Biomedical subjects
J E Bennett
Publications and source records attributed to J E Bennett.
Decompression in constricting burns: a reappraisal.
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Further experience with the alcohol test for cryptococcal meningitis.
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Expanding forearm hematoma after apparent minor injury.
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A ganglion of the temporomandibular joint presenting as a parotid tumor.
A case of temporomandibular joint (TMJ) ganglion is described, and 4 previously reported cases are noted. In all cases, initial diagnosis of parotid neoplasm proved incorrect at surgical exploration. Management of all cases consisted of identification of the facial nerve and excision of the ganglion with a cuff of TMJ capsule. The diagnosis of TMJ ganglion should be entertained when a presumed parotid neoplasm changes in size or position with jaw movement.
Differences in Cryptococcus neoformans capsular polysaccharide structure influence assembly of alternative complement pathway C3 convertase on fungal surfaces.
Binding of complement component C3 and Factor B to Cryptococcus neoformans serotypes A through D via the alternative complement pathway was measured in a system containing fresh nonimmune human serum. Serotypes B and C (C. neoformans var. gattii) bound approximately half as many molecules of both complement components as serotypes A and D (C. neoformans var. neoformans). In contrast, removal of xylosyl and glucuronyl side chains from the mannan main chain of capsular polysaccharide by the Smith degradation procedure resulted in binding of similar quantities of C3 to each of the four serotypes. We conclude that the relatively high degree of side chain substitution of capsular polysaccharide from C. neoformans variety gattii contributes to inefficient surface assembly of the alternative pathway C3 convertase. Inefficient binding of alternative pathway complement components to serotypes B and C may contribute to the relative difficulty in successfully treating infections caused by these organisms.
Criteria for evaluation of therapeutic response to antifungal drugs.
A therapeutic trial of antifungal therapy in humans requires not only well-defined objectives and a sufficient number of patients, but also standardized criteria for the diagnosis and evaluation of response, including the efficacy, failure, and toxicity of any new agent or treatment modality. Generally, the retention of a patient in a study should require, as a minimum, confirmation of the etiologic diagnosis by culture of the organism from the infected site. Two different systems for evaluation of therapy are proposed. The first is a set of definitions of response to therapy; these are adaptable for use in any type of prospective clinical trial and emphasize cure as the best possible outcome. The second system of evaluation employs scored criteria and thereby enables quantitative comparison of the status of a patient before therapy with his or her status at intervals during therapy, at the end of therapy, and at intervals after therapy. This system provides an objective means of measuring improvement in a given patient; thus it is most useful in those diseases in which significant improvement rather than cure is a more realistic goal of therapy, e.g., coccidioidomycosis.
Capsular polysaccharides of Cryptococcus neoformans.
Polysaccharides of Cryptococcus neoformans are considered to have a role in the virulence of this encapsulated fungus. The structure has been determined for the most abundant polysaccharide, a glucuronoxylomannan of varying xylose and ester content. The structural complexity of the capsular material increases from serotype D to A to B to C, but even for the simplest capsule (type D), the immunodeterminants seem to occur only on the side chains. The interactions of some of these groups with antibodies is discussed.
Rapid diagnosis of candidiasis and aspergillosis.
Published studies support the hypothesis that at least two antigens of Candida albicans and Candida tropicalis circulate in the bloodstream of patients with severe candidiasis. One antigen (probably mannan) is stable and the other (probably protein) is labile. The stabile antigen can rarely be detected without prior dissociation from antibody. Dissociation treatment destroys the labile antigen, leaving in doubt whether any is antibody bound. Dissociation steps have also been necessary for detection of Aspergillus fumigatus antigen in sera from patients with invasive aspergillosis. Concentrations of the stable antigens of both Candida and Aspergillus appear to be in the nanogram-per-milliliter range, generally lying at the limits of detection by conventional assays. Improvements in sensitivity and practicality are needed, but the tests are clearly promising.
Early excision: a financial assessment.
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Giant hairy nevus: preventable cause of amblyopia.
An infant with a congenital giant hairy nevus causing occlusion of the visual axis of the right eye is presented. The nevus was removed at the early age of three weeks because of concern that the child would develop deprivation amblyopia. Since such nevi can undergo malignant changes, early removal may be justified for that reason alone.
The prognosis on regionalization is poor.
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