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Biomedical subjects

S E James

Publications and source records attributed to S E James.

At least 19 recordsLinked to original sources
PubMed2002

Survival of a 75% burn in a patient with longstanding Addison's disease.

This is the first reported case of survival of a significant burn in a patient with established Addison's disease. The systemic stress response to thermal injury is well recognised, there is a marked hypermetabolic response with prolonged periods of catabolism. In particular, the elevation of plasma cortisol levels is crucial for this response to severe systemic stress. Cortisol elevation is maintained for the duration of burn wound healing, is proportional to the burned body surface area and the normal circadian rhythm of endogenous cortisol is lost. Acute adrenal insufficiency has been described in patients suffering major burn injuries with generally poor outcomes. We discuss the management and complications of adrenal replacement therapy in a severe burn setting, as illustrated by this case report.

Addison Disease↗
PubMed2001

The potential for eye bank limbal rings to generate cultured corneal epithelial allografts.

PURPOSE: Patients with severe limbal deficiencies are unable to maintain a stable corneal surface. If sheets of cultured allogeneic corneal epithelium could be prepared from eye banked corneal limbal rings, which are normally discarded after keratoplasty, the sheets may be beneficial for grafting onto patients with limbal stem cell deficiencies. METHOD: Biopsies of limbal tissue (2-3 mm2) removed from organ-cultured corneal limbal rings or from fresh whole globes were either trypsinized or set up as explants to assess their potential for corneal epithelial cell production. RESULTS: Several biopsies were taken from each of 21 organ-cultured limbal rings and 10 fresh cadaveric globes. Cultures were generated from every cadaveric eye (10/10), although not all biopsies from the same eye gave rise to cultures. Confluent sheets of cultured cells were also produced successfully from limbal rings that had been in organ culture for up to 25 days, but the success rate from limbal ring material was variable (14/21). An analysis of parameters associated with each limbal ring was carried out in an attempt to identify the reasons for the different efficiencies of epithelial production. No obvious single parameter correlation was detected, although there was a trend to poorer efficiency with increased donor age. CONCLUSIONS: Confluent sheets of cultured corneal epithelial cells, suitable for grafting, can be produced from limbal tissue taken from eye bank organ-cultured corneas, although it takes longer, on average, to reach confluence (17-21 days) than an equivalent sample from a fresh eye (9-12 days).

Adolescent↗
PubMed2001

The Soho nail bomb: the UCH experience. University College Hospital.

This paper documents the clinical course of the casualties treated at University College Hospital, following the detonation of a terrorist nail bomb in a public house in Soho, London. The need for adequate primary debridement is paramount, including consideration of definitive primary limb amputation.

Adult↗
PubMed2000

Werner's syndrome T lymphocytes display a normal in vitro life-span.

Werner's syndrome (WS) is an autosomal recessive disorder displaying many features consistent with accelerated ageing. Fibroblasts from WS patients show a distinct mutator phenotype (characterised by the production of large chromosomal deletions) and a profound reduction in proliferative capacity. The disorder results from a mutation in a novel ReqQ helicase. Recently, we demonstrated that the proliferative defect was corrected by the ectopic expression of telomerase. From these data, we propose that mutations in the wrn gene lead to deletions at or near the telomere which reduce the cells replicative life-span. This hypothesis predicts that cell types which retain the ability to upregulate telomerase as part of their response to a proliferative stimulus would fail to show any significant effect of wrn gene mutations upon life-span. Human T lymphocytes represent a well-characterised example of such a cell type. To test the hypothesis, WS T lymphocytes were cultured until they reached replicative senescence. These cultures displayed life-spans which did not differ significantly from those of normal controls. These findings are consistent with the hypothesis that the effects of wrn mutations on replicative life-span are telomere-mediated.

Cells, Cultured↗
PubMed2000

Low-friction arthroplasty with Boneloc bone-cement: outcome at 2 to 4 years.

We report the clinical and radiologic outcome of 109 Chamley low-friction arthroplasties implanted with Boneloc bone-cement (Biomet, Bridgend, South Wales, UK) into 104 patients. The mean follow-up was 30 months (range, 2-48 months). There were 72 women (mean age, 71 years) and 32 men (mean age, 72). Cartridge-packed cement was used in 37 cases and vacuum-packed cement in 72 cases. Survivorship analysis based on revision for aseptic loosening showed 79% survival at 4 years. Seventeen (15.5%) hips have been revised for aseptic loosening to date, in which all stems and 4 cups were loose. Extensive femoral osteolysis was always present and resulted in 4 cases of femoral cortical perforation at revision. Survivorship analysis based on revision and radiologic failure showed only 55% survival over the same period. When radiologic loosenings were included as failures, the vacuum-packed cement performed significantly worse than the cartridge-packed cement it replaced. These poor results were consistent with the withdrawal of Boneloc from clinical use in 1995, and we recommend indefinite follow-up for surviving prostheses.

Aged↗
PubMed1998

Fulfilling the promise: community response to the needs of sexual minority youth and families.

Gay, lesbian, bisexual, transgendered, and questioning youth, and the children of gay and lesbian parents, are particularly vulnerable to harassment and other forms of risk. This paper reviews the literature and outlines common processes beginning to be used in some U.S. communities to meet the needs of these youth and families. An illustration of progressive community action is offered in the case of a church-initiated effort still ongoing in a small town in Massachusetts.

Adolescent↗
PubMed1996

Postoperative radiographs or thermal prints after internal fixation of fractures? A study of DHS fixation of hip fractures.

Immediate postoperative radiographs confirm the quality of reduction and fixation of fractures. This information is already available from the image intensifier and can be saved as hard copy thermal prints. If thermal prints give the surgeon the necessary patient and clinical information them immediate postoperative radiography should not be required. In this retrospective study of 20 hip fractures treated by dynamic hip screw (DHS) fixation, plain radiographs and thermal prints were compared for the patient and clinical information they contained. Thermal prints were found to be deficient in some areas but, nevertheless, can potentially replace postoperative radiographs in many orthopaedic procedures saving time, money and radiation exposure.

Aged↗
PubMed1995

Mennen plate fixation for fracture of the femoral shaft with ipsilateral total hip and knee arthroplasties.

A method of treatment for a femoral shaft fracture in a patient with well-functioning ipsilateral total hip and knee arthroplasties is described. Total hip and knee arthroplasties are commonly performed, but ipsilateral femoral shaft fracture is an infrequent and troublesome complication. Management of these fractures is often difficult. Various operative treatments have been described in the literature with varying success.

Aged↗
PubMed1994

The non-operative management of radial head fractures: a randomized trial of three treatments.

Ninety-eight consecutive patients with Mason type 1 and 2 radial head fractures were randomized into three treatment groups to compare early mobilization with immobilization in flexion and extension. Eighty-one patients were reviewed on average 25 months following fracture and assessed for pain, disability and range of movement. Loss of full extension was the most frequent restriction of movement and was found in 17 patients. Two patients had restricted flexion without limited extension. Patients immobilized in a flexion cast had a significantly reduced range of movement compared with patients immobilized in extension (P = 0.02). Nineteen patients had residual pain and again the flexion group fared worse than the extension group (P = 0.06). Results from early mobilization in a sling were not significantly different from the other two groups. Treatment of radial head fractures in flexion casts should be avoided.

Adolescent↗
PubMed1992

Three-dimensional CT imaging of the wrist. A practical system.

Three-dimensional computerized tomography provides a new approach to radiological imaging. Raw data from sequential two-dimensional scans have been reconstructed as a three-dimensional model of the carpal area using the Medical Graphics and Imaging Workstation. This study demonstrates the anatomical accuracy and potential diagnostic qualities of a reconstruction of the carpus using this system. The advantages, pitfalls and suggested applications of this technique of carpal imaging are discussed. Three-dimensional imaging is shown to provide a great deal of information which cannot be viewed on conventional radiographs or CT images.

Humans↗
PubMed1992

Pelvic underpinning: eight years' experience.

A new method to reconstruct major acetabular floor defects is described. It relies on the placement of special nails into each of the three bones of the hemipelvis. Curved lugs attached to the nails are coalesced using bone cement forming a platform onto which a standard acetabular prosthesis is located. Forty-seven cases are reported with a mean follow-up of 4.4 years (1 to 8). No loosening of an acetabular cup or migration of the device has occurred.

Acetabulum↗
PubMed1991

Bi-articular hemiarthroplasty of the hip: a 7-year follow-up.

A bi-articular prostheses was used to replace the femoral head in 323 patients over 7 years in an attempt to reduce the incidence of acetabular erosion, which has been reported by others who have used different types of prostheses. No erosion of the acetabulum has yet been found in our series, but from the point of view of cost, we consider that the use of this prosthesis should be restricted to active younger patients.

Aged↗
PubMed1989

Percutaneous disc surgery.

The rationale and clinical methods of percutaneous disc surgery have been modified during the past four years. Experience with a consecutive series of 48 patients suggests that the procedure now offers results comparable to open surgery and the advantages of reduced surgical trauma.

Adult↗
PubMed1988

A further assessment of factors influencing measurements of thioguanine-resistant mutant frequency in circulating T-lymphocytes.

We have used the T-Lymphocyte cloning technique as a method of monitoring the human population for somatic cell mutant frequency. We present a statistical analysis of the experimental factors which may influence the observed mutant frequency. We have obtained consistently high plating efficiencies of T-cells from the mononuclear cell fraction from donor blood samples (mean of 56%, based on 123 observations from 70 individuals). Nevertheless, an inverse correlation of mutant frequency with plating efficiency was observed, and some experimental factors (serum and interleukin-2 batch, and worker) may have a significant effect on the observed mutant frequency. We discuss the difficulties that these possible effects present in establishment of a reference database and design of long-term studies. No significant effect of donor sex on mutant frequency was observed, but age (1.3% increase per year for normal adults) and smoking (56% increase over normal non-smokers) both significantly increased the mutant frequency. We discuss the utility of the assay for the monitoring of populations for heritable DNA damage, and we compare the results to those obtained with lymphocytes using other endpoints, e.g. chromosome aberrations, micronuclei and sister-chromatid exchange.

Age Factors↗