Biomedical subjects
Publications and source records attributed to R A Strauss.
Orthognathic surgery is a rapidly growing biotechnologic interaction involving alterations of facial form and dental occlusion. This article describes some of the important and complex psychological, sociological, ethical, and public policy issues involved. Advances in the latter issues are necessary for advancement of the field.
A possible association between mucocutaneous lichen planus and chronic liver disease has been previously postulated in the medical literature. Despite the frequency with which lichen planus occurs in the oral cavity, little mention of such a relationship has been made in the dental literature. A case of lichen planus occurring in a patient with primary biliary cirrhosis and a review of the subject are therefore presented.
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Hyperbaric oxygen (HBO) therapy is an established technology that is proving to be effective in the treatment of osteoradionecrosis. However, the studies that have shown this treatment modality to be effective have not established the optimum pressures, times of exposure, and frequency and number of treatment necessary for healing. In addition, most of the studies used HBO as an adjunctive treatment in the management of refractory osteoradionecrosis. The efficacy of HBO as a primary treatment modality has not as yet been established. Strictly controlled clinical trials are necessary for identification of patients who are likely to respond to HBO without aggressive surgery, to delineate a timetable for treatment of patients with HBO, and to coordinate surgery with HBO to resolve osteoradionecrosis when a significant amount of bone loss is involved.
Spuriously elevated automated platelet counts secondary to in vivo bacteremia have not been reported previously. Two patients are described with blood cultures positive for Escherichia coli and Klebsiella pneumoniae, respectively, and bacteria present on peripheral blood smear. Those bacteria caused falsely elevated platelet counts to be generated by the Ortho ELT-8. These cases illustrate an unusual artifact and demonstrate that spurious counts can be generated by laser optical blood cell counters.
Early and effective cytoreduction for high peripheral white blood cell counts in pediatric patients with acute leukemia may be helpful in preventing complications secondary to hyperviscosity. It also may be a useful adjunct to systemic chemotherapy. As an alternative to automated apheresis for this purpose, manual exchange transfusion is efficacious and does not require hemapheresis instrumentation and disposables and the related special staff. Two patients, a neonate with acute myeloblastic leukemia and a white blood cell count of 422.2 k/microliter as well as a 2 1/2-year-old with an admission diagnosis of acute promyelocytic leukemia and a white blood cell count of 617.4 k/microliter, underwent manual exchange hemotherapy for acute cytoreduction. The procedures were tolerated well, and significant leukocyte removal was achieved, with the respective leukocyte reductions being 81.1 and 68.7%. The techniques available for pediatric cytoreduction are compared, with emphasis on their efficiency and safety and appropriateness for very small children.
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A 42-year-old leukaemic black male developed shortness of breath, itching, hot flushes, substernal pain, marked hypotension, and cardiorespiratory arrest after the infusion of 50 ml of pooled platelet concentrates. The patient had had one previous and uneventful red blood cell transfusion. Serologic studies of this patient's post-transfusion serum showed the presence of an antibody against one denatured IgA2 protein with the phenotype A2m(1 + 2-). All of the platelet donors were A2m(1) positive. The patient was successfully transfused with platelets from donors with the phenotype A2m(1 - 2+). Although 35.8% of Blacks and 30.0% of Chinese are A2m(1) negative, this is the first reported transfusion reaction associated solely with the occurrence of a possible anti-A2m(1) in an individual of the type A2m(1 - 2+).
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Cost comparison of two comparably effective techniques of plateletpheresis, a manual method and an automated discontinuous flow centrifugation technique, is presented using a hypothetical model. The former procedure costs $62.48 per pheresis for disposables and labour as opposed to $78.32 per pheresis for disposables and labour for the latter. The annual volume of plateletpheresis at which the accumulated costs equal the total charges, i.e. the 'break-even' point, is calculated and found to be 63.7 for the automated technique and 10.9 for the manual method, if the charge for each is $200.00. For the manual method at a current charge of $80.00, the break even point is 85.8. The assumptions underlying this hypothetical model are examined, and the effects of deviation from these assumptions are analyzed in terms of the break even point. Cost accounting of plateletpheresis is shown to be dependent upon the choice of approach to allocation of costs, the assumptions of the cost accounting model, and the selection of an appropriate charge.
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Scribner shunts were placed in nine patients, who had clinical and laboratory evidence of Reye's syndrome and ranged in age from four to fifteen years, to facilitate repeated, rapid exchanges of large volumes of blood. A method of inserting the Scribner shunt is described. Over a period of 30 to 90 minutes, 3 to 8 units of blood were easily exchanged without hemodynamic or mechanical difficulties. There were no infections; all shunts were removed from survivors after four to eight days without permanent sequelae.
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An unusual case of metastasis to two lymph nodes from an adenocarcinoma arising in an adenomatous polyp of the sigmoid colon is presented. Invasion of the stalk could not be detected, but penetration of the muscularis mucosae was observed. Immunoperoxidase staining was used to detect an antigen in the invasive and metastatic components of the tumor that reacted with an antiserum to a tumor associated antigen. A focus of intraepithelial carcinoma was also detected by this method. The relevance of these findings to the adenoma-carcinoma sequence is discussed.
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