UK slow to develop specialty of disability medicine.
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Biomedical subjects
Publications and source records attributed to D C Burke.
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Analysis of 628 consecutive admissions to the Spinal Injuries Unit, Austin Hospital, between July 1978 and December, 1985 illustrates the value of a comprehensive data collection system which has been developed at the hospital since 1978. Some brief epidemiological data is presented, together with a detailed analysis of the urological outcome of patients with traumatic lesions whose discharge has been completed. A high rate of catheter-free status and urine sterility at discharge is reported, and factors affecting these results are analysed. The authors hope that an international system of data collection can be developed in the future to allow meaningful comparison of results between units.
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A prospective system of data collection, using computer storage, has been developed in the Spinal Injuries Unit, Austin Hospital. Three hundred and fifty-two consecutive admissions to the Unit between 1 July 1978 and 31 December 1982 are analysed, and this epidemiological data compared with other reports. Over 92% of the admissions were the result of spinal cord trauma and the balance due to a variety of non-traumatic causes. A high incidence of young males injured in road accidents, predominantly from motor cars, and lesser numbers from sporting, occupational and domestic accidents is noted. A high proportion of country accidents and a disproportionately high number of people who live in country areas indicates the need for greater concentration of preventative measures to rural areas. The study has confirmed the usefulness of such a sophisticated data collection system to collect, at relatively low cost, useful epidemiological data on a specific disability group. The system will help to plan treatment programmes, as well as preventative measures, for the future.
The data collection system described in a previous study has been used to analyze some of the results of treatment of 352 consecutive admissions to the Spinal Injuries Unit, Austin Hospital. The results indicate that the basically conservative approach to the management of the spinal injury, supplemented by surgery in selected cases, appears to be vindicated by the low rate of instability of the spine, and good neurological sequelae of the spinal cord injury. An intermittent catheter regimen for management of the neurogenic bladder has resulted in a low rate of permanent indwelling catheterization on discharge from hospital and a low rate of urinary infections. The survival rate of patients in a well integrated unit, with a multi-disciplinary team, is high. The relatively long periods of hospitalization are justified by the return to the community of a high proportion of independent, healthy, disabled people.
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Brain abscess is an uncommon complication of the insertion of skull tongs. The two cases reported demonstrate the difficulty that may occur in diagnosis and the high mortality associated with this complication.
NIH 3T3 mouse cells were infected at very high multiplicity with murine sarcoma/leukaemia virus (MSV/MLV) and then cloned. All of the 48 clones obtained were morphologically transformed, all but one showed anchorage-independence of growth, typical of MSV-transformed NIH 3T3 cells and most (91%) produced MSV/MLV. When cells which had been pre-treated with 10(4) units/ml of purified interferon (IF) were infected under the same conditions and then cloned in the presence of the same amount of IF, only 6 of a total of 63 clones were morphologically transformed. All but these 6 showed a degree of anchorage-independence typical of the uninfected parental cells and very few (2.4%) produced virus. Furthermore, the MSV genome could not be rescued in any of the 23 clones tested and only 1 out of 10 clones produced tumours. The properties of these clones remained stable over a period of 10 to 20 passages in the absence of interferon. We conclude that interferon can irreversibly block an early step in the MSV/MLV infectious process.
When L929 cells were treated with interferon and subsequently with poly(rI).poly(rC), there was a pronounced toxic effect. Most of the cells lysed, but some survived and grew at the same rate as control cells to yield cells which were as sensitive to the effects of interferon and poly(rI).poly(rC) as the original population. The proportion of surviving cells did not vary with either the cell cycle or the cell density. The treated cells produced interferon and some of the interferon was produced by the resistant cells. Cells which had been X-irradiated before treatment with interferon and poly(rI).poly(rC) behaved similarly so cell division was not necessary for the development of toxicity. The toxic effect also developed when cells were enucleated with the aid of cytochalas in B after treatment with interferon, but not if they were enucleated before treatment. It is concluded that the nucleus is essential for interferon to exert its effect on the cells, but not for the development of cytotoxicity after the addition of poly(rI).poly(rC).
After treatment with Sendai virus, Namalwa cells form large amounts of interferon. RNA extracted from treated whole cells or from their polysomes was injected into Xenopus laevis oocytes and the interferon formed was titrated. The results show that the amount of interferon mRNA was maximal by 9 h after treatment of the cells with Sendai virus and then declined. Sucrose gradient centrifugation of the mRNA gave substantial purification and showed that its size was 12 S.
5-Bromodeoxyuridine (BrdUrd) increased interferon production by the Namalwa line of human lymphoblastoid cells treated with Sendai virus, but inhibited their growth. Thymidine, which also inhibited cell growth had no effect on interferon production, so that growth inhibition per se was not the cause of the stimulation. BrdUrd was incorporated into cellular DNA; 5-chlorodeoxyuridine and 5-iododeoxyuridine (which are also incorporated) increased the interferon yield, but 5-fluorodeoxyuridine (which is not incorporated) did not. Thymidine reduced both the incorporation of BrdUrd and its stimulatory effect on interferon production. Deoxycytidine (which prevents the cytotoxic effects of BrdUrd) had no effect on the stimulation. BrdUrd also stimulated interferon production in response to poly(rI) . poly(rC) in growing human diploid fibroblasts but not in SV40 virus-transformed human cells. Since BrdUrd was incorporated into the DNA of all these cells, we concluded that incorporation is necessary, but not sufficient for the stimulation of interferon formation.
Forty-two primary human-mouse cell hybrids, derived in two separate experiments, were treated with Newcastle disease virus (NDV): eight hybrids were found to produce human interferon and this was shown in every case to be predominantly of the fibroblast type. An extensive analysis was made in terms of karyotype and marker enzymes on all the eight hybrids producing interferon and also on five hybrids which did not produce interferon, five randomly selected hybrids and eleven subclones resistant to diphtheria toxin. The results suggest that, contrary to previous reports, a gene on chromosome 5 is not involved in production of human interferon. Its production was however correlated with the presence of chromosome 9 in the hybrids. Analyses of two sets of human-Chinese hamster hybrid subclones from two different crosses were also consistent with the assignment of a human interferon gene to chromosome 9.
A correct and accurate diagnosis of paraplegia or tetraplegia due to a spinal cord injury is an important first step in the treatment. A simplified method of performing such an examination is presented to help overcome a diagnostic blind spot of many medical practitioners. Some of the traps and subtleties of diagnosis are discussed.
This paper reviews the medical records of 100 consecutive patients with tetraplegia owing to diving injury. Their high survival characteristics, plus youth on presentation, create the problem of an expanding population of chronically disabled patients.
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Pluripotential embryonal carcinoma (EC) cells do not produce interferon after treatment with a wide variety of inducers, nor are they sensitive to its action. Several differentiated lines derived from the EC cells, however, both produce and are sensitive to mouse interferon. Differentiation of EC cells in vitro is accompanied by development of interferon inducibility and sensitivity.