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Biomedical subjects

S J Matthews

Publications and source records attributed to S J Matthews.

13 recordsLinked to original sources

A role for tumour necrosis factor-alpha in the human mixed lymphocyte culture reaction.

The possible role and influence of tumour necrosis factor-alpha (TNF-alpha) in the human mixed lymphocyte culture (MLC) reaction was investigated. Polyclonal rabbit sera to recombinant human-TNF-alpha (rhTNF-alpha) consistently inhibited the MLC, and this could be reversed by simultaneous addition of rhTNF-alpha to the culture medium. Under optimal cell culture conditions, the exogenous addition of 1000 U/mL of rh TNF-alpha had a variable but generally small enhancing effect on the MLC reaction. Additional studies have clearly highlighted the importance of MLC assay conditions in influencing the effect of exogenous rhTNF-alpha. Enhancement of the MLC reaction was only consistently observed under suboptimal cell culture conditions. While the present study clearly supports an important role for TNF in controlling the proliferative response in the human MLC reaction it also highlights the influence of in vitro tissue culture conditions in determining the effect of exogenous TNF-alpha in this assay.

Humans

Anterior cruciate ligament reconstruction using the Gore-tex ligament.

Twenty two Army patients with synthetic (Gore-tex) anterior cruciate ligament (ACL) reconstructions were reviewed (mean follow up 18 months). Reconstruction appeared to abolish the pivot shift sign in all cases, but some subjective instability persisted in all but 6 patients. Outcome was also assessed by medical (PULHHEEMS) grading: 6 patients were fully fit (graded L2), 7 returned to moderate activity but not full fitness (L3), and 9 remained severely incapacitated (L7 or L8) with 4 of this group being medically discharged. Specific operative complications included: prosthesis breakage (3 partial, 1 complete), infected prosthesis(1), and problems with the tibial screw(3). The range and frequency of complications was similar in other series. Physical fitness is an integral part of a soldier's job, placing particular demands on the knee and on surgical repair of knee injuries. Reports on the Gore-tex ACL prosthesis in other groups have been more encouraging, but there are difficulties in comparing this study with others. ACL insufficiency remains a serious problem, with implications for a soldier's fitness and career. The Gore-tex prosthesis improves stability but does not always allow a soldier to return to full fitness.

Adult

Zidovudine and other reverse transcriptase inhibitors in the management of human immunodeficiency virus-related disease.

Licensed in 1987, zidovudine remains the only medication with proved efficacy for the treatment of disease caused by the human immunodeficiency virus (HIV). New information on the pharmacology (adults and children), effects of kidney and liver dysfunction on the disposition of the drug, and drug-drug interactions have improved the way we use and monitor this agent. The serious toxicity associated with zidovudine has led researchers to develop safer dosage regimens. Also, recognition that zidovudine slows but does not halt progression of disease has increased the search for effective alternatives. The best-studied agents are didanosine (2',3'-dideoxyinosine, ddl), zalcitabine (2',3'-dideoxycytidine, ddC), and foscarnet.

Acquired Immunodeficiency Syndrome

Bleomycin pneumonitis potentiated by oxygen administration.

A case of a 53-year-old man who developed acute pneumonitis after bleomycin and moderate oxygen administration is presented. The patient received bleomycin 189 U over five days for preoperative control of a squamous cell carcinoma of the right tongue and tonsil. Surgery to remove the remaining tumor was performed 19 days later. The highest intraoperative oxygen concentration was 33 percent, but 40 percent oxygen was administered for four days postoperatively. He became febrile and developed a productive cough and pulmonary infiltrates on postoperative day 4. Despite antibiotic therapy, his pulmonary function deteriorated and 100 percent oxygen was required to maintain adequate oxygenation. He sustained a myocardial infarction on postoperative day 7 and progressively deteriorated and expired five days later. Autopsy findings were consistent with bleomycin and oxygen-induced pulmonary damage. Oxygen potentiation of bleomycin-induced pulmonary toxicity is discussed.

Bleomycin

Drug therapy reviews: methenamine mandelate and methenamine hippurate.

The mechanism of action, spectrum of antimicrobial activity, pharmacokinetics, adverse effects, therapeutic use, and dosage of methenamine hippurate and methenamine mandelate are reviewed. The antimicrobial activity of methenamine depends on its conversion in the urine to formaldehyde. Formaldehyde's spectrum of antibacterial activity encompasses all urinary tract pathogens. Urinary concentrations of formaldehyde vary with pH and urine volume; however, there is no documentation that acdification of the urine enhances methenamine's therapeutic activity. Adverse reactions to methenamine, including gastrointestinal intolerance and skin reactions, are mild and reversible and occur infrequently. Methenamine mandelate and hippurate are effective in the prevention of recurrent urinary tract infections except in patients with Foley catheters or who require intermittent catheterization.

Bacteria