Biomedical subjects
Publications and source records attributed to J E Bennett.
An auricular compression stent has been developed for maintaining uniform and adjustable compression after surgical removal of earlobe keloids. The two-component device is made from heat-polymerized acrylic resin and assembled with nylon screws.
Aspergillus fumigatus galactomannan was prepared and its structure partially characterized. Galactofuranosyl groups were immunodominant when this polysaccharide antigen was reacted with antibody raised in rabbits.
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The cases of two children with giant nevi of the trunk that were excised and closed in early childhood are presented. Both had cosmetic and functional deformities and were treated by scar excision and skin grafting. The 2 cases demonstrate that excision and closure of giant nevi in young children should be discouraged, as it can result in distortion of surrounding structures.
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Three latex agglutination test procedures for detecting Candida antigen in human serum were compared in a retrospective study of 69 patients and 20 normal volunteers. Untreated human serum was reacted with two different latex reagents; one reagent also was reacted with serum treated with protease and heat. The test procedure with treated serum was best, detecting serum antigen in 17 of 21 patients (81%) with disseminated candidiasis. Judging by autopsy-proven cases, there was an increase in positive test results in the last 2 weeks of life. When untreated sera were tested with this reagent, only 3 (14%) of the 21 patients with disseminated candidiasis had detectable antigen in serum. A subset of these same sera was tested by a commercial latex reagent (Candida Detection System lot C001; Ramco Laboratories, Inc., Houston, Tex.) and untreated serum. Of 18 patients with disseminated candidiasis, 5 (28%) had at least one positive serum. Sera from patients with less severe clinical forms of candidiasis were usually negative regardless of the test procedure used. With one exception, sera from control patients were negative or were positive only in sera containing rheumatoid factor. Latex agglutination tests for Candida spp. in treated serum may prove to be a useful procedure for the rapid diagnosis of severe disseminated candidiasis.
A case of extensive necrotizing fasciitis arising from an episiotomy is presented. Group B beta-hemolytic streptococcus and Staphylococcus aureus were isolated. Prompt recognition and aggressive therapy resulted in a favorable outcome despite significant morbidity. Salient clinical features of this rare postpartum complication are discussed and previous cases are reviewed. In addition to wide surgical resection, therapy included aggressive volume resuscitation with Swan-Ganz catheter monitoring, the use of military antishock trousers (MAST suit) to control diffuse hemorrhage, and temporary application of porcine xenografts.
Examined the MMPI correlates of relatively localized brain damage classified along dimensions of laterality and caudality. Forty patients with lateralized lesions that involved anterior or posterior cerebral areas were studied. Based on a multivariate analysis of variance, results revealed significant differences in MMPI profiles between left hemisphere and right hemisphere lesion groups. The MMPI profile for the left hemisphere lesion group is well within the normal range; the right hemisphere lesion group is beyond normal limits, primarily on scales 8 and 2. Several issues are discussed in an effort to integrate these findings with previous studies.
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This report of the worldwide distribution of two varieties of Cryptococcus neoformans was drawn from data on 628 clinical isolates and from data on 97 additional isolates from other laboratories. Tests showed that 100% of the cultures from Austria, Belgium, Denmark, France, Germany, Holland, Italy, Switzerland, and Japan belonged to C. neoformans var. neoformans. More than 85% of the isolates from Argentina, Canada, the United Kingdom, and the United States (except southern California) were of C. neoformans var. neoformans, the remainder being of C. neoformans var. gattii . There was an unusually high prevalence (35-100%) of C. neoformans var. gattii in Australia, Brazil, Cambodia, Hawaii, southern California, Mexico, Paraguay, Thailand, Vietnam, Nepal, and countries in central Africa. These findings indicated that C. neoformans var. gattii is prevalent only in tropical and subtropical regions. Seventy per cent of the total isolates studied were of serotype A of C. neoformans var. neoformans. Serotype D (9% of the total) was common in Europe, but was found infrequently in other regions. Among the two serotypes of C. neoformans var. gattii , serotype B was 4.5 times more prevalent than serotype C. The majority (88%) of type C isolates in our collection were from southern California.
The global distribution of 96 clinical isolates of Cryptococcus neoformans var. gattii among a total of 725 C. neoformans isolates was investigated. While C. neoformans var. gattii was not found among isolates obtained from Europe (excluding the United Kingdom) and Japan; and it was found only infrequently in North America (excluding Southern California), the United Kingdom, New Zealand, and Argentina; the variety was prevalent in regions with tropical to subtropical climates such as South East Asia, Southern California, Brazil, Mid to South Pacific, and the central part of Africa. Among the isolates of C. neoformans var. gattii in our collection, serotype B predominanted (77 of 96), and the serotype C isolates were almost exclusively from North America.
Patients with the hyperimmunoglobulin E-recurrent infection (Job's) syndrome, which is characterized by an elevated immunoglobulin E level, recurrent staphylococcal infections, and an abnormality of neutrophil chemotaxis, have been reported to have visceral Candida infections in addition to their more frequent pyogenic infections. We report a patient with Job's syndrome who presented with massive hematemesis secondary to esophageal cryptococcosis. A thorough evaluation for an occult neoplasm or extraesophageal cryptococcosis was negative. The patient received a 6-wk course of amphotericin B (970 mg) and 5-fluorocytosine with complete radiographic and endoscopic resolution of the lesion. He is doing well 18 mo after therapy. The patient was not anergic, and his response to T-cell mitogens, helper-to-suppressor T-cell ratio, total number of T cells, and immunoglobulin-producing capability were all normal. This case is unusual in that it is the first documentation of a cryptococcoma of the esophagus and underscores the importance of culturing abnormal specimens for unsuspected pathogens in unusual clinical circumstances.
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Antibodies to Cryptococcus neoformans Type D have been raised in rabbits. The partially purified antibody pool was fractionated by affinity-chromatography, and it was shown that antibodies to the capsular polysaccharide of Type D were present in the pool. Neither methyl alpha-D-mannopyranoside, nor D-mannose were inhibitors of the binding of Type D polysaccharide to the antibody-pool. Thus it appears that the serum contains antibody populations which are specific for terminal side-chain carbohydrate moieties of the immunizing antigen.
The in vitro susceptibility of Candida albicans isolates to flucytosine was compared to therapeutic effect in experimental murine candidiasis (candidosis). Four groups of 10 isolates were chosen, based upon their broth dilution minimal inhibitory concentrations (MICs), from a group of 402 isolates from patients without prior flucytosine therapy. Group I MICs were less than 12.5 micrograms/ml after seven days, whereas group II, III, and IV MICs exceeded 12.5 micrograms/ml on days 7, 2, and 1, respectively. Pilot experiments selected challenge inocula of similar virulence. Mice were infected intravenously and given various flucytosine doses. Significant prolongation of survival correlated with MICs and with agar disk-diffusion zone diameters (P less than 0.05). In vivo response to therapy was more favorable for group I isolates compared with group IV isolates (P less than 0.01). The present study demonstrates in this animal model that in vitro susceptibility does correlate with in vivo response to therapy, although exceptions occur with individual isolates.
Five cases of scleroderma en coup de sabre are reported, along with a brief review of the literature [3, 10, 11]. Surgical management was tailored to the defects. Involved discolored skin was excised and the resultant wound repaired by direct closure (forehead, lower lip) or with full-thickness skin grafts. Soft tissues were augmented with dermal or dermal-fat grafts. Bony defects were corrected with prefabricated silicone implants (forehead) or autogenous bone (mandible).
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