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Biomedical subjects

J M Lawrence

Publications and source records attributed to J M Lawrence.

At least 73 records · Page 4Linked to original sources

Arthropathies of cystic fibrosis: case reports and review of the literature.

Patients with cystic fibrosis (CF) have demonstrated more arthritides with their longer life expectancy. The most common presentations have been that of an episodic arthritis or a hypertrophic osteoarthropathy. However, other arthropathies have been associated with CF. We now describe 3 new patients with CF and arthritis, and review the types of arthritis that may be found in patients with CF. This report is to increase awareness of the arthropathies that may be found in patients with CF so that proper evaluation, classification, and treatment may be facilitated.

Adult↗

Femoral strut allografts in cementless revision total hip arthroplasty.

One hundred thirteen cases of cementless femoral revision total hip arthroplasty using either cortical strut or proximal calcar allografts were reviewed for radiographic incorporation at an average 4.75 years after operation. All cortical strut grafts were used to supplement the host bone after achieving stable femoral fixation by a tight distal diaphyseal fit. Eighty-seven of the 95 cortical strut grafts showed radiographic evidence of graft incorporation. Eleven of the 18 calcar grafts had resorbed. Complications consisted of eight dislocations, three pulmonary embolisms, two superficial infections, two myocardial infarctions, and two sciatic nerve palsies. When stable distal fixation of cementless femoral prostheses have been achieved, the cortical strut allograft can be readily incorporated into the host femur and augments the host bone structure.

Adult↗

Revision total hip arthroplasty. Long-term results without cement.

The authors present their results for cementless femoral revision arthroplasty using extensively porous coated implants. Patients have been prospectively followed for 5 to 11 years (mean 7.4 years). The revision rate was 5.7%, and the radiographic loosening rate was 1.1%, to give a mechanical failure rate of only 6.9%. As a result of the revision procedure, the pain level was improved for 89.1% of the patients, walking status was improved for 82.8% of the patients, and functional level was improved for 88.5% of the patients. These results compare very favorably with any reports on revision arthroplasty using cement with a similar length follow-up.

Adult↗

Case report of a female-to-male transsexual homicide offender.

A 22 year old female-to-male half-Aboriginal transsexual had been exposed to gross neglect and violence, separation and inconsistent cultural supports during childhood. Her mother had also been convicted of homicide in a context of alcohol and violence. Transsexual identification, antisocial behaviours, self mutilation, substance abuse and unmet dependency needs were evident from childhood or early adolescence. The killing was a confrontational peer group stabbing in a brawl under influence of alcohol--the male mode of homicide. This is the first known case in world literature of a female-to-male transsexual guilty of homicide.

Adult↗

Cultured epithelioid astrocytes migrate after transplantation into the adult rat brain.

A highly purified population of dividing epithelioid astrocytes has been prepared from postnatal rat corpus callosum. These cells were labelled in culture by incorporation of either [3H]thymidine or fluorescent microspheres and transplanted in a fibrin clot into the hippocampi of adult syngeneic rats. Transplanted cells divided in vivo and progressively migrated into the host brain from the site of implantation up to distances of about 1 mm. After a 1-week survival, transplant cells stained strongly for glial fibrillary acidic protein and had the thick sinuous processes characteristic of stellate astrocytes. Artefactual transfer of radiolabel to host cells was ruled out by control experiments in which either the proportion of transplant cells that were radiolabelled was varied or radiolabelled transplant cells were killed prior to implantation. Astrocyte migration over the first days after implantation was determined to occur at a rate of approximately 100 microns per day. Transplant cells moved into both grey and white matter areas of the host brain and over the migratory period were commonly observed to be associated with blood vessels. Some transplant cells were directly juxtaposed against neuronal perikarya and dendrites. Many labelled astrocytes were located in areas that were apparently completely free of damage caused by implantation. These results define a class of mature astrocytic cells that have the ability to migrate through the adult brain. The existence of pathways for cell movement in the adult CNS has implications for the mechanisms of tissue remodelling after injury and transplantation, for regenerative repair of the CNS, and for the dynamics of cell-cell contacts in the normal adult mammalian brain.

Animals↗

Transplantation of postnatal rat enteric ganglia into denervated adult rat hippocampus.

These experiments explore the possible value of the myenteric plexus as a source of donor cells for autografting into the central nervous system. Neurons and glia from 10-12-day postnatal rat myenteric plexus survive for at least one month after transplantation into cholinergically denervated syngeneic adult rat hippocampus. A population of donor cholinergic neurons has acetylcholinesterase-positive processes, but these appear not to innervate host tissue. Host gliosis in response to these implants seems to be less than that seen with other peripheral ganglia, and unlike Schwann cells, the enteric glia form end-feet on brain capillaries.

Acetylcholinesterase↗

Mechanisms of allograft rejection in the rat brain.

Embryonic rat hippocampal primordia from class I and class II major histoincompatible donors were transplanted into the hippocampus of adult rat hosts. The allografts were rejected by a specific host immune response, which was identified by reference to events at a histocompatible hippocampal primordial graft (syngeneic to the host) of similar embryonic age placed simultaneously in the contralateral hippocampus of the same hosts. The present combined light immunohistochemical and electron microscopic study was undertaken to elucidate the mechanism of induction of the immune response by a graft of a tissue which does not constitutively express major histocompatibility antigens, to identify which cells are involved, and how they enter the brain and attack the graft, and to look for possible sources of variability in the outcome of such an attack. Our main findings are (1) that host and graft microglia play a prominent role from the earliest stages, and throughout the evolution of the histological changes, (2) that the later entry of host dendritic cells, lymphocytes, and lymphoblasts (with associated mitoses) into the perivascular cuffs of the graft vasculature ensures that the local immune response becomes self-propagating, (3) that the allografted neurons are killed by host cytotoxic lymphocytes only after a previous encirclement by host macrophage-derived microglial cells, and (4) that the observed variability (especially within different regions of a single allograft) is associated not with failure of immune induction, but with local failure of the graft tissues to express allotypic major histocompatibility antigens. Our observations confirm that once the host immune system has been primed, local factors leading to the induction of transplant major histocompatibility complex antigens make histoincompatible intracerebral transplants of embryonic into adult brain tissue vulnerable to vigorous and effective immune attack. The histological picture of the immune response observed in our intracerebral allografts resembles that described in intraventricular allografts of embryonic brain, in allografts of other organs and tissues such as skin, kidney, and heart, and also that seen in the response to brain autoantigens in multiple sclerosis and experimental allergic encephalomyelitis. However, the involvement of a special cell type, the perivascular microglial cell, in the early stages of immune induction in brain raises the possibility of designing future therapeutic approaches which might selectively block this step in conditions such as multiple sclerosis.

Animals↗

Ciprofloxacin and the fluoroquinolones. New concepts on the mechanism of action and resistance.

Ciprofloxacin, a new fluoroquinolone, is a potent, broad-spectrum antibacterial agent. It rapidly blocks bacterial deoxyribonucleic acid (DNA) replication by inhibiting DNA gyrase, an essential prokaryotic enzyme that catalyzes chromosomal DNA supercoiling. Molecular genetic approaches have been used to study the interaction of 4-quinolones with DNA gyrase from quinolone-sensitive strains and from uropathogenic quinolone-resistant clinical isolates of Escherichia coli. An important mutational locus in the gyrase A gene that confers resistance to ciprofloxacin and other quinolones has been identified, and a new, rapid method to examine clinical isolates for the presence of mutations at this position has been devised. A quinolone resistant gyrA gene has been previously cloned and sequenced from an E. coli clinical isolate. Genetic analysis indicated that resistance resulted from a Ser-83----Trp change in the 875 residue gyrase A protein: two other changes observed in the protein, Asp-678----Glu and Ala-828----Ser, were neutral. GyrA genes carrying these mutations have now been expressed, corresponding mutant gyrase A proteins purified, and their quinolone resistance properties tested by complementing with gyrase B protein and studying the resulting gyrase activity in an adenosine triphosphate-dependent DNA supercoiling assay. The in vitro DNA supercoiling activity of the A (Ser-83----Trp) mutant subunit complemented with wild-type gyrase B subunit was highly resistant to ciprofloxacin and other 4-quinolones. In contrast, A subunit carrying codon 678 and 828 changes reconstituted a quinolone-sensitive gyrase activity. Thus, quinolone-resistant gyrase A proteins may be readily obtained for study by using high-copy gyrA plasmids. In addition, other quinolone-resistant strains of E. coli have been examined for the presence of mutations at gyrase A codons 82 and 83 using a new analytical method based on a restriction fragment length polymorphism (RFLP). This analysis revealed that seven of eight resistant clinical isolates of E. coli examined carried gyrA mutations at codon 82 or 83, whereas five sensitive strains appeared to possess wild-type sequence. Thus, mutations at codon 83 (and possibly 82) in the gyrA gene frequently confer resistance to 4-quinolones, including ciprofloxacin. The RFLP method described should prove useful in examining strains for such mutations. These results are discussed with regard to the mode of interaction of the 4-quinolones with gyrase.

Anti-Infective Agents↗

Stress problems in the medical profession.

Doctors are renowned for denial of illness in themselves and often do not respond in the most helpful way to signs of distress in colleagues. As a result, doctors and their families may get second class treatment, especially for stress related problems. Why is this so? How may stress affect doctors? How can we help?

Depression↗

Visualization of migration of transplanted astrocytes using polystyrene microspheres.

Fluorescent polystyrene microspheres have been used to mark rat astrocytes for transplantation. Highly fluorescent cells were generated by incorporation of microspheres over periods of the order of 10 h. Microspheres ranging in average diameter from 50 to 200 nm and derivatized with either rhodamine or fluorescein have been used to label cells. There were no apparent cytotoxic effects of microsphere incorporation. Loaded astrocytes retained their complement of microspheres over periods of at least several weeks. The microspheres could be visualized in the transmission electron microscope. They were most likely phagocytosed by a coated-pit mechanism and accumulated in various types of lysosomal vesicles. Labelled astrocytes from neonatal PVG rats were implanted stereotaxically (as a plasma clot) into hippocampi of recipient syngeneic adult rats. Donor cells migrated from transplant to host over about 7 days. Transplant cells tended to be close to blood vessels over this period. Their location in paravascular spaces was determined from observation of microsphere-bearing cells in electron microscopy. Microsphere-loading of astrocytes is a simple method for marking cells for extended periods of time for transplantation which allows direct identification of marked cells with both fluorescence and electron microscopes.

Animals↗

Increased activity and phase delay in circadian motility rhythms in geriatric depression. Preliminary observations.

Locomotor activity levels and rhythms of eight hospitalized geriatric unipolar depressed patients (DSM-III criteria) were compared with those of eight healthy elderly controls in a similar environment. Activity was measured using a wrist-worn electronic activity monitor with solid-state memory. Depressed patients had a 29% higher mean total 24-hour activity level, with no change in circadian amplitude or frequency. Daily peak activity (acrophase) averaged 2.05 hours later in depressed patients, with no overlap between the groups. The degree of phase delay correlated significantly with the 4 PM postdexamethasone serum cortisol level. These tentative findings suggest that elderly unipolar depressed patients have prominent chronobiological disturbances in the modulation of activity levels and possibly other physiological processes. These differ strikingly from reported disturbances in younger or bipolar depressed patients.

Adult↗

Contamination of detergent cleaning solutions during hospital cleaning.

Twenty-two detergent cleaning solutions from different ward areas were sampled for bacteria when freshly prepared, during use and at discard. Contamination, mainly by Gram-negative bacilli, was found in 10 freshly prepared solutions and in 21 of the 22 at discard. Preliminary studies showed that the detergent solution was bactericidal to Staphylococcus aureus but allowed the survival but not multiplication of Escherichia coli.

Detergents↗

A method of audit for ward clinical waste.

We describe the conduct of an annual audit concerning the handling of clinical waste at ward level. The annual audit resulted in an improvement in the supply of colour coded bags and holders, and improved the efficiency of waste disposal in the hospital. The annual report of the audit enabled the hospital administrators to pinpoint defects and was partly responsible for the appointment of an "administrative officer responsible for waste".

England↗