Pleural effusion: a diagnostic dilemma.
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Biomedical subjects
Publications and source records attributed to D W Jenkins.
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Three patients seen recently at Wilford Hall USAF Medical Center emphasize the point that coccidioidomycosis may resemble lymphoma because of persistence of adenopathy on the chest roentgenogram after the initial infiltrate has resolved. Such a clinical picture strongly indicates dissemination and is probably sufficient reason to initiate therapy.
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Two patients were seen with Histoplasma capsulatum infection of mediastinal nodes which had eroded into the esophagus to produce dysphagia. Fungal serologies were of value in the diagnosis in one of the patients. Both patients responded well to amphotericin B therapy. A traction diverticulum was noted to follow healing in 1 patient.
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Eighty-four patients with culture-positive Mycobacterium tuberculosis infections of the lung were evaluated with the Mono-Vacc and tine tuberculin skin tests. A previous report indicated that false negative reactions with the tine may occur in up to 6 per cent of patients when it is used as a screening device for tuberculin sensitivity. However, as indicated by this study, it is unlikely that either screening tests would miss active tuberculous infection; no false negatives occurred in the 84 patients.
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The United States Biosatellite Program includes critical and sophisticated experiments to study the effects of weightlessness and decreased gravity at the cellular, tissue, organ, and organism levels during orbital periods of 3 to 30 days. The experiments involve a wide variety of plants and animals from single-celled organisms to primates. The effects of weightlessness combined with a known source of radiation will be studied to determine if there are any antagonistic or synergistic genetic or somatic effects on various organisms. Experiments are included to study the effect of removal from the Earth's rotation in relation to biological rhythms of organisms. The experimental test organisms have been exposed to the simulated dynamic forces of launch and flight profiles.
Previous analyses of minor salivary gland tumors (MSGTs) have not clearly established the role of radiotherapy in their treatment. The following is a retrospective review of 44 patients treated from 1956 to 1984 with MSGT of the maxillary sinus (15 of 44), nasal cavity/ethmoid complex (six of 44), or hard palate (23 of 44). Histological findings included adenocarcinoma (18), adenoid cystic (17), high-grade mucoepidermoid (six), and mixed malignant (three). Treatment was by surgery (18 of 44), radiotherapy (eight of 44), or a combination of both (18 of 44). Patients treated with radiotherapy, either alone or combined with surgery, had disease that was inoperable, marginally resectable, or residual after surgery. Despite this handicap, 3-year local control rates for all treatment modalities were similar (surgery, 78%; radiotherapy, 63%; and combined treatment, 83%). Absolute 3-year survival rates were 94% for surgery, 63% for radiotherapy, and 78% for combined therapy, with death attributable to distant metastases a significant factor in the advanced cases treated with radiotherapy. A dose response relationship was apparent in those patients whose treatment involved radiotherapy. Clearly, MSGTs are radioresponsive lesions and radiotherapy can play an important role in their management.
In 1843, James Syme introduced an amputation which he believed had numerous advantages over more proximal amputations. Despite these claims, utilization of the Syme's amputation has been limited due to a less than ideal compatibility of the surgical result with prosthetic design and function. In this article, the history of the Syme's amputation is reviewed along with indications and surgical technique. Modifications to the original surgical procedure are discussed as well as advantages and disadvantages inherent to the Syme's amputation. A description of the biomechanical function of the residual limb/prosthesis and management of the Syme's amputee is provided emphasizing the quest for an ideal prosthesis which is found, could very well allow Dr. Syme's amputation to reach the potential as he had originally envisioned.