Biomedical subjects
Publications and source records attributed to B D Gold.
A case of dislodgement of a submandibular sialolith into the oropharynx during nasal intubation is presented. The deleterious effect of the patient aspirating the stone into the lungs was averted by the taking of a lateral skull radiograph and localization and removal of the sialolith.
The purpose of this study was to provide some understanding of punk rockers. Although they have received media attention in the depiction of their unusual hair and clothing styles, there is limited information about their personalities. In this study a delinquent group of punk rockers was compared with a delinquent group of nonpunk rockers on self-image, a personality factor related to teenagers' mental health and adjustment. Each group consisted of 20 subjects, 15 males and 5 females, aged 14 to 17. Subjects were administered a Screening Questionnaire, the Offer Self-Image Questionnaire (OSIQ), and the California Psychological Inventory (CPI) while detained at a Southern California juvenile hall. Interest in the CPI was focused on the Socialization (So) scale. A one-way analysis of variance was conducted on each of the five OSIQ dimensions. No significant differences were found between the groups. The importance of these findings is that even though punk rockers may look and act unusual, they may actually be similar to other groups. Due to possibly invalid CPI test protocols a t test and content analysis of the CPI So scale was conducted. The t test was significant and the chi-square analyses were significant on two questions of the CPI So scale. This suggests that there may be differences between the groups in terms of family dynamics. Professionals can utilize these findings in their work with this misunderstood segment of society.
The maxillofacial trauma patient whose neurologic status undergoes a rapid and serious deterioration may have a severe hyponatremia secondary to the inappropriate secretion of antidiuretic hormone (SIADH). Other causes of hyponatremia must be ruled out, especially posttraumatic cerebral salt wasting, which necessitates a different mode of therapy. A case of SIADH is reported, and the work-up and differential diagnosis of posttraumatic hyponatremia are discussed.
The clinical entities of bacterial contamination, septicemia, and septic shock have been discussed, and an unusual case of septic shock has been presented. The associated risks of intravenous delivery of drugs or fluids are stressed.
The use of electrocautery and topical thrombin at the donor and recipient sites has decreased most of the oozing normally present in skin graft vestibuloplasty procedures. It has effectively reduced operating room time, has significantly reduced post-operative morbidity, and has shortened both hospital stay and recovery time for the patient.
Our goal was to determine what nervous mechanisms mediate the secretion of macromolecules from tracheal submucosal glands of ferrets. To do this, we studied the secretion of 35SO4-labeled macromolecules in vitro in response to electrical or pharmacological stimulation in the absence and presence of a specific nerve blocker and autonomic antagonists. We found that electrical field stimulation and the agonists acetylcholine, phenylephrine, terbutaline, and norepinephrine each cause secretion of radiolabeled materials. The molecular weights of the labeled materials released during base line and after electrical stimulation were greater than 1,000,000. The antagonists atropine, phentolamine, and propranolol alone prevented the responses to acetylcholine, phenylephrine, and terbutaline, respectively, without preventing responses to any other of these agonists or changing baseline secretion. Only phentolamine and propranolol together prevented the response to norepinephrine. Tetrodotoxin prevented the response to electrical stimulation but not the responses to the agonists. Each of the antagonists inhibited a significant portion of the response to electrical stimulation, but the combination of all three did not completely prevent secretion. We conclude that cholinergic nerves mediate secretion via muscarinic mechanisms, that adrenergic nerves mediate secretion via both alpha- and beta-adrenergic mechanisms, and that nonadrenergic-noncholinergic nerves mediate secretion via unidentified mechanisms.
We studied whether ozone-induced hyperresponsiveness could be inhibited by neutrophil depletion in dogs. Responsiveness was assessed with dose-response curves of acetylcholine aerosol versus pulmonary resistance; depletion was assessed by counting neutrophils in venous blood and in biopsies of the airway epithelium. Responsiveness and neutrophil numbers were determined 5 days and 1 day before ozone and 1 h after ozone (3.0 ppm, 2 h) in 6 untreated dogs and in 6 dogs treated with hydroxyurea (200 mg/kg daily for 5 days starting 5 days before ozone). In untreated dogs, responsiveness and neutrophil numbers 5 days and 1 day before ozone did not change, but responsiveness and epithelial neutrophils increased markedly after ozone. In treated dogs, circulating neutrophils decreased from 8.9 +/- 2.2 to 0.6 +/- 0.01 X 10(3) per mm3 (mean +/- SEM), and responsiveness before ozone did not change. Furthermore, increases in responsiveness and epithelial neutrophils did not occur after ozone. Six wk after stopping hydroxyurea, responsiveness and epithelial neutrophils increased markedly after ozone. The results suggest that ozone-induced hyperresponsiveness may depend on the mobilization of neutrophils into the airways.
We studied whether airway hyperresponsiveness induced by ozone exposure is associated with changes in the numbers of different types of cells in bronchoalveolar lavage in dogs. Airway responsiveness to acetylcholine and the numbers of cells in lavage fluid were determined 1 wk before and then 1 h and 1 wk after 2-h exposures to filtered air and to ozone (3.0 ppm) in each of 5 dogs. Airway responsiveness and the numbers of cells in lavage fluid did not change after exposure to filtered air. By contrast, airway responsiveness increased markedly 1 h after exposure to ozone and returned to control levels 1 wk later. In addition, the numbers of neutrophils and of ciliated epithelial cells in lavage increased markedly 1 h after ozone and returned to control levels 1 wk later. Our previous study showed that airway hyperresponsiveness induced by ozone is associated with an influx of neutrophils into the most central airways (1); the present results suggest that the hyperresponsiveness is also accompanied by an influx of neutrophils into more distal airways and by desquamation of airway epithelial cells.
We studied whether ozone-induced airway hyperresponsiveness correlates with the development of airway inflammation in dogs. To assess airway responsiveness, we determined increases in pulmonary resistance produced by delivering acetylcholine aerosol to the airways. To assess airway inflammation, we biopsied the airway mucosa and counted the number of neutrophils present in the epithelium. Airway responsiveness and inflammation were assessed in anesthetized dogs before ozone exposure and then 1 h and 1 wk after ozone (2.1 ppm, 2 h). Airway responsiveness increased markedly at 1 h after ozone and returned to control levels 1 wk later in each of 6 dogs, but it did not change after ozone in another 4 dogs. Furthermore, dogs that became hyperresponsive also developed a marked and reversible increase in the number of neutrophils in the epithelium, whereas dogs that did not become hyperresponsive had no change in the number of neutrophils. For the group of dogs, the level of airway responsiveness before and after ozone exposure correlated closely with the number of epithelial neutrophils. The results suggest that ozone-induced airway hyperresponsiveness may depend on the development of an acute inflammatory response in the airways.
A case of bilateral protracted mandibular dislocation complicated by the presence of unusual degenerative changes in the temporomandibular joints is presented. A synopsis of treatment modalities that have been used previously to treat similar conditions is given. Our treatment consisted of bilateral condylectomies, eminectomies, and insertion of Proplast-coated Vitallium condylar prostheses. These procedures resulted in the re-establishment of normal TMJ anatomy, the maintenance of proper posterior mandibular vertical dimension, correction of malocclusion, and relief of the patient's symptoms.
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A significant number of previously undetected pathologic conditions was disclosed when routine urinalysis and hematocrit determination were done on a large number of patients who came for treatment to a private oral and maxillofacial surgery office. This discovery of abnormalities could cause alteration of plans for contemplated surgery or anesthesia and is a contribution to the good health of patients seen.
A series of 25 cases of human bites of the facial region has been presented. Treatment procedure has been outlined for use in both infected and noninfected cases. Three case histories have been outlined.
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Inflammation of the gastric and duodenal mucosa is the end result of an imbalance between mucosal defensive and aggressive factors. The degree of inflammation and imbalance between defensive and aggressive factors can then result in varying degrees of gastritis and/or mucosal ulceration. Gastritis and ulcers of the duodenum or stomach can be classified as primary or secondary. The majority of children with chronic gastritis and ulcers in the stomach or duodenum have secondary inflammation or mucosal ulceration. These secondary ulcers generally occur due to a systemic condition like head trauma or overwhelming sepsis, or as sequelae to drug ingestion (i.e. non-steroidal anti-inflammatory agents), but secondary gastroduodenal ulcers can also occur in specific disease conditions such as Zollinger-Ellison syndrome or Crohn's disease. In almost all children with primary duodenal or gastric ulcers mucosal inflammation and, less frequently, ulceration is caused by a spiral shaped, gram-negative, microaerobic rod Helicobacter pylori. Recent epidemiological evidence has linked chronic H. pylori infection with the development of gastric carcinomas.
Across populations of children, Helicobacter pylori prevalence ranges from under 10% to over 80%. Low prevalence occurs in the U.S., Canada, and northern and western Europe; high prevalence occurs in India, Africa, Latin America, and eastern Europe. Risk factors include socioeconomic status, household crowding, ethnicity, migration from high prevalence regions, and infection status of family members. H. pylori infection is not associated with specific symptoms in children; however, it is consistently associated with antral gastritis, although its clinical significance is unclear. Duodenal ulcers associated with H. pylori are seldom seen in children under 10 years of age. H. pylori-infected children demonstrate a chronic, macrophagic, and monocytic inflammatory cell infiltrate and a lack of neutrophils, as compared with the response observed in adults. The effect of H. pylori infection on acid secretion in children remains poorly defined. The events that occur during H. pylori colonization in children should be studied more thoroughly and should include urease activity, motility, chemotaxis, adherence, and downregulation of the host response. The importance of virulence determinants described as relevant for disease during H. pylori infection has not been extensively studied in children. Highly sensitive and specific methods for the detection of H. pylori in children are needed, especially in younger pediatric populations in which colonization is in its early phases. Criteria for the use of eradication treatment in H. pylori-infected children need to be established. Multicenter pediatric studies should focus on the identification of risk factors, which can be used as prognostic indicators for the development of gastroduodenal disease later in life.
Laryngeal granuloma is an uncommon complication arising from irritation of the laryngeal structures. We present a case where bilateral laryngeal granulomas became clinically evident 3 mo after orthognathic surgery. The patient, a 19-yr-old female, developed acute dyspnea after experiencing gradual voice loss. Excision of the lesions under endotracheal general anesthesia led to an uneventful outcome. The causes, predisposing factors, diagnostic features, and treatment of laryngeal granuloma are reviewed.