Biomedical subjects
Publications and source records attributed to D Lew.
Reconstruction of the severely burned lip may require both reconstitution of the tissue bulk and an increase in size of the vermilion. We present two patients in whom a bipedicled lip flap was used to transpose both bulk and vermilion from the relatively normal donor lip to the atrophic burned lip.
A case of a pseudoaneurysm secondary to bleeding which occurred during an intraoral vertical osteotomy of the mandible is presented. The bleeding was thought to be controlled by packing, but ultimately a pseudoaneurysm formed. Arteriography was used to diagnose the lesion and embolization to treat it. Duplex ultrasound played a complimentary role in the diagnosis, and in monitoring the therapeutic course.
In a prospective, randomized trial, teicoplanin (at a 400-mg intravenous loading dose followed by 200 mg/day intravenously or intramuscularly) was compared with flucloxacillin (8 g/day) in patients with severe staphylococcal infections. Teicoplanin proved unsatisfactory for the following reasons: failures or relapses were more frequent in the teicoplanin group, and blood levels were difficult to predict and tended to be low 24 hr after the loading dose. Future trials with this agent should use much-higher doses.
Using a previously developed guinea pig model of foreign body infection, we examined ultrastructural and functional surface alterations of Staphylococcus aureus strain Wood 46 during the early phase of infection. Exopolymer-free bacteria were prepared and inoculated into subcutaneously implanted tissue cages. After three hours, the bacteria showed abundant capsular and intercellular exopolymers, which were visualized by transmission electron microscopy. Exopolymers were also produced by S. aureus exposed in electron microscopy. Exopolymers were also produced by S. aureus exposed in vitro to fluid from the tissue cage. In contrast, human serum albumin prevented exopolymer production by S. aureus. The influence of exopolymers on the susceptibility of S. aureus to ingestion and phagocytic killing by neutrophils was tested in vitro and found to be negligible. Furthermore, adherence of S. aureus to fibronectin-coated surfaces was unaffected by the presence or absence of exopolymers. Thus, in our experimental model, exopolymers are produced early during the onset of infection, but they have little impact on adherence and phagocytosis.
We have isolated and sequenced a cDNA clone encompassing the entire protein coding region of the Xenopus laevis estrogen receptor (xER). The Xenopus ER, the first steroid hormone receptor to be sequenced from a cold-blooded organism, exhibits two regions of striking amino acid homology with the human and avian ERs. In the putative DNA binding region, the amino acid sequence of the xER differs from those of the human and avian ERs at only one of 83 amino acids. The putative hormone binding region contains 44 and 46 amino acid blocks in which the sequence is identical in the Xenopus and human ERs. Blot hybridizations of Xenopus liver RNA suggest that the xER is encoded by four mRNAs with lengths of approximately 9, 6.5, 2.8, and 2.5 kilobases. In contrast, hybridization of human RNA to a human ER cDNA clone reveals only a single major ER RNA, approximately 6.7 kilobases in length.
Traditional transoral rib grafts were combined with particulate hydroxylapatite (HA) for augmentation in four patients who had advanced alveolar atrophy or cortical resection of the mandible. Follow-up evaluation for up to 18 months revealed restoration of mandibular morphology, with good prosthetic function and insignificant resorption. No infection or graft loss was observed, in spite of wound dehiscence in two of the four patients, possibly due to the placement of the HA lateral and superior to the rib grafts.
The use of an intraoral alveolar ridge soft tissue expander to aid in reconstruction of the alveolar ridge is described, and the results in five cases are reported. The technique was found to be reliable and efficient, and patient acceptance was uniformly good.
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Six patients who presented with unusual symptoms or uncommon ailments after a trip to a Third World country, and who were seen during the last ten years by a member of the Infectious Diseases Division, Cantonal University Hospital of Geneva, are reviewed and discussed.
We review our clinical experience with infectious sphenoid sinusitis in an effort to characterize the clinical presentation, bacteriology and associated severe complications of this frequently misdiagnosed infection.
We studied 30 patients with infectious sphenoid sinusitis (15 acute cases and 15 chronic cases) in an effort to characterize the clinical presentation, bacteriology, and associated complications of this frequently misdiagnosed infection. Severe frontal, temporal, or retro-orbital headache that radiated to the occipital regions or pain in the trigeminal (V1 to V3) distribution or both were the most prominent presenting symptoms. In acute cases, purulent exudate was frequently seen in the middle and superior nasal turbinates. Computerized axial tomography or sinus tomography and cannulation of the sphenoid sinus proved to be the most useful diagnostic studies. Organisms detected in acute cases included streptococci other than Streptococcus pneumoniae (41 per cent), Staphylococcus aureus (29 per cent), and Str. pneumoniae (17 per cent). In chronic infections, gram-negative bacilli (43 per cent) and staphylococcal species (24 per cent) were the predominant organisms. In acute disease, early diagnosis and aggressive therapy, including surgical drainage, were important. Delay in treatment was always associated with serious morbidity or mortality. Fatal complications included cavernous sinus thrombosis and bacterial meningitis.
Amydopyrine is known to cause agranulocytosis by an immunological mechanism [2]. However, pancytopenia due to amydopyrine is extremely rare and usually mild and transient [3]. This report describes a patient with severe pancytopenia presumably due to amydopyrine sensitivity. Granulocytotoxic and lymphocytotoxic antibodies were detected in the patient's serum using a 51Cr-release test.
Occurrence of immune complexes in malignant pleural effusions has been investigated by the 125I-c1q binding test. 55% of the pleural effusions had C1q binding activity levels higher than those found in transudates used as controls. The levels of C1q binding activity in effusions were significantly higher than those found in the serum of the same cancer patients. High levels of C1q binding activity were found in malignant effusion independently of type or differentiation of the tumors involved. The C1q binding material had properties of immune complexes. The levels of CH50 and C3d, i.e. the degradation product of C3, in malignant effusion were similar to those of transudates. These observations show a high incidence of immune complexes in malignant effusions and a slight activation of complement inadequate for its local consumption. The persistence in major quantity of immune complexes in malignant effusion suggests local formation or decreased clearance.
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Up to 30% of patients with advanced germ cell tumors will fail induction chemotherapy or will relapse. New agents with activity in this still potentially curable subgroup of patients are needed. Edatrexate (10-ethyl, 10-deaza-aminopterin) is a methotrexate analogue that has preclinical and clinical activity in breast, lung, and head and neck cancers, as well as in non-Hodgkin's lymphomas. A phase II trial of edatrexate in relapsed or refractory malignant germ cell tumors was conducted by the Southwest Oncology Group (SWOG). Twenty-five patients were enrolled in the trial. Edatrexate was administered intravenously at a dose of 80 mg/m2 weekly for four weeks followed by a one-week rest period. The treatment course was repeated every five weeks. Among the 23 patients evaluable for response, there were no objective responses with all patients developing progressive disease. Thirteen patients (56%) developed Grade 3-4 toxicities, predominantly stomatitis and malaise/fatigue/lethargy. One patient developed Grade 4 anemia while another developed grade 4 anemia and thrombocytopenia. No patients discontinued treatment due to toxicity nor were there any toxic deaths. Edatrexate administered in this dose and schedule has no antitumor activity and has substantial toxicity in patients with relapsed or refractory germ cell tumors.