Biomedical subjects
Publications and source records attributed to S Gray.
This report presents descriptive and analytic data for serum total cholesterol, cholesterol lipoproteins, and triglycerides for adults 20-74 years of age by age, sex, and selected subgroups of the population at risk of developing coronary heart disease. This information is from the second National Health and Nutrition Examination Survey, which was conducted during the years 1976-80.
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Seventy-three pediatric patients with acute hepatitis and 19 control patients without liver disease living in Cairo, Egypt, were evaluated with a newly developed Western blot assay for IgM antibody to hepatitis E virus (IgM anti-HEV). The mean age of acute hepatitis patients was 6.4 years (range, 1-13 years); 56% were male. Among the 73 acute cases, hepatitis A was diagnosed in 30 (41%), possible acute hepatitis B in three (4%), hepatitis E in nine (12%), and by exclusion, non-A, non-B hepatitis in 29 (40%). Two additional acute cases were positive for both IgM anti-HAV and IgM anti-HEV. None of the 19 control subjects had IgM anti-HEV. Parenteral risk factors were associated with cases of non-A, non-B hepatitis but were not associated with acute hepatitis E. Contact with a family member with jaundice was associated with acute hepatitis A. In contrast to prior epidemics of enterically-transmitted non-A, non-B hepatitis, HEV was found to be a common cause of acute hepatitis in a pediatric population. This study provides additional evidence that HEV may be a frequent cause of acute sporadic hepatitis among children living in some developing countries.
The recent popularity of acid-etched, resin-bonded retainers (RBR) has initiated improvements in design, technique, and etching. This study compared the shear strength of chemically etched Biobond retainers with electrolytically etched retainers bonded to enamel using identical cement. Shear fracture loads were recorded using Instrom testing for all specimens. The mean fracture load for the electrolytically etched castings was greater than that of the chemically etched castings. Electrolytically etched specimens also recorded the greatest and the least fracture load values. These results indicated that, while there were significant differences between the two groups with greater shear strength values for electrolytic etching, there was also more variation in shear fracture load with electrolytic etching.
We have studied the antigenic (immunotype) and physical characteristics of the lipooligosaccharide (LOS) of epidemiologically related Neisseria meningitidis case (36) and carrier (76) isolates associated with a virulent clone of meningococci (ET-5 complex). LOS immunotypes were determined by dot blotting using immunotype specific monoclonal antibodies and physical characteristics were determined from silver stained SDS-PAGE following proteinase K digestion. The genetic similarity of the different isolates was confirmed by analysis of the restriction fragment length polymorphisms. An association between LOS immunotype expression and invasive disease was found; 97% of case isolates expressed the L3,7,9 immunotype, of which 13% additionally expressed the L1,8,10 determinant. The LOS immunotypes of carrier strains were much more heterogeneous. The predominant immunotype was L1,8,10 (70%) and only 24% expressed L3,7,9 alone. Genotypically related case isolates from Norway (6) and Austria (18) expressed the L3,7,9 immunotype with similar frequency to the U.K. isolates. The combination of LOS immunotype and capsule expression appears to be related to the virulence of these meningococcal strains.
A "natural experiment" examined the effects of staff turmoil caused by personal and group issues during and after the merger of two formerly separate neuropsychiatric evaluation units, on patient acting-out behaviors. Interviews with staff members identified the periods of high staff stress, and then two periods of personal resolution (3 to 4 months after the merger) and group reconstitution (8 to 12 months later). Patient acting-out behaviors (1:1 supervision, length of time on 1:1, use of the quiet room, seclusion, and restraints) tended to peak at times of staff peace. Behaviors under patient control (72-hour notices and discharges against medical advice) were also frequent during these periods, but showed additional activity in the time between personal and organizational resolution. While the relationship between staff issues and patient behavior is by no means straightforward, analysis of quantitative and qualitative data gathered here provides some support to the "reverse hypothesis" that when staff are upset, patients will not act out and vice versa. Implications for management, clinical practice, and research are presented.
A prevalence study of 2072 male US shipboard military personnel scheduled for deployment to South America/West Africa and the Mediterranean was conducted to determine whether serologic evidence of prior hepatitis A, B, or C infection is associated with exposure in foreign countries. There were 210 subjects (10.1%) who had antibodies to hepatitis A virus (anti-HAV), 76 (3.7%) to hepatitis B core antigen (anti-HBc), and 9 (0.4%) to hepatitis C virus (anti-HCV). By multivariate analysis, anti-HAV seropositivity was independently associated with age, non-white racial/ethnic groups, birth outside of the United States, and prior Caribbean deployment for less than 1 year. Anti-HBc seropositivity was independently associated with black and Filipino race/ethnicity, foreign birth, a history of a sexually transmitted disease, South Pacific/Indian Ocean deployment (less than 12 months), and South Pacific or Mediterranean duty for (greater than 1 year). No geographic risk factors were associated with anti-HCV positivity. These data indicate that military personnel deployed outside the United States are at increased risk of viral hepatitis infection and should be considered for vaccination.
Using proven satellite technology, Medical Television Network has set up a series of permanent UK receive sites for regular, interactive medical teleconferences. The format of the programmes regularly transmitted educates and updates busy doctors in fast-changing fields of medicine, encourages peer-group discussion, and enables the audience to question the expert faculty. This article describes the rationale for this development, the importance of shared 'ownership' with the postgraduate medical centres (PGMCs), the evaluation of audience response, and exciting areas for future growth and development.
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The mainstay for repairing subglottic and tracheal stenosis has been the rib graft with prolonged stenting. A refinement of this treatment was the use of the anterior cricoid decompression (split). We present single-stage reconstruction of the airway as an additional refinement of the laryngotracheoplasty. This article describes the experience of two institutions with single-stage reconstruction and offers some observations on the principles of the technique.
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Mentally handicapped adults with and without Down's syndrome performed single movements and movement sequences following both verbal and demonstration cueing conditions. While the type of cue did not influence the performance of control subjects, Down's syndrome individuals exhibited more error following verbal cueing. These findings could not be explained on the basis of verbal encoding differences between the groups. The results support the notion that Down's syndrome persons suffer from a dissociation of the functional system responsible for speech perception and the system involved with the organization of complex movement.
From September 1, 1984 to March 1, 1988, 201 patients were evaluated for liver transplantation. Ninety-one orthotopic liver transplants were performed on 80 children ranging in age from 3 months to 15 years. The average waiting time for a transplant was 5 months, with children less than 10 kg in weight waiting a disproportionately long time. The average operative time was 10.6 hours and the average blood product replacement was 2.7 blood volumes. There was a steady improvement in both operative time and blood loss from 1985 to 1987. The overall hepatic arterial thrombosis rate was 9%; complex reconstructions having a thrombosis rate of 39%, and end-to-end anastomoses having a thrombosis rate of 1.4%. The average hospital stay was 37 days, and the major causes of postoperative morbidity and mortality were rejection (75%), infection (50%), and diarrhea (76%). The 1- and 3-year survival rates were 75% and 73%, respectively. Children with a successful transplant returned to home and school. After transplantation, 60% of the children exhibited catch-up growth and 88% have normal liver function. Pediatric liver transplantation is an effective modality in the treatment of children with terminal liver disease. Increased pediatric organ donation and the investigation of new operative techniques and types of preservation are necessary to meet the needs of an expanding recipient pool.
Twenty-five patients underwent type 1 thyroplasty (external medialization of abducted true vocal cord) during a 2-year period 1986 to 1988) at the University of Iowa. The most common indication for thyroplasty was post-thyroidectomy vocal cord paralysis. Eighteen patients (72%) had either a good or an excellent initial result. Five patients were revised. Postrevision, 21 patients (84%) had achieved either a good or an excellent result. Complications were limited to one case of significant vocal cord edema and another instance of vocal cord hemorrhage. No patient required a tracheotomy. No prosthesis extruded. We feel that phonosurgery has the advantages over traditional Teflon injection of allowing the patient's head to be in a neutral position during the operation; of allowing local anesthesia; of permitting a predictable, graduated end point of the procedure; and of being infinitely adjustable, with preservation of the vocal cord mucosal wave.
Laryngeal framework surgery has increased the options the otolaryngologists have available to treat voice disorders ranging from unilateral vocal cord paralysis to pitch disorders.