Biomedical subjects
Publications and source records attributed to L Mandel.
A diagnosis of the deep plunging ranula usually is based upon the history and clinical examination of the patient. The case presented here highlights the role of the CT scan in facilitating a definitive diagnosis. Visualization of the anatomic relations of the accumulated secretion, as it dissects its way through the cervical tissue planes, also is made possible.
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The aim of this study was to investigate spontaneous immunoglobulin production and a pattern of isotype switching by thymic B lymphocytes (TBL) as compared with cells isolated from spleen during early ontogeny using a pig model in which B-cell development is not influenced by maternal regulatory factors. A sensitive ELISPOT assay was therefore employed to detect immunoglobulins in pig fetuses, colostrum-deprived germ-free (GF) piglets as well as conventionally (CONV) reared pigs. The first spontaneously immunoglobulin-secreting cells in the thymus were detected in 67-day-old fetuses (the length of gestation period in pigs is 114 days), their number increasing during fetal ontogeny. In contrast to fetal splenic cells, which secrete exclusively IgM, fetal thymic immunoglobulin-secreting cells were determined to undergo spontaneous isotype switching to IgG and IgA. In 28-day-old GF piglets and 3-month-old CONV pigs the number of thymic immunoglobulin-secreting cells of all isotypes was comparable to the number of thymic immunoglobulin-secreting cells detected in the newborn thymus. Considerable augmentation of IgG and IgA production by splenic immunoglobulin-secreting cells in CONV pigs was observed as compared to GF newborns and GF piglets, in which IgG- and IgA-secreting cells were detected occasionally. Our results indicate that TBL represent the first B-cell population in early fetal ontogeny spontaneously undergoing isotype switching to IgG and IgA; in the postnatal period the TBL population does not appear to be influenced by external antigenic stimuli of conventional microflora.
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Because of its anatomical location, the submasseteric abscess mimics a parotitis. This is particularly true when the usual dental source of the infection is not present. A thorough medical history and clinical examination as well as computed tomography are important tools in the differential diagnosis.
The etiology, pathogenesis and surgical management of intraoral and deep plunging ranulas are summarized. The term "ranula" is defined, and its derivation traced to the oral anatomy of the frog.
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Mucosal surfaces covered by a layer of epithelial cells represent the largest and most critical interface between the organism and its environment. The barrier function of mucosal surfaces is performed by the epithelial layer and immune cells present in the mucosal compartment. As recently found, epithelial cells, apart from their participation in absorptive, digestive and secretory processes perform more than a passive barrier function and are directly involved in immune processes. Besides the well known role of epithelial cells in the transfer of polymeric immunoglobulins produced by lamina propria B lymphocytes to the luminal content of mucosals (secretory Igs), these cells were found to perform various other immunological functions, to interact with other cells of the immune system and to induce an efficient inflammatory response to microbial invasion: enzymic processing of dietary antigens, expression of class I and II MHC antigens, presentation of antigens to lymphocytes, expression of adhesive molecules mediating interaction with intraepithelial lymphocytes and components of extracellular matrix, production of cytokines and probable participation in extrathymic T cell development of intraepithelial lymphocytes. All these functions were suggested to influence substantially the mucosal immune system and its response. Under immunopathological conditions, e.g. during infections and inflammatory bowel and celiac diseases, both epithelial cells and intraepithelial lymphocytes participate substantially in inflammatory reactions. Moreover, enterocytes could become a target of mucosal immune factors. Mucosal immunosurveillance function is of crucial importance in various pathological conditions but especially in the case of the most frequent malignity occurring in the intestinal compartment, i.e. colorectal carcinoma. Proper understanding of the differentiation processes and functions of epithelial cells in interaction with other components of the mucosal immune system is therefore highly desirable.
STUDY OBJECTIVE: To determine the effect of infant/child CPR training on CPR knowledge, self-efficacy, and anticipated anxiety among parents of healthy infants/children. PARTICIPANTS: Parents (n = 36) undergoing a 4-hour training program in infant/child CPR at a tertiary-care hospital located in a suburb of a large metropolitan region and a control group of parents (n = 47) without CPR training were enrolled in the study. DESIGN: Two parallel forms developed specifically to assess the impact of infant/child CPR training on CPR knowledge, self-efficacy, and anticipated anxiety were independently evaluated for their psychometric characteristics before being administered to the parents with and without CPR training. The CPR-trained parents were requested to complete one form immediately before and the other 1 month after CPR training, and the control group completed the two forms over a 1-month interval. Estimates of the likelihood of infant/child CPR situations were also rated by the parents at the same times. Demographic data were obtained during administration of the second form. RESULTS: Self-efficacy had increased significantly and anticipated anxiety about CPR had decreased significantly 1 month after CPR training among CPR-trained parents, compared with controls. We found no significant changes in the CPR-trained parents' CPR knowledge or estimates of the likelihood of experiencing CPR situations over the 1-month interval on comparison with data from the controls. CONCLUSION: Community-based infant/child CPR training programs affect parents on a variety of levels but may not effect changes in CPR knowledge.
STUDY OBJECTIVE: To increase the rate of bystander CPR in a community by use of a free, mailed, 10-minute videotape of CPR instruction. DESIGN: Prospective, randomized intervention trial. One half of the households (8,659) received the free videotape (video-tape group) and were considered the intervention group, and one half (8,659) served as the control (no-videotape group). All households were followed from December 1991 to March 1993 to determine whether a cardiac arrest occurred and who initiated CPR. A telephone interview obtained additional information about circumstances of the arrest and whether members of the household viewed the videotape. SETTING: City of Everett and South Snohomish County, Washington. A commercial mailing list was used to identify 17,318 households with a head of the household who was more than 50 years old. PARTICIPANTS: A case was defined as a cardiac arrest in which CPR was initiated or continued by emergency medical services personnel. Only cardiac arrests due to presumed underlying heart disease were included. Arrests occurring after arrival of emergency medical services personnel were not included. INTERVENTIONS: The intervention was a free 10-minute videotape with CPR instructions mailed to the 8,659 intervention households. Paramedic run reports were reviewed and interviews were conducted with cardiac arrest bystanders to determine who initiated CPR and whether they had received and viewed the videotape. RESULTS: Sixty-five cardiac arrests occurred in the study households: 31 in households that received the videotape and 34 in households that did not review the videotape. The overall rate of bystander CPR was 47% in the videotape group and 53% in the no-videotape group (P = NS). In nine cardiac arrests, an individual was present who had watched the videotape; six of these nine cases (66%) had bystander CPR. CONCLUSION: Mass mailings of CPR instructional videos are likely to be ineffective in increasing the rate of bystander CPR in a community.
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It is not unusual for patients who are pregnant or have a hiatal hernia to develop gatroesophageal reflux with the resultant symptoms of heartburn. This article reviews the role reflux plays in causing episodes of increased salivation. Stimulation of the esophagus by gastric acids excites and esophagosalivary reflex. A marked increase in salivary flow ensues, neutralizing the acid content of the esophagus. The dental practitioner is in a strategic position to be consulted about or recognize the existence of the esophagosalivary reflex and the consequent bouts of sialorrhea. Recognition mandates medical consultation.