Three-allele synergistic mixed model for insulin-dependent diabetes mellitus

Application of the method of antigen genotype frequencies among patients to HLA-DR data pertaining to insulin-dependent diabetes mellitus substantiates the results of Rotter et al. and Thomson that a single-predisposing-allele model is incompatible with the observed data. The method is also modified to take into account the possibility of blanks (untyped antigens) in the assumed homozygotes. The rejection of all intermediate single-allele models is still obtained. A minimum of two HLA-linked predisposing components are necessary to account for the data. The patterns observed are consistent with a three-allele model, in which the two predisposing alleles interact synergistically (negative complementation). Furthermore, a model in which the DR3-associated predisposition allele is recessive in the absence of the other allele and the DR4-associated predisposing allele is additive (dominant) in the absence of the other is more consistent with the data than a model in which both alleles are recessive or additive in the absence of the other.     

Survey of 1975-1987 graduates of Houston's High School for Health Professions

Baylor College of Medicine and the Houston Independent School District created in 1972 the Houston High School for Health Professions (HSHP). Fifteen years later, Baylor conducted a follow-up study of HSHP graduates to determine whether the high school has been successful in encouraging and supporting young people to pursue health professional careers. Of the 2,033 students who graduated from the HSHP between 1975 and 1987, 951 (46.8%) returned usable responses to the survey. The results raised some concerns about the value of the high school's counseling services and showed that financial barriers posed problems for many students in their pursuit of health-related careers. Also, the results suggest that gender stereotyping may influence the students' career choices. Overall, however, the results of the survey were clearly favorable and provide evidence that the HSHP has been successful in fostering its students' pursuit of careers in the health professions and related careers.     

Sources of variability in the clinical photostress test

The photostress test is a simple clinical technique that can differentiate between retinal and postretinal disease. Unfortunately a wide range of normal results have been reported in the literature and it is perhaps for this reason that the test has been little used by clinicians. The purpose of this investigation was to evaluate the effect of photostress technique, age, ametropia, pupil size and acuity on photostress recovery time (PSRT) in normal subjects. Photostress recovery time was measured in 50 healthy subjects whose ages ranged from 21 to 69 using three clinically applicable techniques and a reference technique designed to bleach a consistent amount of photopigment. The agreement between each clinical technique and the reference technique was determined. Mean photostress recovery time differed for each of the techniques studied. Analysis of the data obtained with the reference and the best clinical technique showed that age was the only factor that had a significant effect on PSRT. The best clinical technique involves exposing the eye to the light from the direct ophthalmoscope for 30 s and measuring the time taken for acuity to return to within one line of pre-bleach acuity. Photostress recovery time increases with age but is independent of pupil size, ametropia and visual acuity.     

Endoscopic evaluation and treatment of sleep-associated upper airway obstruction in infants and young children

A method is described for observing the pharyngeal airway in children with proven sleep apnoea using a flexible nasendoscope during light anaesthesia. Fifteen children were referred for endoscopic evaluation and treatment. All had documented obstructive sleep apnoea. Flexible endoscopic assessment of the airway revealed the site of obstruction in all cases and allowed a rational and successful management plan. The mechanism of obstructive sleep apnoea in infants and young children is discussed and the findings at endoscopy and results of treatment are reported.     

A review of the reconstructive surgery needs of 3167 survivors of burn injury

A retrospective review of all patients admitted for acute care over the past 15 years was undertaken to identify readmission for reconstructive surgery. Of 3167 survivors 629 or 19.9 per cent were readmitted for at least one reconstructive procedure. Those patients requiring readmission for reconstructive surgery were younger and had larger total body surface burns compared to the group that were not readmitted for reconstructive surgery. The percentage of patients now being readmitted for reconstructive surgery is decreasing significantly and covers all size burns. The most common area of reconstruction, by frequency, involved the hand and wrist, arm and forearm, face, and neck. These data indicate that the goal of reducing the incidence of burn scar contractures in this patient population is being achieved. However, further work needs to be done to reduce the frequency of reconstructive surgery and to identify those variables which predispose patients to burn scar contractures which are amenable to intervention.     

On-table lavage to achieve safe restorative rectal and emergency left colonic resection without covering colostomy

On table orthograde colonic lavage has been used in a nearly consecutive series of 122 cases of restorative rectal resection (16 for acutely obstructing rectosigmoid lesions), and in a further 4 cases of acutely obstructing left colonic carcinoma, with the aim of both achieving safer anastomoses in these adverse circumstances and avoiding a covering colostomy. The technique was found to be safe and to be effective, only five temporary colostomies being required for management of anastomotic leakage. The incidence of clinical anastomotic leakage was 4.8 per cent.     

Anthropometry and leisure activities of some Dunedin children aged 11 to 13, 1976 and 1984

A study of weight, skinfold thickness and leisure-time activities of a group of Dunedin children aged 11 to 13, conducted in 1976, was repeated in 1984. Both weight and skinfold thickness were materially lower in the 1984 study, the difference being particularly marked in the girls. Both boys and girls spent significantly more time playing sport on Saturday in 1984 than in 1976 and twice as many walked or rode a bicycle to school. The time spent watching television was a little less in 1984; playing videogames is much more common among boys than girls.     

OUTPATIENT TRANSURETHRAL BALLOON URETHROPLASTY

Transurethral balloon dilatation was performed on 6 patients, who were assessed pre- and post-procedure on symptomatic and urodynamic criteria. Follow-up was on average 11.7 months. Only 1 patient had a successful result, despite early initial improvement in five. In view of our results and reports from other centres we cannot recommend transurethral balloon dilatation of the prostate as treatment in patients with bladder outlet obstruction due to benign prostatic hypertrophy, except in exceptional circumstances.