Predicting two types of hospital innovation.
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Biomedical subjects
Publications and source records attributed to D B Smith.
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In a review of 50 patients with oral cancer treated by cryosurgery, local control of the tumor for more than two years was achieved in 90%. In only 4 of 25 instances where the tumor had superficially invaded bone, or was adjacent to it, was resection necessary. Cryosurgery was effective in controlling benign and premalignant lesions also. The treatment is often palliative and sometimes curative when patients refuse other recommended care.
A ramus retractor with a variable high-intensity light source has been designed. It offers access, direct high-intensity visibility, reliability, compactness, and sterilizability. We have used this modification for the past five years. It has allowed direct visibility and identification of structures in the surgical field without the use of cumbersome overhead surgical lights, headlights, or spotlights.
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Two patients experienced chronic rhinorrhea following maxillary resection for cancer. This annoying symptom had been persistent for 12 and 13 years, respectively. Transposition of the parotid duct orifice on the operated side from a position lying above the maxillary prosthesis to a point below the prosthesis brought relief. Both patients had endured this nuisance for many years thinking it was a normal sequela of their operation. Multiple physicians had failed to identify the problem.
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Through-and-through retention sutures are inherently inefficient and prone to produce skin and subcutaneous damage. Most surgeons are reluctant to permanently bury non-absorbable retention sutures. This new technique uses tube conduits to bring the retention sutures from deep fascial level to above the skin-surface, where they are available for removal. Thus, the sutures do not cross the skin and subcutaneous tissue, and they exert maximal efficiency at the deep fascial layers. This method has been used in over 60 cases without deep-wound separation, and complications have been minimal.
Dimethyl adipimidate was used to cross-link the polypeptides within hemoglobin, haptoglobin, and hemoglobin-haptoglobin complex. Cross-linked hemoglobin retained considerable ability to bind haptoglobin, although the amounts bound were reduced and the haptoglobin reaction could be used to fractionate the modified hemoglobin. With cross-links limited to intramolecular sites, hemoglobin showed four bands on polyacrylamide gel electrophoresis in sodium dodecyl sulfate, identified, with reference to the subunit polypeptides, as monomer, dimer, trimer, and tetramer. The dimer region consisted of at least two separable species. When hemoglobin-haptoglobin complex was cross-linked, a band of hemoglobin dimer was present, which demonstrates that at least two hemoglobin subunits have a close spatial relation when bound to haptoglobin. Some comparisons with adipimidate-reacted hemoglobin were made using malonimidate and suberimidate and some marked differences were noted.
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