Ian McColl

IMMUNOGENICITY OF HUMAN AMNIOTIC EPITHELIAL CELLS AFTER TRANSPLANTATION INTO VOLUNTEERS

Human amniotic epithelial cells do not express on their surfaces HLA-A, B, C, and DR antigens, or beta 2-microglobulin. In vitro these cells synthesise the enzymes lacking in patients with selected enzymatic deficiencies: the survival of a transplanted monolayer of human amniotic epithelial cells was therefore investigated in seven volunteers. None of the volunteers showed clinical signs of acute rejection, and amniotic epithelial cells were demonstrated by biopsy up to 7 weeks after implantation. HLA antibodies were not detected in samples of serum from four volunteers thoroughly investigated, and there was no in-vitro lymphocyte reaction to the amniotic cells in two of them. The results suggest that acute immune rejection does not occur after the transplantation of human amniotic epithelial cells.

NHS data book

1 Population.- 2 Socioeconomic factors.- 3 Mortality and morbidity in a district.- 4 Social pathologies.- 5 Inequalities in health correlates of social class.- 6 Structure and roles of NHS.- 7 Facilities and resources.- 8 Personnel in NHS.- 9 Education, training and careers.- 10 Utilization of resources and content of work.- 11 Prescribing.- 12 Psychiatry.- 13 Maternity services.- 14 Eyes and teeth.- 15 School medical service.- 16 Quality and outcomes.- 17 Complaints.- 18 Costs.

The Effect of Problem-Oriented Medical Records on Clinical Management Controlled for Patient Risks

This study examines the change in clinical management by 28 medical and surgical firms* in three London teaching hospitals following the introduction of Problem-Oriented Medical Records (POMR) in one of the hospitals. Comparison is made between firms using and not using POMR. The data are analyzed using a regression model. Analysis is based on the coefficient of change in each firm between the two study years when modified by the physiological and demographic patient variables significantly associated with the management of each disease. Although not conclusive, the results in four of the seven diseases studied encourage the speculation that POMR may have improved the thoroughness of patient management. The significant patient variables in each diagnosis suggest that patient risk on admission can affect management scores. Were this to be found elsewhere, the influences of patient mix might be considered in using explicit criteria to make comparisons between hospitals that serve different kinds of populations.

An investigation of psychosocial factors in patients with upper abdominal pain: a comparison with other groups of surgical outpatients.

The purpose of this study was to examine the personality patterns, levels of anxiety and the importance of life events in patients with upper abdominal pain and to compare these patients with other groups of patients attending a general surgical outpatient clinic. The relevance of age, sex and social class was also studied. The patient groups were compared on each of the psychological measures and no differences were found between the groups. In addition the data were subjected to principal component and discriminant analyses in order to determine whether the U.A.P. patients could be distinguished on the basis of a combination of indices. Both analyses failed to produce any distinguishing criteria for the U.A.P. patients. A number of other observations on these patients are also discussed but the overall results are more consistent with a non-specific model of stress and disease than with the idea of specific psychological factors being involved in the development of upper abdominal pain.

In vitro studies on the effect of salicylates on the synthesis of proteins by guinea pig gastric mucosal tissue.

In the work reported in this paper we have studied the effect of salicylates on protein synthesis by (A) intact guinea pig gastric mucosa, (B) isolated gastric epithelial cells of guinea pig stomach and (C) cell-free homogenates of the isolated cells. In experiments on intact gastric mucosa, (A), secretion of newly-synthesised proteins into the mucosal media was also investigated and the nature of the effected, secreted proteins examined by isopycnic CsCl gradient fractionation. Results indicate that synthesis of proteins, as assessed by incorporation of L-[U-14C]leucine into trichloroacetic acid-insoluble proteins, is significantly impaired in the presence of salicylates in all three systems investigated. In experiments using isolated epithelial cells and cell-free homogenates of these cells, the effect was found to be dose-dependent and not associated with a corresponding reduction of the uptake of the precursor from the medium into the acid-soluble intracellular pool. The inhibitory effect of salicylates on protein synthesis was found to be reversible in experiments using both the intact gastric mucosa, as also the isolated epithelial cell preparations. In all experiments it was found to last for the duration of exposure of the tissue to the action of the drug. In experiments using intact gastric mucosa secretion of the newly-synthesised radioactive proteins into the mucosal medium was also impaired by O-acetyl salicylic acid. Isopycnic CsCl gradient fractionation of the secreted proteins did not reveal any qualitative differences between the salicylate-treated samples and the control samples, indicating non-specific inhibition of protein synthesis by the drug.

Studies on gastric mucosal IgA: Separation of immunoglobulin rich fraction from gastric mucoproteins

Abstract Human gastric mucosal scrapings were subjected to fractionation on an isopycnic CsCl gradient. Immunoglobulin A was found between the 5th and 10th ml from the top of the tube. (Total volume 12ml). After two-fold fractionation the combined IgA containing fraction accounted for 4%–7% of the total carbohydrate content of the original gastric mucosal scrapings. Gas liquid chromatography of sugars showed the fraction to be enriched in Mannose and N-Acetyl glucosamine. The total carbohydrate content of the material was 5.5%–7% by weight. Immunodiffusion against specific anti Secretory component serum failed to demonstrate the presence of the secretory component in this fraction. It is concluded that gastric mucosal IgA, which appears to differ from a typical sIgA in lacking the characteristic secretory component activity, can be separated from the carbohydrate-rich gastric mucoproteins by CsCl fractionation. This indicates the absence of covalent bonding between IgA and the mucoproteins of gastric mucus.

Studies on human gastric mucosal immunoglobulin A.

Immunoglobulin A (IgA) was found in mucus scraped from the surface of the human antrum. Fresh human gastric mucosa removed at operation was washed free of loosely adhering material and the gelatinous mucus lining the tissue scraped. The scrapings were separated by gel filtration on Sephadex G-200 and on Sepharose 4B into two carbohydrate-containing fractions. One of these fractions was shown by immunodiffusion to contain IgA which differs from human colostral secretory IgA by being devoid of secretory component activity. Moreover, secretory component was not detected in our unfractionated gastric mucosal scrapings. It is concluded that, contrary to the general belief, the predominant immunoglobulin A of human gastric mucus is not associated with the secretory component. Our results do not exclude the possibility that, as in serum, small amounts of secretory IgA and of the secretory component may be present in gastric secretions, however if so, the levels of these compounds would fall below the level of sensitivity of our methods.

Studies on human gastric mucosal immunoglobulin A. II. Further evidence for the absence of the secretory component from the predominant immunoglobulin A of human gastric mucus

Abstract In this work fresh human gastric mucosal scrapings were fractionated on an isopycnic CsCl gradient into three fractions: L1, the top part of the gradient free of immunoglobulin A, immunoglobulin A-positive middle layer L2, and L3 the lower part of the gradient in which again immunoglobulin A was not detected, but which accounted for a large proportion of the total carbohydrate of the original suspension. Layer 2 (L2) was further fractionated by gel chromatography to give an immunogloblin A-enriched fraction S4B/2. The material in this fraction failed to reveal the presence of the secretory component indicating that the predominant gastric mucosal immunoglobulin A is not of the secretory type. In the second part of our work we have attempted to determine the effect of gastric mucosal scrapings on the secretory component of saliva as well as of milk whey. No apparent reduction of the amounts of the secretory component due to the presence of the scrapings was observed. We have also followed the fate of the immunological activity of the secretory component of the gastric-salivary immunoglobulin A-containing mixture throughout the whole fractionation scheme used for the isolation of the original gastric immunoglobulin A-positive fraction S4B/2. The secretory component was detected at all stages of fractionation of the mixture in the immunoglobulin A-containing fractions. These results indicate that, if present, the secretory component can be detected even in the presence of gastric mucosal components. Consequently, it is concluded that our inability to detect the secretory component in suspensions of gastric mucosal scrapings reflects the absence of this component from the tissue in measurable quantities, although appreciable quantities of immunoglobulin A are present.

Communication as a method of medical audit.

Advances in the practice of medicine over the past forty years have rendered informal communication ineffective in setting and maintaining standards of clinical care. In the past five years, four methods in communication have been introduced in the department of surgery at Guys Hospital: problem-oriented medical records, death-and-complications meetings, unit review meetings, and a clinical information service. It is suggested that these can achieve quality control.

Late presentation of a traumatic abdominal hernia associated with constipation.

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