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Biomedical subjects

R N Matthews

Publications and source records attributed to R N Matthews.

At least 55 records · Page 3Linked to original sources
PubMed1982

Old burns and pregnancy.

Burns rarely cause problems in subsequently occurring pregnancies. Occasionally abdominal wall scarring is so dense and extensive that consequent maternal pain in the second half of pregnancy demands surgical decompression. This does not usually precipitate labour and the resultant raw areas should be covered with split skin autografts. It is exceptional for burns to destroy the entire breast disc; residual breast mound development occurs during puberty, and hypertrophy and engorgement during and after pregnancy. Although absence of the nipple-areola complex precludes breast feeding, distortion of it does not prevent feeding in all cases. Split skin autografting with customized pressure therapy is the best remedy for correction of contracture deformity.

Abdominal Muscles↗
PubMed1981

Results of cessation of treatment in childhood acute lymphocytic leukaemia.

From 1972 to 1977, 55 of 161 children with acute lymphocytic leukaemia discontinued treatment after being in continuous complete remission for three years. A low total white cell count as diagnosis (less than 10 X 10(9)/L) was significantly associated with cessation of therapy, but there was no significant association with age or sex. Nine patients have relapsed, all but one within 50 weeks of cessation of treatment. Testicular relapse occurred only in one patient. Actuarial complete remission rate with a median duration of follow-up 140 weeks was 76%, and there was no significant sex difference. It is proposed that the relatively good prognosis in boys after cessation of therapy may be related to limited use of steroids during induction chemotherapy.

Child↗
PubMed1981

Studies on the possible mechanism for deficiency of nonsuppressible insulin-like activity in thalassemia major.

Previous studies have shown that serum levels of the somatomedin, nonsuppressible insulin-like activity (NSILA-S), are extremely low in patients with thalassemia major. Since these patients are not GH deficient, several other possible mechanisms for the reduced levels of NSIL-S have been explored. No evidence for the presence of NSILA inhibitors was obtained either in mixing experiments of normal serum and thalassemic sera or after acid gel chromatography of thalassemic sera. The high iron and ferritin levels of thalassemia had no effects on the NSILA-S bioassay itself or on the binding of GH to its hepatic receptors. GH molecules secreted as a result of exercise-induced GH stimulation tests were shown to be both immunologically and biologically reactive. No circulating GH-binding proteins were present in thalassemic sera. Since the liver function in the group of patients included in this study was only slightly abnormal, it is considered unlikely that generalized hepatic damage due to the severe iron overload of thalassemia is a major cause. These results suggest that neither NSILA-S inhibitors, abnormal GH molecules, nor hepatic damage contribute to the failure of these patients to produce NSILA-S and that a specific defect may exist at the hepatic GH receptor or postreceptor level.

Adolescent↗
PubMed1981

Lack of response of nonsuppressible insulin-like activity to short term administration of human growth hormone in thalassemia major.

We have recently demonstrated that nonsuppressible insulin-like activity (NSILA-S) is very low or undetectable in beta-thalassemia major. The mechanism for this deficiency has been proposed to result from a defect at the GH receptor level or at a site distal to the receptor in the pathway leading to NSILA-S generation. To study this proposal further, the NSILA-S response to exogenous human GH (hGH) was assessed in six affected subjects (aged 12-20 yr), four of whom were on or below the third percentile for height and three of whom were prepubertal. On the basis of immunoreactive and receptor-active hGH responses to exercise, GH deficiency as a primary cause of low NSILA-S levels was essentially ruled out in five of the six patients. hGH (5 mg) was administered im daily for 3 days. Bioassayable NSILA-S failed to rise normally in response to the exogenous hGH in four of the six subjects. In the other two, a limited response was seen only on day 4, reaching 54% and 29%, respectively, of the mean peak response in normal adults. The impaired production of NSILA-S in thalassemia major thus appears to be due to hGH insensitivity and not to a biologically inactive endogenous hGH molecule. These results confirm that the site of the defect may therefore be at the membrane receptor for hGH or at a subsequent step in the NSILA-S synthetic pathway, perhaps related to excessive hepatic iron deposition. These results also suggest that in subjects where the defect is partial, treatment of their short stature with hGH may be beneficial.

Adolescent↗
PubMed1980

Advances in the management of homozygous beta-thalassaemia, including desferrioxamine infusion therapy and prenatal diagnosis.

With migration, beta-thalassaemia has become a world health problem. Research into its nature and management is being performed in many countries. Where transfusion services are readily available, new intensive transfusion programmes are being attempted and result in better general health, and inhibition or delay in the onset of bone changes and hepatosplenomegaly. Intravenous and subcutaneous infusions of desferrioxamine now offer possible reduction in transfusional haemosiderosis. Prenatal diagnosis of beta-thalassaemia is now possible. Techniques for fetal blood sampling and laboratory investigation are being perfected in a number of centres.

Blood Transfusion↗
PubMed1979

Poor outlook for childhood acute lymphoblastic leukaemia with relapse.

Results of treatment in 72 children with a relapse of acute lymphoblastic leukaemia were analysed. A second remission was induced in 57 children (79%). Remission rates were significantly higher in males, and in patients with white cell counts less than 30 X 10(9)/L. The median duration of the second remission was only four months, and the median duration of survival from the time of relapse was nine months. The median duration of survival from the time of diagnosis was 27 months. Among children who suffered a relapse was a small group who had prolonged survival and prolonged second remissions. It is uncertain whether some of these may have a chance of "cure".

Child↗
PubMed1978

Treatment of childhood lymphocytic leukaemia with high white-cell counts.

Combination chemotherapy with cytosine arabinoside, cyclophosphamide and L-asparaginase (Asnase) was given to 22 children with acute lymphocytic leukaemia (ALL) with a white-cell count greater than 30 X 10(9)/1, and other features suggestive of poor prognosis. Complete remission was induced in all patients--in 19 after 2 courses of chemotherapy and in the remainder after a third course. During induction, neutropenia occurred in 18 and severe infection in 3. Anaphylaxis to Asnase occurred in 8 patients after the second course and one other had transient Asnase-induced diabetes. All patients received central-nervous-system prophylaxis after achieving remission, during which they were also treated with weekly vincristine and a 2-week course of prednisolone. Continuation therapy consisted of short cycles of intermittent chemotherapy and BCG inoculation or long cycles of intermittent chemotherapy +/- BCG. Life-table analysis shows 46% complete remission rate at 28 months, with 6 patients all in complete remission followed up between 28 and 41 months. There were minimal complications of continuation therapy, and BCG inoculation was well tolerated.

Adolescent↗
PubMed1977

Intermittent chemotherapy and BCG in continuation therapy of children with acute lymphocytic leukemia.

Continuation therapy using intermittent chemotherapy and BCG inoculation was commenced in 28 children with acute lymphocytic leukemia (ALL) immediately after remission induction and "CNS prophylaxis." At a median followup time of 17 months, 71% remain in total remission and 86% in bone marrow remission. Complications of the therapy were minimal. Major infections occurred on two occasions and there were no deaths in remission. Neutropenia, "minor" infections and postponement of chemotherapy occurred most often during the first three courses of treatment. There were no local or systemic BCG infections. Tuberculin sensitivity was tested in 25 patients. It was positive in 17 of 18 patients in total remission and all four patients with only CNS relapse, and was negative prior to relapse in three patients who developed bone marrow disease.

BCG Vaccine↗
PubMed1976

Thalassaemia--a preventive approach.

Thalassaemia is a significant public health problem in Australia. There is a need for improved patient education about the disease in order to prevent unnecessary anxieties. The recent advent of methods for antenatal diagnosis has given emphasis to a preventive approach. A screening and counselling service established at Queen Victoria Memorial Hospital, Melbourne, is described, and some of the problems encountered are discussed. Psychological problems are common, and these need to be managed carefully.

Adult↗
PubMed1975

Intermittent chemotherapy and immunotherapy with BCG in remission maintenance of children with acute lymphocytic leukemia: effects upon immunological function.

Twelve children with acute lymphocytic leukemia who had been in complete remission on continuous chemotherapy for at least 12 months, were treated with intermittent courses of chemotherapy alternating with BCG inoculation during the drug-free intervals. Measurements were made of leukocyte populations in blood and bone marrow leukemic blastogenic responses of blood lymphoid cells to phytohemmagglutinin and soluble leukemic blast cell membrane antigen. Antibody titers to a soluble leukemic blast-cell membrane-derived antigen were determined. Comparison was made with similar measurements during a second phase of intermittent chemotherapy without BCG inoculation (phase II). Two children showed bone-marrow relapse and two developed central nervous system leukemia during the study. Rises in blood and bone-marrow lymphoid cell numbers were found during both phases of the study. Blastogenic responses to phytohemagglutinin, depressed at the start of the study following at least 12 months of continuous chemotherapy, rose during intermittent chemotherapy and BCG and remained within normal ranges during phase II. Antibody titers and blastogenic responses to leukemia blast-cell membrane antigens increased in eight of twelve and six of seven children respectively during the BCG phase and were maintained during phase II. Only one child showed further increases in phase II. The combination of BCG and intermittent chemotherapy may increase leukemia-associated immunity in some patients with acute lymphocytic leukemia in remission. The separate contributions of either BCG or intermittent chemotherapy in producing this effect cannot be determined by this study.

Antibodies, Neoplasm↗