Diffuse well differentiated lymphocytic lymphoma: a clinical study of 22 patients.

An analysis is presented of the clinical and prognostic features of 22 patients diagnosed with diffuse well differentiated lymphocytic lymphoma at Cleveland Metropolitan General Hospital between 1974 and 1987. At presentation, the disease was usually advanced with 86% of patients having stage IV disease and 73% of patients exhibiting bone marrow involvement. Ten second malignancies were documented in 7 (32%) of our patients.

Endoscopic placement of a Foley catheter across a stricture and rectovaginal fistula to perform a barium enema.

Evaluation of enteric fistulas is often best performed with barium contrast studies. Clinical situations that preclude the satisfactory installation of barium decrease the yield of the study. A case is presented of a 59-yr-old female with stage III-B cervical carcinoma and a known rectovaginal fistula with an adjacent sigmoid colon stricture.

Care of the asthmatic oral and maxillofacial surgery patient.

It is estimated that asthma affects 6 to 9 million people in the United States. The nature of this disease makes it a special concern to the oral and maxillofacial surgeon. Appropriate management of the asthmatic patient with regard to anesthesia and surgical procedures of the oral and maxillofacial region is discussed.

The use of recorded interviews to enhance physician-patient communication.

Audio recordings were made of the initial interview conducted between a cancer physician and 29 patients at the time of initial diagnosis and treatment planning. The tape recordings were then given to these patients to allow review as often as desired. Follow-up questionnaires were collected to evaluate this experience.

Seeking psychological treatment as a cure for a medical problem.

Today health care providers are more likely to experience legal, moral and ethical dilemmas regarding their treatment principles given the climate of health care. Clinical practice in the United States is being affected by many external forces which can affect patient care. Government and insurance companies are attempting to legislate treatment as evidenced by DRG's and reimbursement patterns.

Aortic endothelial and smooth muscle cell co-culture: an in vitro model of the arterial wall.

Interactions between vascular endothelial (EC) and smooth muscle cells (SMC) contribute both to the normal function of the vascular wall and to the pathogenesis of lesions such as atherosclerosis and fibrointimal hyperplasia. However, study of these interactions has been hampered by the difficulty in growing these two cell types in simultaneous culture. Methods using conditioned media, shared media, and bilayer culture have been described, but none is well suited to the study of vascular cell interactions.

Estimation of maxillary alveolar cleft volume by three-dimensional CT.

Reconstruction of cleft lip and palate deformities is a challenging problem involving a variety of the subspecialties of surgery, dentistry, and medicine as well as radiology. This paper outlines the contribution of three-dimensional CT to preoperative treatment planning for bone grafting of a maxillary cleft alveolus.

Long-term results after chemoradiotherapy for locally confined squamous-cell head and neck cancer.

The long-term results after simultaneous chemoradiotherapy in 54 patients with previously untreated or minimally treated, locally confined (M0) squamous-cell carcinoma of the head and neck are presented. Multiple concurrent courses of radiation therapy and chemotherapy with cisplatin and a four-day 5-fluorouracil infusion were given. Twenty-eight patients underwent definitive surgery and 26 were treated without surgical resection.

Competitive inhibition of LDL binding and uptake by HDL in aortic endothelial cells.

High-density lipoprotein (HDL) may inhibit the binding and cellular uptake of low-density lipoprotein (LDL) as one means of regulating the delivery of exogenous cholesterol to nonhepatic tissues. This may play an important role in atherogenesis, by altering lipid metabolism in cells of the arterial wall. To verify and better characterize this effect, endothelial cells were harvested from bovine aorta and maintained in tissue culture.

An epidemiologic survey of facial fractures and concomitant injuries.

A 5-year review of facial fractures and concomitant injuries at a level 1 trauma center is presented. The anatomic location of the facial fractures, age and sex of the patients, cause of injury, and associated systems injuries are presented. The majority of facial fractures were found in males; the most prevalent age range was 16 to 30 years.

Prevention of hepatocyte injury and lipid peroxidation by iron chelators and alpha-tocopherol in isolated iron-loaded rat hepatocytes.

These experiments were performed to characterize the relationship between lipid peroxidation and hepatocyte viability in iron overload. Hepatocytes were isolated from rats with chronic dietary iron overload and the effects of in vitro iron chelation on lipid peroxidation, cell viability and ultrastructure were studied over a 4-hr incubation period. Cell viability was significantly reduced at 3 and 4 hr in iron-loaded hepatocytes compared with controls and was preceded by an increase in iron-dependent lipid peroxidation.

A prospective, multi-center clinical trial of the Taylor intragastric balloon for the treatment of morbid obesity.

This report describes the result of a prospective, multicenter clinical trial of the Taylor intragastric balloon for the treatment of morbid obesity. Sixty patients, who had failed sustained weight loss on prior dietary restriction and behavior modification programs, were enrolled in four clinical centers. The Taylor intragastric balloon, a 550-ml, pear-shaped, liquid-filled, silicone device, was inserted in all patients for a period of 16 wk, and patients were maintained on a dietary restriction and behavior modification program.

Structural determination of the conjugated metabolites of ritodrine.

Ritodrine is a beta-2 adrenergic agonist which is used clinically for the management of preterm labor. Since ritodrine is resistant to the action of monoamine oxidase and catecholamine-O-methyltransferase, conjugation is a major route of metabolism. Glucuronide and sulfate conjugates of ritodrine are found in maternal urine.

Direct quantitation of skin elasticity in systemic sclerosis.

A simple instrument, the "skin elastometer," was used to evaluate the elastic and plastic properties of volar forearm skin in 24 patients with systemic sclerosis and 24 healthy individuals matched for age, race and sex. Skin elastance in 17 patients with diffuse scleroderma was found to be significantly different from matched controls (p less than 0.001), and was associated with clinical skin scores independently determined by examination (r = 0.

Effect of codeine on the sensations elicited by loaded breathing.

The present study examined the effect of codeine, a centrally acting opiate, on the respiratory sensations elicited in normal subjects by breathing to exhaustion against externally applied inspiratory threshold loads. Subjects were tested on two separate days following the double-blind, randomized administration of either placebo or codeine (90 mg). The intensity of the sensations of effort and discomfort experienced during two loaded breathing trials (a "high" load that was 73% of the maximum inspiratory pressure (MIP) and a "low" load that was 63% of the MIP) was evaluated using category (Borg) scores on each day of study.

Thoracic CT scanning in critically ill patients. Information obtained frequently alters management.

Conventional radiographic studies of the chest in the intensive care unit often fail to positively identify suspected intrathoracic pathology due to many patient- and equipment-related variables. Our experience has indicated that CT scanning of the chest improves diagnostic accuracy, precisely defines anatomic abnormalities, frequently affects treatment decisions, and has been performed safely in this fragile patient population. Examples of correctable lesions have included pneumothorax, empyema, lung abscess, mediastinal abscess and pleural effusion.

Intracranial chemical-shift artifacts on MR images of the brain: observations and relation to sampling bandwidth.

The purpose of this study was to evaluate the presence of chemical-shift artifacts on cranial MR and to illustrate the interrelationship among chemical-shift artifacts, variable acquisition parameters, and field strength. Measurements of chemical-shift artifacts were performed on scans obtained from a volunteer imaged in a 1.5-T General Electric system at bandwidths of 8, 16, and 32 kHz, using a 24-cm field of view and an 8-kHz bandwidth with a 48-cm field of view.

Peripheral vs central squamous cell carcinoma of the lung. A comparison of clinical features, histopathology, and survival.

We reviewed the clinical features and histopathologic findings of 21 peripheral pulmonary squamous cell carcinomas (SCC) resected at our institution between 1961 and 1981 and compared them with 19 central SCCs. Histologic features were scored semiquantitatively from 0 to 3+. Peripheral SCC represented 16% of all resected SCCs.

Quinine hepatotoxicity. An underrecognized or rare phenomenon?

Quinine-induced hepatic injury has been reported very rarely. We report a case involving a patient with an apparent hypersensitivity to quinine, manifested by a clinical syndrome mimicking a viral illness and a mixed hepatocellular-cholestatic liver injury pattern. We briefly review the unusual literature on this topic, which features many cases of hypersensitivity to the optical isomer of quinine, quinidine; yet, to our knowledge, there has only been one prior report of quinine hepatotoxicity.

Simultaneous versus sequential combined technique therapy for squamous cell head and neck cancer.

Forty-eight patients with locally confined (M0) squamous cell head and neck cancer were prospectively randomized to receive either simultaneous (SIM) or sequential (SEQ) combined technique therapy with a 5-fluorouracil infusion, a cisplatin bolus injection, and radiation therapy. Patients with residual resectable disease underwent surgery after induction therapy, whereas those achieving a complete response to induction did not require surgery. Patients on the two treatment arms were equivalent in all measured variables, including disease extent.

Effect of diaphragmatic contraction on intramuscular pressure and vascular impedance.

The purpose of the present study was to determine whether the diaphragm, like limb muscles, generates high levels of intramuscular pressure during contraction. Studies were performed on in situ diaphragm strips in 15 dogs. An isometric force transducer was used to measure strip tension, and intramuscular pressure was assessed using both wick and balloon catheter techniques.

Long saphenous vein grafts as an aid to microsurgical reconstruction of the trunk.

The authors describe a method of closing truncal defects using free-tissue transfer when neither local tissue or vascular access are available. The long saphenous vein is dissected free as far distally as necessary and turned up, leaving its upper drainage intact. The distal end is then anastomosed to the femoral artery to create a temporary arteriovenous loop.