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Biomedical subjects

A C McCartney

Publications and source records attributed to A C McCartney.

At least 91 records · Page 5Linked to original sources
PubMed1988

Posterior scleritis: a clinical and histological survey.

The clinical course of 47 patients with posterior scleritis is reviewed. Though clinical presentation varied widely, 73% of the patients presented with a visual acuity of 6/18 or less. Because the posterior scleritis was not always associated with pain or with anterior scleritis, the diagnosis was often not considered when the patient was first seen. The most common findings in the fundus were disc swelling, retinal detachment, and macular oedema and the most useful investigation was B scan ultrasound. No common aetiology was found, although 60% had a systemic disorder which was accompanied by a vasculitis. Those who were diagnosed and treated with the minimum delay had the most satisfactory visual outcome. However, there appears to be a group of patients with no underlying systemic disease who fail to respond to intensive therapy, and lose vision. A new sub-group of West Indians with the disease is described. The histopathology of 7 cases confirmed the presence of scleral vasculitis of the vessels in and around the sclera in all the specimens. Other significant findings include inflammatory swelling and focal loss of pigment epithelium together with choroidal vascular closure. This could account for the fluorescein angiographic findings.

Adolescent↗
PubMed1988

Medulloepithelioma (diktyoma).

Sixteen cases of medulloepithelioma are described. Clinical data and follow-up were available on 15. Four patients underwent iridocyclectomy initially; all later needed enucleation and one had an orbital recurrence. The remaining 12 patients underwent primary enucleation. All 15 patients with follow-up are alive with no evidence of tumour recurrence. It is suggested that enucleation be performed for all but the most localised tumour. Rubeosis was noted in 13 of the 16 eyes, and this may assist in making the diagnosis. The World Health Organisation histological classification of medulloepithelioma was applied, but some problems were encountered, particularly where the presence of heteroplastic brain tissue was used as a criterion for teratoid tumour and where rosettes were used as a criterion for malignancy.

Adolescent↗
PubMed1988

Serum C reactive protein in infective endocarditis.

C reactive protein (CRP) was measured serially in 29 patients with infective endocarditis. Twenty one patients were initially treated with antimicrobial drugs. In 13, serial measurement of CRP concentrations showed a progressive return to normal (less than 10 mg/l), which correlated with a satisfactory recovery. Of the remainder (eight patients), five had persistently high concentrations of CRP, indicating a failure to respond to antimicrobial treatment alone. Two of these five patients died and three underwent valve replacement. Of 11 patients treated with antibiotics and valve replacement, CRP concentrations returned to normal in nine. Two patients had infective complications and the CRP concentration did not return to normal. A transient rise in CRP concentration during an otherwise uneventful fall to normal was a sign of allergic reaction in two and of intercurrent infection in three more patients. Serial measurements of CRP concentrations in patients with infective endocarditis may be useful to monitor treatment and also to detect other infections and complications.

Adolescent↗
PubMed1988

Cerebral microembolism during cardiopulmonary bypass. Retinal microvascular studies in vivo with fluorescein angiography.

To observe microembolic events in the central nervous system during cardiopulmonary bypass, we subjected 21 patients undergoing elective coronary operations to retinal fluorescein angiograms 5 minutes before cardiopulmonary bypass was discontinued. Patients with diabetes or clinically evident cerebrovascular disease were excluded. Bubble oxygenation and nonpulsatile perfusion were used for bypass. After 31 to 167 minutes of cardiopulmonary bypass, all 21 (100%) patients had retinal microvascular occlusions indicative of microembolism. Control fluorescein angiograms obtained preoperatively and in five patients immediately before bypass but after aortic cannulation showed retinal perfusion. During bypass there was a mean of 3.5 (range 1 to 7) blocked arterioles of less than 50 micron caliber and a mean of 6.3 (range 1 to 10) focal areas of capillary nonperfusion per 30-degree field of retina centered on the macula per patient. Repeat studies 30 minutes after discontinuation of bypass showed partial reperfusion with occlusions in four of the five (80%) patients and a decrease in the mean total microembolic count from 12.6 to 4.8 (38%). In later studies at a median of 8 days postoperatively, only two of 16 (12.5%) patients had persistently occluded retinal vessels. The total microembolic count did not correlate with bypass time (r = 0.14) and was not reduced by arterial line filtration with a Pall 40 micron filter (Ultipore) in a subgroup of 11 patients. Twenty patients completed four standardized psychometric tests. Retinal microvascular occlusions were more numerous in those patients with a psychometric deficit (n = 7) than in those with no deficit (n = 13; p = 0.075). In a dog model of cardiopulmonary bypass, eight of nine (88.9%) had retinal microvascular occlusions after 10 to 90 minutes of bypass. Retinal histologic studies revealed intravascular platelet-fibrin microaggregates 20 to 70 micron in diameter and focal ischemic changes in seven of the nine (77.8%) dogs. Six dogs undergoing sham bypass had normal retinal perfusion and histologic findings. This study demonstrates a very high incidence of microvascular occlusions in the territory of the internal carotid artery during bypass consistent with a microembolic origin. The clinical significance of these findings is uncertain.

Animals↗
PubMed1988

Endotoxaemia in multiple organ failure due to sepsis.

Patients with multiple organ failure secondary to intraabdominal sepsis are often blood culture negative despite exhibiting the features of septic shock. This study examined the possible central role of endotoxin in such patients. In 15 consecutive intensive care patients with the above clinical picture endotoxin was measured by a chromogenic limulus (LAL) assay; on admission and thereafter 4 hourly. Regular blood cultures and cultures of any primary septic focus were also performed and liver function was assessed by measurement of indocyanine-green clearance from plasma (ICGC). All 15 patients had significant endotoxaemia at least intermittently. No significant difference was observed between survivors (n = 5) and non-survivors (n = 10) in either initial or peak endotoxin levels, although the pattern of endotoxaemia differed with non-survivors exhibiting consistently high or steadily increasing levels. Of 5 patients with an intra-abdominal (I/A) septic focus only one had a positive blood culture while 5 of 10 patients with extra-abdominal (E/A) infection had positive cultures. Despite this the I/A group had higher initial and peak endotoxin levels. 3 patients with Gram-positive septicaemia had significant endotoxaemia in the absence of any gram-negative infection. Changes in ICGC appeared to be of useful prognostic significance. ICGC was significantly lower in the I/A group and in both groups there was a significant negative correlation between ICGC and the level of endotoxaemia. These results suggest that endotoxin may play a central role in the syndrome of multiple organ failure and further suggest that the endotoxin is endogenous (gut-derived) secondary to failure of hepatic filtration.

Adult↗
PubMed1987

Endotoxaemia, fever and clinical status in immunosuppressed patients: a preliminary study.

A prospective study was performed in order to find out whether endotoxaemia assays are clinically relevant in neutropenic patients. In a group of 10 immunocompromised patients, serial haematological, bacteriological and clinical investigations were done in parallel with serial plasma endotoxin assays. The chromogenic modification of the Limulus amoebocyte lysate (LAL) assay for endotoxin used in this study had a sensitivity of less than 10 pg endotoxin per ml plasma. It was found that endotoxaemia was associated with Gram-negative bacteraemia but infection with Gram-negative bacteria did not always produce endotoxaemia. Furthermore, infections with Gram-positive bacteria and administration of blood products may lead to raised endotoxin values. Endotoxin assays may be of value for elucidating mechanisms of fever in immunocompromised patients but it seems unlikely that routine assays of endotoxin will help in the clinical management of these patients.

Adult↗
PubMed1987

The measurement of C-reactive protein and immune complexes in endocarditis caused by coagulase-negative staphylococci.

Coagulase-negative staphylococci are a major cause of early endocarditis following the insertion of prosthetic heart valves but rarely cause endocarditis in natural valves. From a 2-year prospective study we report seven cases: six with endocarditis related to prosthetic valves and one with endocarditis related to a natural valve. Each isolate of coagulase-negative staphylococcus was identified biochemically (six Staphylococcus epidermidis; one Staphylococcus hominis) and characterised by bacteriophage typing. Six isolates were also examined for slime production and for extracellular toxins and enzymes: all produced toxin but enzyme and slime production was variable. Concentrations of immune complexes and C-reactive protein in the serum were measured in six of the patients. Our results suggest that measuring C-reactive protein may be useful but measuring immune complexes is not helpful and takes more time.

Antigen-Antibody Complex↗
PubMed1987

Oncocytoma of the eyelid: a case report.

Oncocytic tumours of the eyelids are rare, only one previous case having been reported. This paper describes a second such lid tumour affecting the medial upper lid. We present the clinical features, surgical management, and histology of the lesion.

Adenoma↗
PubMed1987

Rapid diagnosis of an outbreak of Legionnaires' disease at Glasgow Royal Infirmary.

In the last three months of 1985 there was an outbreak of legionnaires' disease at Glasgow Royal Infirmary affecting 15 patients and one surgeon; five patients died. Legionnaires' disease was first suspected when a second case of severe nosocomial pneumonia occurred in a high dependency unit. The application of the direct fluorescent antibody test to specimens obtained at bronchoscopy was responsible for the rapid diagnosis of legionnaires' disease, which led to the prescription of appropriate antibiotic treatment and the shutting down of the contaminated cooling tower, thereby containing the outbreak. It also led to a search for further cases. It is suggested that these diagnostic techniques should be included in the investigation of affected patients in an outbreak of pneumonia.

Aged↗
PubMed1986

Outbreak of Legionnaires' disease in Glasgow Royal Infirmary: microbiological aspects.

The bacteriological investigation of an outbreak of Legionnaires' disease in Glasgow Royal Infirmary affecting 16 patients is described. Most of the patients had been treated in high-dependency areas on two floors of the hospital supplied by the same two air-conditioned ventilation systems. The source of infection was traced to contamination of a cooling tower from which a plume of spray discharged into the intake vents of the two ventilation systems. Rubber grommets within the cooling tower probably provided a nidus of infection there. The control and management of the outbreak are discussed: a policy of frankness about the course and progress of the investigations was adopted and helped to allay anxiety on the part of both staff and media.

Air Conditioning↗
PubMed1986

Effect of heat on endotoxin in plasma and in pyrogen-free water, as measured in the Limulus amoebocyte lysate assay.

Four modes of heating endotoxin in plasma and two different times of heating endotoxin in pyrogen-free water were compared. There were no significant differences in standard curves after heating endotoxin in plasma at 100 degrees C for 1 and for 10 min. However, the standard curve after heating for 10 min at 75 degrees C had a significantly less steep slope, and after heating for 10 min at 56 degrees C, it was completely flat. Heating of endotoxin in pyrogen-free water for 1 min also resulted in the flattening of the standard curve, which was even more pronounced after 10 min of heating.

Endotoxins↗
PubMed1986

The ribosome-lamellar complex; is it a normal structure?

Ribosome-lamellar complexes were seen in mast cells in the iris of a patient with Usher's syndrome (retinitis pigmentosa associated with deafness) and in the neoplastic cells of an alveolar soft part sarcoma of the thigh. These 'organelles', originally described and associated with haematopoietic malignancy, where they have been described as the hallmark, are being increasingly often described in neoplastic and nonneoplastic cells. We believe that their usefulness in diagnosis should be questioned and the concept of their association with malignancy abandoned.

Adult↗