Trends in health care coverage and financing and their implications for policy.
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Economic Competition↗
Biomedical subjects
B M Smith
Publications and source records attributed to B M Smith.
Reconstruction of a severely atrophic maxilla using a Le Fort I downgraft and dental implants: clinical report.
A 55-year-old woman developed chronic infections of the maxillary sinuses with osteomyelitis resulting in extensive bone destruction and atrophy from a failed subperiosteal implant. After surgical removal of the subperiosteal implant, extensive debridement of the maxilla, and long-term antibiotic therapy, maxillary reconstruction was initiated. A Le Fort I osteotomy and downgraft was performed, and a posterior iliac bone graft was harvested and grafted to reconstruct the severely atrophic maxilla. In a later surgical procedure, maxillary and mandibular implants were placed. Implant-retained overdentures were fabricated to restore function and esthetics.
Alveolar Bone Loss↗
Sequence-selective carbohydrate-DNA interaction: dimeric and monomeric forms of the calicheamicin oligosaccharide interfere with transcription factor function.
The synthetic oligosaccharide moiety of the antibiotic calicheamicin and the head-to-head dimer of this oligosaccharide are known to bind to the minor groove of DNA in a sequence-selective manner preferring distinct target sequences. We tested these carbohydrates for their ability to interfere with transcription factor function. The oligosaccharides inhibit binding of transcription factors to DNA in a sequence-selective manner, probably by inducing a conformational change in DNA structure. They also interfere with transcription by polymerase II in vitro. The effective concentrations of the oligosaccharides for inhibition of transcription factor binding and for transcriptional inhibition are in the micromolar range. The dimer is a significantly more active inhibitor than is the monomer.
Aminoglycosides↗
A comparison of outcome criteria in the diagnosis of renovascular hypertension.
The outcome criteria used for the diagnosis of renovascular hypertension (RVHT) following renal revascularization have not been validated. Differing criteria of indeterminate accuracy have yielded conflicting conclusions concerning the prevalence and efficacy of treatment of RVHT. We compared the accuracy of conventional outcome criteria used in the diagnosis of RVHT to that of novel, ordered outcome analysis to determine whether such an analysis might provide a more consistent means of diagnosing RVHT. Twenty-seven patients underwent intervention for treatment of presumed RVHT (group I), and 40 patients with presumed essential hypertension were treated with antihypertensive medication alone (group II). A standard dichotomized (improved or unimproved) outcome scheme and a five-level, ordered outcome scheme (ranging from definitely unimproved to definitely improved) were used to generate nominal outcomes of therapy for each patient. The resultant outcome groups were examined to determine the effect of such partitioning on blood pressure and medication requirements. To determine their diagnostic accuracy, the conventional and ordered outcome schemes were compared with a consensus outcome scheme derived from the use of numerous criteria. Significant correlations were observed between the ordered outcome score and posttreatment reductions in systolic blood pressure (r = 0.53, p = 0.007), diastolic blood pressure (r = 0.74, p = 0.0001), and medication score (r = 0.71, p = 0.0001). Overall diagnostic accuracy was estimated to be 91% for ordered criteria and 85% for dichotomized criteria. Correlation of the ordered and conventional schemes' assignments with the consensus scheme's assignments was 0.79 (p = 0.0001) and 0.63 (p = 0.0001), respectively. A simple, ordered outcome scheme compares favorably with the standard dichotomized scheme in assigning a diagnosis of RVHT to patients following renal revascularization or nephrectomy. The ordered scheme offers the advantages of simplicity and accuracy over current schemes.
Aged↗
Single-lung ventilation in pediatric patients.
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Child↗
Acute cholecystitis and cholangitis caused by Echinococcus granulosus.
We report for the first time in the recent North American literature, the case of a patient with rupture of a hepatic hydatid cyst into the gallbladder, with subsequent obstruction of the cystic duct by a daughter cyst acting as a ball-valve and causing acute acalculous cholecystitis.
Acute Disease↗
Factors influencing limb salvage and survival after amputation and revascularization in patients with end-stage renal disease.
BACKGROUND: Critical lower-extremity ischemia in patients with end-stage renal disease is associated with high operative mortality and low rates of limb salvage. PATIENTS AND METHODS: The outcomes of 102 operations for lower-extremity ischemia in 77 patients with end-stage renal disease were analyzed to determine predictors of limb salvage and operative survival. RESULTS: Patients undergoing amputation (n = 50) and revascularization (n = 52) were similar in age, cause, and duration of renal failure, and prevalence of coronary artery disease. Operative mortality was 13% in revascularized patients and 20% in amputated patients, and was caused by sepsis in 12 of the 17 deaths (71%). Limb salvage in surviving patients was 91% at 30 days and 67% at 1 year. One-year survival was 72% in both groups. Factors associated with limb loss included advanced generalized atherosclerosis, extensive tissue necrosis, failed ipsilateral bypass, and poor cardiac functional status. Overall, factors associated with mortality included failure of limb salvage procedures, hemodynamic instability, and poor cardiac functional status. CONCLUSIONS: More liberal use of primary amputation for end-stage renal disease patients with critical leg ischemia appears to be an important factor in improving both limb salvage rates and overall operative mortality.
Amputation, Surgical↗
Laparoscopic splenectomy in childhood.
The authors describe their technique for laparoscopic splenectomy in childhood. Five ports, including one 12-mm port for an endoscopic stapler, are placed. With the patient in the supine position, the short gastric vessels are divided between clips. The patient is then placed in the lateral decubitus position for mobilization of the splenic flexure of the colon, division of the posterolateral ligamentous attachments, and en masse transection of the splenic hilum using the EndoGIA stapler. The freed spleen is placed in a nylon reinforced Lap Sac, which is exteriorized at the neck. The spleen is morcellated and the sac removed. Concomitant cholecystectomy is performed in patients with hereditary spherocytosis who have cholelithiasis or sludge. The procedure has been performed without complication in six patients who had hematologic disorders. For another patient, the procedure was converted to an open splenectomy to achieve better hemostasis.
Adolescent↗
Lesch-Nyhan syndrome. A case report.
Lesch-Nyhan syndrome is a rare anomaly consisting of a deficiency in the production of hypoxanthine phosphoribosyltransferase that leads to the overproduction of purine and the accumulation of uric acid. Major manifestations include mental retardation and self-destructive behavior resulting in self-mutilation through biting and scratching. Because no medical treatment exists to alleviate the symptoms of self-mutilation, direct dental intervention is the only way these behaviors can be affected. A unique case of this type involving two male identical twins is reported.
Child↗
Laparoscopic Duhamel pullthrough procedure for Hirschsprung's disease in childhood.
Advances in instrumentation and technique now make laparoscopic correction of some congenital anomalies possible. We report on a 2-year-old boy with biopsy-proven Hirschsprung's disease successfully treated by a laparoscopic Duhamel pullthrough procedure. The technique and its potential role in the treatment of Hirschsprung's disease are described.
Child, Preschool↗
Health benefits and practical aspects of high-fiber diets.
Over the past 20 y dietary fiber has emerged as a leading dietary factor in the prevention and treatment of chronic diseases. High fiber intakes are associated with lower serum cholesterol concentrations, lower risk of coronary heart disease, reduced blood pressure, enhanced weight control, better glycemic control, reduced risk of certain forms of cancer, and improved gastrointestinal function. Dietary fiber can be categorized into water-soluble and water-insoluble components. Dried beans, oat products, and certain fruits and vegetables are good sources of soluble fiber. Most plant foods are good sources of insoluble fiber and wheat bran is a concentrated form of insoluble fiber. Current guidelines advise a doubling of dietary fiber intake for Americans. Inclusion of ample servings of fruits and vegetables, whole grains, and dried beans and peas will help individuals meet these guidelines.
Dietary Fiber↗
Nonpenetrating trauma to the carotid artery: seven cases and a literature review.
Nonpenetrating carotid trauma is uncommon and frequently missed on initial examination. The cases of seven patients seen over a period of 21 years are presented and 100 cases from the most recent literature are reviewed. Causes and mechanisms of injury, clinical presentation, investigations, management, and outcome are discussed. Causes of injury were three motor vehicle collisions, two falls, one sports injury, and one blow to the face. Clinical presentation was early in four and delayed in three. The earliest symptoms and signs were a change in mental status, headache, unprovoked fall, focal weakness, neglect, and dysphasia. Doppler studies may be useful in screening, but a definitive diagnosis is made with the help of angiography. Two patients were treated surgically; one died, one with delayed symptoms from a pseudoaneurysm recovered completely. Five patients were given anticoagulants; all survived with permanent deficits related to their pretreatment neurologic status. The outcome in 100 recent cases from the literature has improved compared with previous reports. The overall mortality was 12%. The outcome in our seven cases supports recent trends toward a strategy of early anticoagulation and selective surgical treatment.
Adult↗
Oral and maxillofacial surgery partnership in the dental team approach to implant education.
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Dental Implantation↗
The lost needle: a laparoscopic dilemma.
A case is presented in which a curved needle became lost during extracorporeal suturing in laparoscopic surgery. Maneuvers to find the needle were fruitless until an intraoperative x-ray showed it was stuck in the flapper mechanism of a laparoscopic cannula. Caution is given against the use of "pop-off" needles during extracorporeal suturing and an x-ray of cannulae is suggested when a lost needle cannot be found using routine maneuvers.
Child↗
Laparoscopic splenectomy.
Splenectomy is easily amenable to laparoscopic technique. Compared with the open technique, its advantages include improved exposure, decreased pain, improved pulmonary function, shortened hospitalization, rapid return to unrestricted activities, and improved cosmetic appearance. These advantages are at the expense of prolonged operative time that, with experience and improved instruments, should diminish.
Adolescent↗
Use of auricular cartilage in the repair of orbital floor defects.
Various materials have been used to repair orbital defects. This article advocates the use of autogenous conchal cartilage, especially in the repair of large posttraumatic defects, where contour, biocompatibility, and strength are most important. The technique for harvesting the cartilage is reviewed, and a case demonstrating its successful use is reported.
Adult↗
Prospective, randomized, controlled comparison of the effects of low-fat and low-fat plus high-fiber diets on serum lipid concentrations.
Previous studies examining the hypocholesterolemic effects of high-soluble-fiber diets have not been designed to control for dietary fat intake. Serum cholesterol reductions may therefore be accounted for by differences in consumption of fat. Moderately hypercholesterolemic, nonobese, Caucasian men and women, 30-50 y old were randomly assigned to low-fat, low-fat plus high-fiber, or usual-diet groups and followed for 12 mo. At 12 mo the high-fiber group consumed significantly more soluble fiber than both the low-fat and usual-diet groups (P = 0.0063 and P = 0.0001); the high-fiber group did not differ from the low-fat group in quantity of dietary fat consumed. The high-fiber group experienced a greater average reduction (13%) in serum cholesterol than did the low-fat (9%) and usual-diet (7%) groups. After adjustment for relevant covariates, the reduction in the high-fiber group was significantly greater than that in the low-fat group (P = 0.0482). Supplementation with soluble fiber reduces serum cholesterol beyond the reduction observed with low-fat diet alone.
Adolescent↗
Differential induction of 15 and 16 kDa nuclear proteins in promotion sensitive and promotion resistant mouse JB6 cells.
Gene expression relevant to promotion of neoplastic transformation was investigated by measuring proteins differentially synthesized in two mouse epidermal JB6 cell lines sensitive (P+) or resistant (P-) to tumor promoter induced transformation. One dimensional polyacrylamide gel electrophoresis of proteins from cells that had been pulse labeled with 35S-methionine after various times of exposure to the phorbol ester 12-O-tetradecanoylphorbol 13-acetate (TPA) revealed two protein bands whose intensity increased after 20-24 hr exposure to TPA. Cell fractionation showed that these proteins of 15 and 16 kDa were localized in the nuclear, not the cytosolic, fraction. Parallel studies with 32P-labeled cells showed no evidence for phosphorylation of these proteins. Comparison of P- with P+ cells showed that the observed induction of p15/16 synthesis at 20 hr was specific for P+ cells, with little evidence for stimulated synthesis in P- cells during a 48 hr period. We thus conclude that the tumor promoter produces a late stimulation in the rate of synthesis of 15 and 16 kDa nuclear proteins preferentially in promotion sensitive cells.
Animals↗