Biomedical subjects
Publications and source records attributed to I Mackay.
Vidian neurectomy has previously been reported as having a high success rate in alleviating secreto-motor rhinopathies. We report a prospective study of 24 consecutive patients who underwent transnasal vidian electrocoagulation. An overall improvement in symptoms was found in 59.1%. A worsening of overall nasal symptoms was complained of by 27.3%. The possible reasons for this are discussed.
Chlamydia and Legionella are recognized causes of atypical pneumonia. A case of pneumonia due to Chlamydia psittaci/TWAR and Legionella bozemanii following renal transplantation is described. Legionella bozemanii infection was diagnosed by a rise in antibodies and by isolation of the organism from bronchoscopy specimens. It is unusual to find pneumonia caused concomitantly by two such agents. This case, despite the fatal outcome, emphasises the necessity for a comprehensive approach to the diagnosis of atypical pneumonia, including culture for Legionella, especially in immunocompromised patients.
Holmes is concerned with a conflict between law and medicine about the problem of psychopathy, in particular as it relates to homicide. He looks for a consistent set of legal principles based on a variety of medical concepts and in doing so criticises the court for its commonsense approach, its disregard for medical evidence and for employing lay notions of responsibility and illness. This commentary explores how Holmes's notions fit into existing legal rules and explains how the court seeks the assistance of medical evidence when looking at the evidence as a whole to enable it to decide upon issues of defence, which involve legal and not medical concepts.
The renal excretory and haemodynamic responses to sustained moderate exertion were investigated in normotensive humans with impaired renal function and normal volunteers. The heart rate increase with exercise was similar in each group. Subjects with impaired renal function showed a significant fall in glomerular filtration rate on exertion, while normals did not. In the presence of renal disease, urine osmolality did not rise with exertion, although it rose markedly in the normal group. Free water clearance became negative after exercise in the normal group only. The diseased kidney is unable to maintain glomerular filtration rate or conserve water under the stress of exertion as well as the normal kidney.
Statistical methods have been used to determine an optimal approach to the definition of the reference range for CD4 ("helper") and CD8 ("suppressor/cytotoxic") T cell numbers and the CD4/CD8 ratio in the peripheral blood. A graphical presentation of the absolute values for CD4 and CD8 for 85 healthy blood donors showed that a reference ellipse defined by fitting a gaussian distribution to logarithmically transformed data for absolute counts of CD4 and CD8 cells was superior to the fitting of an ellipse to untransformed data. Further analysis for another 147 subjects showed that the 95% tolerance prediction for the CD4/CD8 ratio in health could be stated with 95% confidence as 0.6 to 5.0. This approach allows clear definition of reference ranges for T cell tests in health and would also be applicable to results for patients with a disease such as HIV 1 infection in which a reference range for "well" patients exists and a change in the T cell ratio is of prognostic significance.
Thirty patients with functional and/or morphological abnormalities of respiratory tract cilia were identified. The diagnosis of primary ciliary dyskinesia was based on observed abnormalities of ciliary ultrastructure or beating in vitro (beat pattern, beat frequency or percentage of motile cilia). Beat frequency and motility indices approached the normal range in some cases and suggests that the term 'immotile cilia syndrome' is not appropriate. Morphological abnormalities were most commonly due to deficiency of dynein arms, affecting the outer arms (n = 7), inner arms (n = 3) or both (n = 10). Examples of radial spoke and microtubular defects were also identified but in seven subjects ciliary ultrastructure was normal. In six patients paired samples of nasal and bronchial cilia were obtained and showed consistent abnormalities of motility and ultrastructure. Adenosine triphosphate and adenosine triphosphatase did not restore in vitro motility when added to dynein deficient cilia. The clinical picture was of life-long sinusitis and recurrent bronchial infection but the spectrum was broader than that encompassed by Kartagener's triad (dextrocardia, sinusitis and bronchiectasis). Fourteen patients had normal cardiac situs and definite or highly suggestive evidence of bronchiectasis was present in only 17 patients. Radiological evidence of sinusitis was common but absence of frontal sinuses was not universal. Chronic serous otitis media was a frequent finding but deafness was rarely profound. Fertility problems were common but were not universal in female subjects. Lung function testing revealed evidence of airflow obstruction but this was mild in most cases.
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Twenty-three simple and pathological fractures of the shaft of the humerus were treated by insertion of a Rush pin through the greater tuberosity, without exposing the fracture site. An image intensifier was used during the insertion of the pins. This technique results in few complications with simple fractures, and in pathological fractures relief of pain can be achieved without exposing the fracture site or surrounding soft tissues, which are often diseased.
Using radionuclide methods the relationship between total and central blood volume and left ventricular function was studied in 12 patients with untreated essential hypertension and contrasted with the findings in eight normotensive subjects. The principal findings were of an increased stroke volume and end-diastolic volume with an increase in the ratio of pulmonary to total blood volume in the hypertensive patients. Left ventricular ejection fraction was similar in both groups but end-systolic volume was increased presumably in response to the increased afterload of the ventricle. The increased pulmonary blood volume may be secondary to altered left ventricular mechanics and not a primary determinant of cardiac function.
The effects of synovectomy and excision of the radial head in 40 elbows affected by rheumatoid arthritis have been assessed. In contrast with many reports indicating minimal side-effects of this procedure, a common pattern of deterioration from what was often a satisfactory initial result has been demonstrated. A biomechanical theory of one of the factors responsible for failure has been put forward and the importance of conserving or replacing the radial head emphasised.
A simple, inexpensive and reproducible clinical test for determining abnormal mucociliary clearance is proposed which identifies those patients in whom in vitro study of ciliary motility and mucus properties should be carried out.
A Nose Clinic, run jointly by an ENT surgeon and a chest physician, has been established to consider the relationship between diseases affecting the upper and lower parts of the respiratory tract and the contribution of malfunctioning respiratory defence mechanisms to such disease. The logistics of the clinic are described. Initial results suggest that mucociliary clearance abnormalities, immunity deficiencies and secondary infection in allergic rhinitis underlie a number of conditions presenting to ENT clinics. It is proposed that investigation of such patients leads to a better understanding of the pathogenesis of these conditions and, hence, a more logical approach to both medical and surgical treatment. It is suggested that early recognition and treatment of such underlying abnormalities may avoid irreversible damage.
This paper reports our experience of using the Silastic radial head prosthesis in 18 elbow joints affected by rheumatoid arthritis. There was a varying degree of severity of involvement in 15 of the elbows, and in a further 3 cases replacement was carried out at an early stage of the disease. The 3 cases in whom early replacement was carried out had the best results at follow-up and 11 of the remaining 15 were considered to have a satisfactory overall result. The major benefit of operation has been the relief of pain, even in the late cases, whilst preserving stability of the elbow in all but 3 cases.
A case of closed rupture of the extensor digitorum communis tendon following a fracture of the lower end of the radius with anterior displacement, is described. This rare complication was treated successfully by abductor pollicis longus tendon transfer.
Eighteen patients with marginal depressed or comminuted fractures of the head of the radius, nine of whom had an associated posterior dislocation of the elbow, had a Silastic replacement carried out shortly after injury. After an average follow-up of twenty-six months satisfactory clinical results were observed in seventeen cases; three prostheses broke. The prosthesis has been particularly effective in the group with an associated posterior dislocation of the elbow.
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