Biomedical subjects
Publications and source records attributed to E Collins.
We report the case of a two year old boy who developed a large tumour on his face. The lesion resembled a pyogenic granuloma clinically and histologically. Viral studies indicated a parapox infection and a bovine source was supported on epidemiological grounds. The lesion was removed by shave excision and the area healed without significant scarring.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Individuals with traumatic spinal cord injury (SCI) are extremely inactive yet little is known about the long-term consequences of chronic inactivity. Current research investigated the concentrations of high density lipoprotein cholesterol (HDLc) and its subfractions HDL2 and HDL3 in 66 extremely sedentary SCI admissions to a rehabilitation center. High density lipoprotein cholesterol is a primary risk factor for cardiovascular disease with decreased levels associated with increased cardiovascular risk. The concentrations of HDLc observed in the SCI sedentary population were compared with 22 olympic caliber wheelchair athletes (SCI athletes) and 126 able-bodied controls. Total HDLc, HDL2, and HDL3 was significantly lower in the male SCI sedentary population (34.2 mg/dl, 8.9 mg/dl, 25.3 mg/dl) than the male SCI athletes (42.7 mg/dl, 13.9 mg/dl, 28.8 mg/dl) or male able-bodied control populations (47.1mg/dl, 11.3mg/dl, 35.8 mg/dl). A similar pattern emerged for the female subjects. The reduction in HDLc seen in the SCI sedentary would predict over a 60% increased risk of heart attack compared to nondisabled controls. The primary difference between the two SCI groups was the level of physical activity, suggesting that this may be an important parameter for elevating total HDLc and HDL2, and presumably decreasing the risk for coronary heart disease. Therefore, physical activity positively affects total HDL and the supposedly antiatherogenic subfraction HDL2 in the SCI patient.
Dean's community mottling index, though a useful summary measure, suffers from the use of arbitrary scores and the inability to describe the frequency in each of the levels of mottling. An alternative statistical approach, based on the proportional odds model, is used here to describe the severity of mottling in a community. The use of this model is demonstrated on prevalence data collected on 16 Texas communities.
The severity of dental mottling in 2,592 school-aged, lifetime residents of 16 Texas communities was investigated in 1980-81 to identify factors associated with mottling and to construct a prediction model for the prevalence of mottling. The communities were selected to obtain a wide range of levels of fluoride in the drinking water. The children within each of the communities were contacted through their schools and received a dental examination to assess the severity of mottling. Information on demographic, dental health practice, and other candidate predictor variables was obtained from a questionnaire completed by a parent. A number of water quality measurements were also recorded for each community. White and Spanish-surname children had about the same prevalence of mottling while Blacks had a higher prevalence, odds ratio (OR) = 2.3, 95% confidence interval = 1.4, 3.7. Children from homes which had air conditioning had a lower prevalence of mottling (OR = .6, (0.4, 0.8)). The use of fluoride toothpaste or drops and the number of fluoride treatments were almost identical among those who did and did not develop moderate mottling. In addition to fluoride, total dissolved solids and zinc were water quality variables associated with mottling.
Forty-three immunocompromised patients with progressive cutaneous herpes simplex virus infections were studied in a double-blind, placebo-controlled evaluation of topically applied acyclovir. Patients were randomized and 22 received acyclovir and 21 placebo; medications were applied four times daily for 10 days. Both study populations were balanced for all demographic characteristics. Acyclovir therapy resulted in no median differences in time to total healing compared with placebo responses, p = 0.13. However, those patients who received the acyclovir ceased shedding virus more rapidly, p less than 0.001, and lost pain more readily, p = 0.04, than placebo counterparts. Neither group experienced adverse effects. Because of the protracted nature of mucocutaneous herpes simplex infections in these patients, the immunocompromised host provides a good model for evaluation of topical antiviral therapy.
A 12-year-old girl, who was later found to have systemic lupus erythematosus (SLE), had a protein-losing enteropathy. Histologic documentation of intestinal lymphangiectasia in the absence of congestive heart failure, retroperitoneal masses, or constrictive pericarditis marks this case as demonstrating a unique association of SLE with intestinal lymphangiectasia.
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Salicylates have been the most widely studied of the nonnarcotic analgesics in pregnancy, and in the last 20 years evidence has accumulated indicating that their ingestion in pregnancy may have adverse effects on the mother and her child. Salicylates have been found to reduce the mean birth weight of the offspring in animal studies and in 1 human study. In the third trimester of pregnancy the maternal and fetal effects are mediated through the antiprostaglandin properties of salicylates and include prolongation of gestation and labor, increased blood loss at delivery, and increased perinatal mortality. Bleeding manifestations and withdrawal symptoms in newborn infants are associated with raised fetal blood salicylate levels. These effects of salicylates warrant routine antenatal urinary screening for salicylates in communities known to use them heavily. Adverse maternal or fetal effects form acetaminophen use in pregnancy have not been reported, but formal clinical or epidemiologic studies of its use have not been conducted.
The patterns of access to primary health care for 27 154 people were examined, using the raw data of the 1974 General Household Survey about self-reported morbidity and use of services. Access rates were calculated for four categories of health: the not ill, the acutely sick, the chronically sick without restricted activity, and the chronically sick with restricted activity. Contrary to the conclusions of existing publications, the analysis shows that the NHS has achieved equity in terms of access to primary health care: there is no consistent bias against the lower socioeconomic groups and, in the case of some health care categories, these have proportionately higher rates of access than their rates of self-reported morbidity would indicate. The findings also show large variations in patterns of access both between and within these categories of health.
Twenty-seven per cent of children (24 out of 90) born consecutively in an inner-city hospital had not completed their primary courses of immunization at the end of the first year of life. Many of the parents of these children had no knowledge of how many doses of vaccine their children required. When 578 schoolchildren aged 12 years were studied, only 40% of these were found to be immune to all three poliovirus serotypes and 12% were not immune to diphtheria. The proportion of children who were not immune to diphtheria varied greatly, and was 24% in one school. The reasons for these low levels of immunity are discussed, and several recommendations are made. It is suggested that a standard immunization record card or book be adopted throughout Australia, and that this card be issued to the newborn child. It is also suggested that consideration be given to the introduction of laws which require that evidence of immunization (or certification of exemption from immunization) be presented at the time of school entry. In the meantime, mopping-up programmes should be conducted in schools where herd immunity is low and a poliomyelitis vaccine (Sabin) booster should be recommended for all children at the age of 12 years.
Ninety-four patients with non-specific lumbar pain referred to hospital rheumatology and orthopaedic clinics participated in a double-blind controlled trial comparing mobilisation and manipulation with placebo physiotherapy. Results were assessed immediately after the tratment course, two months later, and at one year. Many patients showed improvement, but in contrast to a study on general-practitioner patients with nonspecific back pain no definite advantage could be associated with mobilisation and manipulation. The benefits of mobilisation and manipulation for low back pain are probably restricted to hastening recovery in patients likely rapidly to improve spontaneously. Hence patients whose severity and duration of symptoms warrant specialist referral are less likely to benefit from the technique.
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Seventeen patients with thirty-four decubitus ulcers were treated with dextranomer, collagenase, or sugar and egg white. All seven patients in the dextranomer group and two of five patients in the collagenase group improved at the end of the study, but none of the five patients on sugar and egg white treatment improved. Although collagenase can be helpful in the treatment of decubitus ulcers, dextranomer is significantly better.