Biomedical subjects
Publications and source records attributed to J D Dickerman.
A 7-year-old child developed slipped capital femoral epiphysis (SCFE) 3 years following pelvic irradiation for rhabdomyosarcoma. The reasons for this occurrence are discussed. This is the second report of radiation-induced SCFE and it is anticipated that more such cases are likely to occur.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Splenosis has been shown to occur after traumatic injury to the spleen. It is postulated that this is the mechanism for the low incidence of bacterial infection in this group of patients when compared to those who undergo splenectomy for other reasons. Therefore, we studied the effect of exposure to an aerosolized suspension of type III Streptococcus pneumoniae on splenectomized mice who had either all or half of their splenic tissue cut up and reimplanted into the abdominal cavity 8 wk prior to bacterial exposure. It was determined that the mortality experience of these two groups of mice was similar to each other and no different from the sham control group, although all three groups had a statistically significant lower mortality experience than the splenectomized control group. This study demonstrates that splenosis in mice can protect against aerosolized bacterial infection.
Prophylactic penicillin has been recommended for use in asplenic patients and postsplenectomy patients. A laboratory model using aerosolized pneumococci has been devised to test the effectiveness of prophylactic penicillin in a manner analogous to human experience. There is increased mortality, over time, in asplenic mice exposed to aerosolized type III Streptococcus pneumoniae. One hundred twenty-one male Swiss mice (mean weight 26 g) were divided into four groups: splenectomized, sham-operated, splenectomized + penicillin, and sham-operated + penicillin. After 2 wk the four groups were exposed for 30 min to an aerosolized atmosphere of 2.4 x 10(9) colony-forming units of type III S. pneumoniae using a Tri-R model A-42 airborne infection apparatus. Penicillin was given at a daily intramuscular dosage of 40,000 units procaine penicillin G beginning 2 days prior to exposure and continuing through the third day after exposure. The splenectomized and sham-operated mice given penicillin showed significantly lower mortality (p less than 0.001) than mice not given penicillin.
Most reported experimental studies concerning the effect of splenectomy in animals have shown enhanced mortality from pneumococci injected either intravenously or intraperitoneally. We have developed a laboratory model in which mice are exposed to type III Streptococcus pneumoniae via an aerosolized atmosphere, thus closely approximating the route of human infection with this organism. Ninety-one male Swiss mice (mean weight 26 g) were divided into three approximately equal groups of control, sham-operated, and splenectomized animals. Two weeks later they were exposed for 30 min in individualized compartments within a confined chamber to an aerosolized atmosphere producing a uniform challenge of 5.9 X 10(9) colony-forming units per ml of pneumococci. A statistically significant increase (P less than 0.01) in mortality was demonstrated in the splenectomized group over the pooled sham-operated and control groups. The animal model used in these investigations can be applied to the study of infections acquired by the respiratory route in numerous experimental designs.
Hemoglobin studies are presented on two children in whom electrophoretic analysis of hemolysates at alkaline pH initially suggested the diagnosis of hemoglobin SC disease. In both patients the course of the disease was unusually severe, blood smears contained irreversibly sickled cells, and crystal formation did not occur when red cells were incubated in 3 per cent sodium chloride solution. Each of these findings is inconsistent with the interpretation of the electrophoretic patterns. Family studies demonstrated that one of the patients had sickle cell anemia and was also a carrier of an alpha chain variant; citrate agar electrophoresis at pH 6.2 of the second child's hemolysate revealed that the "C-like" hemoglobin was not hemoglobin C. Tryptic peptide analyses of the nonhemoglobin S fractions showed that the first child has SS/GPhiladelphia disease and that the second child has SOArab disease. These observations emphasize the importance of integrating the clinical and hematologic data with the results of electrophoretic procedures in order to define precisely the hemoglobin abnormality in patients with sickling disorders.
In an infant with unexplained hyperbilirubinemia, abdominal mass and a fall in hematocrit, an IVP with total body opacification should be considered so that the diagnosis of adrenal hemorrhage, which is almost always a benign conditions, may be made. Follow-up abdominal films at 3 months of age may further substantiate the etiology by revealing calcifications in the involved areas.
The risk of bacterial sepsis in the surgically or functionally asplenic host is reviewed. The lowest morbidity occurs in patients splenectomized because of trauma to the spleen; the highest morbidity occurs in patients splenectomized for thalassemia. There is approximately a 50% mortality associated with sepsis secondary to asplenia and the pneumococcus is responsible for over 50% of the cases. Normal spleen function and alteration in host defense occurring as a consequence of asplenia is discussed. Finally, alternatives to and indications for splenectomy as well as prophylactic measures are considered. It is concluded that, at the present time, antibiotic coverage for an indefinite period of time may be indicated for surgically or functionally asplenic patients.
A patient with Stage IV-A nodular sclerosing Hodgkin's disease is described who, at initial presentation, demonstrated an apparent large filling defect in the spleen by 99mTc-sulfur colloid scan. Following a 6-month course of MOPP therapy, the patient was clinically free of disease although the spleen scan remained unchanged. After laparotomy, the spleen was found to be entirely normal histologically.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A 13-year-old boy presented with cardiac tamponade. Echocardiography revealed a large mass extending from the right and left ventricles into a large pericardial effusion. Pathology confirmed the first reported case of a primary cardiac extraskeletal Ewing's sarcoma.
Wilms' tumor is the most common malignancy of the genitourinary tract in children but the occurrence of extrarenal Wilms' tumor is extremely rare. Extrarenal Wilms' tumor, which by definition excludes a primary tumor in the kidney, has been reported less than fifty times. The ultrastructural appearance of renal Wilms' tumor has been well documented, but the present report is believed to be the first description of the ultrastructural appearance of extrarenal Wilms' tumor. The authors report, for the first time, localization of intermediate filament proteins (vimentin and cytokeratin) and epithelial membrane antigen (EMA) by immunoelectron microscopy in this neoplasm. Demonstration of the coexpression of vimentin and cytokeratin within the same blastemal cell, as well as the identification of desmosomes in a cell with vimentin intermediate filaments, suggests a relationship between stroma, blastema, and epithelia similar to that proposed in renal Wilms' tumor.