Power to prevent.
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Biomedical subjects
Publications and source records attributed to D Hunter.
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Revascularization of the ischemic diabetic extremity presents a significant diagnostic and technical challenge. The in situ saphenous bypass provides a conduit that allows revascularization to arteries at the ankle and proximal foot. Evaluation of the distal circulation, the adequacy of the saphenous vein, and routine follow-up after bypass, along with the operative procedure, are described. Balloon inflow occlusion arteriography, duplex mapping of the saphenous vein, operative technique, and follow-up protocol are discussed.
In a retrospective case note study, 73 young females with anorexia nervosa were compared with 88 young females with affective psychosis. These groups of patients did not differ in terms of place of residence, birth order or social class. They differed very significantly, however, in terms of age at onset of symptoms, marital status, educational attainments and in the pattern of family histories of psychiatric illness. It is concluded that anorexics and young females with affective disorders are two quite distinct groups of patients.
Cardiac involvement is well recognised in most forms of the mucopolysaccharidoses but there is poor documentation of abnormalities specific to Morquio's syndrome (type IV mucopolysaccharidosis). Ten patients with the classic form or type A Morquio's syndrome with a median age of 12.5 years underwent echocardiographic assessment. Abnormalities were detected in six (60%) cases with mitral valve involvement in five patients and aortic valve disease in four. One patient had severe mitral leaflet thickening to the point of mitral stenosis. Two patients had evidence for myocardial involvement by way of echocardiographic ventricular hypertrophy. The cardiac lesions were haemodynamically mild. A cardiac murmur was audible in only three of the six cases. It is concluded that there is a high prevalence of silent cardiac abnormalities in patients with Morquio's syndrome with predominantly left sided valve involvement. Echocardiography should be part of the assessment of these patients and bacterial endocarditis prophylaxis should be advised for those with cardiac abnormalities.
Experience with thirty-seven patients demonstrating the versatility of the split calvarial graft in facial reconstruction is presented. A total of sixty grafts have been used with no evidence of significant clinical reabsorption, infection, or extrusion; advantages and limitations are discussed. We conclude that the split calvarium represents a readily available and reliable source of membraneous bone for grafting maxillofacial defects with minimal limitations and low morbidity.
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There is growing concern to ensure that the results of health services research reach, and are understood by, those who plan and provide health services. Because of the complexity and variability of services, it is often difficult to translate findings from one setting to another. This paper discusses an attempt to disseminate the findings of one study, Patterns and Pathways of Care of Old People, by visiting local health services on request. The main conclusion is that, for a qualitative study such as this, considerable effort is needed to predetermine which relevant research aspects and local people to bring together to make the exercise useful to either party. If dissemination of National Health Service (NHS) funded research is to be promoted, a central issue to be addressed is who is responsible for initiating and funding this stage. The paper raises a number of options.
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Cystinuria is a rare cause of renal calculi, accounting for about 1 percent of cases. Herein we describe our experience with a series of 10 patients with cystinuria and highlight the particular problems of the use of extracorporeal shock-wave lithotripsy (ESWL) to treat these types of stones and our resultant emphasis on percutaneous techniques.
Buttercup extract (BE), an extract of the buttercup plant (Zanthoriza simplicissima), inhibits RNA and DNA synthesis by HL-60 promyelocytic leukemia cells. Exposure of these cells to 3% BE for 48 hours results in dramatic inhibition of RNA synthesis without loss of cell viability. The effect of BE is partially reversible over 12-24 hours with the level of RNA synthesis returning nearly to control levels during this time period. DNA synthesis is also reversibly inhibited by exposure to BE. Despite the inhibition of RNA synthesis in HL-60 cells, there is no decrease in the level of c-myc mRNA, even at high BE concentrations. The level of gene-specific mRNA for the c-Ha-ras, c-fms, and c-mos genes in these cells also remained constant during exposure to BE. Ribosomal RNA is not degraded during 24 hours of BE treatment in vitro, suggesting that BE does not maintain the relative mRNA level for these genes by selective degradation of other RNA species. The inhibition of RNA and DNA synthesis by BE without a corresponding alteration in the level of expression of the c-myc gene suggests that this agent dissociates c-myc expression and cellular proliferation in these cells.
Studies on the peripheral nerves in rats and other species have helped in the development of laser-assisted nerve anastomosis (LANA), but offer little in evaluating the efficacy of this technique in primates. The authors present a study of LANA in the peripheral nerves of rhesus monkeys. Twelve adult rhesus monkeys underwent bilateral resection of a portion of the peroneal nerve followed by placement of autogenous sural nerve interposition fascicular grafts. The grafts were completed with conventional microsurgical suture technique on one side and with LANA on the other. At 5, 8, 10, and 12 months, the grafted nerves were evaluated for continuity, nerve conduction, and histology (both light and electron microscopy). No significant difference in continuity, conduction velocity, nerve degeneration, nerve regeneration, axon fiber number, or axon fiber density was found in any animal between grafts performed by conventional microsuture and LANA grafts. There was no difference in distal or proximal myelinated fiber density between the LANA grafts and the conventional microsuture grafts. It was concluded that LANA is as effective as microsurgical suture nerve anastomosis in a primate model of nerve repair and grafting.
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We performed percutaneous intrarenal surgery on 22 patients with acquired strictures of various degrees of severity in the region of the ureteropelvic junction. Of 17 patients with strictures through which a guide wire could be passed (type 1) 8 (47 per cent) had good or excellent long-term results. Of 4 patients with strictures that were patent radiologically but through which a guide wire could not be passed (type 2) only 1 (25 per cent) had good long-term results. The patient with a stricture that totally obliterated the lumen (type 3) suffered recurrence. We conclude that percutaneous techniques for the management of acquired strictures in the region of the ureteropelvic junction can be difficult technically and currently are most successful in the treatment of strictures of short duration that occur after pyeloplasty.