Biomedical subjects
Publications and source records attributed to H Foster.
Urethral catheterization with 5 or 8F feeding tubes in 5 boys was complicated by stochastic knotting within the bladder thereby impeding removal. The common factor in these patients was insertion of excessive length within the bladder. Percutaneous endoscopic retrieval was done successfully in 1 child. This technique may avoid urethral trauma associated with catheter removal, particularly in younger boys.
Tracheostomy self care at home can be a problem for some patients. The Nottingham System attributes a competence ratio to each patient. Those liable to develop problems can be identified early and the appropriate support provided. The Nottingham System is described.
A study of HLA and primary Sjögren's syndrome (1 degree SS) was performed in 40 index cases and 180 relatives all of whom were Caucasian. The association of DR3 and 1 degree SS was confirmed. In probands, DR3 associated with extraglandular manifestations of 1 degree SS and homozygosity for DR3 associated with younger onset of disease. Familial clustering of 1 degree SS was evident. Definite or probable 1 degree SS (Fox criteria) occurred with a prevalence of 4.4% in the relatives, exclusively in older female first degree relatives and was associated with DR3. The relative risk was greatest in those who expressed anti-nuclear factor, rheumatoid factor or Ro and DR3. We identified a group of young females expressing some criteria for 1 degree SS and the same immunogenetic markers. They may be at risk of full expression of 1 degree SS as they become older. Milder forms of 1 degree SS were common in older relatives but not DR3 associated. 1 degree SS in males was rare and mild irrespective of immunogenetic status. Symptoms of 1 degree SS in relatives were mild or absent. Such individuals will only be identified through a family study or a community survey.
We have documented the initial clinical features of 100 patients with primary Sjögren's syndrome (SS) together with the results of their baseline investigations. The evolution of the disease in these patients has been followed for a median of 34 months (range 3-84 months). The majority of patients were females aged 40-60 years, and common clinical features included eye symptoms (100%), xerostomia (100%), polyarthralgia (94%), Raynaud's phenomenon (81%) and salivary gland swelling (47%). Thyroid disease was relatively common (14%) while other endocrine disease was rare. Four patients died during follow-up, and three cases of lymphoma were detected. Other serious complications included pericarditis (10%), pleuroparenchymal lung disease (9%), renal tubular acidosis (3%) and cerebrovascular accidents (2%). The presence of anti-Ro antibodies identifies patients with more severe systemic disease. Spontaneous improvement occurred in 12 patients, while steroids were required for specific complications in 18. Overall, although lymphoma was found to excess in our group, the high mortality reported with primary SS elsewhere was not seen.
Explore the source record for details and available documents.
The incidence of lymphoma and myeloma is increased in rheumatoid arthritis (RA), though the reasons for this are incompletely understood. The predictive value of monoclonal gammopathy in RA for the later development of lymphoproliferative malignancy was assessed. A serum paraprotein was discovered in 23 patients (14 female) with a median age of 58 years and a median duration of RA of six years. The paraprotein was quantified and further investigations, including a bone marrow examination and skeletal survey, were undertaken to study the possible development of a lymphoproliferative disorder. Secondary Sjögren's syndrome was noted in 12 patients. The paraprotein was monoclonal in 21 patients and was classed as IgG (12 cases), IgA (six cases), or IgM (three cases). Biclonal paraproteins were seen in two patients. Free light chains were found in the urine of eight patients. Bone marrow abnormalities were found in 13 subjects. The bone marrow was abnormal in four of six patients with an IgA paraprotein, in two of three with an IgM paraprotein but in only five of 12 patients with an IgG paraprotein. Patients were followed up for a median of four years, and five patients with an abnormal bone marrow developed myeloma, of whom three had an IgA lambda paraprotein. Two other patients developed non-Hodgkin's lymphoma. Extra-articular bone erosions were seen in four patients, three of whom developed myeloma, but the presence of urinary free light chains was not specific for the development of malignancy. Paraproteinaemia in RA indicates monoclonal B cell proliferation and carries a high risk of malignant transformation.
OBJECTIVE: This study was designed to identify variables that correlate with the risk of suicide in two patient groups that differ mainly in their level of expressed aggression. METHOD: Twenty-eight psychiatric patients with a history of violent behavior who were in a forensic psychiatric facility were tested and compared to 28 psychiatric inpatients without a history of violence who were admitted to a large municipal hospital. Measures used included a battery of self-report questionnaires, with acceptable reliability and validity, that provided indices of risk of suicide, risk of violence, impulsivity, anger, anxiety, and various mood states. RESULTS: The two groups, matched on demographic variables and overall risk of suicide, differed significantly on the measured risk of violence. The two groups showed similar patterns of correlations between risk of suicide and such variables as risk of violence, anger, fear, state and trait anxiety, lack of impulse control, suspiciousness, and rebelliousness. They differed in the correlation between suicide risk and depression. In the nonviolent patients there was a high correlation between risk of suicide and sadness; in the violent patients there was no correlation between these variables. CONCLUSIONS: The low correlation between sadness and risk of suicide in the violent patients, and the low prevalence of affective disorder diagnoses in these patients compared to other patients, suggests that suicidal risk should be managed differently in highly violent patients than in others.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.