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PubMed1988

Intracytoplasmic crystalline inclusions in dermal infiltrating cells of granulomatous contact dermatitis due to gold earrings.

A case of granulomatous contact dermatitis due to gold earrings for pierced ears was studied ultrastructurally. The patient was a 24-year-old woman, who had reddish brown papules on the earlobes. Patch test using gold sodium thiomalate proved strong positive, with blister formation. Histological observation of the papule showed dense cell infiltration throughout the full thickness of the dermis. Ultrastructurally, dermal infiltrating cells consisted of lymphocytes and histiocytes. Unusual crystalline inclusion bodies were observed in the cytoplasm of these cells. These structures were elliptical, not encapsulated and showed a regular fingerprint-like pattern of parallel lines along the short axis. The width of the lines and their intervals was 12 nm. These findings suggest that continuous contact between gold and dermis may induce inflammation, causing granulomatous changes and the development of crystalline inclusion bodies.

Adult↗
PubMed1980

[Combined use of cutaneous homografts and autografts in extensive burns. Mowlem-Jackson's phenomenon (author's transl)].

The prognosis of extensive 3rd degree burns has been considerably improved by the use of homografts pierced with holes to allow application of small portions of autografts. The histological appearances after successful grafting of the skin are described in detail. Grafts of this type allow maximum economy of remaining healthy skin, and this technique is a very great improvement over Mowlem-Jackson's procedure. Successful results have been obtained in 3rd degree burns covering 90% of the body surface.

Burns↗
PubMed1995

Granisetron as antiemetic therapy in children with cancer.

The safety and efficacy of the new 5HT-3 antagonist granisetron as an antiemetic in children with cancer was evaluated in 40 children at a single dose of 40 micrograms/kg. No adverse affects attributable to the granisetron were noted. The overall major and complete response rate was 82.5% and this was highest in the younger children. Only 2 patients showed no response. Pharmacokinetic studies showed associations between some pharmacokinetic parameters and age which were no longer apparent after normalisation for body weight. Granisetron is an effective and very well-tolerated antiemetic and appears to be an important addition to the supportive care available for children with cancer.

Adolescent↗
PubMed2006

Polyethylene sterilization and production affects wear in total hip arthroplasties.

Production and package sterilization techniques for the polyethylene used in acetabular components for total hip arthroplasties are known to affect wear. We considered three combinations of techniques: sterilization by radiation in inert gas with isostatically molded polyethylene, in inert gas and ram-extruded polyethylene, and in air with extruded polyethylene. The intent of this study was to confirm that molded polyethylene and polyethylene radiated in inert environments reduce wear rates in vivo, to determine the combination of methods with the least wear, and to determine how much variance in wear is attributable to these methods. We reviewed 150 consecutive total hip arthroplasties done in 133 patients using 28-mm cobalt-chrome femoral heads and polyethylene-lined, titanium, ring-locked acetabular components. The least wear occurred in gamma inert-molded polyethylene components. The mean volumetric wear rates were 52.12 mm3/year for gamma inert-molded, 62.32 mm3/year for gamma inert-extruded, and 66.09 mm3/year for gamma air-extruded polyethylene components. Relative risk assessment found gamma air-extruded and gamma inert-extruded polyethylene components to wear 16% and 11% more than gamma inert-molded polyethylene components, respectively. Gender, body mass index, and age accounted for the greatest amount of the explained variance in volumetric wear (57.5%, 21.6%, and 14.4, respectively), followed by angle of wear (3.4%), and sterilization and production technique (3.2%).

Acetabulum↗
PubMed1989

Effects of Thy-1+ cell depletion on the capacity of donor lymphoid cells to induce tolerance across an entire MHC disparity in sublethally irradiated adult hosts.

Thy-1+ cell depletion with anti-Thy-1.2 mAb and complement markedly reduced the capacity of C57BL/6J, H-2b bone marrow to establish mixed lymphoid chimerism and induce tolerance to C57BL/6J skin grafts across an entire MHC disparity in BALB/c, H-2d hosts conditioned with sublethal, fractionated 7.5 Gy total-body irradiation. In this model tolerance can be transferred to secondary irradiated BALB/c hosts only by cells of C57BL/6J donor, not host, genotype isolated from the spleens of tolerant hosts. Thy-1+ cell depletion abolished the capacity of C57BL/6J donor cells from tolerant BALB/c host spleens to transfer tolerance. The capacity of semiallogeneic BALB/c x C57BL/6J F1, H-2d/b donor BM and spleen cells to induce chimerism and tolerance to C57BL/6J skin grafts in BALB/c parental hosts was also reduced by Thy-1+ cell depletion. Thus the requirement for donor Thy-1+ cells cannot be explained simply on the basis of alloaggression. It is unlikely that the requisite Thy-1+ cells are nonspecific suppressor cells: Thy-1+ cell depletion had no effect on the slight but significant prolongation of third-party C3H/HeJ, H-2k skin grafts in irradiated BALB/c hosts injected with allogeneic C57BL/6J or semiallogeneic BALB/c x C57BL/6J F1 BM compared to irradiated controls injected with medium only. Furthermore, injections of semiallogeneic F1 spleen cells had no significant effect on the survival of the third-party grafts, although these cells were fully capable of inducing tolerance, and their capacity to induce tolerance was significantly reduced by Thy-1+ cell depletion. The requirement for a specific population of lymphoid cells, i.e. Thy-1+, remains unexplained but suggests that donor cells might play a role in the induction or maintenance of tolerance in this model other than merely providing a circulating source of donor antigens.

Animals↗
PubMed1985

The role of donor lymphoid cells in the transfer of allograft tolerance.

Tolerance to murine skin allografts across a MHC disparity was induced by conditioning primary hosts with sublethal fractionated total-body irradiation (FTBI) and transfusion of allogeneic bone marrow (BM). Tolerance could be adoptively transferred to secondary hosts conditioned by FTBI with infusion of spleen cells from hosts bearing intact skin allografts greater than 60 days. Tolerance could not be transferred by tolerant host spleen (THS) preparations from which cells of the donor genotype had been deleted by cytotoxic alloantisera. Deletion of host genotype cells, however, did not diminish the capability of THS to transfer tolerance. All of the tolerizing activity of THS appeared to reside within cells of the donor genotype. Small numbers of normal donor spleen cells could induce tolerance in FTBI hosts but only at the expense of very high mortality, in contrast to the low mortality observed with tolerizing injections of allogeneic donor cells from THS or injections of normal semiallogeneic F1 hybrid spleen cells. If an active immune response is responsible for tolerance induction/transfer in this model, allogeneic donor lymphoid cells derived from BM, in contrast to donor spleen cells, must be capable of mounting this response without concomitant severe GVHD. In future experiments, cells of donor genotype can be isolated from THS and purified in sufficient numbers to compare their tolerizing efficiency vs. that of normal donor cells, detect possible suppression of normal host cell alloreactivity in vitro and identify the donor cell phenotypes involved.

Animals↗
PubMed2005

Utility of cranial boost in addition to total body irradiation in the treatment of high risk acute lymphoblastic leukemia.

PURPOSE: Total body irradiation (TBI) as part of a conditioning regimen before hematopoietic stem cell transplant (HSCT) is an important component in the management of acute lymphoblastic leukemia (ALL) that has relapsed or has other certain high-risk features. Controversy exists, however, as to whether a cranial boost in addition to TBI is necessary to prevent central nervous system (CNS) recurrences in these high-risk cases. Previous national trials have included a cranial boost in the absence of data to justify its use. Therefore, the aim of this study was to assess risk of CNS recurrence in ALL patients treated with TBI, to identify subsets of these high-risk patients at an increased or decreased risk of CNS recurrence after TBI, and to investigate whether regimens with higher doses of cranial irradiation further reduce the risk of CNS recurrence. METHODS AND MATERIALS: Charts of 67 consecutively treated patients with ALL who received TBI before HSCT were reviewed. Data including patient demographics, clinical features at presentation, conditioning regimen, donor source, use of a cranial boost, remission stage at transplant, histologic subtype, cytogenetics, and extramedullary site of presentation were retrospectively collected and correlated with the risk of subsequent CNS recurrence. RESULTS: At the time of analysis, 30 (45%) patients were alive with no evidence of disease, 8 (12%) were alive with recurrence of leukemia, 7 (10.5%) had recurrent ALL but with successful salvage, 7 (11%) died subsequent to recurrence, 14 (21%) died from complications related to HCST, and 1 patient was lost to follow-up (1.5%). Of the patients who recurred after HSCT, the relapses were hematologic in 13 (57%), CNS with or without simultaneous marrow involvement in 3 (13%), and other sites in 7 (30%). Forty-one (61%) patients did not receive an extracranial boost of irradiation with TBI. Two of these patients (4.9%) suffered CNS failures compared with 1 of 26 (3.8%) who received a cranial boost (p = 0.84). None of the 40 patients who presented only with hematologic disease developed a CNS recurrence despite the fact that only 13 of 40 of these patients received a cranial boost after TBI. Cranial boost was therefore not associated with a reduction in CNS recurrence, especially in patients with only hematologic disease at presentation for which there were no failures regardless of the use of additional cranial radiotherapy. CONCLUSIONS: Patients who present with hematologic disease only at the time of HSCT have a low risk of CNS recurrence after TBI regardless of the use of a cranial boost, suggesting that a cranial boost may not be necessary in these patients.

Adolescent↗
PubMed1970

Intestinal fluid and electrolyte transport in human cholera.

The site, nature, magnitude, and duration of fluid and electrolyte loss into the small intestine during the acute and recovery phase of human cholera was defined in 27 Indian patients. 11 subjects without cholera served as controls. The marker perfusion technique employed was shown, in preliminary experiments, to measure accurately jejunal and ileal fluid and electrolyte transmucosal transport rates under conditions of cholera diarrhea. Fluid loss into the lumen occurred from jejunal and ileal mucosa. The fluid was isotonic in both regions. Bicarbonate concentration was significantly higher in ileal than jejunal fluid during all phases of the disease. Bicarbonate concentration in both regions was significantly higher in acute cholera than during convalescence. Fluid loss into the intestinal lumen ranged from 0.07 to 10.9 ml/hr per cm. Losses were significantly greater from jejunum than ileum. Net ileal absorption was recorded in five of 10 acute cholera studies. During the acute phase of the disease, net jejunal fluid transport showed a positive correlation with fasting intestinal flow rate and stool output. Stool output was also positively correlated with jejunal fasting intestinal flow rates. Recovery of normal fluid and electrolyte absorptive function was usually complete in both jejunum and ileum by the sixth day after admission. These findings in human cholera validate the animal models of choleraic diarrhea and suggest that similar measurements of small intestinal secretory function in other nonspecific diarrheal diseases using the marker perfusion technique may be rewarding.

Adolescent↗
PubMed2002

Jewelry-induced diseases of the head and neck.

The desire to modify a person's outer appearance is a phenomenon that can be traced back to the beginning of humankind. Body modifications have been practiced among all cultures around the globe to differing extents. The authors present medical complications through jewelry in a series of 35 consecutive patients. Patient charts were evaluated for age, gender, type and sequelae of injury, complications, and treatment results. The male-to-female ratio was 1:2.2. Most of the recorded complications were related to the new vogue of piercing, with the ear affected most commonly. Usually the complications were minor; however, 2 patients sustained disfiguring damage to their auricular cartilage as a result of high ear piercing, a child nearly asphyxiated on an aspirated earring, and 2 patients experienced severe dysphagia as a result of tongue piercing. The most severe complication was a lethal strangulation injury in a female patient whose necklace got trapped in the headrest of her car seat during a front-end collision.

Adolescent↗
PubMed2007

Gait initiation in children with cerebral palsy.

The task of gait initiation (GI), or taking a first step from a static standing position requires the development of forward momentum while maintaining dynamic balance as the body's center of mass (COM) moves forward and outside the base of support. The dynamics of GI in children (aged 7-12 years) with hemiplegic cerebral palsy (CP), diplegic CP and children with typical development (TD) were compared to characterize the mechanics and control of this task. Ground reaction forces (GRFs) and muscle activity were collected during GI at three different self-selected speeds (slow, moderate and fast). Movement of a sacral marker was also tracked to estimate downward shifting of the body during the GI task. Results demonstrate the presence of a motor sequence characterized by increased forward momentum development with increased GI speed for all groups of children. Anticipatory movements of children with CP were different when compared to children with TD. Children with hemiplegic CP demonstrated decreased lateral shifting while children with diplegic CP demonstrated a trend of decreased downward shifting of the body compared to children of TD. Analysis of the GI motor sequence in children provides a means to characterize coordination and motor control of a functional ambulatory task in children with CP compared to children with TD.

Analysis of Variance↗
PubMed2001

Endocarditis after nipple piercing in a patient with a bicuspid aortic valve.

Piercing the skin for cosmetic reasons can be dangerous in young adults who have previously undergone surgery for congenital defects of the heart. We report the case of a 24-year-old man in whom coarctation of the aorta had been corrected 15 years earlier. Two months after piercing his left nipple without antibiotic prophylaxis, he developed a local mastitis, followed by bacterial endocarditits that required replacement of the aortic valve.

Adult↗
PubMed1985

The late effect of grenade fragments.

Following the explosion of a grenade or shell, the victim may be peppered with literally hundreds of pieces of metal. Troublesome fragments which perforate a major viscus may be removed but others are often left behind, as it is felt (usually correctly) that these fragments will cause no harm. We describe a case in which a grenade fragment received 16 years previously pierced the large bowel. A psoas abscess developed which was located by ultrasound. Pus was aspirated under ultrasound control and the lesion was successfully treated by antibiotics.

Abscess↗
PubMed2006

Alternative donor bone marrow transplant for children with Philadelphia chromosome ALL.

Children with Philadelphia chromosome positive (Ph+) acute lymphocytic leukemia (ALL) have only a 20% event-free survival when treated with chemotherapy alone. Bone marrow transplant (BMT) for patients with matched siblings has been associated with significantly better long-term survival. We asked whether children who lack a matched sibling donor would do as well if an alternative donor was utilized. Between 1987 and 2002, we transplanted 29 children and adolescents using either an unrelated donor (23) or a mismatched family member (six). The conditioning regimen included cytosine-arabinoside, cyclophosphamide and total body irradiation. Graft-versus-host disease (GVHD) prophylaxis consisted of T-cell depletion (antibody T10B9 or OKT3 and complement) with post transplant cyclosporine (CSA). All patients engrafted. Four developed grades III-IV acute GVHD. Three of 24 evaluable patients developed extensive chronic GVHD. Two patients died of relapse (7%). Two long-term survivors (>6 years) died of malignant glioblastoma multiforme. Event-free survival at 3, 5, and 10 years is 56, 51, and 46%, respectively. Five of six patients in >CR2 or relapse at the time of transplant died. Our data should encourage the use of alternative donor transplants early in the course of disease for children with Ph+ ALL.

Adolescent↗
PubMed1985

Sublethal fractionated total-body irradiation and donor bone marrow infusion for induction of allograft tolerance.

Tolerance to skin allografts across the strong histocompatibility barrier H-2b to H-2d was achieved with sublethal fractionated total-body irradiation, FTBI, delivered to H-2d mice in 3 doses of 250 rads within 24 hr, followed by transfusion of 3 X 10(7) H-2b donor bone marrow (BM) cells. H-2b skin allografts were applied within 48 hr after the initial radiation. 70% of the mice became long-term (greater than 180-day) survivors with fur-bearing grafts. Marked interexperiment variability in survival rates suggested that infection was the major cause of death in this model and lower weight gain and survival rates for allogenic BM vs. media-treated controls suggested that graft-versus-host disease (GVHD) was also a factor. The observation, however, that long-term survivors (70% of all mice) gained weight and appeared healthy suggested that the GVHD might be self-limiting. Chimeric analysis revealed that approximately 25% of spleen cells were of donor origin, both at short-term (6 weeks) and long-term (greater than 1 year) intervals after tolerance induction. In spite of hematopoietic chimerism, a low incidence of spontaneous tumors, less than 1%, occurred in the long-term survivors.

Actuarial Analysis↗
PubMedDate not supplied

Reevaluation of the radiographic method for measurement of total lung capacity.

To clarify whether the radiographic estimate of total lung capacity (TLC) using the method of Barnhard et al., as modified by Loyd et al., yields accurate values, we measured TLC in 20 young healthy subjects with the above technique (Vb). We compared it to the more sophisticated radiologic method of Pierce et al. (Vp) and to plethysmographic measurements (Vbox). Plethysmographic results, 7.38 +/- 0.94 l (mean +/- SD) or 101.7% of predicted, were significantly higher than Vb (mean difference 0.53 +/- 0.68 l; p less than 0.005 by paired t test), but were not significantly different from Vp (mean difference 0.13 +/- 0.52 l). Based on these and previous data, we conclude that the Pierce et al. approach yields more accurate results than the Barnhard and Loyd method, although individual data, in both methods, should be interpreted cautiously.

Adult↗
PubMed2000

Exposure to metallic gold in patients with contact allergy to gold sodium thiosulfate.

Gold allergy is common, with approximately 10% of patients patch tested because of eczematous disease being positive to gold sodium thiosulfate (GSTS). However, clinical relevance seems to be rare. The aim of this prospective double-blind study was to demonstrate the effects of exposure to metallic gold, in this case earrings, in gold-positive patients. 60 female patients with pierced earlobes test-positive to GSTS were included in the study. The patients were randomized into 2 groups, 30 patients receiving earrings with a surface layer consisting of 24-carat gold and 30 patients earrings with a surface layer of titanium nitride, virtually indistinguishable from gold. The patients wore the earrings for 8 weeks. During the study, any dermatitis on the earlobes, as well as on other body sites, was registered. The skin reactions observed were weak but, in total, 17 of the 60 patients had a skin reaction (local or remote) during the study, 12 of whom had received gold earrings and 5 titanium (p<0.05). 11 patients had a reaction on the earlobes, 7 of whom had received gold earrings and 4 titanium (NS). With these facts it is hard to exclude that exposure to gold jewelry can be clinically relevant in persons hypersensitive to gold.

Adult↗
PubMed2001

[Botryomycosis--peculiar bacterial granuloma].

Botryomycosis is a chronic granulomatous infection, usually of skin or mucous membranes in predisposed individuals. Infection in internal organs may occur in immunosuppressed persons and is serious but uncommon. Trauma or foreign bodies and defective immune defense mechanisms predispose for the disease, which is mainly caused by Staphylococcus aureus, but also by other bacteria. The histopathological picture is diagnostic and biopsy is encouraged in granulomatous infections. Differential diagnoses may be mycobacteriosis, mycosis and parasitosis. If excision, the preferred treatment, is not radical, prolonged antibiotic treatment is required. The disease may become more widespread in connection with the common use of piercing in young immunocompetent persons.

Aged↗
PubMed1964

ACCIDENTS IN CHILDHOOD: A REPORT ON 17,141 ACCIDENTS.

The causes of injury to 17,141 children brought to the emergency department of a large pediatric hospital in one year were studied. The leading causes of injury were: falls, 5682; cuts or piercings, 1902; poisonings, 1597; and transportation accidents, 1368. Included in these are 587 falls on or down stairs, 401 cuts due to glass, 630 poisonings from household or workshop substances, 510 poisonings from salicylate tablets, and 449 accidents involving bicycles or tricycles. Other findings included 333 injuries to fingers or hands in doors, usually car doors; 122 instances of pulled arms; 384 ingestions and 53 inhalations of foreign bodies; 60 alleged sexual assaults, 58 chemical burns, 127 wringer injuries, and four attempted suicides. A rewarding opportunity in accident prevention exists for hospitals that undertake to compile and distribute pertinent source data.

Accident Prevention↗