever, chills, myalgias, granulocytopenia, mucositis, diarrhea, skin rash, neurological symptoms, and hand-foot syndrome. Future studies of 5-FU with rIFN should investigate schedules aimed at reducing toxicity without compromising efficacy and also should explore mechanisms of enhanced activity.

Aged