The breath of life: medical technology and the careers of people with post-respiratory poliomyelitis

Abstract This paper examines the impact of medical technology on the careers of people with post-polio respiratory disability. The data have been taken from multiple in-depth interviews with ten people who contracted polio during the epidemics of the early 1950s, all of whom used or had used a variety of methods of mechanical respiratory support. It focuses on ideologies of disability and the adoption of technology, the management of respiratory insufficiency and strategies of'trading off whereby the benefits of technology are maximized and the costs minimized. While technology made an enormous contribution to the quality of life of these people, the problems it created transformed both their experience of the illness and the character of their everyday existence.     

Clinical correlates of changes in self-perceived oral health in older adults

Abstract Although numerous investigators have reported on self-perceived oral health status in adult and older adult populations, few have examined how these perceptions change over time. This paper uses data from a longitudinal oral health survey of community-dwelling Canadians aged 50 years and over to explore this issue. Data were collected at baseline and after 3 years. Change was assessed using a global transition judgement and change scores on four subjective oral health status indicators. These indicators addressed chewing capacity, oral and facial pain symptoms, other oral symptoms, and the psychosocial impact of oral disorders. Overall, 23.0% reported that their oral health had worsened over this period, 66.5% that it had remained the same and 10.5% that it had improved. Change scores on the four indicators showed a similar pattern and were significantly associated with these global judgements. Over the same period, substantial proportions lost one or more teeth, acquired new coronal or root DPS increments or experienced loss of periodontal attachment. An additional 17% complained of dry mouth. However, the only clinical indicator associated with changing perceptions of oral health was tooth loss. Of interest was the fact that rates of tooth loss were equally high among those who reported a worsening of oral health and those who reported an improvement. This suggests that the impact of tooth loss on health status may be positive or negative depending upon the condition of the teeth lost.     

Microdochectomy for single-duct discharge from the nipple

Microdochectomy has been the accepted treatment for single-duct nipple discharge. Review of 97 consecutive patients undergoing microdochectomy between 1980 and 1987 revealed a total of eight patients with ductal carcinoma in situ. All of these had pre-operative mammography, results of which were highly suspicious of malignancy in six patients. Tiny foci of ductal carcinoma in situ were found in the two patients with normal mammograms. We suggest an expectant policy in cases where the mammogram is normal, omitting routine microdochectomy.     

The synthesis and localization of alternatively spliced fibronectin EIIIB in resting and thrombin-treated megakaryocytes

There are several species of alternatively spliced fibronectin (FN). One of these, FN EIIIB, is primarily present in embryonic and in proliferating and migrating cells and is believed to be important for cell maturation. We have studied the synthesis, localization, and secretion of this FN isoform in isolated guinea pig megakaryocytes, nonmegakaryocytic bone marrow cells, and platelets. There was 7.5 times more general FN in megakaryocytes than in nonmegakaryocytic cells based on the analysis of equivalent amounts of protein. FN EIIIB was detected by Western blotting in megakaryocytes but not in nonmegakaryocytic cells present in bone marrow. Neither megakaryocytes nor platelets secreted FN EIIIB, while megakaryocytes secreted 25.3% +/- 4.6% general FN and platelets secreted about 61% general FN in response to thrombin. Analysis of immunostained cells by confocal microscopy revealed that FN EIIIB had been redistributed to the surface of megakaryocytes in response to thrombin. Synthesis was studied by metabolic labeling, and megakaryocytes were shown to synthesize FN and FN EIIIB. Thus, megakaryocytes and platelets are among a small number of adult cells and tissues that synthesize and contain FN EIIIB. The expression of FN EIIIB on the megakaryocyte surface may influence migration and maturation.     

The pathology of posttransplant lymphoproliferative disorders occurring in the setting of cyclosporine A-prednisone immunosuppression.

Posttransplant lymphoproliferative disorders (PTLDs) were diagnosed in 43 patients from the Pittsburgh-Denver series between June 1980 and March 1987. This constitutes a detection rate of 1.7%. Major categories of clinical presentation included a mononucleosislike syndrome, gastrointestinal/abdominal disease, and solid organ disease. The median time of onset in patients initially immunosuppressed with cyclosporine-A (CsA)-containing regimens was 4.4 months after transplant, regardless of tumor clonality. A strong association of PTLD with Epstein-Barr virus (EBV) was observed. A histologic spectrum of lesions from polymorphic to monomorphic was observed. Whereas polymorphic lesions could be either clonal or nonclonal, monomorphic lesions appeared to be clonal in composition. The presence of large atypical cells (atypical immunoblasts) or necrosis did not appreciably worsen the prognosis. Twelve patients had clonal, 13 had nonclonal, and five had both clonal and nonclonal tumors. Clonality was indeterminate in 13 cases. Most patients were treated with a regimen based on reduced immunosuppression and supportive surgery. Almost all nonclonal and about half of the clonal lesions respond to this conservative therapy, indicating that it is an appropriate first line of treatment. This behavior suggests that a spectrum of lesions ranging from infectious mononucleosis to malignant lymphoma constitutes the entity known as PTLD. Some monoclonal tumors can undergo regression, however, apparently in response to host immune control mechanisms. Because of its short latency and strong association with EBV, PTLD is an important model for the study of virus-associated tumor progression in humans.     

Die Gewebsatmung der Froschhaut unter verschiedenen experimentellen Bedingungen,im Vergleich zu anderen Kalt- und Warmblütergeweben

Zusammenfassung 1. Die Atmung der Haut des Winter- und Sommerfrosches wurde im Temperaturbereich von 17,5 bis 42,5° C unter dem Einfluß von 4,6-Dinitro-o-kresol (DNOC) untersucht.2. Sie ist unbeeinflußt und unter DNOC-Einfluß beim Winterfrosch absolut höher als beim Sommerfrosch.3. Unter DNOC-Wirkung kommt es bei allem Konzentrationen, unabhängig von absoluter Steigerung oder Hemmung der Zellatmung, zu einem Maximum der prozentuellen Aktivität bei tiefen Temperaturen und mit Temperaturerhöhung zu einer Verminderung der relativen Aktivität. Dementsprechend ändert sich die Konzentrations-Wirkungsbeziehung mit der Temperatur. Die Aktivierungsenergie () der Hautatmung erfährt unter hohen Konzentrationen von DNOC am Winterfrosch eine leichte Zunahme.4. Die höhere Atmung der Haut des Winterfrosches kann durch die Abhängigkeit der Gewebsatmung von der Körpergröße erklärt werden.5. Die Ergebnisse werden im Lichte der Theorie von Johnson und eigener vorangegangener Untersuchungen über den Einfluß von DNOC auf die Gewebsatmung der Leber homoiothermer und poikilothermer Tiere interpretiert. Es ergibt sich, daß in bezug auf die allgemeine (enzymatische) Aktivitätslage die Froschhaut mehr Ähnlichkeit mit der Leberatmung von Säugern als mit der von Amphibien aufweist.6. Zu den pharmakologischen Reaktionstypen der Zellatmung nach Meier u. Schuler wird Stellung genommen.Mit 4 Textabbildungen     

Blood transfusion and survival in colorectal cancer

PURPOSE: This study examined the effect of blood transfusion on the prognosis of patients undergoing surgery for colorectal cancer. METHODS: Potentially curative resections for colorectal cancer were performed in 266 patients who were followed prospectively, with a minimum follow-up of 41 months. They were divided into transfused (n=121) and nontransfused (n=145) groups according to their perioperative blood transfusion requirements. RESULTS: There were significantly more rectal tumors (χ²=9.5, df=1, P=0.002) and fixed tumors (χ ² =4.5, df=1,P=0.03) in the transfused group. There was no statistically significant difference between the two groups with regard to recurrence-free survival (χ ² =1.1, df=1,P=0.3) and overall survival (χ ² =2.8, df=1,P=0.09). CONCLUSION: In this study we have found no statistically significant effect of perioperative blood transfusion on the prognosis of colorectal cancer patients.