Calculation of intraocular lens power using the Texas Instruments Ti Programmable 59 calculator.
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Biomedical subjects
Publications and source records attributed to J Little.
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Weekly evaluation of serum antibody activity in IgA, IgM, IgG1 and IgG2 as well as serum IgE levels indicates highly significant reduction in IgE and elevation of IgA in calves experimentally desensitized with Micropolyspora faeni soluble antigen. Serum IgG2, IgG1 and IgM levels were also elevated. Results are discussed in the light of the possible significance of reagin-mediated reactions in initiation of hypersensitivity pneumonitis.
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Histocompatibility antigens have been solubilised from baboon spleen cell membranes by brief exposure to sodium deoxycholate (DOC). Preparations contained a high molecular weight species (DOCH-Ag) excluded by Sephadex G-200, and a low molecular weight species (DOCL-Ag) which eluted in the included fraction (molecular weight 46,000). The low molecular weight antigen was stable and was not sedimented by high speed centrifugation even after dialysis against a low molar salt solution. It elicited a delayed-type hypersensitivity response in sensitised baboons but not in normal animals. DOCL-Ag cultured in vitro with sensitised allogeneic lymphocytes produced a 1.3- to 24.9-fold stimulation, whereas when cultured with normal lymphocytes the maximum stimulation index was 2. Intravenous administration of donor DOCL-Ag (2 mg/kg) at the time of transplantation and without additional immunosuppression significantly prolonged the mean survival time of baboon liver allografts. The same treatment with donor DOCH-Ag did not prolong graft survival.
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Rare, inadvertent injury to the carotid artery during head and neck surgery may result in disastrous neurologic sequelae or even death. Several cases are presented and used as the stimulus for an analytical discussion of the pathogenesis and management of cerebrovascular complications following head and neck surgery. The major pathogenetic mechanisms are identified as (1) microembolism from an ulcerated plaque; (2) intravascular thrombus with occlusion; (3) unintentional ligation, laceration, or transection; (4) ligation of a dominant external carotid; and (5) transient reduction in cerebrovascular perfusion pressure. Methods for identifying and evaluating the patient at risk for developing cerebrovascular complications are discussed and recommendations are made. The central question in the management of inadvertent arterial injury concerns whether to ligate the vessel or to restore blood flow. The controversies surrounding this issue are discussed in perspective through an analysis of current physiological concepts and of the collective clinical experiences of head and neck, vascular, and neurological surgeons handling extracranial cerebrovascular occlusive disease, penetrating injuries to the carotid artery, and tumor-related carotid catastrophes. Several factors are considered critical in determining appropriate management of any individual case; these include (1) whether recognition of the injury occurs intraoperatively or postoperatively; (2) the presence and severity of neurological deficits; (3) time from the injury to its recognition; (4) a quantitative assessment of collateral circulation; (5) a history of wound contamination or radiation therapy; (6) overall prognosis. These and other considerations are organized into a working framework through which the otolaryngologist and head and neck surgeon can better understand and manage the problem of inadvertent injury to the carotid artery.
Values and criteria for abnormality of the eleventh nerve evoked electromyography (EEMG) have been determined. The nerve conduction velocity and duration appear to be relatively consistent from subject to subject. Amplitude of response, while varying significantly from subject to subject, remains relatively constant when the right shoulder is compared to the left shoulder and when a retest is performed.
In humans, associations between germ-cell mutations and hypothetical aetiological factors can be investigated by (1) examining the relationship between the factor of interest and conditions known to be of genetic aetiology; (2) examining the relationship between conditions of unknown aetiology and route of exposure, especially paternal preconceptional exposure. As regards smoking, alcohol and 'recreational' drugs, the first approach has been applied in studies of retinoblastoma, Wilms' tumour and chromosomal anomalies. Only Down's syndrome has received intensive investigation, in relation to maternal smoking during pregnancy; the relative risks would be compatible with there being no association in all recognized conceptuses. The second approach has been applied in studies of sperm quality, miscarriage, congenital anomalies and childhood cancer. The available studies do not show a consistent relationship between smoking and sperm quality; there are few data on the effects of the other exposures. There are a substantial number of studies of childhood cancer and smoking by the father; the majority do not indicate any relationship. Some studies of childhood cancer suggest a positive association with use of 'recreational' drugs by the parents, but it has not been possible to clarify which route of exposure, or the specific type of drug which may be involved. Use of molecular techniques to detect individual genetic changes should enable progress to be made in elucidating the origin of mutation. In the meantime, public health actions are justified on the basis of the known non-genetic effects of these agents.
The epidemiology of mental and behavioural disorders is considered in comparison with spina bifida, chromosomal anomalies and brain tumours. Descriptive epidemiology is important not only in assessing the frequency of neurodevelopmental disorders, thereby aiding planning of service provision, but also because variations by geographical area, over time, and by personal characteristics provide clues regarding etiology. The value of the latter application is exemplified by research on spina bifida and other neural tube defects (NTDs). The descriptive epidemiology of mental and behavioural disorders has been less investigated. The descriptive epidemiology of NTDs suggested that diet might be of etiological importance. Analytical epidemiologic investigation proceeded by testing dietary hypotheses in case-control and cohort studies. Subsequently, folate supplementation was shown to reduce recurrence risk in a randomized controlled trial. The analytical epidemiology of other neurodevelopmental disorders is less well understood. Study design issues are discussed in relation to mental and behavioural disorders.
Up to 80% of people with mental and emotional disorders have abused or will abuse street drugs or alcohol at some point in their lives. Similarly, over half of people with substance use disorders are also diagnosed with a mental disorder at some point. In clinical populations and institutional settings, the numbers are far higher. The term dual diagnosis (coexisting mental and substance use disorders) refers to a large and complex group of people. This article addresses general issues regarding the complexities of dual diagnosis--differential diagnosis, the difficulty of achieving abstinence for people who perceive significant benefits from drug use, and the problems due to the historical split between the mental health and substance abuse treatment systems. Harm reduction, an approach to treating drug-using clients that focuses on the damage done by drugs and alcohol without insisting on abstinence from all psychoactive substances, can offer a useful way of conceptualizing treatment of dual diagnosis. A treatment group specifically designed for dually diagnosed clients is described. This group, inspired by the idea that changes in addictive behavior occur in a series of stages and that motivation can be influenced by the quality of the relationship with the treatment provider, uses a drop-in structure to provide low-threshold access to supportive treatment, to meet clients "where they are."
The aim of this study was to investigate what affect profiling dialysate sodium and ultrafiltration rate had on cardiovascular stability during haemodialysis, and if there was any effect on patients' fluid balance, thirst, serum sodium levels, blood pressure, or comfort and tolerance. The past decade has seen major advances in haemodialysis machine technology. Parallel developments have included profiling dialysate sodium levels and fluid removal during dialysis. However, some dialysis centres do not use profiling due to fears of long-term detrimental effects, especially with regard to hypertension and fluid control. Within my own workplace, approximately 30% of haemodialysis treatments utilise either sodium or ultrafiltration profiling, or a combination of both. Anecdotally, we have seen an increase in cardiovascular stability and haemodialysis tolerance. The aim of this study was to identify the effects of profiling haemodialysis, to ensure that the treatment we offer patients is safe and effective.
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