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Biomedical subjects

R C Bone

Publications and source records attributed to R C Bone.

At least 235 records · Page 13Linked to original sources
PubMed1977

The case for elective prophylactic neck dissection.

The possibility of improving the cure rate of cancer of the head and neck by radical neck dissection of the clinically negative neck (elective neck dissection) continues to pose a therapeutic dilemma. This paper seeks to review the available information, analyze relevant aspects of the issue and attempt to draw conclusions which will be helpful both to physicians and their patients. The discussion is confined to squamous carcinoma of the larynx, pharynx, and oral cavity.

Carcinoma, Squamous Cell↗
PubMed1977

Mandibular trauma: secondary problems in reconstruction.

Cosmetic and functional restoration of the fractured mandible in the great majority of cases is the sine qua non of therapeutic success. Not only must an acceptable low complication rate be obtained, but when present, their complex nature must be understood from the onset. Successful treatment of complications is a multifaceted problem requiring planned, interdisciplinary, often times staged reconstruction. The radiologist and dental prosthodontist make valuable contributions towards the surgeon's ultimate rehabilitation of the patient. A three year experience of 111 mandibular fractures treated on the UCSD Otolaryngology Service is characterized. Sixteen complications nine of which were seen after initial treatment elsewhere provide the focus of this report. Special emphasis is given to the pre-treatment planning and surgical techniques necessary to correct malunion and nonunion. Particular advantages achieved by the use of osteogenic autogenous marrow, cellulose acetate filters and Vitallium (chrome cobalt) trays are detailed.

Adult↗
PubMed1977

Treatment of allergic aspergillosis with triamcinolone acetonide aerosol.

The successful management of a patient with allergic asperillosis with triamcinolone acetonide for one year is reported. This patient had been maintained previously on systemic attempt to withdraw systemic corticosteroids continuously for eight years. An initial attempt to withdraw systemic steroids after initiation of aerosol therapy was unsuccessful; however, following bronchoscopic removal of mucus plugs, the transfer to maintenance therapy with triamcinolone aerosol alone was uneventful.

Adult↗
PubMed1977

Gastrointestinal hemorrhage in patients in a respiratory intensive care unit.

Significant gastrointestinal hemorrhage occurred in 20% (20) of the patients in a respiratory intensive care unit. Risk factors significantly associated with the development of gastrointestinal hemorrhage included (1) the principal respiratory diagnosis of adult respiratory distress syndrome; (2) increasing numbers of days on a ventilator, days in the respiratory intensive care unit, and total days of hospitalization; and (3) the development of thrombocytopenia. Factors not associated with an increased risk of gastrointestinal hemorrhage were the age and sex of the patient, the respiratory diagnosis of chronic obstructive pulmonary disease, and the use of therapy with either heparin or corticosteroids. Routine prophylactic administration of antacids was associated with a decreased incidence of hemorrhage. The mortality of bleeders was significantly greater than that of nonbleeders.

Antacids↗
PubMed1977

Pulmonary lavage in patients treated with mechanical ventilation.

Mucous plugs and secretions in smaller bronchi may be responsible for impaired exchange of gases and abnormal compliance. Conventional therapy is often insufficient for removal of these plugs and secretions, especially in patients treated with mechanical ventilation. Therefore, pulmonary lavage with 237 +/- 6 ml of physiologic saline solution infused through the flexible fiberoptic bronchoscope in patients with respiratory failure was accomplished on 43 occasions to evaluate the therapeutic benefit of this procedure on oxygenation and compliance. Eighty-one percent (35) of the 43 lavages were associated with a significant increase of the ratio of arterial to alveolar oxygen pressures (PaO2/PAO2) (11 +/- 1) hours after lavage; 63% (27) of the 43 lavages were associated with a significant increase in effective static compliance (Cst) at 8 (+/- 1) hours after lavage. There were no persistent complications other than transient decreases in PaO2/PAO2 and effective Cst soon after lavage. The results suggest that this procedure is a useful therapeutic method in selected patients with respiratory failure.

Blood Gas Analysis↗
PubMed1976

Desquamative interstitial pneumonia following long-term nitrofurantoin therapy.

Two patients with diffuse interstitial lung disease after long-term nitrofurantoin therapy were characterized clinically by exertional dyspnea and basilar rales, roentgenographically by diffuse interstitial infiltrate and physiologically by a restrictive lung defect. Pathologically, light microscopy revealed desquamative interstitial pneumonia. In one patient electron microscopy was characteristic of desquamative interstitial pneumonia. Immunofluorescent studies of one biopsy specimen showed specific fluorescence of interstitial cells with immunoglobulin E and third component of complement. In in vitro studies, nitrofurantoin therapy failed to induce lymphoblast transformation or histamine release. Treatment consisted of discontinuing the administration of nitro=furantoin and adding corticosteroids. Both patients felt better and showed clinical improvement. Our findings suggest that in some cases desquamative interstitial pneumonia may be drug related.

Adult↗
PubMed1976

Mandibular fracture complications.

This paper presents the authors' experiences with 111 treated mandibular fractures and 16 cases of complication. Pertinent data on the fresh fractures are given, but the major part of the study deals with cause, diagnosis, and treatment of the complications of mandibular fractures. These are divided into four categories-infection, nonunion, malunion, and temporomandibular joint ankylosis, although only infection and temporomandibular joint ankylosis are included here. Unique mandibular fracture complications are reviewed.

Adolescent↗
PubMed1976

Intravascular coagulation associated with the adult respiratory distress syndrome.

In seven of 30 consecutive patients with the adult respiratory distress syndrome, disseminated intravascular coagulation (DIC) developed. Increasing respiratory dysfunction characterized by decreased effective static compliance and increased hypoxemia coincided with the development of DIC. Patients in whom DIC developed were characterized by a high incidence of bleeding, gangrene of the extremities, renal dysfunction, mortality and autopsy evidence of fibrin microthrombi in the lungs, kidney and skin. In 12 of 23 patients who did not meet the criteria for DIC, the platelet count decreased by at least 50 per cent of the initial values at some time during their illness. Fibrin microthrombi were found in the lungs in the majority of the patients subjected to autopsy. These data support the concept that depostion of platelet on damaged pulmonary capillary endothelium may be more common in the adult respiratory distress syndrome than the DIC syndrome.

Adult↗
PubMed1976

Laryngeal papillomatosis: immunologic and viral basis for therapy.

The distressing nature of laryngeal papillomatosis and lack of clinical progress in its treatment are reviewed. Presently accepted and investigative methods of therapy are reviewed with special attention being given to immune therapy. Support for the concept of a viral etiology is discussed and other etiologic agents considered. Known and possibly significant roles of wart virus antibodies are discussed and the importance of complex interplay between maternal and fetal immune systems explored as a possible explanation for some puzzling aspects of laryngeal papillomatosis. Finally, a proposed experimental design is outlined, the purpose of which is to provide a useful animal model to investigate immune changes in laryngeal papillomatosis, as well as effects of surgical or medical therapy.

Adult↗
PubMed1976

Diagnosis of gastric aspiration by fiberoptic bronchoscopy.

At the time of bronchoscopic observation, 28 of 31 patients proved to have aspirated gastric contents by the presence of gastric contents in the trachea or by direct observation of gastric aspiration followed by respiratory distress and erythema of subsegmental bronchi. Since gastric aspiration is a difficult diagnosis to make and few objective data are available to make the diagnosis, the present study would indicate that early fiberoptic bronchoscopic observation of the tracheobronchial tree is a useful procedure to establish a definitive diagnosis and to allow proper planning for clinical management.

Bronchitis↗
PubMed1976

Diagnosis of causes for acute respiratory distress by pressure-volume curves.

The determination of effective dynamic and static relationships between pressure and volume aided in the diagnosis of pulmonary disease, its course, and the effects of therapy in 22 patients receiving continuous mechanical ventilation. These measurements were made on multiple occasions early in the course of mechanical ventilation and were repeated after any indication of clinical deterioration. Abrupt changes from control measurements provided supportive evidence for the presence of cardiogenic pulmonary edema in four patients, progressive pneumonia in four patients, bronchoconstriction in four patients, retained secretions in five patients, pneumothorax in two patients, intubation of main-stem bronchus in three patients, and atelectasis in two patients and were useful in evaluating the results of subsequent therapy. These determinations are simple, noninvasive, and can be accomplished within minutes. The equipment needed is the same as that needed for continuous mechanical ventilation.

Bronchial Diseases↗
PubMed1976

Sphenoethmoidal mucocele: radiographic diagnosis.

Fourteen cases of mucocele of the sphenoid sinus are reviewed to assess differentiating radiographic features. Recognition is usually possible using detailed tomography in the frontal, lateral, and submentovertex projections. Two constant findings were opacification of the sinus (usually bilateral) and expansion and thinning of the sinus walls. Contiguous opacification of the ethmoid sinuses was present in most cases, and pansinusitis was frequent. Distinction from intrasellar lesions is based on the absence of sellar enlargement. Early and correct diagnosis is important to prevent permanent visual loss and to assure appropriate surgical approach.

Adolescent↗