Biomedical subjects
D I Shepherd
Publications and source records attributed to D I Shepherd.
Prevalence of multiple sclerosis in Rochdale.
The prevalence of multiple sclerosis in the Rochdale Metropolitan Borough in the north east of Greater Manchester has been established. Case ascertainment was partly prospective via a neurological register from 1979 and by contact with general practitioners, therapists, and social services. On prevalence day, 1 January 1989, 254 patients with multiple sclerosis were living in Rochdale. The overall prevalence was 122/100,000 population and 96/100,000 population for probable cases only. The peak rate for women aged 35 to 44 years was 437/100,000 population and for men aged 45 to 54 years 221/100,000. Familial multiple sclerosis was present in 10.8% of families. In this, the first study in north west England, the prevalence of multiple sclerosis in Rochdale is similar to that in southern England and Wales but lower than that in Scotland.
Cortical blindness in a 35-year-old man.
Explore the source record for details and available documents.
Acute neuromuscular respiratory paralysis.
Explore the source record for details and available documents.
Internuclear ophthalmoplegia and Horner's syndrome due to presumed giant cell arteritis.
Explore the source record for details and available documents.
A critical appraisal of in-patient neurological services in a subregional centre.
A computer database was established for the medical audit of admissions to the North Manchester General Hospital neurology unit. Over a six-month period, 277 patients completed 300 hospital stays. A higher proportion of patients were admitted from the North Manchester District compared with the peripheral districts served by the unit, suggesting that more neurology in these areas was performed by general physicians. This supports claims for an increase in the number of neurologists to improve the quality of service at district level. The introduction of a programmed investigation unit, closed at weekends, would allow financial savings since 60% of cases did not require a bed at the weekend. It would also allow more efficient pre-booking of investigations. The diagnostic yields from routine B12 and folate levels, syphilis serology, thyroid function tests, chest radiography and electrocardiography were low and should be replaced by more selective investigations. Savings might also be made by performing the 38% of myelograms restricted to the lumbar region in the out-patient department. The introduction of out-patient magnetic resonance imaging will make significant savings by obviating the need for many of the inpatient myelograms which were required in 55 patients. The simple and relatively inexpensive technology used in this study provided medical staff with valuable information on which to base changes in practice and evaluate their consequences.
Deficiencies in anti-acetylcholine receptor antibody measurement in myasthenia gravis.
In a retrospective case note study of 86 patients with myasthenia gravis, 60 had an anti-acetylcholine receptor antibody assay performed by the regional immunology laboratory. Antibody was detected in 38% which compares with 66-93% in other series. Whilst the use of staphylococcal protein A to precipitate the antibody-receptor complex, rather than anti-human immunoglobulin, may be partly responsible for this low sensitivity, other methodological problems are likely to exist. It is suggested that this potentially critical assay becomes a subject for regular audit.
Increased risk of multiple sclerosis among nurses and doctors.
Explore the source record for details and available documents.
Hyperextension injuries to the cervical cord in the elderly.
Explore the source record for details and available documents.
Relative efficacy of intravenous methylprednisolone and ACTH in the treatment of acute relapse in MS.
To compare the efficacy of high-dose intravenous methylprednisolone with intramuscular ACTH in the treatment of acute relapse in multiple sclerosis, we undertook a double-blind, randomized, controlled study involving 61 patients. There was a marked improvement in both groups in the course of the study, but no difference between them in either the rate of recovery or the final outcome. High-dose IV methylprednisolone is a safe alternative to ACTH in the management of acute relapse in MS.
Delayed somatosensory evoked potentials in pernicious anaemia with intact peripheral nerves.
Explore the source record for details and available documents.
Formed visual hallucinations with pituitary adenomas.
Explore the source record for details and available documents.
A further prevalence study of multiple sclerosis in north-east Scotland.
A second epidemiological study of multiple sclerosis (MS) in north-east Scotland has confirmed that the area has the highest prevalence rate in the world for any population of comparable size. On 1 December 1973 the prevalence was 144 per 100000 population. The age and sex specific prevalence rates are the highest ever recorded, one in every 306 of the population aged 40 to 59 years being affected. All patients have been tabulated in the National Health Service Central Register to facilitate future studies. The MS mortality rate in north-east Scotland is similar to the rate for the whole of Scotland. Throughout most of Scotland, therefore, MS probably is as prevalent as it is in the north-east.
Clinical features of multiple sclerosis in north-east Scotland.
The clinical features of multiple sclerosis (MS) in north-east Scotland have been examined along with an epidemiological study to determine the prevalence of the disease on 1st December, 1970. Patient information was collected from all available diagnostic indices, both retrospectively and prospectively from 1965. Every family doctor in the region contributed. The age and sex specific prevalence rates for MS in north-east Scotland on 1st December, 1970, are the highest ever recorded. Among the 80,000 women aged 40 to 69, one in every 340 had the disease. The mean incidence rate for a 12-year period was 5.0/100,000. A significantly better prognosis with regard to disability was found for onset with sensory symptoms, a relapsing/remitting type of course, men with long disease duration, and an initial remission period of 4 or more years. The occurrence of various abnormal neurological signs and symptoms has rarely been recorded in a large epidemiological study. The findings in this study, however, are similar to previous non-epidemiological studies.
Prevalence of multiple sclerosis in north-east Scotland.
Explore the source record for details and available documents.
Prevalence of multiple sclerosis in north-east Scotland.
An epidemiological study of multiple sclerosis (MS) in north-east Scotland was carried out based on data correct on 1 December 1970. The prevalence of MS was 127 cases/100 000 population, which is greater than in any other surveyed area with a comparable population. The disease was not spread homogeneously within the region, and in one district one in 400 people was affected. The geographical distributions of MS and the presence of HLA antigens A3 and B7,which are associated with the disease, are remarkably similar, and the prevalence of B7 in north-east Scotland is higher than elsewhere. This may partly explain the high prevalence of MS in this area, but the essential additional environmental factor remains to be established.
Adult-onset hereditary ataxia in Scotland.
A systematic search for cases of adult-onset hereditary ataxia was conducted on location in Scotland. The investigation resulted in the discovery of eight pedigrees with 42 patients of whom 16 were alive in 1975. Nine patients were examined by the authors and recent hospital records were available on the remaining seven. The clinical features were quite variable. In declining order of frequency, findings were gait and limb ataxia, dysarthria, hyperreflexia, extrapyramidal motor disturbances, impaired vibratory sense, spasticity, defects of extraocular movements and nystagmus, reflex depression, Babinski signs, impaired joint position sense, muscle weakness, optic atrophy, and mental abnormalities. Foot deformity occurred only once. Inheritance was compatible with autosomal dominant transmission, but complicated by consanguinity in two families. The minimum prevalence was calculated as 0.31/100,000. Autopsy in two members in one family revealed olivopontocerebellar degeneration.