Biomedical subjects
Publications and source records attributed to H G Brown.
Dermal eccrine cylindroma, or turban tumour, is a rare benign tumour of the eccrine sweat glands. Despite its histologically benign behaviour, the disease process is distressing for the patients. We present our experience of this condition, with a review of the literature, and recommend a treatment protocol for the disease.
The autopsy has historically served as a critical research and teaching tool in medicine as well as a means to ensure control over the quality of health care. In recent years, however, the autopsy has lost favor among the public and fallen into disuse within the medical community. This paper offers some insights into the reasons behind the decline of the autopsy as viewed by the lay public. Programs to help revitalize use of the autopsy are suggested.
The lens epithelium is essentially the basal layer of the crystalline lens of the eye, an uncommon stratified epithelium. Ions and metabolites present in the aqueous humor gain access to the lens epithelium by diffusion through the lens capsule (the basement membrane of the lens epithelium). Then, it is presumed, the underlying lens fiber cells obtain necessary ions, metabolites, and nutrients through gap junctions conjoining the apical surfaces of the lens epithelial cells from the basal layer with the apical surfaces of elongating fiber cells from upper strata. In this report, correlative morphologic, biochemical, and immunochemical evidence is presented that both lens epithelial and fiber cells use endocytotic and/or transcytotic processes rather than being solely dependent on gap junctions for metabolic cooperation. Freeze-fracture analysis of the apicoapical interface between lens epithelial and elongating fiber cells (epithelial-fiber cell interface [EFI]) revealed protrusions and pits of two distinct sizes (average diameters, 46 and 126 nm). Gap junctions with tight particle packing were only rarely observed at the EFI. Gap junctions with loose particle packing were never observed at the EFI. "Orthogonal arrays" of intramembrane particles (OAPs) were not uncommon at the EFI. Thin-sections taken perpendicular to the EFI confirmed the existence of micropinocytotic and clathrin-coated vesicles in both lens epithelial and elongating fiber cells. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) of separate preparations of lens epithelial and fiber cells, specifically enriched for clathrin-coated vesicles, showed a 180-kD protein. Western blot analysis of this protein revealed selective cross-reactivity with polyclonal anticlathrin antibodies. These results strongly suggest that transcytotic processes provide a primary route for the entry and egress of macromolecules in the lens.
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During the 10 year period between 1974 and 1983, 20 replacement arthroplasties of the proximal interphalangeal joints have been performed in six patients with long standing systemic sclerosis. A recent review of 5 of the 6 patients revealed significant improvement in hand function and appearance, accompanied by a much lower than expected complication rate.
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The common peroneal nerve was transected and repaired by epineurial suture in nine cats. In a further nine the nerve was transected twice and similarly repaired so as to produce a short autograft. Recovery of stretch receptors in peroneus brevis was monitored histologically and physiologically from six to fifty weeks. In recovery after single neurotomy functionally identifiable muscle-spindle and tendon-organ afferents were reduced to 25% and 45% of normal, respectively; after double neurotomy (autograft) both were reduced to about 10% of normal. Muscle spindles were reinnervated with annulospiral terminals, or wholly abnormal fine axon terminals, or both. Recovery evidently entails not only a reduction in number of stretch afferents, but also the making of some incorrect reconnections that presumably result in abnormal proprioceptive feedback and reflex action. When a graft is used the sensory impairment is compounded.
Fifteen dermofasciectomies, the excision extending from the distal palmar crease to the distal interphalangeal crease and carried out to the midaxial line on either side are reviewed, stressing the good take of skin graft in well vascularised fingers. The technique is strongly recommended as the first line of treatment in recurrent digital Dupuytren's contracture.
The lay public's exposure to information on the purposes and value of the autopsy is sparse. When approached for consent to perform an autopsy, they are often indifferent and uncooperative. If the autopsy is worthy of revitalization as the ultimate medical consultation, pathologists must know what the general public is exposed to, what they think, and what their perceptions about autopsy are. There have been mass media and some specialized media contributions during the years 1977 through 1982. I studied the public's areas of concern regarding the topic and detailed the perceptions and unspoken thoughts of laymen. There are steps that can be taken to join the lay community and pathologists together in renewed efforts to revitalize the role of the autopsy while simultaneously educating the public about the advantages and needs of medical education.
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Commercial microcolumns introduced in 1976 by Helena Laboratories ("Hb A2 Quik Column") and by Isolab, Inc. ("Quik-Sep") provide a rapid, simple, accurate method for quantitation of hemoglobin A2 (Hb A2). However, these kits cannot be used for the quantitation of Hb A2 in the presence of slow-moving variants such as Hb S. Recently, Isolab, Inc., produced a new kit ("Quik-Sep Improved Hb A2 Test") for quantitation of both Hb A2 and Hb S. We compared results obtained with the new Isolab kit to results obtained with the original Tris/HCl method for quantitation of Hb A2 and Hb S. Blood was drawn from persons with sickle cell trait (A/S), sickle cell anemia (S/S), sickle cell/beta+ thalassemia (S/beta+ thal) and sickle cell/beta 0 thalassemia (S/beta 0 thal) and percentages of Hb A2 and Hb S were determined by each method. We found no significant differences in Hb A2 percentages by the two methods, and the coefficients of variation were similar. Both methods showed only slight overlap of Hb A2 values from subjects with some form of beta thalassemia and those with A/S or S/S. However, the Tris/HCl method consistently gave values for Hb S that were higher and closer to those expected, suggesting that the Isolab kit does not accurately quantitate Hb S.
A trial was run in the Hand Unit of the Royal Victoria Infirmary, Newcastle upon Tyne, involving sixty consecutive children who has sustained finger tip injuries with tissue loss over a period of three years. The three forms of treatment used in different groups of children were split skin grafting, local flap repair, and a conservative method, with twenty children in each group. The results are compared from both functional and cosmetic points of view and the results analysed.
It is suggested in certain circumstances, that a divided palmaris longus tendon should be repaired, as it is an ideal choice for a tendon graft, or could be of use as a tendon transfer. The musculotendinous unit may be of use as an autogenous free graft.
A series of 170 hands in 152 cases of carpal tunnel decompression presented from the Hand Unit of the Royal Victoria Infirmary, Newcastle-upon-Tyne. Special emphasis is laid on unsatisfactory results of the surgical procedure and their remedy.
A case is presented in which one tendon of the flexor digitorum sublimis was partly replaced by muscle in the palm and there was absence of the associated lumbrical.
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