AIDS and ethics in Birmingham: a betrayal of trust.
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Biomedical subjects
Publications and source records attributed to M Fitzpatrick.
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Bidirectional laser Doppler velocimetry (BLDV) for the measurement of retinal blood flow was validated in six anaesthetised minipigs, by comparing BLDV derived results with those obtained using radioactively labelled microspheres (RLM). The mean velocity of blood (Vmean) was calculated from the maximum red blood cell velocity measured by BLDV. Volumetric flow rate was determined from Vmean and vessel diameter, measure from monochromatic fundus photographs. Total retinal blood flow (TRBF) was calculated by summating flow values obtained for each retinal vein draining into the optic disc. A significant correlation was found between the TRBF results obtained by the two techniques (r = 0.99, p less than 0.001). The BLDV results were between 3-35 microliters/min lower than the corresponding RLM results (p = 0.05). Values of 57 +/- 24 microliters/min and 76 +/- 34 microliters/min were obtained for TRBF using the BLDV and RLM techniques respectively. Reproducibility studies with BLDV were also performed in six anaesthetised pigs over three hours and in six normal human volunteers over two hours and two weeks. No significant difference between measurements was found with time. Ninety five percent confidence limits of +/- 9.8% for the six pigs and +/- 8.9% for the six human volunteers were found for measurements on the same day and at two weeks. We conclude that with a sample size of six, changes in flow of approximately 20% can be detected using BLDV and monochromatic fundus photography.
This paper reports results of an open prospective study of 26 patients who met DSM-III criteria for panic disorder or agoraphobia with panic attacks. Cognitive-behavioral treatment alone produced clinically and statistically significant improvement in panic symptoms, including both full-blown and limited symptom episodes. In addition, the treatment produced improvement in associated symptoms of phobic avoidance and generalized anxiety. This work provides further preliminary indication of the usefulness of cognitive-behavioral strategies as an alternative to medication in symptom-oriented treatments.
Six patients with panic disorder who had panicked during sodium lactate infusion were given cognitive-behavioral treatment for 12-24 weeks. After treatment they underwent another lactate infusion, and four patients were rates as having no panic, suggesting that reduced vulnerability to lactate accompanies remission of panic. Controlled trials of cognitive-behavioral therapy and use of lactate infusion as a measure of remission are recommended.
Three hundred and forty-six patients of all ages and both sexes were admitted to coronary care with documented unstable angina. Management was conservative, without the routine use of beta-blockers or calcium antagonists. Mortality was 3.2%, and the nonfatal myocardial infarction rate was 10.1% during the first 28 days. After one year, coronary mortality was 10.5% with a nonfatal infarction rate of 13.1%. Twenty-six patients were subjected to coronary artery bypass surgery, eleven during the first 28 days and fifteen subsequently. No patient underwent coronary angioplasty. The factors influencing immediate and long-term prognosis in these patients were studied. Persistence of pain in hospital, previous chronic angina, and age had an adverse effect on outcome. A total of 143 patients complained of persistent pain lasting for 24 hours or more. The use of beta blockers or calcium antagonists in patients with persistent pain exceeding five days did not appear to influence outcome. The current widespread adherence to "intensive medical treatment," including the routine use of beta blockers and calcium antagonists, is questioned.
The phenomenon of stress cracking of Pellethane 2363-80A (PEU) was investigated using the cage implant system. A cytotoxic polyvinylchloride (PVC) and a silicone rubber containing an anti-inflammatory steroid were used to create inflammatory environments in which the biostability of the pre-stressed PEU was tested. These coimplants provided alternative in vivo environments to study in vivo polymer interactions. The inflammatory responses to the implanted cages were monitored by analyzing the exudates aspirated from the cages at different implantation times over 21 days. The pre-stressed PEU specimens were retrieved after 5, 10, and 15 weeks postimplantation and examined by optical microscopy (OM) and scanning electron microscopy (SEM). The results support the conclusion that in vivo cracking of stressed (strained) Pellethane 80A is related to cell-polymer interactions. Severe cracking or rupture of the implanted PEU specimens was observed as early as 5 weeks postimplantation. Molecular chain degradation of the implanted specimens was evident from molecular weight measurements. Neither surface cracking nor degradation of macromolecules was found on the pre-stressed PEU specimens with the added cytotoxic PVC implanted over 15 weeks. No cracking was observed on the pre-stressed specimens in the presence of steroid silicone rubber, even after 10 weeks implantation.
This study explored the level of knowledge, attitudes and activity related to sexuality in a group of adolescents and young adults with myelomeningocele, a group of matched controls and a group of adolescents with cystic fibrosis. Slightly more than half of the study sample were female, the mean age was 17.2 years, and their backgrounds were mainly middle-class. 28 per cent of the myelodysplastic group reported previous sexual activity, compared with 60 per cent of the control group and 43 per cent of the group with cystic fibrosis. Most of the disabled adolescents expressed a desire to marry and have children, but fewer than 20 per cent had sought information regarding their sexual or reproductive function from their physician. Among those sexually active, 60 per cent of the controls and 67 per cent of those with cystic fibrosis had used contraception, compared with 16 per cent of the myelodysplastic group. The authors conclude that sex education and screening for contraceptive need is indicated for adolescents with chronic disabilities.
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In order to study the effects of acute immunologically mediated liver disease on circulating thyroid hormones, serum levels of thyroxine (T4, total and free) and triiodothyronine (T3) were measured in 8 baboons before and for 60 days after allogeneic liver transplantation. In 3 animals early rejection and jaundice developed; T4 levels declined as liver function deteriorated. In the 5 tolerant animals liver function was only temporarily deranged without jaundice and there was a consistent early rise in T4 (P less than 0.01) followed by a later fall. T3 concentrations were relatively normal in both groups. The T3 resin uptake test remained virtually unchanged in all animals. Serum T4 and T3 responses to exogenously administered bovine thyrotropin (TSH) were similar in the jaundiced and anicteric animals. We conclude that the early rise in T4 in the tolerant animals was caused by transient increases in thyroid binding globulin in (TBG) while the fall in thyroid hormones in these and in the jaundiced animals was related to a decline in TBG levels. Thyroid responsiveness to TSH is not disturbed by moderately deranged liver function.
Vitamin A receptors of the retina appear to be differentially extractable in light and in dark suggesting that they could function as inter- or intra-cellular transport vehicles in the visual cycle.
Unlike the true left ventricular aneurysm, false aneurysms have recently been shown to be subject to late rupture. Rarely diagnosed before surgery or autopsy, the false aneurysm has never been identified by noninvasive techniques. We report the first such noninvasive diagnosis employing radioisotope gated cardiac blood pool imaging. Due to the unique and possibly life-threatening clinical course and potential for surgical cure of false left ventricular aneurysm, early noninvasive diagnosis by imaging techniques may be critical. The methods shown here are generally applicable, becoming widely available and may help in evaluation of false left ventricular aneurysm as a cause of sudden death.
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Parents of pediatric dental patients were observed in a university clinic waiting room as they were greeted by student dentists. Soon after the dentist left with the child, the parents completed a series of scales assessing their perceived social support from the dentist, their anxiety and distress levels, and their confidence in the dentist. Regression analysis indicated that perceived social support from the dentist was associated negatively with parental distress regarding the dental treatment (beta = .-45, P < .01) and parental state anxiety (beta = .-37, P < .01). In addition, social support was associated positively with parent's confidence in the dentist beta = .54, P < .01). Possible mediational paths and clinical implications are discussed.