Biomedical subjects
Publications and source records attributed to N Thomson.
The aim of this paper is to highlight Potts puffy tumour as a pathological entity distinct from other causes of peri- and supraorbital swelling. This uncommon condition is usually not recognised initially and is easily confused with neoplasms or local eye pathology. A case is reported and investigations and management reviewed.
We conducted a randomized trial in seven Australian hospitals of the efficacy and safety of three immunosuppressive regimens after first transplantation of a cadaver kidney: long-term cyclosporine, short-term (three months) cyclosporine followed by azathioprine and prednisolone, and azathioprine and prednisolone without cyclosporine. Patients assigned to long-term cyclosporine (n = 138) or short-term cyclosporine followed by azathioprine and prednisolone (n = 141) had similar actuarial 12-month survival (98.4 vs. 96.4 percent) and graft survival (83.9 vs. 82.1 percent). Patients assigned to receive only azathioprine and prednisolone (n = 138), with optional use of antithymocyte globulin, had a significantly poorer survival rate (91.3 percent, P = 0.015) because of deaths from cardiac causes and infection, but their graft survival of 76.0 percent (P = 0.31) did not differ significantly from that of either group receiving cyclosporine. After the switch from cyclosporine to azathioprine and prednisolone, 15 percent of patients had reversible rejection episodes, but the frequency of rejection and graft loss did not differ from that in the long-term cyclosporine group. After the change to azathioprine and prednisolone, serum creatinine levels declined in nearly all patients, so that after three months they were comparable to those in the group receiving azathioprine and prednisolone only, and significantly lower than those in the group receiving long-term cyclosporine therapy (P less than 0.003). We conclude that the two cyclosporine regimens result in comparable patient and graft survival, but that changing to azathioprine and prednisolone at three months improves graft function.
Renal transplantation in HBsAg+ chronic carriers has a relative low risk of progressive liver disease, with mortality associated with liver disease at 7%. In contrast, HBsAg+ recipients who acquired their disease in the early posttransplant period had a mortality of 60%. HBeAg-positive patients who remain persistently positive are a subgroup with a poor prognosis and should not be offered a renal transplant.
We describe the surgical management of six patients with occlusive disease of the visceral arteries caused by Takayasu's arteritis. All patients suffered from renovascular hypertension and, in addition, three of the patients also had symptoms of mesenteric angina. Surgical repair is recommended in the "burn-out" phase of the disease when further progression of the disease is unlikely. Revascularization of the kidneys was by autotransplantation to the iliac vessels. Mesenteric or celiac artery inflow was provided by an extra-anatomic vein bypass graft from the iliac artery. In all cases distal disease-free vessels were available for reconstructive surgery.
The total number of Aboriginal deaths occurring in selected country regions of New South Wales in 1980 and 1981 has been estimated, based on the deaths reported by Aboriginal health workers and those identified on the newly modified Form of Notification of Death. Aboriginal mortality was more than four times that of the total NSW population, with young and middle-aged adults having death rates up to 12 times higher. The Aboriginal expectation of life at birth was estimated at 48 years for men and 57 years for women. The principal causes of death were diseases of the circulatory system and injuries. The effect of alcohol appeared to be substantial, particularly in the 35-44 year age group.
An analysis of the available population and death data confirms that the level of Aboriginal mortality is significantly higher than that of the total Australian population. The mortality of Aborigines in the Kimberley region of Western Australia in 1980-1982 was twice that of the total Australian population in 1981; for the Northern Territory, and for 14 Queensland and five South Australian Aboriginal communities the level was 3-31/2 times higher. In 1980-1981, Aboriginal mortality in country regions of New South Wales was 41/2 times the 1981 Australian total population level. In 1980-1982, specific indices of Aboriginal fetal and infant mortality in these regions and for Western Australia (excluding the Kimberley region) were generally at least 2-4 times those of non-Aboriginal Australians, and up to 7 times higher for deaths occurring after the neonatal period.
The health status of Australia's Aborigines is far inferior to that of non-Aboriginal Australians. The factors underlying this low standard of health are complex, but relate to the gross social inequality experienced by Aborigines, even today. The social inequality, characterised by extreme socioeconomic deprivation and relative powerlessness, is the end result of the European occupation of Australia, which caused Aboriginal depopulation and dispossession. Since the early 1970s a number of special programs have attempted to overcome the health inequalities of Aborigines, but have really met with only limited success. This limited success is explicable in terms of the gross social inequalities experienced by Aborigines. Alleviation of Aboriginal ill-health requiries integrated comprehensive programs, with continued support, at least in the medium term, of special Aboriginal health programs.
An analysis of the limited available data confirms that the health status of Australia's Aborigines remains much worse than that of non-Aboriginal Australians. Despite significant improvements over the past decade Aboriginal fetal and infant mortality is still approximately three times that of non-Aborigines. Aboriginal life expectancy remains at least twenty years less than that of the total Australian population. Levels of Aboriginal hospitalisation have declined markedly, but remain well in excess of overall levels, particularly for infants and children. For Aborigines, the reduced overall impact of the communicable diseases has been balanced by a worsening of the "lifestyle" diseases, particularly hypertension, coronary heart disease and diabetes mellitus. Alcohol abuse plays an important role in these diseases, and in the level of accidents and violence amongst Aborigines. The current patterns require a reassessment of Aboriginal health priorities, with more attention being directed at the health problems of Aboriginal adults. Special Aboriginal health programs need to be expanded, and integrated with broad wide-ranging programs aimed at alleviating Aboriginal social inequality.
Ratings of behaviour and family relationships were made on the basis of (a) a non-schedule standardised interview, (b) direct observation of family interaction during a meal time and (c) direct observation of mother-child interaction during free play. A number of scales met a battery of reliability and other criteria, and possible generalisation of these ratings across methods (interview versus direct observation) and settings (meal time versus free play) was assessed. For the vast majority of scales this was low. Reasons for this, together with some clinical implications, are discussed.
We have tried to clarify this confusing area by demonstrating the common relationships of these abnormalities. The development of the craniovertebral junction was present in order to understand the formation of the anomalies discussed. The radiologic lines and measurements that have been described are actually to measure the degree of compromise of the functional size of the foramen magnum. This mechanical compromise, either from direct neural compression and/or from a secondary vascular impairment (arterial or venous), leads to the signs and symptoms of cervicomedullary compression.
Preservation of cadaveric renal allografts by ice storage and by machine perfusion after a preliminary flush with a hypertonic citrate solution has been compared in a prospective clinical trial between matched pairs of kidneys from the same cadaver donor. Over a two-year period, ice storage after flushing with the new solution gave results comparable with machine perfusion. Times of warm ischaemia and total times of storage were similar in ice-stored and machine-perfused kidneys and averaged about 16 hours. In each group of recipients, more than half of the kidneys had good early function and one-year survival times were also similar.
A prospective clinical trial comparing flushing and ice storage using a new hypertonic citrate solution, with machine preservation by continuous perfusion showed early graft function was similar with each method, and preservation times were comparable. Good early function occurred in half the grafts with preservation times up to 24 hours. Graft survival at three and 12 months was similar with each method of preservation. Graft survival at 12 months was worsened by poor early graft function, whereas patient survival at 12 months was unaffected by early function or by the method of preservation.
The complete structure of the anterior sensory nervous system of the small nematode C. elegans has been determined by reconstruction from serial section electronmicrographs. There are 58 neurons in the tip of the head. Fifty-two of these are arranged in sensilla. These include six inner labial sensilla, six outer labial sensilla, four cephalic sensilla and two amphids. Each sensillum consists of ciliated sensory neurons ending in a channel enclosed by two non-neuronal cells, the sheath and socket cells. The amphidial channel opens to the outside as does that of the inner labial sensilla so that these probably contain chemoreceptive neurons. The endings of the other sensilla are embedded in the cuticle and may be mechanoreceptive. The cell bodies of all the neurons lie near the nerve ring and their axons project into the ring or into ventral ganglia. One of the ciliated sensory neurons in each of the six inner labial sensilla makes direct chemical synapses onto a muscle making these sensory-motor neurons. The anatomy of four isogenic animals was compared in detail and found to be largely invariant. The anatomy of juveniles is nearly identical to that of the adult, but males have four additional neuron processes.
Macrophage-rich peritoneal cell populations from C57BL/6 mice grafted with DBA/2 skin were found to be cytotoxic against 51Cr-labeled target cells from the donor strain. Normal peritoneal macrophages were also rendered cytotoxic by incubation with acellular supernatants of mixed lymphocyte cultures (MLC) between an allograft recipient and a donor mouse. Supernatants alone were not cytotoxic. The macrophage arming factor(s) was found in supernatants when the MLC was performed after more than 6 to 9 days following grafting. In order to produce MAF, sensitized lymphocytes must usually be stimulated in a specific way by donor type cells. The armed macrophage cytotoxicity was, however, not found to be specific in these experiments.
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