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Biomedical subjects

N Bellamy

Publications and source records attributed to N Bellamy.

137 records · Page 8Linked to original sources

Perception--a problem in the grading of sacro-iliac joint radiographs.

Reliability in the assessment of radiographic abnormalities in the sacro-iliac joint was investigated by rheumatologists and radiologists experienced in the reading of such films. This study differs from previous ones in that films were masked to reduce cueing from the radiographic appearance of other pelvic bone and joint structures. Agreement was greatest (greater than or equal to 80%) when only the presence or absence of abnormality was considered. When corrected for chance, agreement on the individual radiographic abnormalities was frequently poor or modest. The use of reference radiographs reduced absolute disagreement and had a modest influence on absolute agreement. The scoring of films for epidemiologic purposes should preferably be delegated to senior radiologists using standard reference films. Nevertheless, there remains a considerable margin of error in the interpretation of sacroiliac joint radiographs which is of clinical and epidemiological importance considering the weight that radiographs of this joint carry in diagnostic rheumatology.

Ankylosis↗

Bio-inorganic effects of D-penicillamine in children and in the elderly.

The principle mechanisms of action of dimethylcysteine (D-penicillamine) are thiazolidine formation, sulphhydryl -disulphide exchange, chelation and superoxide dismutase-like activity; as a consequence, it can enter into many varied biological interactions. Thiazolidine formation with maturing collagen makes D-penicillamine potentially teratogenic; sulphhydryl -disulphide exchange allows the formation of a mixed disulphide with L-cysteine from the L-cystine dimer; chelation permits it to bind metals such as copper; and superoxide scavenging makes it theoretically capable of influencing the inflammatory response of specific cell systems. Not surprising, D-penicillamine is of value in the treatment of cystinuria, Wilson's disease, juvenile rheumatism, rheumatoid arthritis and various other conditions.

Abnormalities, Drug-Induced↗

Gold therapy in the elderly rheumatoid arthritis patient.

Forty elderly (greater than or equal to 60 years old) and 101 young (less than 60 years old) rheumatoid arthritis patients receiving injectable gold therapy were followed prospectively between April 1971 and April 1982. The mean total gold compound received was 1,392 mg in the young group and 1,861 in the elderly group. Besides age, the only significant difference between the two groups was the increased gold compound received by the elderly. To determine efficacy and toxicity within and between certain age groups, the 141 patients were divided into 4 arbitrary age groups: group A (less than 30 years), group B (30-44 years), group C (45-59 years), and group D (greater than or equal to 60 years). The elderly responded to the gold therapy as well as the young patients did, at any time frame examined after 3 months of therapy. There was no difference in clinical benefit among groups A, B, C, and D. Nine patients in the elderly group and 15 in the young group had therapy discontinued because of no response. This difference was not significant among the groups A, B, C, and D. There was no difference in outcome of individual toxicity between the elderly and the young groups, and no difference in frequency of toxicity between the age groups A, B, C, and D. Serious hematologic toxicity occurred only in patients over 47 years of age, and nephrotic syndrome occurred only in patients over 52. In this study, gold therapy was found to be as clinically beneficial in the elderly as in the young patients, and the toxicity and drug failure rates were not significantly different.

Adolescent↗

Immunoregulation in rheumatoid arthritis: evaluation of T lymphocyte function in the control of polyclonal immunoglobulin synthesis in vitro.

Immunoglobulin production by peripheral blood B lymphocytes in cultures containing various combinations of B and T cells was studied by a reverse hemolytic plaque forming cell assay in 21 patients with definite rheumatoid arthritis (RA) and 26 normal controls. Responses were markedly enhanced in controls when T cells were irradiated at 3200 rads or T cells bearing Fc receptors for IgG were removed by rosetting prior to coculture with B cells, while no such responses were observed in rheumatoids. In allogeneic cultures and T depleted cultures supplemented by normal T replacing factors, RA B lymphocytes functioned normally. These data suggest that there is an abnormality in immunoregulation that exists at the level of the T cell and that the defect involves T helper cells and/or their interaction with B lymphocytes. An increase in the ratio of T helper:suppressor (OKT4:OKT5) cells due to a reduction in suppressor cells among active RA patients was observed but did not correlate with this defect that was independent of disease activity. These data imply that functional alterations exist in vitro in circulating helper T cells from RA peripheral blood.

Arthritis, Rheumatoid↗

Judging "current disease activity" in rheumatoid arthritis--an international comparison.

Judgments of "current disease activity" made on "paper patients" (patient data presented on simple forms) reflect those made when seeing the real patients on whom the "paper patients" are based (R = 0.853) and furthermore are highly reproducible (R = 0.952). Judgments made on the same "paper patients" in a rheumatology department in the UK and one in Canada also correlate highly (R = 0.860) and this may reflect a common experience in the type of patients seen. Such general similarities between centers justify comparisons of more detailed analysis of clinical judgment using "paper patients."

Arthritis, Rheumatoid↗

The WOMAC Knee and Hip Osteoarthritis Indices: development, validation, globalization and influence on the development of the AUSCAN Hand Osteoarthritis Indices.

Clinical measurement in both clinical research and clinical practice requires tools and techniques that are valid, reliable and responsive. Patient-centred self-reported measures provide opportunity to evaluate consequences of osteoarthritis, that are important and relevant to patients with the condition. The WOMAC and AUSCAN Indices are health status measurement questionnaires that are valid, reliable and responsive, easy to complete, simple to score and available in multiple language forms and scaling formats. They provide opportunities to capture patient relevant information, relating to the impact of interventions, in clinical research and clinical practice environments. WOMAC data have also contributed to the development of proposed definitions for responder criteria and state-attainment criteria in osteoarthritis.

Biomedical Research↗