Biomedical subjects
Publications and source records attributed to J Spencer.
Colonic pseudo-obstruction may have many possible causes. Some of these are well described and pose no diagnostic problems. Drug-related colonic pseudo-obstruction remains underreported, but is of importance in modern society where drugs are endemically abused. This case highlights the importance of drugs in altering colonic motility and emphasizes the nonsurgical management of this condition.
A 29-year old male with an 8-month history of spasmodic torticollis was treated after three baseline assessments with progressive relaxation, positive practice, and visual feedback. Subjective, behavioral, and physiological (EMG) data indicated that EMG declined across baseline assessments and treatment, while substantial changes in subjective and behavioral data occurred with treatment. Improvement on all dependent measures also was found at a 2-year follow-up. The data are discussed in terms of the non-specific effects of treatment, and the utility and economy of these primarily self-administered procedures.
In a double-blind design, sixteen volunteer students were administered 50 mg of chlorpromazine or a placebo in tablet form on separate occasions, two hours prior to testing. The test was a lexical decision paradigm involving unilateral presentation of pairs of neutral, positive and negative emotional words and nonwords to the left or right visual fields. Reaction time to identify words and nonwords was recorded. Neutral stimuli were processed faster in the left hemisphere, while negative stimuli were processed faster in the right hemisphere. Chlorpromazine improved speed of response for neutral stimuli presented to the right hemisphere and for affective stimuli presented to the left hemisphere. Thus chlorpromazine seems to benefit right hemisphere processing of nonaffective stimuli and benefit left hemisphere processing of affective stimuli. Chlorpromazine appeared to have a different impact on neutral and affective words, and on the right and the left hemispheres. The general effect of chlorpromazine was to reduce lateralisation. It was suggested that this occurred because chlorpromazine blocked dopamine and possibly other neurotransmitters.
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Gamma/delta T cells are increased in the gut epithelium of patients with coeliac disease compared with normal controls. The aim of this study was to determine whether the increase in gamma delta intraepithelial lymphocytes (IEL) is specific for coeliac disease, in which case it could be of diagnostic importance. Biopsies were obtained from children with no intestinal disease, coeliac disease, cow-milk-sensitive enteropathy/post-enteritis syndrome (CMSE PES) and miscellaneous other enteropathies (n = 67). Intraepithelial CD3+ and gamma delta T cells were identified in frozen sections using peroxidase immunohistochemistry. In normal biopsies there were 0-7 gamma delta IEL/100 cells in the epithelium. In untreated coeliac patients this increased to 9-22 gamma delta IEL/100 cells in the epithelium (P = 0.000004). Of 27 patients with morphologic intestinal damage which was not due to coeliac disease, four with CMSE/PES had gamma delta IEL/100 cells in the epithelium in the same range as the patients with coeliac disease. Of these, two had high densities of CD3+ IEL in the epithelium and were indistinguishable from patients with untreated coeliac disease. The other two could be excluded as possible coeliacs because their CD3+ IEL/100 epithelial cells were in the normal range. Thus an increase in gamma delta IEL is not specific for coeliac disease. However, enumeration of both of gamma delta IEL and CD3+ IEL densities will be useful in the exclusion of coeliac disease as a diagnosis in some children.
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Popliteal cysts occur commonly in both normal and arthritic knees. Most cysts are formed by distension of the medially situated semimembranosus bursa. Popliteus bursa distension occurs uncommonly as a lateral popliteal cyst. Two cases of rupture of lateral cysts which produced symptoms related to the anterolateral lower leg are reported. The difficulty of diagnosing the condition because of this unusual site of inflammation and subsequent management problems are discussed.
Small bowel enteropathies that are associated with an autoimmune process are often resistant to treatment. Two children with autoimmune enteropathy were treated with cyclosporin A for eight months. Both improved, as assessed by growth, small intestinal mucosal morphology, and carbohydrate absorption. Cyclosporin A is useful in the treatment of autoimmune enteropathy. This report also suggests that T cell activation (which is suppressed by cyclosporin A) is important in the pathogenesis of this condition.
The potential of Helicobacter pylori to degrade gastric mucus was examined. Colonies of H pylori cultured from antral mucosal biopsy specimens of patients with non-autoimmune gastritis were washed with sterile saline, passed through a sterilisation filter, and the filtrate examined for urease, protease, and mucolytic activity. The filtrate failed to hydrolyse bovine serum albumin, or to degrade stable mucus glycoprotein structures of high particle weight that had been separated from human gastric mucus on Sepharose 2B. The high particle weight mucus glycoprotein was, however, extensively degraded when incubated with H pylori filtrate (which possessed urease activity) in the presence of 2 M urea, to release fragments of Mr approximately 2 X 10(6). The high particle weight mucus glycoprotein was also broken down to a comparable extent when incubated with Jack bean urease in the presence of 2 M urea, or 1 M ammonium carbonate, or 40 mM carbonate-bicarbonate buffer (pH 8.7), but not when treated with 4 M urea alone, or Jack bean urease alone. These results indicate that the loss of high particle weight mucus glycoprotein in gastric mucus from patients with gastritis and gastric ulcers is unlikely to be due to the mucolytic action of an extra-cellular protease produced by H pylori, but it may result from the destabilising effects of a carbonate-bicarbonate buffer, generated at the mucosal surface when H pylori urease hydrolyses transuded plasma urea.
Immunohistochemistry with monoclonal antibodies to the T cell receptor V beta regions 5, 6, 8 and 12 was used to determine whether normal intestinal lymphocytes that are potentially exposed to many bacterially derived superantigens show any preferential expression of particular V beta regions compared with the blood. No difference between V beta expression in the mucosa and the blood was observed, suggesting that they share a common pool of alpha beta T cells and that there is no expansion of alpha beta T cells in response to bacterial "superantigens" in the gut. The T cell receptor V beta expressed by the activated T cells in the lamina propria of bowel from patients with Crohn's disease was also studied. There was no increase in V beta 8 expression in these cells, suggesting that the increase in V beta 8 observed in the blood and mesenteric nodes of patients with Crohn's disease is not of primary importance in the aetiology of the disease. Finally, V beta expression by mucosal T cells in coeliac disease was studied. There was no difference in V beta use by T cells in coeliac disease and those in the blood and normal jejunum.
Caecal biopsy specimens from Jamaican children with the Trichuris dysentery syndrome (TDS) and age matched Jamaican controls were investigated by immunohistochemistry and by light microscopy. Biopsy specimens from all children (with TDS and controls) showed a mild to moderate increase in inflammatory cells. Except in the vicinity of the worm, where the epithelium was flattened, there was no other epithelial abnormality. Compared with controls, children with TDS had increased IgM lamina propria plasma cells and decreased intraepithelial T cells. There was also an increase in crypt epithelial cell proliferation. Lamina propria T cells (both activated and non-activated) were no more common in children with the Trichuris syndrome than controls. Epithelial cell HLA-DR and VLA-1 expression (which are increased in other colitides) were the same in both groups. Despite the presence of large worm burdens and chronic dysentery, therefore, only minor changes were seen in the caecal mucosa of children with TDS.
The gene coding for the late lactation protein (LLP) in Macropus eugenii has been mapped using in situ hybridization to the proximal region of the long arm of chromosome 3. This position was confirmed by means of exclusion Southern blot analysis.
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Pain control for a person with a terminal illness provides the same sorts of challenges for those people who choose to stay at home as those who remain in hospital. The differences lie in the choices that are made for treatment, at times, the response to treatment; and the consequential effects treatment may have on families. This article discusses a case study in which the client's pain was managed in the home within a Hospice Care program that incorporates a visiting domiciliary nursing service. In Australia, such a program has all the advantages of a hospital setting, in that it has access to oncology units and the knowledge therein as well as catering to individual's needs in their own environment.
A case of metastatic angiosarcoma of the ovary, complicated by disseminated intravascular coagulation, is described. The tumour was diagnosed by histopathologic examination and immunohistochemical studies. Angiosarcoma of the ovary, although extremely rare, appears to be a highly malignant neoplasm with an aggressive course and effective therapy is unknown.
OBJECTIVE: To compare ultrasonography with intravenous urography in the investigation of adults with haematuria. DESIGN: Prospective study entailing the examination of all patients with both investigations concurrently. The investigations were performed independently on routine lists by different duty radiologists. Each was aware of the details of the request form but not of the findings of the other investigation. SETTING: Radiology department of a teaching hospital. PATIENTS: 155 Consecutive adult patients (aged 18-93) referred from general practitioners and hospital outpatient clinics with a history of haematuria. FOLLOW UP: When results of both examinations proved normal no clinical or radiological follow up was sought. All abnormal findings of either investigation were correlated with results of subsequent imaging studies or operative findings. RESULTS: 81 Patients (52%) had normal findings on urography and ultrasonography. Overall, the findings of ultrasonography concurred with those of urography in 144 cases (93%). Among the discrepant findings of the two investigations ultrasonography missed two ureteric calculi; one was in a non-dilated ureter, and in the other case ultrasonography detected the secondary ureteric dilatation. Ultrasound examination alone detected four bladder tumours not visible on urography with sizes ranging from 5 to 21 mm, representing one fifth of the 20 cystoscopically proved bladder tumours detected in the series. Ultrasonography detected all the 22 neoplastic lesions discovered in the study (20 bladder, two renal). Ultrasonography clarified the nature of renal masses evident in three urograms (simple cysts). CONCLUSIONS: Ultrasonography is a safe and accurate method of investigating the urinary tract in adults with haematuria. When combined with a single plain abdominal radiograph it proved to be superior to urography as the primary imaging study in this series. Ultrasonography should certainly be preferred to urography if cystoscopy is not planned. No urothelial tumours of the upper urinary tract were found in the series, reflecting their rarity. For those patients in whom ultrasonography and plain radiography have shown no abnormality and in whom cystoscopic appearances are normal urography would be advisable to exclude urothelial tumours of the upper urinary tract.
OBJECTIVE: To compare ultrasonography with intravenous urography for investigating adults with proved urinary tract infection. DESIGN: Prospective study of patients presenting consecutively for radiological investigation of urinary tract infection between October 1988 and December 1989. Both investigations were performed concurrently and performed independently on routine lists by different duty radiologists, each of whom knew the details on the request form but not the findings of the other investigation. SETTING: Radiology department of a teaching hospital. PATIENTS: 158 Consecutive adults (89 women, 69 men; mean age 49.7 (range 18-83)) referred from general practitioners and hospital outpatient clinics with a history of proved urinary tract infection. INTERVENTIONS: Urography and ultrasonography performed concurrently. When both examinations gave normal findings no clinical or radiological follow up was sought. All abnormal findings detected with either investigation were confirmed by subsequent imaging studies or by operative procedures. MAIN OUTCOME MEASURE: Accuracy of detection of abnormalities of urinary system by ultrasonography compared with urography. RESULTS: 113 Patients (72%) had normal urographic and ultrasonic findings. Overall, ultrasonography concurred with the findings of urography in 149 (94%) patients, and when a single abdominal radiograph was included in the procedure, in 152 (96%). Ultrasonography missed only one important diagnosis, that of mild papillary necrosis in normal sized kidneys in a diabetic patient. It detected one early bladder tumour not visible on urography and was able to clarify the nature of renal masses (simple cysts) evident on three urograms. CONCLUSION: Ultrasonography provides a safe and accurate method of imaging the urinary tract in adults with infection. Combined with a plain abdominal radiograph, it should replace urography as the initial imaging investigation in these patients. Major savings would result from adopting this policy, and the risks to patients from ionising radiation and intravenous contrast media would be appreciably reduced.
Primary low-grade B-cell lymphomas of mucosa-associated lymphoid tissue (MALT) are tumours with distinctive clinico-pathological characteristics, two of which are studied in this paper, namely the tendency of the tumours to remain localized and the morphologic and phenotypic resemblance of the malignant cells to splenic marginal zone B cells. We have made a detailed study of a small intestinal lymphoma and a gastric lymphoma, which together with the spleen were resected from the same patient. Using a monoclonal antibody (7G3) raised against a unique determinant on the small intestinal tumour, we were able to detect disseminated small intestinal tumour cells in the stomach and spleen. The tumour in the stomach was genetically related, but non-identical to that in the small intestine, and was not recognized by 7G3. Lymphocytes expressing the marker of the small intestinal tumour (7G3) were present in lymphoid nodules in the stomach, and 7G3+ plasma cells were present beneath the gastric epithelium. In the spleen, cells expressing 7G3 were present in the marginal zone and plasma cells expressing the same marker were present in the red pulp. These findings suggest that low-grade MALT lymphomas may migrate beyond the primary tumour site, but that tumour cells distant to the primary site may differentiate into mature, non-dividing plasma cells. The localization of small intestinal tumour cells in the splenic marginal zones reinforces the suggestion of lineage homology between these populations of cells.