Biomedical subjects
Publications and source records attributed to J Lloyd.
A 51 year old woman presented with rectal bleeding from a mass lying just above the dentate line. Multiple biopsies were taken before the diagnosis of a benign lymphoid polyp was made. This is a rare condition that more commonly presents in children and poses a diagnostic challenge.
The measurement of urine albumin now has a well-established role in the monitoring of patients with diabetes mellitus. We have developed a particle-enhanced immunoturbidimetric inhibition assay for urine albumin on the Dade aca analyzer. The inhibition approach removes any of the potential antigen excess difficulties that could be expected from the wide clinical range of urine albumin, but retains the sensitivity advantages of latex-enhanced immunoturbidimetry. Human serum albumin (HSA) is covalently attached to 40-nm poly(chloromethyl)styrene-modified latex particles. This reagent, along with monoclonal antibody to HSA, is aliquoted into the aca reagent pack along with polyethylene glycol 8000 in a tablet form (giving a final reaction concentration of 15 g/L). A 150 mmol/L phosphate buffer, pH 7.8, is used to fill the reagent pack in the instrument and the agglutination reaction is monitored at 340 nm. The sample volume is 100 microL and the calibration curve covers the range 2-250 mg/L. Evaluation of commercial scale reagents against the Beckman Array nephelometric immunoassay system gave a Deming regression correlation of aca = 0.87 x Beckman + 8.5, r = 0.995, n = 145. Mean analytical recovery was 104+/-4.5%, n = 20, and there was no evidence of a lack of parallelism. Interassay precision was 8.8% at 10.0 mg/L and <2.5% at >65 mg/L. Calibrator stability was in excess of 60 days. A small reference range study (24-h urine collections, n = 27) gave a mean of 5.6 mg/L with a range of 0.5-16.2 mg/L. Analytical sensitivity (2.5 SD from zero) was 0.40 mg/L.
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We have identified 11 mutational changes in the PAX3 gene in patients with type 1 Waardenburg syndrome (WS1) including three in the paired domain, six within or immediately adjacent to the homeodomain and two previously described polymorphic variants in exons 2 and 6. The affected members of one family carried substitutions involving two base pairs separated by one unaltered codon. Two of the deleterious mutations were identical and three others were identical to previously reported mutations. A comparison of clinical findings in families carrying substitutions in the same codon failed to reveal conspicuous similarities. Although subtle mutation-specific effects may well exist, allelic heterogeneity clearly cannot account for within family variation. However, the striking concordance of a pair of monozygotic twins with Waardenburg syndrome (WS) and previous reports of similar pairs indicate that phenotypic variation in WS has a genetic basis. If the genetic effects are mediated by oligogenic epistasis, as studies in the mouse suggest, it may ultimately be possible to predict clinically relevant aspects of the Waardenburg phenotype.
Outlines the author's experiences and the lessons learnt from work in the field of management training for doctors and other medical personnel. Explains the policy of using a dual approach: economic concepts and ideas in practical situations. States that by adopting this participative, problem-solving approach and involving the discipline of economics in tandem with other skills and subjects, it addresses some of the issues which medical personnel face in their places of work.
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Recombinant factor VIIa (rFVIIa; NovoSeventrademark) was availablefor compassionate use in Australia and New Zealand from 1991 to 1994. Over this period there were 18 treatment episodes in 9 patients, age 8-66 years, with haemophilia A and high titre inhibitors cross-reacting with porcine factor VIII. There were no significant adverse effects. Treatment with rFVIIa resulted in a successful outcome in 8 potentially life-threatening (retroperitoneal, subdural, gastro-intestinal) bleeds. Elective cystoscopy, repair of a cranial flap, yttrium synovectomy and inguinal herniotomy were performed successfully, as was surgical decompression of a flexor pollicis longus bleed. Treatment of a patient with an infected haematoma had limited success, attributed to intermittent suboptimal doses. In 2 patients, satisfactory haemostasis was achieved for multiple dental extractions; subsequent oozing was attributed to suboptimal rFVIIa and/or antifibrinolytic therapy.
With the advent of in vitro immunologic testing, we can now detect exposed individuals who are sensitized to beryllium and those who have chronic beryllium disease (CBD) with lung pathology and impairment. Earlier detection and more accurate diagnostic tools raise new questions about the natural history of sensitization and granulomatous disease. Preliminary data suggest that early detection identifies people who are sensitized to beryllium and that these individuals are at risk for progressing into clinical disease. This article discusses the historical, recent, and ongoing studies germane to our understanding of CBD natural history, including the immunologic and inflammatory basis of the disease, the environmental and host risk factors for disease progression, biological markers of disease severity and activity that may help predict outcome, and the implications for broad-based workplace screening to identify patients at the earliest stages of beryllium sensitization and disease.
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Screening pediatric inpatients for psychosocial dysfunction offers physicians an opportunity to identify emotional and behavioral problems that might otherwise go unrecognized. In this study, the Pediatric Symptom Checklist (PSC), a brief, parent-completed questionnaire, which has been validated in a variety of outpatient settings, was used to screen 98 pediatric inpatients. Results indicated that the PSC can be easily administered in a busy inpatient setting and is well-tolerated by both house staff and patients' parents as a routine part of the admissions process. The percentage of children who screened positive with the PSC in this inpatient setting was similar to the percentages generated by using the PSC in outpatient settings. Routine use of the PSC in inpatient settings serves to heighten house staff awareness of psychosocial concerns and facilitate parent-physician discussion of pediatric mental health issues.
The unsafe use and disposal of injection equipment continues to put patients, health care workers, and the general community at risk of infections such as hepatitis B virus and human immunodeficiency virus. Although the potential for unsafe injection practices varies substantially with the type of equipment that is used, technology alone cannot totally eliminate the risk. A knowledge of the cost, practicality and, most importantly, the potential for misuse, is critical for selecting the most appropriate injection equipment for each immunization setting. Four types of injection equipment are currently available for administering vaccines: sterilizable needles and syringes; standard disposable needles and syringes; autodestruct needles and syringes; and jet injectors. In general, the cost per injection is lowest with sterilizable equipment and highest with autodestruct. However, only autodestruct syringes virtually eliminate the risk of unsafe injection practices. Owing to differences in cost and programme factors, in some settings it may be appropriate to use a combination of equipment. For example, autodestruct syringes may be used in areas where it is difficult to ensure adequate supervision, while in medium-sized, fixed-site clinics with safe injection practices, sterilizable equipment will be the most cost-effective.
The speed of onset of analgesia following intravenous ketorolac, morphine and placebo was investigated in a single-dose, double-blind, randomized, parallel group study of 105 patients. The onset of analgesia was defined as the time at which the pain intensity score reached 50% of the baseline score in 25% of patients. Post-operative patients with moderate or severe pain were dosed and followed for 1 h. Pain reduction by at least 50% occurred in 25% of patients within 40 min (placebo), 15 min (morphine 5 mg), 6 min (morphine 10 mg) and 20 min (ketorolac 10 mg). The pain reduction time for morphine (10 mg) was significantly shorter than that for ketorolac (P = 0.01) or placebo (P < 0.01).
Government action and the advocacy activities that influence it are as important a concern for cancer control as they are for any other public issue. Policy advocacy strategies have proven themselves effective in cancer prevention efforts involving tobacco use and nutrition. Much of what has been learned from this experience can be applied with great effect in advocacy efforts for other cancer control measures. The implementation of Proposition 99, the 1988 tobacco tax initiative in California, illustrates the effectiveness of aggressive policy advocacy strategies such as provocative paid advertising, mobilization through coalitions, and community-level public relations, to bring about government action at all levels of government and in the private sector. Today, largely as a result of these activities, more than 70 of California's 471 cities have a 100% smokefree workplace and/or a 100% smokefree restaurant ordinance, and nearly 300 cities currently have ordinances that restrict smoking pollution and/or restrict youth access to cigarette vending machines. About 150 cities have ordinances that were either adopted or greatly strengthened since 1990 when the program hit the streets. Ironically, although the primary aim of these strategies has been to reduce uptake of tobacco use by adolescents, the program's gains so far--including the reduction in adult smoking prevalence from 26% in 1988 to 20% in 1993, for an estimated savings in 1993 alone of $386 million in direct medical costs in the state--have been the result of adult smokers quitting, especially those older than 50.
The functional and psychological outcome of 43 patients with polyarticular juvenile arthritis was assessed in order to evaluate the impact of disease on their quality of life. Mean disease duration was 19.7 yr (range 10-39 yr), mean age 26.7 yr (range 18-54 yr) with sex ratio 1:3 (male:female). Severe disability was present in 8% of systemic onset, 34% of RF negative (Rh-P), 38% of RF positive (Rh+P) and 86% of extended pauci-articular (ExP) juvenile arthritics-this last high percentage was due to ocular impairment. The Rh+P had more hip (100% of the group) and knee prostheses (31%) compared with Rh-P (77 and 11% respectively). The Rh+P and ExP groups were the most disabled with the highest proportions of patients with currently active disease (85 and 71% respectively). Psychological testing showed that 21% of the patients were clinically depressed and the rate increased (P = 0.06) with the degree of disability. The proportion of patients demonstrating an anxious preoccupation with their disease increased (P = 0.002) with the degree of disability. Despite this, 66% of patients were employed and 38% felt that their arthritis had no effect on their ability to form relationships.
Eight-year-old lychee (Litchi chinensis Sonn.) trees, cv. 'Bengal,' growing in krasnozem soil were subjected to soil water deficit from one month before flowering until harvest by covering the ground with polyethylene sheeting and withholding irrigation. The ratio of daytime stomatal conductance of unirrigated to irrigated trees decreased 20% during the three months of increasing water deficit. Predawn leaf water potentials of irrigated trees averaged about -0.3 MPa throughout the period, whereas they declined progressively to -0.9 MPa in unirrigated trees. Minimum daytime leaf water potential in the unirrigated trees decreased from -1.0 to -1.1 MPa at the beginning of the drought period to -2.2 to -2.4 MPa after three months, and calculated whole-plant conductance did not change with decreasing availability of water. The calculated soil-root water potential declined to less than -1.0 MPa in unirrigated trees. Capacitance effects on the relationship between leaf water potential and transpiration were significant only at low transpiration rates. Although unirrigated trees reduced soil water content at 0-30 cm depths to an equivalent water potential of -1.0 MPa, fruit shedding was significantly less than in irrigated trees. Water deficit had no effect on the fresh weight of pericarp, but caused increased seed size and decreased fresh weight of flesh, resulting in fruit from unirrigated trees being 16% lower in total fresh weight per fruit than fruit from irrigated trees.
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