Showing papers by "Cyrus Cooper published in 1986"
TL;DR: A positive correlation was demonstrated between the weight to volume ratio of the ash and two radiological indices in the contralateral femoral neck: the Singh grade and the femoral calcar width, which will provide useful epidemiological tools for the measurement of bone mass in the proximal femur.
45 citations
TL;DR: The epiphyseal ossification centers of the distal femur (DFE) and proximal tibia (PTE) appear and enlarge during the third trimester of pregnancy, and the epiphysis of the proximal humerus (PHE) begins to ossify in some fetuses.
Abstract: The epiphyseal ossification centers of the distal femur (DFE) and proximal tibia (PTE) appear and enlarge during the third trimester of pregnancy. Late in the third trimester, the epiphysis of the proximal humerus (PHE) begins to ossify in some fetuses. Using the amniocentesis lung profile to determine the value of sonographic epiphyseal visualization as a predictor of pulmonary maturity, we studied 50 fetuses prospectively and compared the sonographic epiphyseal findings with results from the amniocentesis lung profiles. Nine fetuses with a visible PHE had a mature amniocentesis lung profile (accuracy of positive prediction = 100%), and then fetuses with an immature amniocentesis lung profile had no visible PHE (conegativity = 100%). Fetuses in which the combined DFE and PTE diameters were greater than 11 mm or in which the DFE and the PTE diameters were similar in size (DFE less than or equal to 1 mm larger than PTE) also yielded positive results. Copositivity and accuracy of prediction of an immature amniocentesis lung profile, on the other hand, were low (22%-25%) for the same epiphyseal parameters. These data suggest that antenatal visualization and measurement of the epiphyseal ossification centers of the fetal knee and shoulder may help to identify fetuses that would have a mature amniocentesis lung profile.
19 citations
TL;DR: Thyroid acropachy is a rare condition associated with pretibial myxoedema and exophthalmos, and the signs are finger and toe clubbing, and subcutaneous tissue swelling of the extremities, which are pale and firm with normal skin temperature; stiffness is the only symptom.
Abstract: and prominent hair follicles give a peau d'orange appearance. The patches vary in size and may extend from the skin on to the dorsum of the feet. There may be increased sweating or hypertrichosis over the lesion. There are three types: (1) sharply circumscribed with nodule formation; (2) diffuse, producing solid, non-pitting oedema; (3) elephantiasis form with oedema and nodule formation. The micropathology shows an atrophic epidermis with a flattened epidermal-dermal junction. The dermis is thickened due to an increase of mucopolysaccharide sixteen times normal, the bulk being hyaluronic acid. The latter causes the collagen to appear fragmented. The aetiology is still unclear, but antibodies from the class of thyroid-stimulating immunoglobulins (TSI) are involved. High serum levels of TSI are found which return to normal after successful treatment. Direct stimulation of receptors on the fibroblasts is thought to cause the production of mucopolysaccharide. Serum levels of antibody equal those in the dermis, which discounts local antibody formation. Treatment involves continuous application of concentrated steroid cream under an occlusive dressing for many months. Spontaneous remission occurs in 50% but regression may be very slow. Thyroid acropachy is a rare condition associated with pretibial myxoedema and exophthalmos. Its incidence is less than 1% and it occurs any time from weeks to over 25 years following the onset of hyperthyroidism, but more than 95% of patients develop it following treatment of thyrotoxicosis. The signs are finger and toe clubbing, and subcutaneous tissue swelling of the extremities, which are pale and firm with normal skin temperature; stiffness is the only symptom. The aetiology is thought to be similar to that in pretibial myxoedema, that is antibodies (TSI) act on the subcutaneous tissues and bones of the extremities; The -differential diagnosis is from hypertrophic pulmonary osteoarthropathy. On X-ray, spicules of new periosteal bone are seen affecting the metacarpals, classically the ulnar side of the fifth metacarpal and the radial side of the others. The proximal phalanges and the radial ends of the radius, ulna and distal phalanges may be affected. Bone scan shows areas of increased bone activity associated with radiological changes. There is no treatment available. Thyroid-stimulating immunoglobulin (TSI) is an IgG1. It mimics thyroid-stimulating hormone (TSH) by stimulating cyclic adenosine monophosphate production, radioactive iodine uptake and colloid droplet formation. TSI and TSH appear to compete for the same binding site on the TSH receptor. In patients with Graves' disease there are abnormalities in cell-mediated and humoral immunity. As these are controlled by T lymphocytes, it is possible that T cell control is malfunctioning. Normal control is made by suppressor T lymphocytes which suppress abnormal clones of T helper cells directed against self. In Graves' disease a randomly mutating clone of helper T cells directed against thyroid survives2, and these direct B cells to produce polyclonal thyroid autoantibodies (TSI). There is an HLA-DR3 association with Graves' diseaseand the class II major histocompatibility antigens encoded by genes in the HLA-D region are important in the presentationof antigens and regulation of immune response3. So it seems that a genetic predisposition is involved in the deficit in immune control. Endo et al.4 showed that TSI will bind to thyroid plus tissues outside the gland, e.g. fat cells. In this way various manifestations of an autoimmune reaction occur together, i.e. ophthalmopathy, pretibial myxoedema, thyroid acropachy. The explanation is that immune control affecting several clones of helper T-cells are made which cause antibodies (TSI) to be produced which each affect different tissues, i.e. eye, dermis, bones. Some recent work by Rennie et al.' has demonstrated invitro suppression of autoantibodies to thyroglobulin in Hashimoto's disease. Perhaps a similar technique could be developed to suppress the autoimmune mechanism in Graves' disease and so offer useful treatment of the signs described as an adjunct to surgery.
17 citations
TL;DR: A 35 year old woman had a six year history of SLE, which has been clinically quiescent since 1982, and presented with a one month history of spontaneous swelling in the left arm, which showed a case of rupture of a non-weight bearing tendon, namely the long head of biceps.
Abstract: SIR, We note with interest the report on spontaneous rupture of weight bearing tendons in systemic lupus erythematosus (SLE).' We report a case of rupture of a non-weight bearing tendon, namely the long head of biceps. A 35 year old woman had a six year history of SLE, which has been clinically quiescent since 1982. In January 1985 she sustained a fracture of the surgical neck of the left humerus with minimal displacement. This was treated conservatively, and she made an uneventful recovery. In August 1985 she presented with a one month history of spontaneous swelling in the left arm. Examination showed
5 citations