Current opportunities in clinical research.
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Research↗
Biomedical subjects
J Booth
Publications and source records attributed to J Booth.
Characterisation of a series of human immunodeficiency virus isolates derived sequentially from a single patient.
Five HIV-1 isolates were obtained sequentially from a single seropositive individual during the later stages of AIDS. Four of these isolates were adapted to grow in a continuous human T-lymphocytic cell line. Comparative biological and biochemical studies of the virus isolates were made using persistently infected cultures or virus derived from these systems respectively. The data obtained clearly shows that viruses with different biological properties can be isolated from the same individual at different times during the course of clinical AIDS.
Acquired Immunodeficiency Syndrome↗
Happy to be home? A discharge planning package for elderly people.
Research shows elderly people do not receive the support they need following hospital discharge. If they are to be enabled to return home successfully, patients need careful assessment of their needs well in advance, so that arrangements for adequate aftercare support can be made.
Aftercare↗
The management of change on a nursing development unit.
This article presents a descriptive account of the management of the change process and the nature of nursing developments which have been implemented on a Nursing Development Unit in Manchester Royal Infirmary. The fundamental aim underlying all innovations is to improve the quality of care delivered to patients. Consequently, the evaluation of the change process and whether it has actually served to improve standards is an issue of concern within this article. It is acknowledged that this case study cannot be upheld as an ideal model for innovation in nursing practice. It may however, serve as an example of how idealistic principles might be combined with realism derived directly from clinical practice, and may thus serve to inspire others along similar paths.
Hospital Units↗
Virus infection induces redistribution and membrane localization of the nuclear antigen La (SS-B): a possible mechanism for autoimmunity.
To investigate the possibility that anti-La (SS-B) antibodies in Sjögren's syndrome were induced by virus infection we studied the distribution of La in virus-infected human cell lines. Three monoclonal antibodies to La were used with monoclonal anti-Sm (derived from MRL/lpr lupus mice) and anti-rat immunoglobulin antibodies as controls. In uninfected cells La was predominantly in the nucleus. Twenty-four hours after infection of HEp-2 cells with adenovirus 2, the La and Sm antigens appeared to aggregate and accumulate in the periphery of the nucleus and, after 48 h, La was seen in the cytoplasm and cell membrane. No cytoplasmic or membrane expression of Sm was seen. Infection with adenovirus or cytomegalovirus caused a 2-13-fold increase in the concentration of La in three cell lines. Treatment of HE--2 cells with interferon-gamma (IFN-gamma) and infection with Epstein-Barr virus and cytomegalovirus caused cytoplasmic, but no definite membrane expression of La. The appearance of La on the surface of virally infected epithelial cells together with IFN-gamma induced class II expression could form the basis of a T cell dependent mechanism for anti-La autoantibody induction.
Adenoviridae Infections↗
Nefopam in rheumatoid arthritis. Results of a double-blind placebo controlled study.
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Adolescent↗
Methotrexate kinetics in rheumatoid arthritis: is there an interaction with nonsteroidal antiinflammatory drugs?
Pharmacokinetic drug interaction between methotrexate (MTX) and nonsteroidal anti-inflammatory drugs (NSAID) has been implicated in several case reports of MTX related toxicity. We therefore studied the kinetics of low dose (15 mg) oral MTX with and without concomitant NSAID therapy after preliminary determination of the systemic bioavailability of commercial tablets. Fourteen patients with rheumatoid arthritis, age range 44-77 years, participated in paired kinetic studies performed 1-4 weeks apart. The Abbott TDx fluorescence polarization immunoassay was used to measure serum levels and urinary excretion of MTX over 72 h after a single dose. The mean systemic bioavailability was 73% for the 15 mg oral dose. Area under the serum concentration versus time curve for a 50 mg oral dose was 1.1-2.7 times that of the 15 mg oral dose indicating dose dependent absorption. Mean kinetic variables after oral MTX did not differ significantly with and without NSAID therapy despite apparent interactions in individual patients. Renal clearance of MTX correlated with creatinine clearance (r = 0.8, p less than 0.01).
Adult↗
Abdominoscrotal hydrocele.
This report concerns the youngest case so far described in the world literature of abdominoscrotal hydrocele. Although this rare variant of hydrocele of the tunica vaginalis was first described in 1834, only five cases have been recorded in childhood to date; our case represents the sixth.
Abdomen↗
An early marker of fetal infection after primary cytomegalovirus infection in pregnancy.
Fourteen patients with primary cytomegalovirus infection diagnosed by serological screening at antenatal attendances were examined for their responses in the lymphocyte transformation test against cytomegalovirus. Tests were done during pregnancy, shortly after the diagnosis of primary infection. Eight women showed positive lymphocyte transformation responses and gave birth to uninfected babies. Six showed negative responses and four of the babies were born congenitally infected. Cellular immunity therefore plays a part in preventing intrauterine transmission of cytomegalovirus, and its depression after primary infection in the mother during pregnancy may be used as an early marker of fetal infection.
Adolescent↗
Detection of rubella-specific IgM in subclinical rubella reinfection in pregnancy.
Seven cases of asymptomatic rubella reinfection in early pregnancy are described. In each, there was a history of exposure to a rubelliform illness and low levels of rubella-specific IgM subsequently appeared in the serum. Four of the women had been immunised, after having been shown to be susceptible to rubella, one had been immunised at school without previous antibody screening, and two were uncertain about immunisation. One pregnancy was terminated and rubella virus was not isolated from the products of conception. Six pregnancies went to term and the infants showed no evidence of intrauterine infection. In a further case it was impossible to discriminate between reinfection and primary infection, and termination of pregnancy was offered.
Adult↗
Evidence that synthetic 31-amino acid inhibin-like peptide lacks inhibin activity.
We studied the biological activity of a recently characterized 31-amino acid inhibin-like peptide (ILP) using a synthetic preparation. While the material yielded a single component on chromatography, amino acid sequence analysis suggested that only 30% of the molecules possess the complete structure. Bioactivity was tested in vitro using whole pituitaries from 25 day-old male Sprague-Dawley rats. Pituitaries were incubated with 500 ng/ml of the ILP preparation or vehicle alone for 60 min, followed by a 3 h exposure to 2 ng/ml of luteinizing hormone releasing hormone (LHRH) or its diluent. In the ILP-incubated pituitary media, no significant suppression of basal FSH and LH release or stimulated FSH release was observed, while a significant increase in stimulated LH release was seen (p less than 0.05). An in vivo bioassay study was performed on 38 day-old male Sprague-Dawley rats. Test animals were injected with 0.1, 1, 10 or 20 mcg of ILP immediately after castration, and 10 and 24 h later. Control animals received bovine serum albumin or vehicle alone. There were no statistically significant differences in serum LH or FSH concentrations taken at 30 h after castration between the ILP-treated rats and controls. Possible reasons for our inability to demonstrate inhibin bioactivity (selective FSH suppression) with this ILP preparation include: Only about 30% of the peptides had the complete amino acid sequence. Other peptides with deletions might have acted as antagonists, thus obscuring the inhibin bioactivity. The 31-amino acid ILP may not be the authentic inhibin molecule. We suggest that further studies are needed to determine the true identity of inhibin.
Animals↗
Excretion of doxepin and N-desmethyldoxepin in human milk.
Doxepin and N-desmethyldoxepin concentrations in plasma and breast milk from a lactating mother and in plasma from her infant were measured during an 8 week period using high performance liquid chromatography. Plasma concentrations ranged from 35-68 microgram l-1 for doxepin and 65-131 microgram l-1 for N-desmethyldoxepin. Mean pre-feed milk/plasma ratios were 1.08 and 1.02 for doxepin and N-desmethyldoxepin respectively and increased to 1.66 and 1.53 at the post-feed samples. Only N-desmethyldoxepin (15 microgram l-1) was detectable in the infant's plasma sampled after 43 days of maternal therapy.
Adult↗
Clinical evaluation of the histochemical diagnosis of Hirschsprung's disease.
The histochemical staining of suction rectal biopsies for acetylcholinesterase (AChE) activity is a safe and accurate diagnostic tool in the management of patients with symptoms and signs of Hirschsprung's disease. In this study 101 patients who have undergone AChE analysis of suction rectal biopsies are presented in order to correlate histochemical findings with subsequent clinical course after a minimum of 18 months follow up. There were no false positive results, but the limitations and problems associated with the technique which we have encountered are discussed. Equivocal, atypical, or negative results when contradicting clinical features are indications for repeat biopsy or full thickness biopsy, and awareness of the situations in which false negative results may occur is essential.
Acetylcholinesterase↗
Hyperkalemia in the elderly.
Hyperkalemia is a common and potentially dangerous condition in elderly patients. These subjects are more likely to have a disease or be taking medications that may induce this disorder. We describe three such cases where the increased concentration of potassium in plasma resulted from decreased renal excretion of this ion, and suggest a simple approach to the etiological diagnosis of hyperkalemia.
Aged↗
Clinical evaluation of immunoinhibition determination of creatine kinase B subunits in coronary care.
One hundred patients with chest pain of cardiac origin were evaluated on the basis of clinical findings, electrocardiograph results, and total creatine kinase (CK) and creatine kinase B-subunit (CK-B) activity (as determined by immunoinhibition with the Boehringer CK-MB kit) in serum. All patients diagnosed as having had an acute myocardial infarction had increased values for both CK-B and total CK. In no case was normal total CK activity associated with an increased CK-B, nor was normal CK-B associated with an increased total CK. During collection of data for reference ranges, we found 10 patients who had no evidence of cardiac disease but had various other diseases, who exhibited high values for CK-B in serum; four of these had normal values for total CK. We conclude that estimations of CK-B in serum by this method added no more diagnostic information than did data on total CK in the evaluation of chest pain.
Aged↗