Biomedical subjects
Publications and source records attributed to R G Mitchell.
Systemic mycosis due to Penicillium marneffei is described in a man infected with human immunodeficiency virus and who had travelled in S.W. China. He responded completely to treatment with amphotericin B and a prolonged course of ketoconazole. Problems of diagnosis are discussed and all previously reported cases reviewed.
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A latex agglutination test was compared with the micro-titration haemolysin inhibition method for the detection of anti-streptolysin O (ASO) antibodies in 428 serum samples. After slight modification of the latex method to produce maximal agglutination good agreement was shown between the results obtained by the two methods. The latex test had a sensitivity of 83.6%, a specificity of 93.3%, a predictive positive value of 86.5% and a predictive negative value of 91.6%. It was convenient, required less labour than the haemolysin test, and permitted economic testing of small numbers of sera.
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Sexual reproductive stages of fungi are very rarely found within mammalian tissues. We report here coexistence of cleistothecia associated with Emericella nidulans and its conidial state, Aspergillus nidulans, in a fungal mass which developed in a maxillary sinus.
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Legionella pneumophila serogroup 1 can be subgrouped by panels of monoclonal antibodies. The Oxford panel divides serogroup 1 strains into three major subgroups, provisionally named Pontiac, Olda and Bellingham. Strains causing outbreaks tend to be in the Pontiac subgroup, with strains from the other subgroups appearing also in sporadic cases. Isolates from sources in the UK unassociated with outbreaks are mainly the Olda and Bellingham strains; only 10% are Pontiac, yet this strain has caused 80 to 90% of the cases of Legionnaires' Disease so far studied. We compared our method with other methods of subgrouping serogroup 1 strains.
Great advances in perinatal care during the past two decades have been accompanied by reduced mortality rates in progressively lower birthweight groups. Continuing effort may be warranted by these improved results or by the need to preserve human life, yet rising costs in terms of disability, stress on parents and attendants, and financial resources raise questions about the value and justification of such effort. If rational policies are to be formulated for the future, accurate data based on planned population studies are essential. Perinatal care is only one of the determinants of outcome--environmental influences are also important and must be taken into account. Resources should be directed to improving the sociocultural environment as well as the standards of perinatal care.
Five cases of peritonitis occurred during continuous ambulatory peritoneal dialysis in which unusual yellow pigmented Gram negative bacteria were isolated in pure culture. Four of these isolates were identified as the so called "Agrobacterium yellow group." The remaining isolate was identified as Pseudomonas paucimobilis, an organism closely related to the Agrobacterium yellow group.
Meningitis due to Gemella haemolysans developed in a 73 year old woman after thermolysis of the Gasserian ganglion for trigeminal neuralgia. The taxonomy of this organism is discussed, and previous cases of infection are reviewed.
Pneumonia caused by Legionella bozemanii and acquired by a 75-year-old man while on holiday in Majorca is described. This appears to be the first report of such a case from Europe. Despite artificial ventilation and intravenous erythromycin the patient died. The causative organism was isolated from part of the lung obtained post mortem. Examination of a single sample of serum by means of an indirect immunofluorescence test gave a titre of 32 in respect of L. bozemanii antigen.
Complications of sinusitis caused by 'viridans' streptococci, mainly Streptococcus milleri, are described. The identification, bacteriology and pathogenicity of the organism are discussed and an approach to antimicrobial therapy outlined.
During 1980, 1153 employees attended the Occupational Health Department with back pain out of a working population of 13,958 in a car factory. Four hundred one were absent from work and a further 64 patients were restricted by back pain and unable to perform their normal work. One hundred forty-seven cases of back pain arose at work, and 71 in and around the home. All those who were absent or restricted were questioned about the onset of back pain in order to distinguish between accidental and nonaccidental injuries (NAI), and an accident model was used to structure the information. There were 122 accidents, 114 NAI, and 165 patients who could not attribute a cause to their back pain. A significantly higher proportion of the NAI arose at home and, conversely, a higher proportion of accidents occurred at work. Eighty (66%) of the accidents were underfoot accidents, including 57 slips. There were highly significant differences between the body movements contributing to accidents and NAI. Significantly more of the NAI than the accidents involved load handling, but 52% of the patients able to attribute a cause to their back pain were not moving loads. While handling of loads is important, attention should be directed to other contributory factors such as unsafe floor surfaces and bending and twisting movements--not only at work but also in and around the home.
Actinomyces odontolyticus was isolated from genital tract specimens from 4.8% of 561 women fitted with intrauterine contraceptive devices and from 4% of 101 women with pelvic inflammatory disease and 1.8% of 525 women without pelvic inflammatory disease who were not known to be intrauterine contraceptive device wearers. The strains were isolated by prolonged anaerobic incubation of blood agar, with or without added 5% metronidazole or 1% neomycin. A odontolyticus has not been previously reported in cervico-vaginal specimens, and possible reasons for this are discussed.
In William Harvey's day, Celtic civilization in Western Scotland was still flourishing and medical practice was ahead of that in other parts of Europe. Reasons are advanced for believing that Harvey knew more about this Celtic world than his biographers indicate. The opportunities he had for acquiring such knowledge are described.
The authors report a case of cerebellar pseudotumor caused by a Candida species without evidence of any underlying systemic disorder or extracranial disease. Total removal followed by treatment with amphotericin B resulted in a favorable outcome.