Biomedical subjects
Publications and source records attributed to A H Johnson.
Chemical analysis of the livers from four calves with GM1 gangliosidosis was negative for significantly elevated levels of glycosaminoglycans. The chemical findings confirmed morphological studies in which hepatic changes were minimal or absent. The findings were compared with the published evidence for the hepatic storage of glycosaminoglycans in human GM1 gangliosidosis.
The development of behavioral science in a family practice residency has first to be structured around a statement of purpose and adequate goals. These goals can only be implemented when the purely custodial function of the medical profession is rejected and the ethical responsiblity of the physician to society is allowed to direct the role innovations that must be incorporated. It is the person of the physician as a diagnostic and therapeutic tool that must be cultivated. The curriculum presented has included behavioral science conferences, a one-month behavioral science rotation, a two-month orientation program, behavioral science clinical attendings, and a personal counseling program for each resident throughout the three years of training. To be complete, such a program requires the further refinement of behavioral objectives that allow reliable evaluation and redefinition by residents and faculty.
Behavioral science confronts at least three major problems within American medicine that must be overcome if the family physician of the future is to receive an adequate graduate education and maintain his professional integrity. Through increasing specialization, the once unified biological perspective of man was severely fragmented, and with increasing emphasis on the science of medicine, the disease process was objectified and reified. Twentieth century man joined his myth of technological mastery with medicine's desire to eliminate pain and suffering. This gave rise to the idea that life could be medically managed and existential dilemmas anesthetized. To overcome these problems behavioral science has two ethical issues to address in family medicine. First, behavioral science must restore the physician's sense of personhood by recognizing the person of the physician as the primary diagnostic and therapeutic "tool" of family practice. Second, behavioral science must help family practice refocus its professional responsibility on the social problems of the day. This will happen through a critical review of the custodial aspects of the physician's role and an emphasis on role innovation. Approaches to these two ethical issues at the Medical University of South Carolina family practice residency are described.
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Too frequently the behavioral sciences have been conceived as another specialty from which will be derived new techniques to extend the physician's armamentarium. The doctor/patient relationship as well as referrals and consultations have been assumed to be reducible to ritualized protocols and treatments. The personality of the physician and his interpersonal style both with patients and colleagues have often been ignored as being beyond the purview of professional concern. Yet the person of the physician is subject to the influence of colleagues and patients as well as their factual reports. Traditionally, the physician has not received training to allow him/her more objectively to understand the dynamic social processes through which health care planning is formulated, delivered, and received. With such social skills training the physician is in a better position to understand the dynamic processes within the family itself. Both health-care teams and families exhibit similar problems with parental authority, sibling rivalry, differential learning styles, and different career priorities. It is, therefore, essential that an adequate behavioral science program be structured to include learning experiences in which the physician can gain a greater awareness of self, interpersonal style, professional role, and group dynamic processes. Simulated health-care team exercises and encounter groups are two avenues through which such learning can be approached.
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Two cases of rubella are described which caused initial problems in laboratory diagnosis due to abnormal features in the immune response. One patient presented with thrombocytopenic purpura and associated circulating immune complexes. The other patient, who was in early pregnancy, had an unusually prolonged rash and a delayed humoral immune response. The possible reasons for the difficulties in serological confirmation are discussed.
The results of attempts to detect circulating immune complexes in sera by two methods are described. Both rely on the binding of the first complement component (C1) to the complex for its detection. The results, using these methods, of attempts to show which patients have complexes which contain nucleic acid and hence possibly viral antigens in the complexes are discussed. The anti-complementary complexes found in some patients seem to be associated with immune-complex vascular disease.
Bidirectional strong stimulation in one-way mixed lymphocyte cultures (MLC) is reported between an HL-A recombinant and sibling, apparently differing only at the LA or first locus HL-A. The strong MLC reaction may represent a second strong MLR-S locus associated with the LA or first locus HL-A. Alternative explanations are discussed. A second example of a recombinant HL-A haplotype transmitted to progeny is also reported.
This paper analyzes the social boundaries derived from an adequate definition of family practice and family medicine and explores the social dynamics between them and other social institutions and disciplines, More precise objectives for family practice and family medicine are delineated using a model which specifies social targets, methods, and purpose of intervention. Implication for further research in family medicine are discussed as well as their future effect on family practice.
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To evaluate whether immunological enhancement plays a role in adaptation to renal allografts, we studied sera from transplant recipients to determine whether those which suppressed mixed leukocyte culture (MLC) responses in vitro contained alloantibodies reactive with donor cells. Sera from five of nine renal transplant recipients consistently and specifically suppressed autologous autologous MLC responses to donor cells without impairing the blastogenic responses to third-party leukocytes, soluble antigens, or nonspecific mitogenic agents. In three of the five cases the suppressive activity of the serum was striking; in two cases the effect was less marked but still readily demonstrable in studies designed to evaluate the dose of serum which provided optimal suppression of MLC responses. Serum from one of the recipients nonspecifically suppressed blastogenic activity both to donor cells and other stimuli. No alloantibody reactive with donor leukocytes was found in any of the sera which exhibited suppressive activity in MLC, whereas in one patient, serum which contained antibody reactive with donor cells did not suppress MLC response to that donor. These findings suggest that, if the serum factors which suppress MLC responses in vitro are enhancing antibodies, they are not detectable even with very sensitive techniques either because they are present in very low concentrations, belong to immunoglobulin classes other than IgA, IgG, or IgM, or are complexed with donor antigen in such a way that their ability to react with fresh donor cells in vitro is blocked.
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