Biomedical subjects
Publications and source records attributed to G Walker.
Two patients with squamous cell carcinoma of the breast are described. In one patient the lesion represented a primary breast tumor; in the second, a metastases from primary bonchogenic carcinoma. Neither lesion possessed estrogen receptor protein. This report emphasizes the rarity of epidermoid lesions of the breast and the importance of identifying an extramammary primary source of metastases to the breast.
Plasma prednisolone levels have been measured by radioimmunoassay after oral and rectal administration to healthy volunteers and to patients with idiopathic proctocolitis. The amount of prednisolone absorbed from a 20 mg retention enema given to patients with proctocolitis was about 44% of that absorbed from the same dose orally administered. Adrenocortical response to synthetic ACTH in patients receiving prolonged rectal therapy was either normal, or only slightly impaired, and this may be related to the pattern of steroid absorption rather than to the total amount absorbed.
An investigation was carried out on the effects on hearing aid response of placing the earphone in the earmould rather than in the case of a behind-the-ear hearing aid. Results from a number of physical configurations are reported and discussed and it is shown that it is possible to achieve a considerable reduction in the height of frequency response peaks. On the basis of the research reported some specific recommendations are made about future aid design.
We applied a method previously described for treating cellulsoe acetate gel strips with boron trifluoride in methanol, to make them suitable for isoelectric focusing of proteins, to dry cellulose acetate membranes. The results obtained are shown to compare very favorably. Both wide and narrow pH gradients may be used and coupled either to conventional protein staining or to specific identification by immunofixation. Focusing ordinarily takes 90--120 min, is technically easy, and is economical in the use of ampholytes.
Explore the source record for details and available documents.
The mandibular deficiency syndrome is a constellation of abnormalities, including a spectrum of skeletal, neuromuscular, occlusal, and esthetic conditions. The extremes of this syndrome exhibit different skeletal and esthetic morphology and growth patterns. Different orthodontic and surgical approaches must be considered for optimal functional and esthetic correction in the three different facial types. Differentiation between cases with low, medium, and high mandibular plane angles and knowledge of the growth tendencies will permit different surgical and orthodontic considerations for each of the three basic morphologic types. Predictable functional and esthetic results can then be expected.
The somatomedin activity in synovial fluids from 50 patients with a variety of joint diseases has been studied and compared with the activity in each of the patient's own serum and a standard reference serum (SRS). The porcine costal cartilage bioassay of Van den Brande and Du Caju (1974a) has been used with the isotopes 3H-thymidine and 35S-sulphate. Synovial fluids from most patients with post-traumatic and post-operative effusions, osteoarthritis and arthritis associated with psoriasis, Reiter's disease, and ankylosing spondylitis stimulated the synthesis of DNA and proteoglycans in cartilage. Synovial fluids from patients with rheumatoid arthritis either had impaired capacity to stimulate DNA synthesis, or they inhibited it; a similar, but less evident pattern was observed for proteoglycan synthesis. Some synovial fluids from patients with miscellaneous synovitides stimulated, while others inhibited cartilage metabolism. It is concluded that the synovial fluid from patients with rheumatoid arthritis and from some patients with miscellaneous synovitides contained an inhibitor(s) to DNA and possibly proteoglycan synthesis. The sera from nearly all the patients stimulated both DNA and proteoglycan synthesis, but the somatomedin potency ratios for serum in terms of SRS were generally less than 1.0. There was a significant inverse correlation between the serum somatomedin potency ratio and the age of the patient.
During the past few years greater interest has been shown in ways in which the coverage of health services in developing countries might be increased. Frequently, it has been advocated that greater use be made of mobile health services, often using relatively sophisticated transport systems, including aircraft. The present article examines the uses to which mobility in health services has been put and the merits of different forms of transport, within the resource constraints and health "needs" of Third World countries. Our main conclusions are that for the majority of health service movement appropriate intermediate technology transport should be used (i.e. bicycle, animals, or motorcycles). The use of mechanical transport within health services with the highest benefit per unit cost is likely to be that employed in the regular supportive (not policing) visits to permanently staffed fixed basic care facilities by more highly skilled and scarce health personnel. Those clinics located closer to the regional base can usually be reached more cheaply by land transport, while those at a distance might justify the use of a light aircraft. Where aircraft are used in this supportive role, it is important they are integrated into the ongoing health services and tightly scheduled to lessen the risk of their diversion to less cost-effective activities.
The design and use of a small light portable craniostat is described. Made of clear polystyrene, with adjustable pegs of the same material, the device is small, light, unbreakable and easily portable. It facilitates rapid and stable positioning of skulls in any position for study of photography.
Explore the source record for details and available documents.
The techniques of cost-effectiveness are employed to simplify resource allocation decisions concerned with the use of land and air transport systems in the health services of a developing country. Outcome classifications are produced for patients seen by mobile and fixed primary care units. The mobile services examined were far more costly (8 to 14 times greater) per likely-effective-patient-contact than comparable care delivered from permanently staffed fixed clinics. This was particularly so for the air-delivered service. The disparity in cost-effectiveness was due mainly to the small proportion of patients seen by the mobile services who could be treated effectively in contrast to a far larger proportion at fixed clinics. This was a consequence of the periodic availability of care from the mobile services as against the continuing provision of care at fixed clinics. The main justification for the use of mechanical transport in connection with primary health care is regular supportive (not policing) visits by skilled health workers to rural clinics. Land vehicles are cheaper than aircraft for visiting the more accessible facilities; for the more distant clinics, the cost of journeys by land vehicle are similar to those by aircraft.
Abnormalities of synovial fluid, as a lubricant and nutrient, may have relevance to the causation of certain articular diseases. The somatomedin activity in normal synovial fluid obtained from the knee joint of the ox has been studied and compared with the activity in serum from the same animal. The porcine costal cartilage bioassay of Van den Brande and Du Caju (1974) has been used with the isotopes 35S-sulphate and 3H-thymidine. The mean potency ratio of ox synovial fluid in terms of ox serum for 35S-sulphate incorporation was 0-28 (range 0-19-0-47) and for 3H-thymidine incorporation 0-35 (range 0-21-0-63). A significant correlation was found between the somatomedin activity (as measured by 35S-sulphate incorporation) and the total protein and albumin concentrations in the ox synovial fluids and the ox sera, but there was no significant relationship between the somatomedin potency ratios and the globulin concentrations. The possible relevance of these findings to injury and disease in synovial joint is discussed.
Explore the source record for details and available documents.
The uneven provision of health care in a developing country, Botswana, is examined. Curative out-patient attendance and in-patient hospitalization rates were found to vary markedly for groups of the population living at different distances from health facilities. Those people living 10 miles or less from clinics and hospitals had far higher utilization rates than those living at further distances. If the disparity in service provision described is to be altered then the planning and development of health services should concentrate upon the provision of basic health care and adapt to the manpower and economic constraints within which such systems operate.
Explore the source record for details and available documents.
Islet-cell antibodies (I.C.A.) were found in 38% (319/829) of insulin-dependent diabetic patients, in 5% (6/112) of insulin-independent diabetics, and in 1.7% (3/177) of non-diabetic subjects. In the insulin-dependent group I.C.A. were found in 85% of patients immediately after the onset of symptoms and they became less common as the duration of disease increased I.C.A. were equally common in both sexes and the decline in their prevalence was independent of age. The antibodies were directed against cytoplasmic components of islet cells but not against insulin itself. The appearance of I.C.A. probably follows cell damage occurring before the onset of symptoms. By contrast, thyroid and gastric autoantibodies were more common in older patients and females. There was no correlation between the presence of these antibodies and I.C.A. in patients with either diabetes of recent onset or longstanding disease.
In a random series of 139 insulin-dependent diabetics aged 30 or under at the onset of disease islet-cell antibody (ICA) was detected in 33 cases (24%). In 27 patients who had had diabetes for less than one year 16 (59%) had ICA. Only one out of 51 patients with maturity onset diabetes who were not dependent on insulin were positive for ICA. Four out of 19 patients with late onset insulin-dependent diabetes had ICA. There was no association between the presence of ICA and any particular HLA phenotype. Within families containing two or more HLA haploidentical siblings with juvenile onset diabetes ICA was a variable finding both in its occurrence and in its relation to the duration of disease. A possible mode of action for the HLA-linked gene may be to permit a rapid immunological destructive process, possibly associated with viral infection.
Sera from 54 pairs of identical twins, 29 discordant and 25 concordant for insulin-dependent diabetes, and 11 pairs of concordant non-insulin dependent identical twins were examined for pancreatic islet-cell antibodies (ICAs). ICAs were found in 10 of the 29 diabetic discordant and eight of the 50 concordant twins (difference not significant P greater than 0-05). Six out of nine twins tested within one year of onset of diabetes were positive, whereas nine out of 29 tested after one to 10 years and three out of 41 tested after 10 years were positive. Only one of the 22 non-insulin-dependent twins had ICAs. Repeat ICA testing in five pair of insulin-dependent twins and in the siblings of one pair showed that ICAs may be present in people with normal glucose tolerance' may precede clinical diabetes by several years; and may decline in titre or disappear with increasing duration of disease. Thyroid or gastric autoantibodies, or both, were found in 36 out of 108 insulin-dependent twins and three out of 22 non-insulin dependent twins (difference not significant P less than 0-05). Only four twins had both ICAs and thyrogastric antibodies. There were no significant associations between autoantibodies and HLA histocompatibility types. As ICAs are more common in the diabetic than the non-diabetic twins of the discordant pairs they must be associated with juvenile onset diabetes. ICAs may appear some years before the onset of diabetes, but their prevalence declines with increasing duration of diabetes. The factors determining the production of ICA differ from those for thyroid and gastric autoantibodies.