Biomedical subjects
Publications and source records attributed to M F Smith.
Radical nephrectomy has a morbidity and mortality similar to that of the more simple procedure. Local control of disease may be obtained safely even in those patients with gross venous extension and worthwhile survival may be obtained in this group of patients. Further study of this extended operation would appear desirable.
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Allograft reconstruction of the middle ear transformer mechanism is not difficult and affords a like-for-like replacement of missing parts. Allografts also afford a logical system of middle ear and external auditory canal reconstruction by providing a very similar biologic and anatomic replacement when autograft material is not available. The allograft fibrous tympanic membrane is most valuable in maintaining the accurate position of the malleus. An otologic allograft sterilized by ethylene oxide and freeze-dried is an attractive alternative to the use of chemically fixed grafts or prosthetic alloplasts. It has the inherently superior mechanical design of an allograft as well as minimum of donor tissue physiochemical alteration. Moreover, it is capable of more normal metabolc and mechanical function, a more normal histological structure, and a more normal gross anatomical appearance. In addition, it may be reliably remodeled and repaired.
A female infant with presumptive deletion of the 7p2 region and an unusual translocation between a part of the short arm of chromosome 1 and a deleted chromosome 7 is described. The patient showed congenital craniosynostosis of the coronal and metopic sutures; marked turricephaly; hypotelorism; deeply cleft palate; shallow orbits with prominent bulging eyes; a depressed nasal bridge; anteverted nostrils; short hands with broad thin fingers and elongated thumbs; a mild talipes calcaneovalgus deformity of the feet; a systolic murmur due to a small VSD; and psychomotor retardation. The child died of bronchopneumonia at 10 weeks of age. The parents are chromosomally normal.
Five studies were conducted in yearling heifers which were either puberal or prepuberal utilizing the Syncro-Mate-B (SMB) treatment (G. D. Searle & Co., Chicago, Ill.). In trial 1 the pregnancy rate in Brahman crossbred heifers after 21 days of breeding was 56% and 28% greater (P<.005) in the SMB treated groups than in the nontreated groups. Pregnancy rate in 3 4 Simmental heifers (trial 2) was increased 39% (P<.05) after 21 days of breeding. Hereford and crossbred heifers (trial 3) weighing less than 250 kg failed to respond to SMB treatment whereas heifers weighing greater then 250 kg had increased reproductive performance. Conversely the results obtained in trial 4 using Brahman crossbred heifers was not influenced by weight or SMB treatment. Crossbred Santa Gertrudis heifers (trial 5) weighing greater then 250 kg and treated with SMB had improved reproductive performance compared to the control groups. While in treated heifers weighing less than 250 kg reproductive performance was far from optimum.
A thorough awareness of the nutritional and metabolic status of the hospitalized patient is crucial for all persons directly involved in patient care. The catabolic nature of the body's response to illness or injury induces a serious drain on vital organs and tissues. Therefore, a complete assessment of the body's various compartments must be carefully taken, and any nutritional depletion must be quickly alleviated. Due to the alarming incidence of often undetected severe malnutrition in hospitalized patients, if becomes imperative that attention be paid to nutritional status, to decrease unnecessary morbidity and mortality.
All patients with a VIIth nerve paralysis with any limitation of closure of the eye should have in the office or out-patient clinic setting: 1. paper tarsorrhaphy of the upper or possibly lower lid; 2. artificial tears and/or ointment; and 3. glasses to protect the cornea from air currents. Kinetic and static surgical procedures are discussed. The kinetic procedures include facial nerve repair and grafting, VIIth-XIIth nerve anastamosis, muscle nerve block transplantation, transposition of nonparalyzed muscle and cross over. The principals of VIIth nerve repair and grafting and presented in the intracranial, internal auditory canal, labyrinthine, tympanomastoid and extratemporal sites. The static procedures include resection of redundant skin, fascia lata strip suspension, weakening of contralateral non-paralyzed musculature, and adjunctive procedures such as resection of ptotic melolabial fold, plication of parotid-masseteric fascia, dermal graft suspension, blepharoplasty, brow lift, canthoplasty, horizontal shortening of lower lid, fascial suspension of lower lip, McLaughlin tarsorrhaphy, and palpebral spring. Patient counseling is emphasized.
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Sexual adjustment is believed to be a fundamental aspect of the medical and psychosocial rehabilitation of the disabled and chronically ill. A sample of 26 occupational therapists involved in adult rehabilitation services were given a list of specific tasks identified in the literature to be related to medical (physical) aspects of sexual rehabilitation. The results indicated that a small percentage of occupational therapists participate in these tasks. The majority believed that the tasks were important in occupational therapy but that their preparation to perform the tasks was inadequate. The subjects, as a group, held positive attitudes toward sexual rehabilitation and considered it a legitimate aspect of health care for which an appropriate content should be integrated into the basic curricula in occupational therapy.
Seventeen patients undergoing 19 major urological operations for bladder cancer or rectal leiomyosarcoma (1 case) were studied after randomization for 3 hypocaloric dietary regimens, preoperative keto-adaptation by a carbohydrate-free, oral protein diet continued in the postoperative period by isotonic amino acid infusions, postoperative amino acid infusions only and 5 per cent dextrose infusions. In these normally nourished patients serum transferrin (plus 13 mg./dl. minus 30 mg./dl., minus 69 mg./dl., p less than 0.05 for the first and combined amino acid groups against the third group) and 2 other short half-life hepatic secretory proteins, prealbumin and retinol-binding protein, represented sensitive indexes of visceral protein and nutritional support, superior to nitrogen balance, anthropometric assays, delayed hypersensitivity skin test reactivity and serum albumin. Near isotonic amino acid infusions were more effective in preserving visceral protein status than 5 per cent dextrose but preoperative keto-adaptation was not shown to have any increased benefit over protein-sparing therapy given only after an operation.
Cholesteatoma of the EAC is a rare otologic problem, particularly when keratosis obturans otica is excluded. The predominant features of EAC cholesteatoma are acute external symptoms, severe pain, recurrent physician visits, and paucity of X-ray findings. Poorly responding otitis externa should always alert the physician to the possibility of neoplasm, diabetes, or some other underlying condition which will not respond to just topical treatment. Cholesteatoma of the external auditory canal should also be considered in refractory cases of otitis externa. Three patients with EAC subperiosteal cholesteatoma are reviewed.
The suboccipital craniectomy done with the patient in the prone position using modern microsurgical methods gives good anatomical exposure essential for efficient, accurate, total removal of cerebellopontine angle neoplasms and allows adjacent, uninvolved neurological structures to be spared. Modifying the anatomical exposure by varying the size and shape of the osseous craniectomy and placing the dural incision closer to the porus acousticus permits extradural retraction of the cerebellum. Thus large cerebellopontine angle neoplasms can be excised with less chance of damage to the cerebellum and smaller risk of hydrocephalus. The suboccipital craniectomy may be extended anteriorly to the facial nerve, thereby combining the suboccipital with the translabyrinthine approach, and providing a more direct angle to a large neoplasm involving the brain stem and cerebellum.
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The central theme of this communication is the recognition of an immunodiagnostic potential in a herpes virus antigen, the molecular interrelationship of which with cervical tumor cells is described. In addition to the productive infection caused by herpes simplex virus type 2 (HSV-2) we are confronted by latency and, as suggested by recent studies, by cancer. These different types of virus-host cell interactions are discussed at the host, as well as at the cellular level. A defined level of molecular interaction between host and viral gene products must exist if the virus is to co-exist with the host, as is the case in latency and carcinogenesis. The molecular interpretations posit the presence, in the squamous cervical tumor cells, of a product of the expression of the viral genome that has immunodiagnostic potential. The antigen designated AG-4 fulfills these predictions and appears to have immunodiagnostic potential. AG-4 is present in cervical tumor biopsies, but not in normal cervical tissue. It is a structural component of the HSV-2 virion that, in tissue cultures infected with HSV-2, is synthesized preferentially under conditions that prevent the normal replication of the virus. In view of its structural nature it is most probably virus-coded. AG-4 antibody identified in complement fixation assays with antigen prepared in tissue culture, disappears following successful tumor removal and reappears during cancer recurrence. This antibody also potentially identifies those patients with cervical atypia that are at high risk of neoplastic progression. The clinical benefits of the assay are evident.
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