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Biomedical subjects

H S Rubenstein

Publications and source records attributed to H S Rubenstein.

At least 19 recordsLinked to original sources

The value of the chest X-ray in making the diagnosis of bronchial asthma.

Although bronchial asthma is one of the most common chronic illnesses of children and young adults, it remains underdiagnosed. To assess the value of the chest X-ray in helping to make the diagnosis of asthma at the primary care level, we studied the medical records of 58 patients aged 18-40 with the diagnosis of mild to moderate asthma and for whom both simple spirometry-forced one-second expiratory volume (FEV1) and/or peak expiratory flow rate (PEFR)--and a chest X-ray had been performed. Only 21 of 58 (36%) had spirometry indicative of asthma (SPI+) while 34 of 58 (59%) had abnormal chest X-rays (CXR+)--"increased markings" and/or "low diaphragm." Although CXR+ discriminated between asthmatic patients and a normal control group, no difference was found between asthmatic patients and a group of patients with acute bronchitis. Nonetheless, the number of asthmatic patients with CXR+ and SPI - (n = 23) was significantly larger than the number with CXR- and SPI+ (n = 10), which indicates that for mild asthma the chest X-ray may be more sensitive than spirometry even though not as specific. These results were surprising at the time of the investigation. Subsequently, however, the importance of the inflammatory response in asthma came to light, which rendered the results more interesting than surprising. We conclude that the chest X-ray has value in making the diagnosis of mild bronchial asthma.

Acute Disease

Bee stings.

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Bee Venoms

Bee-sting diseases: Who is at risk? What is the treatment?

Many of the large number of people who are stung each year by bees experience frightening systemic reactions, but the vast majority of such reactions are not life-threatening. There is no evidence that the very few who die as a result of a bee sting come from the pool of those who once before sustained a systemic reaction. On the contrary, no reaction at all may be a more ominous predictor of a lethal outcome on a subsequent sting. Death comes about through multiple mechanisms, and not through anaphylaxis alone. Like most cases of sudden death, underlying coronary atherosclerosis appears to be the principal mechanism. External factors that affect mortality include environmental temperature and site of sting. In general, however, because the numbers of deaths are so small, death comes unpredictably, and those at risk have not been identified. Immunotherapy, whether with venom or whole-body extract, has not been proven to prevent death from a bee sting.

Adult

Adolescent and postadolescent asthmatics' perception of their mothers as overcontrolling in childhood.

One of us (HSR) reported that adolescent and postadolescent patients with well-controlled bronchial asthma coming to a university health services clinic were more likely to arrive late for an appointment, or not to show up for it at all, than non-allergic healthy patients, patients with perennial rhinitis, patients with seasonal rhinitis, or patients being investigated for cardiac disease. He wondered whether such behavior might be a reaction against an overcontrolling mother. To determine whether patients with bronchial asthma perceived their mothers as having overcontrolled them in their childhood, we asked adolescent and postadolescent patients coming to a university health services clinic to answer a questionnaire anonymously. Three disease groups were studied: 1) bronchial asthma, 2) perennial rhinitis, 3) seasonal rhinitis; and a group of non-allergic healthy controls. Asthmatics significantly more often than the other groups reported that when they were children their mothers (but not their fathers) had overcontrolled them (p less than .001).

Adolescent

Evidence for successful acceptance of irradiated free gingival allografts in dogs.

Free graft samples were excised via split thickness dissection from two mongrel dogs, washed in lactated Ringer's solution, immersed into tubes containing glycerol and distilled water, and frozen to -55 degrees C. Subsequently the grafts were exposed to 2.5 x 10-6 rads of 60-Co gamma-radiation. The irradiated allogeneic grafts were later reconstituted and surgically transferred to four recipient subjects. Three autogenous nonirradiated grafts were also placed as controls. The animals were killed so as to furnish healing data at 0, 3, 7, 10, and 40 days postoperatively. Fourteen allografts were evaluated. They were judged to be nonantigenic, immunologically incompetent and nonviable. However, retention of an essentially unaltered connective tissue corium may have been instrumental in supporting subsequent epithelial regeneration from adjacent host tissue, while being passively incorporated into a very dynamic receptor zone. The graft thus served as a scaffolding for connective tissue deposition and attachment. It appears that the experimental regime obviated the immunologic interference usually encountered in allografting procedures. Thus, high intensity irradiation of the graft tissue may have rendered the tissue to be immunologically tolerable. Further studies are required to ascertain the duration of the host's immunologic unresponsiveness to the alien tissue, as well as ultimate structural and biologic fate of the transplanted tissues. Experiments are now in progress which have been designed to test the extent of immunologic sensitization induced by the grafted tissue.

Animals