Open or closed tympanomastoidectomy for cholesteatoma in children.
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Biomedical subjects
Publications and source records attributed to M Abramson.
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Keratin debris is a constant feature in middle-ear cholesteatoma. Keratin prepared from rat skin induced a foreign-body granuloma in the subcutaneous space in the rat. In vitro this granuloma produced high levels of bone-resorbing factors: prostaglandin E2, osteoclast-activating factor, and leucine aminopeptidase. In the in vivo study, keratin-induced granuloma in the rat middle ear caused partial resorption of the cochlear wall. Macrophages, fibroblasts, and osteoclastlike cells were found at bone-resorption areas. These cells appeared to be responsible for bone resorption through production of prostaglandin E2, osteoclast-activating factor, and proteases.
Since collagen comprises over 90% of bone protein, collagenase appears to be a major factor in the resorption process of the organic matrix of bone. We have studied the mechanism of production of collagenase in cell cultures of rat skin fibroblasts and macrophages under various conditions. Production of collagenase by fibroblasts increased significantly with the addition of the conditioned medium obtained from the culture of endotoxin-activated rat peritoneal macrophages. This study concludes that the endotoxin-activated macrophages produced factor or factors which stimulate fibroblasts to produce collagenase.
We report 2 cases of hypertension associated with unilateral hydronephrosis. Lateralization of renal vein renins and exaggerated hyperreninemia following captopril suggested renin-mediated hypertension in 1 case, which responded well to nephrectomy.
Collagenase was identified within naturally occurring rat chronic otitis media by the use of an immunohistochemical technique with peroxidase-antiperoxidase to stain the paraffin. Collagenase was found in fibroblasts, mononuclear cells, and osteoclast cells in the bone-resorbing area. Collagenase was found only in fibroblasts in contact with epithelial basal cells. Macrophages from rat peritoneum were cultured with different concentrations of a lipopolysaccharide. The prostaglandin E2 level reached a maximum during the 12- to 24-hour period in the presence of endotoxin. This prostaglandin E2 was confirmed by immunofluorescent staining. The endotoxin-activated macrophage produced an insignificant amount of collagenase. These findings suggest that activated macrophages may be able to stimulate fibroblast collagenase production through the chemical mediator prostaglandin E2. Also, the interaction between fibroblasts and epidermal cells appears to encourage and enhance the biochemical events resulting in bone resorption in chronic otitis media.
This paper analyzes the meaning of collective responsibility in interdisciplinary collaboration in health care from a social work perspective. Three questions about collective decision making are considered: (1) How ought moral agency and responsibility be allocated in collective decision making? (2) How does each member of a collective decision making group exert his/her own moral agency and what is the extent of the responsibility to do so when one disagrees with the group's decision? (3) In the face of conflicting obligations, to whom is moral responsibility primarily due? Preliminary guidelines for enhancing collective responsibility in teams are suggested.
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Chronic otitis media can be successfully managed by purposeful and aggressive medical therapy. Frequent and meticulous debridement, topical treatment, and adjunctive systemic antibiotics should be used. Medical treatment is appropriate either as a curative measure, or for preoperative preparation of the ear.
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While the effects of benzodiazepines on punished responding (response-dependent shock) are straightforward and unambiguous, their effects on behavior suppressed by response-independent shock are conflicting and inconsistent. Some investigators reported that benzodiazepines either have no effect on, or suppress further, responding during response-independent shock, while others reported that benzodiazepines enhance response rates during independent shock delivery in the same manner as during dependent shock. The present study compared the effects of diazepam on rates of lever pressing maintained by a variable-interval 35-sec schedule of food delivery in rats exposed alternately to fixed-interval 180 sec (response-dependent) and fixed-time 180 sec (response-independent) schedules of shock delivery. Diazepam increased punished responding in a dose-dependent manner for each animal. "Rate-dependency," degree of suppression and presence of external stimuli influenced rate-enhancement by the drug. Effects of diazepam on responding suppressed by response-independent shock were inconsistent, with two animals revealing rate enhancement comparable to punished responding, and two others revealing further increases in response suppression. Reasons for the differential effects of diazepam on response-rates suppressed by the two forms of shock delivery remain obscure, although the basic phenomenon seems to be real and not merely an artifact of "rate-dependency."
Two cases of hypertension following renal trauma are reported. In both cases, blood pressure was controlled with captopril, an angiotensin converting enzyme inhibitor. Mechanisms of hypertension following renal trauma are reviewed and the place of medical or surgical management discussed.
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This paper presents a model for identifying, clarifying and analyzing the ethical dilemmas inherent in the discharge planning process of the chronically impaired older person from an acute care hospital to the community or an institution. From the myriad of moral quandaries that patients, families and service providers face in the process, this paper will address two categories of questions. The first concerns the conflict between provider paternalism and client autonomy. The second question involves distributive justice and the allocation of scarce resources. Two cases at different stages of the identification, assessment and disposition process will be examined in order to identify the morally relevant facts and persons, possible alternatives and competing values and ethical principles.
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Adult male guinea pigs were anesthetized, catheterized and i.v. infused with either saline and then ouabain or with linoleic acid salt and then ouabain. The linoleic acid pretreatment produced a significant delay until the onset of digitalis induced cardiac arrhythmias.
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