Biomedical subjects
Publications and source records attributed to N Kirkham.
Any patient claiming to have swallowed a bone and to have it stuck in his throat should be believed. The bone will probably not show in a lateral radiograph of the neck. The bone must be looked for and removed: otherwise the patient may die of septic complications.
Explore the source record for details and available documents.
The pursuit of more effective systemic treatments in breast cancer has been limited by a failure to maintain or grow tumour cells in vitro. This study reports our experience in obtaining clonogenic growth in 54 primary breast cancers obtained at mastectomy. Of 47 assays free of infection, clonogenic growth was achieved in 22 (41 per cent). Only 5 of 23 oestrogen receptor positive tumours grew compared to 14 of 21 oestrogen receptor negative tumours chi 2 = 9.03; P less than 0.01). None of the 5 cytosolic receptor positive tumours contained a nuclear receptor for oestrogen. Growth was not related to tumour stage, menopausal status, age or histological grade. Receptor negative tumours had higher thymidine labelling indices, but these were no different to the tumours grown in the assay.
The presence of focal collections of lymphocytes within the thyroid gland has been associated with autoimmune thyroiditis. In a prospective study 197 thyroid glands were examined from post mortems performed in two Southampton hospitals over a 12 month period. The mean thyroid mass was 19.5 g in women and 22.2 g in men. Varying degrees of focal lymphocytic thyroiditis were present in 54 per cent of women and 24 per cent of men. Morphometry showed that on average less than 4 per cent of the gland was infiltrated by lymphocytes. There was no significant relationship with age. A possible association between focal lymphocytic thyroiditis and circulating thyroid autoantibodies has been shown.
Epidermal and pilar cysts have been stained with anti-keratin antibodies raised from human hair and human callus. The staining properties of the two cysts are different and, in general, support the idea that they originate from epidermis and trichilemmal hair follicle layer respectively.
Colonic tumours were induced in Wistar rats using 12 consecutive subcutaneous injections of azoxymethane at a dose of 10 mg/kg/week. Pairs of rats were killed at five weekly intervals after initial injection until 25 weeks. Colonic mucosa was sampled from five standard areas along the length of the colon and examined by both scanning electron microscopy and conventional light microscopy. The crypt cell production rate was measured by stathmokinetic techniques. Scanning electron microscopy showed microadenomas as early as five weeks and consistently after 15 weeks. They were found predominantly in the distal colon and increased in size with time. The lesions showed a progressive increase in the number of crypts per adenoma and increasingly disorganised slit shaped crypt orifices. The presence of epithelial dysplasia in the microadenomas and of invasion of the colonic wall by carcinoma was confirmed histologically, although fewer lesions were identified in tissue sections than by scanning electron microscopy. Crypt cell production rate increased with time, particularly in the distal colon. This increase was significant between five and 25 weeks. The results of these observations suggest that there is an adenoma-carcinoma sequence in this animal model. The value of scanning electron microscopy in identifying and quantifying the mucosal changes during carcinogenesis is emphasised.
Explore the source record for details and available documents.
We report four cases of rectal spirochaetosis, one in an active male homosexual. One of the heterosexual patients was referred to the genitourinary clinic by a general surgeon after spirochaetes had been found on histopathological examination of a rectal biopsy specimen. We doubt that most of our cases represent sexual transmission of spirochaetosis, or that the condition causes disease in most people. Rectal spirochaetosis possibly occurs only when the normal flora of the gut are disturbed for other reasons. Most of our patients became asymptomatic after nonspecific treatment, although metronidazole appears to be specific.
Three cases are described of a primary cutaneous neoplasm occurring in elderly patients, histological and immunohistochemical features of which support an origin from Merkel cells. Microscopically sheets of uniform small cells filled the dermis, often with a prominent trabecular pattern. Ultrastructurally the cells showed neurosecretory granules, tangles of microfilaments, scattered mitochondria and occasional intranuclear rodlets. Immunohistochemical staining for neurone-specific enolase was positive and for prekeratin was negative in each case. The definitive diagnosis of Merkel cell tumour can be made with a combination of electron microscopy and immunohistochemistry.
Merkel cell carcinoma is a recently described tumour which may occur on the face of the elderly. We report such a lesion which presented as a cyst on the eyelid of an 88-year-old woman. This tumour differs from other tumours of the eyelids in its propensity for local and distant spread.
Previous studies of natural killer (NK) activity in the peripheral blood of breast cancer patients have failed to show a reduction in cytotoxicity, an observation at variance with results obtained in other malignancies. Interpretation of the data however is complicated by the presence of treated and post-mastectomy patients in the groups studied.In this study, lymphocytes from preoperative blood samples of untreated women with benign and malignant breast disease were tested at various effector-to-target ratios for cytotoxicity activity against the NK sensitive erythromyeloid cell line, K562.A significant reduction in NK activity was observed between carcinoma patients and the control group (P=0·02). When the carcinoma group was further divided into pre- and postmenopausal patients, the reduction was found to be a feature only of premenopausal women (P=0·002). The levels of NK activity in patients with benign breast disease were not significantly different from those in controls, irrespective of menstrual status. There was no correlation between NK activity and tumour size, oestrogen-receptor or lymph-node status in the carcinoma patients.A preliminary analysis of NK activities in the control group suggests that women donating blood in the first half of their menstrual cycle show significantly reduced NK activity in comparison with those in the second half (P=0·001). This finding, coupled with the variation in NK activity shown between pre- and postmenopausal breast carcinoma patients, suggests that hormonal effects in conjunction with malignancy determine the level of NK activity in breast cancer.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Myocardial infarction in the virtual absence of risk factors occurred in a 25-year old man shortly after smoking a cigarette containing marijuana. Subsequent coronary arteriography was normal.
The clinical features of four adult patients with Noonan's syndrome and cyanotic congenital heart disease are presented. These findings, together with those of previously reported cases, illustrate the wide spectrum of cardiac anomalies that may be associated with the multiple somatic abnormalities of Noonan's syndrome.
A patient in whom pulmonary arterial bleeding occurred during percutaneous supraclavicular puncture of the subclavian vein is described. A retrospective survey of over 600 subclavian venepunctures disclosed seven patients in whom serious traumatic complications occurred, six of them in the hands of inexperienced operators.
Explore the source record for details and available documents.
A patient, who underwent aortic valve replacement, developed a transient, autoimmune haemolytic anaemia in association with a significant rise in titre of antibodies against cytomegalovirus. A serological survey of blood donors indicated that the source of infection was fresh blood transfused during and shortly after surgery. A number of cases of short-lived haemolytic anaemia after large volume blood transfusion with cardiac surgery may be explained by this mechanism. It may be preferable to use only blood that has been screened for evidence of recent cytomegalovirus infection if post-perfusion complications of this disease are to be avoided.