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Biomedical subjects

R M Kline

Publications and source records attributed to R M Kline.

18 recordsLinked to original sources
PubMed1998

Azygous lobe presenting as a posterior mediastinal mass in a 2-year-old boy.

Posterior mediastinal masses encompass a varied group of surgical lesions that include malignant diseases as well as the anatomic malformations of four organ systems. The authors report on a 2-year-old child with a posterior mediastinal mass who was found at thoracotomy to have a chronically infected "hepatized" azygous lobe of the right lung. The authors review current literature on this topic as well as the embryogenesis of azygous lobes.

Child, Preschool↗
PubMed1998

A detailed analysis of charges for hematopoietic stem cell transplantation at a children's hospital.

We analyzed hospital charges for pediatric hematopoietic stem cell transplantation (HSCT) to understand better the medical origin of these charges. Forty-nine patients undergoing HSCT at Kosair Children's Hospital between January 1992 and August 1995 had hospital charges analyzed by cost center, donor type and clinical outcome. Thirty-three autologous, two syngeneic and 14 allogeneic transplants were performed. Twenty-four transplants were performed for hematological malignancies, 22 for solid tumors, and three for non-malignant diseases. Pharmaceutical charges comprised the largest single component of total hospital charges (THC), accounting for 38.9%. Room charges were the next largest group at 33.7% of THC. Other cost centers, in order of magnitude, were central supply (7.9%), transfusion services (7.5%), laboratory (5.8%), microbiology (3.6%), miscellaneous (1.9%), and radiology (1.4%). Within the pharmaceutical cost center, colony-stimulating factors comprised the largest single item, making up 18% of total pharmacy charges and 7% of THC. Antibiotics were the second largest component, at 16% of pharmacy charges and 6% of THC. Patients transferred to the intensive care unit (ICU) had charges 68% greater than non-ICU patients. Allogeneic transplant patients had THC 35% greater than autologous transplant patients, but also a four-fold greater chance of becoming an ICU patient. THC for non-ICU allogeneic transplant patients were 18% greater than for autologous non-ICU patients. THC for allogeneic ICU patients were 21% greater than for autologous ICU patients. Patients who died of transplant-related toxicity prior to day 100 had THC 83% greater than those who survived beyond day 100. This is the first published comprehensive and detailed analysis of charges associated with hematopoietic stem cell transplantation. With increased emphasis on the provision of cost-effective care in both Europe and the USA, medical practices must be examined with the goal of reducing inefficiencies while preserving quality of care. Understanding the genesis of charges in expensive procedures such as stem cell transplantation is an initial step in cost containment.

Adolescent↗
PubMed1998

Trunk reconstruction with the free vastus lateralis flap.

A case is presented of a massive, full-thickness, trunk-wall defect successfully reconstructed with a free-tissue transfer of the entire vastus lateralis muscle. Indications, technical details, and donor-site considerations are discussed.

Aged↗
PubMed1998

Umbilical cord blood transplantation: providing a donor for everyone needing a bone marrow transplant?

BACKGROUND: Bone marrow transplantation (BMT) has been limited in the past by the availability of matched donors for patients. Over the past decade, the use of umbilical cord blood (UCB) as a source of hematopoietic stem cells has revolutionized the field of BMT, providing a source of hematopoietic stem cells for an increasing number of patients in need of a transplant. RESULTS: Umbilical cord blood transplantation (UCBT) appears to result in sustained engraftment of donor hematopoiesis similar to results achieved with marrow and peripheral blood hematopoietic stem cells. Early results indicate that UCBT is associated with a lower incidence and less severity of graft-versus-host disease than other sources of stem cells, potentially decreasing the morbidity and mortality of BMT. As the potential of UCBT has been realized, cord blood storage facilities have been established to provide UCB. The rapid emergence of UCBT has transformed a waste product of birth into a life-saving resource. Its use, however; has raised numerous ethical and medical concerns unique to this alternative source of stem cells. CONCLUSIONS: Umbilical cord blood transplantation represents a major advance in providing another stem cell source to patients in need of allogeneic hematopoietic stem cell transplantation. As with all new technologies, UCBT will have to be carefully studied over the next several years to determine its safety, efficacy, and precise indications in comparison with other sources of hematopoietic stem cells. The ethics of UCBT must properly respect the rights and needs of both donors and recipients.

Adolescent↗
PubMed1997

Leptomeningeal metastasis from a paraspinal rhabdomyosarcoma with a der(13)t(1;13)(q23;q32) in a 14-month-old boy.

Cytogenetic analysis performed on a 14-month-old boy with a primary retroperitoneal/paraspinal alveolar rhabdomyosarcoma showed the presence of a der(13)t(1;13)(q23;q32) resulting in partial trisomy of the 1q23-->qter region and loss of the 13q32-->qter region. The present case is discussed with reference to a similar case reported in the literature.

Chromosomes, Human, Pair 1↗
PubMed1997

Management of craniofacial anomalies.

Children with craniofacial anomalies comprise a diverse group of patients, with problems involving many organ systems. In the fairly recent past, no satisfactory treatment was available for many of these problems. Through the contributions of Tessier and many other innovators, however, multidisciplinary groups such as the Medical University of South Carolina's Craniofacial Team are now able to offer substantial improvement to many patients with congenital or acquired deformities of the craniofacial region. The best reconstruction for any given patient can be determined only after a careful analysis of the patient's problems and the patient's and family's wishes. Using this approach, we are able to help many patients significantly. As we treat today's patients, however, we must continue to critically assess our results and improve our methods, for only through this process will tomorrow's patients enjoy even better outcomes than today's.

Child, Preschool↗
PubMed1996

Bone marrow 'boosts' following T cell-depleted haploidentical bone marrow transplantation.

Nine patients transplanted for non-malignant conditions (eight severe combined immunodeficiency, one aplastic anemia) received lectin-treated T cell-depleted BMTs from haploidentical donors. Each patient subsequently received a second T cell-depleted transplant (¿boost') from the same donor, without conditioning, because of a delay in the recovery of T cell immunity associated with evidence of engraftment. The median time to boost after initial BMT was 0.5 years (range 0.2-4.6 years). No conditioning therapy was used prior to the boost (except one patient who received ATG) and no GVHD prophylaxis was used during either the initial or subsequent BMTs. Eight of the nine patients are surviving at a median follow-up of 2.9 years (range 0.3-6.2 years). Following BMT boost, T cell function improved with the lymphocyte proliferative responses to PHA, PWM and alloantigen all increasing at least eight-fold. The mean percentage of CD3+ lymphocytes increased from 20 +/- 7% of total lymphocytes following the first BMT to 66 +/- 7% following the marrow boost (P < 0.001). This increase was generated primarily by an increase in the CD4+ lymphocyte subset which increased from 13 +/- 3% post-transplant to 44 +/- 6% after the BMT boost (P < 0.005), and was reflected in both the CD4+/Leu8+ and CD4+/Leu8- lymphocyte populations. Measurements of B cell immunity (immunoglobulins, isohemagglutinins and B cells) showed no significant effect of the marrow boosts. These results suggest that bone marrow 'boosts' are an effective means for improving T cell immunity in patients who fail to recover adequate immune function after T cell-depleted bone marrow transplantation and may be applicable as immunotherapy following allogeneic BMT undertaken to treat malignancy.

Anemia, Aplastic↗
PubMed1995

Complications associated with the harvesting of cranial bone grafts.

This study was undertaken to determine the incidence of serious neurologic injury associated with the harvesting of cranial bone grafts. A personal series of 1000 consecutive bone-grant harvestings (cranial, iliac, costal, tibial, and mandibular) was examined in detail for complications. Then a survey of members of the International Society of Craniofacial Surgeons was performed, and data were compiled on complications of bone-graft harvestings performed by the respondents. Data also were compiled on neurologic complications related to cranial bone-graft harvestings performed by other surgeons which the respondents were aware of through direct personal knowledge, medicolegal review, the medical literature, or other channels. No neurologic complications were associated with any of the 586 cranial bone grafts taken in the authors' series. The survey respondents reported that they had performed 12,672 cranial bone-graft harvestings. Temporary neurologic complications were associated with graft harvesting in 3 cases (0.02 percent). The respondents also identified 8 other neurologic complications (4 permanent and 4 temporary) associated with cranial bone-graft harvestings performed by other surgeons. Five cases were performed by surgeons having little or no experience in harvesting cranial bone grafts, and three were performed by surgeons having only limited training. It appears that cranial bone grafts can be harvested with an extremely low incidence of serious complications by surgeons who have had proper training. Techniques are suggested for safe harvesting of cranial bone grafts, as well as for detecting and managing complications when they arise.

Bone Transplantation↗
PubMed1990

Surgical treatment of brachial artery injuries after cardiac catheterization.

A consecutive series of 532 patients (1.5%) required local thrombectomy and arterial repair after 34,291 transbrachial cardiac catheterizations performed at the Cleveland Clinic from 1980 to 1988. A total of 514 patients (97%) were discharged from the hospital with normal radial pulses and/or normal ulnar pulses after a single surgical procedure. Fourteen others (3%) each required one additional procedure to regain a distal pulse, and four patients either underwent two reoperations, received thrombolytic therapy, and/or remained pulseless. Surgical delay of more than 1 day after catheterization was associated with a higher incidence of recurrent thrombosis (12% vs 2%, p = 0.025). In comparison to our previous experience with iatrogenic brachial injuries, the liberal use of segmental arterial resection and overnight heparin anticoagulation seem especially to reduce the risk for early failure in all patients, but improvement was particularly marked in women (25% vs 6%, p = 0.0004).

Brachial Artery↗
PubMed1986

Isolation and structural identification of nine avilamycins.

Avilamycin is an antibiotic complex produced by cultures of the organism Streptomyces viridochromogenes, strain NRRL 2860. These compounds belong to the orthosomycin family of antibiotics. Structural composition of the major avilamycins and several minor avilamycins are known. Nine additional minor avilamycins, designated F through N, have been isolated via semi-preparative silica gel or reverse-phase high performance liquid chromatography with final purification using a reverse-phase column loading solvent switching technique. 1H NMR and mass spectroscopy, negative ion fast atom bombardment (neg FAB) and electron impact, were used to structurally identify the avilamycins. All of the compounds were microbiologically active and similar in structure to other known avilamycins.

Anti-Bacterial Agents↗
PubMedDate not supplied

Oral contraceptives: a cause of hyperbilirubinemia in stem cell transplant patients.

Conjugated hyperbilirubinemia in the clinical setting of hematopoietic stem cell transplantation can have multiple etiologies that may prompt various therapeutic interventions. Two patients who received short courses of a high-dose estrogen-progesterone combination to treat breakthrough menstrual bleeding during transplant are reported. Conjugated hyperbilirubinemia developed in both patients within days of beginning therapy and resolved after the ethinyl estradiol and norgestrel (Ovral; Pharmacia and Upjohn, Kalamazoo, MI, U.S.A.) was discontinued. In one of the patients, this occurred on three separate occasions during the course of transplantation. Recognizing the cholestatic effect of estrogens during transplantation may prevent unnecessary alterations in therapy beyond the simple discontinuation of these medications.

Adolescent↗