Biomedical subjects
Publications and source records attributed to A Young.
A significant fall in brain T1 relaxation time, consistent with a reduction in brain water of approximately 0.3%, occurred in 19 chronic alcoholic patients admitted for detoxification. There was no correlation between T1 and the severity of withdrawal symptoms and hence no evidence that changes in brain water levels contributed to the abstinence syndrome.
Compared with the proximal ileum, the distal ileum in rat has a greatly reduced capacity for electrogenic ion secretion induced by secretagogues and for electrogenic, sodium-linked glucose transfer assessed in vitro. Similarly, in vivo, there is a great reduction in distal ileal basal fluid absorption and secretagogue-activated fluid secretion compared with proximal ileal values. This reduced absorptive and secretory capacity of the distal ileum would allow minimal changes in the concentrations of the luminal contents, facilitating its putative role as final chemosensor of the luminal contents of the small intestine.
Two cases of agranulocytosis occurring after addition of a butyrophenone to a course of phenothiazine treatment are reported and possible mechanisms for this interaction are discussed.
Nineteen patients who had been drinking on the day of admission had significantly raised levels of renin, aldosterone and cortisol and a non-significant increase in angiotensin II. Five patients were hypertensive (systolic blood pressure greater than 160 mmHg or diastolic blood pressure greater than 95 mmHg) at some point during the study and there was a significant tachycardia. Over the first 4 days of abstinence there were falls in all of the measures reaching significance for renin, cortisol, systolic blood pressure and pulse. There were no correlations between blood pressure and any of the hormones measured although there was a significant association between pulse and both aldosterone and cortisol. It is concluded that the activity in the renin-angiotensin axis and hypothalamic-pituitary-adrenal axis is not responsible for alcohol-related changes in blood pressure.
A case of systemic allergic-type vasculitis after the administration of quinidine and digoxin is described. The renal biopsy findings are unique in that they describe an arteritis with eosinophilic infiltration and non-caseating granulomata. We believe quinidine is the antigen that was responsible for the reported findings.
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Two methods for rapid detection of adenovirus were tested: (i) 24-well plate centrifugation followed by staining with a monoclonal antibody after incubation for 24 h and 48 h, and (ii) pretreatment of A549 cells used in conventional cell culture and 24-well plate centrifugation with 10(-5)M dexamethasone. Twenty-seven clinical isolates of adenovirus and 12 specimens from which adenovirus had been recovered were included in the analysis. Both isolates and specimens had been frozen at -70 degrees C for up to 6 months. By 24-well plate centrifugation both with and without dexamethasone, 21 (78%) and 27 (100%) isolates were positive for adenovirus at 24 h and 48 h, respectively. Of the specimens, 6 (50%) and 8 (67%) were positive by 24-well plate centrifugation without dexamethasone at 24 h and 48 h, respectively, whereas with dexamethasone 3 (25%) were positive at 24 h and 7 (58%) were positive at 48 h. Overall, combining isolates and specimens, the sensitivity of 24-well plate centrifugation for detection of adenovirus at 24 h was 69% without dexamethasone and 62% with dexamethasone, and at 48 h the sensitivity was 90% without dexamethasone and 87% with dexamethasone. The specificity under all conditions tested was 100%. In conventional tissue culture dexamethasone inhibited recovery of adenovirus. Without dexamethasone, adenovirus was recovered from all 39 samples within 7 days after inoculation; however with dexamethasone pretreatment, the virus was detected in only 31 (79%) of the samples tested in the same period of time.
Two groups of patients were examined for anti-Trypanosoma cruzi antibodies by immunofluorescence and ELISA (i) inhabitants of the village and surrounding rural area of Tibu, Norte de Santander, Columbia (n = 327) and (ii) employees of the Empresa Colombiana de Petroleos (ECOPETROL, n = 849). The latter group had a lower rate of positive serology (12 as compared to 29%) but the distributions of antibody titres were very similar in the two groups. A total of 119 serum samples (37 village and 82 ECOPETROL, including 25 seronegative controls) were analysed for their ability to immunoprecipitate the 7 major polypeptides of T. cruzi trypomastigotes of Mr greater than 72 kDa. Although 10 sera from positive patients showed no immunoprecipitation, all of the remaining positive sera contained antibodies which reacted with the 150, 90 and 85 kDa polypeptides. When the T. cruzi immunofluorescence positive, immunoprecipitation negative sera were retested by ELISA using GP90, all were negative thus suggesting that the patients had had a misdiagnosed T. rangeli infection. The new diagnosis was confirmed by immunofluorescence and ELISA with T. rangeli epimastigotes. Longitudinal studies were carried out on 19 patients from the ECOPETROL group for up to 3.5 years. Five seropositive patients showed a change in their anti-trypomastigote immunoprecipitation profiles over this period; one by loss of a previously recognized high molecular weight band and four others by conversion from a negative to a positive immunoprecipitation profile. These latter patients presented initially with uncomplicated T. rangeli infection but then acquired a T. cruzi superinfection. These patients represent the nucleus of a group in which prospective studies will identify the effect of T. rangeli infection on the course of subsequent South American trypanosomiasis and Chagas' disease.
Clinical and laboratory measurements taken at the onset of rheumatoid arthritis in 149 patients were compared with the severity of radiological changes seen at 3 years in the hands and feet, and cervical spine. The strongest association with the severity of peripheral radiological damage was rheumatoid factor (p less than 0.0001 for both the latex titre and RAHA titre). Subluxation of the cervical spine was associated only with the presence of HLA-Dw2 (p less than 0.02) and HLA-B7 cross-reacting group (p less than 0.02). Discriminant function analysis utilizing latex titre, RAHA titre, haemoglobin level, and platelet count predicted the development of erosive or nonerosive disease in 79%. This method was less successful in predicting the actual severity of erosive damage and was not improved by the addition of HLA data. Radiological outcome in the cervical spine was successfully predicted in 82% using HLA-Dw2, HLA-B27 and age of onset of disease. It is concluded that the best predictors of erosive disease were standard laboratory features measured at onset, but that more powerful discriminant factors are needed if these are to influence clinical practice. Further prospective studies will establish whether rheumatoid involvement of the cervical spine is an expression of the influence of HLA determinants in this disease.
A review of findings obtained from a follow-up study of rheumatoid arthritis implicated a positive rheumatoid factor test as the most useful indicator of subsequent joint erosion.
We describe two patients with strangulated obturator hernia to enhance clinical awareness of the varied presentations of this uncommon hernia, which occurs especially in elderly women with either recurrent abdominal pain or partial intestinal obstruction, a positive Howship-Romberg sign, and an absent thigh adductor reflex. Early laparotomy for unexplained bowel obstruction is essential to avoid the complications associated with strangulated obturator hernia.
A-549 cells were compared with other cell lines for virus recovery, except from specimens submitted specifically for detection of cytomegalovirus. Of 589 specimens submitted specifically for detection of herpes simplex virus (HSV), 163 (28%) were positive for HSV--159 (97.5%) in A-549 cells and 156 (96%) in primary rabbit kidney cells. HSV cytopathic effect was identified an average of 0.6 day earlier in A-549 cells. Virus was recovered from 194 (11%) of 1,790 specimens submitted for general virus isolation. Of 40 HSV isolates, 85% were positive in A-549 cells, 72.5% were positive in MRC-5/WI-38 cells, and 42.5% were positive in HEp-2 cells. With adenovirus, 96% of 45 isolates were detected in A-549 cells, 62% were detected in HEp-2 cells, 38% were detected in MRC-5/WI-38 cells, and 31% were detected in PMK cells. Of the 76 enterovirus-positive specimens, 71% were positive in PMK cells, 62% were positive in A-549 cells, and 62% were positive in MRC-5/WI-38 cells. None of 12 respiratory syncytial virus, 14 rhinovirus, or 7 influenza A virus isolates were detected in A-549 cells. Of the cell lines examined, A-549 cells performed optimally for recovery of HSV and adenovirus, they allowed good growth of many of the enterovirus isolates, but they did not allow recovery of any of the respiratory syncytial virus, rhinovirus, or influenza A virus isolates.
Specific T cell cytotoxicity to Epstein-Barr virus (EBV) infected B cells is reported to be abnormal in rheumatoid arthritis (RA). The regression phenomenon was used to determine whether the immunoregulatory defect in RA is restricted to T cells, B cells, or HLA type. Peripheral blood T and B cells from patients with RA and their HLA identical healthy siblings were mixed in varying ratios with and without EBV, and thymidine incorporation was measured on days 7, 14, and 21. The results suggest that the T cell abnormality is related to disease activity and that an inherent defect exists in the rheumatoid B cell which is independent of disease activity.
Stored samples from within the first year of disease of 119 patients with rheumatoid arthritis (RA) enrolled in a long-running prospective study have been studied for the presence of IgM and IgA rheumatoid factors (RF), using agglutination of rabbit IgG-coated red blood cells to detect IgMRF and an ELISA technique using rabbit IgG coated on the microtitre plates and labelled F(aB)2 fragment of goat anti-IgA. Outcome measures at a mean follow-up of 10.1 years (range 3-20) included the Steinbrocker functional grade and grading of erosive changes on hand and feet Xrays using a modification of Lawrence's method. Both IgA and IgG levels at presentation correlated significantly with outcome measured by erosive changes and functional grade at a mean of 10 years and with the time of first appearance of erosions. In patients who are IgMRF negative early in the disease, IgARF positivity indicates a greater chance of developing both erosions and impaired function than when both tests are negative. IgARF positivity seems to precede IgMRF.
The 'failed back' represents a major clinical problem. Among the causes recognized for the 'failed back' is lateral root stenosis which has led to the use of electromyography (EMG) in the diagnosis of root compression. One hundred and thirty-two patients selected for surgical decompression were compared with 25 undergoing spinal fusion. EMG was found to be diagnostic in 95% of patients with bony canal stenosis, but only gave positive results in 62.5% of prolapsed disc patients. EMG improved in those patients who made a good recovery after surgery.
In 1987 a committee of the Home Health Assembly of New Jersey began a study of ethical issues in home care situations where the autonomy of the elderly patient is at risk. The study was based on four case histories describing actual situations of elderly patients, their families, and the professional practice of nursing and social work in the home. To determine concerns of home health agency administrators and their staffs, the committee did surveys, held round-table discussions, and conducted telephone interviews. As a result, it identified four key ethical concerns: 1. Maintaining agency solvency without denying care to patients who lack adequate financial resources. 2. Responding to the conflicting needs of patients and families. 3. Practicing healthcare in situations where patients may be abused or neglected. 4. Addressing decisions about candor and treatment in the care of the terminally ill. The committee identified five characteristics unique to the home care setting that create challenging situations which are rare in other healthcare settings: 1. Strongly asserted autonomy. 2. Limited definition of communal values. 3. Patient isolation. 4. Patient dependency on family care givers. 5. Inadequate long-term care policies.
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