Biomedical subjects
E M Critchley
Publications and source records attributed to E M Critchley.
A comparison of human and animal botulism: a review.
Botulism can arise from preformed toxin, wound infection or intestinal toxico-infection. All three forms can occur in humans as well as in animals. The examination of botulism in veterinary practice can alert the medical profession to the hazards which can occur with the introduction of dietary alterations and hermetic sealing of foodstuffs. There is also the possibility that the development of pica through lack of essential nutrients could lead to the ingestion of contaminated substances rendering the child (or even adult) susceptible to botulinum intoxication. A positive gain has been that research leading to the elimination of shaker foal disease has provided a comprehensive analysis of factors which may underline the risk of toxico-infection in infants.
Human botulism.
The survival of Clostridium botulinum spores in improperly processed foods varies considerably with pH and temperature. The greatest risk arises from commercial or home-prepared condiments, vegetables, non-acid fruits and preserved raw fish. Clinical problems with botulism arise from the rapidity of development, unexpected manifestations involving the autonomic nervous system, including paralytic ileus, gastric dilatation and hypotension, and the need to ensure ventilation.
Outbreak of botulism in north west England and Wales, June, 1989.
The clinical features of 27 patients identified in an outbreak of botulism in Lancashire, England, and North Wales are reviewed. All but 1 of the patients (age range 14 months to 74 years) were admitted to hospital: 12 were treated in intensive care units, and 8 received positive pressure ventilation. 1 patient died with an aspiration pneumonia. The clinical presentations contained several unusual features, with evidence of segmental demyelination in some patients and drowsiness, sore throats, and fever in others. The widely dispersed source of intoxication with patients presenting singly to several hospitals added to the difficulties of diagnosis. Successful clinical management depends on full and early recognition both of the dangers of impaired oropharyngeal function and of the rapid neurological changes in botulism.
Loss of memory for people following temporal lobe damage.
A 40-yr-old woman, K.S., is reported, who shows a severe loss of memory for people following a history of epilepsy and right anterior temporal lobectomy. Despite this memory problem, K.S. is not clinically amnesic, has a Memory Quotient of 122 on the Wechsler Memory Scale in line with her IQ of 119, and performs well on conventional tests of recognition and recall. She does not have a generalized semantic memory deficit for living things, but her deficit extends beyond people to include famous animals, buildings and product names. Autobiographical memory is good, except where memory for people is concerned. The nature of the memory store that is impaired in K.S. is discussed, as are the implications of her case for theories of the organization of long-term memory.
Drug-induced neurological disease.
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The diagnosis and management of migraine.
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Electroencephalography today.
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Diffuse myelitis associated with rubella vaccination.
Two patients who had received live rubella vaccine developed diffuse myelitis shortly afterwards. Neither patient fully recovered her motor function. In one patients the time between vaccination and development of neurological signs was rather too short to indicate definitely a causal relation. Nevertheless, the chronological association is suggestive, and other observations of such an association may strengthen the suspicion that rubella vaccination may occasionally cause severe neurological damage.
Letter: Peak-dose dysphonia in parkinsonism.
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Dupuytren's disease in epilepsy: result of prolonged administration of anticonvulsants.
In a study of chronic epileptics in a residential centre we recorded a 56% incidence of Dupuytren's disease. The lesions were usually bilateral and symmetrical and frequently associated with knuckle pads and plantar nodules. There was no direct relationship between Dupuytren's disease and frozen shoulder. Dupuytren's disease was seen equally in those with idiopathic or symptomatic epilepsy. The incidence increased with the duration of epilepsy and is probably a sequel to long-term administration of phenobarbitone. Reasons are given for presuming that the association between Dupuytren's disease and antiepileptic therapy is mediated through the peripheral stimulation of tissue growth factors and not through the central release of growth hormone or through alterations in liver metabolism.
Control of epilepsy with a single daily dose of phenytoin sodium.
Fifty-three patients in an epileptic centre have been studied. All were receiving phenytoin and many were also receiving other antoconvulsant drugs. 2. Thirty-six patients took part in a three month cross over study. There was no significant change in the frequency of epileptic seizures or in the late morning serum concentration of phenytoin when the treatemtn was changed from two to three spaced doses of phenytoin sodium/day to a single dose at 12.00 hours. 3. Seventeen patients acted as a control group. They received phenytoin sodium as two or three spaced doses/day throughout the study. There was no significant change in the frequency of epileptic seizures or in the late morning serum concentration of phenytoin between the first and second three month periods of observation. 4. It is concluded that the total daily dose of phenytoin sodium may be given once daily without reduction of the anticonvulsant effect.