Biomedical subjects
J L Stone
Publications and source records attributed to J L Stone.
Basal cell carcinoma in Kauai, Hawaii: the highest documented incidence in the United States.
BACKGROUND: In Kauai, Hawaii, we observed an exceedingly high incidence of basal cell carcinoma in an earlier 1-year study. OBJECTIVE: Our purpose was to report the incidence of basal cell carcinoma in a defined population in Hawaii. METHODS: A prospective 5-year population-based incidence study was conducted on Kauai, Hawaii, between 1983 and 1987 to investigate the frequency of basal cell carcinomas in Caucasian residents. A total of 242 residents, 161 men and 81 women, were identified with an initial episode of basal cell carcinoma during the 5-year period. RESULTS: The average annual incidence per 100,000 Kauai Caucasian residents standardized to the 1980 U.S. white population was 576 for men and 298 for women with a combined incidence of 422. The average patient age was 56.5 years, and men had a significantly higher incidence of cancer than women (p < 0.000001). The head and neck was the most common site. The trunk was the second most common site, representing one third of lesions. Subsequent new basal cell carcinomas occurred in 16.9% of patients. Only 3.3% of patients had recurrent carcinomas after treatment. CONCLUSION: Kauai's incidence rates of basal cell carcinoma are the highest yet documented in the United States. As an unexpected finding, a decreasing incidence trend was noted in the study's later years and may warrant further investigation. Finally, a significant number of basal cell carcinomas developed on the trunk, suggesting and reinforcing the expectation that sun exposure is not limited to the face and neck in this Hawaiian population.
Basal cell carcinoma and keratoacanthoma in Hawaiians: an incidence report.
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Civilian gunshot wounds to the head.
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Non-melanoma skin cancer and keratoacanthoma in Filipinos: an incidence report from Kauai, Hawaii.
BACKGROUND: Non-melanoma skin cancer is the most common malignancy in the white population of the United States with an estimated 700,000 new cases each year. Regrettably, data on minority racial groups are either scarce or lacking entirely. METHODS: This study was designed as a 5-year prospective incidence study of non-melanoma skin cancer and keratoacanthoma by using an island-wide survey of Kauai's Filipino residents and covers the years of 1983 to 1987. RESULTS: Seven basal cell carcinoma (incidence: 12.3/100,000), one squamous cell carcinoma (incidence: 1.8/100,000) and four keratoacanthoma (incidence: 7/100,000) patients are reported. CONCLUSIONS: To the best of our knowledge, this is the first population-based incidence report on non-melanoma skin cancer and keratoacanthoma in this population.
Microvascular sling decompression for trigeminal neuralgia secondary to ectatic vertebrobasilar compression. Case report.
A patient with trigeminal neuralgia caused by a tortuous and ectatic vertebrobasilar artery is presented. He was treated with microvascular decompression using a fine silicone sling sutured to the dura over the petrous pyramid. The technical details are described.
Mohs micrographic surgery: a synopsis.
Mohs micrographic surgery is a method for removal of non-melanoma skin cancer in thin layers, allowing frozen-section examination of all peripheral and deep margins. Subsequent tissue layers are removed as dictated by microscopic examination, allowing for maximal sparing of normal tissue. This method offers cure rates significantly higher than excision or other modalities. Mohs micrographic surgery is the method of choice for removal of large, recurrent or incompletely excised skin cancers or for tumors located in regions of high recurrence.
Keratoacanthoma in Kauai, Hawaii. The first documented incidence in a defined population.
BACKGROUND AND DESIGN: A prospective 5-year population-based incidence study was conducted on the island of Kauai, Hawaii, from 1983 through 1987 to investigate the frequency of keratoacanthoma in white residents. RESULTS: A total of 53 residents, 36 men and 17 women, were identified with an initial episode of keratoacanthoma during the 5-year study. The average annual incidence rate per 100,000 Kauai residents, standardized to the US white population, was 144 for men and 73 for women, with a combined rate of 104. The average patient age was 63.5 years. The limbs, particularly the hands and arms, were the most common anatomic site, with the trunk second. Only one patient developed a new subsequent keratoacanthoma, and no recurrent lesions were observed. Three patients had two keratoacanthomas when they first presented, and 13 patients had concurrent skin cancer. Sixty percent (32) of our patients developed skin cancer at one time or another. CONCLUSIONS: We report the first population-based keratoacanthoma incidence rates documented in the United States, which are almost equal to those of squamous cell carcinoma. Keratoacanthoma also shares many common epidemiological features with squamous cell carcinoma, such as increasing incidence in progressively older age groups.
Amniocentesis and chorionic villus sampling.
Amniocentesis performed at 16 to 18 weeks' gestation has been the gold standard approach for prenatal cytogenetic diagnosis. Over the past few years, large collaborative studies on chorionic villus sampling have confirmed the safety and efficacy of chorionic villus sampling as a viable alternative for women seeking prenatal diagnosis. While the expanding experience with chorionic villus sampling has answered questions regarding the safety of the transabdominal approach, it has also raised questions concerning possible associations with limb abnormalities, its usefulness in multiple gestations, and the clinical significance of confined placental mosaicism. These issues, as well as the technical and gestational age limitations of chorionic villus sampling, have led many investigators to study the technical feasibility, safety, and accuracy of amniocentesis performed in the first trimester or early second trimester. While this approach appears both safe and efficacious, there are concerns regarding orthopedic abnormalities and the reliability of first-trimester amniotic fluid acetylcholinesterase and alpha-fetoprotein levels in the diagnosis of neural tube defects.
Treatment of mandibular squamous cell carcinoma in cats by use of mandibulectomy and radiotherapy: seven cases (1987-1989).
Seven cats with squamous cell carcinoma involving the mandible were treated by surgery and radiotherapy. Surgery consisted of hemimandibulectomy or combined rostral and hemimandibulectomy, gastrostomy tube placement, and submandibular lymph node excisional biopsy. Radiotherapy (orthovoltage or 60Co) commenced 2 weeks after surgery. Histologically, the tumor invaded surgical margins in 6 of 7 cats. Nerve infiltration was histologically identified in 2 cats. All cats had stage-3 disease with radiographic evidence of mandibular bone involvement. Age ranged between 8 and 16 years (median, 10 years). Hypercalcemia (2), feline immunodeficiency virus (2), and hyperthyroidism (1), were detected in cats prior to treatment. Survival after surgery was a median of 14 months (range = 3 to 36 months, mean = 15 months). Six cats were euthanatized because of recurrence of disease at 3, 7, 9, 16, 21, and 36 months. One cat was euthanatized at 14 months because of an unrelated disease. Complications of tongue lagging, drooling after meals, mandibular drift, maxillary ulceration, and alopecia of the jaw developed in a few cats. Radiation at the primary site and regional lymph nodes after surgery of curative intent extended survival in cats with mandibular squamous cell carcinoma.
Morphometric analysis of macular photoreceptors and ganglion cells in retinas with retinitis pigmentosa.
There have been a number of histopathologic studies of retinas that were taken post mortem from patients with retinitis pigmentosa (RP), but few have addressed the question of transneuronal degeneration of ganglion cells secondary to photoreceptor death. We studied sectioned maculae that were obtained from 41 patients with different genetic forms of RP: autosomal dominant (n = 11); X-linked (n = 9); and simplex (n = 21). We also studied sectioned maculae that were taken from 20 age-matched normal subjects. We counted cell bodies in the photoreceptor and ganglion cell layers at 100-microns (0.35 degrees) intervals from the foveola to 1500-microns eccentricity and compared the mean cell counts among each group with RP. Each RP type had significantly fewer (P < .05) photoreceptors than those of the control group at each 100-microns interval. At eccentricities of 700 to 1500 microns, the retinas with X-linked and autosomal dominant RP had significantly fewer (P < .05) ganglion cells than those of the control group; the simplex RP mean ganglion cell counts were significantly lower (P < .05) than those of the control group, from 1000 to 1500 microns. The mean photoreceptor and ganglion cell counts had a .43 correlation (P < .001) in the zone of 700 to 1500 microns, consistent with transneuronal ganglion cell degeneration. Current experimental attempts to restore vision in diseased retinas by simulating or replacing photoreceptors are based on the premise that ganglion cells are retained after photoreceptor death. Our findings support this assumption.
The Lennox-Gastaut syndrome: electroencephalographic characteristics, clinical correlates, and follow-up studies.
Electroencephalographic and clinical findings are reported for 100 patients with the Lennox-Gastaut (LGS) triad of slow bilateral spike and wave (BSW), retardation and multiple seizures. Neurological and mental deficits were frequently observed, especially in patients who developed seizures before age 1 yr. More than half of the patients had focal epileptiform discharges that peaked in occurrence at age 4-6 yrs. EEG follow-up showed that background frequency slowed when patients developed the LGS pattern, and increased after recovery. Only 2 patients developed normal EEGs on follow-up, although 22 patients no longer showed the LGS pattern after an average of 3 yrs 3 mos follow-up.
A protocol for intraoperative somatosensory (SEP) and motor evoked potentials (MEP) recordings.
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Spinal cord decompression via a modified costotransversectomy approach combined with posterior instrumentation for management of metastatic neoplasms of the thoracic spine.
Fifteen patients with thoracic spinal cord compression from metastatic neoplastic processes were managed by spinal canal decompression via a modified costotransversectomy approach. Ten of the patients also underwent sequential posterior stabilization with Luque or Harrington instrumentation based upon proximity of the lesion to the thoracolumbar junction, prognosis for regaining or maintaining ambulatory ability, and additional spinal stability considerations. A modified lateral decubitus position with the scapula falling away from the side of exposure was used for T1-5 segment lesions, and a prone position was used for the (T-6)-(T-12) segment. Adequate decompression of the spinal canal was achieved in all cases. All patients who were ambulating preoperatively maintained ambulatory ability, and pain and/or further neurological improvement as well occurred in 75%.
Rupture of a giant carotid aneurysm after extracranial-to-intracranial bypass surgery.
We report a case of a fatal rupture of a previously unruptured giant aneurysm of the bifurcation of the internal carotid artery (ICA), which occurred after an extracranial-intracranial (EC-IC) bypass and the partial occlusion of the ICA. Interim angiography showed retrograde filling of the proximal middle cerebral artery to the aneurysm. There have been four previously reported cases of giant aneurysms rupturing after treatment with an EC-IC bypass and carotid ligation, and it appears likely that a change in pressure/flow dynamics produced by the bypass may have been the cause. The technique of carotid ligation with an EC-IC bypass is used frequently to treat unclippable intracranial aneurysms, and the resulting hemodynamic changes need to be considered carefully to prevent this type of complication. To minimize hemodynamic stress on the aneurysm, we suggest that 1) the bypass caliber should be as small as possible consistent with sufficient cerebral blood flow after ICA occlusion, and 2) complete ICA occlusion should be performed as soon as possible after the bypass.
Hematoma in the posterior fossa secondary to a tangential gunshot wound of the occiput: case report and discussion.
The case of 16-year-old boy who incurred a subdural hematoma in the posterior fossa an intracerebellar hematoma after a tangential civilian gunshot wound is reported. The skull was not fractured, and yet surgically significant clots required removal. The patient recovered. The discussion centers on the mechanism of injury and seriousness of tangential gunshot wounds and traumatic hematomas in the posterior fossa.
The effect of an anesthetic induction dose of midazolam on motor potentials evoked by transcranial magnetic stimulation in the monkey.
The effect of a hypnotic dose (0.5 mg/kg) of midazolam (MDZ) on motor evoked potentials (MEPs) was examined in 12 monkeys. MEPs were elicited by transcranial magnetic stimulation (TMS) and the resultant potentials recorded from abductor pollicis brevis (APB) and anterior tibialis (AT) muscles contralateral to the stimulation site. After administration of MDZ, sequential MEP recordings were obtained at postinduction, hypnosis, awakening, emergence, and recovery periods. The results were compared with control values using one-way analysis of variance and Tukey's post-hoc test. Under hypnosis, MEP reproducibility was problematic as the potentials were occasionally ill identified and questionable. MDZ resulted in marked MEP scalp field reduction, coil demography alteration, stimulation threshold elevation, and amplitude suppression (p <0.01). Latency response was unaltered. During hypnosis, awakening, and recovery periods, the mean APB and AT thresholds were elevated by 39, 23, and 0% and by 60, 34, and 4% respectively; while APB and AT amplitudes were depressed by 95, 86, and 53% and by 99, 91, and 60%, respectively. We conclude that an induction dose of MDZ can produce profound and prolonged attenuation of TMS MEPs. The drug inhibitory effect on MEPs may persist after recovery. Anesthetic doses of MDZ should cautiously be used in the settings of MEP monitoring.
The effect of neuroleptanalgesia (droperiodol-fentanyl) on motor potentials evoked by transcranial magnetic stimulation in the monkey.
Motor evoked potentials (MEPs) after transcranial magnetic stimulation (TMS) have been examined in 12 monkeys under neuroleptanalgesia (NLA). Compound muscle action potentials were recorded from abductor policis brevis (APB) and gastroncnemius (GN) muscles contralateral to the stimulation site. After obtaining baseline tracings during emergence from methohexitone, 10 mg/kg i.m., NLA was induced using droperiodol, 0.3 mg/kg i.v. followed by fentanyl, 0.006 mg/kg i.v. Sequential MEP recordings were obtained 10 min after i.v. droperiodol, 2, 8, and 16 min after i.v. fentanyl, and during recovery. Replicable TMS MEPs were consistently recorded under NLA. However, droperidol and fentanyl caused significant stimulation threshold elevation, amplitude depression, and latency delay compared to control values (p <0.01). Ten minutes after droperiodol administration, the APB-GN threshold, amplitude, and latency values (mean +/- SD) were 0.81 +/- 0.2-0.84 +/- 0.1 T (baseline 0.57 +/- 0.1-0.59 +/- 0.1 T), 3.4 +/- 2.1-4.0 +/- 2.5 mV (baseline 8.0 +/- 3.7-9.0 +/- 3.7 mV), and 15.8 +/- 1.3-21.1 +/- 1.2 ms (baseline 14.9 +/- 1.2-20.1 +/- 1.3 ms), respectively. Addition of fentanyl resulted in further response deterioration. Two minutes after fentanyl injection, the APB-GN threshold, amplitude, and latency values were 0.88 +/- 0.18-0.95 %% 0.15 T, 2.1 +/- 1.7-2.0 +/- 2.1 mV, and 16.0 +/- 1.4-21.9 +/- 1.3 ms, respectively. Subsequent MEPs revealed gradual response improvement but, in contrast to baseline, remained markedly altered (p <0.05). During the recovery period (53 +/- 6 min), the APB-GN threshold, amplitude, and latency measurements were 0.66 +/- 0.1-0.77 +/- 0.2 T, 4.4 +/- 3.1-4.2 +/- 2.9 mV, 15.5 %% 1.4-20.9 +/- 1.7 ms, respectively. We conclude that, in a primate model, NLA maintains measurable TMS MEPs. Nevertheless, droperiodol and fentanyl produce significant and prolonged response alterations. Knowledge of these changes, while administering NLA drugs intraoperatively, is essential to interpretation of MEP data.