Biomedical subjects
Publications and source records attributed to R I Frankel.
Many healthcare workers have frequent household contact with persons at high risk for influenza-related complications. Educating healthcare workers about the risk of domestic transmission of influenza may improve their acceptance of influenza vaccination. Concerns regarding vaccine efficacy and safety also need to be addressed.
International travel and migration will continue to contribute to the changing patterns of Hansen's disease (HD) in the United States. The majority of cases will be immigrants and refugees entering the country from leprosy-endemic regions. The Compact of Free Association, through its provision of free travel between the Freely Associated States and the United States without need for health screening, has created new public health issues. This cluster of HD cases in Kona, Hawaii, U.S.A., highlights the difficulties in detecting and monitoring the spread of disease in immigrant populations. This is a growing problem only likely to worsen in the coming years. In groups with cultural, language or other socioeconomic barriers, special and creative methods may be needed to tackle the problems of detection, treatment and education. Clinicians must remain mindful of the diagnosis of HD in high-risk groups.
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November 8, 1995, marked the 100th anniversary of Wilhelm Conrad Röntgen's discovery of x-rays. This remarkable scientific achievement has had an effect on medicine and science that has been matched by few other advances. I will briefly review the events leading up to Röntgen's discovery and the subsequent development of radiology as a discipline.
Type 1 Hansen's disease reaction (reversal reaction) is believed to result from a change in the immune response in patients with borderline Hansen's disease. The only effective therapy for significant type 1 reactions has been systemic corticosteroid therapy. Cyclosporine is an immunosuppressive drug which has been widely used in organ transplantation. We report a case of type 1 reaction complicating borderline lepromatous Hansen's disease. Cyclosporine therapy resulted in prompt and sustained resolution of the reaction. The possible mechanism of action of cyclosporine and the implications regarding the immunopathogenesis of type 1 reaction are discussed.
Physicians long have been a high-risk group for developing tuberculosis. The progressive decline in the incidence of tuberculosis in the United States over most of the second half of the 20th century led to less tuberculosis and less awareness of tuberculosis among physicians. Recent changes, however, have led to an increase in the incidence of tuberculosis in the U.S. and may lead to more physicians being affected. Two physicians in Hawaii were diagnosed as having active tuberculosis in 1990. Physicians should take steps to prevent its spread and should consider the disease in the differential diagnosis when physicians or their patients are ill.
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Of the hundreds of species of bacteria in seawater, in marine sediments, and associated with marine organisms, more than 20 are known human pathogens. Based on published data, wherein a variety of marine bacteria have been cultured from open wounds (eg, coral cuts) and from near-drowning pneumonias, it is hypothesized that these bacteria can provide a primary infectious inoculation of open marine wounds and of the respiratory tract of near-drowners.
A middle-aged woman suffered from chronic diarrhea and malnutrition as a result of a small intestinal infection with a coccidial protozoan--Cryptosporidium. This parasite has been found among a wide range of reptilian, avian and mammalian hosts, but rarely in human beings. This woman ultimately died as a result of disseminated toxoplasmosis of the type usually encountered in an adult whose immune responses were compromised. There was clinical evidence of both humoral and cellular immunologic incompetence, such as depressed levels of complement and immunoglobulins, and decreased T cell reactivity, respectively. The former could be accounted for on the basis of malnutrition causing deficient protein synthesis, and the latter may have been a manifestation of altered function of transformed T cells.
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Seventy-four mothers were surveyed to determine their attitudes toward the use of a Papoose Board (PB, Olympic Medical Corporation, Seattle, WA) to treat their uncooperative children (mean age 3.1 years). If, at the initial exam, it was agreed that the PB might be an acceptable treatment modality, the child was prescribed a sedative for the next appointment. At that appointment, the child was placed in the PB and teeth were restored using local anesthetic, mouth prop, and/or nitrous oxide. Afterward, each mother received a survey to complete at home and mail back anonymously. Seventy-four surveys were issued; 59 were mailed back. Of the 59, 50 were answered comprehensively; nine were incomplete. Of the 50 surveys, 90% of the mothers approved of the use of the PB, 96% thought the PB was necessary to perform the dentistry, 78% did not think it had a later negative effect on the child, and 86% were willing to use it with their next child.