The spread of odontogenic infections to the orbit: diagnosis and management

Four cases of orbital cellulitis following the extraction of maxillary molars are presented. The time interval between dental extraction and development of orbital symptoms ranged from two hours to 13 days. All patients presented with fever, elevated leukocyte counts, and radiologic evidence of acute ipsilateral paranasal sinus infection. In addition, one patient presented with meningitis. Predisposing factors in three patients included nephrotic syndrome with chronic antral inflammation, pregnancy with upper respiratory tract infection, and heroin addiction. Sequelae included empyema and death, severe loss of vision, and blindness with ptosis and exotropia. One patient recovered completely. The anatomic pathways by which dental infection can spread to the orbit are discussed, and general therapeutic considerations are emphasized.     

Homer Wright rosettes in ependymoma

Summary A brain tumor in the fourth ventricle of a 26-year-old woman displayed numerous Homer Wright rosettes by conventional histology, but immunostaining and electron microscopy revealed the tumor an ependymoma. Since the presence of Homer Wright rosettes in ependymoma has not been well appreciated in the past, the diagnostic importance of this finding is discussed.     

Evaluation of the Cockroft-Gault, Jelliffe and Wright formulae in estimating renal function in elderly cancer patients.

BACKGROUND: More elderly patients are being treated with chemotherapy. Reliable and accurate measures of renal function are needed to obtain predictable, safe and effective exposure to renally excreted drugs. The Jelliffe, Cockroft-Gault and Wright formulae have been used to evaluate renal function, although they have not been validated in elderly oncology patients. We performed a retrospective evaluation of these formulae using the [51Cr]-ethylenediamine tetraacetic acid ([51Cr]-EDTA) method of measuring glomerular filtration rate (GFR) as the 'gold standard'. PATIENTS AND METHODS: Inclusion criteria were age > or = 70 years and serum creatinine <250 micromol/l, performed within 4 weeks of glomerular filtration rate (GFR) measurement. Creatinine clearance was calculated using the Cockroft-Gault, Jelliffe and Wright formulae. The precision and accuracy of the three formulae were compared with the gold standard. RESULTS: Two hundred and twenty-five patients were evaluated: median age, 74 years (range 70-89); males, 108; females, 117; median creatinine, 84 micromol/l (range 44-186). Correlation coefficients of the Jelliffe, Cockroft-Gault and Wright formulae were similar. In the specific GFR ranges of 50-70, 70-90 and 90-120 ml/min, the bias [mean percentage error (MPE)] was +8%, -4% and -13%, respectively. The degree of bias was greater with the Cockroft-Gault and Jelliffe formulae across the same range of GFR with the MPE being -15%, -25%, -32% and -12%, -19% and -23%, respectively. All three formulae have reduced precision and greater bias at the extremes of GFR. CONCLUSIONS: The Wright formula is the most accurate, precise and least biased formula for the calculation of GFR in elderly patients with a GFR >50 ml/min. These results allow the physician to make a decision regarding the use of the formula based on an expected degree of bias.     

Autotransfusion in the subhuman primate

In the subhuman primate, autotransfusion of up to four times the calculated blood volume has been achieved with a commercially available system without significant development of microaggregates or pulmonary dysfunction when the animal has been adequately heparinized and maintained normotensive. These findings correlate clinical results achieved in elective autotransfusion carried out with systemic heparinization. Persons subjected to trauma and shock may be more susceptible to platelet aggregation, microembolization, and pulmonary insufficiency. Although these sequelae may occur after autotransfusion, they are not necessarily caused by autotransfusion of even massive proportions.     

Combined multiple-valve procedures: a five-year experience with 125 patients.

One hundred twenty-five patients underwent 128 operations for combined multiple-valve procedures, with an overall early mortality of 16%. Highest mortality was associated with mitral and tricuspid valve disease (28.5%), followed by triple-valve disease (18.2%) and aortic and mitral valve disease (14%). Left ventricular end-diastolic pressure, cardiac index, mean pulmonary artery pressure, pulmonary artery wedge pressure, and arteriovenous oxygen difference were all significantly different in patients with regard to early mortality. Late follow-up of 94% has been achieved in 105 early survivors, with a late mortality rate of 11.2%. Analysis of late functional results reveal that 85% of survivors improved at least one Functional Class. Actuarial 5-year survival of 75% was achieved for early survivors of operation.     

Controlled,semielective, segmental resection for massive colonic hemorrhage

An aggressive diagnostic work-up to determine the site of bleeding was employed in all 25 patients requiring transfusion of over 1,500 cc of blood for colonic hemorrhage in New Haven in 1977 and 1978. A specific bleeding site that permitted segmental colectomy was found in 23 patients (92 percent). The mortality rate was zero, reflecting the rapid improvement in survival that has occurred in the last decade among patients with massive colonic hemorrhage.     

Patterns of Incident Reporting Across Clinical Sites in a Regionally Expanding Academic Radiation Oncology Department

PurposeWe evaluated patterns of event reporting across five clinical locations within an academic radiation oncology department, with the goal of better understanding variability across sites.Methods and MaterialsWe analyzed 1,351 events reported to a departmental incident learning system over 1 calendar year across the five locations with respect to volume of events, event type, process map location of origin and detection, and event reporter.ResultsWe found marked variability in reporting patterns, including reporting rate, event type, event severity, event location of origin and detection within the departmental process map, and discipline of event reporters. These differences relate both to variability in process and workflow (reflected by frequency of specific workflow events at each site) and in reporting culture (reflected by volume or rate of event reporting, and discipline of event reporter).ConclusionsThese data highlight the variability in reporting culture even within a single department, and therefore the need to tailor and individualize safety and quality programs to the unique clinical site, with the long-term goal of achieving a common culture of safety while supporting unique processes at individual locations. This work also raises concern about extrapolating single-institution incident learning system results without understanding the unique workflow and culture of clinical sites.     

滇丹参的生药学研究

滇丹参为云南地区习用药材，来源于Salvia yunnanensis C.H.Wright的干燥根及根茎。对其植物来源，药材性状，显微及理化特征作了研究，为滇丹参药材的鉴别及药材质量标准的规范化研究提供了科学依据。