Biomedical subjects
Publications and source records attributed to I Goldberg.
A benign osteoblastoma of the anterior part of the pelvic ring was excised with the pubic rami ischium and lower part of the acetabulum. The patient recovered with normal hip function. This case confirms the resectability of large pelvic lesions.
Following administration of phenothiazines for schizophrenia, a 25-year-old patient developed a malignant neuroleptic syndrome followed by bilateral periarticular ossification of the knees, with severely limited motion. Two years later, the patient regained useful motion after bilateral excision of the ossified tissue and intensive physiotherapy. No recurrence of ossification was observed 3 years after operation, and the patient has maintained almost normal motion.
A case report of a malignant eccrine poroma metastasizing to long bones is described. This rare tumor of intraepidermal eccrine sweat duct origin usually metastasized to visceral organs. This is the second reported case of bone metastasis. Although a hip disarticulation was performed for ipsilateral femoral and tibial metastases presenting seven years after resection of the primary tumor, this 43-year-old man died six months later, from pulmonary metastases.
In a long-term follow-up study (average, 10.7 years) of 222 patients (351 feet), the results after proximal phalangeal osteotomy (the Akin procedure) for hallux valgus deformity were found to be unsatisfactory, both subjectively and objectively. The range of motion in the metatarsophalangeal joint was limited postoperatively in 90 per cent of the patients, and in 21 per cent there was recurrence of deformity. The appearance of the foot was poor in 75 per cent. Only 53 per cent of the patients expressed satisfaction with the result of the operation. There was a direct relationship between the development of subluxation or dislocation of the metatarsophalangeal joint and postoperative dissatisfaction of the patient. We concluded that the operation is biomechanically unsound because it does not address the principal mechanical factors that are responsible for the deformity: abnormal function of the adductor hallucis and the abnormal intermetatarsal angle. The Akin procedure is indicated only in combination with other operations that are designed to correct the two cited abnormalities.
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Edema of the arm can be a significant complication following treatment of breast cancer. To determine the risk of arm edema and factors associated with this risk in patients treated with primary radiotherapy, we reviewed the records of 475 women with early breast cancer treated between 1968 and 1980. During this period, the use of axillary surgery prior to radiation gradually increased, and all patients received full axillary irradiation until late in the series. Based on the surgeon's report, the extent of axillary surgery was classified as either a sampling, a lower dissection, or a full dissection. Edema of the arm was scored on clinical grounds and ranged from mild hand swelling to an increased arm circumference of 8 cm. At 6 years, the actuarial risk of developing arm edema was 8% for the entire study population. This risk was 13% for 240 patients who had axillary surgery and 4% for 235 patients not undergoing axillary surgery (p = 0.006). For patients undergoing axillary surgery, the risk of arm edema was 37% with full dissection compared to 5% with sampling (p = 0.0003), and 8% with lower dissection (p = 0.03). The risk of arm edema at 6 years was 28% if more than ten nodes were removed, and 9% if one to ten nodes were removed (p = 0.03). However, the extent of axillary dissection was stronger predictor of subsequent edema than was the number of nodes obtained. The role of axillary irradiation could not be evaluated since 91% of patients received axillary irradiation. The use of chemotherapy, the site or size of the primary tumor, clinical nodal status, patient age and weight, type of suture, the use of a drain, and subsequent local or distant failure did not appear to be significant risk factors. We conclude that the combination of full dissection and full axillary irradiation results in an unacceptably high risk of arm edema.
Continuous endobronchial insufflation of air in paralyzed animals (continuous flow apneic ventilation - CFAV) has been shown to maintain adequate oxygenation and carbon dioxide removal. CFAV in patients using oxygen resulted in adequate oxygenation but a mean rise in PaCO2 of 0.6 mmHg/min (0.08 kPa/min). This experiment compared carbon dioxide removal in dogs with air and oxygen. Ten dogs were anesthetized and paralyzed, and CFAV was used for 1 h with either air or oxygen in a randomized fashion. Adequate oxygenation was obtained with air and oxygen. Normal PaCO2 levels were obtained with air; however, in the animals where oxygen was used, PaCO2 levels rose to a mean of 6.45 +/- s.e. mean 0.4 kPa (48.5 +/- s.e.mean 3.2 mmHg).
From geometrical considerations of the trabecular meshwork, ciliary muscle contraction has been predicted to produce an inward movement of the mesh. Goniophotographs taken under carefully controlled conditions before and after topical administration of pilocarpine showed a change in angle between cornea and mesh that is consistent with the predicted change.
The accumulation and excretion of fumaric acid, and to a lesser extent malic and succinic acids, by Rhizopus arrhizus occurs under aerobic conditions in a high-glucose medium containing a limiting amount of nitrogen and a neutralizing agent (CaCO(3)). An overall four-carbon dicarboxylic acid molar yield of up to 145% (moles of acid produced per mole of glucose utilized) is obtained after incubation for 4 to 5 days. Evidence is presented that fumarate is synthesized from pyruvate via a carboxylation reaction yielding oxaloacetate, which is then converted to malate and further on to fumarate via the reductive reactions of the tricarboxylic acid cycle. The possible formation of fumarate from the normal (oxidative) operation of the tricarboxylic acid cycle was not excluded by the data. Yield, C nuclear magnetic resonance, and enzymatic activity studies were carried out in a strain of R. arrhizus which produces high levels of fumarate from glucose and carbonate. The observed high fumarate molar yield (greater than 100%) can therefore be explained in terms of the carboxylation of pyruvate and the operation of the reductive reactions of the tricarboxylic acid cycle under aerobic conditions.
A recombinant plasmid carrying the recA gene of Vibrio cholerae was isolated from a V. cholerae genomic library, using complementation in Escherichia coli. The plasmid complements a recA mutation in E. coli for both resistance to the DNA-damaging agent methyl methanesulfonate and recombinational activity in bacteriophage P1 transductions. After determining the approximate location of the recA gene on the cloned DNA fragment, we constructed a defined recA mutation by filling in an XbaI site located within the gene. The 4-base pair insertion resulted in a truncated RecA protein as determined by minicell analysis. The mutation was spontaneously recombined onto the chromosome of a derivative of V. cholerae strain P27459 by screening for methyl methanesulfonate-sensitive variants. Southern blot analysis confirmed the presence of the inactivated XbaI site in the chromosome of DNA isolated from one of these methyl methanesulfonate-sensitive colonies. The recA V. cholerae strain was considerably more sensitive to UV light than its parent, was impaired in homologous recombination, and was deficient in induction of a temperate vibriophage upon exposure to UV light. We conclude that the V. cholerae RecA protein has activities which are analogous to those described for the RecA protein of E. coli.
The cholera toxin operon (ctxAB) is located on a 7-kilobase pair variable genetic element which undergoes genetic duplication and amplification events in Vibrio cholerae. Amplification of the ctx genetic element was investigated by substituting the resident ctx loci of two V. cholerae strains with a DNA fragment encoding resistance to kanamycin. Although these strains were not normally resistant to greater than 150 micrograms of kanamycin per ml, spontaneous derivatives could be obtained that grew well on 3 mg of kanamycin per ml. Southern blot analysis of these highly resistant isolates demonstrated that the ctx element was amplified approximately 20-fold. This amplification process was completely inhibited in the absence of a functional recA gene. The V. cholerae RecA protein, therefore, is essential for cholera toxin gene amplification. Spontaneous deletions of the ctx structural genes were observed in both recA+ and recA- V. cholerae strains, although such deletions occurred at a 21-fold-lower frequency in the latter case. Structural analysis of these ctx amplification and deletion events supports a model for their formation that involves unequal crossing over between repetitive sequences located upstream and downstream of the ctx operon.
A retrospective study was undertaken of twenty patients with a Mason type-II and sixteen patients with a Mason type-III closed fracture of the radial head who had excision of the radial head. The average length of follow-up was 16.4 years (range, three to twenty-seven years) and the average age of the patients at operation was forty-two years (range, eighteen to seventy-five years). Thirty-one patients (86 per cent) were satisfied with the results, and thirty-four (94 per cent) returned to their preoperative occupations. Only three patients lost 30 degrees or more of flexion of the elbow or of pronation or supination of the forearm. A measurable proximal migration of the radius of more than one millimeter was found in eight patients (22 per cent), but no harmful effects of this were found. All of the patients showed osteoarthritic changes on roentgenograms of the elbow that had been operated on, but these did not affect the functional scoring. According to the functional classification that we used, thirty-three (92 per cent) of the patients were able to function satisfactorily in activities of daily living and only three were not. We concluded that if, for any reason, operative treatment is undertaken for these fractures, good functional results can be expected. Nevertheless, because the results of non-operative treatment of Mason type-II fractures, as reported in the literature, have been almost identical to ours, we have adopted a non-operative approach in the last few years.
Argon laser trabeculoplasty (ALT) was used to treat 237 eyes of 156 presurgical patients with various open-angle glaucomas. Patients with primary open-angle glaucoma formed the largest group; intraocular pressure (IOP) control judged clinically to be adequate was achieved in 77.3% of eyes. Eyes with pseudoexfoliative glaucoma demonstrated the greatest IOP reduction achieving control in 90.7%. Eyes with combined-mechanism glaucoma underwent argon laser iridectomy prior to ALT. One month after ALT the IOP was considered adequate in 70% of eyes. ALT may benefit eyes with low-tension glaucoma, pigmentary glaucoma and aphakic open-angle glaucoma. Treatment failures were frequent in eyes with angle recession and uveitis. Complications included IOP elevation (7.8%) and mild iritis; technique modifications minimized their frequency and intensity. ALT demonstrated an excellent benefit-to-risk ratio. Its effect additive to medications, ALT often permitted a reduction in the medical regimen, but rarely cessation of drug therapy. ALT is recommended as an alternative to drainage surgery.
Between 1976 and 1983, 40 women with intraductal carcinoma of the breast without invasion underwent excisional biopsy and irradiation as an alternative to mastectomy. The median age was 53 years (range, 28 to 77 years) and the median follow-up time since initiation of radiation was 44 months (range, 14 to 97 months). Twenty-seven patients presented with a palpable mass; in 13 patients the tumor was detected only by mammography. A limited axillary dissection was performed in 13 patients, and all lymph nodes removed were negative. Treatment was administered to the breast and adjacent chest wall to a dose of 4,600 to 5,000 rad, with 26 patients also receiving a boost dose of 1,000 to 2,000 rad to the site of the primary. Four patients have developed a recurrence in the treated breast, at 17, 19, 35, and 63 months after the beginning of radiation therapy. The 5-year actuarial rate of local recurrence is 10%. Three of the recurrences were in those four patients who presented with a nipple discharge and a central primary. In two cases, the recurrence consisted of only intraductal carcinoma; in the other two, both intraductal and invasive cancer were found. All four patients with recurrence underwent mastectomy and are well without evidence of distant metastases at 1, 12, 15, and 15 months since mastectomy. Cosmetic results were excellent. No patient has developed distant metastases. Since the number of patients treated is small and the period of follow-up is short, one must be cautious in the interpretation of these results. Nonetheless, the treatment of intraductal carcinoma of the breast by excision and irradiation appears to give acceptable local control and excellent survival when suitable precautions of patient selection and evaluation are taken.
The diagnosis of isolated tuberculosis of the Achilles tendon was made in a 50-year-old man by excision of the lesion and histologic examination. The patient was free of other systemic symptoms or other foci of infection. The wound healed without complication with the aid of antituberculous chemotherapy. The lesion recurred after nine years, at which time it was again excised and the diagnosis confirmed. Eight years later, the patient remains symptom-free with no signs of recurrence.
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The aglycon form of the steroidal sapogenin furost -5-ene-3 beta, 22,26-triol, 3 beta- chacotrioside 26 beta-D-glucopyranoside was isolated from cell suspension cultures of Dioscorea deltoidea and its molecular structure was determined by mass spectrometry and 1H and 13C n.m.r. spectroscopy. From kinetic studies and incorporation experiments with [1-14C]acetate it was concluded that the steroidal compound (in the glycoside form) is an intermediate in vivo in diosgenin biosynthesis. It accumulated in growing cells of D. deltoidea and was metabolized to diosgenin (in the glycoside form, i.e. dioscin ) in non-dividing cells.