Death from unsuspected diverticular disease in patients taking corticosteroids for polymyalgia rheumatica or giant cell arteritis.
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Biomedical subjects
Publications and source records attributed to E Paice.
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We report a case of rupture of the extensor tendons at the wrist shown histologically to be related to calcium pyrophosphate crystal deposition disease. This cause for extensor tendon rupture has not previously been described.
We describe a case of systemic sclerosis with sympathetic and parasympathetic neuropathy and detail autonomic testing in six further patients. Of these six patients, three showed early parasympathetic damage. None of the patients had evidence of peripheral neuropathy, and there was no correlation between the presence of autonomic dysfunction and the severity of Raynaud's phenomenon.
The labial biopsies from 13 patients with secondary Sjögren's syndrome (SS) and four disease controls were examined with a panel of monoclonal antibodies to human leucocyte antigens. Large numbers of T cells were found in most of the biopsies. In seven SS patients the T helper/inducer subset was found to be predominant. Antibody to HLA class I antigens consistently stained leucocytes, but other cell types stained more variably. Although the staining with antibody to HLA class II antigen was often weak, approximately as many cells stained with this antibody as with an antileucocyte antibody, implying that the T cells were activated. Anti-IgD revealed membrane staining of a corona of IgD-positive cells in structures resembling germinal centres. Isolated cells throughout the sections also showed strong cytoplasmic staining with anti-IgD. These results suggest a role for T-cell-dependent local antibody synthesis in the pathogenesis of the disease.
Plasma samples from 44 patients with systemic lupus erythematosus (SLE) and 43 with rheumatoid arthritis (RA) were assayed for C3d, a breakdown product of the third component of complement (C3), which was also measured in parallel. Levels of C3d varied in direct proportion with disease activity in RA, whereas C3 showed little change. Although C3d values also increased with worsening clinical condition in SLE, this trend was not considered to be sufficiently clear to be useful and did not provide any advantage over the routinely performed C3 assay.
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In a survey of senior house officers' (SHOs') satisfaction with training, overseas graduates rated their posts at least as highly as British graduates. Overseas graduates were older, more experienced and more likely to be training in district general hospitals.
Postgraduate deans throughout the UK have launched a drive to ensure that improvements in the education, supervision, working and living conditions of preregistration house officers are rapidly introduced.
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Recently there have been several initiatives to improve the working conditions and training of junior doctors. However, monitoring is infrequent considering the rapid changes in the health service, thus a mechanism to detect early problems is necessary. With this in mind, we have drawn up a charter for house officers that outlines standards which they should expect and the action they should take if they are not met.
Many changes are occurring in the organization and management of postgraduate medical education and training. Hospital Doctors: Training for the Future (Department of Health, 1993) highlights the need for shorter training programmes and structured curricula. A number of issues still require analysis, particularly the resource implications of expanding the consultant grade.
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A structured, modular management training programme has been developed to introduce junior doctors to basic management skills and concepts, successfully improving the efficiency of the organization.
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