Communication. 3. Taking the simple route.
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Biomedical subjects
Publications and source records attributed to E Perry.
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Data on prevalence of antibody to hepatitis B surface antigen (anti-HBs) and of hepatitis B surface antigen (HBsAg) among 95 matched pairs of Down's syndrome (DS) and other mentally retarded (OMR) patients in an institution were analyzed by age on admission and by length of residence. Passive hemagglutination test were used to determine anti-HBs. Anti-HBs prevalence increased with admission age among DS patients (26%, 42% and 56% for age groups less than or equal to 5, 6-15 and greater than 15 years, respectively) but decreased among OMR patients (85%, 71% and 78%), giving overall rates of 38% for DS and 77% for OMR which are significantly different (p less than .001). Anti-HBs prevalence increased with length of residence for OMR patients but was unchanged for DS patients. For both groups, the prevalence of hepatitis B (HB) infection (both anti-HBs and HBsAg) increased with length of residence and, overall, was nearly the same for DS and OMR patients. These observations are consistent with the hypothesis that, with respect to response to HB virus, younger DS patients are immunologically immature.
Although the treatment of the ordinarily incurable portwine birthmark by lasers has been practiced for more than 10 years, recent therapeutic investigations have been carried out particularly with the argon laser. Argon lasers now available for medical purposes produce treatment spots that are small. For certain practical reasons, at present, only relatively small portwine marks can be treated effectively. With trained personnel and proper safety measures, the treatment is safe for the patient and the operator. The treatment as yet is not proved to be better with the argon laser because the ruby laser and even an incoherent infrared thermal coagulator can produce similar and often larger cleared areas. It is recommended for the present that treatment of portwine marks by argon lasers be restricted to investigation in medical centers where critical evaluations, control studies, and more powerful laser systems can be developed.
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The prevalence of hepatitis B surface antigen (HBsAg) in 155 patients with Down's syndrome (DS) and 209 with other types of mental retardation (OMR) at Huronia Regional Centre, Orillia, Ontario was 34.8 and 5.3%, respectively. There was no significant difference in prevalence between males and females in either group of patients. In 75 matched pairs (DS-OMR) the HBsAg prevalence was 45% in DS and 8.3% in OMR males; in females 40% of those with DS were HBsAg-positive, whereas all the OMR residents were negative. The prevalence of HBsAg in both DS and OMR groups was higher in those admitted in early childhood and in those who had resided in the institution for more than 10 years. In all 54 HBsAg-positive DS patients the antigen subtype was ad. Among the 11 HBsAg-positive OMR patients the subtype was ad in 10 cases and ay in 1.
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Hepatitis B antigen (HBAg) from blood donors and patients with hepatitis was tested for ad and ay subspecificity by immunodiffusion in agarose. A total of 59 sera from blood donors and 81 sera from hepatitis patients were subtyped.Subtyping of HBAg from blood donors showed ad and ay subspecificity in 64.4 and 35.6% of cases respectively. Patients' sera on the other hand showed HBAg with ad and ay subspecificity in 6 and 94% of cases respectively. Therefore, ad subtype was more frequently associated with blood donors whereas ay subtype was predominant among hepatitis patients. The relationship between clinical findings and HBAg subtype is also discussed.
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Transplantation of immediately vascularized grafts across species barriers in which preformed cytotoxic antibodies exist, otherwise known as discordant combinations, has uniformly resulted in hyperacute rejection. We studied how well plasma exchange and perfusion through organs removes preformed immunoglobulin M cytotoxic antibodies and prolongs survival of a porcine heart heterotopically transplanted into a rhesus monkey. With the use of plasma exchange or absorption of antibodies by porcine kidney perfusion with or without immunosuppression, graft survival was prolonged, although antibody-mediated rejection ultimately occurred. In one case in which plasma exchange, kidney perfusion, and immunosuppression were combined, a functioning pig heart survived in a rhesus monkey for 8 days without evidence of rejection. The animal was killed on day 8 according to protocol because of a wound dehiscence. With this animal we were able to demonstrate that circulating antibodies against graft endothelium had bound to the graft endothelium without inducing rejection, a process referred to as accommodation. In this case, despite the presence of antiendothelial antibodies, complement did not appear to be activated, and fibrin thrombi did not form. Although we have achieved this rejection-free survival only in one animal, this case suggests that it may be possible to maintain xenotransplants in discordant species without rejection if preformed antibodies are appropriately lowered or altered during the initial period of graft implantation.