Bioethics and prenatal diagnosis of foetal diseases.
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Biomedical subjects
Publications and source records attributed to D Allison.
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Several theoretical studies have suggested that large samples of randomly ascertained siblings can be efficiently used to ascertain phenotypically extreme individuals and increase power to detect genetic linkage. Phenotypes that can be reliably measured by questionnaire are of obvious utility for such selection strategies, as large numbers of individuals can be contacted without laborious individual interview. As the first step in developing a large randomly-ascertained family cohort in southwest England, a sample of 88,000 individuals, including more than 34,000 sibling pairs in 20,000 sibships, was administered the Eysenck Personality Questionnaire (EPQ) by commercial mailing. The sample age ranges were 20-67 years and comprised 59% males and 41% females. Descriptive properties of the EPQ scales are similar to those reported from other large family cohorts. Test-retest correlations on 1681 probands in the sample are substantial for the N-scale (r = 0.93), but somewhat more modest for the other scales (range r = 0.70-0.88). Phenotypic and sibling correlations correspond quite closely to those of twin studies.
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A workshop entitled "Obesity Solutions" was held on January 11, 1996, at St. Luke's-Roosevelt Hospital in New York City and was jointly sponsored by the St. Luke's-Roosevelt Obesity Research Center and the Nestlé R&D Center, Inc., of New Milford, Connecticut. The purpose of the workshop was to bring together experts from the research community and the pharmaceutical and food industries to address the epidemic of obesity in the United States and offer potential solutions. The following is a report of that meeting.
Completed suicides in the city of San Francisco, California, were examined across all ages in the racial groups of Caucasians (n = 798) and Asians (n = 124) from 1987 to 1994. A comparison of Caucasians and Asians showed that there were differences between them in their rates across all age groups. The major findings are: (1) Caucasians predominantly used gunshot to complete suicide whereas Asians predominantly used hanging to complete suicide, (2) Asian women over the age of 85 have the highest rates across both groups and genders, (3) Asians, as compared to Caucasians, used fewer drugs and alcohol at time of death. Theoretical connections between differences in suicide and definition of the self, as influenced by culture, are discussed.
The long-term follow up of 128 colorectal cancer patients is reported. Seventy-nine percent (101/128) of the patients had curative resections: 70 patients had radical lymphadenectomies with wide removal of tumor-adjacent nodes, and 31 patients had standard resections. The 5-year overall survival rates for Dukes' stage B and C patients and for all rectosigmoid cancer patients significantly favored radical resection (60% vs. 38%, 57% vs. 29%, respectively, P < 0.05). Tumor-free survival rates were also higher after radical lymphadenectomy but did not reach statistical significance. Eleven percent (14/128) of the patients required multiorgan resections, and/or preoperative radiation to render fixed cancers resectable, and these patients had a 10-year tumor-free survival rate of 45%, compared to zero % 5-year survival for the 27 patients who underwent palliative procedures (P < 0.01). These results confirm that many colorectal cancer patients will be cured with aggressive treatment and they support the need for a controlled trial for evaluation of lymphadenectomy for this disease.
With increasing numbers of elderly people, and the escalating costs of health care, screening becomes increasingly important for identifying those older people with social health care needs who appear in their primary care physicians' offices. Many people are not aware of available social services. Families with serious social problems are not finding the help they need. The aim of this study was to develop and refine a questionnaire as a screening tool to identify elderly outpatients in primary care settings who are at high risk for psychological, social or environmental needs. This study identified those ten factors at each site which were most indicative that further intervention was needed. There were consistencies among the coordinators across sites in terms of what factors triggered intervention. Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) were more likely to be predictive of the coordinator's intervention than were other factors.
Whirlpool baths are fitted with hydrojet circulation and/or air induction bubble systems. Water in a whirlpool bath, unlike a spa pool, is not filtered or chemically treated but the bath is drained and cleaned between each bather. This is, we believe, the first report of Pseudomonas aeruginosa wound infection associated with the use of a whirlpool bath in a nursing home. Microbiologically confirmed infections with P. aeruginosa of identical antibiotic sensitivity patterns arose in one week in wounds of four of 24 residents who used a whirlpool bath from which P. aeruginosa was also isolated. P. aeruginosa was not isolated from the wounds of a further seven residents who did not use the whirlpool bath. The incident control team advised that use of the whirlpool bath should be restricted to continent residents with intact skin, and that the bath should be cleaned with a degreasing agent and disinfected with hypochlorite between use by individual residents. The hazard of infection posed by whirlpool baths, particularly in nursing homes, needs to be assessed. National guidance for their cleaning, maintenance, and disinfection is required.
We have developed three specific enzyme-linked immunosorbent assay (ELISA) formats which quantitate inhibin A in conditioned media and serum. The assays are sensitive in a range 0.078-5.0 ng/ml and have been characterized in terms of cross-reactivity to inhibin related proteins. The CK:CK assay format recognizes inhibin A, inhibin B and inhibin-related molecules, while the 9A9:CK assay format recognizes inhibin A and inhibin A precursors, but not free alpha-subunit. The 11B5:CK assay appears to recognize only mature 32 kDa inhibin A. Additionally, we have developed separate, specific ELISA formats which quantitate activin A and activin B. The assays have a range of 0.2-50 ng/ml and 0.4-50 ng/ml for activin A and recombinant activin B, respectively. These assays are presently being used to examine the concentration of inhibin A, activin A and activin B in clinical serum samples.
An electrophoretic karyotype has been established for Trichoderma reesei strain QM6a, and several of its derivatives, by pulsed-field gel electrophoresis. All strains examined appear to have seven chromosomes with a total genome size of approximately 33 megabases (Mb). The sizes of the chromosomal bands in strain QM6a are approximately 6.2, 6.0, 5.1, 4.2 (doublet), 3.6 and 3.2 Mb. Genes encoding the cellulase complex and xylanases of T. reesei have been mapped, as have several other genes.
A 15 year old girl with a family history of type 1 multiple endocrine adenomatosis presented with reversible neurological disturbances, hypoglycaemia and hyperinsulinaemia. Initial radiology was normal, but portal venous sampling suggested an insulinoma in the tail of the pancreas which was removed with conservation of the spleen. Hypoglycaemia persisted despite high doses of diazoxide and intravenous dextrose. A second laparotomy revealed a pancreatic endocrine tumour and sub-total pancreatectomy was performed. Histology revealed islet cell microadenomatosis. Hypoglycaemia persisted despite treatment with somatostatin analogues and 40% intravenous dextrose was required to maintain normoglycaemia. A possible lesion near the splenic hilum on computed tomographic scan was reported as a splenunculus although further peripheral, hepatic and portal venous sampling suggested hepatic or systemic lesions. A positron emission scan and selective visceral angiography suggested a lesion in the left upper quadrant. Acute lactic acidosis, rhabdomyolysis and renal failure supervened. Post mortem revealed the putative 'splenunculus' to be a residual insulinoma, whilst the splenic vein was thrombosed, accounting in part for discrepant venous sampling data. Hyperinsulinaemia in type 1 multiple endocrine adenomatosis may require more aggressive surgical and hormonal intervention than when dealing with solitary insulinomas. Insulinomas may mimic developmental abnormalities on computed tomographic scanning.
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A patient presenting with upper gastrointestinal bleeding had two visceral angiograms, the second of which demonstrated the hepatic veins in the late phase of the hepatic arterial injection. This observation led to the correct diagnosis of hepatic telangiectasia with arteriovenous shunting and the suspicion, subsequently confirmed at endoscopy, of similar-lesions in the gastrointestinal tract. Visualisation of hepatic veins in visceral arteriography is unusual but may, as discussed, be normal.
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