Biomedical subjects
Publications and source records attributed to L J Dunn.
A 64-year-old man with a suspicious asymptomatic coin lesion received a thoracotomy that showed two foci of isolated nodular pulmonary amyloidosis. Ultrastructural analysis verified the amyloid nature of the lesion and suggested that the fibrils were produced by plasma cells and processed by macrophages. The pathogenesis of this lesion is discussed in light of recent studies.
A total of 1,996 direct fetal heart rate (FHR) tracings in labor were analyzed using the first and last 30 minutes of monitoring in order to evaluate individual FHR characteristics as to their ability to predict the fetal status. Comparisons were made between individual FHR characteristics occurring alone ("uncomplicated") and those occurring in association with others ("complicated") in predicting fetal status as judged by 1 and 5 minute Apgar scores. These comparisons were made separately for the first 30 minutes and the last 30 minutes of monitoring.
The first 30 minutes and the last 30 minutes of 1,996 intrapartum FHR tracings were analyzed for baseline FHR, variability (amplitude and frequency of oscillations), accelerations, and decelerations. A modified FHR scoring system incorporating these FHR features was employed. According to the association between various FHR scores and the incidence of low Apgar scores, FHR patterns were grouped into three basic categories with distinct prognostic significance: (1) normal FHR patterns, (2) compensated distress patterns, and (3) decompensated distress patterns. It is concluded that the prognostic significance of FHR tracings is increased by incorporating several FHR monitoring criteria in the analysis.
Detection and treatment of cervical carcinoma in the preinvasive stage have increased substantially as a result of the widespread cytologic screening made possible by development of the Papanicolaou test. The numerical system of reporting has been abandoned, and reports are now descriptive and more specific than formerly. Outpatient evaluation of the patient with abnormal cytologic findings has been improved by the use of colposcopy and directed biopsies. Cold cone biopsy is used less frequently than in the past but still has specific indications. Therapy depends on histologic diagnosis and cannot be based on cytologic or colposcopic findings alone.
In considering which of several models to adopt with regard to the treatment of terminally ill patients, hospitals should consider their specific needs, the needs of their staffs, and the laws of their state. The involvement of the patient's family should not include an unwarranted creation or imposition of legal rights that do not exist, and the model that is adopted must be workable and followed.
Medical staff review committees and their records can play a major role in a hospital's defense against malpractice actions. Members of such committees are liable to varying degrees to actions for conspiracy, tortious interference with a business relationship, defamation and malpractice. Various defenses and statutory immunity in many states provide ample protection where the participant is acting reasonably and in good faith.
A new and easy technique for handling and applying a split-thickness skin graft to the vulva is described. The use of petrolatum gauze backing and application with the skin stapler, as well as postoperative management, are discussed.
Although electron microscopy has been of limited value in detecting malignant neoplasms, some neoplasms do exhibit characteristic ultrastructural features. Intensive study of these features may offer insight into the etiology and activity of such tumors. In an attempt to characterize the ultrastructure of endometrial adenocarcinoma, tissue was examined with the electron microscope and compared with normal postmenopausal endometrium. Endometria from biopsy, hysterectomy, or curettage were processed routinely for light and electron microscopy. Several ultrastructural features of the adenocarcinoma were common both to previous descriptions of endometrium of the postovulatory phase and to the normal postmenopausal endometrium, described here, viz, atypical mitochondrial forms and cell surface modifications. Ribosomes were abundant in adenocarcinoma of the endometrium, normal postmenopausal endometrium, and normal cyclic endometrium in the preovulatory phase.
Application of the silastic ring to the Fallopian tubes through the laparoscope seems to be a simple, safe and acceptable method of tubal sterilization. The technique and results in 337 patients are described. In the majority of cases, the procedure was effected in the outpatient department under local anaesthesia. Transsection of the tube (with or without bleeding), tearing of the mesosalpinx, and avulsion of the tube at the uterotubal junction were the most common complications; with experience and adherence to the proper technique of ring application, the above can be minimized. The pregnancy rate following this procedure seems to be acceptable, but long-term follow-up is necessary for definitive conclusions.
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Recent statutes and judicial decisions rendering the records and documents of quality assurance committees not subject to discovery and/or inadmissible in evidence are tactically ill advised, probably unconstitutional, and clearly self-defeating. A better alternative would be to allow access to the documents and information to all parties with a legitimate interest and to grant physicians immunity from tort liability for actions performed in good faith during the peer review process.
When fetal brain weight (BrW) is expressed as a modified exponential function of total body weight (BW), there is close agreement (p = 0.9841) between measured and calculated values (Sy = 6.16 g). Fetal BrW in utero can be determined from the neurocranial cross-sectional area (CSA) of the fronto-parieto-occipital plane. The standard error of the estimate is Sy = 8.03 g. The estimation of BW from the abdominal circumference and BrW from the CSA is the basis of two indexes which reflect the BrW:BW relationship. By definition, the brain size index (BSI) is 100 in the normally growing fetus. In a given case, a value greater than 100 denotes the amount by which measured BrW exceeds the BrW which is appropriately for a normal fetus of the same BW. The somatic retardation index (SRI) expresses as a percentage the amount by which total fetal weight lags behind normal ponderal growth in cases of IUGR. The indexes provide quantitative data on relative brain and body weights and serve as a ratio scale of the severity of the pathology in IUGR.
Detrusor muscle dysfunction is a common reason for lower urinary tract symptomatology in women. This report summarizes observations in 35 patients diagnosed as having detrusor dysfunction. Similar involuntary detrusor contractions were observed in 25 incontinent patients and in five patients who were not incontinent but who had urgency and frequency of urination. The incontinent patients were separated into the "urge incontinence" group and the "detrusor dyssynergia" group, based on whether or not the detrusor contraction was preceded by a strong sensation of urge. The patients who were not incontinent were grouped as "urgency frequency syndrome." No patient had urinary tract infection, neurological, urologic, or metabolic disease. Thirty patients responded satisfactorily to similar management consisting of bladder drills and anticholinergic drug therapy. Decreased cortical inhibitory activity seems to be a common pathophysiologic mechanism.
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A case is reported in which transbronchial lung biopsy using the fiberoptic bronchoscope was complicated by massive, fatal hemorrhage. This previously unreported complication occurred despite normal prothrombin and partial thromboplastin times and platelets of 93,000. Pathological examination revealed that a very small (0.5-mm) vessel was the source of the bleeding. Although severe complications are undoubtedly rare, this report suggests that the transbronchial lung biopsy is not a totally benign procedure. Suggestions are made to prevent future similar occurrences in very ill patients or in patients with coagulative abnormalities or blood dyscrasias.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.