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Biomedical subjects

J Salomon

Publications and source records attributed to J Salomon.

At least 37 records · Page 2Linked to original sources

Bilateral simultaneous groin flaps in the salvage of a pediatric blast-injured hand.

The groin flap was first described by McGregor and Jackson in 1972. Since then it has been applied to a wide variety of reconstructive problems. The flap is amenable to both staged and free tissue transfer and can provide cutaneous or composite tissues. However, use of this flap in the pediatric population has been limited. We herein describe the first known case of simultaneous bilateral staged groin flaps for salvage of a blast-injured hand in a child.

Blast Injuries↗

A third recognition element in bacterial promoters: DNA binding by the alpha subunit of RNA polymerase.

A DNA sequence rich in (A+T), located upstream of the -10, -35 region of the Escherichia coli ribosomal RNA promoter rrnB P1 and called the UP element, stimulates transcription by a factor of 30 in vivo, as well as in vitro in the absence of protein factors other than RNA polymerase (RNAP). When fused to other promoters, such as lacUV5, the UP element also stimulates transcription, indicating that it is a separate promoter module. Mutations in the carboxyl-terminal region of the alpha subunit of RNAP prevent stimulation of these promoters by the UP element although the mutant enzymes are effective in transcribing the "core" promoters (those lacking the UP element). Protection of UP element DNA by the mutant RNAPs is severely reduced in footprinting experiments, suggesting that the selective decrease in transcription might result from defective interactions between alpha and the UP element. Purified alpha binds specifically to the UP element, confirming that alpha acts directly in promoter recognition. Transcription of three other promoters was also reduced by the COOH-terminal alpha mutations. These results suggest that UP elements comprise a third promoter recognition region (in addition to the -10, -35 recognition hexamers, which interact with the sigma subunit) and may account for the presence of (A+T)-rich DNA upstream of many prokaryotic promoters. Since the same alpha mutations also block activation by some transcription factors, mechanisms of promoter stimulation by upstream DNA elements and positive control by certain transcription factors may be related.

Base Sequence↗

Predictors of perioperative morbidity and mortality in repeat valve replacement: a seven-year experience.

Forty-nine consecutive repeat cardiac valve replacements in 46 patients were reviewed to define in-hospital morbidity, mortality, and determinants of risk. The overall operative mortality rate was 10.2%; it was 9% for the first reoperation and 25% for the second (four patients). The mortality rate was 12% at the mitral position (25 patients), 11% at the aortic position (18 patients), and 0% for repeat double valve replacement (four patients). Univariate and multivariate stepwise logistic regression models show that age over 70 years and the use of an intraaortic balloon pump preoperatively predict operative mortality, and age over 70, preoperative care in the coronary care unit, endocarditis, and the presence of an intraaortic balloon pump are determinants of perioperative morbidity in patients undergoing repeat valve replacement. Based on these data, close follow-up of patients with initial valve replacement is encouraged so that reoperation to correct prosthetic malfunction or periprosthetic leak can be done before hemodynamic collapse occurs. Furthermore, since age was the most significant factor affecting mortality (P < .01) and since most of the deaths (80%) in this study occurred in patients with torn bioprosthetic leaflets, the use of bioprostheses for initial valve replacement in patients under 70 years of age is discouraged.

Adult↗

Liquid crystal temperature monitoring for microsurgery.

Postoperative monitoring of free tissue transfers remains a problem for the microsurgeon. Liquid crystal temperature probes (LCT) are used by anesthesiologists to monitor patient core temperature and to indicate changes in temperature trends as an indicator of pending malignant hyperthermia. By placing an LCT monitor on the flap and adjacent tissue at the completion of surgery, temperature differentials can be reliably monitored. If the temperature differential exceeds 2 degrees C, the flap is re-explored. The LCT readout resembles a standard thermometer and can easily be recorded by even inexperienced personnel. LCTs are a convenient, inexpensive, and easy method to monitor both free muscle and free fasciocutaneous flaps.

Body Temperature↗

Apolipoprotein B messenger RNA editing is developmentally regulated and widely expressed in human tissues.

Apolipoprotein B (apoB) messenger RNA (mRNA) undergoes posttranscriptional (C to U) editing, producing tissue-specific forms of apoB from the unedited (apoB100) and edited (apoB48) transcripts. ApoB mRNA editing is developmentally regulated in human fetal small intestine, producing parallel changes in the synthesis and secretion of apoB100 and apoB48. Neither fetal nor adult liver contained detectable levels (less than 1%) of edited apoB mRNA. By contrast, apoB mRNA is incrementally edited during development in several extraintestinal fetal tissues. These tissues demonstrated significant differences, however, in both the extent and developmental profile of apoB mRNA editing. Additionally, while apoB100 synthesis and secretion was demonstrated in these tissues, apoB48 synthesis was confined to the small intestine. Thus, although the molecular mechanism underlying this process remains unclear, the capacity to edit apoB mRNA is widely distributed among both fetal and adult tissues. We speculate that the asynchronous and developmentally modulated induction of apoB mRNA editing may provide a novel mechanism for regulating lipoprotein biogenesis in both the developing fetus and adult human.

Adult↗

[Aortic dissecting aneurysm during pregnancy].

Aortic dissecting aneurysm is a rare, serious complication of pregnancy. This condition was diagnosed in a 34-year-old woman in the 38th week of pregnancy. Cesarean section was immediately performed, and was followed by surgical repair of the dissection. A normal male infant was delivered.

Adult↗

Dissecting aortic aneurysm in pregnant women without Marfan disease.

Dissection of the young women without Marfan disease is related, in most instances, to pregnancy. The structural changes in the arterial wall that occur during pregnancy may predispose women to this complication of pregnancy. In this study, two young women, who had none of the characteristics of Marfan's syndrome, were operated upon for dissection of the ascending aorta. The first patient was in the 35th week of gestation and a cesarean section was performed prior to replacement of the ascending aorta. In the second patient, diagnosis of dissection and severe aortic regurgitation occurred in the postpartum period. Knowledge of this albeit relatively rare complication of pregnancy may assist the clinician in diagnosing and referring patients early for surgical treatment that, in most instances, may save the lives of both mother and fetus.

Acute Disease↗

Sudden cardiac death from acute fluoride intoxication: the role of potassium.

The mechanism of sudden cardiac death following acute fluoride intoxication has been thought to result from profound hypocalcemia produced by the precipitation of calcium fluoride salts. In studies of a canine model, the onset of lethal ventricular arrhythmias was temporally more associated with an elevation of serum potassium than with a drop in serum calcium. Fluoride-induced hyperkalemia could not be prevented with glucose, insulin, or bicarbonate. In the erythrocytes, a five-minute exposure to 10 mM NaF caused a 50% increase in extracellular potassium concentrations after 12 hours compared to control erythrocyte suspensions (P less than .001). The total potassium efflux after 12 hours of incubation was linearly related to the log of fluoride contact time (r, 0.886; P less than .001). The treatment of fluoride-induced hyperkalemia may depend on removal of fluoride and potassium.

Animals↗

Echocardiogram of pulmonary embolism in evolution.

Echocardiography during active pulmonary embolism can reveal the embolic mass in transit through the chambers of the right side of the heart. The pattern produced is that of multiple masses of varying sizes, shapes, and densities moving from the right atrium to the right ventricle. It was not present on repeated echocardiogram performed several weeks later, after anticoagulation treatment. Proper recognition of this pattern can lead to prompt medical treatment with anticoagulants, which, in this case, led to a quite satisfactory clinical outcome.

Echocardiography↗

Constrictive pericarditis after myocardial infarction. Sequela of anticoagulant-induced hemopericardium.

Hemopericardium developed following adequate (and not excessive) anticoagulation in a patient with acute transmural anterior myocardial infarction and an early pericardial friction rub. Drainage of a bloody effusion by pericardiocentesis did not prevent progression to constrictive pericarditis within one year. The clinical features of this case and of the only two other similar occurrences reported in the medical literature are described and lead to a discussion of therapeutic and preventive measures.

Anticoagulants↗

The manipulation of potassium efflux during fluoride intoxication: implications for therapy.

Based on findings in 2 fluoride-toxic patients, it was suspected that hyperkalemia played a clinically important role in the etiology of sudden death from fluoride poisoning. Using fluoridated human erythrocytes as an in vitro model, it was confirmed that fluoride produced a marked potassium efflux from intact cells. Further, neither glucose and insulin in pharmacologic doses, nor various buffers could halt the efflux by shifting the potassium intracellularly. If these results can be extrapolated to the clinical situation, removal of potassium and fluoride via exchange resins or dialysis remains the only reasonable approach to this life threatening problem. Aside from sudden hyperkalemia and hypocalcemia, no serologic marker for fluoride toxicity has been identified. A high degree of clinical suspicion is therefore essential to the diagnosis.

Calcium↗

Nuclear left ventriculography at rest and during atrial pacing in the evaluation of coronary artery disease.

This study was undertaken to examine the value of rapid atrial pacing (RAP) combined with left-ventricular nuclear (LVN) angiography in the diagnosis of ischemic heart disease. It included 32 patients: 12 normal subjects and 20 with clinical coronary artery disease (CAD) and greater than 50% narrowing of a coronary artery (significant CAD). The ECG and an LVN angiogram (LVNA) were recorded at rest and during graded RAP. In the normal subjects, left-ventricular wall motion was normal at rest and during atrial pacing, but a wall motion abnormality (WMA) appeared in one subject. Left-ventricular ejection fraction (EF) did not change significantly. In the 20 patients with significant CAD, the diagnostic sensitivity of the ECG during RAP was 100% and 90% for the nuclear angiogram (presence or appearance of WMA at rest and during RAP). The mean EF in this group decreased from 0.38 to 0.31. WMA on the LVNA was present in 79% of patients with significant left-anterior descending, in 44% of those with right, and in 33% of those with circumflex coronary artery disease. WMA (at rest or on pacing) occurred in 17% of patients with 50 to 89% narrowing of an artery, in 50% with 90 to 99% narrowing and in 68% with total obstructions. The LVNA (rest and/or RAP) identified patients with significant single-vessel disease, but underestimated the extent of double-and triple-vessel disease. The LVNA at rest and during atrial pacing was an excellent method of evaluating significant coronary artery disease.

Adult↗