Biomedical subjects
C J Ellis
Publications and source records attributed to C J Ellis.
Extrapancreatic origin of chronic unexplained hyperamylasemia.
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How should we use metronidazole?
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Pseudomonas meningitis treated with azlocillin.
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Malaria in Birmingham and a London teaching hospital.
During the past five years the incidence of imported malaria increased among patients seen in East Birmingham Hospital and in St Thomas's Hospital, London. Plasmodium vivax was the predominant species in Birmingham, and was almost always acquired by Asian immigrants visiting the Indian subcontinent. In St Thomas's P falciparum was most commonly imported, usually by African immigrants visiting Nigeria and Ghana. Two patients (one Irish, one Japanese) died of falciparum malaria after visiting tropical Africa. In both hospitals the immigrant patients had seldom taken prophylactic drugs, and the few who had, ceased to do so on arrival in the UK and sometimes before leaving the malarious country. Apparently immigrants who visit their homeland do not consult their general practitioners before travelling, are given inappropriate advice, or do not take appropriate advice when given. Since the incidence of imported falciparum malaria in the UK is rising, the following points should be considered: the infection may be lethal, particularly in patients lacking immunity; it can mimic other diseases, which may lead to delayed diagnosis; severe disease may be associated with few parasites on a blood film, and even if the result is negative further tests should be performed; clinicians and hospital pharmacists should be aware of the need to keep permanent stocks of parenteral chloroquine and quinine preparations.
Mezlocillin and azlocillin: an evaluation of two new beta-lactam antibiotics.
Mezlocillin and azlocillin are broad spectrum penicillins for parenteral administration. In this study it was shown that they were very active against a wide range of pathogenic bacteria. Thirty-five patients were treated with mezlocillin, and 5 patients were treated with azlocillin (in combination with cefoxitin in 3 cases). The serum, bile and CSF levels of the drugs were measured. Both antibiotics would appear to be safe and efficacious in treating serious infections by sensitive pathogens. Infections caused by unknown pathogens could be treated by one of these agents in combination with a broad spectrum beta-lactamase stable cephalosporin or cephamycin.
Inequality of the direct and consensual light reflexes in normal subjects.
Anisocoria in darkness and during reflex responses to unilateral light stimulation was studied in 150 normal subjects with television pupillometry. It was commonly found that the direct light reaction of the stimulation eye exceeded the consensual reaction of the other eye. This light-induced anisocoria, termed 'contraction anisocoria', had a mean value of 0.075 mm or 6.1 % of light reflex amplitude. The measurement showed a high degree of repeatability in 20 subjects who were tested on two occasions a year apart. It occurred in the presence and absence of prior dark adaptation and increased proportionally with reflex amplitude as the intensity of the stimulating light was raised. IT IS CONCLUDED THAT, CONTRARY TO PREVIOUS OPINION, A SMALL DEGREE OF CONTRACTION ANISOCORIA IS NORMAL.
The afferent pupillary defect in acute optic neuritis.
Twenty-two patients with acute optic neuritis were studied by the techniques of infrared pupillometry and visual evoked responses (VER) to pattern reversal. A relative afferent pupillary defect was found in all cases and the magnitude of this defect was found to be related to the amplitude, but not to the latency, of the VER. During follow-up the afferent defect was found to remain persistently abnormal while other methods of clinical evaluation could not demonstrate abnormality reliably. The amplitude of the VER also remained low.
Measurement of serum amylase, urinary amylase and clearance amylase/creatinine using a protein-containing chromogenic substrate.
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Influence of amylase assay technique on renal clearance of amylase-creatinine ratio.
The influence of amylase assay technique on the renal amylase/creatinine clearance measurement was determined by analysis of serum and urine specimens obtained from 10 normal subjects. CAm/CCr averaged 2.19 +/- 0.18% with a saccharogenic technique, 1.52 +/- 0.2% with an iodometric technique, and 0.80 +/- 0.08% with a chromogenic technique. Each of these values differed significantly (P less than 0.05) from the other two. Recovery studies were carried out by adding partially purified human salivary or pancreatic amylase to human newborn serum or urine (which contain minimal endogenous amylase). Equal amylase activity was recovered from serum and urine by the saccharogenic technique whereas recovery from urine was less than 50% of that from serum using the iodometric and chromogenic techniques. The accuracy of the chromogenic technique is markedly improved by the addition of albumin to the urine assay system. Although it appears that only the saccharogenic method provides an accurate estimate of CAm/CCr, each assay technique distinguished the elevated CAm/CCr of patients with pancreatitis from the normal range established for that technique. Accurate clinical interpretation of CAm/CCr measurment requires knowledge of the amylase assay technique used.
Mechanism of increased renal clearance of amylase/creatinine in acute pancreatitis.
We investigated three possible causes of the increased ratio of amylase/creatinine clearance observed in acute pancreatitis. The presence of rapidly cleared isoamylase was excluded by studies of serum and urine, which demonstrated no anomalous isoamylases. In pancreatitis, the ratios (+/-1 S.E.M.) of both pancreatic isoamylase (9.2+/-0.6 per cent) and salivary isoamylase (8.6+/-1.6 per cent) were significantly (P less than 0.01) elevated over respective control values (2.4+/-0.2 and 1.8+/-0.2 per cent). Increased glomerular permeability to amylase was excluded by the demonstration of normal renal clearance of dextrans. We tested tubular reabsorption of protein by measuring the renal clearance of beta2-microglobulin, which is relatively freely filtered at the glomerulus and then avidly reabsorbed by the normal tubule. During acute pancreatitis the ratio of the renal clearance of beta2-microglobulin to that of creatinine was 1.22+/-0.52 per cent, an 80-fold increase over normal (0.015+/-0.002 per cent), with a rapid return toward normal during convalescence. Presumably, this reversible renal tubular defect also reduces amylase reabsorption and accounts for the elevated renal clearance of amylase/creatinine observed in acute pancreatitis.
Thyroid responses to acoustic stimulation.
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Left ventricular to right atrial shunt resulting from infective endocarditis.
A unique case is described in which infective endocarditis of the aortic valve led to intractable heart failure and necropsy examination showed that the patient had developed a communication between the left ventricle and right atrium.
Intrahepatic distribution of hepatic blood flow: single-input studies.
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Intrahepatic distribution of hepatic blood flow: double-input studies.
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Travelling expenses.
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Seasonality of presentation of imported Plasmodium vivax malaria in Birmingham, UK.
Residents of the UK returning from northern Pakistan with Plasmodium vivax infection tend to develop symptoms and present to hospital in the summer months, irrespective of the month of return. Thus, infections acquired in the cooler months of November to April appear to have a longer latency before presentation. Experiments suggest that more hypnozoites arise from the liver when ambient temperatures fall, somehow 'programming' parasites within biting mosquitoes.