Biomedical subjects
Publications and source records attributed to D C Wilson.
We describe a one year old boy with meningococcaemia complicated by the adult respiratory distress syndrome. Maintenance of oxygenation required a positive end-expiratory pressure of 20 cm H2O. Resultant barotrauma produced pneumothorax and pneumomediastinum. Prompt recognition and treatment of this complication can reduce its high mortality rate.
Manganese (Mn), selenium (Se) and glutathione peroxidase (GPX) levels were determined in 56 paired samples of maternal and cord blood plasma at birth in both term and preterm pregnancies. Correlations existed between maternal and newborn plasma levels for Se, but not for Mn or GPX. Values of Mn, Se and GPX were all greater in the term than the preterm infant. Levels of Mn were greater in the pregnant than the non-pregnant woman, but levels of Se and GPX were lower during pregnancy.
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Twenty two babies who developed bronchopulmonary dysplasia were compared with 22 babies matched for gestational age who did not. Those with bronchopulmonary dysplasia weighed less at birth and had lower energy intakes from day 7 to day 56. Undernutrition before and after birth is a major problem in babies who develop bronchopulmonary dysplasia.
Very low birth weight infants often receive multiple blood transfusions. We measured the plasma levels of the trace elements selenium, manganese, and glutathione peroxidase in 20 very low birth weight infants prior to blood transfusion and then at 24, 48 and 72 h after transfusion. There was no detectable change in mean selenium or glutathione peroxidase concentrations after transfusion, but the mean (SD) plasma manganese increased from 3.8 (1.5) to 6.0 (2.3) micrograms/l at 72 h.
Patients with brown recluse spider bites commonly suffer from pain, muscular aching, and a variety of local dysesthesias during the acute and resolution phases of toxin-induced injury. This is our first well-documented observation of persistent cutaneous anesthesia caused by a spider bite. The anesthetic area conformed to the distribution of a specific nerve, the transverse cervical cutaneous nerve. The identification of the spider as a brown recluse and the location of the bite over the nerve's usual pathway strongly suggest that the venom was responsible for this complication.
We have described a case of herpes genitalis in a patient with Evans's syndrome who had violaceous macules leading to deep ulcerations. This case serves as a reminder that HSV infection may be atypical and have an unusual course in immunocompromised patients. With the availability of specific therapy for this infection, it is important to consider HSV in the differential diagnosis of all ulcerative skin lesions.
A previously well 10 year old boy presented with scoliosis, a mass in the chest wall, and a pleural effusion. Chest radiography showed the triad of chronic consolidation, pleural effusion, and rib periostitis. Investigations confirmed thoracic actinomycosis. Tissue spread was evaluated by computed tomography. It was successfully treated with benzylpenicillin, which was later replaced by clindamycin.
Pneumocystis carinii pneumonia (PCP is the most frequent opportunistic infection in patients with AIDS and is the most common cause of death in these patients. Conventional parenteral trimethoprim/sulfamethoxazole or parenteral pentamidine treatment is often not completed because of frequent incidence of adverse reactions. Aerosolized pentamidine appears to be better tolerated and is considered an alternative treatment for PCP in both hospital and community settings. This report describes our experience with 34 patients with AIDS who received aerosolized pentamidine at home. All patients were over 18 years old and had received either parenteral or aerosolized pentamidine within a medically supervised setting before home treatment was initiated. The Respigard II nebulizer system powered by an oxygen source was used as the delivery system. All patients took two puffs of metaproterenol sulfate 10 minutes prior to two 15-minute sessions of pentamidine inhalation. No relapse or adverse reactions were observed in patients. Large randomized clinical trials currently are underway to compare the value of aerosolized pentamidine with other forms of treatment for PCP.
The only spiders of real medical importance to humans in the United States are the Loxosceles and Latrodectus species, primarily the brown recluse and the black window, respectively. These spiders bite humans only when trapped or crushed against the skin. Severe brown recluse spider bites produce dermonecrosis within 72-96 hours, which should be treated with rest, ice compresses, antibiotics, dapsone, and surgery delayed for several weeks. Using systemic corticosteroids may be helpful in treating the much rarer systemic loxoscelism, which has minimal skin changes but produces massive hemolysis. Black widow bites do not produce marked skin changes but primarily produce muscle cramping, pain, and other neuromuscular-related symptoms. Though a specific antivenin for black widow bites is available, pain control, muscle relaxants, and calcium gluconate are generally adequate treatment. Many other spiders inflict painful bites, but arachnids do not medically deserve the bad reputation that they generally have with the public.
Fetal hydrops (hydrops fetalis) remains a significant cause of fetal and neonatal mortality. The decreased incidence of rhesus iso-immunisation due to prophylaxis with rhesus immune globulin (anti-D), improved antenatal ultrasound screening, and advances in neonatal intensive care have greatly altered the clinical outlook in this condition. A retrospective review of all 27 liveborn cases of hydrops in the Royal Maternity Hospital, Belfast in the period 1974-89 showed that in the last five years 40% of cases were non-immune in origin. The mortality rate fell from 100% in the first part of the study to 50% in the second.
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An infant presented with hypoglycaemia secondary to nesidioblastosis. Subtotal pancreatectomy failed to prevent recurrent post-operative hypoglycaemia. Subcutaneous somatostatin analogue (SMS 201-995) was shown to increase the blood concentrations of glucose and B-hydroxybutyrate while lowering serum insulin levels. Regular use of somatostatin analogue was helpful in long term management without causing significant side effects.
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