Biomedical subjects
Publications and source records attributed to J W Ross.
A case of carotico-cavernous fistula following facial trauma is reported. Clinical details of the case are described together with a review of the literature. Aetiology and treatment of the condition are discussed. Carotico-cavernous fistula is a rare complication of facial trauma. The case reported is important because the complication presented as a late event some 9 weeks after the initial trauma.
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A panel of healthy volunteers was screened by bronchial histamine provocation. The response used was the flow rate achieved during a partial forced expiratory manoeuvre at a lung volume 30% of the vital capacity above the residual volume. Those subjects who were relatively sensitive to the bronchoconstrictor effects of inhaled histamine took part in a reproducibility study. Those with consistent responses took part in a further study in which the bronchodilator, and bronchoconstriction-protective, effects of orally administered chlorpheniramine, terfenadine and salbutamol were investigated. The technique was able to demonstrate the efficacy of these drugs in non-patient volunteers. Thus it seems to be a suitable method for the early evaluation, in man, of certain drugs with an anti-asthma therapeutic potential. It also provides useful information on the dose and duration of action of compounds prior to the first efficacy trials in patients.
The ethics of limited resuscitative efforts or partial code orders has been the subject of considerable disagreement. The customary objection to partial code orders is that they are ineffective in sustaining life and are intended to deceive the patient and/or patient's family into believing that resuscitation is possible when, in fact, the patient's death is imminent. This article suggests that the ethics and acceptability of partial code orders depend on their intent and that the motivation for partial code orders may differ substantially.
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This review of the evolution of evaluation criteria in the College of American Pathologists Survey and of theoretical grounds proposed for evaluation criteria explores the complex nature of the evaluation process. Survey professionals balance multiple variables to seek relevant and meaningful evaluations. These include the state of the art, the reliability of target values, the nature of available control materials, the perceived medical "nonusefulness" of the extremes of performance (good or poor), this extent of laboratory services provided, and the availability of scientific data and theory by which clinically relevant criteria of medical usefulness may be established. The evaluation process has consistently sought peer concensus, to stimulate improvement in state of the art, to increase medical usefulness, and to monitor the state of the art. Recent factors that are likely to promote change from peer group evaluation to fixed criteria evaluation are the high degree of proficiency in the state of the art for many analytes, accurate target values, increased knowledge of biologic variation, and the availability of statistical modeling techniques simulating biologic and diagnostic processes as well as analytic processes.
The types and performance characteristics of the present rules for acceptance and rejection of quantitative results by proficiency testing agencies are reviewed. The rates of false acceptance and rejection by peer group evaluation are high when compared with explicit medical usefulness criteria. Accuracy-based target values and fixed limits provide the technologic basis for process control of interlaboratory accuracy, and their efficacy contrasts with that of peer limits. However, uniform criteria for result accuracy are also required. A clinical statistical model predicting the effect of method error on clinical diagnostic accuracy is proposed. A criterion is proposed for result accuracy defined in terms of uniform clinical benefit. The criterion specifies a fixed error limit for each type of application of a medical test that is appropriate for the inherent variability of the test application. Recent College of American Pathologists Survey experience with clinical fixed limits for allowable analytic error calculated by the model is presented.
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General anaesthesia is desirable for a wide range of oral and maxillofacial operations and nasal intubation is essential for some procedures, particularly orthognathic surgery. The patient who has undergone pharyngoplasty presents with a reduced velopharyngeal orifice which may interfere with the insertion of the nasal tube. It is suggested that nasal pharyngoscopy or a similar investigation should be included as part of the preoperative assessment for these patients if nasotracheal intubation is anticipated.
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Synthetic PAF-acether injected intraperitoneally (i.p.) into sham-sensitized rats, caused dose-dependent extravasation of plasma proteins into the peritoneal fluids. Platelet aggregating activity was detected in the peritoneal fluids. In rats that had been passively sensitized for a non-histamine mediated immediate hypersensitivity reaction, antigen challenge caused extravasation of plasma proteins into the peritoneal fluids. No platelet aggregating activity was detected in these fluids. PAF is unlikely to be the mediator of extravasation in the non-histamine mediated immediate hypersensitivity reaction in the rat.
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This paper describes a complication of herpes zoster infection of the orofacial region involving a 15-year-old girl who, following herpes zoster of the right mandibular division of the trigeminal nerve at the age of 7 years, suffered abnormal development of the permanent teeth in this quadrant.
An annual seminar for school personnel of elementary school-aged pediatric center patient is described. Facilitating understanding of the educational and social needs of such patients, providing updated information about childhood malignancy and addressing the concerns of teachers, nurses and others is warranted because of the many patients who will be cured and who must be prepared to enter adulthood.