Remission of angina pectoris: correlation with the stress thallium-201 test.
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Biomedical subjects
Publications and source records attributed to C Patel.
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A case of an X-autosome rearrangement is presented in which part of the Xpter is deleted but the STS and MIC2X loci are retained. The normal X is late replicating in 97/100 lymphocytes and 50/50 fibroblasts examined. It is assumed that the initial X-inactivation in the embryo is random, but that cells with the rearranged X inactivated are selected against because inactivation spreads into the attached autosomal segment. This spreading, through the normally active STS locus, is hypothesised to be caused by deletion of a part of Xpter which is critical for the maintenance of activity of the Xpter region as a whole.
Ten patients with cirrhosis and protal hypertension received an initial 20 mg oral test dose of propranolol and subsequently 160 mg of a slow release preparation, orally, each day for seven days. Protein binding, serial plasma propranolol concentrations and effects on heart rate were studied. Protein binding was slightly reduced (mean 85%, range 78.9-88.1%) compared with four normals (mean 87.9%). In patients with severe liver disease (serum albumin less than 30 g/l) propranolol remained detectable in plasma 24 hours after the single 20 mg dose and high steady state concentrations (mean 266.5 ng/ml, range 84-406) were observed during regular dosing. At steady state there was a significant correlation between log total plasma propranolol concentrations and the percentage fall in heart rate (r = 0.659, p less than 0.05). We suggest that in patients with severe liver chronic disease (serum albumin less than 30 g/l), propranolol therapy should be initiated in hospital. The starting dose should be low (20 mg of the conventional formulation tds or 80 mg of the slow release preparation daily) and that regular monitoring of the heart rate should be carried out.
An autoantibody screen is often requested in patients with non-specific symptoms such as pyrexia of unknown origin. However, in a survey of 100 consecutive requests for this investigation in such patients only one patient was encountered in whom the investigation led to a positive diagnosis at an estimated cost of pound 2500. These requests accounted for 5% of the total workload. These observations reaffirm that this should remain a second line investigation and should be deferred until more likely diagnoses have been excluded.
Actinobacillus actinomycetemcomitans is a very uncommon cause of infectious endocarditis. The organism was first described in 1912. Thjotta and Sydnes reported its isolation in pure culture from a long standing abscess which had developed after tooth extraction. Subsequently this organism was found to be part of the normal flora, and the organism was defined as a slow growing, fastidious gram negative bacillus. Carbon dioxide is essential for the growth of A. actinomycetemcomitans. Approximately 50 cases of endocarditis due to A. actinomycetemcomitans have been reported since the first case reported in 1964. The purpose of this report is to document a case of endocarditis due to A. actinomycetemcomitans and to stress the value of the echocardiogram in the assessment of patients with endocarditis.
A patient is reported who presented with fatal hypothermia. The electrocardiographic changes of a sinus bradycardia, prolonged QT interval and Osborn waves were documented and correlated with body temperature. The possible genesis of these electrocardiographic changes is reviewed in this article.
Although the aetiology of ulcerative colitis and Crohn's disease remain unknown, immunological effector mechanisms become activated within the inflamed mucosa and may be responsible for the pathogenesis of chronic disease. There is an increased production of immunoglobulin within the mucosa, some of which has specificity for bacterial antigens, and complement activation occurs during exacerbation of the disease. Lymphocytes isolated from peripheral blood, or from the intestinal mucosa, are cytotoxic to colonic epithelial cells in vitro; a reaction which can be modulated by serum factors and bacterial antigens. Within the mucosa, there are increased populations of T lymphocytes although there is no change in the ratio of helper- to suppressor-cells as defined by phenotype. Studies of immunoregulatory control have shown that there may be alterations in the modulation of the local immune response, especially during active disease, although it is not clear whether these changes are primary or merely secondary to inflammation. It is posulated that many of the humoral and cellular responses to gut-associated antigens occur as a result of increased antigen absorption, increased presentation of antigen to the immune system due to the expression of Class II antigens by the inflamed epithelium and altered immuno-regulatory control.
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1. An investigation of the intermediates of the urea-diacetylmonoxime reaction and the isolation of the protochromogen has been described. A comparative spectral study of the protochromogen with that of the literature values suggested the structure of the protochromogen to be a diureide. 2. The diureides of 1-phenyl-1,2-propanedione-monoxime and 2,3-pentanedione were synthesized and their visible, U.V., I.R., NMR, and mass desorption spectrometry data were analyzed. The study suggests that the structure of each of these compound is that of a diureide. When these diureides were redissolved in acid media, they gave the color expected of the corresponding chromogens found from the respective diketones and urea. 3. The 3a-methyl-6a-phenyl-glycoluril was synthesized by a base-catalyzed reaction. When this glycoluril was dissolved in concentrated HCl, a pink color was obtained, similar to that of the corresponding diureide. These studies indicate that both the diureide and the glycoluril (if formed at all in acid-catalyzed reaction) are converted to the same chromogen, possibly via a rearrangement. 4. When 2,3-butanedionemonoximethiosemicarbazone was reacted with urea in acid medium, characteristic spectral data were obtained which were very similar to those of the urea-diacetylmonoximethiosemicarbazide reaction. This tends to indicate that the possible structures of the protochromogens are similar and of the open chain diureide type.
Damage to the ciliated cells of the tracheobronchial tree and incidence of postoperative pulmonary complications were measured by point-scoring systems in 202 patients who breathed dry and humidified anesthetic gases for 225 +/- 78 min. The incidence of postoperative pulmonary complications decreased as the humidity of administered anesthetic gases increased from 0 to 32.5 mg H2O/l. A similar relationship was found between the amount of inhaled moisture and the damage to the ciliated epithelium of the tracheobronchial tree. These results appear to indicate that a high inspired humidity is beneficial for operations on normothermic patients, and that cellular damage caused by dryness is a possible contributory factor in the production of the pulmonary atelectasis that follows stoppage of the mucociliary transport system in the immmediate postoperative period.
A unique combination of a Duchenne-like muscular dystrophy in a girl with a translocation-inversion rearrangement involving an X chromosome and a no 1 chromosome appeared as a result of both gene mutation and chromosome mutation in the mother. The X-autosome rearrangement would permit full expression of an X-linked recessive gene, such as that for Duchenne muscular dystrophy, in a female, and this would satisfactorily explain the characteristic Duchenne-like course of our patient's illness. The simultaneous de novo appearance of the Duchenne mutation and the X;1 rearrange suggests possible sites for the Duchenne locus on the X chromosome short arm (at Xp1106 or Xp2107).
Cardiac toxic reactions and pulmonary consolidation in the left lower lobe developed in a patient who was receiving amphotericin B therapy for cryptococcal meningitis. Following surgical resection of the lobe, multiple subcutaneous cryptococcal abscesses appeared. Flucytosine administered intravenously failed to eradicate the lesions. Transfer factor therapy and multiple drainage procedures elimniated the skin abscesses. Transfer factor therapy was administered for one year; the patient was asymptomatic 16 months after therapy was discontinued.
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A scaled-down version of a modified adult circle system capable of increasing normal humidity output 300% was constructed for pediatric use. The moisture content of the gases leaving the system was tested and found to be superior to that of any pediatric circle system commercially available that does not incorporate an electrically heated water vaporizer.
Prospective observations on 442 consecutive samples have confirmed that pregnancies with CNS malformations are regularly associated with an abnormal cellular content of amniotic fluid. A crude semiquantitative test of the cell content can give valuable clinical information in relation to borderline amniotic fluid alpha-fetoprotein values, and help to detect false positive AFP's.
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