Biomedical subjects
Publications and source records attributed to P Atkinson.
Three cases of jaundice after ingestion of 3,4-methylenedioxymetamphetamine (MDMA), known as 'ecstasy', are reported and the complications associated with the misuse of this drug, which was initially misrepresented as 'safer than alcohol' are described. Ingestion of 'ecstasy' should be considered when investigating unexplained jaundice in younger patients.
Explore the source record for details and available documents.
Immunisation with the peripheral nerve myelin proteins P0 or P2 induces inflammatory neuropathy in animals. We sought antibodies with an ELISA to these proteins in 38 patients with acute Guillain-Barré syndrome (GBS), 32 patients with chronic idiopathic demyelinating polyradiculoneuropathy (CIDP), 31 patients with other neuropathies (ONP) and 26 normal control (NC) subjects. We discovered IgM antibodies to human P0 protein in the sera of 18.5% of the patients with GBS, 15.6% with CIDP, 6.4% with ONP and 3.8% of NC subjects. Of the sera which reacted with P0, sera from 4/7 of GBS, 3/5 of CIDP, 1/2 of ONP patients and 0/1 of NC subjects reacted with a synthetic P0 peptide representing residues 150-169 from the cytoplasmic portion of the molecule. IgG antibodies to P0 were slightly less common than IgM antibodies, being present in only 7.9% of GBS, 0% of CIDP and 3% of ONP patients and 0% of NC subjects. We found antibodies to bovine P2 protein more commonly than antibodies to P0. IgM antibodies were present in 39.5% of GBS, 34.4% of CIDP, 16.1% of ONP patients and 15.4% of NC subjects. IgG antibodies were present in 18.4% of GBS, 12.5% of CIDP, 3.2% of ONP patients and 7.6% of NCs. Of the sera which contained antibodies to P2 protein, only a few reacted with P2 peptides 14-25 or 58-81, but without any consistent pattern of reactivity.(ABSTRACT TRUNCATED AT 250 WORDS)
Seven cases of subacute idiopathic demyelinating polyradiculoneuropathy had a monophasic illness characterized by progressive weakness of all four limbs that evolved during 4 to 8 weeks. Neurophysiological investigations implied demyelination in all seven cases. In two patients, sural nerve biopsy specimens that were taken showed macrophage-associated demyelination. All patients made substantial or complete recoveries with oral prednisolone (four cases) or without treatment (three cases). None of the patients required ventilation or had autonomic complications. These cases provide a link between the acute idiopathic demyelinating form of Guillain-Barré syndrome and chronic idiopathic demyelinating polyradiculoneuropathy.
Glomus tumours are hamartomas derived from the normal glomus body. A total of 43 glomus tumours have been seen over the past 18 years, and are reviewed. Their clinical presentations and pathology are analysed and the continuing difficulty in diagnosis is examined.
T-cell infiltration was detected by immunohistochemistry in only 2 of 10 sural nerve biopsies from patients with Guillain-Barré syndrome (GBS). The number of endoneurial macrophages, identified by the monoclonal antibody MAC 387, was increased, compared with the number in 10 cases of axonal neuropathy. Macrophage-associated demyelination was identified in 7 and axonal degeneration in 8 cases. Cytomegalovirus (CMV) genome was not detected with the polymerase chain reaction.
The introduction of new GP contracts in April 1990 incorporated a financial incentive to undertake minor surgical procedures. Previous reports have noted large increases in the number of GP-derived skin specimens after April 1990. Our present study intended to address whether similar changes have occurred in Grampian Region as well as, more specifically, noting whether there have been changes in the quality of practice following the 1st April 1990. A retrospective study of skin biopsies removed by general practitioners in Grampian Region was undertaken. Cases were selected from four periods of six months (1st April to end of September) in 1987, 1988, 1989 and 1990. All skin specimens sent by general practitioners to the Department of Pathology, Aberdeen Royal Infirmary, were included. Following April 1990 there was a two-fold increase in skin specimen numbers--an increase significantly greater than increases observed over previous years (p < 0.01). Of particular note was the contribution made to this increase by Aberdeen City GPs whose contribution rose five-fold (p < 0.0001). Non-benign lesions (ie malignant plus carcinoma-in-situ-) represented 6% of lesions excised. A non-benign clinical diagnosis or an indication of suspicion was written on only one third of request forms for histopathologically diagnosed non-benign lesions. The proportion of histologically incompletely excised lesions rose over the four years (p < 0.01); moreover the increase in total numbers of lesions resulted in a striking increase in the actual numbers of incompletely excised lesions after April 1990.
Explore the source record for details and available documents.
The paper is based on qualitative research on the early experiences of student midwives in one school of midwifery. During their initial encounters the students go through a status passage from experienced nurse to novice midwife. Student diaries and ethnographic data were used to explore how students manage the transition and to document their coping strategies. In particular it is shown how, in response to the uncertainties of their new status, student midwives may revert to routinised nursing activities.
Explore the source record for details and available documents.
Species of three spider genera are known to cause dermonecrotic lesions in man. The incidence of necrotic araneism caused by species of these genera is a function of their behaviour and their geographical distribution in relation to areas of high human population density. Evidence based on an analysis of 39 diagnosed spider bites suggests that sac spiders (Chiracanthium sp.) are responsible for most spider bites, followed by violin spiders, Loxosceles sp.
A simple key that will enable the clinician to diagnose the culprit species in cases of spider bite in Africa south of the equator in the absence of the culprit is presented. Species of four spider genera are responsible for virtually all the cases of araneism requiring medical attention, viz. Latrodectus, Chiracanthium, Loxosceles and Sicarius. The signs and symptoms at various intervals following envenomation by these spiders are sufficiently distinctive to allow specific diagnosis in most cases. To make this more easily possible the signs and symptoms at various intervals after envenomation have been tabulated in the form of a diagnostic key.
Synthetic block copolymers composed of polyoxyethylene and poly-oxypropylene have been demonstrated to possess ionophore activity selective for monovalent cations and to cause histamine release from mouse mast cells and human basophils. We now report calcium-dependent release of granule contents from human neutrophils by the most active of these agents, TI30R2. At a concentration of 100 micrograms/ml (12.5 microM), net lysozyme release ranged from 17-40% after 30 minutes incubation at 37 degrees. Lysozyme release was dose-dependent over stimulus concentrations of 5-50 micrograms/ml (0.625-6.25 microM). Release was dependent upon the presence of extracellular calcium. T130R2 did not induce the release of superoxide anions over 30 minutes of incubation. As T130R2 induces sodium influx into cells, it is likely that a depolarizing influx of sodium ions in the presence of extracellular calcium constitutes a sufficient signal for granule release but not superoxide production by human neutrophils.
We examined platelet aggregability during nocturnal sleep and daytime wakefulness in patients with a history of sleep-related stroke onset (SOS) and compared it to that of matched awake-onset stroke (AOS) patients and controls without evidence of vascular disease. Aggregability was evaluated in-vitro at least seven weeks following stroke onset. Platelets were more aggregable to ADP, collagen and arachidonic acid (AA) during both sleep and wakefulness in patients with AOS (p less than 0.01). No significant difference in the mean aggregation thresholds during sleeping or waking periods were found between SOS and control groups. However, platelets were significantly more responsive to AA during sleep than during wakefulness in the SOS patients (p less than 0.01). This difference was confined to the subgroup of SOS patients who had experienced nocturnal as opposed to daytime sleep-related stroke onset, suggesting that the observed difference in platelet responsiveness to AA may be related to a circadian fluctuation in platelet aggregability rather than to a sleep-related fluctuation. Significant sleep-related changes in platelet aggregability were not identified in the other two groups.
Medically important spiders in southern Africa are discussed in terms of their morphological features and distribution, the signs and symptoms of envenomation and the possible treatment thereof. A simple pictorial key is provided to enable the non-specialist to identify the neurotoxic and cytotoxic species. The following spiders are now known to be medically important in southern Africa: Latrodectus indistinctus (neurotoxic), Chiracanthium lawrencei (cytotoxic), Loxosceles sp. (cytotoxic) and Sicarius sp. (cytotoxic - haemotoxic).
Platelet counts and mean platelet volume (MPV) were studied in 564 normal subjects and 297 pregnant women using a Coulter Model S-Plus electronic counter. The reproducibility of these measurements both intra- and inter-sample was documented. The mean platelet count in the normal group was 283 x 10(9)/l while the mean MPV was 9.32 fl. An inverse correlation between platelet volume and platelet number was documented (r = -0.38; P less than 0.0001). By interval analysis, this inverse relationship was shown to be non-linear. In the pregnant subjects there appeared to be a progressive decrease in platelet count with advancing gestation; this reached a significant level when the first and third trimesters were compared with each other (P less than 0.05). The MPV was unchanged. The fact that the platelet count decreased in proportion to the red cell count suggested that a common factor, such as haemodilution, was in part responsible. There was again an inverse relationship between MPV and platelet number (r = -0.39; P less than 0.0001) shown to be non-linear by interval analysis.
The relationship between mean platelet volume (MPV) and platelet count was evaluated in 259 patients with rheumatoid arthritis and 311 patients with various haematological disorders. Platelet volume-number relationships determined in a previous study on normal subjects were used as a reference range. There was a significant inverse relationship between MPV and platelet count in patients with rheumatoid arthritis (r = -0.49; P less than 0.0001), which by interval analysis was shown to be non-linear. In the patients with haematological disorders, the platelets were found to be disproportionately small for number in patients with aplastic anaemia, chemotherapy-induced marrow suppression and some cases of acute idiopathic thrombocytopenic purpura (ITP). In subjects with chronic ITP followed longitudinally, the inverse platelet volume-number relationship was retained. MPV was appropriate for platelet number in myelodysplastic syndromes, variable in iron deficiency anaemia and disproportionately large in myeloproliferative syndromes, most notably in agnogenic myeloid metaplasia. The observation that the MPV was disproportionately large in comparison with the platelet count was used in establishing the diagnosis of an hereditary giant platelet syndrome in a family of British origin.
Cyclic antidepressants can produce cardiac complications in patients with certain types of cardiac conduction abnormalities. Most cyclic antidepressants have a quinidinelike effect on the heart, which, in combination with Type I antiarrhythmic agents such as quinidine, disopyramide and procainamide, may induce heart block and potentially lethal arrhythmias in susceptible individuals. Patients with known cardiovascular disease warrant careful evaluation before tricyclic therapy is initiated. Guidelines are presented for identifying high-risk patients and for using cyclic antidepressants in patients with cardiac conduction abnormalities.