Biomedical subjects
Publications and source records attributed to A McDonald.
A pilot study evaluating cisplatin in combination with 5-fluorouracil, methotrexate and epirubicin in advanced gastric cancer was initiated. Twenty patients were treated, eight with locally advanced or recurrent disease, and 12 with metastatic gastric cancer. The overall response rate was 35% (95% confidence interval 14%-56%).
Recurrent annular pustular psoriasis over the trunk of an 11-year-old boy followed infantile psoriasis in the napkin area. Etretinate therapy induced a partial remission. The difficulty in distinguishing between annular pustular psoriasis and subcorneal pustular dermatosis of Sneddon and Wilkinson is discussed.
AIMS: To measure the extent and characteristics of cases of duplicate notification of diagnoses of Acquired Immunodeficiency Syndrome (AIDS) between Australia and New Zealand. METHODS: Cases of AIDS notified to the national AIDS registries in both Australia and New Zealand were identified, using date of birth and a name code. Cases determined to have been notified to both registries were analysed with respect to exposure category, country of birth and country of death. RESULTS: Twenty-six cases of AIDS were determined to be common to both registries, representing 1.1% of cases notified to the Australian registry and 11.1% of cases notified to the New Zealand registry. Exposure to HIV was attributed to male homosexual contact for all cases, and a history of injecting drug use was reported more frequently to the Australian registry for the cases in common. For the majority of cases notified to both registries, country of birth was recorded as New Zealand. Deaths following AIDS were reported as occurring in both countries with equal frequency.
Hydrops of the gallbladder is an uncommon condition of infants and children. There is acute distension of the gallbladder in the absence of calculi without evidence of inflammation in the early stages of the disease. A case of hydrops of the gallbladder in a 4-year-old male child is presented. The literature is reviewed and the diagnosis and treatment of the condition discussed.
OBJECTIVE: To further examine the hypothesis that Kaposi's sarcoma (KS) among people with AIDS is caused by a sexually transmissible infectious agent. DESIGN: Analysis of Australian AIDS surveillance data for the period 1982-1991 by sex, age, exposure category, country of birth, year and place of diagnosis. MAIN OUTCOME MEASURES: Percentage of people with AIDS who had KS. RESULTS: In Australia, by November 1991, 17.2% (527 out of 3067) of individuals with AIDS aged > or = 13 years had presented with KS as their AIDS-defining illness: men, 17.6% (524 out of 2977); women, 3.4% (three out of 87) (P < 0.001). KS was predominantly reported in people aged 20-49 years and there were no cases in children < 13 years of age. In general, KS was more common in those who had acquired HIV by sexual contact rather than parenterally. Among people aged > or = 13 years, the proportion with KS ranged from 0.0% (none out of 41) in men with haemophilia to 1 Iford 9.0% (483 out of 2542) in men reporting homosexual contact. Between 1984-1985 and 1990-1991, the percentage of men with AIDS reporting homosexual contact who presented with KS declined from 30% (37 out of 124) to 15% (145 out of 995) (chi 2 for a linear trend, P < 0.001). For men with AIDS reporting homosexual contact, the percentage with KS in New South Wales and Victoria (20.3%) was higher than in the other States and Territories (12.5%) (P < 0.001). New South Wales and Victoria have also reported the highest incidence of AIDS in Australia. CONCLUSION: The epidemiological characteristics of KS among people with AIDS in Australia are broadly consistent with those reported from the United States and Europe. This provides further evidence that KS may be caused by a sexually transmissible infectious agent. The nature of the infectious agent and its mode of transmission have yet to be determined.
A national study was designed to determine computer utilization trends in biomedical art and illustration in North America. In the fall of 1991, 453 surveys were mailed to the Association of Medical Illustrators and the Association of Biomedical Communications Directors; 112 (25%) completed survey forms were returned. The survey compares similarities and differences between the groups with regard to the impact (e.g., staffing, time, cost, and quality control) of computer technology (e.g., hardware, software) on biomedical artwork in the health sciences.
A case of thoracic outlet syndrome (TOS) treated at the University Hospital of the West Indies, Jamaica, is presented. The diagnosis, investigation and management of TOS are discussed.
Vascular malformations (VMs), including haemangioma, of the upper gastrointestinal tract, are rare causes of bleeding. Bleeding from these lesions is often recurrent and diagnosis is often delayed for months to years. A patient with severe, recurrent upper gastrointestinal bleeding requiring repeated hospitalization and blood transfusions is presented. Upper endoscopy, barium meal and small bowel enteroclysis were negative. Selective mesenteric angiography revealed a VM in the second part of the duodenum. Segmental resection of the duodenum was performed and microscopical examination showed cavernous haemangioma. VM should be considered in patients with recurrent gastrointestinal bleeding and negative conventional investigations. Mesenteric angiography may be the only investigation which will identify these lesions. Results after excision are excellent.
The Coronary Artery Risk Development in (Young) Adults (CARDIA) Study developed and implemented quality control (QC) measures to minimize misclassification associated with dietary data. Manual and automated data inspection were used to monitor quality. Of the 5111 participants who completed a dietary history, 717 (14%) had dietary forms reviewed and 153 (3%) had the interview audiotaped. Results show that for the 717 forms reviewed, the overall form completion error rate was 0.22% and the "critical" error rate (i.e., those errors impacting on nutrient computations) was 0.12%. The proportion of forms free of any type of error increased over time (p less than 0.0001). The discrepancy rate in recording and interviewing methods as estimated from the 153 audiotaped interviews was 0.7%. Inter-interviewer differences were small as indicated by the audiotaped interviews and the proportion of error-free forms completed by interviewers. The results indicate that the dietary data collected in CARDIA were completely and accurately recorded for use in analysis.
Vascular disease increases in incidence with age and is the commonest cause of morbidity and mortality among elderly people. Hypertension is associated with hypertrophy of the arterial media. This study was designed to investigate changes in arterial structure that may occur with age independent of blood pressure. Collapsed sections of human mesenteric arteries (external diameter 2-3 mm) were measured using a semi-automatic image analysis system. There was a nonlinear increase in both the wall/lumen area ratio and the relative intimal area with age. There were no significant relationships between blood pressure and either the wall/lumen ratio or the relative intimal area.
Cross-sectional associations between body fat and its distribution and environmental factors influencing energy balance were examined in 5115 young adults. Protein was directly associated with body mass index (BMI) in all race and sex groups (P less than 0.01) after age, education, cigarette-smoking status, alcohol intake, and physical activity were adjusted for. Carbohydrate intake was inversely associated with BMI in males (P = 0.02). Total physical activity was inversely associated with BMI in white women and with skinfold-thickness measures (P less than 0.01) in all groups. Waist-to-hip-circumference ratio (WHCR) was positively associated with total kilojoules (kilocalories) in women, inversely associated with percent of kilojoules (kilocalories) from carbohydrates in whites, grams of crude fiber/4184 kJ (1000 kcal) (except in black men), and physical activity (except in white women). WHCR was directly associated with cigarette smoking except in black men, and with total alcohol intake in men. Beer was consistently associated with WHCR in all race and sex groups.
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A total colectomy and a mucosal proctectomy with ileo-anal anastomosis (c-mp-iaa) effectively removes all debilitating, potentially malignant colonic mucosa. Preservation of the anorectal sphincter predictably results in good to excellent anal continence with a low mortality and acceptable morbidity. Since 1983 at the University Hospital of the West Indies (U.H.W.I.), Jamaica, five (5) patients have undergone c-mp-iaa for colonic mucosal disease. All have good to excellent anal continence with an average of 2-6 continent, formed stools per day. There were no operative deaths. The five (5) cases are described and a plea is made for the earlier use of this definitive surgical procedure where indicated.
A number of methods for categorization of carcinogens, including classification and ranking, have been examined and applied to 13 carcinogenic chemicals. Compounds known to be carcinogenic to humans ranked highly in the ranking systems. The TD50 approach was a satisfactory ranking system. The examination of the classification system of the International Agency for Research on Cancer, and the studies of the ranking systems revealed the importance of considering the underlying mechanisms of carcinogenesis. Some of the important problems of categorizing carcinogens are discussed.
The Coronary Artery Risk Development in Young Adults (CARDIA) study completed baseline dietary assessment, measurement of body mass index, and lipid and lipoprotein analyses on 5,111 participants. CARDIA includes black and white men and women between 18 and 30 years of age at baseline (1985-1986), recruited in Birmingham, Alabama, Chicago, Illinois, Minneapolis, Minnesota, and Oakland, California. Diet was assessed by a detailed interviewer-administered diet history that measured the usual eating pattern over the past month. Possible sex, race, age, and educational differences in diet, body size, and lipids-lipoproteins were explored. Nutrient analyses indicate that the Keys score, a measure of dietary fat composition, is significantly correlated with plasma cholesterol in older (aged 25-30 years) white men (r = 0.12, p less than 0.01) and older white women (r = 0.12, p less than 0.001). In multiple linear regression analyses, body mass index was positively and significantly associated with total cholesterol and low density lipoprotein cholesterol and inversely associated with high density lipoprotein cholesterol across all race-sex groups. The Keys score was significantly associated with total cholesterol and low density lipoprotein cholesterol in white men and women. Education was associated with high density lipoprotein cholesterol in black and white women and white men. In these young adults, dietary fat intake and body mass index were related to blood lipids in certain subgroups. In black and white men and black women, blood cholesterol increased with age across race-sex groups independently of these covariates. In view of the many factors affecting plasma cholesterol and the limitations of the dietary history method, these cross-sectional data are useful in characterizing diet and lipid differences. There appears to be general disparity between recommended dietary intake of total fat, saturated fat, and other nutrients and actual dietary intake in young adults, regardless of age and educational level.
A case of spontaneous rupture of the colon in a previously asymptomatic patient is herein reported. At laparotomy, apart from the tear in the sigmoid colon, no other pathological problem was present. An awareness of the existence of this condition will lead to early diagnosis and management with improved morbidity and mortality.
To meet the objectives for dietary assessment in the Coronary Artery Risk Development in Young Adults (CARDIA) prospective study, we developed a dietary history to provide accurate and reliable quantitative data on habitual individual nutrient intakes at baseline. The CARDIA dietary history was an interviewer-administered method that included a short questionnaire regarding general dietary practices followed by a comprehensive food frequency questionnaire about typical intake of foods using the previous month as a reference for recall. For each broad category of foods, participants were questioned in detail about specific foods only if they indicated that they consumed foods from that category. Follow-up questions for selected foods concerned serving size, frequency of consumption, and common additions to these foods. Provision was made for reporting foods not found in the food frequency list. The interview took approximately 45 minutes. Cue cards prompted responses and plastic food models assisted in estimating usual amounts consumed. A precoded format standardized coding for reported items and established the detail needed for recall during the interview. Baseline nutrient analyses from the CARDIA dietary history provided estimates that agreed reasonably well with expected caloric intake for body mass index according to the age- and sex-specific Recommended Dietary Allowances, but were higher than those reported from 24-hour recalls for comparable age, sex, and race groups in the second National Health and Nutrition Examination Survey. The CARDIA dietary history is a comprehensive assessment tool that can provide a dietitian with detailed information regarding habitual eating patterns and nutrient intakes among adults.
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