PubMed Health⌕ Search

Biomedical subjects

J R MacKenzie

Publications and source records attributed to J R MacKenzie.

At least 19 recordsLinked to original sources

Eosinophils promote allergic disease of the lung by regulating CD4(+) Th2 lymphocyte function.

Eosinophils are primarily thought of as terminal effectors of allergic responses and of parasite elimination. However, limited studies suggest a more discrete immunomodulatory role for this leukocyte during these inflammatory responses. In this investigation, we highlight the potential of eosinophils to act as APCs and thus modulators of allergic responses by influencing Th2 cell function. In response to Ag provocation of the allergic lung, eosinophils rapidly trafficked to sites of Ag deposition (airways lumen) and presentation (lung-associated lymph nodes and T cell-rich paracortical zones). Eosinophils from the allergic lung expressed class II MHC peptides, T cell costimulatory molecules (CD80 and CD86), and rapidly internalized and processed Ag that was sampled from within the airway lumen. Ag-loaded eosinophils promoted the production of IL-4, IL-5, and IL-13 in cocultures with in vitro-polarized Th2 cells and induced IL-5 production in a dose-dependent manner from Ag-specific CD4(+) T cells isolated from allergic mice. In addition, Ag-loaded eosinophils primed for Th2 cell-driven allergic disease of the lung when transferred to naive mice. Thus, eosinophils have the potential to not only activate Th2 cells to release disease-modulating cytokines but also to assist in priming the immune system for allergic responses. This investigation highlights the potential of eosinophils to not only act as terminal effector cells but also to actively modulate allergic inflammation by amplifying Th2 cell responses.

Administration, Inhalation↗

A polymorphic marker for the human cathepsin B gene.

Human cathepsin B (CTSB) is a proteolytic enzyme implicated in tumor invasion and metastasis. We describe a PCR-based polymorphic marker for this gene comprising two amplimers differing in length by 19 consecutive nucleotides in intron 7, near the exon 8 splice acceptor site, identifying two gene alleles (A and B). Allele frequencies were 0.614 for A and 0.386 for the B allele, with an observed heterozygosity of 0.457 in a cohort of 70 non-related Australian blood donors. One additional nucleotide difference was also revealed through sequencing. The human CTSB gene is located on chromosome 8 and the alleles described here can potentially be used as markers in linkage and association studies of cancers and other diseases.

Alleles↗

Complications of treatment of paediatric malignancies.

Advances in surgical techniques, radiotherapy and chemotherapy have led to improved survival for children with solid tumours and leukaemia. However, the treatment has also resulted in increased side effects both in the short and long term. This article outlines the complications which may arise as a result of treatment under the headings of surgery; chemotherapy; radiotherapy; organ specific complications; infection and graft-v-host disease.

Antineoplastic Agents↗

99Tcm-HMPAO leucocyte labelling in orofacial granulomatosis and gastrointestinal Crohn's disease in childhood and early adulthood.

Orofacial granulomatosis is a granulomatous inflammatory disorder, affecting the soft tissues of the face and mouth. The predominant feature is disfiguring lip swelling. Patients with this condition may be exhibiting a Type IV hypersensitivity reaction to dietary or environmental allergens, or these may be the orofacial manifestations of underlying gastrointestinal Crohn's disease. The results of 99Tcm-HMPAO leucocyte labelling of the gastrointestinal tract in 14 patients with orofacial granulomatosis and 15 patients with known gastrointestinal Crohn's disease are presented, indicating that this is a useful and non-invasive screening test for the identification of gastrointestinal Crohn's disease in paediatric and young adult patients presenting with orofacial granulomatosis.

Adolescent↗

Risk assessment of renal cortical scarring with urinary tract infection by clinical features and ultrasonography.

AIMS: To address some of the issues in the ongoing debate over the optimal diagnostic imaging following childhood urinary tract infection (UTI), by determining the risk of missing renal cortical scarring which would be detected on a technetium-99m dimercaptosuccinic acid (DMSA) gold standard if ultrasound alone were used, factoring for clinical features (upper or lower tract), UTI recurrence, and age group (infants, preschool, or school age). METHODS: Details of UTI clinical features and recurrence were recorded for 990 children with a proven UTI, and their DMSA and ultrasound results were compared for each kidney. RESULTS: The risks of missing DMSA scarring varied between 0.4% (school age children with solitary lower tract UTI) and 11.1% (infants with recurrent upper tract UTI). CONCLUSIONS: UTI clinical features are important in assessing the need for DMSA imaging. Current UK imaging guidelines are endorsed, although preschool children with solitary lower tract UTI remain a controversial group and more attention needs to focused on children with recurrent UTI.

Adolescent↗

A review of renal scarring in children.

It is now widely accepted that children with a proven urinary tract infection should undergo some form of diagnostic imaging to assess the presence of, or the potential to develop, renal scarring. The type of investigation which should be performed is controversial. Some centres still perform intravenous urography, others rely on ultrasound alone, while others believe that a 99Tc(m)-dimercaptosuccinic acid (99Tc(m)-DMSA) scan is essential. This review discusses the advantages and disadvantages of these techniques by drawing from the extensive literature currently available. The consensus view is that a DMSA scan is the most sensitive method of detecting renal scarring and of highlighting the kidney at risk of developing scarring. It is hoped that wider early use of DMSA scintigraphy will lead to a fall in the number of children who develop end-stage renal disease.

Adolescent↗

Total hip replacement for coxarthrosis secondary to congenital dysplasia and dislocation of the hip. Long-term results.

Between 1970 and 1982, sixty-six total hip replacements were performed with cement, without bone-grafting, in fifty-three patients who had congenital dysplasia and dislocation of the hip. Preoperatively, the patients had had Crowe type-II, III, or IV subluxation. Current information was available for fifty-nine hips in forty-six patients after an average duration of follow-up of sixteen years (range, ten to twenty-one years). The average age of the patients at the time of the operation was fifty-three years (range, twenty-three to seventy-three years). The average Harris hip score at the most recent examination was 92 points (range, 61 to 100 points). Eight hips were revised. The reason for the revision was infection in two hips, fracture of the femoral stem in two, and loosening of the acetabular component in four. The rate of revision for aseptic loosening, therefore, was 10 per cent (six hips). In the unrevised hips for which radiographs were available, the rate of radiographic loosening of the femoral component was 5 per cent (two hips) and that of the acetabular component was 32 per cent (twelve hips). We did not find a relationship between the amount of horizontal or vertical displacement of the center of the femoral head and the rate of loosening. Kaplan-Meier survivorship analysis with revision as the end point predicted a rate of survival of 85 per cent (95 per cent confidence interval, 75 to 95 per cent) at fifteen years. With radiographic loosening as the end point, the predicted rate of survival was 68 per cent (95 per cent confidence interval, 54 to 81 per cent) at fifteen years. We concluded that, for patients who have Crowe type-II, III, or IV congenital dysplasia of the hip, good long-term results can be obtained with insertion of a femoral stem with cement. The high rate of loosening of cemented acetabular components is a concern.

Adult↗

The value of ultrasound in the child with an acute urinary tract infection.

OBJECTIVE: To assess the value of an ultrasound examination in children with a proven urinary tract infection. PATIENTS AND METHODS: The results of renal ultrasound and 99mTc-dimercapto-succinic acid (DMSA) studies were compared in 112 children with a first documented symptomatic Escherichia coli urinary tract infection. RESULTS: Ultrasound was particularly effective in detecting the presence of obstruction, renal swelling and parenchymal change consistent with acute pyelonephritis. However, ultrasound failed to detect half of the kidneys with photon deficient areas on 99mTc DMSA scan and was unreliable in detecting the presence of scarring. CONCLUSION: An ultrasound examination alone should not be relied on in the child with an acute urinary tract infection.

Adolescent↗

Total hip arthroplasty with cement in patients who are less than fifty years old. A sixteen to twenty-two-year follow-up study.

Eighty-nine Charnley total hip arthroplasties were performed with cement, by a single surgeon, in sixty-seven patients who were less than fifty years old at the time of the procedure. The follow-up period ranged from sixteen to twenty-two years (average, eighteen years). The most recent evaluation consisted of a clinical and a radiographic examination for forty-six patients (fifty-eight hips), a telephone interview and a review of the most recent radiographs for eleven patients (sixteen hips), and a telephone interview only for six patients (ten hips). Four patients (five hips) were lost to follow-up. Eleven (13 per cent) of the eighty-four hips that were followed were revised because of aseptic loosening of the acetabular implant, and two hips (2 per cent) were revised because of aseptic failure (loosening or fracture) of the femoral component. When the number of hips that were revised was combined with the number of hips in which there was radiographic evidence of failure, the rate of loosening of the acetabular component was 50 per cent (forty-two hips) and the rate of failure of the femoral component was 8 per cent (seven hips). Three hips had recurrent dislocations after the operation; none of the three was revised. One patient (two hips) had Grade-III heterotopic ossification according to the system of Brooker et al.; no other patient had more than Grade-II heterotopic ossification. Nine hips had a trochanteric non-union without migration of the trochanter.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗

Symptomatic cortical irregularities of the distal femur simulating malignancy.

We reviewed the records and radiographs of seven children who presented with knee pain, local tenderness over the medial femoral condyle, and radiological irregularity of the distal medial metaphysis of the femur suggestive of malignancy. In the five patients who had biopsies, histological changes were consistent with musculotendinous avulsion, and the dissection of ten cadavers confirmed the site to be the insertion of part of the adductor magnus. The recognition of this lesion and knowledge of its benign nature may avoid unnecessary anxiety and needless biopsy.

Adolescent↗

Areas of contact and extent of gaps with implantation of oversized acetabular components in total hip arthroplasty.

Contact between porous surfaces and bone and initial stable fixation of the implant to bone are required to achieve bone ingrowth into prosthetic devices. To avoid the potential problems associated with screws that are often used to obtain initial stability of uncemented acetabular components, oversizing of the component has been recommended. This study investigated the shape of the reamed surface compared with the acetabular reamers used, the areas of bone implant contact obtained with oversizing, and the extent of polar area gaps created by this surgical technique. In embalmed hemipelvises, using surface fitting algorithms, the average departure from sphericity, of the reamed acetabular surface, was 0.56 mm. Using Pressensor film, extensive peripheral cup contact but minimal polar area contact was demonstrated when oversizing the components. In addition, large polar area gaps were demonstrated using polyvinylsiloxane epoxy molds. This study confirms the potential concerns associated with oversizing the acetabular component in relation to the reamed acetabular surface. Although excellent peripheral contact was obtained using this technique, polar area contact was demonstrated to be minimal or nonexistent, and large polar area gaps were observed. In addition, this study demonstrates that a precisely reamed surface can be obtained in the acetabulum when accurately sized reamers are used.

Acetabulum↗

Second-trimester placental biopsy for rapid fetal karyotyping.

Since January 1988 the technique of first-trimester chorionic villus sampling (placental biopsy) has been extended to include cases in the second trimester. To date, 40 procedures have been performed. The main indication for the late chorionic villus sampling was a low serum alpha-fetoprotein value in association with an increased risk for Down syndrome (n = 28), abnormal ultrasonographic finding (n = 7), and failed amniotic cell culture (n = 3). Successful karyotype results were achieved in all but two cases. Most results were obtained within 48 hours with direct cytogenetic techniques. No cases of mosaicism were found. The highest yield of abnormal karyotypes was obtained from the cases with abnormal ultrasonographic findings (one trisomy 21, two 45,X). One case of trisomy 21 was identified in the 28 cases of low serum alpha-fetoprotein. No spontaneous losses have occurred. The technique is easy to learn, does not differ from first-trimester procedures, and may have a lower complication rate than cordocentesis. The reporting of cases to the CVS Newsletter should help evaluate late chorionic villus sampling as another method for rapid fetal karyotyping.

Adult↗

Value of antenatal diagnosis of abnormalities of the urinary tract.

OBJECTIVE: To assess the value of antenatal diagnosis of abnormalities of the urinary tract on ultrasonography. DESIGN: Retrospective study. SETTING: Two obstetric units in Glasgow. SUBJECTS: 62 Fetuses in which renal abnormalities were diagnosed on antenatal ultrasonography. INTERVENTIONS: Six fetuses had their bladders aspirated to determine renal function. Fifteen pregnancies were terminated on the basis of the findings on antenatal ultrasonography, and if possible necropsy was performed on the fetuses. In babies who were born alive the final diagnosis was made by postnatal ultrasonography, intravenous urography, radionuclide scanning, cystography, and, in those who died in the early neonatal period, necropsy. Neonates who were referred with a known obstructed kidney had nephrostomy or pyeloplasty. END POINT: Assessment of the value of antenatal diagnosis of renal abnormalities on ultrasonography for babies who had no clinical evidence of disease postnatally. MAIN RESULTS: Eighteen fetuses did not survive birth; the antenatal diagnosis was accurate in all 18. Of the 44 babies born alive, five had normal urinary tracts, in two of whom antenatal ultrasonography had probably indicated a false positive diagnosis. Fourteen babies died during the early neonatal period. Twenty five babies with renal abnormalities were followed up; the antenatal diagnosis was inaccurate for 10 of them, the commonest misdiagnosis being hydronephrosis for multicystic kidney and vice versa, and there was one false positive diagnosis. The initial clinical findings in 14 babies would have led to the early detection of a urological abnormality. In the 30 babies with no clinical evidence of disease the antenatal diagnosis was of definite value in eight, probable value in 15, and marginal value in seven. Overall, an accurate antenatal diagnosis was made in 46 of the 62 cases (74%); in 12 cases renal disease was detected but its specific nature was not determined; and in four cases the diagnosis was misleading. CONCLUSIONS: The overall value of antenatal diagnosis is that it indicates early termination of fetuses with fatal renal disease, prepares parents and medical staff for the likelihood of serious neonatal problems, and shows abnormalities of the urinary tract that may not be detected postnatally.

Abortion, Induced↗