Biomedical subjects
Publications and source records attributed to M Dodd.
Desmopressin and vasopressin were used to control massive haemoptysis in a patient with cystic fibrosis. After bolus doses a continuous infusion of vasopressin was maintained for 36 hours and haemoptysis stopped.
The role of exercise in aiding sputum expectoration in patients with cystic fibrosis and the comparative roles of exercise and physiotherapy in sputum expectoration were assessed in two studies. In the first study 19 adult patients undertook a two month programme of home exercise using a cycle ergometer. In the 12 patients completing the study peak work capacity, maximum oxygen consumption, and maximum minute ventilation had increased significantly by the end of the exercise programme; the increase in daily sputum weight (from 24 to 37 g) was not significant (p = 0.055). In the second study (with 10 patients) more sputum was expectorated during and after physiotherapy than during and after exercise (9.8 v 4.0 g). Exercise may have a role in aiding sputum expectoration in patients with cystic fibrosis but should not be considered as a replacement for physiotherapy.
Thirty six adults with cystic fibrosis were studied over one year to determine the incidence of infection with respiratory viruses and atypical organisms. Nineteen patients entered the study during an acute exacerbation of respiratory symptoms with an increase in purulent sputum production, cough, or breathlessness accompanied by a fall in FEV1 (group 1); 17 patients entered when they were stable both clinically and in terms of lung function values (group 2). Group 1 patients had a mean of 2.6 (range 1-4) infective exacerbations during the year and group 2 patients a mean of 1.1 (0-2) exacerbations. Eleven patients developed serological evidence of viral (influenza virus A and B, cytomegalovirus, human rhinovirus 2, adenovirus) or Mycoplasma pneumoniae infection. There was no difference in seroconversion rates between group 1 (five patients) and group 2 (six patients). There was a weak association between viral seroconversion and the isolation of Pseudomonas aeruginosa from sputum, though this was not significant.
A small cell surface antigen of Streptococcus mutans was partially sequenced and the amino terminal peptides of 11, 15 and 20 amino acid residues and a dimer of the 15 and 20 residues peptides were synthesized. The synthetic peptides (SP) were used in topical oral immunization of the gingivomucosal epithelium of macaque monkeys. Sequential examination for antibodies over a period of up to 30 weeks revealed that six applications of the linear or cyclized SP11 and a random SP11 induced negligible or very low antibody levels. In contrast, the SP17 (SP15 with added cysteine at each terminus), SP21 (SP20 with one cysteine) and the dimer (SP35) induced significant anti-SP as well as anti-native streptococcal antibodies in the gingival fluid and in saliva. The functional significance of this immune response was examined by studying its effect on oral colonization of S. mutans following feeding of a carbohydrate-rich diet. Whereas control animals, sham-immunized with a random SP of 11 residues, showed increased colonization of the teeth by S. mutans, there was no colonization or a significant reduction in colonization of animals immunized with the cyclized SP17, linear SP21 or dimerized SP35. These experiments suggest that local immunization with SP derived from the sequences of a streptococcal cell surface antigen induce a dual local immune response of gingival IgG and salivary IgA antibodies against the SP and native SA. These antibodies may be involved in preventing colonization of S. mutans, which is the principal agent in the development of dental caries.
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A case of idiopathic subglottic stenosis treated by endoscopic laryngeal laser. A brief review of other forms of treatment and the place of Respiratory Function Tests in diagnosis and management.
The behaviour and fate of allogenic skin transplanted to rabbit deciduomata was investigated and compared with orthotopic and subcutaneous allografts. Allografts implanted in the decidua of non-sensitized hosts were alive and showed no evidence of immunological rejection 14 days after grafting. The surrounding decidual tissue showed no infiltration by lymphocytes. Allografts in the myometrium of nonsensitized hosts demonstrated immunological rejection as early as 7 days post grafting. Orthotopic allografts on non-sensitized hosts were rejected between 7 and 8 days. Allografts implanted in the decidua of pre-sensitized hosts were alive and histologically healthy 6 days after grafting but showed minimal survival at 8 days. Since rejected grafts were not usually infiltrated with lymphocytes it was concluded that humoral antibody, in the absence of a cell mediated effect, may have procured the destruction of grafts. Subcutaneous allografts in pre-sensitized hosts were rejected between 4 and 6 days after grafting and demonstrated a classical second set type of immunological reaction. The significance of these results was discussed and it as suggested that the decidua, possibly because of its structure, may serve to restrict invasion of its substance by maternal immunocompetent cells thus contributing to the immunologically privileged nature of pregnancy.
A register of patients receiving lithium in the Edinburgh and Lothian area of Scotland has been kept by the Medical Research Council Brain Metabolism Unit since 1967. Using this register, information was obtained on 784 patients receiving lithium for a period of up to 115 months (97.4% of the population available for study). 33 patients died during the period of study due predominantly to cardiovascular causes or to suicide. There was nothing to suggest that long-term exposure caused more deaths than short-term exposure and the pattern of mortality resembled that found in other studies of manic-depressive illness, i.e. the majority of deaths occurred in the early stages of follow-up.
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It is notoriously difficult to evaluate educational initiatives. Nevertheless, with the introduction of mandatory vocational training, it seems curious that there has been no formal, structured assessment of whether dental vocational training is perceived as having fulfilled its aims. Nor is there information on how participation in continuing dental education relates to feelings of competence or confidence in clinical practice. This paper reports on the experience of two cohorts of 'new' dental graduates from Scotland and provides evidence to inform the debate on vocational training, general professional training and recertification for the dental profession.
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