Showing papers by "St Thomas' Hospital published in 1990"

Proliferating cell nuclear antigen (PCNA) immunolocalization in paraffin sections: An index of cell proliferation with evidence of deregulated expression in some, neoplasms

Abstract: Proliferating cell nuclear antigen (PCNA) is a 36 kD nuclear protein associated with the cell cycle A monoclonal antibody, PC10, that recognizes a fixation and processing resistant epitope has been used to investigate its tissue distribution Nuclear PCNA immunoreactivity is found in the proliferative compartment of normal tissues PCNA immunoreactivity is induced in lectin stimulated peripheral blood mononuclear cells in parallel with bromodeoxyuridine incorporation and the number of cells with PCNA immunoreactivity is reduced by induction of differentiation in HL60 cells In non-Hodgkin's lymphomas a linear relation between Ki67 and PCNA staining was demonstrated These data suggest that in normal tissues and lymphoid neoplasms, PCNA immunolocalization can be used as an index of cell proliferation However, in some forms of neoplasia, including breast and gastric cancer and in vitro cell lines, the simple relation between PCNA expression and cell proliferation is lost In some breast and pancreatic tumours there is apparent deregulation of PCNA with increased expression in tissues adjacent to the tumours The over-expression in some tumours and in adjacent morphologically normal tissue may represent autocrine or paracrine growth factor influence on PCNA gene expression

Pulmonary hypertension in a lupus clinic: experience with twenty-four patients.

Abstract: The clinical and serological findings on 24 patients with pulmonary hypertension (PHT) seen at the Lupus Clinic of St. Thomas' Hospital, London are presented. Twenty-two patients had systemic lupus erythematosus (SLE), one other a primary antiphospholipid syndrome and another an SLE/progressive systemic sclerosis (PSS) overlap syndrome. In 21 of the 24 patients, the disease resembled the primary idiopathic variety with clear lung fields and no clinical evidence of pulmonary thromboembolism, although angiography and nuclear perfusion scans were not performed. Two patients clearly suffered from thromboembolic PHT, one with SLE and one with an antiphospholipid syndrome. One patient with SLE/PSS overlap syndrome developed pulmonary fibrosis. The frequency of antiphospholipid antibodies (lupus anticoagulant and antibodies to cardiolipin was 68% which appears to be higher than generally found in patients with SLE, and the clinical significance of this finding is unknown. Other associated features of the antiphospholipid syndrome in this group were uncommon. Death occurred in 13 of the 24 patients, 4 were lost to followup and 7 are known to be alive. The cause of death was circulatory failure in the majority; sudden death once this complication occurred was particularly common. One patient died from adult respiratory distress syndrome and one from hemorrhagic shock while undergoing heart/lung transplantation. Two patients underwent successful heart/lung transplantation. One, however, died of a mesenteric occlusion and bowel infarction following a second lung transplantation because of rejection of the first heart/lung transplantation after one year. The other patient is alive and well 2 years later.

The 'Jupiter' sinking: effects on children's fears, depression and anxiety.

Abstract: Twenty-five girls who survived the sinking of the cruise ship 'Jupiter' were compared with three other groups of girls--71 controls from a separate school; 46 girls in the same school who had not wanted to go on the cruise; and 13 girls who were in a 'near miss' group in that they wanted to go but did not get places. All completed the Fear Survey Schedule for Children (revised form), the Children's Manifest Anxiety Scale and the Birleson Depression Inventory. Survivors did not become generally more fearful. Rather, they developed significantly greater fears to stimuli related to the traumatic event. The results are discussed in relation to the conditioning theory of the acquisition of phobias. Language: en

A comparison of three methods of axillary brachial plexus anaesthesia.

Abstract: Summary One hundred patients scheduled for elective outpatient hand surgery had blockade of the axillary brachial plexus by one of three techniques; insertion of a catheter into the brachial plexus sheath (n = 25), use of paraesthesia (n = 50) or use of the nerve stimulator (n = 25) to localise the plexus. Only two patients required general anaesthesia for the planned surgery. Assessment of the dermatomes blocked did not demonstrate a statistical difference between the success rates of the three groups. The more nerves detected in the paraesthesia and the nerve stimulator groups before injection of local anaesthetic the higher the success rate of the block. We advocate use of the nerve stimulator technique in view of the possible risk of neurological damage associated with paraesthesia and the technical difficulties with the catheter technique, for routine brachial plexus blockade.

Ischemia, reperfusion, and the determinants of tissue injury.

Abstract: Much of the damage arising during ischemia and reperfusion can be attributed to the consequences of flow deprivation. However, while reperfusion is a prerequisite for the survival of tissue, it may have an injurious component, which, if counteracted, might enhance postischemic recovery. The complex and dynamic changes that occur during ischemia in the diseased human heart are difficult to model in experimental preparations. As a consequence, much remains to be learned about the identity and manipulability of cellular changes leading to irreversible injury. Although the subject of most studies, injury to the myocyte may not be the primary determinant of tissue injury and changes in the endothelium or vascular smooth muscle may play an important role. Once critical ischemia-induced cellular changes have been identified, interventions can be developed to delay their progression such that at the time of reperfusion more cells are potentially salvable. Suboptimal reperfusion may limit the recovery of the tissue through the induction of "reperfusion injury." Much controversy surrounds the importance and even the existence of this phenomenon. It is proposed that reperfusion injury may express itself in four distinct forms: a) reperfusion-induced arrhythmias, which are potentially lethal (but preventable or reversible) events occurring in otherwise viable tissue; b) myocardial stunning, which is expressed as prolonged (but eventually fully reversible) contractile and metabolic dysfunction; c) the induction of lethal injury in tissue that was potentially viable in the moments before reperfusion; d) accelerated necrosis in tissue that is already irreversibly injured (the "oxygen paradox"). All but the third of these categories has been shown to exist experimentally and clinically, and can be advantageously manipulated. Although it is likely that lethal reperfusion injury also exists, there is as yet no definitive proof. Clarification of this issue is of considerable importance to those undergoing angioplasty or thrombolytic procedures.

The subdural space: the third place to go astray

Abstract: Subdural placement of the tip of the Tuohy needle or epidural catheter may account for many unexpected complications of attempted epidural blockade, for example, 'unexplained' headache, false-negative aspiration test down needle or catheter, false-negative test dose, unilateral block, delayed total spinal and neurological sequelae, as well as profound block of delayed onset that is characteristic of subdural blockade. Cases are reported in support of this hypothesis.

Microvascular study of the retrolaminar optic nerve in man: The possible significance in anterior ischaemic optic neuropathy

Abstract: Microvascular study of the retrolaminar optic nerve in man: The possible significance in anterior ischaemic optic neuropathy

The effect of short-term fasting on processing of food cues in normal subjects.

Abstract: The effect of food deprivation on the selective processing of food- and body-size-related information was investigated using a modified version of the Stroop task. Fasting subjects were slower than controls in color-naming food-related words but not body-size-related words. This interference effect was found for both males and females. The findings could not be explained in terms of other variables and appeared to be a reflection of current concern with food and eating produced by the food deprivation.

Antegrade curettement, bone grafting and pinning of osteochondritis dissecans in the skeletally mature knee

Abstract: In the period between 1981 and 1983, we treated 40 patients who had osteochondritis dissecans of the knee. Seventeen patients were skeletally mature and had large lesions (2 to 3 cm in diameter) of the medial femoral condyle that required surgery. Each of these patients, who underwent antegrade curettement, bone grafting, and pinning, had either failed a conservative program or had a loose or separated fragment. The average age at the time of surgery was 17. Followup ranged from 5 to 7 years.Postoperative evaluation included the criteria of the Hughston et al. rating scale, subjective assessment, clinical examination, and AP, lateral, and tunnel radio graphs. According to the osteochondritis dissecans rating scale described by Hughston et al., there were two excellent, nine good, five fair, no poor results, and one failure. Additional evaluation, not included in the Hughston rating scale, consisted of Cybex II muscle strength testing, strict grading of preoperative and postoperative roentgenograms for deg...

The changing role of primary afferent neurones in pain.

Abstract: There is a belief amongst many scientists and clinicians that the peripheral mechanisms involved in pain have by and large been settled apart from their molecular biology. This belief affects not only the writers of textbooks, but also clinicians in the conceptual framework they carry with them for the assessment of patients in pain, and their choice of therapy for those patients. The conventional view is now in need of modification with the recent emergence of new data which has relevance to all those interested in pain mechanisms. The conventional wisdom on peripheral nociceptive mechanisms goes back to the thinking of the scientists working at the end of the last century. The German physiologist von Frey concluded that ‘pain sensations of the skin, as far as superficial pain is concerned, originates in the free intraepithelial nerve endings’ [33]. His English contemporary Sherrington emphasised the sensory discriminative and defensive component of acute pain, summarised in his statement that ‘pain seems the psychical adjunct to protective reflexes’ [29]. Decades before direct experimental evidence was obtained, Sherrington postulated the existence of nociceptors that acted as an immediate alarm system detecting tissue damage or potentially injurious stimuli. With this conceptual goal in mind, nemoscientists sought and found discrete classes

The management of empyema thoracis by thoracoscopy and irrigation.

Abstract: A technique of irrigation for the management of empyema thoracis is described. Initial thoracoscopy using a laparoscope under general anaesthesia enabled adequate debridement and breakdown of loculi within the empyema cavity under direct vision. Following this procedure irrigation of the cavity with two tubes was started and continued until three consecutive cultures of drained irrigation fluid became sterile. The procedure was then discontinued. The results in 14 patients are presented using this method, irrigation was required for an average of 14 days. Patients remained in hospital for an average of 4.8 weeks. Tuberculous empyema was not found to be a contra-indication to the irrigation technique.

The association of selected bacteria with the lesions of root surface caries

Abstract: Plaque from the root surfaces of 165 subjects (mean age 655 years, 22–26 teeth/subject) was analysed for specific bacteria Five subject groups were defined: A (DMFS 164), B (DMFS 559), C1 (DMFS 556), C2 (DMFS 570) and C3 (DMFS 481) Groups C1 and C2 had unrestored root surface lesions: Groups A, B and C3 were free of unrestored root caries and differed in their coronal caries experience Streptococcus mutans was isolated more frequently from the root lesions in Groups C1 and C2 than from intact root surfaces in Group A, Streptococcus oralis, Streptococcus mitis 1 and Streptococcus sanguis were isolated more frequently from Group A The percentage contribution that S mutans made to plaque from lesions in Groups C1 and C2 was higher than that from plaque in Group A and Actinomyces viscosus serovar 2 contributed more to plaque in Group C1 than in samples from Group A The percentage counts of Lactobacillus in plaque from lesions in Groups C1 and C2 were higher than those from intact roots in Groups A, B, and C3 Subjects were also grouped on the presence of Lactobacillus and S mutans in plaque samples Samples with both organisms (n= 17) showed significantly higher isolation frequencies of specific strains of S mitis 1 and also A viscosus serovar 2 compared with samples of plaque containing S mutans or Lactobacillus Actinomvces naeslundii serovar 1 was not isolated from samples containing both S mutans and Lactobacillus The results confirm an association of S mutans and Lactobacillus with root surface lesions and suggest a relationship between lesions and A viscosus serovar 2 Selection of samples based on the presence of S mutans and Lactobacillus showed that specific and different communities may be associated with root surface lesions These communities reflect the local environment and as such could be valuable indicators of the state of the disease or risk of progression of lesions

GB3 monoclonal antibody for the diagnosis of junctional epidermolysis bullosa: results of a multicenter study.

Abstract: GB3 monoclonal antibody detects a normal basement membrane component (GB3 antigen) that is variably expressed in junctional epidermolysis bullosa. To assess the accuracy of GB3 in the diagnosis of junctional epidermolysis bullosa, we have reviewed its use in 250 cases of the major types of epidermolysis bullosa. In the majority of cases of the simplex and dystrophic forms of epidermolysis bullosa, GB3 antigen is normally expressed. In the Herlitz variant of junctional epidermolysis bullosa, GB3 antigen expression is consistently abnormal, but in the non-Herlitz and indeterminate forms of junctional epidermolysis bullosa, 40% of cases express GB3 antigen normally. We propose that GB3 monoclonal antibody is, useful in the accurate identification of patients with Herlitz junctional epidermolysis bullosa and may prove equal to electron microscopy for the diagnosis of this disease. For the non-Herlitz variants, it should not be used as an alternative to electron microscopy but may be of special value in the determination of prognosis.

Diversity of staphylococci exhibiting high-level resistance to mupirocin.

Abstract: Summary Plasmids mediating high-level resistance to mupirocin (MIC ≫ 1000 mg/L) in staphylococci from various sources were studied by restriction endonuclease cleavage. Several patterns were obtained but six plasmids isolated from various Staphylococcus aureus and S. epidermidis strains were indistinguishable. The diversity and spread of these plasmids is illustrated.

Use of 1M NaCl split skin in the indirect immunofluorescence of the linear IgA bullous dermatoses.

Abstract: We compared 1M NaCl split skin with intact skin as substrates for detection of circulating IgA anti-basement membrane (BMZ) antibodies in linear IgA dermatosis (LAD). The sera of 63 patients with LAD including 27 adults and 36 with chronic bullous dermatosis of childhood (CBDC) were examined. 62% of patients overall had circulating IgA anti-BMZ antibodies detectable on intact skin. 73% of patients had circulating antibodies detectable on 1M NaCl split skin as an additional 7 sera were positive. This was a statistically significant increase (p less than 0.01). The sera were mostly positive at a higher titre on the split skin when compared with intact skin. On routine indirect immunofluorescence (IIF) all positive sera produced linear fluorescence on the epidermal side of the split. Twenty serum samples were incubated with split skin overnight; 4 of these specimens exhibited linear fluorescence on the epidermal and dermal sides of the split after this prolonged incubation. These findings suggest that 1M NaCl split skin is a more sensitive substrate for detection of circulating IgA anti-BMZ antibodies in LAD, that these antibodies are heterogeneous and that the target antigen has an epidermal component.

The natural history of non-arteritic anterior ischaemic optic neuropathy.

Abstract: Seventy one patients with non-arteritic anterior ischaemic optic neuropathy were studied retrospectively. Sixty three (89%) were followed to the end of the study or death, mean follow up time was 5.3 years. Whilst twenty (28%) had diabetes or hypertension, in thirty nine (55%) no predisposing condition was identified. In those who had monocular disease at presentation (68), subsequent involvement of the second eye occurred in seventeen (25%), seven within the first year. Nineteen patients died within the study period. Of these, nine died from myocardial infarction and four from cerebrovascular disease. This is a significant increase above figures calculated from the Office of Population Census and Surveys (p less than 0.001 for all causes, p less than 0.002 for myocardial infarction and cerebrovascular disease). Such an increase in mortality has not been previously reported, and implies that this condition carries a more sinister systemic prognosis than is frequently supposed.

Opisthotonus and other unusual neurological sequelae after outpatient anaesthesia

Abstract: Four patients who developed unusual neurological sequelae after outpatient anaesthesia are described. Propofol is strongly implicated as the cause. All four patients were female with no previous history of psychiatric disorder or neurological disease, unpremedicated, and had procedures of duration less than 20 minutes. Hyperreflexia and hypertonicity were present postoperatively and the reactions appeared to be triggered by an external stimulus. Three patients were examined by a neurologist and had a normal electroencephalograph. Two patients were on the same operating list; quality control was carried out on the anaesthetic agents used, and blood samples sent for toxicology showed no abnormalities. Mechanisms underlying these reactions are discussed.