Mark A. Mandel

Radial artery cannulation and complications in 1,000 patients: Precautions

A review of 1,000 radial artery cannulations performed over a 2-year period showed that, with careful selection of patients, by means of the Allen test and Doppler studies, and with the apparatus used, only two serious complications were encountered; embolectomy was necessary in one and arterial reconstruction in another. Twenty-four percent of patients had evidence of diminution of flow, but in none did it persist for more than 2 weeks. Critical factors in reducing complications were a short period of cannulation, use of a Teflon catheter, and a continuous arterial line flush system.

Salivary immunoglobulins in patients with oropharyngeal and bronchopulmonary carcinoma

Oropharyngeal cancers are found almost exclusively in patients with histories of smoking and/or ethanolism. This study was designed to determine the relationship between these habits, the secretion of local immunoglobulins, and cancer. The saliva of 260 patients was analyzed for immunoglobulin content. In each patient, IgA was the predominant, often exclusive, immunoglobulin. The mean values of IgA secreted per 15‐min. collection interval for the groups were: 30 normal controls (non‐smokers, non‐drinkers), 0.58 mg (S.D. ± 0.18 mg); 35 smokers, 1.35 ± 0.46 mg; 35 smokers and drinkers, 2.11 ± 0.48 mg; 35 patients with primary oropharyngeal cancer, 2.15 ± 0.65 mg; 35 patients with bronchogenic cancer, 2.11 ± 0.49 mg. Control groups consisting of patients that neither smoke nor drink were studied to determine the effects of non‐related cancer and oral inflammation on salivary IgA. Normal IgA titers were found in 25 patients with cancer of the genitourinary tract. Twenty‐five patients with oral inflammatory conditions exhibited titers comparable to those of the smoking groups. It is concluded that smoking and drinking alter the secretory dynamics of the oropharyngeal salivary glands with resultant increased output of IgA. The highest IgA titers were seen in patients with oral and pulmonary cancers.

Fibrodysplasia ossificans progressiva: A distinctive bone‐forming lesion of the soft tissue

A 3‐month‐old white female presented with a bone‐forming lesion of the soft tissue of the left cheek. Skeletal survey revealed numerous associated radiographic abnormalities, predominantly involving the phalanges. Mineral metabolism and endocrine function were within normal limits. Multiple operations were performed over a 17‐year period for palliation of sequelae arising from inability to open the mouth due to ankylosis of the temporomandibular joint by the progressively ossifying lesion. Histologically, the pathologic material had features resembling those of periosteal grafts, with all stages of membranous bone formation and a tendency for more mature lesions later in the course. The clinicopathologic features are those of fibrodysplasia ossificans progressiva (FOP). The differential diagnosis of this rare condition from other bone‐forming lesions of the soft tissue such as myositis ossificans, extra‐skeletal osteosarcoma and osseous metaplasia is discussed.

Immune competence and diabetes mellitus: Pyogenic human hand infections

An unexpectedly high incidence of diabetes mellitus was found in 12 patients with pyogenic hand infections. Three patients had overt diabetes, four had latent diabetes, and only five were normal when tested after resolution of the acute inflamatory state. Cellular immunity, assessed in five patients by intradermal injections of common antigens and the topical application of the neoantigen, dinitrochlorobenzene, appeared to be grossly normal in all patients. If changes in immunity were present, it is likely that the skin tests were not sensitive enough to detect these alterations.

Immune competence and diabetes mellitus: II. Experimental mouse studies

Abstract An experimental model utilizing congenitally diabetic mice was established to answer the question whether such animals have altered immune responses and ability to ward off infections. Cellular immunity was suppressed in diabetic mice when the parameters of granuloma formation, allograft rejection, and delayed footpad swelling were tested. Spleen cells from diabetic mice grown in tissue culture had an impaired mitogenic response compared to those from control animals. In addition, when diabetic mice were inoculated with the common human intraoral organisms, B-hemolytic streptococcus and Staphylococcus aureus , they could not contain the infection as well as normal littermates. Thus, immune function and infectious control mechanisms appear to be deficient in diabetic mice.

The presence of silicone in breast capsules

The presence of silicon-containing compounds in the capsules of women undergoing secondary surgical procedures has been identified by energy dispersion X-ray analysis. The birefringence and surface configuration qualities have been examined by polarized light-microscopic and electron-microscopic methods. The data indicate that silicone polymer (polydimethyl siloxane) is present both within cells and in the intercellular matrix of the capsule; the source of this material is the silicone gel-filled implant. A histiocytic and foreign-body giant-cell response was found to be associated with the silicon-containing compounds. It remains conjectural whether this chronic response is associated with the pain present in significant breast capsule formation.

Syringe liposculpture revisited

Syringe liposculpture was introduced by Fournier almost a decade ago. Recent advances have improved the technique, making it easier for the surgeon to use. To determine the efficacy of the syringe in reducing morbidity, groups of patients who had between 1200 and 1500 mL of adipose tissue removed were evaluated using different infiltration and power source (syringe vs machine) regimens. There was less blood lost when the syringe was used. In addition, syringe-treated patients appeared to heal faster, return to work in a shorter period of time, and have less pain. The advantages of the syringe technique are considerable and increase the safety factor of the liposculpture procedure.

Blood and fluid replacement in major liposuction procedures.

Major liposuction procedures require considerable fluid resuscitation to make them safe. A simple fluid replacement formula is presented that will estimate crystalloid and blood losses. It takes into account the daily fluid requirement, volume extracted, and the multiplicity of areas treated. Removal of 1500 mL required single-unit autotransfusion while amounts greater than 2500 mL necessitated a two-unit autotrasfusion. These figures must be tempered by the surgeons clinical assessment of each patient. The keys to successful and safe management of the liposuction patient are proper preoperative preparation and adequate fluid replacement.

Salivary immunoglobulins in patients with oropharyngeal or pulmonary cancer

Abstract Patients with head and neck and pulmonary cancer secreted large amounts of IgA in their saliva when compared to both normal age-controlled groups and those with an unrelated (urological tract) carcinoma. The chronic use of alcohol and cigarette smoking habits known to predispose to the development of head and neck neoplasms also resulted in increased salivary secretory patterns. Transient elevation of IgA titres was noted in patients with acute oral inflammatory conditions; after 1 month these titres returned to normal whereas in the cancer group persistence of the high titres was noted. In a group of 50 head and neck cancer patients, only 2 neither smoked nor drank; both had elevated salivary IgA titres. The specificity of this local response, and its relationship to systemic host anti-tumour defences remains to be delineated.

The elimination of graft-versus-host cells from an immune population. A potential tool in cancer immunotherapy

Abstract The treatment of patients with immune deficiency disorders, and those with cancer, by the parenteral administration of viable allogeneic immune cells is of therapeutic significance. Transplantation of immunologically reactive tissue into a nonreactive host may result in a graft-vs-host (GVH) reaction which is often lethal. It would be advantageous if the cells causing this reaction could be eliminated from the total population without removal of cells capable of protecting the host from challenge with other antigens. To this end we examined the distribution of cells mediating GVH reactions and other immunologic activities in an equilibrium sedimentation system capable of fractionating populations of cells. A suspension of spleen cells from Balb/c mice was layered on 17–35% (v/v) discontinuous gradient of bovine serum albumin. After centrifugation at 4°C for 30 min at 10,000 g , the cells distributed in the gradient on the basis of their buoyant density. The activity of cells from each fraction was assayed by the Simonsen spleen weight technique for its ability to cause a GVH reaction. A fivefold concentration of GVH activity, as compared to the uncentrifuged spleen population, was found with some of the fractions. Other fractions were devoid of activity. The total activity for a given number of spleen cells could be accounted for by summing the activity of each of the individual fractions. The administration of the GVH cell fractions into newborn C57B1 mice resulted in a more rapid host death than when equivalent numbers of whole spleen cells were used. On the other hand, an enhanced survival was noted when the fractions from which GVH cells were excluded were injected. It is concluded that this method of immune cell fractionation will be useful in the clinical realm since it might allow elimination of GVH producing cells, as well as permit studies of cellular function with more homogeneous populations than heretofore reported.