Early outcome of noma surgery.

INTRODUCTION: Reconstructive noma surgery is performed on many short-term medical missions. The treatment outcome, however, has rarely been studied. MATERIALS AND METHODS: We studied complications and clinical outcome of reconstructive noma surgery performed during four short-term medical missions. Logistic regression analysis was used to determine which factors influenced treatment outcome. RESULTS: A total of 74 treatments were performed on 63 patients. We found a complication rate of 64% (n=47) and a success percentage of 59% (n=44). Complexity of treatment procedure and occurrence of complete trismus were independent significant factors negatively influencing the outcome. Only 14 of the 36 complex procedures had a good outcome. CONCLUSIONS: Our study is one of the first to evaluate the early clinical outcome of reconstructive noma surgery in short-term medical missions. It shows that the outcome is not always favourable, particularly in complex reconstructions and in the subgroup of patients with complete trismus.

Human skin dermatan sulfate with sulfated and unsulfated non-reducing ends.

The non-reducing ends of the preponderant dermatan sulfates of adult human skin (DS18 and DS28) can have D-GalNAc, D-GlcA and L-1doA. D-GlcA of DS18 and D-GalNAc of both DS18 and DS28 are sulfated.

Local anesthetic effects in the presence of chronic osteomyelitis (necrosis) of the mandible: implications for localizing the etiologic sites of referred trigeminal pain.

The aims of this study were: (1) to demonstrate how reproducible variations in incomplete anesthesia of the inferior alveolar nerve can be used as a guide to locate the etiologic sites of referred trigeminal pain emanating from the mandible; (2) to describe the salient histopathologic features of a lowgrade, nonsuppurative osteomyelitis seen in this patient population. Forty-six patients with idiopathic facial pain were subjected to a specific protocol of local anesthetic injections to sequentially block branches of the mandibular nerve to determine the effects on his/her pain. If this significantly reduced or altered the pain on three separate appointments, then exploratory surgery was conducted near identified zones of unanesthetized gingiva. Blocking (92%), bridging (4%), and divergence (4%) were observed patterns of anesthetic resistance of the mucogingival tissues used to categorize the incomplete anesthesia. A 100% correlation was found between the identified zones of unanesthetized gingiva and the discovery of intramedullary pathology. Medullary fibrosis with ischemic and degenerative changes in the cancellous bone were common findings, along with chronic inflammatory cell infiltrates and clusters of lymphocytes. It is concluded that Ratner's method of diagnostic anesthesia be implemented when searching for occult pain producing pathology of the jaws.

Hematologic neoplasia associated with primary mediastinal germ-cell tumors.

Between September 1983 and December 1988, we observed 16 cases of hematologic neoplasia associated with mediastinal germ-cell tumors. Twenty-eight similar cases have been reported in the literature. A review of the clinical and cytogenetic details in these patients suggests that the hematologic neoplasia is not the result of cisplatin-based chemotherapy of the mediastinal germ-cell cancer. This syndrome was found only in patients with nonseminomatous mediastinal germ-cell tumors, particularly those with serologic or histologic evidence of yolk-sac elements. The two most common hematologic neoplasms seen in this syndrome were acute megakaryoblastic leukemia and malignant histiocytosis. Consistent cytogenetic abnormalities have not yet been identified, but the finding of the marker chromosome isochromosome (12p) in the mediastinal germ-cell tumor and associated leukemic blasts in one patient suggests that these tumors may arise from a common progenitor cell.

Mixed leukemia, lymphatic and myelomonocytic.

A 76-year-old man who was admitted to the hospital had mixed lymphocytic and myelomonocytic leukemia. A review of the world literature revealed 21 previously reported cases dating from 1906. Most of these patients had initial chronic lymphocytic leukemia with the subsequent development of myeloblastic or monoblastic leukemia. In some patients, development of the second form of leukemia may have been related to prior exposures to ionizing radiation or alkylating agents.

Inhibitory effect of heat-labile serum factors on detection of staphylococcal, pseudomonas, and hepatitis B surface antigens by solid-phase radioimmunoassay.

Specific antibodies have previously been found to impair detection of staphylococcal antigen by solid-phase radioimmunoassay. The inhibitory effect of heat-labile serum factors on the detection of antigen is now described. Heating of serum at 56 C for 30 min prior to addition of antigens of Pseudomonas aeruginosa or Staphylococcus aureus improved sensitivity by eight- to 32-fold. Heating was less effective when performed after addition of antigen. Treatment with zymosan reduced the inhibitory effect of serum, although less effectively than did preheating. Antigen in buffer was detected with 16 times less sensitivity in antibody-coated tubes exposed to fresh serum than in tubes exposed to heated serum. These findings suggest that complement factors can interact with antibody in coated tubes and at least some antigens and thereby inhibit detection of antigen. The finding that heat treatment improved the sensitivity of Ausria II -125 (Abbott Laboratories, North Chicago, Illinois) for hepatitis B surface antigen is of potential immediate clinical applicability.

In vitro functional capabilities of canine polymorphonuclear neutrophils collected simultaneously by continuous-flow centrifugation and continuous-flow filtration leukopheresis.

Polymorphonuclear neutrophils were simultaneously collected from dogs by continuous-flow centrifugation and continuous-flow filtration leukapheresis. In vitro studies were performed on cells obtained by the two methods as well as on control cells. Studies consisted of assessment of phagocytic capacity, degranulation, chemotaxis, hexose monophosphate (HMP) shunt activity, and bacterial killing. The cells obtained from the filter were metabolically more active than those harvested by centrifugation, as evidenced by increase in resting HMP shunt activity and dimunition in total available lysozyme-secreting activity compared to centrifuged cells. Despite their impaired phagocytic capacities, the filtered cells were able to kill Staphylococcus aureus as efficiently as the centrifuged cells. Both cell populations responded to chemotactic gradients equally.

Multiple myeloma and macrogammaglobulinemia. I. Urinary protein excretions and serum interrelationships.

Protein studies measuring selected serum and urinary biopolymers, representing activities of different organ systems, e.g., IgG, IgA, and C'3 complement (reticuloendothelial system), and albumin, transferrin, ceruloplasmin, and alpha-2 macroglobulin (liver) are compared and discussed. Mean normal excretions were 2.91 mg. per 24 hr. for IgG, 2.00 mg. per 24 hr. for IgA, and 20.39 mg. per 24 hr. for albumin. Renal function was estimated using creatinine clearance. The data suggest that concentration variations in certain of the proteins of the plasma pool are related to altered renal function. Such differences strayed below the normal but little, yet significant quantities of these proteins were found in urine. The identification and quantitation of abnormal urinary protein components in urine of patients who have myelomatosis and macrogammaglobulinemia may eventually be useful in medical management.