Biomedical subjects
Publications and source records attributed to R L Goode.
The glycerin test has been proposed as an adjunct in the diagnosis of Meniere's disease. Complications of the test are rare and usually minor. We describe a case in which a 20- to 40-dB hearing loss developed in the uninvolved ear of a patient during a standard glycerin test. He made a complete recovery within three days after the test. We discuss the possible mechanisms of the loss.
Eighteen patients with advanced squamous cell cancer of the head and neck were treated with cis-diamminedichloroplatinum in a 24-hour infusion. The most frequent dose used was 80 mg/m2 repeated every three weeks. Six were treated preoperatively for Stage III or IV disease, and twelve were treated for recurrent disease. The overall response rate was 72% with one complete remission, greater than 50% regression in six patients, and 25--50% regression in six patients. Toxicity was minimal: creatinine greater than 2 in 6% of courses, leukopenia in 9%, anemia in 29%, vomiting in 76%, and documented minimal hearing loss in one patient. Plasma and urine platinum levels during infusion are presented. The dosage of 80 mg/m2 administered over 24 hours gives a response rate in head and neck cancers equivalent to that reported with higher doses given by rapid infusion, and toxicity is minimal.
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It appears that a variety of surgical techniques are available to safely decrease the size of hyperplastic inferior turbinates; when used properly in appropriate patients they can provide significant improvement in the symptoms of chronic nasal obstruction.
A new liquid nitrogen turbinate probe for freezing of the free edge of the inferior turbinate in cases of chronic hypertrophic rhinitis has been designed.
Nineteen cases with major resections of the head and neck were treated with laryngeal suspension and cricopharyngeal myotomy in an attempt to allow swallowing function postoperatively and avoid a total laryngectomy. Sixteen cases were available for evaluation. Eight cases (50%) were able to eat by mouth, 15 patients (94%) had a normal airway and 14 patients (87%) had intelligible speech.
A review of 1,192 student medical records shows a prior history of tonsillectomy in 41 percent of a control group and 22 percent of an infectious mononucleosis group--a significant difference (p less than 0.01). Nine hundred eighty-nine Stanford University students (421 females, 568 males) who visited Cowell Student Health Center between April and September, 1973, comprise the control group. Two hundred three students with positive monospot tests and clinical mononucleosis diagnosed between June, 1968, and May, 1973, comprise the experimental group. The lower incidence of tonsillectomy in the infectious mononucleosis group implies that the tonsillar lymphoid tissue serves as a reservoir and possible replicating milieu for the Epstein-Barr virus. Prior tonsillectomy may reduce the possibility of contracting infectious mononucleosis.
Three hundred and five patients with oropharyngeal carcinomas received linear accelerator radiation therapy at the Stanford University Medical Center between 1956 and 1973. All were staged by the TNM system, using the UICC Classification of 1962. Actuarial five year survival for patients with tonsil cancers ranged from 50% to 18% for those with T1 and T3 lesions, respectively. Disease-free survival was higher than actuarial survival for patients with T1 and T2 lesions, reflecting an alteration of the latter curves by deaths from intercurrent diseases and second primary malignancies. Actuarial survival for patients with base of the tongue carcinomas was approximately 35% for those with T1 and T2 primary lesions and 22% for patients with T3 carcinomas. Considering all oropharyngeal sites of involvement together, clinically involved cervical lymph nodes were controlled by radiation therapy alone in 60 of 91 patients with N1 nodal involvement (67%), in twelve of 25 with N2 neck disease (48%) and in 46% of those patients with N3 involvement (34 of 74). Eighty-nine percent of patients whose lymph nodes were not controlled by radiation therapy alone also had uncontrolled primary cancers. Over 90% of the patients whole cervical lymph nodes were initially uninvolved remained free of late nodal metastases if at least the regional (first echelon) lymph nodes were included in the primary treatment fields. The results of a randomized trial which compared surgery and radiation therapy alone and the two modalities in combination for the treatment of a limited number of patients with advanced cancers of the oropharynx, supraglottic larynx and hypopharynx suggest that surgery alone is not the treatment of choice.
We describe a useful technique for local brow-lift operation. We discuss the results and outline procedural modifications that minimize postoperative scarring. The operation may be performed in conjunction with blepharoplasty or other cosmetic surgery.
The benzo[a]pyrene 4,5-, 7,8-, and 9,10-oxides and the six corresponding phenols (4-, 5-, 7-, 8-, 9-, and 10-hydroxybenzo[a]pyrene) have been tested for mutagenic and cytotoxic activity in bacteria and in a mammalian cell culture system. Benzo[a]pyrene 4,5-oxide (K-region) was highly mutagenic in two histidine-dependent strains (TA1537 and TA1538) of Salmonella typhimurium which detect frameshift mutagens. In contrast, benzo[a]pyrene 7,8- and 9,10-oxides were less than 1% as mutagenic as the 4,5-oxide. Benzo[a]pyrene 7,8- and 9,10-oxides were unstable in aqueous media, whereas the 4,5-oxide was stable for several hours. This difference in stability could not account for the different mutagenic activities of the three arene oxides. The benzo[a]pyrene oxides were inactive in a strain (TA1535) that is reverted by base pair mutagens such as N-methyl-N'-nitro-N-nitrosoguanidine or in a strain (TA1536) that detects framshift mutagens similar to the acridine half-mustard ICR-191. Benzo-[a]-pyrene and the six phenols were all stable in aqueous media, but they had little or no mutagenic activity in any of the four Salmonella strains. Conversion of 8-azaguanine-sensitive Chinese hamster V79 cells to 8-azaguanine-resistant variants was increased by benzo[a]pyrene 4,5-oxide, whereas the 9,10-oxide was considerably less active. Benzo[a]pyrene and the other derivatives had little or no effect. Benzo[a]yrene 4,5-oxide was more cytotoxic to the Chinese hamster V79 cells than the 7,8- and 9,10-oxides, while 8-hydroxybenzo[a]pyrene was the most cytotoxic of the six phenols.
Isolates of Bacillus subtilis that had been presumed to carry the cysA14 lesion have been studied. Our data indicate that these strains contain four mutations, all of which are linked by transformation and lie in the region of the ribosomal markers. The requirement for cysteine results from a defective serine transacetylase that is coded for by the cysA locus. Therefore, these mutants grow only in the presence of cysteine but not with sulfate, sulfite, or sulfide as the sole source of sulfur. A second genetic lesion (css) can be recognized by an increased sensitivity to the amino acid L-cysteine. The inhibited enzyme(s) has not been determined but inhibition is overcome by a mixture of eight amino acids. The third mutation (hts) results in the overproduction and excretion of hydrogen sulfide. This compound appears to be produced from cysteine by the enzyme cysteine desulfhydrylase and not by an increased activity of the sulfate-reductive pathway. This locus presumably codes for a regulatory element involved in the control of cysteine desulfhydrylase. The fourth mutation (cym) is not well characterized biochemically but results in a requirement for cysteine or methionine. The following order of these mutations has been established by transformation studies: hts, cysA, css, cym. The generally poor growth of these mutants in minimal-salts glucose media supplemented with cysteine can now be explained by these observations. The cysA14 mutants not only require an amino acid that is itself inhibitory to growth but they also overproduce the highly toxic compound hydrogen sulfide.
Eight ears with complications due to chronic eustachian tube insufficiency had insertion of a silicone rubber tympano-frontal shunt tube between the mastoid antrum and the ipsilateral frontal sinus. A one-way valve designed to open at -10 mm H20 was placed on the tympanic end of the tube to minimize tube obstruction by ear secretions. Follow-up an average of 20 months post insertion showed six of the eight ears to have an aerated middle ear without fluid or tympanic membrane retraction or perforation.
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Alpha-toxin from five strains of Staphylococcus aureus, including Wood 46, was purified by isoelectric focusing. The alpha-toxins obtained from different strains were similar. The isoelectric point of the purified toxins was 8.65 +/- 0.15. Sharp concentration peaks were not always obtained. In the ultracentrifuge the alpha-toxins migrated usually as three peaks which could be dissociated with propionic acid to yield one peak. A single line of identity was obtained in immunoelectrophoresis when a heterologous antiserum was reacted with the five purified toxins. It was concluded that the widespread use of the Wood 46 strain for the production of alpha-toxin is justified.
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