Incontinence management: in praise of sheaths.
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Biomedical subjects
Publications and source records attributed to R Watson.
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The presence of antibodies directed against the Ro (SS-A) antigen is the strongest risk factor for the neonatal lupus syndrome. In most instances, the pregnant woman is asymptomatic; however, the presence of subclinical connective tissue disease and the subsequent emergence of overt connective tissue disease have been reported. This article will review the molecular biology of the Ro antigen, assays for anti-Ro antibodies, prevalence of anti-Ro antibody in normal people and patients with systemic lupus erythematosus, and the clinical, immunogenetic and pathophysiologic features of the neonatal lupus syndrome. Finally, current concepts concerning treatment of pregnant women with anti-Ro antibodies will be reviewed.
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In situ hybridization with synthetic oligonucleotides was used to fine map the extent and continuity of herpes simplex virus type 1 (HSV-1) latency-related RNA (LR RNA) in trigeminal ganglia of latently infected humans. A series of 34 20 residue oligonucleotides were employed to cover a 3 kb region of the HSV-1 genome to which the latency-related gene had previously been mapped. The 5' end of the main LR RNA transcript began approximately 1210 nucleotides downstream from the 3' end of the mRNA from the immediate early gene ICP0. The 3' end of the LR RNA overlapped the 3' end of the ICP0 mRNA by approximately 1000 nucleotides. A potential small intron was detected near the 3' end of the LR RNA.
The effects of three increasing doses of ketamine on the blood flow to, and oxygen consumption of, the liver, were studied in seven anaesthetised greyhounds. Hepatic arterial and portal venous blood flows were measured continuously using electromagnetic flow probes, and mean arterial pressure and cardiac output monitored as appropriate. Ketamine, even at the highest dose, had little effect on the blood flow to the liver: hepatic arterial blood flow and portal venous blood flow did not differ significantly from their baseline values. However, the oxygen delivery to the liver decreased due, probably, to an increase in oxygen consumption by the pre-portal organs.
The latency-related (LR) gene of herpes simplex virus type 1 (HSV-1) is transcriptionally active during HSV-1 latency, producing at least two LR-RNAs. The LR gene partially overlaps the immediate-early gene ICP0 and is transcribed in the opposite direction from ICP0, producing LR-RNAs that are complementary (antisense) to ICP0 mRNA. The LR gene is thought to be involved in HSV-1 latency. We report here the fine mapping and partial sequence analysis of this HSV-1 LR gene. 32P-labeled genomic DNA restriction fragments and synthetic oligonucleotides were used as probes for in situ hybridizations and Northern (RNA) blot hybridizations of RNA from trigeminal ganglia of rabbits latently infected with HSV-1. The two most abundant LR-RNAs appeared to share their 5' and 3' ends and to be produced by alternative splicing. These LR-RNAs were approximately 2 and 1.3 to 1.5 kilobases in length and were designated LR-RNA 1 and LR-RNA 2, respectively. Their 5' ends started approximately 1,210 nucleotides downstream from the 3' end of the ICP0 mRNA. Their 3' ends overlapped ICP0 by nearly 1,000 nucleotides. LR-RNA 1 appeared to have at least one intron removed, while LR-RNA 2 appeared to have at least two introns removed. The LR-RNAs contained two potential long open reading frames, suggesting the possibility that one or more of the LR-RNAs may be a functional mRNA.
Thrombocytopenia has been documented infrequently in association with congenital heart block or lupus dermatitis in the neonatal lupus erythematosus syndrome. We report the cases of two infants with transient neonatal thrombocytopenia born to mothers with connective-tissue disease. Both mother/infant pairs were Ro(SS-A) antibody positive. Although the finding of neonatal thrombocytopenia in the presence of maternal connective-tissue disease suggests an autoimmune thrombocytopenia, platelet antibody studies were negative in both mother/infant pairs. We have found the Ro (SS-A) antibody with increased frequency in idiopathic thrombocytopenic purpura and thrombocytopenia associated with Sjögren's syndrome, but the nature of the association is unknown. We suggest that thrombocytopenia in our patients is a manifestation of the neonatal lupus erythematosus syndrome. This syndrome should be included in the differential diagnosis of neonatal thrombocytopenia.
During the period 1973 to 1982, 35 patients with carcinoma of the anal canal were seen at this hospital. The main form of treatment was abdominoperineal excision, unless specific contraindications to this procedure were present. Between 1982 and 1984, a further 18 such patients were seen; the primary method of treatment then was combination chemotherapy and radiotherapy. Abdominoperineal excision was reserved for those patients who failed to respond to therapy or whose carcinoma recurred during the period of follow-up. The over-all five-year survival rate for the first 35 patients was 50%; the actuarial disease-free survival at two years for those who went into complete remission was 78% in the 18 patients who were seen in the second part of the study. We conclude that conservative treatment by chemoradiation is of value in the management of anal carcinomas.
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Male sex offenders against minors were grouped according to age and sex of victims, and according to whether they had offended against one or more than one minor. Cases of incest or courtship disorder were not included in the study. Among offenders against female children, the number of one-case offenders was substantially larger than that of multicase offenders. The opposite was true of offenders against male children, and there was no significant difference between one-case and multicase offenders against female or male early adolescents. If these counts reflect corresponding prevalences within sex offenders against minors in a Western cultural setting, some inferences can be made from these comparisons.
To determine if collateral ventilation (CV) occurs in pigs and dogs during intermittent positive-pressure ventilation (IPPV) and high-frequency oscillation (HFO), seven pigs and seven dogs were studied by measuring Xenon 133 washout (XeW) from an occluded subsegmental bronchus. The rate constant/min (K) for Xe blood uptake (KXeb) was derived, and when subtracted from K for XeW (KXeW) gave K for removal of Xe by CV (KXecv). Pig XeW were single exponentials with mean KXew = 0.25/min during IPPV and 0.12/min with HFO. In pigs, mean K of XeW was no different from KXeb so that all XeW occurred by blood uptake and none by CV. XeW in dogs had two exponentials. Dogs had over 11 times greater mean KXeW than pigs during IPPV and over 24 times greater during HFO. In dogs, on average, 79% (IPPV) and 87% (HFO) of XeW occurred by CV. CV is a means of gas exchange during HFO and IPPV in dogs but not in pigs.
Ketamine 4 micrograms/kg/minute produced pain relief similar to that from morphine 33 micrograms/minute in a double-blind study that compared analgesia from constant-rate intravenous infusions of the two drugs in 60 patients. The analgesic efficacy of the infusions, as assessed by pain scores and the requirement for supplementary self-administered morphine, was poor. Ventilatory depression, the most significant side effect, occurred only in patients who received morphine infusion. The low dose ketamine infusion did not provide clinically useful analgesia even though adequate plasma concentrations were achieved.
Available data support the idea that the neonatal lupus erythematosus syndrome results from an autoantibody produced in the mother and passed across the placenta to the fetus. Despite the evidence for the presence of the Ro(SSA) autoantigen both in the skin and heart and the almost universal presence of the Ro(SSA) autoantibody in mothers of infants with neonatal lupus, there are emerging data to suggest that La(SSB) and, rarely, nRNP antibodies play an important pathologic role in some cases of the neonatal lupus syndrome.