Biomedical subjects
Publications and source records attributed to A Whelan.
A case of acute myeloid leukaemia (AML) occurring in a patient with untreated chronic lymphatic leukaemia (CLL) is presented. The diagnosis of two simultaneous leukaemic processes is based on morphological, cytochemical and immunological findings. The significance of the development of AML in patients with CLL is discussed.
A case of chronic lymphocytic leukaemia (CLL) with intracytoplasmic crystalline inclusions in peripheral blood lymphocytes is presented. The inclusions were identified as crystals of lambda (lambda) light chain and were present in bone marrow derived (B-cells) lymphocytes. The occurrence of light chain crystals in CLL may reflect a more primitive defect in immunoglobulin (Ig) synthesis, intracellular transport or secretion than has previously been reported.
Antibodies are considered to play a specific pathogenic role in certain disease states such as myasthenia gravis, Graves' disease and autoimmune haemolytic anaemia. Autoantibodies which interfere with the function of enzyme cascade systems have also been described in diseases such as acquired haemophilia (anti-factor VIII antibodies) and glomerulonephritis (C3 nephritic factor). The identification of these autoantibodies is crucial to an understanding of the aetiology of such diseases and is also of importance in revealing the inter-relationships of the immune system with other biological pathways. This is the first report of an immunoglobulin G (IgG) autoantibody reactive with C1-inhibitor (C1-Inh), a pivotal inhibitor of the inflammatory response which is known to inactivate proteins of the complement, kinin, fibrinolytic and 'contact phase' systems. This autoantibody was isolated from a patient with a novel variant of acquired angioedema and C1-Inh dysfunction. This finding highlights the involvement of the immune system in the pathogenesis of disorders characterized by the presence of dysfunctional inflammatory response proteins.
BACKGROUND: While treatment guidelines have been developed to guide the management of Staphylococcus aureus bacteraemia, there is a need to validate these guidelines in different clinical settings and to relate the effect of compliance to clinical outcome. AIMS: To assess the impact of adherence to treatment guidelines on clinical outcome and to explore the role of transoesophageal echocardiography (TOE) in risk stratification. METHODS: We undertook a 2-year mixed retrospective and prospective study of all cases of S. aureus bacteraemia at Fremantle Hospital, documenting the clinical and microbiological features of each case, the results of echocardiography, adherence with published clinical guidelines and clinical outcome. RESULTS: Failure to comply with guidelines was observed in 41% (38 of 93) of cases, the majority receiving abbreviated treatment. An increased rate of relapse was observed among patients who received inadequate therapy (5/38 vs 1/55; P= 0.04). Ten of 28 eligible patients underwent TOE and the test led to significant changes in management in two of those cases. CONCLUSIONS: While non-adherence with clinical guidelines was associated with an increased risk of relapse, the role of TOE in risk stratification was limited by factors including cost, limited acceptance of the test and the need for prolonged therapy for other indications.
This article explores the genesis and development of the Guckenberger v. Boston University case, detailing the pertinent facts and issues of the case and analyzing the court's decision. The overall question posed by the case (as considered from the perspective of the plaintiffs' attorneys) was whether Boston University violated federal law in its response to the requests for reasonable accommodations by students with learning disabilities. The article quotes primarily from the decision issued by Federal Judge Patti Saris. The court's decision signified an important development in the field of higher education and set an extraordinary precedent in favor of students with disabilities under both the Americans with Disabilities Act and the Rehabilitation Act of 1973.
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Evaluation of publicly funded services is an issue of accountability but also of continuous improvement. In health care services, the users can be adversely affected by poor services and the financial, psychosocial and physical costs can be enormous. It is increasingly important that evaluation be targeted at decreasing health inequalities so that the widening gap between the wealthy and poor can be reduced. The provision of maternity services in western countries has changed over the past few decades and is an excellent case study of the importance of evaluation and evidence-based research. This paper discusses the general context of changes to maternity services and briefly reports on a comparative study of low-risk women choosing birth centre or traditional labour ward care.
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