Biomedical subjects
Publications and source records attributed to I Rappaport.
Immunoglobulin E (IgE) concentrations were measured in 157 paired samples of maternal-fetal sera. A correlation was found between maternal and fetal IgE levels, in contrast to earlier reports dealing with smaller series. The correlation is probably not due to placental transfer of maternal IgE but rather to genetic factors. The possible role of IgE in the fetal immune response is discussed.
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Dermatitis herpetiformis (DH) of linear IgA type occurred in a 6-month-old boy shortly after initiating sulfisoxazole therapy for a urinary tract infection. Generalized pruritic bullae on erythematous bases were present on his trunk and extremities. There were no clinical or laboratory findings suggestive of gastrointestinal involvement. Direct immunofluorescent studies of skin biopsies taken early in the course of the disease and while the child was on systemic corticosteroid therapy were negative. Eventually a linear deposition of IgA at the dermoepidermal junction of involved skin on direct immunofluorescence was demonstrated. No circulating antibodies to the basement membrane were found. Because of close proximity of the initiation of sulfisoxazole (Gantrisin) therapy and the eruption of the initial bullous lesions, this case also presents an interesting diagnostic and therapeutic problem. Negative assays of lymphocyte migration inhibition factor (LMIF) to sulfisoxazole indicated that the likelihood of a hypersensitivity reaction to sulfa drugs was slight. The patient's clinical response to dapsone therapy was dramatic. The conflicting views of subepidermal bullous dermatosis of childhood and the difficulties in confirming a diagnosis of DH are discussed. We contend that when DH is suspected in children, various laboratory tests should be repeated several times before the diagnosis can be confirmed. The case presented here is the youngest child reported with this type of DH.
Five microvascular reconstructions of the mandible were performed in the past 2 years. One dorsalis pedis osteocutaneous flap was used to reconstruct the alveolar ridge and four groin osteocutaneous flaps were used for various defects of the mandible. Free microvascular bone grafts were found useful in previously irradiated fields, in anterior arch reconstruction, and in patients with massive soft tissue and bone loss.
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RAST and intradermal testing correlated reasonably well for untreated patients for ragweed and molds and in treated patients for trees. Capillary blood was found to be comparable to venous blood as a source for RAST for ragweed and mixed grasses.
Although perineural metastases have been studied extensively for various regions of the body, there is a relative paucity of data on cancers of the head and neck region. A case of perineural metastasis from a squamous-cell carcinoma of the lower lip is presented, with symptoms mimicking other neurologic diseases.
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Long-term follow-up is essential to evaluate our present modalities of treatment of arteriovenous malformations of the maxillae. Embolization followed by surgical resection has produced long-term survival in our patient population.
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We have recently had two cases of midfacial granulomas in which laboratory examinations and multiple biopsies did not reveal a more specific diagnosis. Both responded to treatment. We feel that in such cases therapy should be given and based on the extent of local destruction and the history of the disease in the patient.
Thirteen children who had major extirpative surgery of the maxilla or the mandible were followed up an average of five years postoperatively. They ranged in age from three months to eleven years. Facial and oral photographs, cephalograms and cephalometric analysis, and plaster dental models were used to document longitudinal and cross-sectional growth patterns; Our experiences in this limited number of cases has indicated the following: (1) Extensive extirpation of facial bones may be performed in children without significantly jeopardizing function or growth. (2) The roots of healthy teeth may be resected without fear of their noneruption or early loss; loss of sensation with continued viability is the rule. (3) The use of an iliac bone crib with particulate grafts has proved a highly successful means of reconstruction of the mandible in children. (4) Particulate bone has proved to be an effective means of reconstructing large contour defects of the mandible caused by enucleating large tumors in children.
A 51-year-old man with schistosomiasis had symptoms of cholecystitis due to Schistosoma mansoni eggs found in all layers of the gallbladder associated with all stages of inflammatory granulomatous reaction. Adult worms were found in a subserosal venule also. Why parasitism of the gallbladder by S mansoni eggs is apparently rare is not known.
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