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Biomedical subjects

J D Dillon

Publications and source records attributed to J D Dillon.

15 recordsLinked to original sources
PubMed2000

Structural and functional characterization of the leukocyte integrin gene CD11d. Essential role of Sp1 and Sp3.

CD11d encodes the latest alpha-subunit of the leukocyte integrin family to be discovered, and it is expressed predominantly in myelomonocytic cells. We have isolated a genomic clone that contains CD11d and showed this gene to be 11,461 bp downstream and oriented in the same direction as the related CD11c gene. CD11d transcription begins 69-79 nucleotides upstream of the ATG codon. Transfection analysis of CD11d-luc reporter constructs revealed that the -173 to +74 region is sufficient to confer leukocyte-specific expression of luciferase in myelomonocytic cells (THP1 and HL60), B-cells (IM9), and T-cells (Jurkat). Transfection analysis showed that down-regulation of CD11d expression by phorbol ester was myelomonocyte-specific and is mediated by one or more cis-elements within the -173 to +74 region. In vitro DNase I footprint analysis and electrophoretic mobility shift analysis showed that Sp1 and Sp3 bind at -63 to -40. Deletion of the Sp-binding site significantly reduced CD11d promoter activity. Overexpression of either Sp1 or Sp3 in THP1 cells led to activation of the CD11d promoter even in the presence of phorbol ester, whereas down-regulation of either factor by antisense oligonucleotides decreased CD11d promoter activity. In contrast, overexpression of Sp3 in IM9 and Jurkat cells down-regulated CD11d promoter expression. In vivo genomic footprinting revealed that the -63 to -40 region is bound by a Sp protein in unstimulated HL60 cells but not in phorbol ester-stimulated HL60 cells. In contrast, this site is bound in both unstimulated and phorbol ester-stimulated IM9 and Jurkat cells. Together, these results show that myelomonocyte-specific phorbol ester down-regulation of CD11d is mediated through both Sp1 and Sp3.

Amino Acid Sequence↗
PubMed1986

Consciousness and amnesia after penetrating head injury: neurology and anatomy.

Among 342 men who survived severe penetrating brain wounds, only 15% had prolonged unconsciousness and 53% had no or momentary unconsciousness after injury, emphasizing the focal nature of these wounds. The left (or language-dominant) hemisphere was dominant for the "wakefulness" component of consciousness. The areas most associated with unconsciousness included the posterior limb of the left internal capsule, left basal forebrain, midbrain, and hypothalamus. Left dominance was not seen for posttraumatic amnesia after elimination of the wakefulness variable, suggesting that wakefulness may be linked to the role of the left hemisphere in verbal memory.

Amnesia↗
PubMed1986

Computerized clinical dietetics management system.

A computerized Clinical Dietetics Management System (CDMS) was designed to support and facilitate accurate and timely delivery of clinical dietetics services. The CDMS is an integral part of a comprehensive hospital computer system that interfaces with 17 data bases. Thirty-one functions provide order processing, inquiry, calculations, message sending, charge capture, data base maintenance, and management reporting capabilities. System features include immediate and continuous access to the most current patient information, automatic routing of messages, a complete diet-order history for each patient and minimal printed output. Since implementation of the CDMS, users report benefits such as smoothing of workload peaks, fewer interruptions, fewer wasted trays, better and faster problem solving, and increased visibility in clinical dietetics services. The dynamic nature of the system allows additional applications to be added as they are developed.

Computers↗
PubMed1985

Epilepsy after penetrating head injury. I. Clinical correlates: a report of the Vietnam Head Injury Study.

Of 421 veterans who had penetrating brain wounds in Vietnam 15 years ago, 53% had posttraumatic epilepsy, and one-half of those still had seizures 15 years after injury. The relative risk of developing epilepsy dropped from about 580 times higher than the general age-matched population in the first year to 25 times higher after 10 years. Patients with focal neurologic signs or large lesions had increased risk of epilepsy, and site of the lesion may have been more important than size in determining occurrence. Family history of epilepsy or preinjury intelligence had no effect on seizure occurrence. Seizure frequency in the first year predicted future severity of seizures. Phenytoin therapy in the first year after injury did not prevent later seizures.

Adult↗
PubMed1983

Mortality following penetrating craniocerebral injuries. An analysis of the deaths in the Vietnam Head Injury Registry population.

A population of 1127 men with penetrating craniocerebral injuries who were alive 1 week after their injuries has been followed for 15 years. During this time, 90 deaths (8%) occurred. Most of the deaths occurred early in the 1st year after trauma and were secondary to the direct effects of brain injury or the sequelae of coma. Complications, particularly infections, were significant mortality factors. Coma was the best prognostic guideline. Posttraumatic epilepsy was not related to mortality except for the risks accompanying each ictus. The population now appears to be approaching the actuarial norm of their peers.

Brain Injuries↗
PubMed1981

Analysis of brain abscess after penetrating craniocerebral injuries in Vietnam.

A population of 1221 patients from the Vietnam War with penetrating craniocerebral trauma was analyzed. Thirty-seven cases of brain abscess were documented (incidence 3%). This sequela occurred more frequently in association with extensive, deep penetrating injuries; deep, prolonged coma; cerebrospinal fluid fistulas; wound infections; facio-orbital cranial/air sinus injuries; and retained bone fragments. The mortality rate was 54%, and, of the patients who survived, 82% had significant morbidity. This is the last large population study of brain abscess after penetrating craniocerebral trauma before the availability of computed tomographic scanning and more comprehensive coma care. It should serve as base line data against which we can measure improvement.

Brain Abscess↗
PubMed1981

Cerebrospinal fluid fistulas complicating missile wounds of the brain.

The records of 101 casualties of the war in Vietnam have been analyzed, with particular attention to missile wounds of the brain complicated by a cerebrospinal fluid (CSF) fistula. Fifty-four developed CSF drainage at the wound site, 30 presented with rhinorrhea, and 23 with otorrhea. Fifty of the 101 men developed infection, an incidence of 49.5%. The occurrence of a fistula in vertex wounds can usually be traced to failure to close the dura, or to achieve watertight closure of the dura primarily, or by graft. Approximately two-thirds of compound basilar fractures, complicated by rhinorrhea or otorrhea, are due to direct fractures of the anterior, middle, or posterior fossa. The remaining one-third are due to elusive "discrete" fractures of the base of the skull, occurring at a distance from the entry wound, and not in continuity with the fracture of the vault. While direct basilar fractures can readily be recognized, facilitating repair of the dura overlying the basilar fractures, "discontinuous" fractures pose a challenging diagnostic problem. More commonly occurring in vertex wounds crossing the midline, discontinuous fractures producing rhinorrhea or otorrhea may be identified with the aid of tomograms of the base of the skull. Their early diagnosis may well prove to be a significant factor in the reduction of morbidity and mortality of missile wounds of the brain complicated by a CSF fistula.

Brain Injuries↗
PubMed1980

Language and motor disorders after penetrating head injury in Viet Nam.

Aphasia occurred in 244 of 1030 patients with head wounds, correlating with gunshot cause (p < 0.03) and initial loss of consciousness (p < 10(-6)). Aphasia disappeared within 10 years in 84 cases (34%). Sensorimotor aphasia usually changed to motor aphasia; motor aphasia disappeared; and sensory aphasia persisted. These improvements continued years after the accompanying hemiparesis stabilized, and were not related to wound site, depth, or whether the wound was caused by gunshot or fragment. Parietal wounds caused hemiparesis more often (p < 10(-6))than did wounds elsewhere. Regardless of the features of the hemiparesis initially, the severity of the final syndrome was greatest in the hand and arm and least in the face.

Adult↗
PubMed1980

Evolution of craniotomy as a debridement technique for penetrating craniocerebral injuries.

A craniotomy debridement technique was recommended for penetrating craniocerebral injuries as early as 1940, in World War II. However, with due consideration for the bacterial contamination of penetrating injuries, the safety of this technique was questionable. The technique has been recommended in each succeeding war, but no data substantiating the safety or eventual sequelae have been available. Analysis of the data from the large Head Injury Registry of Vietnam casualties indicates that, in properly selected cases, debridement by craniotomy technique can be safe and efficacious.

Adult↗
PubMed1979

Cranioplasty: a review of 1030 cases of penetrating head injury.

A total of 491 cranioplasties performed in a population of 1030 cases of penetrating head injury are reviewed. The morbidity rate was 5.5%, and the mortality rate was 0.2%. The clinical criteria of improving cosmetic defects and restoring craniocerebral protection are established, based on the location and size of the skull defect. Cranioplasty after penetrating head injury should be deferred for a minimum of 1 year to control morbidity. Complication of the original injury and surgical debridement increase the morbidity rate of cranioplasty. Post-traumatic epilepsy is not related to skull defects per se; neither is it affected by cranioplasty. Acrylic is an acceptable cranioplasty material if there is strict adherence to good surgical technique.

Acrylic Resins↗
PubMedDate not supplied

Distinguishing between scar and recurrent herniated disk in postoperative patients: value of contrast-enhanced CT and MR imaging.

Twenty patients with failed back surgery syndrome were analyzed prospectively with MR imaging. In addition, 10 of these patients were analyzed with high-dose contrast-enhanced CT or gadopentetate dimeglumine-enhanced MR imaging. Imaging results were compared with surgical and pathologic findings in all cases. In the 10-patient subset, abnormal epidural soft-tissue specimens were also assessed with light and electron microscopy for vascular density, size of the extracellular space, and collagen orientation and thickness. The average vascular density of epidural fibrosis on light microscopy was found to be 1.19%; the average size of the extracellular space on electron microscopy was 4.29%. Scar 4 months of age or less had a larger extracellular space than did older scar; high- (grade 4 or 5) intensity scar had a larger extracellular space than did less intense scar on long TR/short TE images. Scar 1 year old or less enhanced more intensely on CT than did older scar. The MR signal intensity and CT enhancement characteristics of epidural scar were also found to differ according to epidural location. The percentage of scar that was hyperintense on long TR/TE images was as follows: anterior, 82%; lateral recess, 70%; lateral, 47%; and posterior, 20%. However, no relationship was found between the degree of CT enhancement of scar and vascular density. Gap junction status and extracellular space size, therefore, are more important than vascular density in predicting the degree of enhancement. The accuracy of contrast-enhanced CT and unenhanced MR in separating scar from herniated nucleus pulposus is 80%. This accuracy is related to the partial overlap in imaging characteristics of scar and recurrent herniated nucleus pulposus.

Adult↗