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Biomedical subjects

D K Holmes

Publications and source records attributed to D K Holmes.

At least 19 recordsLinked to original sources
PubMed1998

Giant pleomorphic adenoma of the parotid gland: case report and review of the literature.

Pleomorphic adenomas account for the majority of parotid masses, typically arising in the tail of the gland and enlarging slowly over time. The vast majority are 2 to 6 cm in size when resected. We report resection of the largest benign mixed tumor recorded in the modern English language literature. An 85-year-old reclusive woman had a 20-year history of an enlarging right periauricular mass that had begun bleeding several days prior to admission. The patient ultimately underwent resection of the mass, which measured 26 cm in diameter, weighed 6.85 kg, and proved on pathologic examination to be a benign mixed tumor without malignant degeneration. The implications of this unusual case for the management of mixed tumors are discussed, and a review of the world literature on giant pleomorphic adenomas is presented.

Adenoma, Pleomorphic↗
PubMed1997

Internet image database: development and implementation.

The widespread acceptance of World Wide Web (WWW) hypermedia protocols allows rapid cross-platform development of database interfaces. Using the WWW as the interface promotes easy integration of databases with other publicly available Internet resources. We present our experience with an image database search program (IDBS) developed on the PC platform using freely available UNIX development tools. The database routines were written in PERL. The image database program provides a familiar user interface to a collection of clinical images stored in digital form, either on local media or on the Internet. The design goals of the project and the strategies used to meet them are presented. The source code and a demonstration database are available on the Internet at http:/(/)www.webmedix.com/idbs.

Computer Communication Networks↗
PubMed1996

Fibromatosis colli: a common cause of neonatal torticollis.

In infants and children, cervical masses originate from a variety of pathologic, congenital and developmental conditions, and it is important to distinguish benign from serious lesions. Fibromatosis colli is a rare cervical lesion that typically presents in the neonatal period. It is the most common cause of neonatal torticollis and should be recognized by physicians caring for neonates and infants.

Fibroma↗
PubMed1996

Warfare facial trauma: who will treat?

Most of the facial trauma in the United States is treated in trauma centers in large urban or university medical centers, with limited trauma care taking place in our military medical treatment facilities. In many cases, active duty facial trauma surgeons may lack the current experience necessary for the optimal care of facial wounds of our inquired military personnel in the early stages of the conflict. Consequently, the skills of the reservist trauma surgeons who staff our civilian trauma centers and who care for facial trauma victims daily will be critical in caring for our wounded. These "trauma-current" reservists may act as a cadre of practiced surgeons to aid those with less experience. A plan for refresher training of active duty facial trauma surgeons is presented.

Facial Injuries↗
PubMed1995

Expanding the envelope of neonatal endoscopic tracheal and bronchial surgery.

Diagnostic evaluation of the neonatal airway requires special training and instrumentation. The subglottis of a normal full-term infant will allow passage of a 3.0 bronchoscope (outer diameter 5.0 mm, inner diameter 4.3 mm). On occasion, diagnostic rigid endoscopy with simultaneous ventilation in premature infants necessitates use of a 2.5 bronchoscope (outer diameter 4.2 mm, inner diameter 3.5 mm). Although flexible bronchoscopy can be done through an endotracheal tube, surgical manipulation of the airway is limited. Rigid pediatric bronchoscopic optical forceps are too large for use in neonatal bronchoscopes. Therefore, performance of endoscopic tracheal and bronchial procedures in the premature infant requires innovative techniques with thorough knowledge of instrumentation and anesthetic management, generally including apneic techniques. As advances in neonatology result in survival of smaller and smaller patients, otolaryngologists must keep pace to provide adequate support. A case report of endoscopic removal of a granuloma totally obstructing the right primary bronchus in a 1 kg premature infant illustrates these concepts in neonatal endoscopy.

Bronchi↗
PubMed1995

Unilateral supraglottitis in adults: fact or fiction.

Supraglottitis and epiglottitis have been described for many years by various authors. Haemophilus influenzae type b is the primary cause of childhood epiglottitis, which classically appears between the ages of 2 and 4 years. Onset is usually acute and the presentation can be dramatic with drooling, high temperatures, and stridor. Compared to childhood supraglottitis, adult supraglottitis usually pursues a more indolent course with no significant airway compromise and no identifiable pathogen. Rarely, adult supraglottitis can resemble its childhood counterpart with acute respiratory compromise secondary to H. influenzae infection. Although most incidences of adult supraglottitis are infectious in origin and involve the entire supraglottitis and epiglottis, we present two cases of unilateral supraglottitis caused by inhalation of a hot wire screen used as a filter for smoking crack cocaine.

Administration, Inhalation↗
PubMed1993

Cartilage graft epithelialization. A preliminary study using a goat model.

OBJECTIVE: To determine if the presence of a laryngeal stent adversely affects the epithelialization of an anterior costal cartilage graft. DESIGN: Twelve goats underwent laryngotracheoplasty using an anterior costal cartilage graft. No stent was used in six animals, and a modified endotracheal tube stent was used in the other six. The degree of epithelialization in each group was compared histologically, as well as other histologic criteria (epithelial metaplasia, cilia formation, and inflammatory cell infiltration). SETTING: Children's Hospital Medical Center of Cincinnati (Ohio) Medical Research Building. PATIENTS AND OTHER PARTICIPANTS: No human subjects were used in this study. MAIN OUTCOME MEASURES: Qualitative histologic analysis of cartilage graft epithelialization, epithelial metaplasia, cilia formation, and inflammatory cell infiltration was performed. The stent vs no-stent groups were compared histologically. RESULTS: In the stented group, one cartilage graft extruded, while five remained in place. All of the no-stent cartilage grafts remained in place. A trend was observed in the no-stent group toward increased cartilage graft epithelialization and cilia formation, while there was a decrease in epithelial metaplasia and infiltration by inflammatory cells. CONCLUSIONS: Although the study population was small, the presence of a laryngeal stent tended to predispose the graft to increased inflammation and epithelial metaplasia and may adversely affect cartilage graft epithelialization. The goat may be an adequate animal model for laryngotracheal reconstruction and, possibly, subglottic stenosis.

Animals↗
PubMed1990

Laryngeal and laryngotracheoesophageal clefts: role of early surgical repair.

An uncommon congenital anomaly of the developing aerodigestive tract is the congenital laryngeal cleft and its extension, the congenital laryngotracheoesophageal (LTE) cleft. Because of the subtle findings sometimes seen with clefts confined to the larynx, the diagnosis may be difficult. The potential problems of airway obstruction and repeated aspiration frequently associated with laryngeal and LTE clefts mandate early surgical repair. Over the past 3 years, 14 patients with congenital laryngeal or LTE clefts have been managed at Children's Hospital Medical Center, Cincinnati, Ohio. This report details our experience and philosophy regarding the diagnosis and management of the condition, and presents the histopathologic findings of a case of complete LTE cleft in which surgical repair was delayed and death resulted.

Abnormalities, Multiple↗
PubMed1984

Mandibulectomy without reconstruction can cause sleep apnea.

Anterior mandibulectomy can precipitate the development of sleep apnea. All head and neck tumor patients having had extensive composite anterior oral cavity resections should be evaluated for sleep apnea before decannulation of their tracheostomy tube. Subsequent flap and/or rigid reconstruction of the lower jaw appears to prevent the development of sleep apnea. Fascial sling suspension of the lower lip does not appear to prevent sleep apnea.

Aged↗
PubMed1981

Phosphorylation of nuclear and DNA-binding proteins in proliferating and quiescent mammalian cells.

The dependence of cell proliferation on nuclear protein phosphorylation was studied with exponential-phase and stationary-phase cultures of Chinese-hamster ovary cells. Nuclear proteins were fractionated, according to their DNA-binding affinities, by using sequential extractions of isolated nuclei with increasing concentrations of NaCl. When viable whole cells were labelled with H332PO4, phosphorylation of nuclear proteins was found to be lower in quiescent cells than in proliferating cells. Phosphorylation of nuclear proteins soluble in 0.30M-NaCl (less than 50% of these proteins bind to DNA) was greater than for those proteins soluble in higher salt concentrations (80-100% of these proteins bind to DNA). Cyclic AMP enhanced the phosphorylation of nuclear proteins soluble in 0.3 m-NaCl by 40-50%, and this stimulation was independent of cell growth. Cyclic AMP also increased the phosphorylation of nuclear proteins soluble in 0.6M-NaCl and 2.0M-NaCl by 40-50% in exponential-phase cultures, but not in stationary-phase cultures. Several examples of specific phosphorylation in response to cyclic AMP were observed, including a 35000-mol.wt. protein in the 0.30 M-NaCl-soluble fraction and several proteins larger than 100000 molecular weight within this fraction. A major peptide of molecular weight approx. 31000 extracted with 0.6M-NaCl was also phosphorylated. Its phosphorylation was independent of cyclic AMP in exponential-phase cultures, and it was not phosphorylated in plateau-phase cells. These changes in cell-growth-dependent phosphorylation occurred in the absence of any apparent qualitative changes in the nuclear protein molecular-weight distributions. These data demonstrate that (1) phosphorylation of nuclear proteins is dependent on the culture's proliferative status, (2) both cyclic AMP-dependent and cyclic AMP-independent specific phosphorylation occurs, and (3) the cyclic AMP-dependent growth-independent phosphorylation that occurs does not appear to be a modification of DNA-binding proteins, whereas the cyclic AMP-dependent growth-dependent phosphorylation does involve modification of DNA binding proteins.

Animals↗
PubMed1979

Separation of normal human bone marrow cells by counterflow centrifugal elutriation. I. Morphological analysis and subfractionation of neutrophilic granulocytes.

We have used counterflow centrifugal elutriation to separate the nucleated cells of normal human bone marrow into their major morphologically identifiable cellular components. Human bone marrow cells were separated simultaneously into the major cell types--lymphocytes, monocytes, granulocytes, and erythroid precursors. Significant concentration of bone marrow cell types could be achieved, including myeloblasts (x 25), promyelocytes (x 43), early myelocytes ( x 22), late myelocytes (x 17), metamyelocytes (x 6), eosinophils (x 40), basophils (x 55), erythroblasts (x 35), monocytes (x 40), and plasma cells (x 35). Cell loss is minimal (85% recovery of input) and random, and cell viability, as measured by trypan blue staining, is high (greater than 95%). Factors interfering with separation are also described: a low loading flow rate, the presence of an excess of mature red cells, and the absence of fetal calf serum resulted in poor cell recovery and viability. The use of heparin as the anticoagulant resulted in cell loss, decrease in cell viability, and an ineffective separation. Separation of cells from normal bone marrow by centrifugal elutriation should facilitate the study of bone marrow cell interactions and the purification of individual types of bone marrow cells.

Bone Marrow↗
PubMedDate not supplied

Intranasal granuloma faciale.

A 49-year-old man had a recurring intranasal mass accompanied by erythematous plaques on the forehead. Biopsy specimens of the skin and intranasal mass led to a diagnosis of granuloma faciale, a rare benign skin disorder. Lateral intranasal location and associated facial lesions help to clinically differentiate this lesion from more ominous midline granulomatous diseases. The lesions were treated with intralesional steroid injections. This may be the first reported intranasal occurrence of granuloma faciale.

Facial Dermatoses↗