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Biomedical subjects

R Evans

Publications and source records attributed to R Evans.

At least 343 records · Page 19Linked to original sources

Mechanisms of injury--a pictorial record.

The illustrations of both these incidents show, with extraordinary detail, the mechanism of injury involved in the production of these lesions. It is often difficult, when dealing with the end product of trauma of any description, to appreciate its mechanism of occurrence and gain an accurate estimate of the amount of force which has produced the damage. The two photographic sequences highlight the problem of attempting to prevent sporting injuries, as in both cases the incidents illustrated (Fig. 1 and Fig. 4) would not necessarily be interpreted as ones which precede major sporting injuries. In the case of the knee injury, the forcible anterior translocation of the tibia, as pictured, demonstrates well the mechanism of the tear produced in the anterior cruciate. In the case showing the injury to the spine, the position of the back prior to impact is exactly in keeping with the flexion/rotation forces which cause such spinal damage. The camera has recorded with impassionate accuracy the fact that major injuries, far from always having a preventable cause, are inherent in all high-velocity body-contact sports.

Athletic Injuries↗

Prognostic significance of tumor growth during radiation therapy.

A retrospective review of 282 consecutive patients with squamous cell carcinoma of the head and neck that were seen in the Radiation Oncology Department from January 1, 1980, through December 31, 1983, was performed. From this population a subgroup of six patients was identified that experienced growth of tumor in the radiation field during treatment. All except one of these patients expired from progression of cancer within 16 months. At the time of writing, the one remaining patient has progressive cancer in spite of additional therapy. Growth of cancer in the radiation field during therapy is unusual. It appears to be associated with a very poor prognosis even with aggressive salvage therapy. This observation should be taken into consideration in the medical/surgical management of these patients.

Carcinoma, Squamous Cell↗

Impaired verbal and figural fluency after head injury.

Previous research has found that verbal fluency is reduced in head-injured patients and in patients with focal damage to the frontal lobes. The present study compares a task of verbal associative fluency with a new measure of nonverbal, or figural, fluency that focuses on speed of producing unique designs and accounting for perseverative tendencies. Using results from 35 head-injured patients and 50 normals, we found that both verbal and figural fluency are compromised following brain trauma. Consistent with previous research, patients with severe head injuries were more impaired than patients with moderate head injuries. The discussion focuses on those cognitive factors that might influence verbal or figural fluency.

Journal Article↗

Comprehensive immunization delivery in conjunction with influenza vaccination.

All patients and employees presenting for influenza A and B vaccination were studied for the need for other immunizations or tests, based on criteria of the Immunization Practices Advisory Committee. More than 72% of patients and employees needed at least one other vaccine or test. During a 4 1/2-month period, 1,353 doses of influenza virus vaccine, bivalent, types A and B, were prescribed. Health care providers ordered doses of diphtheria and tetanus toxoids (adult) for 36.8% of these recipients, pneumococcal vaccine, polyvalent 23, for 42.1%, and a tuberculin skin test for 36.3%. Determinations of hepatitis B titers or hepatitis B vaccine doses were ordered for 140 individuals. Patients older than 60 years needed additional immunizations with greater frequency. Rates of delayed adverse reactions (35.9%) and subsequent self-medication (11.7%) were recorded. The systemic adverse reaction rate was 17.3%. Annual influenza vaccination programs are valuable public health opportunities to determine immunizations needed by patients who might not otherwise receive a comprehensive, individualized review of the status of their immunization protection.

Adolescent↗

Preemployment screening for allergy to laboratory animals: epidemiologic evaluation of its potential usefulness.

Employers at laboratory animal facilities have begun to use selection criteria which proscribe employment of persons thought to be at increased risk of developing allergy to laboratory animals. Some of these criteria are: a personal history of allergy, chronic rhinitis, or asthma, positive direct skin tests, elevated serum immunoglobulin E, abnormal forced expiratory volume in 1 second, and a family history of allergy. The usefulness of these criteria were examined in preemployment screening when applied to job applicants who will be handling laboratory animals, by calculating the sensitivity, specificity, and positive predictive value (PPV) of each criterion. Results illustrated that the primary goal of the screening program must be determined before an evaluation can be made of the usefulness of potential screening criteria in meeting the goal, ie, to identify persons who are themselves at high risk (high PPV), to identify a large proportion of low-risk job applicants (specificity), or to screen out a large proportion of occupational disease (high sensitivity), because it is not possible to maximize these parameters simultaneously. Results indicate that, currently, the use of these screening criteria as determinants for hiring persons to work with laboratory animals is unwarranted.

Animals↗

Drug use patterns: implications for the acquired immunodeficiency syndrome.

The acquired immunodeficiency syndrome (AIDS) represents a major public health concern for society. Intravenous drug users continue to be the second largest risk group. While needle sharing has been demonstrated to play a prominent role in the higher risk experienced by illicit drug users, serious evaluations of the inherent immunologic aberrancies attendant to drug abuse have been limited. Partly responsible are the small study sample sizes and inadequate examinations of the role of particular patterns of drug abuse in the development of immunologic dysfunction. The present study represents the preliminary findings of an ongoing investigation to assess the contribution of an array of behaviors on various indicators of immunologic status.The results in 97 patients investigated demonstrate that route of administration and duration of drug use were the factors most significantly associated with a greater prevalence of immunologic abnormalities. There was also a suggestion that abnormal liver function may contribute to altered immune status.

Acquired Immunodeficiency Syndrome↗

Fluorescein angiography in reticular degeneration of the pigment epithelium.

We studied reticular degeneration of the pigment epithelium by fluorescein angiography in 32 eyes of 50 consecutive patients who had ophthalmoscopic indications of this aging-related entity. In this type of degeneration, fluorescein angiography delineated extensive abnormalities of the retinal pigment epithelium and demonstrated normal-appearing retinal vessels and choriocapillaries in the affected areas.

Aged↗

Removal of tropomyosin overlap and the co-operative response to increasing calcium concentrations of the acto-subfragment-1 ATPase.

The co-operative response of regulated actomyosin ATPase to increasing concentrations of calcium has been attributed to nearest-neighbor interactions, presumably between troponin-tropomyosin complexes. The degree of co-operativity was not decreased after the carboxy-terminal 11 amino acid residues had been removed from tropomyosin by carboxypeptidase A. This indicates that the interactions between neighboring troponin-tropomyosin complexes do not occur through the overlapping tropomyosin ends.

Actins↗

Contrast sensitivity in diabetics with and without background retinopathy.

Contrast sensitivity measurements were obtained from 64 patients with insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetes mellitus who had normal Snellen acuity and minimal or no visible diabetic retinopathy. Contrast thresholds were determined for stationary gratings at six spatial frequencies, ranging from 0.5 to 22.8 cycles/degree (c/deg), and for 1.0-c/deg gratings phase-alternated at 15 Hz. Data from each group of diabetic patients were compared with data from age-matched normal subjects. We found that (1) patients with IDDM and no retinopathy had normal contrast sensitivity, (2) patients with NIDDM and no retinopathy had abnormal contrast sensitivity at only one spatial frequency (22.8 c/deg), and (3) patients with NIDDM and background retinopathy had abnormal contrast sensitivity at all spatial frequencies tested. We also found a dissociation of Snellen acuity and contrast sensitivity, indicating that contrast sensitivity can be used as an early index of changes in the retina not demonstrated by measurements of visual acuity.

Adolescent↗

Enhanced lysis of [125I]5-iodo-2'-deoxyuridine-labeled target cells in the presence of normal macrophages: possible mechanisms of action.

The potential mechanisms involved during the faster release of [125I]-iodo-2'-deoxyuridine (125IdUrd)-labeled target sarcoma cells in the presence of normal C57BL/6J peritoneal macrophages were investigated. Maximum (= 90%) "spontaneous" release of 125I from target cells cultured alone occurred over a period of about 10 days. However, after about 3 days, confluent sheets of target cells developed. In the presence of normal macrophages, 90% of the 125I was released between 3 and 7 days, again with the formation of confluent sheets of target cells. This enhanced 125I release was not influenced by increasing the relative concentration of IdUrd using the nonradioactive isotope 127IdUrd. Established mechanisms of target cell destruction were investigated but no evidence was found for the involvement of superoxide anion, hydrogen peroxide, or regulation by prostaglandin synthesis. The macrophage-mediated effect was abrogated by incorporating hydrocortisone-acetate (10(-7) to 10(-4) M) into the culture medium but this did not affect target cell proliferation. The use of serum-free culture medium suggested that macrophages secreted a soluble mediator that was not derived from or dependent on the presence of fetal bovine serum. In addition, macrophage-conditioned medium was able to induce the faster 125I release. The failure to precipitate with 20% trichloroacetic acid the 125I released from target cells cultured in the presence of macrophages indicated that the radioactive component had been separated from the precipitable DNA. The data are discussed in light of two possible hypotheses: that macrophages recognized subtle changes in IdUrd-labeled cells and exacerbate radiotoxicity, and that the faster release reflected proliferative death caused by stimulated growth.

Animals↗

Relationship of ventricular ectopy to nocturnal oxygen desaturation in patients with chronic obstructive pulmonary disease.

Sudden death and oxyhemoglobin desaturation are known to occur during sleep in patients with chronic obstructive pulmonary disease. The present study was undertaken to determine the frequency with which nocturnal oxygen desaturation promotes an increase in ventricular ectopic activity, since such a relationship could represent a potential pathophysiologic mechanism for sudden death during sleep. Forty-two clinically stable subjects with moderately severe obstructive airways disease, mean ratio of one-second forced expiratory volume to forced vital capacity = 51 +/- 12 percent, underwent overnight polygraphic sleep study. Oxyhemoglobin saturation was monitored by ear oximetry, and electrocardiographic leads CC5 and CM5 were employed for arrhythmia detection. Premature ventricular complexes were detected in 27 (64 percent) of the subjects and were complex (multifocal, repetitive, or both) in 17. No significant relationship between premature ventricular complex frequency and arterial oxygen saturation was detected for the group as a whole. In part, this result can be attributed to the relatively mild hypoxemic stress experienced by the 22 subjects in whom arterial oxygen saturation remained greater than 80 percent. In contrast, six (30 percent) of the 20 patients who had desaturation to less than 80 percent showed a greater than 150 percent increase in premature ventricular complex frequency with oxygen desaturation. These results suggest that nocturnal hypoxemia, if of sufficient magnitude, is capable of increasing ventricular ectopy during sleep in a substantial number of patients with chronic obstructive pulmonary disease.

Adult↗

Local recurrence, rate and sites of metastases, and time to relapse as a function of treatment regimen, size of primary and surgical history in 62 patients presenting with non-metastatic Ewing's sarcoma of the pelvic bones.

This report reviews the experience of 62 patients who presented between 1972 and 1978 with non-metastatic Ewing's sarcoma of the pelvis and were entered on IESS I. Seventeen patients (27%) developed a local recurrence, 38 patients (61%) demonstrated metastases and 21 (34%) neither. In the dose range 4000 rad to 6000 rad no dose response could be detected for local control of tumor. Forty-six patients (74%) had a biopsy or exploratory surgery only, 5 patients (8%) had an incomplete resection and 11 patients (18%) had a complete resection of their tumor. In the 46 patients having a biopsy only, 13 developed a local recurrence (28%) as compared to 2 of 11 patients undergoing a complete resection (18%). The most common sites for metastases were lung in 19 patients (31%) and bone in 23 patients (37%). No significant difference was noted in the frequency of overall metastases or metastases to any site between those patients receiving one of the three treatment regimens used in IESS I: VAC and Adriamycin (regimen I), VAC alone (regimen II) and VAC plus bilateral pulmonary irradiation (regimen III). At a median follow-up of 135 weeks no significant difference in median survival could be detected in patients with pelvic primaries between regimens I, II and III. The mean diameter of the pelvic primaries was comparable to the nonpelvic, however, one half of the pelvic cases were in the range 10-15 cm. The median time to relapse of the 241 non-pelvic patients on IESS I was 222 weeks as contrasted with the median time to relapse of 92 weeks in the 62 pelvic patients on the same study (p = 0.002). The possible reasons for the poor prognosis of pelvic primary patients are discussed together with treatment policies that might improve the survival of this group of patients.

Adolescent↗

Incidence and risk of transmission of HTLV III infections to staff at a London hospital, 1982-85.

In 1982 only two cases of acquired immune deficiency syndrome (AIDS) and one case of persistent generalized lymphadenopathy (PGL) were diagnosed at St Stephen's hospital in central London. By 31 July 1985, the numbers of cases with these conditions had increased to 41 and 185 respectively and a total of approximately 400 patients had been recognized as having HTLV III infection. A large increase in the numbers of cases of AIDS was noted between July 1984 and July 1985. Over 80 patients with HTLV III infection were admitted to hospital and had surgery or other invasive procedures carried out. Approximately 3000 blood samples from HTLV III antibody positive patients were processed by the pathology department--mainly by the microbiology and haematology laboratories. Hospital and laboratory staff observed hepatitis B precautions. In spite of regular contact with patients with HTLV III infection and their samples, serological studies on 150 hospital staff showed no evidence of spread of HTLV III from patients to staff.

Acquired Immunodeficiency Syndrome↗

The results of a selective surgical policy on the cognitive abilities of children with spina bifida.

A cohort of spina-bifida children born between 1973 and 1978 and subjected to selection for surgery was divided into those who met specific physical criteria at birth and were offered immediate treatment, and those who had delayed treatment because of adverse criteria. There was a significantly higher level of intelligence among children treated immediately but a fifth of those given delayed treatment had normal levels of intelligence. There were negligible differences in intelligence between the children given delayed treatment and an unselectively treated series of children born between 1964 and 1966, suggesting that postponing surgery for a period does not necessarily have a disastrous effect upon ability.

Child↗