Posttrauma intracapsular bone fragments: association with meniscal tears.
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Biomedical subjects
Publications and source records attributed to J Richmond.
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Thirty-two women with stress urinary incontinence and 27 control continent patients with pelvic relaxation underwent a detailed clinical and urodynamic evaluation of the lower urinary tract. All patients underwent a standard chain urethrocystographic evaluation to detect anatomic pathology of the lower urinary tract. Urethrocystographic study included an evaluation of the posterior and anterior urethral angle, funneling of the proximal urethra on straining, the position of the urethrovesical junction and flattening of the bladder base. No differences were seen in the incidence of radiographic findings in women with pelvic relaxation with or without stress urinary incontinence. All five cystographic criteria were similar in the continent and stress incontinence patients. Static urethrocystography cannot differentiate women with and without stress urinary incontinence from among those with pelvic relaxation and thus should not be relied upon in the evaluation of women with urinary incontinence.
Fifty-seven patients with esophageal cancer were treated with curative intent between January 1979 and June 1985. Seventeen were treated with radical radiation therapy alone (TD 4000-6500 cGy in 200-250 cGy fractions). Twenty-five were treated using radiation therapy (3000 cGy in 200 cGy fractions, day 1-19, and 2600-3000 cGy in 200 cGy fractions, day 50-68) and concomitant chemotherapy (5-FU and Cis-platinum). Fifteen were treated preoperatively by radiation therapy (3000 cGy at 200 cGy fractions) and concomitant chemotherapy (5-FU and Cis-platinum) followed by esophagectomy in 2-3 weeks. Chi square tests showed no significant baseline differences between the patients in the three different treatment groups with respect to A.J.C. stage, T status, location of tumor or histology. Median survival and 2-year survival for the three treatment groups were RT alone: 5 months and 0%, RT and chemotherapy: 12 months and 37%, RT, chemotherapy and surgery 13 months and 38%. A Cox multivariate analysis revealed significant predictor variables for increased survival were treatment strategy, RT dose delivered and T status. Increased local control was seen with either multimodality approach compared to radiation therapy alone. Our data suggests that a multimodality approach is superior as a curative treatment strategy, compared to RT alone, in esophageal cancer. In our series no significant differences were seen with respect to treatment outcome between the two multimodality approaches used.
This paper describes clinical and demographic characteristics of 664 children who attended outpatient child psychiatry clinics in Perth, Western Australia, over a one-year period. All social classes were represented; parents were the most common source of referral and typically the child had been assessed or treated for emotional or behavioural problems by other agencies previously. Referrals from the juvenile justice system were uncommon. The accessibility of clinics to the child population was found to have a significant effect on the rate of referral. Only 10% of the sample received conduct disorder diagnoses, whereas 16.5% had mixed disorders of conduct and emotion, and 42% had emotional disorders. Environmental circumstances, particularly recent marital break-up, family discord and recent experience of loss, were contributing factors to the child's clinical presentation in a large proportion of cases.
Concentrations of the potential pollutants, lead and cadmium, were studied in the perinatal period in a British urban population. Blood lead and cadmium concentrations and iron status were measured in 28 mother and infant pairs at delivery and at five days postpartum in the mother; breast milk collected at five days postpartum under controlled conditions was analysed for lead and cadmium. Placental transfer of both metals was noted; concentrations of lead in breast milk (mean concentration 0.01 mmol/l (2 micrograms/l) were less than in two brands of commercial prepacked formulas, and the concentration of cadmium in breast milk and prepacked formulas (mean 3.6 nmol/l (0.4 microgram/l] were similar. The risk of excess lead or cadmium intake from breast milk is small.
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The effect of preoperative intraparietal (intra-incisional) injection of cefoxitin along the site of the intended incision on the incidence of wound infection has been investigated by a randomized prospective study of 181 consecutive patients undergoing abdominal surgery. A significant reduction in wound infection was evident in the cefoxitin-treated group (4.4 per cent) when compared with controls (16.7 per cent) (chi 2 = 6; P = 0.02). Administration of antibiotic by this route did not delay wound healing or produce any undesirable sequelae.
Immunological indices have been reassessed in 27 patients in remission from Hodgkin's disease for 5 years after treatment and the findings correlated with initial treatment and splenectomy status. Neutrophil counts were lower and lymphocyte and monocyte counts higher at 5 years' remission than at presentation; the increases in lymphocyte count were mainly a feature of the splenectomized patients. Neutrophil function (nitro-blue tetrazolium) was unchanged in remission but cellular immunity (leucocyte migration inhibition and lymphocyte transformation) was depressed at 5 years and progressive falls in serum immunoglobulins were noted. Low values of IgG and IgM were particularly found in patients who had splenectomy and chemotherapy; there was however no excess of infections in this small group.
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The nature of the factor in Hodgkin's disease involved spleen to which many patients with malignant lymphoma react in the leucocyte migration inhibition test has been investigated. Our results suggest that ferritin from Hodgkin's disease involved spleens is antigenically different to that prepared from normal spleen. Isoelectric focusing shows the presence of more acidic 'isoferritins' in ferritin prepared from Hodgkin's disease involved spleen than in that prepared from normal spleen. Further observations using the leucocyte migration inhibition test suggest that sensitization to the abnormal ferritin, acting as an onco-fetal tumour associated substance, may be responsible for the reaction of patients with malignant lymphoma in this test.
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Nine cases of Hodgkin's disease and one of acute lymphoblastic leukaemia occurred in 1972-5 in an area of less than 1 km. Clinical, social, and drug histories provided no relevant information, and definite patient-to-patient contacts before the onset of disease were not established. There was a higher incidence of malignant neoplasms in first-degree relatives of the patients than in those of a small control group living in the same area. There was no apparent reason for this cluster of cases, but geographical, climatic, and entomological studies are being carried out.
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