Screening, ethics and the law.
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Biomedical subjects
Publications and source records attributed to E S Williams.
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A Mycobacterium bovis-infected herd of captive wapiti (Cervus elaphus nelsoni) in Colorado was depopulated after lesions of bovine tuberculosis were confirmed in 8 of 10 tuberculin skin test reactors. Of the 43 animals > 1 year of age, 26 had gross lesions suggestive of tuberculosis, 24 had microscopic lesions of tuberculosis, and 23 had acid-fast bacilli associated with the lesions. Lungs and retropharyngeal lymph nodes were the most frequently affected sites. Most lesions grossly and microscopically resembled tuberculosis in cattle; however, some lesions resembled abscesses or ovine caseous lymphadenitis lesions. Special stains and immunohistochemical techniques labeled few to numerous mycobacteria associated with the lesions.
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1. The effect of 7 consecutive days of strenuous exercise, hill-walking, on water balance and distribution was studied in five subjects. The exercise was preceded and followed by 3 control days. The diet was fixed throughout but water was allowed ad libitum. 2. Packed cell volume was measured daily. Serum electrolytes and arginine vasopressin were measured twice daily. Daily water, sodium and potassium balances were calculated. 3. During exercise there was a fall in packed cell volume, reaching a maximum of 11% by day 5 and a retention of sodium reaching a cumulative maximum of 358 mmol by day 6. During and immediately after exercise there was a retention of potassium, reaching a total of 120 mmol by day 3 after stopping exercise. 4. There was a loss of 650 ml of water on day 1 of exercise, followed by a modest retention reaching a cumulative maximum of 650 ml on day 5 of exercise. 5. Neither arginine vasopressin nor serum electrolyte concentrations were affected by exercise. 6. From the packed cell volume, sodium and water balances it was calculated that by day 5 of exercise there was an increase in plasma volume of .068 litre (22%), an increase in interstitial fluid volume of 2.0 litres (17%) and a decrease in intracellular fluid volume of 1.8 litres (8%). 7. These changes, together with the clinical observation of facial and ankle oedema during the experiemnt, suggest that continuous exercise may cause oedema and thus may be a factor in the aetiology of high-altitude oedema.
In studies concerned with the performance at high altitude it is often not possible to separate the effects which are due to hypoxia from those associated with the stress of ascent. Some of the basic observations concerning exercise at high altitude are reviewed and a study is described which was designed to simulate the physical exertion of high altitude mountaineering but performed at altitudes below 1000 m. Some of the changes observed including peripheral oedema might under other circumstances have been ascribed to altitude.
Between May, 1972 and February, 1978, six cases of paratuberculosis (Johne's Disease) caused by Mycobacterium paratuberculosis were diagnosed in free-ranging Rocky Mountain bighorn sheep (Ovis canadensis) and one Rocky Mountain goat (Oreamnos americanus) on or near Mt. Evans in Colorado. Diagnosis of paratuberculosis was based on gross and histopathologic examination of the animals and by isolation of M. paratuberculosis from three sheep and the goat. The clinical signs and pathologic changes seen in the bighorn sheep resembled those described in cattle, while the lesions in the goat were similar to those described for domestic sheep and goats.
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A variety of new non-invasive imaging techniques are now at the physicians' disposal for patients' management. However, the place of each new imaging modality within the general diagnostic armamentarium is far from established. Not only comparative assessments of these are needed but also pre-defined strategies for use are required for an intelligent approach to a difficult medical problem. The increasing cost of medicine and the decreasing resources available for development enhance the necessity for such an approach. This paper offers an initial solution to the problem.
Observations are presented on the electrocardiogram and plasma catecholamine concentrations of 11 healthy men monitored during two rock climbing ascents. A placebo was administered prior to the first climb and an oral dose of the beta blocking agent oxprenolol ("Trasicor") prior to the second. Mean heart rates were 166 (+/- 20.4 SD) and 120 (+/- 10.2) respectively. Median plasma adrenaline concentrations were 0.05 microgram/1 and 0.33 microgram/1 before and after the climbs following the placebo. No significant difference was observed in the adrenaline concentrations before and after climbing following oxprenolol, or of noradrenaline concentrations on either occasion. These results are interpreted as suggesting that this popular sport represents more an anxiety-type of psychological stress than a physical stress and as such is likely to increase moral fibre rather than muscle fibre.
99mTc-Imidodiphosphonate (99mTc-IDP) was investigated as an agent for nuclear medicine imaging of acute myocardial infarctions. For this purpose a suitable animal model was found. After coronary artery ligation reproducible myocardial infarcts were obtained with 80% of surviving animals. Scans of the myocardial infarcts were recorded with a high resolution gamma camera and good quality images were obtained. 99mTc-IDP ratios for normal and infarcted tissue were calculated and compared with similar data available from other 99mTc-labelled phosphates. With an infarct/normal ratio of 21:1, 99mTc-IDP is so far the best radiopharmaceutical for nuclear medicine imaging of necrosed heart muscle. Images of the myocardial infarcts have been recorded as early as 6 hours after infarction.
99mTc-Imidodiphosphonate was investigated as a new myocardial infarct imaging agent. In the acute phase, 50 patients admitted to the coronary care unit were serially scanned over a period of 7 days. A mobile gamma camera linked on line to a remote data processor was used. Because of higher uptake in infarcted myocardium and faster blood clearance, superior images than those recorded with 99mTc-pyrophosphate were obtained. Its ease of preparation, low cost, and favourable dosimetry (because of its label with conventional 99mTc) transforms this agent into the present radiopharmaceutical of choice for acute infarct imaging in particular if sizing and follow-up is intended versus time and type of treatment. In this series, no false positive cases were seen. The sensitivity of the method in the detection of full thickness myocardial infarction was 95%. It dropped to 70% in the detection of subendocardial infarction. However, some of these apparent false negative cases may reflect severe ischaemia without infarction. It is postulated that this discrimination may not always be realistic.
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