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Biomedical subjects

R Thomas

Publications and source records attributed to R Thomas.

At least 343 records · Page 19Linked to original sources
PubMed1996

T cell receptor V beta expression in human intestine: regional variation in postnatal intestine and biased usage in fetal gut.

A panel of T cell receptor V beta specific monoclonal antibodies was used to analyse V beta gene usage at different sites in human postnatal and fetal intestine. In normal small intestine, at a single site, different patients showed expansion of T cells expressing individual V beta s. Lamina propria and epithelial T cells from the same patient showed overlapping but not identical V beta dominance. V beta dominance was also shown in the T cells of the colonic lamina propria. Analysis of two separate regions of intestine from the same patient (5-100 cm apart) showed that T cells expressing a dominant V beta region were often present at both sites. In most patients, however, major biases in T cell V beta usage (two to 12-fold variation) were also apparent between the two sites. Analysis of V beta expression in human fetal intestine also showed considerable skewing, although the most common dominant V beta in postnatal intestine (V beta 22) was never predominant in fetal intestine. Patchy local variation in the expression of individual V beta s therefore occurs against a background of V beta dominance over large regions of the human gut. Furthermore the results from fetal gut show that factors other than luminal antigen control V beta expression in the gut.

Adolescent↗
PubMed1996

Early continuous ST segment monitoring in unstable angina: prognostic value additional to the clinical characteristics and the admission electrocardiogram.

BACKGROUND AND OBJECTIVE: In unstable angina, clinical characteristics, resting electrocardiography, and early continuous ST segment monitoring have been individually reported to identify subgroups at increased risk of adverse outcome. It is not known, however, whether continuous ST monitoring provides additional prognostic information in such a setting. DESIGN: Observational study of 212 patients with unstable angina without evidence of acute myocardial infarction admitted to district general hospitals, who had participated in a randomised study comparing heparin and aspirin treatment versus aspirin alone. METHODS: Clinical variables and a 12 lead electrocardiogram (ECG) were recorded at admission, and treatment was standardised to include aspirin, atenolol, diltiazem, and intravenous glyceryl trinitrate, in addition to intravenous heparin (randomised treatment). Continuous ST segment monitoring was performed for 48 h and all inhospital adverse events were recorded. RESULTS: The admission ECG was normal in 61 patients (29%), showed ST depression in 59 (28%) (17 > or = 0.1 mV), and T wave changes in a further 69 (33%). The remaining 23 had Q waves (18), right bundle branch block (four), or ST elevation (one). During 8963 h of continuous ST segment monitoring (mean 42.3 h/patient), 132 episodes of transient myocardial ischaemia (104 silent) were recorded in 32 patients (15%). Forty patients (19%) had an adverse event (cardiac deaths (n = 3), non-fatal myocardial infarction (n = 6) and, emergency revascularisation (n = 31)). Both admission ECG ST depression (P = 0.02), and transient ischaemia (P < 0.001) predicted an increased risk of non-fatal myocardial infarction or death, while no patients with a normal ECG died or had a myocardial infarction. Adverse outcome was predicted by admission ECG ST depression (regardless of severity) (odds ratio (OR) 3.41) (P < 0.001), and maintenance beta blocker treatment (OR 2.95) (P < 0.01). A normal ECG predicted a favourable outcome (OR 0.38) (P = 0.04), while T wave or other ECG changes were not predictive of outcome. Transient ischaemia was the strongest predictor of adverse prognosis (OR 4.61) (P < 0.001), retaining independent predictive value in multivariate analysis (OR 2.94) (P = 0.03), as did maintenance beta blocker treatment (OR 2.85) (P = 0.01) and admission ECG ST depression, which showed a trend towards independent predictive value (OR 2.11) (P = 0.076). CONCLUSIONS: Patients with unstable angina and a normal admission ECG have a good prognosis, while ST segment depression predicts an adverse outcome. Transient myocardial ischaemia detected by continuous ST segment monitoring in such patients receiving optimal medical treatment provides prognostic information additional to that gleaned from the clinical characteristics or the admission ECG.

Adrenergic beta-Antagonists↗
PubMed1996

Testicular Tumors.

The prognosis for testicular tumors has greatly improved along with advances in imaging, chemotherapy, and surgical techniques. Factors examined include epidemiology, causes of tumors, histologic classification, diagnosis, staging, and management.

Journal Article↗
PubMed1996

Management of Perthes disease of late onset in southern India. The evaluation of a surgical method.

We analysed the short-term outcome after varus osteotomy for Perthes' disease in 48 older children from south-west India, comparing them with 30 historical controls. The children were between 7 and 12 years of age at the onset of the disease. All had stage-I or stage-II disease, with half or more of the epiphysis involved. The operated children had an open-wedge subtrochanteric varus osteotomy with derotation or extension and a trochanteric epiphyseodesis. Weight-bearing was avoided until late stage III. The non-operated children had been treated symptomatically by conservative methods. At the time of healing, 62.5% of the operated group had spherical femoral heads compared with 20% of those treated non-operatively (p < 0.001). Of the operated children with Catterall group-IV involvement, 48% had good results as against 24% of the non-operated group (p < 0.05). The percentage increase in the radius of the affected femoral head compared with the normal side was significantly lower in children who had operations (14.68 v 25.65; p < 0.001). We have shown that the short-term results of early surgical containment in children over seven years of age are satisfactory.

Bone Plates↗
PubMed1996

Brightness discrimination test is not useful in screening for open angle glaucoma.

PURPOSE: Brightness discrimination test (BDT) is routinely employed to assess asymmetrical optic nerve dysfunction and has been suggested as a screening test for primary open angle glaucoma (POAG). We tested the reliability and validity of BDT in the diagnosis of POAG. METHODS: The study groups included 34 patients with established primary open angle glaucoma, 20 glaucoma suspects, and 33 age-sex matched controls. Cataract was not an exclusion criterion in these groups. The normal brightness score was determined to be 88% (mean score, 94%-2 SD) in a pilot study. Brightness discrimination test was performed in all subjects by two observers independently. BDT showed an excellent interobserver agreement (weighted Kappa 0.84). RESULTS: The presence of a cataract alone increased the risk of brightness impairment twofold, glaucoma alone increased the risk eightfold, and the presence of both conditions by 17 times compared to those with neither condition. BDT was not a useful test in the diagnosis of POAG (sensitivity 67% and specificity 93%); the ability to detect a significant field defect was also poor (sensitivity 53% and specificity 76%). CONCLUSIONS: There was poor association between decreased brightness scores and asymmetrical field defects as determined by the Humphrey's field analyzer (HFA).

Adult↗
PubMed1996

Resiting Molteno implant tubes.

The authors describe a surgical technique for resiting Molteno implant tubes. The indications for this intervention are a blockage of the tube that cannot be resolved by other means; erosion of the scleral flap and conjunctiva by the tube; and pediatric cases in which enlargement of the eye causes retraction of the tube from the anterior chamber.

Filtering Surgery↗
PubMed1996

Vitreous opacities in phacolytic glaucoma.

BACKGROUND AND OBJECTIVE: To report five cases of vitreous opacification in phacolytic glaucoma (PG). PATIENTS AND METHODS: The records of patients with PG were retrospectively reviewed. A total of 135 eyes with PG were studied to determine the presence of vitreous opacification. RESULTS: Five eyes with PG demonstrated opacification of the vitreous, which was first noted at surgery and confirmed postoperatively. All patients had had symptoms of PG for 7 days or more (mean +/- SD, 10.6 +/- 2.4 days) before they sought medical attention. Three eyes had a hypopyon on preoperative examination; two of these eyes showed refractile crystals in the anterior chamber. The opacities resolved spontaneously in all five eyes over a period of 12 weeks and interfered with visual activity only in the immediate postoperative period. CONCLUSION: Vitreous opacification in PG is a self-limited process that may not require surgical intervention unless more rapid visual rehabilitation is desired. The vitreous opacification probably results from an exaggeration of the process causing the anterior chamber reaction.

Aged↗
PubMed1996

Neuronal basis of amblyopia: a review.

Amblyopia is an acquired defect in vision due to an abnormal visual experience during a sensitive period of visual development. The neuronal basis of amblyopia is the study of the effects of "abnormal" environmental influences on the genetically programmed development of the visual processing system. Visual pathway development commences with ganglion cells forming the optic nerve. The process that guides these neurones initially to the lateral geniculate nucleus (LGN) and then onto the visual cortex is genetically programmed. Initially this process is influenced by spontaneously generated impulses and neurotrophic factors. Following birth, visual stimuli modify and refine the genetically programmed process. Exposure to the visual environment includes the risk of abnormal inputs. Abnormal stimuli disrupt the formation of patterned inputs allowing alteration of visual cortical writing with reduction in ocular dominance columns driven by the abnormal eye. Correction of the abnormal visual input and penalisation of the "normal" input is the mainstay of therapy for amblyopia. Further understanding of the mechanisms involved in the development of a normal visual processing system will allow trialing therapies for amblyopia not responding to occlusion therapy. Levodopa is one agent providing insights into recovery of visual function for short periods in apparently mature visual systems.

Amblyopia↗
PubMed1996

Practical approach to diagnosis of strabismus.

Jampolsky's approach to the diagnosis of strabismus is simple. Certain tests are to be performed in sequence to determine 1) the presence of fusion in the habitual head position under normal viewing conditions and in the primary position at near and distance; 2) the presence and characteristics of fusion vergences and 3) the deviations that exist at distance and near. These are established by the cover tests and the prism cover test. 4) Incomitance of the strabismus, A-V phenomena and mechanical weaknesses and restrictions are assessed by observations of eye movements and the forceps tests. Finally, 5) inferences about the state of the sensory system are made based on the history, vision and clinical examination. Additional tests performed on indication are the 4 diopter prism test, the prism adaptation test and the forceps muscle tests. This approach allows an accurate and reproducible examination to be performed in an objective manner making it possible to compare clinical findings over time and allow a rational plan of management to be evolved. Errors in examination arise from poor control of three factors, accommodation, fixation and fusion vergence. These can be controlled by careful attention to the test conditions. This system of diagnosis is simple to follow and understand, economic on time and altogether less of a strain to examiner (and patient) than the traditional system.

Child↗
PubMed1996

Assessment of clinical significance: the number needed to treat.

The practising ophthalmologist is frequently confronted with treatment options shown to be "statistically significantly better" than those currently in use. Unfortunately what is statistically significant may not necessarily be clinically significant enough for the practitioner to change from the currently preferred method of treatment. In this article we use common ophthalmic examples to introduce the "number needed to treat" (NNT), as a simple clinical approach for the practising ophthalmologist wishing to assess the clinical significance of treatment options.

Eye Diseases↗
PubMed1996

Novel mitochondrial DNA insertion polymorphism and its usefulness for human population studies.

The frequency of a polymorphic mitochondrial DNA insertion into the nuclear genome was determined for 870 individuals from a geographically diverse set of 20 populations. The mtDNA insertion frequency varies significantly among populations, having a large GST value (0.178) and high heterozygosity values within populations. The clinal pattern of increasing frequency of the insertion from Africans through Europeans and Asians to native Americans is striking. The polymorphism is a new example of insertion-deletion polymorphisms and is a valuable marker for human population and evolutionary studies.

Base Sequence↗
PubMed1996

Surgical magnification for intracapsular cataract surgery in a rural hospital.

Intracapsular cataract extraction is still the most common type of operation performed in India, especially in eye camps, and most of these are done without magnification. To assess the surgical outcome of intracapsular cataract surgery in a rural hospital with various magnifying systems, 121 consecutive eyes (121 patients) with uncomplicated cataract were randomly allocated to surgery with the operating microscope, binocular loupe or unaided eye. The surgery was performed by either consultants or first year residents. The best corrected vision at least four weeks post-operatively was compared among the three groups. The performance between the consultants and the junior residents was also compared. The improvement of surgical outcome with magnification was statistically significant (p = 0.0045); and clinically important with a relative risk reduction of 60.6%. The comparison between microscope and loupe magnification did not show a significant difference (p = 0.24). However, with an operating microscope, the consultants performed significantly better than the junior residents. These findings suggest that the use of magnification in intracapsular cataract extraction provides a definite advantage over an unaided eye and that the binocular loupe is a good alternative to the operating microscope in this kind of surgery.

Adult↗
PubMed1995

Expression of CD45RB and CD27 identifies subsets of CD4+ memory T cells with different capacities to induce B cell differentiation.

The capacity of four subsets of CD4+ memory T cells, defined by expression of CD45RB and CD27, to provide help for B cells was examined. Larger amounts of Ig were induced by CD45RBdimCD27- cells compared with the CD45RBdimCD27+ population, whereas CD45RBbrightCD27+ or CD27- cells were poor inducers of Ig synthesis. Mitomycin C treatment, which prevents suppressive activity, markedly enhanced Ig production supported by each subset except for CD45RBbrightCD27- cells. Mitomycin C-treated CD45RBdim cells remained the most efficient inducers of Ig production, but no difference was detected between CD27+ and CD27- cells. The subsets also differed in their ability to proliferate and secrete cytokines, but these differences did not explain variations in the capacity to provide help for B cells. Both CD27- subsets exhibited decreased proliferation and uniquely secreted IL-4, with the CD45RBdimCD27- subset producing the greatest quantities of IL-4. No differences in IL-2 and IFN-gamma production were found. IL-10 secretion increased with the acquisition of the CD45RBdim phenotype and, within the CD45RBdim cells, with the loss of CD27. Staining for cytoplasmic cytokines indicated that individual populations of CD27-CD4+ helper T cells produced either IL-4 or IFN-gamma, whereas more than half of the IL-4 producers also synthesized IL-2. Finally, the different abilities of CD4+ memory T cell subsets to support B cell differentiation did not relate to variations in the expression of CD40 ligand. These results indicate that within the CD4+ memory T cell population an increase of helper activity associates with the shift from a CD45RBbright to a CD45RBdim phenotype. Within the CD45RBdim subset, the loss of CD27 is associated with a reduction of suppressive activity.

Adult↗