Vigabatrin-induced optic neuropathy.
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Biomedical subjects
Publications and source records attributed to G O'Connor.
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OBJECTIVES: To compare the incidence and severity of acetabular fractures and associated injuries before and after seatbelt legislation. DESIGN: A retrospective study. SETTING: Two major trauma centres, which are teaching hospitals. PATIENTS: Three hundred and ninety-three patients who sustained acetabular fractures during the 5 years before and 5 years after seatbelt legislation was enacted. Of these, the fractures in 198 patients (50.4%) resulted from a motor vehicle accident. MAIN OUTCOME MEASURES: The number and severity of acetabular fractures and associated injuries. RESULTS: There has been a significant reduction in the number of acetabular fractures (p = 0.005) since seatbelt use became mandatory, and the complexity of the fractures has decreased. There has also been a marked reduction in associated injuries, such as fractures of other bones, and head, chest and abdominal injuries (p < 0.001). CONCLUSION: The seatbelt law has been a useful preventive measure, resulting in a reduction in the incidence of acetabular fractures and associated injuries.
Care of the patient with superobesity requires special precautions and appropriate equipment. Recently, we performed bariatric procedures (modified very-long-limb Rouxen-Y gastric bypass) on patients weighing 355 kg and 377 kg. These procedures required preoperative preparation concerning safe means of transport of the patient, techniques of anesthesia and intraoperative exposure, provisions for postoperative recovery, and measures to assure patient comfort and hygiene postoperatively. In addition to specially designed bariatric procedures for the superobese, specialized equipment is needed to protect the health of the patient and the staff. All health care providers and especially acute care centers must have preconceived protocols to treat the superobese patient. In addition, specialized equipment is necessary to allow safe transport and support of these patients.
Considerable controversy exists in the orthopedic and neurosurgical literature over the true incidence and nature of spinal deformity after multiple-level cervical laminectomy in children. Eighty-nine patients with a mean radiographic follow up of 5.1 years (range 2-9 years) were reviewed. Mean age at surgery was 5.7 years (range 1 month-18 years). Most common diagnoses were Arnold-Chiari malformation, syringomyelia, or both (81%). Significant deformity developed in 46 patients (53%), with 33 developing a mean kyphosis of 30 degrees (range 5-105 degrees) and 13 developing a mean hyperlordosis of 62 degrees (range 40-95 degrees). Peak age at surgery of 10.5 years correlated weakly (P = 0.08) with the development of kyphosis. The development of hyperlordosis was strongly correlated (P = 0.01) with a peak age at surgery of 4.2 years. There was no correlation between diagnosis, sex, location, or number of levels decompressed and the subsequent development of deformity.
Eutectic mixture of local anaesthetics (EMLA) cream with Tegaderm was compared with pre-packaged EMLA patch with regard to analgesic effect, adhesiveness and local reactions during venepuncture in 178 children from three to ten years. One EMLA patch, or half the contents of a 5 g tube of EMLA cream plus Tegaderm was applied to the dorsum of one hand or antecubital fossa for a minimum of 60 min before venepuncture. The subject and observer assessed the degree of pain on a three-point verbal rating scale. The adhesion of the patch vs Tegaderm to the skin and local reactions were recorded. There was no difference between the two groups in pain associated with venepuncture; 95% of the EMLA patch group and 94% of the EMLA cream group reported no or slight pain. There was no difference between the two treatment groups in terms of overall local reactions. The patch was less adhesive (P < 0.001), but this had no apparent influence on its effectiveness. In conclusion, EMLA patch is equivalent to 5% EMLA cream (2.5 g) in cutaneous pain relief when used for venepuncture in children.
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A method is described whereby the packed cell volume (PCV) of a blood sample can be estimated from the haemoglobin concentration. The method defines the relation existing between haemoglobin concentration and the PCV of blood samples and uses the mathematical formula thus obtained to estimate an unknown PCV value for a sample by extrapolation from the known haemoglobin value of the same sample. The method could be used in large scale field studies where haematological services are not available and where an evaluation of red cell status of vitamins such as folate is required.
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Autoimmune thyroid disease (AITD) is often familial and serological HLA disease associations have been described in many different populations. However, such HLA disease associations are weak and the precise molecular contribution of HLA antigens to thyroid disease susceptibility remains unknown. Much of the data available are cross-sectional and few studies have explored familial inheritance of AITD at the molecular level. We have, therefore, examined the inheritance of AITD in multiplex and multi-generational families using restriction fragment length polymorphism (RFLP) analysis of DNA digested with the restriction enzyme BamH1 and probed with a full length human HLA-DQ beta cDNA probe. Thirty seven subjects in 7 informative families were available for study. Eleven subjects had Graves' disease and 4 were diagnosed as having Hashimoto's thyroiditis. Segregation of polymorphic fragments enabled genotyping of each individual to produce fully informative families. LOD scores were computed, using the LIPED program, for dominant and recessive models of inheritance, for recombination fractions of 0.01 to 0.5 for each sex, and for penetrances of 0.1 to 1.0. The results showed that maximum LOD scores were negative for all of the inheritance models tested. If the primary locus for AITD were in the HLA region, LOD scores would be highly positive. These data, therefore, provide strong evidence against a disease locus for AITD in linkage disequilibrium with the HLA-DQ beta locus.
The fact that tonsillectomy (T), or tonsillectomy with adenoidectomy (T & A) or adenoidectomy (A) can be performed safely in selected children on a daycare or outpatient basis is well proven. This article illustrates the approach that the British Columbia Children's Hospital (B.C.C.H.) took to confirm that the procedures were safe locally. A pilot project was started in June of 1984 to perform daycare adenoidectomies only, using two full-time pediatric otolaryngologists. When this proved successful, other otolaryngologists were encouraged to use the program. In June of 1988, a second pilot project was started for daycare tonsillectomies (or tonsillectomy and adenoidectomy). Criteria were established for patient selection, preparation, anesthesia, post-anesthetic recovery (PAR), Daycare Unit (DCU) nursing, and discharge. Follow-up information was obtained. Daycare tonsillectomy with or without adenoidectomy and daycare adenoidectomy are now routine procedures at B.C.C.H.
Despite the fact that preoperative chemotherapy causes substantial necrosis in the primary osteosarcoma tumor, most authorities recommend resecting these lesions with a wide margin of normal tissue to avoid local recurrence. This study evaluated the effect of systemic chemotherapy (doxorubicin) on tumor growth and histology in the MGH-OGS transplantable murine model and examined whether this drug prevents local recurrence after resection of the tumor with positive microscopic margins. The results indicate that doxorubicin caused prolonged cessation of tumor growth, produced substantial necrosis within the lesion, and decreased the risk of local relapse following marginal surgery. The drug effect was dose-dependent and drug efficacy in preventing local relapse was maximal with administration prior to or at the time of surgery.
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Pulmonary function, cigarette smoking, and respiratory symptoms were determined in 3,133 men and women at the 13th examination of the Framingham Study (1972 to 1976). Deaths in the subsequent 10-yr period were identified. Forced expiratory volume in one second and forced vital capacity were standardized for body size by dividing by the square of the height (FEV1/ht2, FVC/ht2). As expected, mean values of these pulmonary function measures were lower in women compared to those in men, older participants compared to younger, smokers compared to nonsmokers, and those with respiratory symptoms compared to those without. In men and women under 70 yr of age and women over 70 yr of age, FEV1/ht2 was inversely related to mortality after adjustment for age, smoking, and respiratory symptoms. In older men, FEV1/ht2 was not related to mortality, but symptoms of dyspnea were associated with increased risk of death.