Communicable disease control in London.
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Biomedical subjects
Publications and source records attributed to M McEvoy.
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A survey of 870 different adult blood samples (primarily from patients with non-haematological disorders) found that 269 (31%) had increased proportions (> 25%) and/or absolute numbers (> 1.0 x 10(9)/l) of morphologically-defined large granular lymphocytes (LGL), and/or phenotypically-defined NK-associated (NKa) cells. Of these, 112 were re-analysed at least 6 months after initial presentation and were classified as 'persistent' (92/112) or 'transient' (20/112) according to whether or not the original abnormality was still present. Lymphocyte counts in most patients with persistent abnormalities were within normal limits (18/92) or slightly increased (68/92), with only six having a lymphocytosis exceeding 10.0 x 10(9)/l. With the exception of five persistent LGL expansions in which the granular lymphocytes did not express NKa determinants (designated LGL+NKa-), the remaining 87 cases could be phenotypically grouped according to their primary abnormality as CD8+NKa+ (n = 33), CD4+ NKa+ (n = 14), CD8dim+NKa+ (n = 7) or CD8-NKa+ (n = 33). TCR genotypic studies in 58 patients showed that the 16 patients with rearranged TCR components were restricted to the CD8+NKa+ group and that, in most of these, the CD8+ fraction showed abnormal relative CD16/CD56 expression. Persistent neutropenia (n = 15) also appeared to be associated with primary abnormalities of CD8+NKa+ cells (12/15), with 10 of these additionally showing rearranged TCR genes. In contrast, persistently increased CD8dim+NKa+ and CD8-NKa+ components did not appear to phenotypically differ from their corresponding 'counterparts' in normal bloods or in patients with transient LGL/NKa+ abnormalities. This survey has therefore established that persistent LGL/NKa+ abnormalities are considerably more common than suggested in published work, that a high proportion of patients with expanded CD8+NKa+ components, with quite diverse clinical histories, show evidence of clonal lymphoid populations, and that the clonal nature of such disorders appears to be associated with abnormal NKa phenotypic patterns.
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Faecal blood loss arising from two prolonged-release formulations of indomethacin was compared in a double-blind, parallel group study in 12 healthy male volunteers. After a 1-week run-in period on placebo, subjects were allocated at random to receive 150 mg indomethacin per day, either as controlled-release 'Flexin Continus' tablets or as slow-release 'Indocid' R capsules, for 2 weeks and followed up for a further 1 week. Faecal specimens were collected over a 4-day period in each week and blood loss calculated using a 51Chromium-labelled red cell count method. Mean blood loss during the placebo run-in period was 2.6 ml/4 days in both study groups. Mean blood loss during treatment Weeks 2 and 3 with 'Flexin Continus' was 8.6 ml/4 days and 7.9 ml/4 days, respectively, and during treatment with 'Indocid' R capsules was 13.9 ml/4 days and 14.2 ml/4 days, respectively. There was a carry-over effect from both preparations as seen by a steady decrease in blood loss during the week after treatment. The mean value for 'Flexin Continus' was 6.9 ml/4 days and for 'Indocid' R was 8.3 ml/4 days during the wash-out week. Faecal blood loss was not statistically significantly different between the two formulations. No significant deterioration in haematological or biochemical results occurred in either group. Adverse symptoms were less frequent with 'Flexin Continus' tablets.
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In a prospective study of 150 health care workers in the United Kingdom who had been accidentally exposed to the human immunodeficiency virus no evidence of transmission was found. Larger studies in the United States and anecdotal accounts in publications from other countries confirm that the risk of occupational infection is very low. Health care workers must adopt safe procedures at all times, however, to avoid exposure to infection.
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We report two cases of acquired immune deficiency syndrome (AIDS), apparently without the usual exposure factors, in whom a temporal association was detected after detailed epidemiological investigation. The index case, a 45 year old housewife, had provided terminal home-nursing care for a 33 year old African man, who died from an undiagnosed encephalitis. At that time she had fissures of the skin of both her hands. Review of post-mortem pathology specimens of the African man allowed a retrospective diagnosis of AIDS with cerebral toxoplasmosis to be made. The type of home-nursing care given by the index case was quite different from that normally provided by health care workers with the training and facilities to prevent the spread of infection.
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An analysis of the lengths of survival of patients with the acquired immune deficiency syndrome presenting with different opportunistic diseases was performed using epidemiological data routinely collected at the PHLS Communicable Disease Surveillance Centre. The overall crude case fatality rate was 55.4% (93/168). The median survival times were: 21.2 months for Kaposi's sarcoma, 12.5 months for Pneumocystis carinii pneumonia, and 13.3 months for other opportunistic infections. The shortest median survival time (6.6 months) was found for those with both Kaposi's sarcoma and P carinii pneumonia. There were significant differences between durations of survival of patients with Kaposi's sarcoma and those with all other diseases, which indicated impaired cellular immunity apart from opportunistic infections. This analysis shows that those with Kaposi's sarcoma alone have the most favourable prognosis.
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The outbreak of the acquired immunodeficiency syndrome in the UK has great implications for health services, and predictions of future numbers of cases have been requested. There is not enough information to make a good estimate of the future epidemic curve, but the trend in new cases can be extrapolated and leads to a predicted number of new cases in the range 460 to 7300 in 1988, with a possible 700 patients from earlier years still alive and needing care at the beginning of 1988.
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A method employing stable isotope-labelled tracers and gas chromatograph-mass spectrometry (GC-MS) analysis has been used to measure the plasma clearance rates (PCR's) of androstenedione (A) and testosterone (T) in normal women and women with androgen abnormalities including hirsutism and polycystic ovary syndrome. A solution of deuterium-labelled A and T is infused at a constant rate and blood samples taken at 2 and 2.25 h. Solvent extracts of the derived plasma samples, to which an internal standard has been added, are derivatized with pentafluoropropionic anhydride and the endogenous steroid and deuterated steroid are quantitated after an injection of the derivatization mixture into a capillary column GC-MS. The concentration of the deuterated steroid in the infusion mixture is measured and the PCR is calculated. In premenopausal normal women the PCRA is 1950 +/- 184 1/24 h (n = 5) and the PCRT is 484 +/- 82 1/24 h (n = 7).
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