Biomedical subjects
Publications and source records attributed to D Russell.
In this study a new pulsed Doppler spectral analysis system was used for the evaluation of extracranial carotid disease. When compared to the arteriography findings in 224 carotid arteries, the Doppler examination correctly detected all stenoses greater than 25%, all occlusions, all normal vessels, and 43% of stenosis causing a diameter reduction of less than 25%.
A central apnoea alarm designed to monitor the breathing of infants placed in four separate cubicles is described. It has been found to be effective and inexpensive, costing about 50 pounds.
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A minor tranquilizer, ketazolam, was tested in a double-blind, randomized, crossover study of 50 patients for its effects in neurologic spasticity. The drug was compared with diazepam (widely accepted as an effective antispasticity agent) and a placebo. The patients with spasticity were almost all cases of multiple sclerosis (24) or stroke (24). Thirty-nine patients completed the study. There was not statistically significant superiority of either diazepam or ketazolam, but both relieved symptoms significantly better than the placebo, as measured clinically and by electromyographic recording of deep tendon reflexes. Ketazolam is a relatively safe and clinically effective antispasticity agent (especially for patients with multiple sclerosis). The well-known "big 3"--dantrolene sodium, baclofen, and diazepam--produce large and small problems in many individual cases; hence, ketazolam now offers a safe and clinically useful alternative.
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Evaporimeter measurements of forehead sweating during attack were carried out in six female patients with chronic paroxysmal hemicrania. The patients served as their own controls. Increased sweating on the symptomatic side was found in two patients, both when compared to the non-symptomatic side during attack and when compared with the symptomatic side outside attack. The remaining four patients, two of whom had only weak attacks at the time of study, showed sweat values within the control range. In one patient, attacks could be precipitated by head flexion and by pressure against certain circumscribed points in the neck ("mechanical" precipitation of attacks). These attacks were also associated with increased sweating on the symptomatic side. Increased forehead sweating does not seem to be a sine qua non in CPH.
Continuous ECG recording has been carried out for at least 24 h in 27 patients suffering from cluster headache. During the study a total of 84 attacks occurred in 25 of the 27 patients who took part. A computerized analysis of the heart rate changes accompanying attacks showed the following: (i) an increase in heart rate at the onset of attacks; the degree of this increase being dependent on the heart rate before attacks, (ii) a relative decrease in heart rate and increased variations in heart rate during attacks, (iii) a relative increase in heart rate at the end of attacks, and (iv) a relative decrease in heart rate after attacks. Five patients (18.5%) showed ECG rhythm disturbances: two frequent premature ventricular beats, one transient attacks of atrial fibrillation, one first degree atrio-ventricular block, and one patient sinoatrial block.
Eighteen cluster headache patients were studied using body heating or exercise tests; all but two of them were also studied with a pilocarpine test (0.1 mg/kg body wt, s.c.). Evaporimeter measurements were made on both sides of the forehead under standard conditions in a thermo room. Heat- and exercise-induced sweating was clearly less pronounced on the symptomatic side than on the non-symptomatic side of the forehead, and was significantly different compared to controls. Pilocarpine on the other hand induced a clearly more pronounced response on the symptomatic side than on the non-symptomatic side, which was also statistically significantly higher than in the control group. These findings suggest a supersensitivity of the sweat glands to pilocarpine on the symptomatic side of the forehead in most cases of cluster headache.
In eight patients with chronic paroxysmal hemicrania (CPH), forehead sweating was measured after various provocation tests-body heating, exercise, and subcutaneous pilocarpine administration (0.1 mg/kg body weight). Evaporation was measured bilaterally on the forehead with an Evaporimeter (in g/m2/h). This was carried out in a thermo room under standardized conditions. There was no definite deficit in heat-induced or exercise-induced sweating on the symptomatic side of the forehead, contrary to findings in cluster headache. Neither did pilocarpine lead to any marked initial, temporary predominance of sweating on the symptomatic side, which has previously been found in cluster headache. In cluster headache there may be denervation supersensitivity of the sweat glands in the forehead of the symptomatic side. The present study does not therefore provide evidence for supersensitivity phenomena which could explain the homolateral forehead sweating increase seen during attacks in some CPH patients. The localized sweating increase in the forehead during attacks of CPH may possibly be a result of direct sympathetic stimulation.
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The epithelioid cell granuloma in high resistant tuberculoid (TT) leprosy was contrasted with the pure macrophage granuloma of anergic lepromatous leprosy (LL) by evaluating various immunological factors operating in these lesions. The immunoperoxidase technique using antisera to immunoglobulin IgG, IgM, complement C3, C3d and C1q and other products of macrophage secretion, lysozyme, plasminogen, a1 antitrypsin and C-reactive protein and of Ia antigens revealed peak levels in tissues of most of these factors in both types of granuloma. The tuberculoid response was linked to low antigenic load and Ia-like antigen and the lepromatous response was secondary to a high antigenic load in the absence of Ia antigen. Complement and other mediators were found intracellularly in both tuberculoid and lepromatous granulomas, but extracellularly only in tuberculoid lesions. This may indicate local hypersensitivity in the tuberculoid granuloma. It is suggested that the mediators in LL macrophages remain bound to lipids of mycobacterial degenerations in the phagocytic vacuole. Secretory cells were differently sited in the two types of granulomas: peripheral in epithelioid cell lesions and central around capillaries over the whole lesion in pure macrophage granulomas of LL. In tuberculoid leprosy many of the central vessels in the granuloma were obliterated. C1q was found in fibroblasts. However, the marked absence of fibrosis in any of the lesions of leprosy, except following severe reactions, casts some doubt on the link which has been postulated between epithelioid cells and fibroblasts as an explanation of fibrosis in granulomas.
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The ECG findings before, during and following 81 spontaneous attacks of cluster headache in 24 patients have been recorded using a Holter cardiography system. No significant change in mean heart rate was found during attacks, when all attacks were considered as a group. Attacks which began when patients were awake differed from those which began during sleep as regards changes in mean heart rate. The mean heart rate decreased during the majority (61%) of attacks which began when patients were awake, whereas it remained unchanged or increased during the majority (67.5%) of attacks which began during sleep. The attacks which began when patients were awake also had higher absolute mean heart rate values before, during and following attacks compared to similar values for those attacks which began during sleep. blood pressure was measured during 11 attacks and showed a significant increase in both systolic and diastolic blood pressure. The heart rate and blood pressure in six patients usually increased during induced head pain.
In four of the approximately 40 cases of chronic paroxysmal hemicrania (CPH) that are known so far, attacks that are similar to the spontaneous ones may be precipitated by head movements or pressure against certain points in the neck. Head flexion was used as the precipitation procedure in a 34-year-old female who was studied several times in the course of five years. Attacks occur within 5-40 sec, and the pain is preceded by tearing and conjunctival injection. External rubbing or external compression of the common and internal carotid arteries on the symptomatic side did not produce attacks. The combination of head flexion and external compression of the common or internal carotid arteries on the symptomatic side invariably produced an attack of usual severity and within the usual time. This investigation would seem to render unlikely the possibility of a primary vascular mediation of the signal from the neck to the ocular region. Sympathetic fibres are the likely mediators of the impulses from the neck to the ocular area.
The polyamines putrescine, spermidine and spermine are intimately associated with cellular growth and division. Previous studies of the polyamines and their rate limiting biosynthetic enzyme, ornithine decarboxylase, in psoriasis have shown significant changes compared with non-psoriatic skin. We have further studied cutaneous polyamines in patients with psoriasis and in normal subjects, epidermal shave biopsies were taken and assayed for ornithine decarboxylase activity and polyamine levels. Psoriasis lesions showed increased ornithine decarboxylase activity compared with uninvolved skin. The levels of ornithine decarboxylase activity in uninvolved psoriasis skin were also higher than in normals. There was increased putrescine in involved psoriasis compared with uninvolved and normal skin. Spermidine and spermine were increased in psoriasis skin and in uninvolved skin and compared with normals. The spermidine/spermine ratio was greatest in involved skin compared with uninvolved and normal. These results confirm abnormal polyamine metabolism in both the involved and uninvolved skin of psoriatics.
The development of a 22-item measure of shyness, the Social Reticence Scale, is described. Shyness is a common but often seriously limiting constellation of feelings and attitudes experienced in social situations. Research on shyness has been hampered by the lack of a valid, reliable and easily administered instrument with which to measure shyness. The Social Reticence Scale was found to have substantial internal consistency and test-retest reliability and several assessments of criterion and construct validity suggested that the scale was a valid measure of shyness. Preliminary evidence regarding discriminant validity is also presented as well as the factor structure of the scale.
A detailed clinical study of 77 spontaneous cluster headache attacks has been carried out. The information was recorded during a period when patients were without medication and with the use of methods which were not dependent on the patients' memory of events. The findings stress the usual rapid onset and termination of attacks, and their short duration. There was a preponderance of attacks beginning during sleep and the majority of daytime attacks began when patients were physically relaxed. No significant difference between nocturnal and daytime attacks was found as regards severity or temporal profiles. A significant positive correlation was found between severity of maximal pain and both duration of maximal pain and total duration of attacks. "Abortive attacks" accounted for 16% of attacks. The apparent spontaneous arrest of these attacks does not appear to be due to special features of patient activity prior to or during attacks, nor are they restricted to a refractory period following more severe attacks.