Showing papers by "St Thomas' Hospital published in 1970"

Lymphangioma of skin. A review of 65 cases.

Abstract: SUMMARY Sixty-five cases of lymphangiomata involving skin or mucous membrane have been reviewed and found on clinical and histological grounds to fall into 3 groups. “Classical” lesions of lymphangioma circumscriptum were often extensive, had a predilection for certain areas and were usually present at birth or appeared in early life. Small “localized” lesions had no particular sites of predilection and could appear for the first time at any age. A small number of lesions with a characteristic sponge-like histological appearance were found in areas where skin or mucous membrane was interwoven with striated muscle. A review of the results of surgery in these patients showed recurrence to be unusual after excision of “localized” lesions but to be common when an attempt was made to excise lesions of the “classical” type.

Current causes of fixed drug eruptions.

Abstract: SUMMARY In a study of 44 patients with fixed drug eruptions presenting between 1964 and 1969 (inclusive), the commonest causes were found to be barbiturates, phenolphthalein, oxyphenbutazone, tetracyclines, chlordiazepoxide and acetylsalicylate. Fixed drug eruptions due to oxyphenbutazone, chlordiazepoxide and isoaminile citrate seem not to have been reported previously.

Evaluation of Pulmonary Arterial End-Diastolic Pressure as an Indirect Estimate of Left Atrial Mean Pressure

Abstract: Simultaneously recorded values for mean left atrial pressure (LAMP) and end-diastolic pulmonary arterial pressure (PAEDP) were compared in 28 patients with acute or chronic cardiac disease. Atrial pressure was varied by alterations in blood volume or the administration of inotropic agents. One hundred twenty paired values were divided into three groups according to the pulmonary vascular resistance which was calculated on each occasion. Although LAMP and PAEDP were shown to correlate significantly at all levels of pulmonary vascular resistance, worthwhile estimates of LAMP could only be obtained from PAEDP when the pulmonary vascular resistance was normal.

The viscosity of bronchial secretion.

Abstract: 1. The viscosity of sputum in patients with chronic bronchitis has been measured with the Weissenberg rheogoniometer, a cone and plate system, using oscillatory movement at low shear rates. 2. A characteristic pattern is described not previously reported for sputum or any other biological fluid. 3. Sputum viscosity decreased steadily with increasing shear rate; over a narrow range of shear rates a ‘notched plateau’ was shown. The destruction of this plateau by higher frequencies of oscillation was attributed to breakdown or rearrangement of the gel structure. 4. The effects of time on viscosity measurement, presumably caused by drying, are also described.

Anaemia in dermatitis herpetiformis. The role of dapsone-induced haemolysis and malabsorption.

Abstract: Summary— Forty-three patients being treated with dapsone for dermatitis herpetiformis were studied to determine the prevalence and mechanisms of anaemia in this condition. Anaemia was more common than in a comparable normal control group although it was usually mild. Most patients had evidence of drug-induced haemolysis which was dose related and this was the most important cause for anaemia. Malabsorption did not seem to be a significant factor in the development of anaemia. The incidence of iron deficiency was no greater than in the controls, despite urinary iron loss. Five patients had low levels of serum B12, of whom 3 had pernicious anaemia. The incidence of low serum folate levels was less than that found by other workers although serial estimations revealed considerable fluctuations. The possibility that patients with dermatitis herpetiformis are more susceptible to the haemolytic effects of dapsone and the possible effects of dapsone on oxygen transport are discussed.

The Influence of Atrial Pressure on Cardiac Performance Following Myocardial Infarction Complicated by Shock

Abstract: Performance curves for both sides of the heart were derived in six patients with acute myocardial infarction complicated by cardiogenic shock. Stroke index and right and left ventricular stroke work index were related to mean atrial pressures which were lowered by venesection. Values for cardiac index, stroke index, and stroke work index were all low, and little change occurred with alterations in atrial pressures. The relationship of right and left atrial pressures to the genesis of pulmonary edema is discussed, and the effects of isoproterenol (isoprenaline) are described.

Flocculation of influenza virus by specific anti-neuraminidase antibody.

Abstract: 1. Flocculation of purified preparations of influenza virus has been demonstrated to occur in the presence of low dilutions of specific anti-neuraminidase sera. High dilutions of the sera caused microscopic aggregation of virions. It is suggested that the effects of anti-neuraminidase antibody on the replication of influenza virus observedin vitro could be caused by antibody binding virions to infected cells, rather than by inhibition of neuraminidase enzymic activity. 2. On examination in the electron microscope of virus floccules obtained with specific anti-neuraminidase sera, surface spikes were clearly seen on the virions. However, when influenza virus was similarly flocculated by serum containing antibodies that inhibited both haemagglutination and neuraminidase activities, the ends of the spikes were almost all completely obscured. 3. Measurement of the Michaelis constant (Km) of X-7 (F1) neuraminidase shows that the enzyme active site is related to that of A2/Singapore/57 neuraminidase.

Effect of x-radiation on salivary gland growth in the rat. II. Quantitative studies of sialadenotrophism induced with isopropylnoradrenaline and its modification by single doses of x-rays.

Abstract: SummaryQuantitative and histometric characteristics of sialadenotrophism induced in rats with isopropylnoradrenaline (ISOP) are described, with particular reference to rates of gland growth, rates of cell enlargement and cell proliferation in the submandibular (SM) salivary gland, and effects of ISOP on body-growth and heart weight. Glandular enlargement is principally due to hypertrophy (auxetic growth) and hyperplasia (replicative growth) of serous acinar salivary cells. Local irradiation of salivary tissues of rats before administration of ISOP caused a dose-dependent reduction of sialadenotrophism, 800 rads reducing gland growth by ∼ = 50 per cent. Histometric and autoradiographic studies showed that irradiation reduced growth by inhibiting cell replication, auxetic cell growth being radio-resistant. Cardiomegaly produced by ISOP in rats was also radioresistant. X-radiation inhibits adaptive growth of SM and parotid glands to a similar degree, but dose–effect curves differ, and the reasons for this ar...

In vitro studies of red cell metabolism in haemoglobin H disease.

Abstract: Summary. A study has been made of glycolysis and some membrane abnormalities in the red cells of six patients with haemoglobin H disease. Haemoglobin H has been shown to be thermolabile and this property was used to determine the amount present in blood samples. Fresh red cells have increased anaerobic glycolysis and hexose monophosphate pathway activity in accord with the low MCHC of the cells and the young red cell population present in blood samples. However, red cell ATP was low in three of four patients studied and GSH was low in four of six patients. Red cell phospholipid was abnormally high in the four patients studied. Following incubation in vitro, red cell phospholipid, AChE activity, ATP and GSH decreased in an abnormal manner not attributable to the abnormal degree of lysis that occurred. Studies with young and old red cell fractions indicated that whilst GSH was significantly low in older cells hexose monophosphate pathway activity tended to be high. The significance of these results is discussed

Ferrokinetic abnormalities and their significance in patients with sideroblastic anaemia.

Abstract: Summary. A study of 10 patients with primary acquired sideroblastic anaemia demonstrates a link between the ferrokinetic abnormalities, the clinical severity and the distribution of storage iron between the labile and the fixed stores. There appears to be a progressive change from an initial mild impairment of haemoglobin synthesis, through a phase of ineffective erythropoeisis and partial erythropoietic failure, to a final stage of complete erythropoietic failure. This progress is associated initially with an increased iron content of the labile store but in the later stages with transfer of iron to the fixed, non-chelatable store. The change from the early Type I phase to the late Type III phase is associated with clinical deterioration and increasing transfusion requirements which are predominantly responsible for an increased iron load which is a feature of this stage of the disease.

The resistance of a lymph node to lymph flow.

Abstract: The relationship between lymph flow, lymph node arterial and venous perfusion pressure and lymph node resistance have been studied in an in vivo isolated canine iliac lymph node perfused through an afferent lymphatic with heparinized canine plasma. The relationship between the rate of perfusion and perfusion pressure across the node was linear but the calculated resistance of the node decreased as the rate of perfusion increased. In nine dogs the mean resistance to lymph flows less than 0.1 ml/min was 180 mmHg/ml min, but 68 mmHg/ml min to rates of perfusion above 1.0 ml/min. An increase of venous pressure in the veins draining the node increased the node's resistance by 8.6 mmHg/ml min for each 10 mmHg increase of venous pressure. The effect on node resistance of an increase of venous pressure was greater at low rates of perfusion. A decrease of arterial pressure in the arteries supplying the node reduced the node's resistance by 2 mmHg/ml min for each 10 mmHg decrease of arterial pressure. Increases of arterial pressure had an opposite effect of a similar magnitude. The effect on node resistance of a change of arterial pressure in either direction was greater at low rates of perfusion.

Correlation Between Psychic and Endocrinological Responses to Emotional Stress

Abstract: Publisher Summary It is questionable which are the best indices of emotional response and whether work that employs one parameter can be compared with studies using a different parameter. In the experiment described in the chapter, several parameters were used, such as plasma 1,1-hydroxycorticosteroid concentrations, blood pressure, pulse rate, and urinary catecholamine excretion rates. The intercorrelations between those parameters were investigated. The volunteers used in the present experiments were male medical students, aged about 20 years, taking the second M.B. anatomy oral examination. A university oral examination is suitable for the investigation of the effects of stress because it is a realistic situation in which the subject's future is involved. There is a highly significant increase in pulse rate, blood pressure, plasma 1,1-hydroxycorticosteroids, and urinary adrenaline and noradrenaline excretion. The degree of concordance among these various parameters is low and there are several possible explanations for this. A physique with a high muscular component appears to be associated with a smaller plasma 1,1-hydroxycorticosteroid rise and a greater noradrenaline excretion rate in response to emotional stress than those with a different kind of body build. The mechanisms responsible for these particular associations between body build and the degree of plasma 1,1-hydroxy- corticosteroid and urinary noradrenaline responses to stress have not been evaluated.

The action of locally applied barbiturates on skin oxygen tension and rate of oxygen utilization.

Abstract: SUMMARY.— Barbiturate solutions were applied to skin after removal of the stratum corneum with Sellotape, and skin surface oxygen tension was measured polarographically. These produced a rise in surface oxygen tension of 30–50 mm. Hg. The rate at which surface oxygen tension fell following arterial occlusion gave a measure of the rate of skin oxygen utilization. This was reduced by a factor which could be as large as 8 after application of barbiturate solutions. It is shown that both epidermal and dermal oxygen utilization rates are reduced, and their return to normal depends on skin blood flow.

Determination of Calcium in Plasma; A Review of Some Modern Methods

Abstract: The requirements for the satisfactory analysis of calcium in serum or plasma are probably more stringent than for any other substance regularly measured. There are three main reasons for this:1. The normal range is narrow: there is fairly general agreement on a range close to 8.9-10.3 mg/loo ml, although small differences may be caused by different methods of analysis or sample preparation (see Table 1). It has been suggested that analytical error should not exceed 45% (Gowenlock, 1969) or 20-33 % (Zwart Voorspuij and van der Slik,1964) of the standard deviation of the biological variation. On this basis, the standard deviation for analytical error should be not more than 0.10.15 mg/loo m!. 2. Deviations as little as 2-5 % above the normal range may be all that occur in hyperparathyroidism (Pyrah et al., 1966) and if this diagnosis is not to be missed in its early stages, the analyst must be confident that such differences can be measured reliably. 3. In many patients, a definite clinical diagnosis is difficult or impossible, and serious forms of treatment, such as surgical exploration of the neck, may depend primarily on the measurement of plasma calcium. Fortunately several good methods for measuring calcium in plasma have been described but none is ideal or has yet established itself as the reference method.

Effect of Brief Hypercalcaemia on Free Water Reabsorption during Solute Diuresis: Evidence for Impairment of Sodium Transport in Henle's Loop

Abstract: 1. The relationship between osmolal clearance (C osm ) and the reabsorption of solute free water ( T c h 2 o) was examined during mannitol and hypertonic saline diureses in both normocalcaemic and hypercalcaemic rabbits. 2. At high values for C osm (2–4 ml/min) in normocalcaemic rabbits T c h 2 o during saline diuresis exceeded that during mannitol diuresis as previously shown. 3. Prolonged hypercalcaemia (72–96 h) reduced T c h 2 o in both mannitol and saline diureses. 4. Brief hypercalcaemia (18–24 h) abolished the increment in T c h 2 o normally seen during saline, as compared with mannitol diuresis. This impairment of T c h 2 o during saline diuresis occurred at a time after the start of hypercalcaemia when T c h 2 o during mannitol diuresis was still unaffected. 5. The results cannot be attributed to an effect of hypercalcaemia on membrane permeability to water, and are best explained by a reversible limitation of sodium transport in Henle9s loop. This interpretation is supported by the fact that the hypercalcaemic rabbits excreted a greater percentage of the filtered sodium load than did the controls.

Effect of vasopressin on the renal excretion of phosphate in man.

Abstract: 1. The effect of vasopressin on the tubular reabsorption of phosphate was studied in both water-restricted and water-loaded man at different baseline rates of phosphate excretion. The latter was varied by altering phosphate intake or by administering aluminium hydroxide to reduce phosphate absorption from the gut. 2. It was found that when phosphate excretion was high, vasopressin had no consistent effect on the phosphate/creatinine clearance ratio. However at low rates of phosphate excretion, vasopressin significantly increased the phosphate/creatinine clearance ratio, suggesting a decrease in net tubular reabsorption of phosphate. 3. This effect of vasopressin was also demonstrated in a patient with hypoparathyroidism, indicating that it is not mediated by release of parathormone. 4. It thus appears that vasopressin has a small parathormone-like effect on the renal tubules, which may result from the common action of both hormones on the adenyl cyclase system.

Continuous monitoring of blood sugar in brittle diabetics.

Abstract: The blood glucose was measured continuously for periods of up to twenty-nine hours in five patients. The method, which does not require heparinization of the patient, is described. — Three unstable diabetics were investigated. In two, diabetic control was considerably improved as a result of alterations made to their therapeutic regime following this investigation. The symptoms of the third diabetic patient were due to complications of diabetes rather than to the disease itself. — The results in these three patients are contrasted with those obtained in two acromegalics (one of whom was also diabetic). Attention is drawn to the occurrence of fasting hyperglycaemia in the early hours of the morning in the brittle diabetics and to the rapidity with which the blood glucose rises. It is thought that growth hormone is not directly responsible for this hyperglycaemia, since marked insulin sensitivity is maintained.

Fixed drug eruption due to cyclizine.

Abstract: SUMMARY.— A case is reported of a fixed drug eruption due to cyclizine which had been taken for the prevention of travel sickness.

Excretion of endogenous non-haem iron by the gastrointestinal tract in human subjects and its influence on the size of body store of iron with particular reference to coeliac disease.

Abstract: The present study demonstrates that there is continuous loss of endogenous non-haem iron by the gastrointestinal tract in man, and underlines its importance in patients with coeliac disease and in those with iron overload. The findings suggest that this loss occurs mainly as a result of desquamation of villous epithelium. The faecal loss of endogenous non-haem iron is markedly increased in patients with coeliac disease in whom the cell turnover of the small intestinal mucosa is increased and it seems that it could be mainly responsible for the causation of iron deficiency amongst a considerable number of these patients. In subjects with normal mucosal structure of the small intestine this loss increases progressively with iron load at high levels of labile iron store and thus reduces the total iron store in the body.

Brain dmage in rats following pentylenetetrazole and high pressure oxygen.

Abstract: La pentylenetetrazole (PTZ) et l'oxygene a haute pression (OHP) ont des proprietes en commun; tous deux causent des convulsions et du dommage aux poumons chez les rats. Elles different en ce que l'OHP — mais non pas la PTZ — produit au cerveau une paralysie spastique. On a trouve que la PTZ, donnee avant et non pas apres l'exposition des rats a l'OHP, reduit la paralysie du cerveau.

Infectious mononucleosis: recent developments.

Abstract: Infectious mononucleosis (IM) remains one of the few common infectious diseases in which the causative agent has yet to be conclusively identified. Although infections caused by such agents as cytomegalovirus, adenoviruses and toxoplasma gondii may occasionally produce an IM-like syndrome, infections by these organisms do not result in the development of heterophile antibodies. However, recent studies precipitated by a chance observation now indicate that a member of the herpes group of viruses, the Epstein-Barr (EB) virus, is closely associated with IM, although it is as yet not possible to determine conclusively whether it is its cause. The EB virus was first detected by Epstein et al (1965) in continuous lymphoblastic cell cultures originally derived from a child with Burkitt’s East African lymphoma, a malignant tumour involving lymphoid tissue, mostly affecting children and occurring in East Africa and other tropical areas including the West Indies, New Guinea and parts of South America. The presence of this virus was soon confirmed in numerous cell cultures derived from these tumours, but although this virus possessed the morphological characteristics of a virus belonging to the herpes group (Fig I) it was shown to be antigenically unrelated to other herpes viruses which infect both man (e.g. herpes simplex, varicella/zoster, cytomegalovirus) and other animals (Henle & Henle, 1966a, b; Epstein & Achong, 1968). These findings were of considerable importance since Burkitt had previously postulated on epidemiological grounds that these tumours might perhaps be caused by a vector-borne transmissible agent (Burkitt, 1962; Haddow, 1963). Serological studies subsequently showed that all children with Burkitt’s lymphoma had antibody to the EB virus, usually at a high titre (e.g. I~o), but that approximately 50% of apparently healthy matched controls also possessed antibody, although mostly at much lower titres (Levy & Henle, 1966). In the U.S.A., where Burkitt’s tumour is excessively rare, antibody to EB virus was also somewhat surprisingly commonly encountered, being acquired at a similar age as antibodies to such other commonly encountered childhood virus infections as measles, mumps and polio in the pre-vaccination era (Henle & Henle, 1967). Thus, amongst a relatively low socio-economic group in Philadelphia, 80% of adults and 50% of children aged 2-4 were already seropositive. Further studies revealed that leucocytes from patients with Burkitt’s lymphoma would proliferate to form continuous lymphoblastic cell cultures and that EB virus could be detected in them. However, similar findings were reported in patients with various forms of leukaemia, as well as in cultures derived from some apparently healthy persons. Thus the EB virus, or one closely related to it, was shown to be a commonly encountered infectious agent, but apart from its possible link with Burkitt‘s lymphoma, until z years ago the virus was in search of a clinical syndrome with which it could be related. However, in 1967 a technician in Dr Henle’s laboratory in Philadelphia developed heterophile-antibody-positive IM. It had previously been shown that her serum was devoid of antibodies to EB virus and in addition attempts to culture her leucocytes had been unsuccessful. Following her illness, not only did she develop EB virus antibodies but it became possible to

Measurement of Periodicity in 32 P Concentration in Breast Tumors with an Automated Integral Counting Technique

Abstract: Radioactive phosphorus 32 P has been used extensively in the assessment of cellular activity. By using mica end-window geiger tubes in contact with surface breast tumors, circadian fluctuations of the 32 P content of breast tumors have been demonstrated in vivo. This paper describes the equipment used and summarizes the results obtained.