Biomedical subjects
Publications and source records attributed to A R Shah.
Four patients with generalized lymphangiomatosis presenting with chylothoraces are described. All four had bone involvement, two had involvement of the spleen, and one of the pericardium. The diagnosis was confirmed by typical radiology, histology, and in three patients by immunohistochemistry. Treatment was mainly palliative. Three patients died within 1/2 to three years of presentation.
We present a case of symmetrical EG of the lower extremities in a 36-year-old man. Several entities are considered in the differential diagnosis. However, many of the features bear a striking resemblance to ECD, which probably coexists in this case. A link between the two entities, EG and ECD, has been suggested by others. Future experience may confirm this hypothesis.
The familial occurrence of chronic lymphocytic leukemia was studied using morphologic, immunophenotypic, cytogenetic, and immunoglobulin gene rearrangement analyses. Three of six siblings developed chronic lymphocytic leukemia. One (patient 1) died 9 years after the diagnosis of chronic lymphocytic leukemia at age 67 years. The other two patients, ages 64 and 68 years (patients 2 and 3, respectively), are alive after chronic lymphocytic leukemia was diagnosed 11 and 4 years ago, respectively. Using the Rye classification, patient 2 and patient 3 had Stage I and Stage O disease, respectively. In contrast, patient 1 had Stage IV disease. The bone marrow of patient 2 was 90% cellular, with sheets of mature lymphocytes, and that of patient 3 was 70% cellular, with a nodular pattern of similar cells. Both patients 2 and 3 had normal karyotypes. Immunophenotyping studies revealed that patient 3 had an expanded population of B cells with minimal to no detectable expression of surface immunoglobulins and membrane-bound light chains. In contrast, the B-cell population of patient 2 expressed immunoglobulins M, D, and Kappa light chains. Gene rearrangement studies performed on these two patients revealed different but distinct patterns of heavy chain rearrangement. This may represent an evolution of two different clones of chronic lymphocytic leukemia in this family.
A 47-year-old woman ingested 7.2 gm of sustained-release verapamil. She developed hypotension, idioventricular rhythm, mild acidosis, mild hyperglycemia, and aspiration pneumonia that required antibiotics and mechanical ventilatory support. In addition, she had a stroke, which resulted from left cerebral hemispheric damage, an unusual complication. Stroke is reported only once in the literature. Special problems related to slow release medication and the need to be aware of them are discussed.
The number of pre-registration house posts allocated by the London Hospital rapidly increased in 1973. This made solution by hand of the allocation problem time consuming and complex. The Operational Research Unit was approahced and a computer aided scheme was designed which was subsequently adopted. Various alternative allocation methods are discussed and examples given. The results of the first five allocations are presented. The percentage of applicants obtaining one of their first three choices varied from 61 to 70%. Of consultants who expressed a choice, the percentage obtaining one of their first three choices was in the range of 72-94%. The allocation scheme has two principal advantages over methods used elsewhere. It is extremely flexible, allowing various weights to be given to either applicant or consultant. It also produces a complete solution which is optimal in terms of the numerical criteria specified. Details of the assignment algorithm are given in the Appendix.
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Nurses represent the largest single resource in terms of numbers of staff employed as well as the revenue cost within the National Health Service. As trainee nurses constitute about 30% of the nursing staff and in some cases provide more than 60% of the bedside care, the effective design of nurse training programmes must receive considerable analytic attention. A computer-aided interactive procedure is described which enables senior nursing administrators to evaluate and improve, from service point of view, a given nurse training programme.