Showing papers by "St Thomas' Hospital published in 1974"

Preparation of human placental villous surface membrane

Abstract: THERE is currently considerable interest in the mechanism of protection of the foetus against rejection by the mother1. Various theories have been put forward to explain this phenomenon, including the existence of an immunologically inert barrier between mother and foetus2, and a reduction of immunological reactivity of the mother during pregnancy3. A further possibility is that a hormone such as progesterone binds to the external villous surface of the placenta and masks its antigenicity.

The pathology of lymphangioma circumscriptum.

Abstract: A study of lymphangioma circumscriptum has been carried out over a number of years in an attempt to understand its nature and pathogenesis, with a view to improving treatment. It is postulated that the lesion consists essentially of a collection of large muscular-coated lymphatic cisterns, lying deep in the subcutaneous plane and communicating via dilated dermal lymphatics with the superficial vesicles. It seems that these cisterns do not communicate directly, if at all, with the general lymphatic system but represent a sequestrated part of it. They have been shown by cannulation to pulsate at a slow steady rate producing a rise and fall of pressure within them. It is believed that the vesicles are saccular dilatations of superficial lymphatics, secondary to raised pressure transmitted from the pulsating cisterns beneath. It is suggested that may be possible to treat these lesions more successfully and with better cosmetic results by excising the subcutaneous cisterns and leaving the overlying skin intact.

Anomalous origin of the left circumflex coronary artery. Recognition, antiographic demonstration and clinical significance.

Abstract: Anomalous origin of the circumflex coronary artery from the proximal right coronary artery or right sinus of Valsalva was recognized in 20 of 2996 patients undergoing selective coronary arteriography (0.67%). The relative frequency of this anomaly demands a high level of anticipation during the performance of selective coronary arteriography to assure that an adequate study has been obtained. Failure to recognize and properly demonstrate the anomaly can be hazardous to patient management. Two angiographic signs have proved reliable in recognizing the anomalous artery before its selective demonstration. These signs are a profile view of the artery behind the aortic root during left ventriculography (the "aortic root sign") and recognition of absent arterial inflow to a significant area of the posterior lateral left ventricle during selective injections of the main left coronary artery (the "sign of non-perfused myocardium"). These angiographic signs are described and the clinical implications of proper dem...

The effects of inhaled beclomethasone dipropionate (Becotide) and sodium cromoglycate on asthmatic reactions to provocation tests

Abstract: Summary A comparison was made between the effects of prior inhalation of sodium cromogly-cate or beclomethasone dipropionate on immediate, late and dual asthmatic reactions to provocation challenge tests with a range of allergens. Whereas sodium cromoglycate inhibited immediate and dual asthmatic reactions, beclomethasone dipropionate had no effect on immediate asthmatic reactions, but consistently inhibited late asthmatic reactions.

Asthma due to inhaled chemical agents: ampicillin, benzyl penicillin, 6 amino penicillanic acid and related substances.

Abstract: Summary Three out of four workers from an antibiotic-producing factory developed late asthma and eosinophilia on inhalation challenge testing with ampicillin and related substances. The chemicals to which each worker reacted varied, suggesting differences in the clinically important allergens for each individual. The taking by mouth of ampicillin in one patient, and benzyl penicillin in another in therapeutic doses led to the development of late asthma accompanied by skin and gastro-intestinal disturbances. The inhalation of 200 μg of beclomethasone dipropionate before in one case, and before and 3-hourly after provocation challenge in the other, blocked the late asthmatic reaction. 40 mg sodium cromoglycate similarly given failed to inhibit the reactions. In one patient, 04416–0.24 mg of isoprenaline sulphate inhaled 10 min before or 60 min after inhalation testing prevented the development of late asthma, and when given during the asthmatic reaction led to its rapid reversal.

Hodgkin's disease involving Waldeyer's lymphoid ring

Abstract: Sixteen patients with Hodgkin's disease involving parts of Waldeyer's lymphoid ring are presented. In four of the cases in which the tonsil was affected, a granulomatous pattern of histologic change was present; this form of the Hodgkin's lesion was also present in the cervical lymph nodes of these cases. The presence of Waldeyer's ring involvement did not seem to affect the natural history of the disease process. A review of the literature citing this rare manifestation of Hodgkin's disease is given. Reasons are suggested, based on modern concepts of the pathogenesis of Hodgkin's disease, for the infrequent involvement of Waldeyer's ring.

Effects of X-radiation on Growth and Function of the Repair Blastema (Granulation Tissue): II. Measurements of Angiogenesis in the Selye Pouch in the Rat

Abstract: SummaryThe Selye pouch technique has been used to stimulate growth of the repair blastema and angiogenesis and measure radiosensitivity of capillary blood vessels in the subcutis. Measurements of radiation damage to the tissue were based on (i) weight per unit area and corresponding DNA content of the repair blastema, (ii) the volume of blood produced in the pouch by angiogenesis and (iii) vascular macrocolony counts. Colony counts gave a D0 value of ∼240 rads for single-dose and ∼180 rads recovery for split-dose irradiation. No significant difference was observed for single doses of irradiation given shortly before or after raising the pouches. Increasing the interval between irradiation of intact skin and raising of the pouch, was associated with rapid and marked repair of radiation damage; a delay of 2–3 weeks resulted in a dose-reduction factor of 500–625 rads for single doses of 1500–1800 rads given to intact skin. Local irradiation of an established pouch with a single large dose (2–4 krads) rapidly...

Pulmonary veno-occlusion—an complex disease?

Abstract: A case of pulmonary hypertension due to veno-occlusive disease is described. The patient was a 33 year old woman who died 11 months after first complaining of breathlessness. Veno-occlusive disease was diagnosed on lung biopsy and confirmed post-mortem. Electron microscopy of the lung biopsy showed electron-dense deposits in the capillary basement membranes, and immunoglobulin and complement were demonstrated in a corresponding position by immunofluorescent microscopy. It is suggested that immune complexes may have initiated thrombotic occlusion of the small pulmonary veins.

The progression of arteriosclerosis. A radiological study.

Abstract: This paper reports the results of a study made on 25 patients who have had two or more translumbar aortograms at intervals varying from one to four years. A technique was devised for the measurement of the diameter of the vessels from the radiographs and the type of atherosclerosis was also classified. The arterial tree, from the lower abdominal aorta to the division of the popliteal artery, was divided into nine anatomical segments. A total of 324 segments were studied. The results show that atherosclerosis must not be assumed to be a progressive and exclusively stenotic disease. In 30% the aorta and common iliac arteries became wider and in another third they showed no change. Fifty percent of the ilio-femoral segments became longer and most of these also became wider, which suggests that a considerable proportion of patients will ultimately develop arteriomegaly. In the superficial femoral arteries 50% of the cases developed further narrowing. Short narrow segments did not all progress to occlusion — 40% of the short stenoses in the aorta and iliac arteries became 2 to 5% wider. Long narrow segments more often became occluded, especially in the superficial femoral artery. It is concluded that arteriosclerotic degeneration is just as often a disease of dilatation as narrowing and that the only way to obtain evidence upon which to base a long-term prognosis is to repeat arteriograms over a period of years.

28) Pyoderma gangrenosum treated with azathioprine and prednisolone

Abstract: F.S., male, aged 52 years. History. The patient developed pyoderma gangrenosum 6 weeks after prostatectomy in October 1972 for prostatitis which had led to retention of urine. Lesions developed in the suprapubic abdominal wound and numerous ulcers appeared on the legs and trunk with sparing of the arms and face. On examination. Lesions began as a pustule and enlarged peripherally, becoming a heaped up ulcer discharging copiously from a cribriform base (Fig. i). There was moderate discomfort. General examination was within normal limits. Investigations. Skin biopsy from a thigh lesion confirmed the clinical diagnosis. The lesions were bacteriologically sterile. Full investigation failed to show any evidence of ulcerative colitis, Crohn's

Cell sodium, potassium and water in uraemia and the effects of regular dialysis as studied in the leucocyte

Abstract: 1. The leucocyte has been used as a model for the study of intracellular sodium, potassium and water in uraemia. The advantages of this cell are described. 2. In undialysed patients with advanced renal failure leucocyte sodium and water contents were significantly greater than normal. Leucocyte potassium content (mmol/kg of dry solids) and concentration (mmol/l of cell water) were reduced. 3. In patients receiving regular dialysis leucocyte water was significantly reduced. Leucocyte potassium content was also reduced in this group, but leucocyte potassium concentration in cell water had returned to normal. 4. In the normal subjects and also in the dialysed patients leucocyte water correlated better with potassium than with sodium content. In contrast, in the undialysed uraemic patients leucocyte water correlated better with sodium than with potassium content, indicating that the increased cell sodium was an important determinant of the increased cell water in this group.

Personality and premenstrual tension.

Abstract: While such complications are most commonly seen in the severe hypertensive, they are not infrequent in the less severe hypertensive and this probably explains the presence of the chronic pattern across both groups of hypertensives, but to a lesser extent in the less severe group. It is worth while mentioning that the typical depressive pattern for the chest patients was the chronic one. This form of depression is therefore most likely a reflection of the illness and could best be called an 'illness effect'. The views expressed by Schwarz and by Bulpitt & Dollery can now be drawn closer together. It appears that reserpine and methyl dopa are still causing depression biochemically. However, with the smaller doses of these drugs used today, the severity of the depression is limited, while the incidence remains much the same. The bulk of the depressions occurring in hypertensive patients are felt to be reflections of the illness itself and these are now occurring in greater severity and are more numerous than the so-called 'biochemical depressions'.

Fluorine compounds in anaesthesia (8). Examination of seven derivatives of propane and three of normal butane.

Abstract: T. H. S. Burns, MA, BM, BCh, FFARCS, St Thomas’ Hospital and the Royal Northern Hospital, J . M. Hall, MB, BS, FFARCS, Guy’s Hospital and the Thoracic Unils, S. E. Region, A. Bracken, PhD, FRIC, and G. Gouldstone, The British Oxygen Company Limited. The animal work was carried out in the Inter-departmental Laboratory at Guy’s Hospital on behalf of the Medical Research Council’s Committee on Non-explosive Anaesthetics. The tests for stability to soda-lime, purity and flammability were. undertaken by British Oxygen Co. Ltd. * In receipt of a Medical Research Couticil grant.

Cigarette smokers' chronic bronchitis: Inhalers and non-inhalers compared

Abstract: Male volunteers for mass radiography, aged 40 or more, were questioned about their smoking habits, sputum production and, where applicable, their method of smoking cigarettes. Of 543 8 cigarette smokers, 4619 (85%) said they usually inhaled whereas the rest, 819 (15%), said they did not. Persons who admitted to producing sputum from their chests for at least 2 years before examination, either on most days of the year or on most days for at least 3 months of the year, were classified as chronic bronchitics in the absence of other causative disease. The age-standardized rate of chronic bronchitis among inhalers (37·9%) was almost 50% higher than that among non-inhalers (25·7%) and, irrespective of the amount smoked, the rates were always higher in those who inhaled. It was again confirmed that chronic bronchitis is commoner among smokers than among non-smokers, and that its prevalence among smokers increased with the amount smoked.