Biomedical subjects
Publications and source records attributed to P Merry.
Eosinophilic fasciitis (EF) is an uncommon condition which unlike systemic sclerosis has only rarely been associated with solid malignancies. We report the occurrence of EF in two sisters, both of whom developed contemporaneous breast cancer.
Twenty-one hospital consultants, representing 20% of the hospital specialists and 54 general practitioners representing 22% of the general practitioners in the Norwich Health District were circulated a questionnaire on the management of polymyalgia rheumatica and giant cell arteritis, as part of a departmental audit. The wide variations in the diagnosis and treatment of these two common conditions are shown in this study. Appropriate recommendations have been made for these two common conditions in the hope of providing a useful guideline for more uniform and effective therapy. We intend to repeat this study at a later date to assess if any of the recommendations have been undertaken successfully.
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OBJECTIVE: To assess the efficacy of single infusion of bisphosphonate AHPrPB (APD) (60 mg) in active Paget's disease of bone. METHODS: Twenty-six patients with symptomatic Paget's disease of bone were treated with a single infusion of APD (60 mg) over 12 h and were assessed for clinical as well as biochemical improvement for a mean period of 2 years. Treatments were repeated if relapse occurred during followup. RESULTS: Bone pain improved in 92% of patients within one month and over 76% of patients had no pain at 6 months. Serum alkaline phosphatase fell to normal level in 78% of patients at 6 months and about 77% at one year. Further treatment with intravenous (iv) APD (60 mg) was given for relapse in 7 patients at one year, 13 at 18 months and 2 at 24 months. CONCLUSION: Our prospective study demonstrates that 60 mg APD given iv is an effective, simple, safe and less expensive treatment for active Paget's disease of bone and this therapy may well be given in a daycare unit or an outpatient setting.
The Sigma Project, underway in a number of health care settings across Trent Regional Health Authority, is making dramatic productivity gains and improvements in the quality of care. The Project is being spearheaded by a number of Trust chief executives and unit general managers.
A patient with systemic lupus erythematosus and elevated cardiolipin antibody levels was given low-dose aspirin therapy prior to and throughout her third pregnancy to minimize the risk of miscarriage. She delivered a boy at 38 weeks with the skeletal deformity of two thoracic hemivertebrae. The putative role of aspirin causing this birth defect is discussed.
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Vascularity is said to be increased (subjectively) in rheumatoid arthritis, yet synovial fluid is hypoxic and acidotic. Morphometry by image analysis was used to quantify vascularity in normal and rheumatoid synovium from the knee joint. Capillaries were distributed more deeply in the rheumatoid synovium (93.3 microns, compared with 32.5 microns in normal synovium) and were significantly less densely arranged (80.2/mm2 rheumatoid, 241.5/mm2 normal). The blood volume fraction fell from 2.9% in normal knee synovium to 1.2% in rheumatoid synovium. These results imply that there is impairment of O2 transfer, which contributes to the intraarticular hypoxia, in rheumatoid arthritis.
We report two patients with contrasting patterns of retinal vascular occlusion associated with the primary anti-phospholipid antibody syndrome. The immuno-pathological features and clinical associations are discussed. This condition is of interest to ophthalmologists because of its association with thrombosis in the eye, brain and elsewhere and because it provides new insights into the pathogenesis of retinal vascular disease in young patients.
Previous work has established the existence of a pathophysiological environment within the inflamed human joint, capable of sustaining a hypoxic-reperfusion event. Using four different assay systems (two standard and two novel) applied to synovial fluid for the assessment of lipid peroxidation, a series of studies demonstrate that exercise of the inflamed human knee promotes radical-mediated lipid peroxidation within the joint. The implication for novel antioxidant therapeutic approaches to inflammatory joint disease is discussed.
A patient with polyarthritis had radiographs of the wrists taken at presentation and again at 6 months. At presentation radiographs were normal, but repeat X-rays at 6 months showed complete erosion of both ulnar styloid processes. This did not correlate with the clinical picture of a mild synovitis. A third X-ray showed normal wrists, revealing the cause to be a positional artefact during the X-ray procedure. Clinicians should be aware of this 'catch'.
It has been proposed that the process of hypoxic-reperfusion injury contributes to the persistence of synovitis in the inflamed human joint. The generation of pathological, exercise induced, intra-articular pressure leading to occlusion of the synovial microcirculation is central to this mechanism. However, acute traumatic inflammatory joint effusions rarely result in chronic synovitis, suggesting that either the basic hypothesis is incorrect, or that joints with acute traumatic effusions show different intra-articular pressure dynamics. In this study the intra-articular pressure was measured at rest and during isometric exercise in five patients with acute traumatic joint effusions and in nine patients with chronic inflammatory joint effusions. The generation of intra-articular pressure in the patients with acute traumatic effusions was significantly lower at rest (mean 2.0 v 19.6 mm Hg) and during exercise (mean 13.7 v 222.5 mm Hg) than in the patients with chronic effusions. This was due to reflex muscular inhibition around the joint, which inhibited the pathological generation of intra-articular pressure. This difference in the ability to generate intra-articular pressure might mitigate against hypoxic-reperfusion injury in joints with acute traumatic effusions, thereby explaining the paradoxical clinical observation that patients with acute traumatic inflammatory joint effusions rarely develop chronic synovitis.
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In summary, we support the hypothesis that the rheumatoid knee is subjected to repeated hypoxic reperfusion injury. Moreover, we speculate that oxidative damage induced as a consequence of hypoxic reperfusion injury leads to the synthesis of intracellular stress proteins. In certain individuals this triggers an autoimmune response which might explain the persistance of the rheumatoid disease process. This gives scope for novel therapeutic approaches in the future development of anti-inflammatory agents.
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