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Biomedical subjects

B S Graham

Publications and source records attributed to B S Graham.

At least 127 records · Page 7Linked to original sources
PubMed1986

Myocardial abscess with complete heart block complicating anaerobic infective endocarditis.

Myocardial abscess caused by anaerobic infection is rare and usually occurs in cases of myocardial infarction, in which it may be related to areas of low oxygen tension. Bacteroides CDC group F-1 infective endocarditis complicated by an aortic valve ring abscess with resultant complete heart block developed in a patient with steroid dependent systemic lupus erythematosus. The genitourinary system was the presumed source of the infection. Endocarditis developed after an elective abortion, despite antibiotic prophylaxis according to American Heart Association recommendations. This case shows that an anaerobic abscess of the aortic valve ring can affect contiguous vital structures of the conducting system. Immunosuppression may increase the risk of anaerobic infection after genitourinary procedures, and in this situation the recommended antibiotic prophylaxis may be inadequate.

Abscess↗
PubMed1986

Influence of plasticizer on soft polymer gelation.

An evaluation has been made of the soft polymer gel systems of the type used as prosthodontic short-term denture-lining materials. The purpose of the study was to determine the effect upon gel strength and gelation time produced by variations in the composition of the plasticizer liquids. Poly(ethylmethacrylate) co-polymers were mixed with combinations of ethyl alcohol and the esters dibutyl phthalate (DBP), butylphthalyl butylglycolate (BPBG), and benzyl salicylate (BS). The relative rate of gelation of plasticizer polymer compositions was obtained by means of a reciprocating rheometer. The gelation rate was found to increase rapidly with an increase in the ethyl alcohol content. Significantly shorter gelation times were also found with liquids containing the lower-molecular-weight esters. A linear relationship was found between the ethyl alcohol content and the log of the gelation time. The higher-molecular-weight esters produced the strongest gel. A linear relationship was found between the gelation (log) times and the seven-day puncture strength. The ratio of polymer to plasticizer liquid was found to have a very significant influence upon the puncture strength and gelation time. Molecular weight or molecular volume of the ester plasticizers was found to have a greater influence on gel formation than the cohesive energy parameter. The strong polar bonding of ethyl alcohol was found to have a significant influence on both the rate of gel formation and the subsequent gel strength. The data indicate that controlled variations in the characteristics of plasticity and gel strength of dental soft polymer systems can be made to suit different clinical prosthodontic requirements.

Chemical Phenomena↗
PubMed1986

Dysphagia associated with an aortic arch anomaly in adults.

Aortic arch anomalies typically become evident in early childhood with clinical manifestations such as cyanosis and feeding problems. Although uncommon and therefore not often considered, this developmental defect can cause dysphagia in the adult. The double aortic arch is the most common vascular ring in infants. Less well-known vascular rings in the adult are a right aortic arch with constricting left ligamentum arteriosum and an aberrant right subclavian artery. Dysphagia is common secondary to the constriction of the esophagus. Two patients recently presented to the Metropolitan Nashville General Hospital with prolonged history of dysphagia. Studies included barium swallow and aortogram, which showed right aortic arch in both patients with constricting left ligamentum arteriosum. The treatment for these symptomatic anomalies was division and excision of the ligamentum arteriosum and freeing of the esophagus. A right aortic arch on the chest roentgenogram in a patient with dysphagia should suggest a vascular ring as the etiology. If this is suspected, diagnosis is easily made and surgical treatment is effective. The relevant embryology will be discussed.

Adult↗
PubMed1985

Blastomycosis presenting as monoarticular arthritis. The role of synovial fluid cytology.

Joint complaints are common among patients with blastomycosis; however, true arthritis is infrequently documented by synovial fluid analysis. Of 72 individuals with blastomycosis who were patients at the Vanderbilt School of Medicine affiliated hospitals during the period 1957-1983, 6 (8%) had arthritis at presentation. In 5 patients (7%), monoarticular arthritis was the chief complaint leading to hospitalization. Cytologic examination of synovial fluid was performed in 4 patients and demonstrated characteristic organisms each time. Three patients had negative 10% potassium hydroxide smears, and 2 had negative synovial fluid cultures. Blastomycosis should be considered in the differential diagnosis of acute arthritis. In patients with blastomycotic arthritis, cytologic examination of synovial fluid can add to the diagnostic yield of synovial fluid fungal cultures and potassium hydroxide preparations.

Adolescent↗
PubMed1985

Ludwig's angina resulting from the infection of an oral malignancy.

A case of Ludwig's angina is reported in a 60-year-old woman who was discovered to have squamous-cell carcinoma of the tongue and floor of the mouth during intubation for airway management. This report emphasizes the need to consider infection of oral malignancies of the tongue and floor of the mouth in the etiology of Ludwig's angina when an odontogenous origin cannot be demonstrated. It also illustrates the value of bronchoscopy-directed nasotracheal intubation for diagnosis and airway management in such cases.

Carcinoma, Squamous Cell↗
PubMed1985

Pseudogout presenting with low synovial fluid glucose: identification of crystals by gram stain.

A man developed acute monoarticular ankle arthritis caused by calcium pyrophosphate dihydrate (CPPD) crystals. The clinical syndrome resembled that of a pyogenic arthritis. Synovial fluid analysis revealed a glucose concentration of 13 mg/dL and 99,000 white blood cells/mm3. Only one other report of an extremely low synovial fluid glucose associated with pseudogout could be found. The diagnosis of pseudogout was initially suggested when rhomboidal forms were seen during synovial fluid Gram stain examination. Synovial fluid examination with polarized microscopy was initially negative, but revealed numerous CPPD crystals when repeated on the third hospital day. This case serves to illustrate how pseudogout can mimic pyogenic arthritis in both clinical presentation and low synovial fluid glucose concentration. The examination of Gram-stained synovial fluid can reveal the rhomboidal forms of CPPD crystals. The appearance of these crystals is documented in this report.

Arthritis, Infectious↗
PubMed1985

Pseudotumor of the lung.

Benign lung tumors in children are rare. An equally uncommon finding is the inflammatory pseudotumor, a lesion that is grossly similar to a tumor and yet cannot be histologically defined as a neoplasm. They have been called xanthomas, histiocytomas, solitary mast cell granulomas, and xanthogranulomas by various authors. There is a tendency to overtreat these lesions as if they were malignant. In previous reports, lobectomy has been the usual treatment for these tumors. If a pseudotumor is suspected at exploratory thoracotomy, a wedge resection and frozen section should be considered. When these benign lesions are easily accessible, they can be enucleated, leaving all of the normal pulmonary tissue intact without compromising cure.

Adolescent↗
PubMed1984

Detection of bacteremia and fungemia: microscopic examination of peripheral blood smears.

Microscopic examination of stained granulocyte smears can lead to the early identification of bacterial and fungal infections. The technique is simple, inexpensive, and safe. Although the test can be time consuming, it is clinically useful if performed when a high grade bacteremia or fungemia is likely to be present (Table 3). The results are examiner dependent, but in the proper clinical setting should be reliable. Moreover, the slide can be saved as a part of the medical record, examined by others, and restained if necessary. A positive smear allows the physician to strengthen the empirical antimicrobial regimen against a particular organism which will hopefully improve the outcome of the septic process.

Bacteriological Techniques↗
PubMed1984

Acid-fast bacilli on buffy coat smears in the acquired immunodeficiency syndrome: a lesson from Hansen's bacillus.

A patient with the acquired immunodeficiency syndrome was found to have a continuous bacillemia of Mycobacterium avium-intracellulare by examination of Kinyoun-stained buffy coat smears. There were 29 cells/cu mm that contained acid-fast bacilli (AFB) and 1.5 X 10(5) AFB/ml of whole blood. The cells of the reticuloendothelial system were engorged with AFB, suggesting reticuloendothelial saturation. The peripheral blood involvement and magnitude of the mycobacterial burden are analogous to leprosy, and it is suggested that other similarities between the immunobiology of leprosy and disseminated M avium-intracellulare infection in the acquired immunodeficiency syndrome may exist.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Cancer cellulitis.

We have described a case of inflammatory carcinoma involving the skin of the inguinal region in a man with rectal carcinoma. This type of metastatic lesion is most often associated with carcinoma of the breast, but may also be a manifestation of lung, pancreatic, or gastrointestinal neoplasms. The diagnosis should be suspected when a patient with cellulitis is afebrile and has a normal white blood cell count. An additional clue is that the leading edge of the cellulitis may be raised as in erysipelas. Empiric antibiotic treatment is recommended until the diagnosis is confirmed by punch biopsy and the culture results are known.

Aged↗
PubMed1984

Counterfeit calculi.

We describe two patients whose initial clinical presentation was that of nephrolithiasis. Eventually, an incontrovertible diagnosis of factitious illness was established. We describe this syndrome, review the underlying psychodynamics, and suggest an approach to treatment, with a plea to physicians to recognize the compulsive behavior as a sign of a disordered psyche and the need for some form of psychotherapy.

Acute Disease↗
PubMed1984

Pseudomonas aeruginosa causing osteomyelitis after puncture wounds of the foot.

Osteomyelitis of the foot caused by Pseudomonas aeruginosa has been a recognized complication of puncture wounds since 1968. This is a report of two cases, one of which had evidence that the source of the P aeruginosa was the inner sole of the footwear. Factors such as warm, moist environment, antibiotics or antiseptics directed against gram-positive flora, and serous exudates, all of which enhance the growth of P aeruginosa, should be avoided in the management of puncture wounds of the foot.

Adult↗
PubMed1984

Opportunistic infections in endogenous Cushing's syndrome.

The cases of 6 patients with endogenous Cushing's syndrome and opportunistic infections were studied, and compared with those of 17 similar patients reported in the literature. Cushing's syndrome was caused by ectopic adrenocorticotrophic hormone production or adrenal tumors in most patients, and hypercortisolism was extreme. Four infectious processes were preponderant: Cryptococcosis, aspergillosis, nocardiosis, or Pneumocystis carinii pneumonia occurred in 21 patients. Signs and symptoms of infection were often masked by the hypercortisolism. Morning plasma cortisol levels correlated with the infection type (rank-order Spearman correlation coefficient = 0.78, p less than 0.01): Levels of less than 70 micrograms/dL or greater than 121 micrograms/dL were associated with cryptococcosis or pneumocystis, respectively, by discriminant analysis. Of the 9 patients who survived their infection, 8 had evidence that cortisol production was reduced to near normal. In contrast, all 14 patients died in whom cortisol production went uncontrolled. In patients with hypercortisolism from endogenous Cushing's syndrome (especially of nonpituitary origin), opportunistic infections should be anticipated and prompt control of cortisol overproduction should be initiated.

Adult↗
PubMed1983

Herpes simplex virus infection of the adult lower respiratory tract.

We have reported six adult patients with HSV infection of the lower respiratory tract diagnosed ante-mortem, and have reviewed the literature on this subject. An attempt has been made to define the natural history of the infection, and suggestions have been made regarding diagnosis and treatment. HSV can infect the lower respiratory tract in immunologically normal patients, as well as the immunocompromised host. Many patients have been burned, or intubated, or have other reasons for squamous metaplasia of the respiratory epithelium. The pathogenesis in many cases is an extension or aspiration of oropharyngeal HSV, but there is a suggestion that some cases may be hematogenously spread. The diagnosis of the site and presence of HSV infection should be based initially on cytologic findings, histologic findings, or both. Viral cultures or immunofluorescent or immunoperoxidase labeling can be used to confirm the cytologic and histologic diagnoses. Bronchoscopy is valuable for visualizing ulcerations or membranes in the respiratory tract, and for improving the sensitivity and specificity of the cytologic diagnosis. Because the process is most often focused in the tracheobronchial tree, percutaneous needle biopsy and open lung biopsy may be less sensitive than bronchoscopy. Standard serologic tests are, in general, not helpful diagnostically. They can help verify that a recent HSV infection has occurred, but do not differentiate between primary and recurrent infection, and do not help in localizing the site of infection. However, paired complement fixation or neutralizing antibody titers may be useful prognostically. If the titers do not rise in the presence of a documented HSV lower respiratory tract infection, the outcome is more likely to be fatal. The respiratory epithelium from the oral mucosa to the alveoli can be infected with HSV. The manifestations can range from a few scattered ulcers in the trachea to a severe ulcerative process resulting in an obstructing, inflammatory tracheobronchial membrane. Focal or diffuse pneumonia can also occur. No specific treatment for the illness can be recommended at this time. There is no evidence that currently available antiviral therapy is effective. The outcome of the illness seems to be largely dependent on the immunologic status of the host, complicating superinfections, and the progression of the underlying disease.

Adult↗
PubMed1983

Pericarditis associated with Hemophilus influenzae type B pneumonia and bacteremia in two adults.

Two cases of pericarditis associated with Hemophilus influenzae bacteremia and pneumonia are reported and the literature reviewed. Both patients were treated with antibiotics alone and had resolution of their illnesses without apparent adverse sequelae. Neither patient required pericardial drainage. It is suggested that there is a stage in the development of H influenzae pericarditis at which antibiotic treatment alone can be curative.

Adolescent↗
PubMed1975

A radioreceptor assay for evaluation of the plasma glucocorticoid activity of natural and synthetic steroids in man.

An assay for plasma glucocorticoid activity has been developed using specific glucocorticoid receptors. Unlike other assays for cortisol and certain synthetic corticosteroids, this radioreceptor assay measures the glucocorticoid activity of all natural an synthetic steroids. Steroids extracted from as little as 0.05 ml of plasma are incubated with 3H-dexamethasone and cytosol receptors from cultured rat hepatome cells. From 0.5 to 50 ng of cortisol are accurately detected. Glucocorticoid activities of adult determined by the assay correlate closely with corticoid levels obtained in the CBG-isotope and fluorometric assays. Other steroids are measured in proportion to both concentration and potency as glucocorticoids. Relative activities include: cortisol 100, dexamethasone 940, prednisolone 230, prednisone 3, estradiol 1 and androstenedione 1. A similar ranking of steroids was found using receptors from a human source (fetal lung). The assay has been useful in detecting glucocorticoid activity in unidentified medications and in measuring plasma glucocorticoid levels after administration of synthetic corticosteroids. A modification of the assay is described for also estimating the level of free (unbound) glucocorticoid activity in plasma. Assays are performed before and after removal by charcoal of steroids not bound to plasma transcortin. This consideration is shown to be particularly important with prednisolone where the unbound steroid level is much less than the total. Thus, the radioreceptor assay provides a relatively simple technique for measuring the total of free plasma of glucocorticoid activity in man due to any natural or synthetic steroid or combination of steroids.

Aldosterone↗