Biomedical subjects
Publications and source records attributed to E B Smith.
The author has had experience with 73 surgical patients who professed the Jehovah Witness faith. The refusal of blood transfusions created problems in circulatory fluid volume, respiratory exchange, and wound healing. The surgical complication rate was excessive and the most frequent was wound infection in 79.4 percent of cases and an overall mortality of 1.4 percent.
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The most common benign tumor of the esophagus is a leiomyoma. Our experiences with six cases during a recent ten-year period at St. Francis General Hospital are presented. A case report that includes the clinical picture, diagnostic tests, and definitive management is presented. These tumors may be symptomatic or asymptomatic. Esophagogram and esophagoscopy are two essential preoperative diagnostic tests. The ideal approach and technique for excision depend upon the location and size of the tumor.
In the soft, gelatinous thickenings that appear to be the precursors of fibrous plaques, concentrations of plasma low-density lipoproteins (LP) and fibrinogen were three to four times higher than that in normal intima, but their concentrations of fibrin was not significantly higher. By contrast, in 60% of cholesterol-rich areas from more advanced plaques, fibrin (mean concentration 22.7 mg/100 mg lipid-extracted dry weight) was ten times higher than normal, and this was associated with a twelve-fold increase in a bound LP fraction that was released by incubation with fibrinolytic enzymes. The origin of this fibrin is uncertain, and to test similarity of fibrin in the lesion with that of mural thrombus free and bound LP, fibrinogen, and cholesterol were measured in thrombi and pseudo-intimas from prosthesis grafts. In the pseudo-intimas and the thrombi that were not covered with endothelium the concentrations of all these substances were very low, but in thrombi covered with endothelium the concentrations of free and bound LP were similar to those in intimal lesions. Thus, endothelialisation appears to promote accumulation of LP in mural thrombi.
Thin layer isoelectric focusing followed by second dimension quantitative immunoelectrophoresis has been used to characterize the free and tightly bound lipoprotein (lp) fractions in human aortic intima. In 3.3% acrylamide gels plasma low density lipoprotein (LDL) focuses rapidly, but very low density lipoprotein (VLDL) fails to enter the gell and remains at the origin (point of application). Samples of normal intima and lesions were placed directly on the gel and focused for 10--12 h; in normal intima and gelatinous lesions which had not accumulated cholesterol 60--70% of the free LP focused with plasma LDL, but with increasing accumulation of cholesterol the proportion focusing with LDL decreased and the component remaining at the origin increased. In 9 of the 39 samples examined one or more components with pI acid to LDL were present, and in one sample the whole peak focused at a more acid pI. In 4 of 5 lipid-rich centres of gelatinous plaques all the free LP remained at the origin, and the bound LP released by incubation with plasmin remained at the origin in all samples in 3.3% gels although it would focus in 2.6% gels. With antiserum to apo-C this large LP did not behave like VLDL, and it appears to be an aggregated LDL. An increased proportion of aggregated LDL was associated with (a) accumulation of cholesterol, (b) topographical location towards the centre of plaques, and (c) partial destruction of endogenous LP during incubation of fresh samples of tissue.
1. Decompression from exposures to raised ambient pressure of sulphur hexafluoride, carbon tetrafluoride, hexafluoro-ethane and nitrous oxide results in the formation of dense foam and pulmonary oedema. 2. The degree of pulmonary oedema produced is dependent on the exposure pressure, although the exposure time required is short in comparison to tissue saturation times. 3. The effect is not prevented by atropine, ephedrine or hydrocortisone. 4. The effect is also produced in vitro by saturated solutions of halothane, chloroform and ether. 5. It is suggested that the mechanism of action is physical with physico-chemical factor involved being a differential partition of these gases within the surfactant: membrane complex.
To evaluate the relative effectiveness of the treatment of tinea pedis, we performed a double-blind study comparing undecylenic acid ointment, tolnaftate cream, and a placebo. Ninety patients with clinically and mycologically proven tinea pedis took part in this clinical trial. Our results showed both agents to be superior to the placebo, but there was no significant difference in effectiveness between the two active agents. We observed no side effects with the preparations used.
Fifty men and women, aged twenty to sixty-one, with dry skin of the legs, were treated over a four week period, comparing the effects of "hard-milled" versus "dry-skin" (triethanolamine) soaps on the condition of the stratum corneum commonly known as dry skin. Subjective preferences of the subjects heavily favored the dry skin soap. Objective grading of skin changes showed a trend in favor of the dry skin soap.
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An high-resolution pulse echo ultrasonic imaging system has been developed to study decompression-induced gas bubbles. It was considered necessary that the system be capable of detecting gas bubbles with a diameter of 10 micrometer and up and be able to monitor the growth of these bubbles. In addition the system needed to be capable of distinguishing separate gas bubbles from within an area containing a number of bubbles and allowing their position to be accurately located. The current system is capable of detecting bubbles as small as 10 micrometer and of resolving bubbles separated by 0.8 mm in azimuth and 0.4 mm in range, and these values correspond to the maximum accuracy of location. Finally, it has been shown that the technique is extremely unlikely to induce any bubble formation by means of cavitation or thermal mechanisms. It is concluded that the system represents a powerful method for studying the factors controlling bubble formation.
LDL, fibrinogen and other plasma macromolecules are retained in intima in substantial amounts. In areas where lipid is accumulating a large part of LDL is immobilized possibily by binding to fibrin. Lipid may be deposited from LDL as a result of degradation by a cathepsin in intima.
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The anaesthetic potencies of binary mixtures of the gases argon (Ar), nitrous oxide (N2O) and sulphur hexafluoride (SF6) have been measured using mice. The mixtures SF6-N2O and N2O-Ar showed additive behaviour, whereas the constituents of the mixture SF6-Ar were non-additive, having a smaller total potency than expected. Further experiments on this mixture with Italian Great Newts and on the carbon tetrafluoride mixtures CF4-Ar and CF4-SF6 with mice suggested that the anomalous potencies may arise from specific pulmonary effects associated with the breathing of SF6 accompanied by a high pressure of some other gas.
During the first 10 days of February 1975, an Australian hitchhiker contracted Marburg virus disease while traveling through Rhodesia and died; the infection was subsequently passed to two other persons, who recovered. Investigators retraced the hitchhiker's steps in March and again in June 1975 in an effort to uncover the natural reservoir of the virus and determine how it was transmitted. Serum samples were collected from humans and animals wherever the patient had come in close contact with animals or insects. Arthropods of various types were collected in June 1975 and again in February 1976 for virus isolation attempts; at no time did the patient come in direct contact with nonhuman primates of any kind, or any other animals. Indirect contact with bats, monkeys, and birds through aerosols was possible, though at some distance. Direct contact with arthropods occurred throughout the trip; on several occasions it was notably severe. We believe that during this outbreak the first Marburg virus infection occurred by vector-borne transmission from an arthropod yet to be identified, and that patients 2 and 3 acquired the disease by exposure to the oropharyngeal secretions of patients 1 and 2, respectively. Studies are underway to identify the species of arthropod involved in this transmission.
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Russian thistle (Salsola kali), the most common plant referred to as "tumbleweed" in the western United States, can cause a dermatitis in persons who come into direct contract with it. Tests were conducted to determine the mechanism of this dermatitis. Mechanical contact with plant branches, as well as scratch, patch, and photopatch tests with Russian thistle extract and scratch tests with 1.5% potassium nitrate, a plant constituent, were employed. These tests, along with transparent adhesive tape preparations and a skin biopsy, showed that in nonsensitized persons, dermatitis was due only to mechanical irritation of plant floral bracts. In sensitized individuals, Russian thistle floral bracts pierced the skin and stimulated an urticarial reaction.
To evaluate the mechanisms, diagnosis, treatment, and prevention of the anastomotic complex, 151 anastomotic disruptions (representing a 20-year-study) were analyzed from records of St. Frances General Hospital, Pittsburgh. These leaks are serious postoperative problems which require individualized treatment. Prevention should be the main approach to controlling the syndrome.
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