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Biomedical subjects

D A Fitzgerald

Publications and source records attributed to D A Fitzgerald.

At least 19 recordsLinked to original sources
PubMed1998

Cancer precursors.

A significant proportion of cutaneous malignancies arise from well-defined precursor lesions that have often been present for many years. This provides an opportunity to reduce rates of skin cancer by recognition and treatment of these lesions. Precursors of keratinocytic malignancy, such as actinic keratoses and Bowen's disease, are extremely common in the older, white population and will frequently be encountered by generalist physicians in the context of examinations for noncutaneous conditions. Less common conditions, such as erythroplasia of Queyrat and nevus sebaceous, are associated with a higher risk of malignant change, and their recognition is therefore imperative. The management of the various precursors of melanoma remains controversial, as the exact risk of malignant transformation of many of these lesions is still unclear.

Bowen's Disease↗
PubMed1998

Treatment of acute asthma: salbutamol via jet nebuliser vs spacer and metered dose inhaler.

OBJECTIVE: To compare the efficacy of salbutamol delivered by jet nebuliser (JN) with salbutamol via a pressurised metered dose inhaler (PMDI) and a large volume spacer (Volumatic) for management of acute asthma. STUDY POPULATION: A total of 160 children aged from 4 to 12 years presenting to an Emergency Department with acute asthma. METHODS: The study was of multicentre (n=5) randomised, double blind, parallel design. Children weighing less than 25 kg received salbutamol 2.5 mg via the JN or 600 microg (six puffs) from the PMDI. Children over 25 kg received salbutamol 5 mg via the JN or 1200 microg (12 puffs) via the PMDI. Clinical score (range 0-12) and PEF (over 7 years) were recorded at baseline and 15, 30, 45 and 60 mins post administration. RESULTS: The improvement from baseline at 30 min in the clinical score was 1.87 for JN and 1.43 for PMDI (P=0.09) and at 60 min was 2.15 for JN and 1.12 for PMDI (P=0.0001). The improvement in PEF at 30 min was 51 L min(-1) for JN and 27 L min(-1) for PMDI (P=0.0007) and at 60 min was 57 L min(-1) for JN and 31.5 L min(-1) for PMDI (P=0.001). CONCLUSION: Administration of salbutamol via a PMDI and a large volume spacer device provides effective relief in the management of acute asthma in children, but to a lesser extent than a jet nebuliser. This difference may represent a dose response effect.

Acute Disease↗
PubMed1997

Risk factors for ischaemic heart disease in patients with dermatitis herpetiformis.

For reasons that are unclear, patients with dermatitis herpetiformis (DH) have a lower than expected mortality rate from ischaemic heart disease. We have compared risk factors for ischaemic heart disease (lipids, fibrinogen levels, smoking history and social class) in 29 DH patients and 57 controls matched for age and sex. Patients with DH had significantly lower cholesterol, triglycerides, apolipoprotein B and fibrinogen and higher HDL2; they also smoked less and were of higher social class. The mechanisms underlying these observations merit further investigation. Intestinal abnormalities or gluten-free diet may account for differences in lipid fractions, and the immunomodulatory properties of cigarette smoke may protect against the development of DH.

Aged↗
PubMed1996

Phenotypic changes and proliferation of adrenocortical cells during adrenal regeneration in rats.

Adrenal regeneration after enucleation includes both cell proliferation and differentiation, but the phenotype of the proliferating cell remains controversial. Immunoperoxidase localization of cytochrome P450 aldosterone synthase (P450aldo) and cytochrome P450 11 beta-hydroxylase (P45011 beta) and of Ki-67 was used to identify adrenocortical cell phenotypes and proliferating cells, respectively. Comparisons were made between regenerating and intact adrenals collected from rats on low or normal Na+ diets. During the first week after enucleation, P45011 beta was expressed reflecting the presence of fasciculata cells; however, P450aldo was detected only in adrenals from low Na+ rats. On normal and low Na+, glomerulosa cells were replaced by intermedia cells, whereas on low Na+, glomerulosa cells were replaced by fasciculata cells. Proliferation was observed only in glomerulosa and fasciculata, but not intermedia cells. These findings suggest that the expression of the glomerulosa cell phenotype is decreased in the early stages of adrenal regeneration, that differentiation from a glomerulosa to an intermediate or fasciculata cell phenotype is influenced by low Na+ and that glomerulosa and fasciculata cells proliferate in response to enucleation.

Adrenal Cortex↗
PubMed1996

Chest radiograph abnormalities in very low birthweight survivors of chronic neonatal lung disease.

OBJECTIVE: To determine whether the neonatal chest radiograph (CXR) at 28 days in very low birthweight (VLBW) infants who develop chronic neonatal lung disease (CNLD) predicts oxygen therapy duration or CXR abnormalities in early childhood. Also, to assess the inter-observer reliability of the radiologists scoring the CXR. METHODOLOGY: Clinically well survivors of CNLD (n = 46) had neonatal CXR scored (mean age 28.5 days) and compared with current CXR (mean age 40 months). The CXR were scored independently and 'blindly' by two paediatric radiologists using a standardized scoring system (range 0-10). RESULTS: There was no correlation between neonatal CXR scores and current CXR scores for either radiologist. There was no association between CXR severity scores and duration of oxygen therapy for either neonatal or current CXR. Radiologist A scored the current CXR significantly more abnormal than radiologist B [medians (range): 3 (1-6) vs 1 (0-5), P < 0.001] with reasonable correlation (r = 0.593, P < 0.005) but worse than chance agreement (kappa = -0.034). The median scores for the neonatal CXR were similar [1.5 (0-8) vs 2 (0-8), P = 0.789] and again there was good correlation (r = 0.760, P < 0.0005) although poor individual agreement (kappa = 0.243) between radiologists. CONCLUSIONS: Follow-up CXR abnormalities in VLBW infants with CNLD are usually minor and are not predictive of the duration of oxygen therapy that will be required nor of the CXR appearance in early childhood. Considerable inter-observer variation exists in the interpretation of the CXR in CNLD.

Bronchopulmonary Dysplasia↗
PubMed1995

Cutaneous infection with Mycobacterium abscessus.

Cutaneous infection with rapidly growing mycobacteria is uncommon and diagnosis may be difficult. However, the histopathological features are distinctive and may aid diagnosis. The three pathogenic species, Mycobacterium fortuitum, M. chelonae and M. abscessus, show major differences in their antimicrobial sensitivities, and species identification is therefore important. We describe a case of infection with M. abscessus, and discuss the clinical and pathological features of such infections, and approaches to their treatment.

Aged↗
PubMed1994

Follicular toxic pustuloderma associated with allopurinol.

Allopurinol is widely prescribed for primary and secondary hyperuricaemia, and cutaneous adverse reactions are seen in 0.8-2.1% of recipients. The majority of these are mild and include pruritus, diffuse or maculo-papular erythema, urticaria and ichthyosis. More severe reactions are well recognized and include exfoliative dermatitis, toxic epidermal necrolysis and a generalized hypersensitivity syndrome. The latter typically comprises fever, rash, hepatic and renal dysfunction and eosinophil leucocytosis. The occurrence of toxic pustuloderma due to allopurinol, confirmed by re-challenge, is reported.

Allopurinol↗