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Biomedical subjects

R Sanders

Publications and source records attributed to R Sanders.

At least 163 records · Page 9Linked to original sources
PubMed1991

The morbidity of salvage surgery following conventional radiotherapy and continuous, hyperfractionated accelerated radiotherapy (CHART).

A comparison was made of the morbidity of surgery for loco-regional recurrence in patients with advanced cancer of the head and neck region following continuous hyperfractionated accelerated radiotherapy (CHART), after conventional radiotherapy, and also in a group following surgery only as the primary treatment. Post-surgical morbidity occurred in 14 (77%) of the 18 patients treated with CHART, of whom 11 (78%) required a further surgical procedure. In the conventional group, morbidity occurred in 14 (58%) of the 24 patients, of whom 9 (64%) required further surgery. Finally, in the surgical group morbidity occurred in 13 (48%) of the 27 patients, of whom 7 (54%) required further surgery. Because of the many factors that may influence the chance of morbidity and of the small number of cases, considered statistical analysis is not meaningful and there must be caution in the interpretation of results. When allowance is made for the greater frequency of more advanced tumors and for sites in the oropharynx and oral cavity, where procedures associated with greater risk of complication were performed, the morbidity seen after surgery was performed upon CHART patients appeared to be no greater than when conventional radiotherapy had been given. As expected, the surgery only group showed less morbidity than either of the radiotherapy groups.

Adult↗
PubMed1991

T-cell maturation and clonal deletion in cyclosporine-induced autoimmunity.

In some circumstances cyclosporine (CyA) induces autoimmune phenomena, and a lethal form of syngeneic graft-vs-host disease (SGVHD) can be induced in rats by the administration of CyA. Although several rat strains develop this disease, in this study, we report that of six mouse strains tested, only the DBA/2 strain developed SGVHD. A comparison of the effect of CyA on thymocytic and peripheral T-cell populations revealed that CyA-induced alterations were similar in the two species, although more marked in rats. Notably, CyA-treated syngeneic bone marrow chimeras (SBMC) had transiently increased numbers of peripheral CD4+ CD8+ T-cells, expressing a marker normally limited to thymocytes. Examination of T-cell receptor (TCR) V beta expression in CyA-treated mice revealed a normal pattern of clonal deletion in all strains (including disease-prone DBA/2 mice), suggesting that CyA may induce autoimmunity without blocking intrathymic clonal deletion.

Animals↗
PubMed1991

Influenza virus activity in Papua New Guinea.

Influenza viruses remain a major cause of respiratory disease in both developed and developing countries. A great deal of information concerning the structure, pathology and modes of transmission of these viruses has been accumulated, but no means of successfully combating them have, as yet, been devised. The most appropriate strategy for limiting the effects of influenza is to monitor the emergence and spread of new strains carefully and warn the public and at-risk groups of impending epidemics. In Papua New Guinea, as in most other developing countries, the major at-risk groups are the very young and the elderly. In the past, influenza epidemics were rare and affected the whole community, but with modern development and increased mobility the transmission dynamics of influenza have changed. The only influenza surveillance centre in Papua New Guinea is at the Papua New Guinea Institute of Medical Research in Goroka, and the surveillance activities of this centre are limited to the immediately surrounding areas. There is a need to establish a national influenza surveillance network, to provide nation-wide monitoring of influenza activity, and to provide a central repository of current information on influenza infections in the country.

Adult↗
PubMed1991

Assessment of burn injury in the accident and emergency department: a review of 100 referrals to a regional burns unit.

Accurate assessment of the extent of thermal injury in the accident and emergency (A&E) department is essential if appropriate resuscitation and referral to a specialist unit is to occur. However, review of 100 referrals to a regional burns unit confirms that assessment is often inaccurate, and usually undertaken by no one more senior than a casualty officer, leading to suboptimal treatment and referral. Severe thermal injury should be assessed by a team of senior doctors, according to the major trauma protocol, and casualty officers should receive better training in the assessment of less extensive burns.

Burn Units↗
PubMed1991

Double-plating of comminuted, unstable fractures of the distal part of the femur.

The cases of nine patients who had a complex fracture of the distal part of the femur and a deficient medial-cortical buttress were reviewed. Stable fixation was not achieved with the lateral condylar buttress plate alone. Collapse of the distal fragment into varus angulation was noted intraoperatively, with the axis of rotation being the junction of the distal screws and the plate. Additional stabilization with a medial plate and a bone graft from the iliac crest was applied in all nine patients: in six, at the time of the index operation and in the remaining three, after the open wound and open fracture were considered clean. At an average duration of follow-up of twenty-six months (range, twenty-one to thirty-four months), all of the fractures had healed. Evaluation of the functional outcome revealed five good and four fair results. In three patients, less than 90 degrees of flexion of the knee was present and in six, the arc of flexion was limited to between 90 and 100 degrees. Additionally, four patients had an extensor lag of 5 degrees.

Adult↗
PubMed1990

A standardized block fabrication technique.

The accuracy of delivered dose is a primary goal in every radiation therapy department. Improved imaging techniques now enable the radiation therapist to define more precisely the area of interest, which helps the sparing of normal surrounding tissue. Tray-mounted customized blocks are routinely used to define this treatment portal accurately and reproducibly. However, the level of accuracy is dependent on the block fabrication technique and the skill of the block cutter. We at Moffitt Cancer Center have standardized our system in a way that minimizes some of the human errors, while keeping the procedure fast and accurate. This system uses a tray template that simulates our blocking trays. The function of this tray is to position the styrofoam (and therefore the cerrobend block) on the tray in such a way as to insure proper alignment with the treatment machine. We also feel this improves upon some common designs using random holes or hole patterns, which may interfere with the treatment area. This system is not overly sophisticated and can be easily implemented in most radiation therapy departments.

Humans↗
PubMed1990

Adjunctive use of tolazamide in newly-diagnosed diabetic children.

Recent data suggests that one of the major actions of sulfonylureas is to potentiate the anabolic cellular effects of insulin. This is the first study to examine the use of sulfonylureas as adjunctive therapy in newly-diagnosed type I diabetic children. A random, prospective, double blind study over 15 months, stratified by age at diagnosis, was conducted. The treatment group (n = 13) received daily oral weight-adjusted tolazamide whereas the control group (n = 11) received placebo. Monthly comparison of the HbA1 values between groups revealed no statistical difference; likewise, the fasting serum C-peptide values were not dissimilar. The mean daily insulin dose per kilogram, however, was less in the tolazamide group (P less than 0.001). The data suggests that the addition of tolazamide may not be of therapeutic benefit in newly diagnosed juvenile diabetics, although insulin requirements may be reduced.

Adolescent↗
PubMed1990

Contact lens related problems presenting in casualty.

The use of contact lenses in preference to spectacles has gained much popularity over recent years. This, however, is not without its complications and eye departments are now seeing an increasing number of contact lens related eye disease. This study seeks to show the range of complications seen, their treatment and outcome. It also outlines the types of contact lens in popular use, the reason for wear, the duration of wear and the sex, age and professional distribution of contact lens wearers.

Adolescent↗
PubMed1990

Limb salvage versus amputation. Preliminary results of the Mangled Extremity Severity Score.

Objective criteria can predict amputation after lower-extremity trauma. The authors examined the hypothesis that objective data, available early in the evaluation of patients with severe skeletal/soft-tissue injuries of the lower extremity with vascular compromise, might discriminate the salvageable from the unsalvageable limbs. The Mangled Extremity Severity Score (MESS) was developed by reviewing 25 trauma victims with 26 severe lower-extremity open fractures with vascular compromise. The four significant criteria (with increasing points for worsening prognosis) were skeletal/soft-tissue injury, limb ischemia, shock, and patient age. (There was a significant difference in the mean MESS scores; 4.88 in 17 limbs salvaged and 9.11 in nine limbs amputated; p less than 0.01). This scoring system was then prospectively evaluated in 26 lower-extremity open fractures with vascular injury over a 12-month period at two trauma centers. Again, there was a significant difference in the mean MESS scores; 4.00 for the 14 salvaged limbs and 8.83 for the 12 amputated limbs (p less than 0.01). In both the prospective and retrospective studies, a MESS score of greater than or equal to 7 had a 100% predictable value for amputation. This relatively simple, readily available scoring system of objective criteria was highly accurate in acutely discriminating between limbs that were salvageable and those that were unsalvageable and better managed by primary amputation.

Adult↗
PubMed1990

Outer gloves in orthopaedic procedures. Cloth compared with latex.

A randomized prospective study was undertaken to determine the rate of punctures of the inner glove when techniques of double-gloving were employed for orthopaedic operations. Group I consisted of twenty-five procedures in which double latex gloves were used, and Group II comprised another twenty-five in which latex inner gloves and cloth outer gloves were worn. As the outer glove was expected to act as a barrier against puncture of the inner glove, only inner gloves were tested. All glove exchanges done intraoperatively for presumed tears of the inner glove were noted, as were punctures of the skin. The type and length of the procedure were also documented. Group I (double latex gloves) had a significantly higher rate of total inner-glove perforations per procedure (p less than 0.0001) than Group II (cloth and latex gloves). Furthermore, unrecognized perforations were significantly higher in Group I than in Group II (p less than 0.01). In Group I, the number of punctures increased with the duration of the operation; a puncture was found in all procedures in which the operation lasted longer than three hours (p less than 0.01). In Group II, only two tears of the inner glove occurred. Both were unrecognized and were independent of the duration of the operation.

Gloves, Surgical↗
PubMed1990

Lack of transmission of human immunodeficiency virus from infected children to their household contacts.

The possibility of transmission of the human immunodeficiency virus (HIV) from infected children to their contacts has been confronted in households, schools, day-care centers, and other child care settings. Cases reported to the Centers for Disease Control and several studies of close contacts of HIV-infected patients suggested that the risk of transmission in these settings is extremely low. However, most of these studies involved infected adults or older children. Younger children, who drool, bite, mouth toys, and are incontinent, may be more likely to transmit HIV in these settings. To assess this possibility, the authors tested 89 members of households in which 25 children with HIV infection, most of whom were preschool-aged, resided. Household members had close personal contact with the infected children. They shared many items likely to be soiled with blood and body fluids, such as toys, toothbrushes, eating utensils, toilets, and bathtubs. Hugging, kissing, sharing a bed, and bathing together were common. Household members were tested no sooner than 4 months after initial contact with the infected child, to allow adequate time for sero-conversion. All 89 participating household members were anti-HIV seronegative, and 78 who were tested were serum p24 antigen negative. It was concluded from this study and other evidence that the risk of transmission from children to their contacts is extremely low and has not been clearly documented in the household setting.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Hepatitis B surface antigen, e antigen and HBV DNA in healthy antenatal patients attending Goroka Hospital and their relationship to tattooing practices.

The prevalence of hepatitis B surface antigen (HBsAg) in women attending the antenatal clinic at Goroka Hospital was 14%. 32% of those positive for HBsAg also had hepatitis B e antigen (HBeAg), indicative of an infectious state. The mean HBV DNA level in HBeAg-positive women was 1800 pg/ml. These results suggest that vertical transmission of hepatitis B virus may be of importance in Papua New Guinea. Tattooing is common in this population: 91% of women in the study had tattoos. Methods employed in tattooing are a potential health risk but in a community which is now exposed to hepatitis B virus early in life tattooing practices are not important in the transmission of hepatitis B infection.

Adolescent↗
PubMed1989

Human interstitial retinoid binding protein. A potent uveitopathogenic agent for the induction of experimental autoimmune uveitis.

Human interstitial retinoid binding protein (HIRBP) is a 136,000 m.w. photoreceptor cell protein which transports retinoids between the retina and the retinal pigment epithelium of the eye. The amino acid sequence of HIRBP suggests that the molecule consists of four continuous homology domains which arose by several gene duplications some 600 to 800 million years ago. When injected into susceptible animal species, including primates, it induces an experimental autoimmune uveitis (EAU), a predominantly T cell-mediated autoimmune disease of the retina and uveal tract of the eye, and the pineal gland. In order to further refine specific sites in HIRBP responsible for its uveitopathogenicity, we synthesized 120 overlapping peptide corresponding to its entire 1262 amino acid sequence, and tested each peptide for its ability to induce an EAU in Lewis rats. Five peptides with extensive amino acid sequence homology, designated HIRBP 715, HIRBP greater than 730 and HIRBP 745, HIRBP 778, and HIRBP 808 were uveitopathogenic when used at a 50 micrograms immunizing dose. The most potent peptide for the induction of EAU was HIRBP 715 (amino acid positions 521 to 540). In dose response studies as little as 0.1 microgram/animal was capable of inducing an inflammatory response. In addition, peptide HIRBP 946 which corresponds to the mid portion of peptide HIRBP 715 and contains only eight amino acids (RTATAAEE) was uveitopathogenic under our experimental conditions. Our study identifies multiple uveitopathogenic sites in HIRBP and further defines the amino acids necessary for the induction of EAU in one of these sites.

Amino Acid Sequence↗
PubMed1989

Prevalence of gallstone disease in Hispanic populations in the United States.

The 1982-1984 Hispanic Health and Nutrition Examination Survey used ultrasonography to investigate the epidemiology of gallstone disease. Mexican American, Cuban American, and Puerto Rican men and women, aged 20-74 yr, were selected from household samples in Texas, New Mexico, Arizona, Colorado, California, Connecticut, New Jersey, New York, and Florida. Ultrasonography was performed on 2299 persons. The age-adjusted prevalence of gallstone disease (gallstones + cholecystectomy) among Mexican American men (7.2%) was 1.7 times that of Cuban American men and 1.8 times that of Puerto Rican men. The prevalence for Mexican American women (23.2%) was 1.5 times that of Cuban American women and 1.7 times that of Puerto Rican women. Rates were about three times higher among women than men and increased with age in both sexes and all ethnic groups except older Puerto Rican women. Among Mexican American women aged 60-74 yr, the prevalence of gallstone disease reached 44.1%. These results support the hypothesis that Mexican Americans are at increased risk of gallstone disease.

Aged↗
PubMed1989

The fate of meshed allograft skin in burned patients using cyclosporin immunosuppression.

Three patients with burns of 35%, 60% and 25% were treated with cyclosporin after the application of allograft skin. Biopsies of the allografts were taken at appropriate intervals. The drug was continued for 3 weeks, 3 months and 3 weeks respectively without ill-effects on the patients. The allografts survived during cyclosporin treatment but were rejected 12 days after cessation of treatment in Case 1 and 5-7 days in Case 2. In Case 3 where a meshed auto/allograft 'sandwich' technique was used, there was no visible evidence of rejection. It is likely that the allograft was replaced by a "creeping substitution" in the sandwich technique. The Langerhans cell is probably not solely responsible for allograft rejection.

Adult↗
PubMed1989

Treatment of subtrochanteric femur fractures using the dynamic condylar screw.

Thirty-two consecutive subtrochanteric femur fractures were treated using the 95 degree dynamic condylar screw between 1982 and 1985. All fractures were classified according to the radiographic criteria of Seinsheimer. Twenty-two patients were available for follow-up study, with an average time of 23.8 months. Functional results were rated using a new traumatic hip score rating system. The overall union rate was 77.3% (17/22), with functional results rated as excellent or good in 68% (15/22). All five technical failures were associated with extensive bony comminution. Four of these failures were not bone grafted. There were no cases of screw penetration of the femoral head or neck. The indications for the use of this device include transverse, short, and long oblique subtrochanteric fractures, with or without lesser trochanteric avulsion. When excessive comminution exists, this device should not be employed.

Activities of Daily Living↗