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Biomedical subjects

R Pool

Publications and source records attributed to R Pool.

At least 73 records · Page 4Linked to original sources

Hot and cold as an explanatory model: the example of Bharuch district in Gujarat, India.

The concepts of hot and cold are important in disease etiologies and systems of food classification in many parts of the world. A number of writers on hot-cold beliefs have assumed that the classification of foods is the central element in this system of beliefs, and that it is consistent. They have then proceeded to explain these beliefs in symbolic or adaptive terms, generalizing from systems of classification which have only local applicability. More recently a number of writers have recognized the importance of intracultural variation in the hot-cold classification of foods, and have turned their attention to revealing the underlying principles of classification. But because food classifications are only consistent within a limited geographical area, if they are consistent at all, these 'general principles' are only applicable to a single area or limited cultural context. In this article I describe the hot-cold system in a rural area of the Indian state of Gujarat. I show that by proceeding from the classification of diseases, and not from the classification of foods, it becomes possible to reveal certain underlying classificatory principles which also appear to be applicable to other manifestations of the hot-cold system. These principles seem to be based on the phenomena which accompany temperature changes in nature. Finally I suggest that hot-cold beliefs should be seen as an explanatory model which seeks to make the puzzling and threatening phenomena of disease and death more acceptable and predictable.

Cold Temperature

Intrafamilial variability of popliteal pterygium syndrome: a family description.

Popliteal pterygium syndrome is one of the autosomal dominant limb pterygium syndromes. It has incomplete penetrance and extreme phenotypic variability that leads to difficulty in diagnosis. A case is presented to emphasize the variable phenotype of this disorder. The absence of pterygia in the family members led to the misdiagnosis of van der Woude's syndrome. However, the presence of a pyramidal fold of skin over the nail of the hallux in family members suggested the diagnosis of popliteal pterygium syndrome. It is concluded that the presence of this distinctive nail abnormality in infants with cleft lip, cleft palate or both suggests the diagnosis of the popliteal pterygium syndrome.

Abnormalities, Multiple

Pessimism concerning palliative bypass procedures for established malignant esophagorespiratory fistulas: a report of 18 patients.

Eighteen patients with established malignant esophagorespiratory fistulas due to primary esophageal cancer were managed by substernal gastric bypass and isolation of the cancerous esophageal segment. Seven fistulas were esophagotracheal and 11 were esophagobronchial. Ten patients died in the hospital between two days and six weeks after operation. Eight patients left the hospital, surviving an average of 3 1/2 months, but 2 patients lived 5 and 7 months, respectively. Unrelenting respiratory infection and clinical inanition caused 7 hospital deaths in patients reestablished on oral alimentation with their fistulas disconnected. Anastomotic leaks occurred in 5 patients; three of these leaks closed. In the other 2 patients, cervicomediastinal sepsis and bilateral pneumonia with respiratory failure caused death. One patient died of anoxic cardiac arrest 48 hours postoperatively. Fifteen of the 18 patients resumed oral alimentation, but the overall results of palliative surgical therapy achieved in this series were not observably worthwhile for the majority.

Adult

Superior vena-caval obstruction in urban blacks. A report of 82 cases.

Eighty-two patients with superior vena-caval obstruction (SVCO) were studied retrospectively. Carcinoma of the bronchus was responsible for the syndrome in 60 patients; of the remaining 22 patients, 7 had mediastinal lymphomas, 5 retrosternal goitres, 4 oesophageal cancer, 3 vascular aneurysms, 2 thymic tumours, and 1 granulomatous mediastinitis. Rigid bronchoscopy, scalene node biopsy or aspiration, cervical mediastinoscopy, anterior mediastinotomy, transthoracic needle biopsy and median sternotomy were the procedures used to make a definitive diagnosis. It is noteworthy that in 9 of the 82 patients malignant disease was not the cause of the SVCO. Seven of the remaining 73 patients had lymphoma causing compression of the superior vena cava. A significant proportion (19.5%) of urban Blacks with SVCO had causes other than hopeless bronchogenic carcinoma as the basis for their condition.

Adolescent

Lung cancer resectability in urban Blacks.

Two hundred and eighty-one patients with carcinoma of the lung were seen over a period of 30 months in our unit. All patients were investigated and staged according to the system of the American Joint Committee for Cancer Staging. Patients with stage I or stage II disease were operated upon, but those with stage III disease or with a pre-operative diagnosis of small cell tumour were not considered for surgery. Of the 281 patients evaluated, 83 (29,5%) underwent thoracotomy and 55 (19,6%) resection.

Black or African American

Late management of penetrating oesophageal injury. Case reports.

Two cases of oesophageal perforation at the thoracic inlet, due to penetrating trauma, are described. In the first case the diagnosis was established 2 weeks after injury; the second case was diagnosed within 30 hours, was treated unsuccessfully and referred to us 1 month after injury. The management of these severely ill patients is discussed. Defunctioning of the oesophagus was necessary in both cases, and later reconstruction was carried out in one of the patients.

Adult

Retrosternal gastric bypass for inoperable esophageal cancer: a report of 71 patients.

Palliative substernal gastric bypass was performed in 71 patients with unresectable cancer of the intrathoracic esophagus. Fifty-six patients (78.9%) left the hospital, 53 eating normally and 3 on a soft diet. There were 15 hospital deaths (21%), 8 due to respiratory failure and pulmonary sepsis with tracheoesophageal fistulization. The remaining 7 deaths were due to aspiration and respiratory failure in 2 patients, anastomotic leakage with sepsis in 2, subphrenic abscess and septicemia in 1, mediastinitis in 1, and intestinal obstruction in 1. Anastomotic leakage occurred in 17 patients (23.9%), 5 of whom died. Wound infections developed in 28 patients (39.4%), 3 with mediastinal esophagocutaneous fistulas. Reestablishment of unimpeded swallowing, relief of respiratory aspiration, isolation of cancerous tracheobronchial infiltration, and freedom from incident-prone endoesophageal tubes were achieved in all patients leaving the hospital. Information is presented on 25 patients who were available for follow-up.

Adult

Composite vascularized free-rib and pleural transfer for laryngotracheal reconstruction.

A free rib pleura composite vascularized transfer for repair of a defect in the canine upper airway is discussed and the results are reported. The procedure was carried out on eight dogs. One dog died from the anesthetic. Three surgical failures resulted from technical difficulties: failure of the vascular anastomosis, torsion of the vascular pedicle, and hemorrhage. Four dogs successfully maintained their airways, although one demonstrated bone absorption. Bone scanning, angiography, tetracycline labeling, and light microscopy confirmed active osseous metabolism of the rib, providing further evidence of the adequacy of periosteal circulation in maintaining normal rib metabolism. Scanning electron microscopy and conventional light microscopy demonstrated the development of a healthy respiratory epithelium. Thus a free flap of rib and attached pleura will provide adequate skeletal support and a moist, functioning, epithelial lining in a single-stage operation for reconstruction of a laryngotracheal defect in the normal dog.

Animals

Massive hemoptysis. Review of 123 cases.

Case histories of 123 patients with massive hemoptysis were reviewed. The causes of hemorrhage were active pulmonary tuberculosis (47), bronchiectasis (37), chronic necrotizing pneumonia (11), lung abscess (six), lung cancer (six), bronchovascular fistula (five), primary pulmonary fungal infection (four), and miscellaneous (seven). Conservative management was used in 66 patients, with 21 deaths (31.8%). Surgical management was used in 34 patients, with six deaths (17.6%). Endobronchial iced saline lavage was used in 23 patients, with one death. All patients treated by lavage stopped bleeding, and further therapy, either surgical (five) or medical (18), was given as appropriate. The early control of tracheobronchial hemorrhage by endoscopic means is an effective though transitory holding procedure. The unpredictability of massive hemoptysis is underscored by eight deaths from sudden, engulfing hemorrhage in seemingly stable patients awaiting endoscopy or operation.

Adolescent

Osteochondrosis of the shoulder joint of the horse.

Osteochondrosis of the shoulder joint in the horse was diagnosed radiographically in 54 shoulders of 38 horses. Clinical signs were those of an intermittent lameness characterized as a swinging leg shoulder lameness with pain elicited by extension, flexion or abduction of the limb. Diagnosis of shoulder lameness was supported by blocking the shoulder joint with local anesthetics. Radiographic changes consisted of: (1) alteration in the contour of the humeral head and glenoid cavity, (2) periarticular osteophyte formation, (3) sclerosis of the subchondral bone, and (4) bone cyst formation. The primary bony lesion in the shoulder of the horse is similar to that described in the dog, pig, bull, turkey and broiler chicken. Secondary joint disease is a prominent finding with osteochondrosis of the shoulder in the horse. A follow-up study of 17 horses indicated that many of the affected horses had been sold and were being used for pleasure riding and breeding purposes. Those horses still in use usually had less severe radiographic changes at the time of diagnosis.

Animals

Further studies on the sources of Klebsiella aerogenes in hospital patients.

We report an investigation into faecal carriage of Klebsiella aerogenes and the distribution of this organism in the environment of three wards. In all three wards faecal carriage rates were high (60-70%). The faecal carriage rate increased with antibiotic administration and with length of in-patient stay. K. aerogenes was widely distributed in the ward environment and was found on the hands of nursing staff. Clusters of isolations of K. aerogenes of the same serotype were demonstrated indicating either patient-to-patient transfer or a common source of infection. The results indicate that even under conditions in which there are no outbreaks of K. aerogenes infection, there is a large reservoir of this organism both in the bowel of patients and in the ward environment.

Adult

Angiographic aspects in kidney transplantation.

In 61 of the 110 patients with renal transplantation an angiography was performed. Besides the indication for angiography different pathological changes are illustrated: arterial stenosis, arteriovenous fistula, dissection of the arterial wall. Before angiography it is necessary to be informed about the operation technique. Sometimes different projections must be applied to get sufficient information about the arterial system of the transplant.

Antigens

Two-point discrimination distances in the normal hand and forearm: application to various methods of fingertip reconstruction.

Two-point discrimination in the hand and forearm is best during the third decade of life. In the fingertips, the ulnar digits are more discriminating than the radial digits. Males and females have equal two-point discrimination during each age decade. Fingertips are twice as discriminating as the thenar and hypothenar areas, and the thenar and hypothenar areas are twice as discriminating as the volar side of the wrist; the wrist is twice as discriminating as the forearm. The Kleinert and Kutler flaps demonstrated the best two-point discrimination among the repaired fingertips.

Adolescent