Wishaw General Hospital

About: Wishaw General Hospital is a healthcare organization based out in Wishaw, Scotland, United Kingdom. It is known for research contribution in the topics: Population & Survival rate. The organization has 256 authors who have published 222 publications receiving 4324 citations.

Biochemical endocrinology of the hypogonadal male

Abstract: extra and in our own time, with outside funding required to support larger studies. It is our opinion that as a minimum standard, laboratories should select a reference interval that is supported by findings in the peer-reviewed literature relating specifically to the assay they are using. Routine laboratories can verify that their assay measures ‘normal’ troponin concentrations that are below the 99th percentile URL by using blood samples from young males and females, e.g. medical students. As a minimum standard for imprecision testing, routine laboratories should verify the withinand between-run precision capability of their assay over the troponin measuring range concentration, e.g. CLSI guideline EP15-A2. The Study Group on Biomarkers in Cardiology of the European Society of Cardiology Working Group on Acute Cardiac Care recommends determination of at least one level close to the clinical decision limit for troponin, which may be the 99th percentile of a reference population value distribution. This enables verification of the limit of quantitation that is clinically relevant. Adequate long-term monitoring of troponin imprecision is also essential to avoid wrong results in clinical samples and to confirm troponin transferability and accuracy across different reagent lots. Ultimately it is buyer beware. A doctor using a pathology laboratory relies on them to produce quality results. When all is considered, it is the responsibility of each laboratory to put out meaningful, quality troponin data.

Assessment of patients with acute abdominal pain

Abstract: Abdominal pain is a common presenting symptom to the GP surgery and can be particularly challenging when trying to decide whether the symptoms are severe enough to warrant a hospital admission. Patients with acute and severe abdominal pain often require urgent surgical intervention and being able to recognise these patients is extremely important. This article will revise the features in the history and examination pointing towards a more serious cause and help discriminate between those patients who can be managed entirely in primary care. It will provide a brief overview of the management of these patients in hospital and their care after discharge.

Secondary cryofibrinogenaemia due to bronchial adenocarcinoma presenting as cutaneous necrosis.

Abstract: A 59-year-old man was admitted with a 1-week history of painful red swollen legs and haemorrhagic blisters. He was otherwise well, except for a past medical history of pulmonary fibrosis. He was a reformed smoker of 20 cigarettes daily for 40 years, having stopped in early 2005. General examination was unremarkable except for finger clubbing; there was a family history of idiopathic finger clubbing. Cutaneous examination revealed necrotic ulcers covered by black eschar with pink to purple irregular edges (Fig. 1). His feet were warm with palpable peripheral pulses. Routine laboratory investigations were normal except for mild neutrophilia and raised inflammatory markers. Coagulation screen demonstrated a prothrombin time of 16.7 s [normal range (NR) 11.5–14], partial thromboplastin time 29.4 s (NR 25.5–38.5) and fibrinogen 6.3 g ⁄ L (NR 1.5–4.5). Protein electrophoresis was consistent with an acute-phase reaction. Urinary protein level was normal, and Bence–Jones protein was not present. Hepatitis B surface antigen, hepatitis C antibodies, rheumatoid factor, antinuclear antibody, antineutrophil cytoplasmic antibodies, cold agglutinins and cryoglobulins were not detected. Anticardiolipin IgG and IgM antibodies were normal. Appearance of cryofibrinogen in the plasma was noted within 24 h with approximately 1016 mg ⁄ L of precipitate. Skin biopsy from the area demonstrated fibrin thrombi within small venous channels in both the dermis and subcutis, resulting in epidermal necrosis and blistering with no evidence of a primary vasculitis or perivascular inflammatory infiltrate (Fig. 2). Direct immunofluorescence staining for IgG, IgA and IgM was negative with faint positivity for C3 in some vessels. Chest X-ray confirmed the appearance of pulmonary fibrosis with possible underlying lymph-node enlargement. Computed tomography scan of the chest showed a solid PD

Biochemical Markers of Bone Turnover

Abstract: The routine clinical assessment of bone mineral density (BMD) is best undertaken by the use of dual-energy X-ray absorptiometry (DXA) and ultrasound scans These techniques will establish BMD at a particular time Using serial DXA measurements it is possible to measure a change in BMD over a set period of time It is presumed that these measured changes in BMD are caused by alterations in bone turnover, but they are not direct measurements of bone turnover Furthermore, DXA scans and ultrasound can only indicate that loss of BMD has occurred, a single measurement cannot indicate that bone loss is occurring, and might lead to a lowered BMD in the future These radiological and ultrasound techniques have other limitations, not least inherent imprecision of the methods, which means that there have to be considerable changes in bone turnover before changes in BMD can be noticed For example, the 1–2% imprecision of DXA measurement limits scanning to 6-monthly intervals, so that observed changes are certain to be owing to bone loss and not imprecision The skilled nature of these techniques combined with the need for special equipment, and in the case of DXA exposure to ionizing radiation, has fueled the search for useful and reliable markers of bone turnover