Biomedical subjects
O J Corrado
Publications and source records attributed to O J Corrado.
Prevalence of Clostridium difficile on a mixed-function ward for the elderly.
We studied the prevalence of Clostridium difficile over a period of 2 months on a mixed-function geriatric ward. Seven (14%) of the 49 patients were long-stay but the remainder were in hospital for acute illness or required a short period of active rehabilitation. Although 69% patients had recently received antibiotics, from only two (4%) was C. difficile isolated from their faeces. Our results show that C. difficile is not endemic in patients on all geriatric wards as has been previously suggested.
A double-blind study of hyposensitization with an alginate-conjugated extract of Dermatophagoides pteronyssinus (Conjuvac) in patients with perennial rhinitis. II. Immunological aspects.
In a 2-year double-blind placebo controlled study an immunological evaluation was carried out on 33 patients (15 males, 18 females, mean age 29.2 years) with mite-induced perennial rhinitis who were submitted to specific immunotherapy (IT) with an alginate-conjugated extract of D. pteronyssinus. The behaviour of IgE, IgG, IgG1 and IgG4 antibodies specific to D. pteronyssinus and its major allergen Der p1 was characterized by assessment of their changes in serum, and changes in IgG in nasal secretions during the treatment. The placebo-treated patients did not show any significant variation in the levels of specific antibodies, while in the actively treated patients we found: a statistically significant decrease (P less than 0.005) of specific IgE, a statistically significant increase of specific IgG (P less than 0.005), IgG1 (P less than 0.005) and IgG4 (P less than 0.005) in serum and a statistically significant increase (P less than 0.001) of specific IgG in nasal secretions. The IgG response showed an early relative predominance of the IgG1 subclass and a late absolute predominance of IgG4 subclass, that confirmed the model of IgG4 restriction in prolonged allergen stimulation. No correlation was found between immunological and clinical data.
The prevalence of positive serological tests for syphilis among elderly hospital patients.
Serological tests for syphilis were performed on 659 elderly patients admitted to hospital medical and psychiatric departments. Positive tests were found in 23 patients (3.5% of the sample), 17 women and 6 men. Six were subsequently discovered to have been treated previously for syphilis, and one other had radiological evidence to suggest that she had been treated with bismuth in the pre-penicillin era. Difficulties were encountered in classifying the stage of infection in some patients, particularly those with significant intellectual impairment. Eleven were diagnosed as late latent syphilis, seven as probable late latent syphilis, one as tabes dorsalis, one as possible cardiovascular syphilis, one as possible meningovascular syphilis, and one as late congenital syphilis.
A double-blind study of hyposensitization with an alginate conjugated extract of D. pteronyssinus (Conjuvac) in patients with perennial rhinitis. 1. Clinical aspects.
The efficacy of hyposensitization with a standardised extract of Dermatophagoides pteronyssinus (D. pteronyssinus) conjugated to alginate and containing known amounts of antigen P1 (Conjuvac) was tested in a double blind, placebo controlled, multi-centre study in 66 adult patients with perennial rhinitis. Patients received 11 weekly injections of increasing concentrations of Conjuvac containing from 56 x 10(1) to 448 10(3) IU D. pteronyssinus or placebo injections of the alginate diluent to some of which 5 micrograms of histamine has been randomly added. This was followed by 15 monthly injections of Conjuvac or placebo. The severity of nasal blockage, sneezing and rhinorrhoea was recorded twice daily in a diary and visual analogue assessments (VAS) made at each clinic visit. Nasal provocation testing (NPT) was performed with increasing concentrations of the same extract of D. pteronyssinus as used in the hyposensitization injections, and changes in nasal airways resistance measured by passive anterior rhinomanometry. VAS was recorded and NPT was performed on entry to the study and after the fifth, ninth and final monthly injection. Conjuvac injections were well tolerated. Large local reactions (greater than 5 cm) occurred within 30 min in only 1% of patients but later in 23%. No systemic reactions or anaphylaxis occurred within 30 min of injections, but urticaria or worsening of asthma and rhinitis was reported later in 3% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Blood alcohol levels in acute elderly admissions to hospital.
Blood alcohol levels were estimated in 141 patients admitted acutely over a one month period to a geriatric unit. Only four (2.8%) had alcohol detectable in their blood. The levels were low, suggesting that alcohol intoxication is not a major factor in the admission of the elderly to hospital.
Gonadal dysgenesis: on mature reflection!
It is unusual for disorders of sexual differentiation to be first diagnosed in old age. We describe a case of 46XY pure gonadal dysgenesis, aged 93 years at the time of diagnosis, the oldest patient with this disorder ever reported.
The effect of nedocromil sodium on nasal provocation with allergen.
We have investigated the effect of nedocromil sodium in preventing the symptoms of rhinitis occurring immediately after allergen provocation in 10 patients with allergic rhinitis. The study had a double-blind, placebo-controlled, crossover design. Nedocromil sodium (1% w/v) and placebo were administered intranasally from identical metered-dose inhalers 20 minutes before allergen provocation. Three variables were measured: nasal airway resistance, the production of secretion, and the number of sneezes. Nedocromil sodium was significantly more effective than placebo in preventing nasal obstruction (p less than 0.01), rhinorrhea (p less than 0.01), and sneezing (p less than 0.05), suggesting that this drug may be useful in the treatment of allergic rhinitis.
Rectal necrosis after a phosphate enema.
We describe a patient who developed rectal ulceration after an apparently minor injury caused during the administration of a 130 ml 'disposable' phosphates enema. Treatment included parenteral antibiotics and a colostomy. Minor degrees of injury by rectal procedures are common. Rectal necrosis is a complication of injury during the administration of phosphates enemata which, although rare, deserves greater awareness. Painless rectal bleeding may be the only sign of injury and is an indication for thorough and repeated rectal examinations and early intervention.
Histamine and allergen induced changes in nasal airways resistance measured by anterior rhinomanometry: reproducibility of the technique and the effect of topically administered antihistaminic and anti-allergic drugs.
1. Changes in nasal airways resistance (NAR) following the topical application of histamine and allergen solutions were measured by passive anterior rhinomanometry. 2. The repeatability of five consecutive measurements of resting NAR prior to provocation with histamine or allergen (expressed as the coefficient of variation) was 32.8% and following instillation of saline control solution 37.2%. 3. The repeatability of five consecutive measurements of NAR during the nasal obstruction produced by histamine and allergen was similar to that recorded prior to provocation; the coefficients of variation (median values) being 39.6% and 33.1% respectively. The degree of variability was not related to the dose of agonist or the degree of nasal obstruction. 4. The reproducibility of histamine or allergen induced changes in NAR on four separate weekly occasions showed no significant intra-subject differences. 5. The effects of sodium cromoglycate (SCG), clemastine and ketotifen administered to the nasal mucosa 30 min before provocation with histamine and allergen were compared in a random order, double-blind, placebo controlled study. 6. Clemastine and SCG, but not ketotifen, significantly inhibited the nasal response to increasing concentrations of histamine. None of the drugs administered in the concentrations used in this study significantly inhibited the nasal response to allergen.
Amyloid (AL) in an octogenarian diagnosed by abdominal wall fat biopsy.
Systemic amyloid (AL) was diagnosed by abdominal wall fat biopsy in an 81 year old woman presenting with severe postural hypotension. The advantages of this little-used diagnostic method are discussed.
Histochemical and functional characteristics of the human nasal mast cell.
It is currently accepted that mast cell heterogeneity occurs not only in different species but also within the same organ in the same species. This study demonstrates that the majority of mast cells in the human nasal mucosa of non-atopic non-rhinitic subjects do not stain after fixation with 10% buffered formol saline and, although they stain with alcian blue, they do not counterstain with safranine O, indicating that nasal mast cells may contain a proteoglycan other than heparin. Further, mast cells in the nasal mucosa are essentially unaffected by the polyamine compound 48/80, indicating that they are functionally dissimilar to the connective tissue type mast cells exemplified by those present in the rat tongue.
Direct in vivo evidence for mast cell degranulation during allergen-induced reactions in man.
There is little or no direct in vivo evidence in man to support the involvement of mast cell-mediator release in the pathogenesis of immediate allergic reactions. We have performed a within-subject controlled study to determine the changes that occur in nasal mast cells during allergen-induced rhinitis. Twelve subjects with asymptomatic rhinitis were studied. Nasal biopsy specimens were obtained from each subject after a control solution (isotonic saline, 0.9% w/v) had been nebulized into one nostril and allergen solution (freeze-dried allergen extract reconstituted with isotonic saline) into the other. The tissues obtained were fixed in Carnoy's solution and stained with the alpha-naphthol AS-D chloroacetate esterase reaction (N AS-D CA ER). Mast cells were counted under light microscopy in the epithelium and lamina propria, and the integrity of each cell was assessed. No significant differences were found in the number of epithelial or lamina propria mast cells in biopsy specimens obtained after saline or allergen administration. However, the number of degranulated mast cells after allergen provocation (89%) was significantly greater than after instillation of control solution (15%) (p = 0.003). Changes of mast cell degranulation after allergen provocation were confirmed by electron microscopy. In six nonatopic, control subjects without rhinitis, there was no significant difference between the percentages of degranulated mast cells after allergen provocation (25.8%) and instillation of saline (24.3%). This study provides direct in vivo evidence for allergen-induced mast cell activation in man.
Nasal response of rhinitic and non-rhinitic subjects to histamine and methacholine: a comparative study.
The nasal responses to provocation with histamine and methacholine were compared in 20 subjects with and 20 without rhinitis. Two variables were measured: nasal airways resistance and the development of rhinorrhoea. Histamine had a greater effect than methacholine in increasing nasal airways resistance while the converse was true for rhinorrhoea. Rhinitic subjects had a significantly greater response to histamine induced changes in nasal airways resistance (p less than 0.05), rhinorrhoea (p less than 0.05) and methacholine induced rhinorrhoea (p less than 0.01) than those without rhinitis. No significant differences were found between the two groups in methacholine induced changes in nasal airways resistance. The findings show that, like the lower airways of patients with asthma, the nasal mucosa of rhinitic subjects shows a greater responsiveness to non-specific agonists than that of non-rhinitic subjects.
Asthma and rhinitis after exposure to glutaraldehyde in endoscopy units.
Four nurses working in endoscopy units complained of respiratory symptoms on exposure to alkaline glutaraldehyde used as a disinfectant for fibre-optic endoscopes. A provocation test was positive in two of these patients. This is the first report to use provocation testing to confirm a relation between exposure to alkaline glutaraldehyde and respiratory disease.