Biomedical subjects
T Gibson
Publications and source records attributed to T Gibson.
Requirements for the establishment of heterohybridomas secreting monoclonal human antibody to rhesus (D) blood group antigen.
Stable cell lines producing monoclonal human antibodies can be derived by fusion of Epstein-Barr virus-transformed peripheral blood B lymphocytes (LCL) with the mouse myeloma line X63-Ag8.653. One major limitation to this approach is the establishment of LCL cultures with sufficient cells secreting the specific antibody. In this study on the production of anti-D(Rh) antibodies, the kinetics of the appearance of specific EBV-transformable precursors in the circulation was followed after secondary immunization, and the optimum time for obtaining B cells for the establishment of suitable LCLs was found to be during the period 2-4 weeks post boost. During this period the probability of obtaining LCLs suitable for fusion is significantly higher than from blood samples collected randomly. From these high-titre LCLs the success rate for the fusion process was high. The specific EBV target cells are presumably memory cells produced after the peak of the antibody response and having only a transient appearance in the circulation.
Sports injuries.
Broad epidemiological information about sporting injuries is lacking, but several studies have examined the spectrum of injuries seen in referral clinics and in particular sporting activities. Attempts have been made to define some of the conditions which increase susceptibility to injury. Other studies have examined the frequency and causes of specific injuries. The increasing popularity of physical exercise and sports participation has almost certainly been followed by an increase of athletic injuries, especially overuse syndromes. The impact of this demand on hospital services has been mitigated in Britain by the growth of private clinics. Nevertheless, back pain and knee disorders caused by sport account for a substantial percentage of hospital rheumatology and orthopaedic referrals. The disabling consequences of some common disorders and the sequelae of serious injury are discussed in relation to society's attitude to body contact sports and the implications for health and social security resources. Evidence that children are especially vulnerable to sporting injuries is not compelling. Long-term adverse effects of childhood athleticism have not been confirmed. Sporting authorities have a duty to lesson the risks of serious injury but cannot do so effectively without allowing proper research. The growth of sports medicine and its professional organization provide opportunities for the instruction of sports-people and their officials. Hospital involvement is important for the academic impetus it may provide. With the exception of knees that have undergone meniscectomy, osteoarthritis is not a well-documented outcome of sporting activity. Evidence that several risk factors for coronary artery disease are reduced by exercise is a major health advantage. Increased bone mass is another benefit, although in females who develop hypogonadism in response to strenuous exercise, osteopenia may follow. The benefits of exercise appear to outweigh the hazards.
Finger flexion function in rheumatoid arthritis: the reliability of eight simple tests.
The inter- and intra-observer errors of eight tests of finger flexion function were estimated from the results obtained by three observers assessing 10 patients with rheumatoid hand involvement. Measurements of finger flexion and muscle power involved both conventional and novel techniques using simple and easily constructed apparatus. For each test, measurements were in agreement between observers and were reproducible on three occasions. These tests may now be used with confidence by other investigators.
Seronegative and seropositive rheumatoid arthritis: similar diseases.
A case control study of 50 rheumatoid factor positive (RA+) and 50 rheumatoid factor negative (RA-) patients with rheumatoid arthritis has been carried out. As expected, the RA+ group has significantly more nodules and vasculitis. In terms of clinical joint involvement, the RA- had large-joint involvement. Radiologically, seropositive disease was characterized by more severe involvement of the metacarpophalangeal joints of the thumb and index fingers and in all the metatarsophalangeal joints of the feet. There was no difference either clinically or radiologically between the two groups in terms of symmetry of joint disease or wrist involvement. Of special interest was the finding that the prevalence of HLA-DR4 was elevated to the same degree in both groups but that genetic markers for ankylosing spondylitis and for psoriasis (HLA-B27 and Cw6 respectively) were similar in both groups and not increased above control population levels. It is concluded that the entity defined as RA includes patients with and without rheumatoid factor (RF) in their serum and that this determines differences in disease expression. Whether these differences are the consequences or the cause of RF cannot be concluded on the basis of this study.
Combined D-penicillamine and chloroquine treatment of rheumatoid arthritis--a comparative study.
Seventy-two patients with relatively early but progressive rheumatoid arthritis were treated with chloroquine sulphate, D-penicillamine or a combination of both drugs over 1 year. Chloroquine resulted in significantly fewer side-effects but combined treatment appeared to increase the risks of toxicity. Significant clinical improvements were seen with each regimen and these were indistinguishable between treatments. However, chloroquine had less impact on haemoglobin, ESR, rheumatoid factor levels and C-reactive protein than the other treatments. Furthermore, radiological deterioration was most frequent amongst those given chloroquine alone. Combination treatment with D-penicillamine and chloroquine thus offered no advantages. Chloroquine caused fewer side-effects than both D-penicillamine and combination treatment but appeared to have a less pronounced effect on the disease process as measured by laboratory and radiological indices.
Diagnosis of pseudogout and septic arthritis.
A patient with septic arthritis of the wrists was noted to have concurrent calcium pyrophosphate crystals in synovial fluid aspirated from both joints. These were present in unusually large numbers and were associated with destructive changes of the joints. It seemed likely that the complete dissolution of calcified cartilage accounted for the liberation of such numerous crystals. Previous reports of pseudogout associated with septic arthritis have noted the presence of abundant calcium pyrophosphate crystals in synovial fluid. It is suggested that this feature should always raise the possibility of concurrent sepsis.
Knee pain in sports people--a prospective study.
Knee pain caused by sport is a common cause of rheumatic symptoms. Clinical diagnosis is frequently difficult and an attempt was therefore made to determine whether particular symptoms and signs were sufficiently characteristic in 129 patients to enable easier recognition of knee disorders. Strict criteria for arthrography and arthroscopy included classical features of internal derangement or disabling pain. Arthrograms were performed in 39 and arthroscopy in 30, revealing good concordance for meniscal tears but none for cruciate tears. Classical histories and signs were often absent from patients with meniscal and cruciate tears. Patellar pain was a prominent symptom of 58 (45%). Questionnaires one year after assessment were returned by 91 (70%). Many patients had persistent symptoms or were unable to resume their sports. The unreliability of clinical diagnosis suggests that more frequent arthroscopic examinations could have increased the recognition of meniscal and cruciate tears.
The "second set" phenomenon as first shown in skin allografts. An historical case which shows also the behaviour of cell free collagen.
A 2-year-old girl had granulating areas on her abdomen and thigh following burns. On these were placed two "sets" of homografts from her father at an interval of 13 days. The first set showed extensive growth in all directions, the second set showed little or none. Between dressings on the 23rd and 26th day after the first set was applied (10 and 13 days after applying the second set) all the epithelium of both sets disappeared. This strongly suggested that a reaction to the father's epithelium had reached an intensity where it destroyed all "homograft" epithelium on the body. The collagenous ghosts of the homografts remained, became grown over by host epithelium and remained visible below it until the end of the observation period of 2 months.
An evaluated programme of rheumatology training for general practitioners.
The management of painful, upper-limb disorders by 34 general practitioners (GPs) was examined 3 months before and 3 months after personal instruction of GPs by a consultant rheumatologist. Tuition was conducted either in GP surgeries or a hospital out-patient department. Following instruction there were significant increases in the application of appropriate treatments (p less than 0.0005) and of local corticosteroid injections by GPs (p less than 0.005), fewer requests for investigations and less-frequent hospital referrals for consultant rheumatology opinions. Hospital out-patient instruction was associated with a significant reduction of patients' time off work (p less than 0.005) and, in general, differences of management appeared to be more pronounced amongst those GPs instructed in the hospital than in GP surgeries. The study showed that personal instruction of GPs by a consultant rheumatologist may result in modifications of practice, at least in the short term. The evidence indicates that such alterations of GP management may significantly reduce patient morbidity.
A double-blind study of the simple analgesic nefopam in rheumatoid arthritis.
The role of pure analgesics in the management of rheumatoid arthritis (RA) remains uncertain. In a double-blind cross-over study of 27 patients, nefopam was a more effective analgesic than placebo when given as a supplement to anti-inflammatory drugs. Both early morning stiffness and grip strength were also improved, suggesting that these are associated with pain perception rather than any other aspect of inflammation. Side-effects occurred in 9 (35%) on nefopam and none on placebo. The results suggest a valuable supplementary role for analgesics such as nefopam in the treatment of RA.
D-penicillamine and psoriatic arthropathy.
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Interaction between probenecid and indomethacin.
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A human-human monoclonal anti-D by direct fusion with a lymphoblastoid line.
The human lymphoblastoid cell line W1-L2-729-HF2 has been fused with B cells from a plasmaphoresed anti-D donor immunized with D+ cells. A stable monoclonal antibody-producing cell line has been produced which yields culture supernatant of good titre without the need for concentration. The production and use of this reagent as an alternative Rh D typing reagent for use by saline and enzyme manual tests and automated tests in a Technicon 16C machine is discussed. Du red cells are detected in enzyme enhanced tests.
Primary closure of maxillo-facial wounds.
In maxillo-facial wounds with soft tissue involvement, the most important object in the initial treatment is to secure primary closure without deformity, or, if that is not possible, primary epithelialisation of the raw surfaces. In addition to the early healing with minimal scar tissue which results, this allows further operative procedures to be carried out much earlier and under much simpler conditions than if healing had occurred by granulation and scarring. The operative technique adopted in a series of 304 patients in a maxillo-facial surgical unit in the BLA included meticulous toilet and excision of wound surfaces before closure by several different methods: when soft tissue loss was minimal, direct closure in layers was affected; when the soft tissue defect was too large for direct closure the wound was closed by either local flaps or skin to mucous membrane suture or skin grafting of the raw surface. Examples of these methods are shown. In a series of 165 cases in whom the immediate results have been personally observed or on whom reports have been received, 153 cases (93 per cent) have been completely successful, 10 cases (6 per cent) have had a partial breakdown of the wound, and two cases (1.2 per cent) have been complete failures.
Production of human monoclonal IgG and IgM antibodies with anti-D (rhesus) specificity using heterohybridomas.
Heterohybridomas secreting human IgM and IgG anti-D antibodies of the rhesus blood group system have been established by fusion of EBV-transformed anti-D secreting cells with the mouse myeloma cells X63-Ag8.653. Both classes of antibody reacted with all Rh-positive cells, some Du cells but not with Rh-negative or DB cells. Concentrations of both antibodies reached between 25 micrograms/ml and 50 micrograms/ml in the culture supernatants. The cell lines have been maintained in culture for 14 months and have been shown to be suitable for large-scale production of antibody.
Controlled comparison of short-wave diathermy treatment with osteopathic treatment in non-specific low back pain.
The effectiveness of spinal manipulation carried out by a non-medical qualified osteopath was compared with that of short-wave diathermy (SWD) and a placebo (detuned SWD) in 109 patients with low back pain. More than half the subjects in each of the 3 treatment groups benefited immediately from therapy. Significant improvements were observed in the 3 groups at the end of 2 weeks' treatment, and these were still apparent at 12 weeks. The outcome of treatment was unrelated to the initial severity or duration of pain or to the trend of pain towards deterioration or improvement. It is, therefore, unlikely that the results simply reflect the natural history of low back pain. Benefits obtained with osteopathy and SWD in this study may have been achieved through a placebo effect.
Potential hazard of clotting during blood transfusion using a blood warming pack.
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