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Biomedical subjects

R L Jacobs

Publications and source records attributed to R L Jacobs.

At least 19 recordsLinked to original sources
PubMed1992

Triple arthrodesis through a single lateral approach: a cadaveric experiment.

Using a single lateral approach, triple arthrodesis was performed on six cadaveric feet. An attempt was made to obliterate the talocalcaneal, talonavicular, and calcaneocuboid joints. The limbs were subsequently disarticulated to allow for an inspection of the talonavicular, talocalcaneal, and calcaneocuboid joints. An estimate of cartilage and subchondral bone removed from each articular surface was made by a single observer (J.V.B.) by direct visual inspection. Results were as follows: calcaneocuboid joint, 90% of cartilage removed; talocalcaneal joint, 80% of cartilage removed; talonavicular joint, 38% of cartilage removed. Failures at the talonavicular joint were attributed to a poor appreciation of the anatomy of the talar head and poor observation. Complications involved in obliteration of the talonavicular joint from a single lateral approach included: inadvertent division of the talar neck; inadvertent division of the talar head; removal of excessive bone stock; medial skin punctures; and creation of an iatrogenic cut through the talar dome. Therefore, a triple arthrodesis through a single lateral approach, as described by Ryerson, Hoke, and Campbell, cannot be recommended. The talonavicular joint should be approached through an auxiliary medial incision, as recommended by Cracchiolo. This paper documents the experience of a beginner with this operation, and demonstrates the value of using the anatomy laboratory.

Arthrodesis↗
PubMed1991

Pseudoaneurysm of the dorsalis pedis artery after Lisfranc amputation.

Pseudoaneurysm formation is usually associated with laceration, fracture, or iatrogenic arterial injury. However, it may also develop as a result of blunt trauma. We report the case of a pseudoaneurysm of the dorsalis pedis artery after a Lisfranc amputation in an individual with diabetes mellitus, Charcot joint changes in the left forefoot, and atherosclerosis of the distal vessels.

Amputation, Surgical↗
PubMed1989

Hypersensitivity pneumonitis treated with an electrostatic dust filter.

A 60-year-old woman had had recurrent acute migratory pneumonias for 9 months. The results of an evaluation, which included tests for serum precipitins, a transbronchial biopsy, and a bronchial provocation, confirmed a diagnosis of hypersensitivity pneumonitis caused by an Aspergillus species. The findings from gravity air cultures in the home showed a heavy infestation of mold. The installation of electrostatic dust filters in the return ducts of the central air conditioning system resulted in the lowering of mold colony counts to normal levels. This change in the environment enabled the patient to live at home without having the signs and symptoms of hypersensitivity pneumonitis, or a need for medication. Thirty months after the electrostatic dust filters were installed, total mold colony counts were still normal, the patient remained free of the signs and symptoms of hypersensitivity pneumonitis, and serum precipitins could no longer be demonstrated. The results of a bronchial challenge to Aspergillus species, however, remained positive; these positive results suggest that long-term memory immune mechanisms may play an important role in the pathogenesis of hypersensitivity pneumonitis and lessen the importance of precipitins in establishing a diagnosis. We report that electrostatic dust filters may be an effective treatment for patients with hypersensitivity pneumonitis when avoidance of the causative antigen cannot be easily and rapidly achieved.

Air Conditioning↗
PubMed1987

Periodontal manifestations of the heritable Mac-1, LFA-1, deficiency syndrome. Clinical, histopathologic and molecular characteristics.

The clinical, histopathologic and functional consequences of the genetic deficiency of leukocyte Mac-1, LFA-1 and p150,95 were assessed among three affected patients, heterozygotes and unaffected individuals among two generations of a single kindred. Longitudinal assessments of this family afforded the unique opportunity to characterize the natural history of severe periodontal manifestations associated with this disorder. Features uniformly observed among each patient included recurrent, necrotic soft tissue infections, impaired pus formation, delayed wound healing, constant granulocytosis, severe abnormalities of adhesion-dependent granulocyte functions and a profound deficiency (3%-6% of normal) of Mac-1 glycoproteins on granulocyte surfaces. Characteristic features of generalized prepubertal periodontitis including rapidly progressive alveolar bone loss affecting the primary and permanent dentitions (leading to premature tooth loss), recession, clefting and migration in association with intense gingival inflammation were uniformly observed. Biopsies of inflamed periodontal tissues in these individuals demonstrated dense infiltrates of mononuclear leukocytes but a striking absence of extravascular neutrophil granulocytes. Heterozygous family members demonstrated approximately half normal Mac-1 protein expression but no susceptibility to systemic infections and normal, adhesion-dependent leukocyte functions. Prepubescent heterozygotes demonstrated no periodontal manifestations but a 31-year-old heterozygous female exhibited clinical and radiographic features typical of postjuvenile periodontitis. The profound periodontal manifestations recognized in this clinical-pathologic model emphasize the physiologic importance of leukocyte adhesion reactions in defense of the periodontium and further suggest a possible pathologic role for Mac-1 proteins in other forms of early-onset periodontitis.

Adult↗
PubMed1987

Osteoid osteoma of the talus. A case study.

Osteoid osteoma can be easy to recognize in a classic presentation involving long bones. However, the diagnosis may be difficult when cancellous bone is involved, and surgical exploration may first lead to the diagnosis. A case is presented illustrating this problem.

Adult↗
PubMed1986

Sunflower oil is not allergenic to sunflower seed-sensitive patients.

The allergenicity of edible oils derived from sunflower seeds was investigated in two patients with anaphylactic sensitivity to sunflower seeds. Specific IgE-mediated hypersensitivity to sunflower seed was demonstrated by history, prick skin tests, positive passive transfer skin test, and RAST. Specific IgE directed toward sunflower oil, refined or cold pressed, could not be conclusively demonstrated. The Prausnitz-Küstner reaction with sunflower oils performed with one patient's serum was negative. Although the cold-pressed sunflower oil was found to contain a minute amount of protein, open challenge with the derivative oils resulted in no immediate or delayed reaction in the two patients studied. Sunflower oil ingestion in these patients who were highly sensitive to the parent material proved safe. Nonallergenicity of derivative products needs to be proven for each case.

Adult↗
PubMed1986

Limb salvage in a diabetic with necrotizing fasciitis: case report and literature review.

Necrotizing fasciitis must be considered in a diabetic with cutaneous ulceration. A case report of limb salvage in a 48-year-old diabetic female with progressive necrotizing fasciitis is presented. Methods of early diagnosis including clinical signs, radiographs, and soft tissue biopsy of the involved extremity are reviewed. The microbiology of the disease is also discussed. A modification of the Orr technique using infrequent dressing changes in the management of necrotizing fasciitis is presented. In our case this resulted in preservation of life and a functional limb.

Ankle↗
PubMed1986

Hypersensitivity pneumonitis caused by Cladosporium in an enclosed hot-tub area.

A 48-year-old woman had an 18-month history of malaise and chronic cough with intermittent episodes of fever, chills, and pneumonic infiltrates. Transbronchial biopsy findings were consistent with hypersensitivity pneumonitis. Cultures of fungus from a hot-tub room in her home were positive for Cladosporium species. Serum precipitins were weakly positive for Cladosporium cladosporioides. Removal of the patient from the home environment led to a resolution of symptoms within 1 week. Within 4 hours of re-exposure to the hot-tub room, symptoms and signs and changes in leukocyte count and spirometric values again occurred. Bronchial provocation with a commercial extract of C. cladosporioides led to a similar pattern 5 hours after the initial challenge. This case identifies a previously unreported etiologic agent and environmental site for hypersensitivity pneumonitis.

Alveolitis, Extrinsic Allergic↗
PubMed1985

The severe and moderate phenotypes of heritable Mac-1, LFA-1 deficiency: their quantitative definition and relation to leukocyte dysfunction and clinical features.

An inherited syndrome characterized by recurrent or progressive necrotic soft-tissue infections, diminished pus formation, impaired wound healing, granulocytosis, and/or delayed umbilical cord severance was recognized in four male and four female patients. As shown with subunit-specific monoclonal antibodies in immunofluorescence flow cytometry and 125I immunoprecipitation techniques, in addition to a NaB3H4-galactose oxidase labeling assay, granulocytes, monocytes, or lymphocytes from these individuals had a "moderate" or "severe" deficiency of Mac-1, LFA-1, or p150,95 (or a combination)--three structurally related "adhesive" surface glycoproteins. Two distinct phenotypes were defined on the basis of the quantity of antigen expressed. Three patients with severe deficiency and four patients with moderate deficiency expressed less than 0.3% and 2.5%-31% of normal amounts of these molecules on granulocyte surfaces, respectively. The severity of clinical infectious complications among these patients was directly related to the degree of glycoprotein deficiency. More profound abnormalities of tissue leukocyte mobilization, granulocyte-directed migration, hyperadherence, phagocytosis of iC3b-opsonized particles, and complement- or antibody-dependent cytotoxicity were found in individuals with severe, as compared with moderate, deficiency. It is proposed that in vivo abnormalities of leukocyte mobilization reflect the critical roles of Mac-1 glycoproteins in adhesive events required for endothelial margination and tissue exudation. The recognition of phenotypic variation among patients with Mac-1, LFA-1 deficiency may be important with respect to therapeutic strategies.

Adolescent↗
PubMed1985

Recurrent acute bronchitis: the association with undiagnosed bronchial asthma.

Forty-six consecutive patients with a history of recurrent acute bronchitis (chest colds) referred from primary care clinics were studied prospectively to determine if hyperreactive airways (mild bronchial asthma) was a concomitant entity. Mild bronchial asthma was diagnosed in 30/46 (65%) patients by history, physical examination, and routine spirometry, or by methacholine bronchial provocation. The incidence of mild bronchial asthma was markedly increased in patients with a history of recurrent acute bronchitis over that seen in the general population. These results emphasize a need to investigate an underlying cause in patients with recurrent acute bronchitis.

Acute Disease↗
PubMed1985

Chronic cough, sinusitis, and hyperreactive airways in children: an often overlooked association.

Ten patients, aged 7 to 16 years, were prospectively evaluated for chronic cough of more than 4 months duration. All patients denied wheezing, but in addition to cough complained of chronic obstructive nasal symptoms. Sinus roentgenograms were consistent with sinusitis in 7/10 patients. Methacholine bronchial provocation was positive in 6/9 patients. The patients were recalled for a 2-year follow-up evaluation. Of seven follow-up patients, bronchial asthma had developed in three, two patients had chronic cough and exercise-induced bronchospasm, and two patients had chronic cough without wheezing. Methacholine bronchial provocation was positive in 6/6 patients. Sinus roentgenograms were compatible with sinusitis in 4/7 patients. Chronic cough in some children may be a complaint of diffuse hyperreactive airways complicated by sinusitis. In some of the children the clinical course evolved into a diffuse respiratory tract disorder including chronic obstructive eosinophilic rhinitis, recurrent or chronic sinusitis and bronchial asthma. An IgE-mediated mechanism usually could not be shown in the pathogenesis.

Adolescent↗
PubMed1984

Nasal polyposis in a chimpanzee.

A 15-year-old female chimpanzee with nasal polyposis sustained respiratory compromise when she was sedated and expired despite resuscitative efforts. Postmortem examination revealed very large fibromyxomatous nasal polyps completely obstructing the upper airway. Gross examination and histopathologic findings were indistinguishable from those of human polyps. The chimpanzee is a potential animal model for nasal polyposis that could provide basic information concerning the relationship of polyps to type I hypersensitivity and to three severe respiratory tract disorders in humans: cystic fibrosis, bronchial asthma, and the immotile cilia syndrome.

Animals↗
PubMed1984

Long-acting, repository antimalarial agents. Duration of protection in mice and monkeys following administration of pyrimethamine pamoate.

The duration of protection from blood-stage malarial challenge following single injections of pyrimethamine pamoate was assessed in mice and monkeys. This duration was dose-related and ranged from several weeks in mice to over 4 months in the monkeys. Comparisons with the previously reported repository drugs, cycloguanil pamoate and acedapsone (diacetyldiaminodiphenyl sulfone), in mice demonstrated that pyrimethamine pamoate provides an equal or greater duration of protection. Studies with mixtures containing acedapsone gave good protection against a pyrimethamine-resistant strain of Plasmodium berghei.

Acedapsone↗
PubMed1983

In vivo and in vitro comparison of fire ant venom and fire ant whole body extract.

Thirty-four patients with a history of immediate hypersensitivity to the sting of the imported fire ant were evaluated in a study designed to compare the diagnostic usefulness of fire ant whole body extract (WBE) preparations with that of fire ant venom (IFAV). Ninety-one percent (31/34) of the hypersensitive patients skin tested with IFAV at a maximal concentration of 1:5 X 10(3), v/v, demonstrated a wheal equal to or greater than the histamine control. Fifty-three percent (18/34) of the group were skin test positive to a WBE preparation. When the criteria for a positive skin test were relaxed, 82% of the hypersensitive group could be identified with the IFAWBE. A comparison of skin test results in sensitive patients revealed variability in the sensitivity of the WBE preparations utilized in the study. Leukocyte histamine release demonstrated a dose-response release of histamine with both IFAV and SIWBEa preparations. Specific venom antisera produced in rabbits identified a precipitin line of common identity in a gel-diffusion system containing IFAWBE and IFAV. This finding was verified by the competitive inhibition of IFAWBE with IFAV in a solid-phase radioimmunoassay system. Fire ant WBEs contain venom constituents and are effective diagnostic agents in up to 82% of patients with hypersensitivity to the sting of the imported fire ant. Marked variability in the responsiveness of sensitive patients to different WBE preparations mandates standardization of these diagnostic preparations.

Adolescent↗
PubMed1983

Primary nasal polyposis.

Twenty patients with nasal polyposis, either asymptomatic or with persistent nasal obstruction, were studied prospectively. Fourteen of 18 patients when free of obstructing polyps had no ongoing nasal symptoms. Nasal secretion eosinophilia of greater than or equal to 20% was demonstrated in 19/20 patients. Prick skin tests and RAST were positive to inhalant allergens with poor clinical correlation in 10/20 patients. Mean total eosinophil count and mean total serum IgE, IgA, IgG and IgM were normal. Sinus roentgenograms were consistent with sinusitis in 11/20 patients. Methacholine bronchial provocation was positive in 11/19 patients. Aspirin challenge was negative to 650 mg and 3250 mg in 18/18 and 8/8 patients respectively. Serum salicylate levels two hours post 3250 mg aspirin challenge had a mean of 18.5 mg/dl. HLA typing to the A and B loci revealed no specific pattern. Patients with primary nasal polyposis are characterized by nasal secretion eosinophilia, lack of ongoing symptoms when free of obstructing polyps, increased frequency of cholinergic bronchial hyper-reactivity, increased susceptibility to recurrent or chronic sinusitis, lack of aspirin sensitivity and high frequency of inhalant prick skin test and RAST positivity without correlation to symptoms. These patients may represent a variant of the syndrome involving nasal polyposis, bronchial asthma and bronchospastic reactions to aspirin and related drugs.

Adolescent↗
PubMed1983

Anaphylactoid reactions to tolmetin and zomepirac.

A 38-year-old male sustained sequential anaphylactoid reactions to tolmetin and zomepirac. This is the first report involving these closely related non-steroidal anti-inflammatory drugs (NSAID) in a single patient. He was historically tolerant of other NSAID and tolerated a graded oral aspirin challenge (up to 625 mg) without reaction. Skin testing with aqueous albumin extracts of tolmetin and zomepirac was negative. These reactions appear to differ from previously described aspirin (NSAID) sensitivity. Physicians should beware of interrupted treatment with either of these preparations.

Adult↗