Subcutaneous emphysema after extraction of maxillary teeth: report of a case

Inappropriate use of dental equipment that is powered by highly compressed air may directly lead to the formation of subcutaneous emphysema that involves the fascial planes of the head and neck. The high-speed dental handpiece and the air and water dental syringe are the instruments that are most commonly implicated in the reported cases. The treatment of such cases requires a reassured patient, prophylactic antibiotic coverage, and close postoperative follow-up care. Patients should avoid maneuvers that could increase intraoral pressure. Complete resolution should be expected within one week.     

Concentrations and total daily output of micronutrients in breast milk of mothers delivering preterm: a longitudinal study

The number of preterm infants fed their own mother's milk appears to be increasing as a result of information suggesting certain benefits over milk from human milk banks or proprietary formulas. It is also apparent that the nutritional requirements of term and preterm infants differ. Thus, the finding of various deficiencies in small preterm infants indicates that studies which examine the nutrient content of milk from mothers who deliver prematurely are important to aid in suggesting appropriate supplementation. In order to provide appropriate recommendations, nutrient content must be assayed during the period of exclusive milk feedings. Accordingly, the concentrations and total daily output of breast milk zinc and copper, and vitamins A, C, and E, were examined in a group of 13 mothers delivering at or before 32 weeks gestation. Collections of a total 24-h output were obtained every 7 days for the first 7 weeks after delivery. Concentrations of all micronutrients were similar to those reported previously during the first 5 weeks of lactation. Most striking, however, was the progressive decline in total output as well as concentration of zinc. After the first 2 weeks of lactation, levels of copper and vitamins A, C, and E were not affected by the duration of lactation. There was substantial variation between mothers in daily output of all the micronutrients. The low output of these micronutrients suggests that some attempt should be made at monitoring the mineral and vitamin status of small preterm infants fed exclusively human milk for the first 3 months of life.(ABSTRACT TRUNCATED AT 250 WORDS)     

Terbutaline metered-dose inhalation vs metaproterenol by hand-held nebulization: a comparison in black inner-city COPD patients

A greater percentage of the inner-city black population suffers from chronic obstructive pulmonary disease (COPD) than does the white population in general. Urban black patients are also more likely than urban white patients to receive primary care for their COPD symptoms in area emergency rooms, which can affect the resources available for medical care in these institutions. The present study compared the standard of therapy at Provident Medical Center, metaproterenol, administered by a hand-held nebulizer (HHN), with therapy using terbutaline, administered by a metered-dose inhaler (MDI) with a spacer, in 60 black patients with mild to moderate respiratory distress.     

Bereavement and social support at the climacteric

The relationship between life events and symptoms was examined in a general population sample of Scottish climacteric women within the framework of the concepts and methods developed in the field of life event research. It was found that at least some of the increase in symptoms at that time of life was due to the occurrence of stressful life events. This relationship was a complex one as different types of life events were associated with symptoms in a differential way. In particular, the occurrence of a bereavement involving a close family member and the consequent loss of social support, were found to be significant factors in provoking physical symptoms, but only in the presence of other life stress. These results are discussed in the context of the findings of other life event researchers.     

Time-courses of zones of differential sensory blockade during spinal anesthesia with hyperbaric tetracaine or bupivacaine

The purposes of this study were twofold: to compare bupivacaine and tetracaine spinal anesthesia with regard to the zones of differential sensory blockade and to evaluate the time-courses of the widths of the zones of differential sensory blockade during spinal anesthesia. In 51 patients, the most rostral levels of sensory denervation to light touch, pinprick, and temperature discrimination were measured. There was no statistically significant difference in the height of sensory blockade in the 29 patients given bupivacaine and in the 22 patients given equipotent doses of tetracaine. The widths of the zones of differential blockade were also not statistically different between the two groups during onset, maintenance, and regression of anesthesia, except that the light touch-to-pinprick and light touch-to-temperature zones of differential blockade were greater with bupivacaine than with tetracaine 30 min after subarachnoid injection. The width of the zones of differential blockade also remained unchanged within each group during onset, maintenance, and regression of anesthesia. Changes in, and absolute levels of, blood pressure and heart rate were similar with both bupivacaine and tetracaine throughout. We conclude that zones of differential sensory blockade are essentially the same with tetracaine and bupivacaine, that the widths of the zones of differential sensory blockade remain constant during onset, maintenance, and offset of spinal anesthesia, and that bupivacaine and tetracaine are associated with similar changes in heart rate and blood pressure during spinal anesthesia.     

Experience with epigastric free flap allograft in the rat

We report our continuing experience with the rat epigastric free vascularized flap as a transplant model. Four groups of ten pure-bred rats underwent transplantation of epigastric vessel based skin flaps. The flaps were immediately revascularized in the recipient animal and the results recorded. No immunologic manipulation was performed. Rejection and acceptance of the flaps occurred according to known genetic predictions in these 40 procedures. This study will serve as a control for immunologic manipulation experiments.     

Humoral and cellular immune responses to Onchocerca volvulus infection in humans

Onchocerciasis is one of the major filarial diseases affecting humans and a leading cause of blindness. Control of the disease by chemotherapy and by elimination of the vector is not feasible in most areas of endemicity. The host immune response is thought to play a major role in the pathogenesis of complications. However, there is no clear evidence of protective immunity to reinfection in individuals who continue to be exposed to infective larvae. Antigens of Onchocerca volvulus are complex and show extensive cross-reactivity with other filarial parasites of humans and animals. Infection in humans results in the production of precipitating and reaginic antibodies to the parasite and in increases in levels of immunoglobulins that have no apparent specificity for parasitic antigens. Chronic antigenic stimulation in the presence of an antibody response leads to increased levels of circulating immune complexes. Cell-mediated immunity to parasite-derived antigens, as measured by migration inhibition, lymphocyte blastogenesis, and delayed skin-test reactivity, is decreased during infection. In addition, there is a decrease in delayed skin-test reactivity and in lymphocyte blastogenesis in response to unrelated antigens.     

Immunocytochemical identification of estrogen receptor in ovarian carcinomas. Localization with monoclonal estrophilin antibodies compared with biochemical assays

Estrogen receptor (estrophilin) has been identified in ovarian carcinomas by a variety of physicochemical methods. Since these methods require disruption of the tissue, they do not provide any anatomic information about the cellular distribution and location of receptor. The authors have used monoclonal estrophilin antibodies and an indirect immunoperoxidase technique to study the immunocytochemical localization of estrogen receptor in 43 tissue samples of ovarian carcinoma from 27 patients. The immunocytochemical findings were compared with the results of conventional estrogen receptor assays of cytosolic and nuclear extracts prepared from adjacent pieces of ovarian carcinoma. Exclusively nuclear localization of estrogen receptor was observed with the immunocytochemical technique in all of the 25 tumor samples which had a cytosolic estrogen receptor content, determined by either the dextran-coated charcoal or hydroxylapatite techniques, greater than 700 fmoles/gm wet weight of tissue. Only 3 of 16 tumor samples with cytosolic estrophilin concentrations of less than 700 fmoles/gm wet weight displayed nuclear staining for estrogen receptor; two of these three were metastases from receptor-rich primaries. Specific cytoplasmic staining for estrogen receptor was not observed. These results indicate that many ovarian carcinomas have estrogen receptor, predominantly localized in the nucleus, which is similar to tissues of the female genital tract (vagina, cervix, endometrium, fallopian tube) and breast carcinoma.