A variant congenital dyserythropoietic anaemia presenting as a fatal hydrops foetalis.
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Anemia, Dyserythropoietic, Congenital↗
Biomedical subjects
G Williams
Publications and source records attributed to G Williams.
Three-monthly GnRH agonist (buserelin) for prostatic cancer.
A new slow release formulation of buserelin given as a 3-monthly depot injection has been evaluated in 4 patients with advanced prostatic cancer previously maintained on shorter acting depots. Treatment was maintained for a mean period of 21 months. Steady state urinary buserelin concentrations were reached by the beginning of the third treatment week and maintained until the end of the third treatment month. Serum testosterone remained suppressed in the castrate range for the duration of the study. Seven previously untreated patients were entered into treatment. Serum testosterone was suppressed into the castrate range between the seventh and fourteenth days after implantation. This preparation offers an advantage for the patient and clinician over existing methods of GnRH analogue administration and will now enter further clinical trial.
Buserelin↗
Ascites induced by interleukin-2 in the treatment of renal cancer.
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Adult↗
Alternatives to prostatectomy.
The danger of the treatments described are that patients may be treated without referral to a urologist. Investigations to determine whether genuine obstruction is the cause of their symptoms may not be performed and follow-up to exclude the side effects of their outflow obstruction or indeed their treatment may not be carried out. In addition, in cases where digital palpation does not alert the clinician to the possibility of prostatic malignancy, the loss of specimens for histological interpretation may lead to missed diagnoses. In summary, the alternatives to prostatectomy are still limited. Hormonal manipulation, hyperthermia and prostatic dilatation using the smaller balloons have no role at present in symptomatic patients. The role of larger balloons has still to be determined. Alpha blockade, while achieving relief in the short-term, still requires long-term objective follow-up studies in patients with urodynamically proven obstruction to assess patient compliance and the effects of treatment before it can be recommended as a long-term alternative. Similar information is also required before the efficacy of hyperthermia in patients with retention can be determined. For high risk patients with a limited life expectancy who present with retention of urine, prostatic stents may have a role, but once again long-term follow-up data are required before this treatment can be advocated in fitter or symptomatic patients.
Adrenergic alpha-Antagonists↗
Treatment of bladder carcinoma using a germ cell chemotherapy protocol.
Elevated levels of circulating beta-human chorionic gonadotrophin (beta-HCG) are commonly associated with a variety of tumours of germ cell origin. Other carcinomas may possess choriocarcinomatous elements but only rarely have there been reports of transitional cell carcinomas of the bladder associated with raised germ cell tumour markers, possibly because assays are not routinely performed. We present 3 patients with advanced transitional cell carcinoma of the bladder, 2 with metastatic and 1 with locally invasive disease, who had raised levels of germ cell tumour markers. These patients were therefore treated with combination chemotherapy appropriate to such tumours, with excellent results, as shown by clinical improvement and return to normal of tumour marker levels. Recent reports of the association between bladder carcinoma and ectopic synthesis of beta-HCG are reviewed. It was concluded that the production of beta-HCG is probably not rare, but that when it is found, the adoption of an appropriate chemotherapeutic regime may be successful.
Antineoplastic Combined Chemotherapy Protocols↗
Pituitary adrenal and gonadal endocrine suppression for the primary treatment of prostate cancer.
Sixty new patients with advanced local or metastatic prostatic cancer were randomised to receive either bilateral orchiectomy, orchiectomy plus dexamethasone 0.5 mg in the morning and 0.3 mg at night, or orchiectomy plus cyproterone acetate 100 mg 3 times per day. All surviving patients have been followed up for a minimum of 2 years. An improvement in both objective and subjective responses in patients receiving dexamethasone compared with those receiving cyproterone acetate suggests a possible additional role for the pituitary in the control of prostatic tumour growth. A larger study with longer follow-up may be indicated.
Aged↗
Visual analogue scales distinguish between low urinary flow rates due to impaired detrusor contractility and those due to bladder outflow obstruction.
In patients with symptoms suggestive of bladder outflow obstruction and a free flow rate less than 12 ml/s a visual analogue scale was used to measure the response to the question "Compared to 5 years ago, how thick is your stream when you pass urine?". The visual analogue scale compared favourably with cystometry in distinguishing between low flow rates resulting from impaired detrusor contractility and low flow rates due to bladder outflow obstruction. A visual analogue scale may serve to alert the surgeon to the presence of impaired detrusor contractility and the need for a fuller urodynamic assessment in patients with a low urinary flow rate prior to consideration for prostatectomy.
Aged↗
The use of prostatic stents in patients with urinary retention who are unfit for surgery. An interim report.
Under local anaesthesia, 19 patients (18 with acute and 1 with chronic urinary retention) underwent insertion of an expandable stainless steel tubular "stent" into their prostatic urethra under fluoroscopic control. All were considered to be at major risk from prostatic surgery. The 18 patients with acute retention voided spontaneously following the initial stent procedure, but the patient with chronic retention required a period of suprapubic catheterisation. Following the endoscopic insertion of an additional stent this patient also voided spontaneously. During a follow-up period of 3 to 7 months (mean 4), 4 patients were lost to follow-up. The remaining 15 patients all void spontaneously. Recurrent asymptomatic urinary tract infections were seen in all but 1 patient initially, but none of those who were followed up for over 5 months had evidence of infection. Although the follow-up period is limited, the results to date demonstrate that the insertion of an expandable prostatic stent is a safe and reliable method of treating acute urinary retention in patients unfit for surgery. Further follow-up is required to assess long-term safety and to exclude late complications.
Aged↗
Symptoms versus flow rates versus urodynamics in the selection of patients for prostatectomy.
Many prostatectomies are performed on the basis of symptoms alone; 39% of patients referred by their family doctors and 23% of patients who were on waiting lists for prostatectomy of other hospitals, but who had not undergone any urodynamic investigations, were found to be unobstructed on urodynamic criteria. A screening peak urinary flow rate of 12 ml/s or less was associated with urodynamic evidence of obstruction in 95% of cases; 35% of patients with symptoms of outflow obstruction and a flow rate greater than 12 ml/s were also found to be obstructed. One year post-operatively, 84% of patients who were selected for surgery on combined symptomatic and urodynamic criteria were pleased symptomatically with their result. The failure of detrusor instability to resolve following prostatectomy was associated with symptomatic failure of treatment. Residual obstruction was demonstrated in 5 patients who had undergone prostatectomy and were asymptomatic at this time. This study illustrates that objective measures are necessary in the assessment of patients prior to prostatectomy in order to select only patients who are obstructed. The importance of a screening flow rate is emphasised. All patients who underwent surgery had cystometric evidence of obstruction but the symptomatic results of surgery were no better than the results in patients who had been assessed according to non-urodynamic selection criteria. We have thus failed to identify a need for routine cystometry in the pre-operative assessment of these patients. Cystometry does, however, have a role in assessing patients with pre-operative flow rates greater than 12 ml/s and in those who remain symptomatic following prostatectomy.
Humans↗
Smoking, eicosanoids and ulcerative colitis.
In this study, which is the first of its kind using normal tissue samples that are very difficult to obtain, we have investigated the hypothesis that smoking protects against ulcerative colitis by altering the colonic mucosal formation of prostaglandins and related substances. Colonic mucosa biopsied from healthy young men produced prostaglandin E, 6-keto-PGF1 alpha (formed from PGI2), leukotriene B4 and leukotriene C4/D4/E4 as determined by radioimmunoassay. With each substance, the median yield was lower in the group of smokers who smoked 3 cigarettes in the 2 h before biopsy, than in the non-smokers. However, with each eicosanoid the statistical probability approached only the 10% level, but the fact that the trend was the same for all eicosanoids somewhat strengthens the possibility of a real difference between the groups.
6-Ketoprostaglandin F1 alpha↗
Anti-cardiolipin antibody and renal disease: a report three cases.
Anti-cardiolipin antibodies have been linked to recurrent arterial and venous thrombosis in multiple organs. We present a biopsy-documented report of thrombotic renal disease apparently attributable to circulating anti-cardiolipin antibodies. One patient had primary anti-cardiolipin syndrome, one had mild SLE, and the third had a mild lupus-like syndrome. All three patients had a clinical course dominated by repeated multi-organ system thrombosis. Renal biopsy disclosed thrombosis at the level of the glomerular capillaries, arterioles, and interlobular arteries--similar to that described in other thrombotic microangiopathies. Renal thrombosis was not associated with active endocapillary proliferative lupus nephritis, suggesting a mechanism independent of subendothelial immune deposit injury. Renal presentation was variable, ranging from asymptomatic mild proteinuria to nephrotic-range proteinuria, renal insufficiency, and hypertension.
Adult↗
Prostatic stents and balloon dilatation.
Prostatic obstruction of urinary flow is a common age-related event resulting in both troublesome symptoms and retention of urine. There have been recent developments in the management of such patients by inserting metallic stents or by balloon dilatation of the prostatic urethra. The role of these treatments as alternatives to surgery is evaluated and some of the difficulties encountered in their usage are described in this article.
Aged↗
Hypothalamic regulatory peptide disturbances in the spontaneously obese JCR: LA-corpulent rat.
Central and lateral hypothalamic concentrations of 9 regulatory peptides implicated in the control of feeding behaviour were measured in corpulent (cp/cp) JCR:LA-cp rats which develop spontaneous obesity, hyperinsulinaemia and hyperlipidaemia, and in lean (+/?) controls. In female cp/cp rats, central hypothalamic levels of neuropeptide Y (NPY), neurotensin, somatostatin and substance P were significantly lower (p less than 0.02) than in lean female controls. Following food restriction with a 16% reduction in body weight, these differences were apparently reversed and there were also significant rises in the lateral hypothalamic concentrations of neurotensin and of galanin. The other 4 peptides examined (bombesin, calcitonin gene-related peptide, neuromedin B and vasoactive intestinal peptide) did not differ significantly between cp/cp and lean females, either fed freely or food-restricted. Male cp/cp rats showed no significant differences from lean males in central or lateral hypothalamic concentrations of any of the 9 peptides. NPY and galanin are powerful and specific central appetite stimulants, whereas neurotensin, substance P and somatostatin inhibit feeding when injected centrally. Disturbances in these putative appetite-regulating peptides may be involved in the hyperphagia and other hypothalamic abnormalities in this spontaneous obesity syndrome. The apparent absence of differences between the male corpulent and lean groups may relate to sexual dimorphism of the syndrome, which is more marked in the females.
Animals↗
Epidemiological survey of coeliac disease and inflammatory bowel disease in first-degree relatives of coeliac patients.
One hundred and sixty-two of 182 patients with coeliac disease provided satisfactory details of family size and the prevalence of coeliac disease and inflammatory bowel disease among their first-degree relatives. Patients ranged in age from 11 months to 79 years with a mean age of 41 (+/- 23) years. Twenty patients had at least one first-degree relative with coeliac disease: a total of 25 of 861 relatives were affected (prevalence = 2904/100,000) compared with an expected 0.9 cases (prevalence = 100/100,000; p less than 0.001). Six relatives had inflammatory bowel disease (prevalence = 697/100,000) compared with an expected 1.3 cases (prevalence = 150/100,000; p less than 0.001). Five of these had ulcerative colitis, and one had Crohn's disease. The relative risk of ulcerative colitis is, therefore, five times greater for first-degree relatives of people with coeliac disease than for the general population (95 per cent confidence interval, 4.7-7.2). There is a clear association between coeliac disease and ulcerative colitis, which may point to factors involved in the aetiology of colitis.
Adolescent↗
Characterization of glucagon-like peptide-1-(7-36)amide in the hypothalamus.
The distribution of glucagon-like peptide-1-(7-36)amide like immunoreactivity (GLP-1-(7-36)NH2 IR) in rat brain was determined. Highest concentrations were found in the hypothalamus. A combination of gel chromatography and anion exchange chromatography showed that the majority of hypothalamic immunoreactivity exactly corresponded in position to synthetic GLP-1-(7-36)NH2. Chromatographic analyses of rat ileum demonstrated a similar pattern, whereas in rat pancreas mainly a large proglucagon fragment and GLP-1 were indicated. Determination of the subcellular distribution by differential centrifugation of hypothalamic tissue revealed that most of the GLP-1-(7-36)NH2 IR was present in the synaptosome fraction. GLP-1-(7-36)NH2 was released from hypothalamic tissue slices in a calcium-dependent fashion by potassium-induced depolarization. Thus GLP-1-(7-36)NH2 appears to fulfil two criteria for a neurotransmitter. No change was found in its hypothalamic content in streptozocin-induced diabetic rats compared to normal controls but a decrease was seen in hyperinsulinemic hyperglycemic KKAy mice compared to KK mice.
Animals↗
Use of stents for treating obstruction of urinary outflow.
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Humans↗
Plasma alpha-tocopherol, total lipids and total cholesterol in wild rockhopper, magellanic and gentoo penguins before and after moulting.
Post moult rockhopper penguins (Eudyptes crestatus) had significantly higher plasma alpha-tocopherol (vitamin E), total lipid and total cholesterol concentrations than their pre-moult counterparts. In the magellanic penguins (Spheniscus magellanicus) there were post moult increases in total lipid, cholesterol and alpha-tocopherol concentrations, but only the increase in alpha-tocopherol was significant. Plasma alpha-tocopherol, total lipid and total cholesterol concentrations in post moult gentoo (Pygoscelis papua) chicks were similar to those in non-moulting adult gentoos. Species differences in the levels of these nutrients in plasma may be due to differences in their dietary habits.
Animals↗