Biomedical subjects
Publications and source records attributed to N Akhtar.
Gallium67 scanning may be used to localize disease activity in pyrexia of unknown origin. In this patient the finding of unsuspected pericarditis also provided a pointer to the correct diagnosis.
OBJECTIVE: To describe a possible case of procainamide-induced intrahepatic cholestatic jaundice that was recognized six weeks after the initiation of procainamide therapy and to summarize the five previously reported cases. CASE SUMMARY: A 77-year-old woman with a history of hypertension, insulin-dependent diabetes mellitus, temporal arteritis, and Wolff-Parkinson-White syndrome who had taken procainamide for six weeks presented to the hospital with disorientation and acute renal and hepatic dysfunction. In addition to disorientation, scleral icterus, and diffuse maculopapular rash, her physical examination was generally normal. There was no evidence of fever, nausea, vomiting, lymphadenopathy, or eosinophilia. Her liver enzyme concentrations increased significantly from baseline (beginning of procainamide therapy). Her N-acetylprocainamide (NAPA) concentration was elevated to 52 mg/L upon admission. Procainamide was discontinued and her NAPA concentration returned to within normal limits in two days. Diagnostic tests were performed to rule out active hepatitis, vasculitis, and liver malignancies. After procainamide was discontinued and prednisone treatment was started, she became more oriented and her liver enzyme concentrations slowly improved. DISCUSSION: Only five cases of procainamide-induced liver abnormalities have been previously reported; these included granulomatous hepatitis and intrahepatic cholestasis. The mechanism for liver dysfunction is not known; however, it is proposed to be a delayed hypersensitivity reaction. Clinical hallmarks of hypersensitivity include fever, eosinophilia, rash, and lymphadenopathy; nausea and vomiting also may be present. Of the five reported cases, all experienced fever and only one experienced pruritus. No patients had eosinophilia or lymphadenopathy. Because of the temporal increase in liver enzyme concentrations after six weeks of procainamide therapy, we believe that this case represents another possible procainamide-induced hypersensitivity reaction. CONCLUSIONS: Procainamide-induced liver dysfunction can occur from one day to six weeks after initiation of the drug and may subside one day to several weeks after discontinuation of therapy. Symptoms may include nausea, vomiting, rash, and fever. Liver enzyme concentrations are abnormal. It is important to recognize the possibility of such a reaction early so that procainamide therapy can be discontinued promptly to avoid further liver damage.
The antibacterial activity of a new cardenolide, 7beta, 14beta - dihydroxy-5-card-20(22) enolide has been studied and it has been found to be active against Pseudomonas pseudomallei. The new cardenolide also exhibited antitumor activity in a potato disc assay.
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Thirty-three clinical isolates from male nongonococcal urethritis and 28 isolates from soft tissue infections and ulcers were identified as Bacteroides ureolyticus by conventional bacteriological tests and were compared with five reference strains of the species. Whole-cell proteins from these clinical isolates and the reference strains were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). The majority of the strains from the two sources could be divided into five different groups, named phenons I to V; phenons I to IV have been described previously by others, while phenon V has been described recently by us. Digestion of chromosomal DNA from 16 of the clinical isolates (including strains representative of each of the five SDS-PAGE phenons) and the five reference strains was attempted with restriction endonucleases EcoRI, PstI, SmaI, and HindIII. After electrophoresis in agarose gels, good digestion was observed with HindIII only, and 12 different banding patterns (restriction endonuclease analysis [REA] profiles) were obtained for the 19 strains digested; one nongonococcal urethritis isolate and one reference strain did not show any digestion. From the agarose gels, HindIII-digested fragments of DNA were transferred to nylon membranes by use of vacuum blotting and subjected to hybridization with 32P-labelled 16S-23S rRNA from Escherichia coli. The resultant pattern of bands (ribotypes), which depends on the restriction fragment length polymorphisms in the rRNA genes, was used as a measure of genomic variation within the species. In total, 13 different ribotypes were obtained for the 19 strains. For some strains, good correlation was achieved among the SDS-PAGE phenons, REA profiles, and ribotypes. However, for others, REA analysis and ribotyping were able to discriminate between strains which shared the same SDS-PAGE phenon. Interestingly, these two techniques of DNA characterization were able to differentiate between isolates from the genital tract and those associated with soft tissue infections and ulcers.
Maternal directiveness, assessed by the mother's use of prescriptives, is correlated with slow vocabulary development. As prescriptives are most often used to redirect a child's attention to a different object or activity, it is hypothesized that attentional regulation underlies this negative relationship. In the present study, twelve mothers were videotaped interacting with their children aged 1;1, and 100 maternal utterances were coded for pragmatic intent. Prescriptives were coded as either changing (leading) or following the child's focus of attention. Only the frequency of mothers' follow-prescriptives correlated significantly with a productive vocabulary measure taken at 1;10. This correlation was high and positive, indicating that, given joint focus, directing a 13-month-old's behaviour can have beneficial effects on subsequent vocabulary development.
The erythrocyte sedimentation rate has previously been identified as an important prognostic factor in Hodgkin's disease. The plasma viscosity has replaced the ESR measurement in many laboratories, but doubts exist about its clinical relevance. In this study plasma viscosity at presentation/diagnosis was studied in 107 patients with Hodgkin's disease. A multivariate analysis of factors influencing prognosis and relapse-free survival identified plasma viscosity and number of disease sites as being highly significant. The risk of relapse increases initially with a rise in plasma viscosity, but after a value of about 2.0 mPa.s no further increase in risk is observed. When all of the prognostic factors are made available to the proportional hazards model, treatment modality and plasma viscosity are selected as the best set for predicting time to first relapse. This study demonstrates that measurement of plasma viscosity at presentation is an important prognostic factor in Hodgkin's disease, in terms of predicting outcome or risk of relapse.
2-year-old children interacted with a robot in a large playroom while their mother sat quietly in the corner. Identical vocalizations from the robot had very different effects on 3 dimensions of the children's behavior when the vocalizations were embedded in reciprocating and nonreciprocating social structures. The reciprocating robot produced (1) more topic-maintaining verbal dialogue, (2) less physical and more linguistically mediated social play, and (3) gender-specific effects on the children's tendency to visually reference their mother during the play session. The data are discussed with reference to the frequently encountered assumption that reciprocal social structures have an impact on children's behavior when the quantity and other qualitative dimensions of social stimulation are held constant, and with reference to the children's attributions about the robot as a social partner.
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The blood of 107 patients undergoing venography for suspected deep vein thrombosis (DVT) was tested for D-Dimers using enzyme immunoassay (EIA) and two latex agglutination techniques. D-Dimer levels by EIA were raised in 88% of patients with proven DVT. However, levels detected with the two agglutination tests were much less sensitive, being raised in only 43% patients with DVT. A more sensitive rapid screening test is needed to provide a useful non-invasive test for the exclusion of DVT.
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This study examined a widely held assumption concerning the development of visual attention, namely, that different aspects of visual selectivity depend on common processing resources. Observers aged 5, 7, 9, and 24 years participated in a speeded classification task designed to examine the relations between covert shifts of attention and filtering. There were three important findings: (1) covert orienting and filtering share processing resources, (2) the ability to orient covertly to a target location and to filter competing information on the same trial became more efficient with age, and (3) 5 year olds were able to filter as efficiently as adults when target location was precued. The implications of these results for theories of attentional development are discussed.
A method for the detection of immunoglobulin light chain mRNA by situ hybridization has been applied to routine bone marrow trephines, from patients suspected of having multiple myeloma. The principle aim was to define monoclonal populations even in cases lacking a paraprotein or an obvious atypical plasma cell proliferation. The expression of light chain mRNA in plasma cells in routine bone marrow trephines from 14 patients with suspected myeloma was studied. Plasma cells in the marrow ranged from 4% to 99%. Clonal populations based on light chain restriction were delineated in 12 patients, using biotinylated probes to kappa and lambda mRNA and visualized using an alkaline phosphatase/fast red naphthol capture method. Normal tonsil and bone marrow trephines were used as controls. In situ hybridization was found to be a specific, safe and rapid technique. It could be applied to both fixed and fresh tissue. It was found to lack the background staining of interstitial immunoglobulin, particularly in sclerotic cases, which is so often encountered with immunocytochemistry. Additionally, this technique will type plasma cell neoplasms (undetected by routine immunocytochemistry) in post-transcriptional block or non-secretory myeloma.
Children aged 4, 5, and 7 years and adults aged 20 years performed a speeded classification task designed to isolate several sources of interference in visual selective attention. On each trial, observers responded to 1 of 4 targets which were mapped to 2 responses. On some trials the targets were also flanked by distractor stimuli, which observers were asked to ignore. The interference measures examined the effects of attentional set, increases in feature number, increases in feature type, response competition, and stimulus generalization. All but 1 of the measures (stimulus generalization) produced reliable interference in the adult observers. However, only 2 of the measures (attentional set, increases in feature number) produced reliable interference in children. The implications of these findings for theories of attentional development are discussed.
Operative cholangiography is for most surgeons a routine part of every cholecystectomy. Computerised digital subtraction angiography was adapted for operative cholangiography using a portable machine. After cannulation of the cystic duct the background image was subtracted before injecting contrast. Only the contrast within the bile duct appears on the monitor and resolution is high. A permanent record was made on 10 X 10 cm spot films. Eighteen pre-exploratory cholangiograms were performed using this method. In 12 no stones were demonstrated on digital subtraction cholangiography (DSC), nor were there clinical indications of common bile duct stones. These patients underwent cholecystectomy only. Stones were demonstrated on DSC in 3 patients and all had stones at exploration of the common bile duct (CBD). Three patients had no stones demonstrated on DSC but were explored on clinical grounds. No stones were found. Postoperative T-tube cholangiograms confirmed the absence of stones in 5 patients. A retained stone was present in one patient who had not had a postexploratory examination at operation and was not related to the use of this cholangiographic technique. DSC combines the benefits of image intensification and still radiography and has been accurate in both predicting and excluding common bile duct stones.
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