Biomedical subjects
Publications and source records attributed to P Gallagher.
Fifty patients had anterior resection of the rectum performed with end-to-end anastomosis using the EEA stapling device. The instrument certainly facilitated low anastomoses, but anastomotic dehiscence occurred in 3 cases, stenosis in 2, wound sepsis in 10, some degree os incontinence (usually only temporary) in 7 and anal fissure in 4 cases.
We report a case of acute pancreatitis associated with campylobacter infection. The patient presented with clinical symptoms and signs which suggested acute appendicitis. However, she was found to have acute pancreatitis with an acute campylobacter infection. Recent reports have shown that campylobacter is pathogenic in the biliary tract, and we suggest that it may also be responsible for some cases of acute pancreatitis in the absence of biliary disease.
The cytotoxic activity of peripheral-blood (PBL), lymph-node (LNC) and tumour-infiltrating lymphocytes (TIL) from 47 patients undergoing surgery for colon carcinoma (Duke's Stage A, 1 patient; B, 24; C, 15 and C with metastases, 7) was examined in short-term 51Cr-release assays, against fresh autologous tumour cells, allogeneic colon cancer cells and the erythroleukaemia cell line, K562. Cytotoxicity against autologous cells was detected in at least one effector population in 23/47 patients (49%), with overall frequencies which did not differ for patients in different Duke's stages of disease. By contrast, lysis of allogeneic tumour cells was infrequent (11%) regardless of the effector population to which they were exposed. Cytotoxicity against K562, cells highly sensitive to NK activity, though variable, was detected in 93% of PBL of normal donors and 83% of patients, and among the latter showed no evidence of significant decline with advancing disease. However, LNC and TIL anti-K562 activity was infrequent (17%) in concordance with previous reports. There was no correlation between the ability of patients' PBL to lyse autologous tumour and K562 cells. The independence of these 2 cytotoxic actions was further explored in studies fractionating lymphocytes: autologous tumour killing was augmented in T-enriched PBL; whereas the greatest anti-K562 activity was found in the corresponding non-T fraction. Lymphocyte cytotoxicity in colonic neoplasia is thus manifest in 2 apparently independent lymphocyte populations; a relatively specific killer T-cell population, detectable in PBL, LNC and TIL, which is preferentially reactive with the autologous cells; and a non-specific killer population, largely limited to PBL, with the properties of NK cells. The activity of neither population reflects the clinical status of patients with this disease.
Sixty-two cases of chondrosarcoma of bone were reviewed and histologically graded as low, medium or high-grade tumours. After excluding patients dead from unrelated causes or lost to follow-up, forty cases were available for ten-year follow-up and fifty-eight for five-year follow-up. The rates of survival, recurrence and metastasis were analysed according to the histological grading. Recurrence was further analysed according to the adequacy of treatment. The results were compared with those previously reported in the literature. There was a ten-year survival rate of 58 per cent. Recurrence developed in 58 per cent and was uncontrollable in 29 per cent. The recurrence rate was 87 per cent with inadequate treatment and 15 per cent with adequate treatment. Recurrences outside the limb bones usually proved uncontrollable; recurrences in the limb bones were amenable to further, and if necessary repeated, operations. High-grade chondrosarcoma had a metastatic risk of 75 per cent and eventual mortality of 88 per cent. Medium-grade chondrosarcoma had a metastatic risk of 14 per cent and a mortality of 60 per cent. Low-grade chondrosarcoma had a metastatic risk of 5 per cent and a mortality of 29 per cent.
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'Double negative' (CD4-CD8-) thymocytes from adult mice of different inbred strains were examined for surface expression of CD3 and of various forms of the T cell antigen receptor (TcR), as well as for the levels of subpopulations defined by the surface markers HSA ('heat stable antigen', recognized by M1/69, J11d and B2A2), CD5 (Ly 1) and Thy 1. Marked variations were found in the level of the double negative subsets which were surface TcR+, or which were HSA-CD5+; these generally varied together since most CD4-CD8-HSA-CD5+ thymocytes were TCR+. The level of the CD3-TCR complex on the surface of those double negative thymocytes which were TcR+ was as high as on mature T cells in some strains (CBA/Ca), but was much lower in other strains (C57BL/6J). In most mouse strains the CD4-CD8-HSA-CD5+ thymocytes expressed predominantly the alpha beta form of the TcR, with an exceptionally high (70%) usage of V beta 8 gene products. In strains which lacked V beta 8 expressing T cells due to a deletion of the V beta 8 gene region, reduced levels of alpha beta TcR+ cells were found within the CD4-CD8- thymocytes; the HSA-CD5+ subset was then only present at low levels (as in SJL/J and C57BR mice) or was present at a high level but expressed predominantly gamma delta TcR (as in SWR mice). The results suggest that the accumulation of CD4-CD8-TcR+ HSA-CD5+ thymocytes is a selective event, and that their developmental pathway is off the mainstream of T cell maturation in the thymus.
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Magnetic resonance imaging of a mediastinal pseudocyst clearly demonstrated the entirely intrathoracic location of the pseudocyst.
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Research on the relationship of social support and arterial blood pressure was conducted in a town in central Mexico. A culturally appropriate measure of social support was developed assessing perceived support from relatives, friends, neighbors, and compadres (ritual kin). The effects of perceived support from these four sources were compared to the effects of the amount of reported social contacts. For males, more support from all four sources was related to lower arterial pressure, whereas amount of social contact was related to higher diastolic blood pressure; support from compadres had the largest inverse correlation with blood pressure. For females the pattern of correlations was dependent on age: support from relatives and friends was related to higher blood pressure for younger females, whereas support from relatives was related to lower blood pressure for older females. This pattern of relationships is consistent with the place of women in the social structure of this Mexican community, and these results point to the need to conceptualize and measure social support in culturally appropriate ways.
Despite the fact that the demand for psychiatric evaluations of organ transplant recipients is increasing, there is not a commonly agreed upon protocol that can guide clinicians. A standard psychiatric interview, although necessary, is not sufficient when interviewing transplant candidates. In addition, it is important to acquire information specific to the medical regimen associated with renal disease and renal transplantation. The purpose of this paper is to present the Structured Interview for Renal Transplantation (SIRT). The SIRT was developed as a tool to guide clinicians through the interview process by providing a comprehensive structure while still allowing for flexibility. There are many advantages of using the SIRT--it is a tool that facilitates a clinician's ability to conduct a thorough evaluation in a time-efficient manner. It is also an excellent instrument for training clinicians, and the structure of the interview is appropriate for use in research.
An important factor in the etiology of anorexia in cancer may be a change in the sensation of taste. Taste thresholds for the four basic tastes were measured in 50 cancer patients and 50 control subjects. Cancer patients had a higher mean threshold for recognition of sweet (126 mmol/1 sucrose), and a lower mean threshold for bitter (620 mmol/1 urea), compared to the controls (86 mmol/1 sucrose, p = 0.027, and 728 mmol/1 urea, p = 0.002). There was no significant difference in the mean threshold for sour or salt. Eight commercial diets (Build-up, Nutrauxil, Ensure, Clinifeed, Triosorbon, Complan, Isocal, Vivonex) were given to each of the cancer patients and control subjects in order to investigate any possible difference in preference. Scores were often improved by the addition of tasting agents such as Nesquick. Scores for each feed were similar for control and cancer patients apart from Nutrauxil, Ensure and Isocal, which appeared to be preferred by cancer patients. Too much emphasis is often placed upon the contents of formulated diets and too little upon taste and patient acceptability.
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