Biomedical subjects
Publications and source records attributed to E Graham.
All aspects of neurosarcoidosis are reviewed, including cranial nerve palsies, neurophthalmology, intracranial lesions, meningitis, cerebellar ataxia, peripheral neuritis, hypothalamus, myopathy, neurophysiology, cerebrospinal fluid, differential diagnosis and treatment.
Six elderly patients with ocular involvement by Non-Hodgkin's lymphoma are reviewed. The characteristic clinical features were a history of fluctuating vision, findings of decreased colour vision, constricted visual fields, vitreous cells and subretinal infiltrates. Fluorescein angiography revealed pigment epithelial abnormalities and attenuated retinal vessels. Non-invasive investigations produced a definite diagnosis in two patients and a presumptive diagnosis in a further three. The ocular involvement was confirmed by vitreous cytology in only one patient: vitreous biopsies in three other patients yielded chronic inflammatory cells and no evidence of lymphoma. The condition responded poorly to steroids but well to radiotherapy.
A patient is described who presented with visual loss due to infiltration of the optic chiasm by chronic lymphocytic leukaemia. This case demonstrates intracranial infiltration as a primary presentation of chronic lymphocytic leukaemia without lymphoreticular involvement and, to our knowledge, is the first report of a chiasmal syndrome due to this lymphoproliferative disorder.
We prospectively studied 196 consecutive survivors of out-of-hospital ventricular fibrillation (VF) not associated with acute myocardial infarction and 46 consecutive, control patients without prior ventricular arrhythmias. Programmed stimulation included two extrastimuli (S3 protocol) in all patients and three extrastimuli (S4 protocol) in the last 140 study patients and in all control patients. Sustained ventricular tachycardia (VT) or VF was not induced in any control patient. In study patients, logistic regression identified two independent predictors of induced, sustained VT for both S3 and S4 protocols: prior spontaneous, sustained VT (37 patients; p less than or equal to .001) and prior myocardial infarction (113 patients; p = .005). With the S3 protocol, sustained VT was induced in 54% of patients with both prior myocardial infarction and prior sustained VT vs 4% without either; with the S4 protocol, sustained VT was induced in 91% vs 13%, respectively. Eighty-three percent of induced VT episodes had a cycle length less than 300 msec, and all required termination by cardioversion or pacing. VF was induced only in survivors of out-of-hospital VF without prior, spontaneous, sustained VT (S3 protocol, 9%; S4 protocol, 24%) but not in study patients with prior sustained VT (S3, p = .10; S4, p = .05) or control patients (S3, p = .06; S4, p = .01). The mean coupling intervals of extrastimuli that induced VF were not significantly different from the intervals that induced sustained VT.(ABSTRACT TRUNCATED AT 250 WORDS)
A study was designed to evaluate the progress of hospital libraries within Region 7 since the Pacific Southwest Regional Medical Library Services (PSRMLS) began in 1969. Library progress was defined as an increase in extent and types of services and resources offered. The study assessed the impact of Regional Medical Library programs on hospital libraries and compared resources and services reported in 1969, 1971, and 1984. The 1984 data were also measured against a set of core library services and resources that should be provided by a full-service hospital library. In addition to assessing the quality of PSRMLS programs and their effect on Region 7 hospital libraries, the study documented extensive growth in staffing, collection size, and services. PSRMLS programs were highly rated by the respondents, who also indicated that participation in PSRMLS programs improved specific library resources and services.
Four patients with candida endophthalmitis are discussed; three had received prolonged intravenous therapy as well as multiple and varied courses of antibiotics for underlying gastro-intestinal disease; one was an intravenous drug abuser. The visual acuity improved dramatically in two of the five affected eyes but in the remaining three eyes remained at 6/60 or less. Visual prognosis is directly related to early diagnosis and treatment, which should include pars plana vitrectomy and systemic antifungal therapy.
Octanol/aqueous buffer solvent distribution ratio and liquid chromatographic retention in a primarily aqueous phase were determined and correlated to estimated substituent Hansch pi values for a series of 1-methyl-isoguanines. Substituent connectivity values (simple, valence, and bond length) were also computed and factored into the correlation equation between known in vitro activity data and these lipophilic parameters. The liquid chromatographic retention data were best correlated with measured activity accounting for 61% of the variation while distribution ratio and Hansch pi accounted for 56% or 52%, respectively, when each was considered alone. Valence connectivity accounted for 30% of the variation alone but did not add significantly to the equations when factored with the other parameters.
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This paper summarises the principal immunopathological mechanisms which may underlie ocular inflammation and draws attention to how autoimmune reactions may be regulated by idiotypic networks of the immune system. The study of autoimmunity in inflammatory eye disease is illustrated by our current investigations of retinal vasculitis in man and of experimental autoimmune uveoretinitis in rodents where three lines of evidence indicate that immune complex formation may be a compensatory host response to the development of antiretinal autoimmunity. In discussing immunological implications of these results we suggest that retinal inflammation in antiretinal autoimmunity is limited by a protective anti-idiotypic antibody response and that retinal disease arises when this compensatory response is improperly balanced. The clinical implications of this reasoning include the identification of patients at risk of relapse of ocular disease and the development of therapeutic methods for restoring an imbalanced anti-idiotypic autoimmune response towards normality.
The 1982 salary survey of the Medical Library Group of Southern California and Arizona (MLGSCA) indicates that 211 health sciences librarians in Southern California and Arizona earned a mean annual salary of $20,910 for 1982. Data analysis shows a positive correlation between salary and educational level. Other factors found to affect salary were job history, number of positions held, MLA certification, and professional responsibility. Age, gender, and MLA certification did not have a consistent positive correlation with salary. Results indicate that the salaries of hospital librarians are, on the average, roughly comparable to those of academic librarians in Southern California and Arizona.
Intelligence and adaptive behaviour scores of Down's syndrome children were compared with parental educational level, socio-economic indicators, and parental age at birth of the child. IQ and adaptive behaviour scores were positively correlated with parental education and socio-economic indicators. Adaptive behaviour scores of children born to older parents were significantly lower than scores of children born to younger parents.
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Sera from 44 patients with isolated retinal vasculitis (RV), 38 patients with retinal vasculitis accompanying systemic inflammatory diseases (RV + SID), and 33 patients with a similar range of systemic inflammatory diseases without eye involvement (SID alone) were assayed for circulating immune complexes (CIC) and for anti-retinal autoantibodies. CIC were present in 41% of patients with isolated RV and 55% of patients with RV + SID, whilst anti-retinal antibodies were present in about 70% of all patients with RV. 42% of those with SID alone had CIC and 30% of those with SID alone had retinal autoantibodies. Titres of anti-retinal antibodies were higher in patients with RV than in those with SID alone. In isolated RV there was an inverse relation between pronounced retinal autoimmunity and the occurrence of CIC--i.e., the more severe autoimmune retinal disease occurred in CIC-negative patients. Most patients with RV + SID tended to have mild or moderate retinal disease accompanied by both retinal autoantibodies and CIC, but severe retinal disease occurred in CIC-positive patients who did not have circulating anti-retinal antibodies. Patients with SID alone had high titres of retinal antibodies only when they were CIC-positive. It is suggested that the formation of CIC, possibly of an idiotype/anti-idiotype nature, may be a compensatory mechanism accompanying anti-retinal autoimmunity and that an imbalance between autoimmunity and immune complex formation may be an important predisposing factor in the development of retinal inflammatory disease.
In a study to assess the natural history of giant-cell arteritis, 90 patients with proved disease were followed up from the time of diagnosis. Early mortality was low and most commonly due to vertebral arteritis, but cerebral infarction did not appear to be a late complication. High maintenance dose steroids and visual loss were associated significantly with a shortened life span (p=0.0003 and p=0.0024). One-third of the patients developed chronic relapsing disease, but serious late complications were not encountered. After the initial attack has been controlled steroid dosage should be reduced to the minimum needed to alleviate symptoms.
Ninety patients with biopsy proven temporal arteritis have been followed up from 6 months to 12 years. There appear to be two groups of patients who suffer with the disease: those that respond well to treatment and those who follow a chronic course depsite treatment. Serious late complications were not encountered in this series. A high maintenance level of corticosteroids (greater than 10 mg daily) correlates significantly with an increased mortality rate.
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During the first 10 years (1963-74) of a new Medical Ophthalmology Unit, 368 of 3,930 admissions had endogenous uveitis, anterior in 215 (58 per cent.), posterior in 65 (18 per cent.), and generalized in 88 (24 per cent.). Acute uveitis in 153 patients tended to have a short course counted in months, whereas in 215 with chronic uveitis the condition was measured over years, punctuated by relapses. Sex distribution was equal. At the time of initial presentation, 60 per cent. of patients were aged 20 to 40 years, 8 per cent. were under 20, and 10 per cent. were over 60 years of age.