Biomedical subjects
Publications and source records attributed to B Smith.
This paper describes the use of fine steel wire as a suture material. The suture was developed by the authors for medial canthal plication and repair, and has been used since 1978 in 125 cases. It describes surgical techniques to be used with this suture material.
The capacity of busulfan and total body irradiation to ablate hematopoietic stem cells as preparation for the allogeneic bone marrow transplantation of patients with congenital bone marrow disorders was studied. Fourteen patients received 18 transplants; busulfan was used in the preparatory regimen of eight transplants and total body irradiation in the regimens of six transplants. Sustained hematopoietic ablation was achieved in six of eight patients prepared with busulfan and in all six patients prepared with total body irradiation. Three patients prepared with total body irradiation died with idiopathic interstitial pneumonitis, whereas no patients receiving busulfan developed interstitial pneumonitis. The optimal antihematopoietic stem cell agent to be used for the preparation of patients with congenital bone marrow disorder for bone marrow transplantation is not certain.
A case is reported of a five-month-old female with incontinentia pigmenti associated with nasolacrimal duct obstruction. Ocular manifestations of incontinentia pigmenti have previously been described to include persistent hyperplastic primary vitreous, retinal dysplasia, retrolental fibroplasia, corneal opacities, cataract, optic atrophy, and strabismus. This case is believed to be the first reported instance of incontinentia pigmenti associated with nasolacrimal duct obstruction. The management of this patient is also discussed.
The authors reviewed the fetal outcomes for 30 pregnant patients who required hospitalization for burns that involved 11 to 97% of the total body area. A positive relationship was found between the percentage of maternal total body burn and maternal mortality, fetal mortality, and premature delivery. Premature delivery and/or fetal mortality occurred primarily within the first five days and followed maternal complications of hypovolemic shock, sepsis, or respiratory insufficiency. In the eight cases in which maternal injury became lethal (20 to 97% total body burn), all fetuses were born spontaneously before maternal death, but seven were stillborn. After overcoming the immediate postburn period, a healthy-appearing term-size infant was likely to be born while the mother continued to receive intensive therapy. The ideal treatment to protect the fetus has not yet been determined.
The complication of extraocular muscle palsy following blepharoplasty is rare. In a review of 920 blepharoplasties at Manhattan Eye, Ear and Throat Hospital, three well-documented cases of diplopia following blepharoplasty could be found. Only one of these cases resolved within two months postoperatively. The explanation offered for this phenomenon is a Volkmann type contracture of the extraocular muscles following edema and hemorrhage into the muscle sheath.
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74 insulin-dependent diabetic patients with background retinopathy were randomised to continue with usual diabetic care (group U) or to a more intensive programme (group A) using ultralente insulin as basal cover and soluble insulin at mealtimes. Group A attended the clinic more frequently, received closer dietary supervision, and were taught home blood glucose monitoring. Group A had a significantly lower mean glycosylated haemoglobin level during the study, although the mean level also fell in group U towards the end of year 2. Renal and sensory-nerve function were significantly better preserved in group A than in group U. Significant improvements were also seen in low-density-lipoprotein-cholesterol and whole-blood low-shear viscosity. The rate of progression of retinopathy was similar in both groups. It appears that a modest improvement in diabetic control, obtainable in most clinics, has been associated with a reduction in the progression of diabetic tissue damage.
We examined 52 consecutive patients who underwent autogenous dermis-fat implantation in anophthalmic sockets during the past five years. The results of the study show that 81% of the cases had no change in the volume of the graft during a mean follow-up period of 2 1/2 years, ranging from a minimum of six months to a maximum of five years. The remaining 19% underwent graft resorption to a varying degree. We consider dermis-fat graft a procedure of choice in cases of extruded or migrated implants, an alternative to a synthetic allograft in primary enucleations, and a useful procedure in selected cases of enophthalmic and contracted socket.
3 metabolic activation systems--organ homogenates, perfused liver, and the intrasanguineous host mediated assay (IHMA)--were compared in their abilities to activate demethylnitrosamine (DMN) and induce gene conversion in Saccharomyces cerevisiae D4. Both rats and mice were used for the organ homogenates and IHMA studies. All activation systems were able to activate DMN; where the different organs were compared, liver was more active than kidney, followed by lung. The IHMA was the most sensitive of the systems examined.
The cosmetic deformities following enucleation are often unavoidable. Loss of orbital volume and atrophy of orbital fat create significant enophthalmos. The literature is filled with numerous procedures that add to the orbital volume of the anophthalmic socket. An outline of three procedures to the upper eyelid to camouflage an enophthalmic appearance are presented. These can be used alone or in conjunction with an "orbital volume increasing" procedure. Two procedures can be used in an office setting to alleviate small deformities; 19 patients have been treated in this manner with a follow-up period of up to 26 months.
The efficacy, toxicity, microbiology and pharmacology of cefoxitin and mezlocillin were compared in a clinical and laboratory study. In 81 patients treated with cefoxitin and 83 treated with mezlocillin, clinical and bacteriological cures were achieved in 79.2% and 85.5% respectively. Both antibiotics were effective in the treatment of septicaemia, pulmonary infections, urinary tract infections, intra-abdominal and pelvic infections and skin and soft-tissue infections. Both were also effective in the treatment of anaerobic infections. No major haematological, hepatic, or renal toxicity was encountered in patients treated with either drug.
We tested the hypothesis that different anesthetic techniques for elective cesarean section would be reflected in the pattern of breathing and its control after birth. The pattern of breathing, including tidal volume, total breath duration (TTOT), minute ventilation, inspiratory (TI) and expiratory times, TI/TTOT ratio, and mouth occlusion pressure, was measured in 27 infants delivered by elective cesarean section during maternal epidural (lidocaine-carbon dioxide-epinephrine, n = 19) or general anesthesia (66% oxygen in N2O and 0.5% halothane, n = 8) at 10, 60, and 90 min and 3-5 days of age. Neonatal acid-base values and Apgar scores were within normal limits in both groups of infants. In general, at any given age the values of the respiratory parameters measured and their variability were similar between the two groups of infants. These findings indicate that the pattern of breathing after birth is not different following epidural or general anesthesia, and on the basis of our measurements, both epidural or general anesthesia appeared equally suitable for elective cesarean section.
The recognition of a herniated lacrimal gland is done by simple examination; it is not usually taught to plastic surgeons. Fullness in the superotemporal aspect of an upper eyelid in younger patients often represents a ptotic gland. Suspension of the glands improves the surgical result of upper-lid blepharoplasty without compromising lacrimal outflow.
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Regional blood-to-tissue transport, expressed as a unidirectional transfer rate constant (K), was measured in experimental RT-9 brain tumors using 14C-alpha-aminoisobutyric acid (AIB) and quantitative autoradiographic techniques. The magnitude of K depends on the permeability, surface area, and blood flow of the tissue capillaries. The transfer rate constant was variable within tumor tissue (range 0.001 to 0.178 ml/gm/min) and depended on tumor size, location (intraparenchymal, meningeal, or choroid plexus associated), and to a lesser extent on necrosis and cyst formation. Brain adjacent to tumor had higher K values, particularly around larger tumors (0.004 to 0.014 ml/gm/min), than corresponding brain regions in the contralateral hemisphere (0.001 to 0.002 ml/gm/min). Estimates of the fractional extraction of AIB by intraparenchymal tumors were between 0.008 and 0.4 ml/gm/min. Values of fractional extraction in this range indicate that tumor capillaries are not freely permeable to this solute. The values of K measured with AIB in this study, for the most part, approximate the permeability-surface area product of tumor and brain capillaries. The experimental data suggest that the permeability-surface area characteristics of the microvasculature in small RT-9 tumors are similar to those of the host tissue, whereas the microvasculature of larger RT-9 tumors is influenced more by intrinsic tumor factors.
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Long-term normal-dose benzodiazepine treatment in seven patients was associated with reduced urinary excretion of MOPEG (4-hydroxy-3-methoxy-phenylglycol). Following the discontinuation of the drugs a characteristic withdrawal reaction occurred, with an increase towards normal values of the MOPEG excretion levels and changes in the excretion of 5-HIAA (5-hydroxyindoleacetic acid). No significant changes in the 24-hr urinary excretion of free cortisol or HMMA (3-methoxy-hydroxy-mandelic acid) were detected.
During the previous six years the authors have performed 118 dermis-fat orbital implants. Fifty-one were primary implantations performed at the time of enucleation. Nineteen grafts were implanted after migrated implants were removed, and 19 grafts were used to correct superior sulcus deformities. Nine dermis-fat grafts expanded contracted sockets. It is becoming increasingly clear that these autogenous implants are effective in maintaining orbital volume while preserving the fornicies and conserving the conjunctiva. Although significant atrophy of primary grafts does not occur very frequently, it is more common in cases of secondary implantation, particularly in cases of chemically injured severely contracted sockets (3 of 9 cases). We have noted only one case of significant atrophy following a primary procedure. This occurred two and a half years following an apparently successful primary graft.