Biomedical subjects
Publications and source records attributed to A Daly.
A 29 year old expectant mother was critically ill at 27 weeks gestation with disseminated metastatic malignant melanoma and was treated with dacarbazine. A dramatic remission was induced and at 38 weeks gestation she went into labour spontaneously and delivered a healthy infant. She relapsed and died eight weeks post partum. This is the first reported use of dacarbazine in pregnancy.
Lactose and casein synthesis by rabbit mammary explants in organ culture was inhibited when fractions of goat milk were included in the culture medium. Inhibition was dose-dependent, and readily reversed when milk fractions were removed. The pattern of effects obtained with various fractions of milk indicated that inhibition was caused by a protein of 10,000-30,000 Da, which was present in the milk serum or whey fraction. The inhibitor fraction decreased milk accumulation when injected into lactating rabbit mammary glands via the teat ducts, whereas other milk proteins had no effect. Results are discussed in terms of autocrine regulation of milk synthesis through negative feedback by milk constituents.
We conducted a study to review the organization of medical care for the 1984 Los Angeles Summer Olympics, to review the spectrum of illnesses encountered by health care providers, to determine the usage patterns of available services, and to assess the role that physicians and other providers play in special event mass medical care. Recorded medical care provided at Olympic venues with a spectator capacity of more than 10,000 (nine of 28 competitive sites) was reviewed retrospectively. Total attendance at these sites during the 15 days of competition was 3,447,807. Of this population, 5,516 (0.16%) were evaluated on site by RNs or MDs. Only 29% required physician evaluation. Common diagnoses (recorded using International Classification of Diseases code) encountered by physicians were minor musculoskeletal and dermal injuries (25%), heat-related illness (12%), and minor gastrointestinal complaints (8%). Two percent of patients presented with symptoms of cardiac disease, and only eight people required physician care for alcohol or drug ingestion. Ninety-one individuals were transferred to hospitals for further evaluation/care; of these, 22 were transferred for musculoskeletal injury and 18 were transferred for suspected cardiac disease. Usage rates (number of patient visits per 1,000 in attendance at each site) ranged from 0.68 to 6.8, with a mean of 1.6, and were higher at venues with multiple daily sessions, outdoor events, and events at which spectators could move about. We found that the majority of medical problems encountered at major athletic events are musculoskeletal, cutaneous, or of an "environmental" nature. The majority of medical problems encountered in our study were managed by appropriately trained and experienced nonphysician health care providers.(ABSTRACT TRUNCATED AT 250 WORDS)
1. Plasma 25-hydroxy-vitamin D concentration was measured in 40 normal subjects, 19 patients with terminal renal failure, 137 patients who had been on dialysis up to 11 years and in 17 renal transplant patients. 2. The mean plasma concentration of 25-hydroxy-vitamin D was below normal in patients with terminal renal failure and in patients who had been on maintenance haemodialysis for less than 1 year. The mean concentration in patients who had been on dialysis for more than 1 year and in renal transplant patients was normal. 3. The seasonal variation of plasma 25-hydroxy-vitamin D concentration found in the 58 patients on maintenance haemodialysis for more than 2 years is similar to that reported in normal subjects.
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Breast feeding has proven benefits for many infants with inherited metabolic disorders (IMDs) but, with the exception of phenylketonuria, there are few reports in other conditions. A questionnaire, completed by dietitians and clinicians from 27 IMD centres from 15 countries (caring for a total of over 8000 patients with IMDs on diet) identified breast feeding experience in IMD. Successful, demand breast feeding (in combination with an infant amino acid formula free of precursor amino acids) was reported in 17 infants with MSUD, 14 with tyrosinaemia type I, and 5 with homocystinuria. Eighty-nine per cent were still breast fed at 16 weeks. Fewer infants with organic acidaemias were demand breast fed (7 with propionic acidaemia; 6 with methylmalonic acidaemia and 13 with isovaleric acidaemia) (usually preceded by complementary feeds of a protein-free infant formula or infant amino acid formula free of precursor amino acids). Only 12 infants with urea cycle disorders were given demand breast feeds, but this was unsuccessful beyond 8 days in CPS deficiency. Further work is needed in developing guidelines for feeding and for clinical and biochemical monitoring for breast-fed infants with IMDs.
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Insulin resistance and hyperinsulinemia are characteristic features not only of obesity and NIDDM, but are associated with the development of hypertension, hyperlipidemia, and atherosclerosis. DeFronzo et al has used the analogy that insulin resistance can be viewed as a large iceberg submerged just below the water. The physician recognizes only the tips of the iceberg--obesity, diabetes, hypertension, hypertriglyceridemia and low-HDL cholesterol, and atherosclerosis--which protrude above the surface, while the complete insulin-resistance syndrome may be missed. With the recognition that insulin resistance consists of a cluster of nutritional causes and biochemical abnormalities, it is important for the various subspecialties to work together closely to define the mechanism(s) responsible for the defects in insulin-mediated glucose metabolism and to discover effective strategies for prevention and treatment.
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Diabetes mellitus may occur in association with endocrine disorders and is termed "other causes of diabetes" by the American Diabetes Association. Hyperglycaemia results from sustained excessive hormonal secretion, which alters insulin secretion or action. It is characterized by the absence of ketosis because of the persistence of endogenous insulin secretion. Diabetes is usually reversible with successful treatment of the underlying endocrine disorder and the correction of hormonal overproduction. Most important endocrine diseases associated with diabetes mellitus are briefly described and the underlying mechanisms of glucose abnormalities are discussed.
We describe the findings of XYY syndrome in the setting of encountering an individual with this particular condition in the endocrinology clinic. XYY syndrome is a relatively frequent if unfamiliar condition, which is characterized by taller than average height. The extra Y chromosome may play a role in determining the height of these individuals. From this case, a differential diagnosis of tall stature is outlined, in addition to a description of the principal syndromes associated with gigantism. These primarily include Klinefelter syndrome, Marfan syndrome, androgen resistance and growth hormone excess. These various entities are described from the point of view of their symptomatology, biology, pathophysiology and therapeutic characteristics.
Evaluations of toxic potential of drugs and chemicals often involve statistical comparisons of effects between treatment groups. Such comparisons are valid and permit elucidation of spontaneous versus treatment effects only if the sampling population is obtained without selection bias. Selection bias is routinely minimized or controlled by random sampling or unbiased allocation of animals to treatment groups. A systematic approach using a computerized procedure is described that fulfills these requirements in a simple and efficient fashion.