Biomedical subjects
Publications and source records attributed to M Doran.
A patient with Gilles de la Tourette syndrome and severe self-injurious compulsions who had failed to respond to drug treatment and behavioural therapy obtained a complete and sustained resolution of his destructive behaviour and improvement in his tics following bilateral limbic leucotomy.
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Initiation of complement activation via the alternative pathway results in cleavage of Factor B into two fragments Ba and Bb. Employing PAGE and immunoblotting analysis we have demonstrated Ba and Bb activation fragments following in vitro and in vivo activation in a range of biological fluids including cerebrospinal fluid and synovial fluid. Quantitative linearity was obtained over the range 5-20 micrograms/ml of Factor B and its fragments in body fluids. Using Davis-PAGE a previously unrecognised triple component heterogeneity of the Ba fragment was observed. This study demonstrates that immunoblotting may be used as a sensitive and quantitative tool for the detection and characterisation of the individual cleavage products of Factor B in complex biological fluids without prior purification.
Dual energy radiographic densitometry was used to follow postnatal changes in the bone mineral content of the radii of 15 infants of less than 30 weeks' gestation. The system permitted bone mineral content to be measured with minimal disturbance to the infants in their incubators. Mean bone mineral content at birth was 2.4 mg/mm shaft length, decreasing to 1.9 mg/mm at 6 weeks of age, before starting to rise. Mineralisation was poor compared with that of a fetus at an equivalent postconceptual age. Mean intakes of calcium and phosphate were considerably less than the intrauterine accumulation of these minerals and it is postulated that this was the main cause of the poor mineralisation. Radiographic densitometry is both accurate and precise and has advantages over photon absorptiometry in that it can be used to measure bone mineral in infants who are not only preterm, but also ill enough to require intensive care.
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Three hypogammaglobulinaemic patients with non-A, non-B hepatitis transmitted by gammaglobulin replacement therapy were treated with lymphoblastoid alpha-interferon. All showed a striking improvement in serum aminotransferases after the start of each course of treatment.
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We report a solid-phase iodine- 125 radioimmunoassay for serum cortisol in which the interfering binding proteins are inactivated by a combination of reaction pH and 8-anilino-1-naphthalenesulfonic acid. The procedure is easy to perform and gives accurate and reliable results. The shift in pH for optimum binding of an antibody resulting from immobilization on a solid support, used to decrease cortisol binding competition in the present test, is potentially exploitable in other antibody and enzyme systems.
Although cytomegalovirus (CMV) is rarely cultured from peripheral-blood leukocytes of immunocompetent patients, it may be cultured from up to 60% of renal transplant recipients, 1 to 4 months after transplantation. During this same period, renal transplant recipients are often referred for psychiatric evaluation. Since CMV may infect the central nervous system, the relationship between isolation of CMV from peripheral-blood leukocytes (viremia) and psychiatric evaluation was investigated in 80 renal allograft recipients at the Massachusetts General Hospital. Five of 16 (31%) patients with viremia and 7 of 64 (11%) patients without viremia required psychiatric consultation (P = 0.04, two-tailed Fisher exact test). CMV viremia may be an important but treatable contributor to psychiatric symptoms in the transplant recipient.
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A pulsed magnetic field gradient spin echo technique was used to study the brain of two volunteers and eight patients. The pulsed gradients were applied both perpendicular and parallel to the image slice. Striking changes in signal intensity were demonstrated in white matter depending on the direction in which pulsed gradients were applied. These effects enabled specific white matter tracts to be identified depending on the direction of their fibres. Abnormalities were also demonstrated in these tracts in patients with a variety of diseases, including cases where only minor abnormalities were seen with conventional, highly T2-weighted sequences. The effects were attributed to anisotropically restricted diffusion within white matter. The technique may have application in a wide range of neurological disease and result in better localisation of lesions and improved detection of disease.
The use of MR imaging to image anisotropically restricted diffusion (ARD) of water in the nervous system is described. The theoretical basis for the use of the pulsed gradient spin echo sequences is outlined, including an estimate of the range of cell dimensions that can be studied with this technique. The importance of restricted diffusion across myelinated white matter fibre tracts is emphasised and the capacity of MR imaging to demonstrate fibre pathways as a function of their direction is illustrated. Technical developments that have been implemented include 256 x 256 spatial resolution, a wider range of diffusion times Td, and an increased range of diffusion sensitivity parameters b. Effects of these are illustrated together with the use of gradient moment nulling methods, oblique sensitisation, and a smaller set of gradient coils that enable shorter values of echo time to be used with the same value of b. The anatomical basis for ARD imaging is analysed, and association, commissural, and projection fibre tracts are demonstrated in different planes. The published literature on variations of the apparent diffusion coefficient from normal is reviewed and examples where diffusion weighted images revealed information that was not necessarily apparent with conventional sequences are illustrated. These include cases of multiple sclerosis, chronic head injury, progressive multifocal leucoencephalopathy, cerebrovascular disease, astrocytoma, and probable metastases to the brain. Imaging of ARD affords a fascinating conjunction between the microscopic movement of water, the properties of myelinated white matter fibres, gross anatomy of the brain, and changes of the diffusion of water in disease.
State immunization laws which exempt religious groups present difficult problems in disease control in measles epidemics. Two outbreaks are described, 136 cases in a college for Christian Scientists, and 51 cases associated with a camp attended by Christian Scientists. Control measures at the college included immunization and quarantine. An alternative strategy at the camp consisted of dispersal of exposed persons from the camp and their being quarantined in their home States. Three deaths (case-fatality ratio = 2.2 percent) were reported at the college; no serious complications were reported from the camp-associated epidemic. No transmission into the general community occurred in either epidemic. Public health officials are encouraged to be aware of the legal rights and obligations of religiously exempt groups so that outbreaks in these groups can be effectively controlled, even if standard immunization strategies are not possible. Early reporting and rapid case identification, investigation, and quarantine or vaccination procedures by public health workers are necessary for disease control in these settings.
BACKGROUND: This prospective cohort study was designed to evaluate the effectiveness of mail and telephone contact with parents as a means to improve the immunization coverage of children less than 7 years old in a family practice residency clinic. METHODS: Immunization records for 519 children enrolled in an outpatient clinic were reviewed and updated. Children whose immunizations were current (55) were excluded, which left 464 children whose immunizations were more than 1 month behind for their age groups. A random sample of one-half of these children (231) were mailed a postcard listing the immunizations that they required to be up to date. The mailing was followed up with telephone contact, when necessary, to prompt compliance. The other one-half of the children were not contacted and served as the control group. Immunizations provided to the two groups were compared 6 months after the initial mailing. RESULTS: Before the initiation of the study, only 10.6 percent of the infants and children in the practice had their immunizations completed or were up to date. There were 124 immunizations given to 49 children in the intervention group compared with 84 immunizations to 33 children in the control (P < 0.047). Thirty-four children were brought up to date in the control group compared with 17 in the intervention cohort (P < 0.011). CONCLUSIONS: Direct mail reminders and telephone contact with parents of children who were behind in their immunizations were effective methods to encourage compliance. The increased number of immunizations received by the children in the intervention group was overshadowed by the poor coverage of the entire practice, a highly mobile and predominantly indigent group. Additional interventions are urgently needed to improve immunization levels in infants and children.
OBJECTIVE: To assess the nature of pleuropulmonary abnormalities, with particular reference to interstitial lung disease (ILD), in patients with systemic lupus erythematosus (SLE). METHODS: 29 patients were prospectively evaluated using high resolution computed tomography (HRCT), plain chest radiography (CXR) and pulmonary function tests (PFTs). Clinical assessments, drug therapy, disease activity, smoking status and serologic markers were also noted. RESULTS: The HRCT was abnormal in 72% (20/29) of patients, while 34% (10/29) had an abnormal CXR. The most frequently detected primary HRCT abnormality was suggestive of ILD and was noted in 11 patients (38%) In 9 of these, ILD was clinically unsuspected, including one patient who had an HRCT suggestive of active alveolitis. Pleuropericardial abnormalities were seen on HRCT in 5 patients (17%). Of 15 patients who were asymptomatic, and had a normal examination, normal CXR and normal PFTs, four (26%) had HRCT features of ILD. There was no correlation between the HRCT appearances and symptoms, disease duration, ds-DNA titres, smoking history or non-pulmonary involvement. Although no statistical significance was noted between abnormal pulmonary function tests and ILD on HRCT (0.10 < p < 0.20), a trend towards significance was noted between disease activity and ILD (0.05 < p < 0.01). CONCLUSION: HRCT is more sensitive than PFTs or CXR in the evaluation of pleuropulmonary disease in SLE. We report an unusually high prevalence of HRCT appearances suggestive of ILD in patients with SLE. Subclinical lung disease is common in patients with SLE.
It may surprise some that presenile dementia has an incidence of 7.2 per 100,000 resulting in approximately 18 new cases per average district general hospital per year. The diagnosis and management of these patients is commonly divided among a number of different medical disciplines leading to varied clinical approaches to the problem. This article will outline an approach adopted at a cognitive function clinic and will emphasize the utility of a multidisciplinary team.