James D. Ruskin

Healing following meniscoplasty, eminectomy, and high condylectomy in the monkey temporomandibular joint

The healing of meniscoplasty, eminectomy, and high condylectomy was studied in five Macaca fascicularis monkeys. After five months of healing, no discontinuity defects were found in any of the plicated menisci, and all recontoured bone surfaces had new soft tissue linings. Fibrous adhesions to the adjacent plicated meniscus developed in 62.5% of the recontoured bony surfaces.

Recurrent enlargement of the left maxillary alveolus

Presented is a case report of osteosarcoma of the maxilla in a patient with Pagets disease. This case is unusual because of recurrent benign soft tissue enlargements at the site of eventual malignant disease.

Flow cytometric analysis of squamous cell carcinoma of the tongue

The purpose of this study was to examine the relationship between anatomic location and the cytogenetic and cytokinetic characteristics of squamous cell carcinoma of the tongue to determine the diagnostic and prognostic potential of flow cytometry. Fifty-two archival, paraffin-embedded specimens of squamous cell carcinoma of the tongue in clinical stages I-IV acquired from 1975 to the present were analyzed with an ELITE flow cytometer (Coulter Diagnostics, Opa Locka, FL). Histopathologic grading was performed by the same pathologist based on tumor differentiation. Of the 40 specimens found suitable for analysis, several correlations were noted. First, as the clinical stage increased, the % S-phase increased. Second, there was no correlation between the histologic grade and the % S-phase. Finally, the % S-phase was higher in those tumors with nodal involvement.

Hematologic management of a patient with Fanconi's anemia undergoing bone grafting and implant surgery

Fanconi’s anemia is a rare autosomal recessive disorder characterized by pancytopenia, progressive bone marrow hypoplasia, chromosomal aberrations, and a multitude of congenital anomalies. It was first described by Fanconi’ in 1927 when he reported three brothers with a progressive lethal anemia. Fanconi’s anemia should be differentiated from Fanconi’s syndrome, which is a proximal renal tubular disorder. According to Glanz,2 congenital malformations can affect the skeletal, ocular, auditory, renal, genital, and central nervous systems (Table 1). Affected persons may have anomalies involving any combination of these systems or, in some cases, may have none of these malformations. Because of the variation and number of malformations, it has not been possible to establish precise diagnostic criteria based on a patient’s clinical presentation. The frequency of occurrence of Fanconi’s anemia is estimated to be one in 360,000, but only about 300 cases have been reported in the literature.’ The male to female ratio is reported to be 2: 1 .4 The diagnosis is usually made in the first decade of life, between the ages of 4 and 7 years, with the typical patient dying of bone marrow complications within the first two decades of life. Most patients, however, succumb within 5 years of the onset of anemia. Fanconi’s anemia has been grouped with other inheritable genetic disorders that involve chromosomal aberrations and are known to cause patients to have a

Flow cytometric analysis of posterior oropharyngeal tumors

To date, few studies have evaluated the diagnostic and prognostic potential of flow cytometry in oropharyngeal tumors. The purpose of this study was to evaluate the interrelationship of anatomic location with the cytogenetic and cytokinetic characteristics of squamous cell carcinomas of the posterior oropharynx. Forty-eight paraffin-embedded squamous cell carcinoma specimens from the posterior oropharynx in clinical stages I to IV were analyzed with an Epics-C flow cytometer (Coulter Diagnostics, Hialeah, FL). Histopathologic grading was performed by the same pathologist, based on tumor differentiation. Of the 38 specimens suitable for analysis, several correlations were noted. First, as the %S-phase increased, the clinical stage increased. Second, as the histologic grade increased, the aneuploid frequency increased. Finally, as the tumor size increased, the histologic grade increased. From the results of this study, it was concluded that %S-phase may be useful in assessing the prognosis of squamous cell carcinomas of the posterior oropharynx. DNA index or aneuploid frequency, also may have value as a prognostic indicator. Finally, the lack of correlation between TNM staging and histologic grading stems not from tumor size but from nodal and metastatic involvement. Further studies are warranted to better define the usefulness of flow cytometric analysis in squamous cell carcinomas of the oropharyngeal region.

Posttraumatic facial swelling and draining sinus tract

The patient, a 32-year-old black man with a long psychiatric history, presented to the admitting area of the Omaha Veterans Hospital on May 2, 1990 after allegedly being struck in the face with a baseball bat. He said he had no loss of consciousness, visual changes, headache, nausea, or vomiting. In addition to left facial pain and swelling, the patient also complained of difficulty opening his mouth and a l-cm, fullthickness laceration of his right ear. Although he voluntarily presented to the admitting area with these injuries, he was described as being quite uncooperative, difficult to examine, and requiring the attendance of security personnel. He was subsequently admitted to the general medicine service and an ENT consultation was requested. Physical examination showed moderate left facial swelling over the left maxillary and temporal regions, left temporomandibular joint tenderness, and decreased interincisal opening. Cranial nerve seven was grossly intact. Oral examination showed an intact dentition. A panoramic radiograph and facial series showed normal facial bones, without evidence of fractures or dislocations. The cervical spine series was also normal. The patient refused any type of blood workup. Treatment recommendations were ice to the facial swelling and cleansing of the right ear laceration. On the second day of admission the patient was noted to have expectorated blood-tinged sputum, the cause of which was not determined because the patient decided to leave against medical advice and seek further medical treatment elsewhere. He was discharged with a prescription for oral penicillin, which he never had filled. The patient again presented to the admitting area on May 2 1, 1990 still complaining of left facial swelling, but now with a purulent discharge from a small external opening in the left nasolabial fold. A general surgery consultation was obtained and a diagnosis of buccal space abscess was made. An extraoral incision and drainage was completed without placement of a drain and the patient was given a prescription for penicillin 250 mg orally four times daily. He was instructed