Showing papers by "St Thomas' Hospital published in 1977"
466 citations
TL;DR: The results of this study suggest that the development of ischemic contracture represents the accumulation of rigor complexes arising as a result of an ATP deficiency that are able to exacerbate the contracture by promoting uncontrolled ATP hydrolysis.
Abstract: Ischemic contracture of the left ventricle (“stone heart”) occurs in the rat heart after a period of global ischemia at 37° C. The time of onset of contracture can be delayed by various interventions that reduce myocardial energy demand, increase myocardial energy supply or reduce cellular calcium influx. Conversely, the time of onset of contracture may be advanced by interventions that reduce the energy supply. Analysis of myocardial energy metabolism, and particularly of adenosine triphosphate (ATP) availability in relation to the onset and duration of contracture suggests that contracture is initiated when the cellular ATP content decreases to approximately 12 μmoles/g dry weight. Furthermore, the progression of contracture is characterized by an acceleration in the rate of ATP degradation and the completion of contracture coincides with the reduction of ATP to 3 to 4 μmoles/g dry weight. The results of this study suggest that the development of ischemic contracture represents the accumulation of rigor complexes arising as a result of an ATP deficiency. These rigor complexes are able to exacerbate the contracture by promoting uncontrolled ATP hydrolysis. Although the development of these complexes and the onset of contracture is calcium-insensitive the results indicate that calcium availability may influence the magnitude of the developed contracture.
386 citations
TL;DR: Cerebral blood-flow was measured in patients with haematocrit values in the range 0·47-0·53 and was found to be significantly lower than in 43 patients with Hct in a lower range, which suggests Hct around the generally accepted upper limit of normal may be an important factor in the causation of occlusive vascular disease.
351 citations
268 citations
TL;DR: Studying the border zone between ischemic and nonischemic tissue after coronary arterial ligation confirmed the existence of a clearly defined border zone, and suggest that therapeutic salvage of this zone could considerably influence the extent of the ultimate infarct.
Abstract: A biopsy instrument with multiple drill heads was used to retrieve simultaneously, and freeze within seconds, 29 individual transmural tissue samples from the left ventricular wall of the dog heart. Studies were undertaken 21 to 26 minutes after coronary arterial ligation to define the border zone between ischemic and nonischemic tissue using the following criteria: (1) metabolic changes (adenosine triphosphate, creatine phosphate, glycogen, lactate, potassium, sodium, water); (2) electro-cardiographic S-T changes; and (3) blood flow distribution (microspheres). The existence, position and sharpness of the gradients for each variable were defined in relation to the edge of the visible area of cyanosis. Adenosine triphosphate, creatine phosphate and lactate values in the nonischemic tissue were essentially constant until 2 to 3 mm from the edge of visible cyanosis. The high energy phosphate content of the tissue then decreased sharply across a zone 8 to 15 mm wide that spanned the visible edge. Across this zone lactate content increased sharply as did S-T segment elevation, and coronary flow decreased to approximately 20 percent of the control value. Multiple cross-correlation studies revealed that changes in the tissue content of adenosine triphosphate, creatine phosphate and lactate were accurately reflected by S-T segment changes, and further that all of these variables were directly related to the degree of ischemia, as indicated by the reduction in coronary flow. In addition to confirming the existence of a clearly defined border zone, these studies suggest that therapeutic salvage of this zone could considerably influence the extent of the ultimate infarct.
153 citations
TL;DR: In double valve replacements with an aortic occlusion time of 1 1/2 hours, both techniques afforded a similar degree of preservation, except that the inner half of the myocardium was markedly better preserved by cold cardioplegia.
139 citations
TL;DR: It is suggested that absorption of 25-OHD undergoing enterohepatic circulation and of dietary vitamin D is reduced in patients with primary biliary cirrhosis and the development of osteomalacia is thus hastened.
110 citations
TL;DR: Until the mechanisms underlying ischemic damage and its prevention are understood, it would seem undesirable to advocate the use of solutions containing extremes of concentration or solutions devoid of ions normally found in the extracellular fluid.
105 citations
TL;DR: The clinical and psychological characteristics of 18 women with pelvic pain but no demonstrable pathology have been compared with those of 17 women with a similar complaint but some form of pelvic pathology and a control group, suggesting that pelvic pain can have a psychosomatic origin which is amenable to short-term psychotherapy measures.
101 citations
TL;DR: Haematocrit levels that are currently acceptable in the management of polycythaemia may therefore be too high.
87 citations
TL;DR: Correct use of the condom by male patients attending a clinic specialising in sexually transmitted diseases has been associated with a significantly lower probability of acquiring gonorrhœa.
TL;DR: The EEG results showed transcendental meditation to be a method of holding the mediator's level of consciousness at stage 'onset' sleep, and no evidence could be found to suggest that meditation produced a hypometabolic state beyond that produced by muscle relaxation.
Journal Article•
TL;DR: The classification criteria for both SLE and antiphospholipid syndrome have been updated, and up to 19 different subsets of neuropsychiatric lupus have been defined.
Abstract: Systemic lupus erythematosus is a common disease--studies throughout the world broadly agree on a prevalence of 1 in 1000 women. Recently an important clinical advance has come from the description of a syndrome of recurrent thrombosis, recurrent abortion and neurological disease associated with antiphospholipid antibodies. The discovery that immunological mechanisms may apply in some cases of thrombosis has led to new insights into the aetiology and treatment of vascular disease in general.
TL;DR: The amyloidosis may arise after only a short duration of bowel disease, and there is evidence that the association may be commoner than is realized, so the need for a prospective systematic search in a large number of patients with inflammatory bowel disease is emphasized.
Abstract: Surprisingly little has been written about the association of amyloidosis with inflammatory bowel disease. On reviewing the literature it appears that there is a correlation between amyloidosis and Crohn's disease, but little definitive evidence of such a relationship with ulcerative colitis could be found. No specific features emerge as aetiological factors in the amyloidosis of inflammatory bowel disease. The amyloidosis may arise after only a short duration of bowel disease, and there is evidence that the association may be commoner than is realized. The need for a prospective systematic search in a large number of patients with inflammatory bowel disease is emphasized.
TL;DR: Investigations revealed multiple benign squamous cell papillomata on the larynx of a 61-year-old male Shopkeeper who presented in November 1975 with a 15 month history of wart-like lesions on both lips.
Abstract: History. M.C., a 61-year-old male Shopkeeper, presented in November 1975 with a 15 month history of wart-like lesions on both lips. These had begun at the angles of the mouth and slowly spread. He had also noticed cracking and soreness of the tongue. In January 1973 he had had a right pneumonectomy for squamous cell carcinoma. The hilar nodes were involved at the time of operation. He remained well until July 1974 when he developed a hoarse voice. Investigations then revealed multiple benign squamous cell papillomata on the larynx. In October 1975 he became breathless due to superior vena caval obstruction and was undergoing radiotherapy for this at the time of his referral with 'warts'.
TL;DR: It is suggested that oxpentifylline may be valuable in the treatment of small vessel occlusive disease associated with lowered fibrinolytic activity and raised fibrinogen levels.
Abstract: SummaryTwenty healthy volunteers were treated for 3 months with oxpentifylline (200 mg 3-times a day) or a placebo in a controlled double-blind randomized trial. The volunteers taking the oxpentifylline showed a significant increase in their fibrinolytic activity, as assessed by the dilute blood clot lysis time and fibrin plate lysis area, and a significant reduction in their plasma fibrinogen levels. No change was found in the control group. These findings suggest that oxpentifylline may be valuable in the treatment of small vessel occlusive disease associated with lowered fibrinolytic activity and raised fibrinogen levels.
TL;DR: Abundant acid fact bacilli were demonstrated in homogenates prepared from the fish thus providing early confirmation of the suspected clinical diagnosis of tropical fish tank granuloma caused by Mycobacterium marinum (balnei).
Abstract: Three cases of tropical fish tank granuloma caused by Mycobacterium marinum (balnei) are described. Abundant acid fact bacilli were demonstrated in homogenates prepared from the fish thus providing early confirmation of the suspected clinical diagnosis: acid fast bacilli could not be demonstrated in biopsy material from the patients' lesions through M. marinum grew on culture. The infection responded to oral co-trimoxazole.
TL;DR: It is suggested that all lung tumours of carcinoid or oat cell type synthesize ACTH‐like materials although clinical evidence of the ectopic ACTH syndrome may be absent, due to a good correlation between the ACTH levels and the presence of secretory granules in the tumours examined ultrastructurally.
Abstract: ACTH levels measured by N- and C-terminal immunoassays and cytochemical bioassay, were measured in fourteen lung tumours not associated with the ectopic ACTH syndrome and in macroscopically normal lung tissue taken from the same patients at thoracotomy. Significant concentrations of immunocative (greater than 3 ng/g wet weight) and bioactive (greater than 0.2 ng/g wet weight) ACTH were found in all the carcinoid and oat cell tumours (n=9), a combined tumour (poorly differentiated adenocarcinoma with large cell carcinoid elements), and a poorly differentiated squamous cell tumour. All the carcinoid tumours contained more C- than N-terminal ACTH immunoactivity. The squamous cell tumours (n=2), anaplastic tumours (n=2) and adenocarcinoma contained insignificant ACTH levels. There was a good correlation between the ACTH levels and the presence of secretory granules in the tumours examined ultrastructually. All the macroscopically normal samples of lung tissue contained immuno and bioactive ACTH-like material, the levels of which correlated well with ACTH levels in the tumour tissue. It is suggested that all lung tumours of carcinoid or oat cell type synthesize ACTH-like materials although clinical evidence of the ectopic ACTH syndrome may be absent. The presence of ACTH-like materials in non-tumorous lung tissue in patients with lung cancer may indicate a low level of ACTH production throughout the lung or sequestration of ACTH containing granules secreted by the tumour.
TL;DR: Five different types of myocardial protection were employed in this series of 168 patients undergoing aortic valve replacement and it was shown that changes in birefringence, indicative of deteriorating myocardium function, are often detectable before parallel cytochemical changes are apparent.
TL;DR: It is concluded that both stress hormones, especially glucocorticoids, and stressful procedures acting independently of stress hormone, can facilitate tumor transplantation.
Abstract: Quantitative transplantation assays of a syngeneic murine adenocarcinoma have been used to investigate the effects of stress hormones and tumor take probability. Cortisol, injected intraperitoneally one hour before and 3 hours after tumor cells, caused a dose dependent reduction of TD50 (number of tumor cells required for 50% takes) by factors of from 4 at a total dose 4 microng/g to 68 at 400 microng/g. ACTH, given at 0.2 I.U. daily for 9 days spanning the time of tumor cell injection, reduced the TD50 2.5-fold, indicating that the peak gluco-corticoid level achieved, rather than its duration, was of greater significance. Adrenaline, while much less effective than cortisol, produced an 8-fold reduction in TD50 at its maximum tolerable dose. The effect of cortisol simulated that of whole body irradiation (WBI), and while both these agents depress immune reactivity, evidence is presented to suggest that immunological mechanisms are not responsible for their effect. WBI constitutes a systemic stress, and the demonstration that surgical trauma (laparotomy) could also reduce the TD50 for this tumor suggested that both might act via endogenous glucocorticoids. However, the failure of prior total adrenalectomy of mice to abrogate the effect of either WBI or laparotomy indicated that stress hormones were not essential intermediaries. It is concluded that both stress hormones, especially glucocorticoids, and stressful procedures acting independently of stress hormones, can facilitate tumor transplantation.
TL;DR: The clinical and histological features of ten pigmented keratoses arising on the face are described, which had been spreading centrifugally and had progressed to become pigmented squamous cell carcinomas.
Abstract: SUMMARY
The clinical and histological features of ten pigmented keratoses arising on the face are described. They were all greater than 1.5 cm in diameter and had been spreading centrifugally. They were variably pigmented and possessed either a smooth, verrucous or slightly scaly surface. Two lesions had progressed to become pigmented squamous cell carcinomas.
TL;DR: The oestrogen receptor from human myometrium has been extensively purified by affinity chromatography and isoelectric focusing and the latter step is necessary to remove contaminating sex-steroid-binding globulin.
TL;DR: No evidence was found to support a viral etiology of acute esophageal ulceration after ingestion of doxycycline hyclate, and the ulcers are postulated to result from close contact between the capsules and the esophagesia.
Abstract: Two patients developed acute esophageal ulceration after ingestion of doxycycline hyclate. Despite vigorous investigation no evidence was found to support a viral etiology. The ulcers are postulated to result from close contact between the capsules and the esophageal mucosa.
TL;DR: It is concluded that the subnormal concentration of low-density lipoprotein (LDL) inthese two subjects is due to a low synthetic rate of VLDL, which may underlie familial hypobetalipoproteinemia.
Abstract: The metabolism of the apoprotein of low-density apoliporprotein-B was studied in a father and son with familial hypobetalipoproteinemia. The synthetic rate of apolipoprotein-B was below the normal range in both subjects, while the fractional removal rate was normal. It is concluded that the subnormal concentration of low-density lipoprotein (LDL) in these two subjects is due to a low synthetic rate. The synthetic rate of apolipoprotein-B of very low-density lipoprotein (VLDL-apoB) measured in the father was subnormal. The fraction of the VLDL-apoB pool which was converted into LDL-apoB was within the normal range. It is suggested that a low synthetic rate of VLDL may underlie the disorder.
TL;DR: Adult mice given two or three intraperitoneal inoculations with avirulent Semliki Forest Virus showed typical lesions of a viral encephalitis similar to those caused by a virulent strain of the virus.
Abstract: Adult mice given two or three intraperitoneal inoculations with avirulent Semliki Forest Virus showed typical lesions of a viral encephalitis similar to those caused by a virulent strain of the virus. Demyelination also was seen in the medulla and in the folia of the cerebellar white matter. Neuronophagia was seen only in mice that had had three successive infections. The repeated inoculations of avirulent virus exacerbates the encephalitis of a single inoculation and causes demyelination. The mice did not have neurological clinical signs except for a short-lived weakness of the hind legs. No central nervous system lesions were seen by the 7th and 8th week after the initial infection and all mice recovered.
TL;DR: The results of 458 prolonged nasotracheal intubations are described in 435 infants and young children up to 5 years of age after open heart surgery, in whom the upper airway was normal.
Abstract: The results of 458 prolonged nasotracheal intubations are described in 435 infants and young children up to 5 years of age after open heart surgery, in whom the upper airway was normal. No deaths occurred which could be attributed to the technique, and no tubes became obstructed. Sub-glottic stenosis did not occur when a loose-fitting endotracheal tube was used, and stridor after extubation was rare. If necessary, the technique can be used with safety for several weeks.
TL;DR: This paper describes experiments undertaken to determine if progesterone can affect the protein composition of human endometrium and uterine flushings in a manner that might be related to the presence of a blastocyst.
Abstract: The changes that occur in human endometrium under the influence of estrogen plus progesterone during the secretory phase of the menstrual cycle are largely related to the nurturing of the fertilized human egg followed by its implantation. Endometrial secretion starts on about Day 18 and is maximal by Days 20-22 of a normal cycle. If fertilization has occurred, the blastocyst attaches to the endometrium on Days 19-20 and is completely implanted by Day 25. Histologic characterization of these progesterone-induced events is well doc~mented,'-~ but biochemical information on endometrium is more sparsek6 and includes virtually no data on protein composition. More information is available for other species, and, in particular, the composition of rabbit uterine secretions is eliciting much interest because of the presence of a progesterone-induced protein called blastokinin or ~teroglobin.~.~ This protein is secreted just prior to implantation and may play an important role in the development and implantation of the blast~cyst .~ The applicability of the rabbit data to humans is dubious, and it is noteworthy that there is no convincing evidence for the existence of a specific progesterone-sensitive protein in human luminal f l ~ i d . ~ . ' ~ Indeed, the data quoted in References 9 and 10 suggest that the proteins of human luminal fluid are derived mainly from plasma. This paper describes experiments undertaken to determine if progesterone can affect the protein composition of human endometrium and uterine flushings in a manner that might be related to the presence of a blastocyst. The experiments fall into two categories: electrophoretic analysis of endometrium and flushings throughout the menstrual cycle, and maintenance of endometrium in organ culture in the presence and absence of progesterone accompanied by incorporation of isotopically labeled leucine into the cell proteins.
TL;DR: In a series of 250 renal biopsies (transplants excluded) the diagnosis of membranous glomerulonephritis was made in 22 cases, and studies emphasized the basement membrane distribution of the deposits of immunoglobulin and the relative sparing of the mesangium.
Abstract: In a series of 250 renal biopsies (transplants excluded) the diagnosis of membranous glomerulonephritis was made in 22. This was done on light microscopy in 17, while the addition of immunofluorescence enabled the diagnosis to be made in a further five. Electron microscopy confirmed the diagnosis in all cases. Immunoperoxidase studies emphasized the basement membrane distribution of the deposits of immunoglobulin and relative sparing of the mesangium. They showed at an ultrastructural level the presence of IgG in the deposits.
TL;DR: The results show that reporting of ventilation perfusion lung scans by eye is reproducible, and support the claims that the technique is 91% to 95% accurate for pulmonary emboli.
Abstract: Reports were made on combined ventilation-perfusion lung scans by three observers on three occasions and by another observer once Reproducibility for each observer varied between 80 and 88% There was complete agreement about the areas of scans reported as abnormal Agreement between observers on whether or not the abnormality represented a pulmonary embolus averaged 77% There was 86% agreement with the final clinical diagnosis Our results show that reporting of ventilation perfusion lung scans by eye is reproducible They support the claims that, under routine clinical conditions, the technique is 91% to 95% accurate for pulmonary emboli