Biomedical subjects
D Lomas
Publications and source records attributed to D Lomas.
Characterization of a new variant of alpha(1)-antitrypsin E(Johannesburg) (H15N) in association with asthma.
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Dysfunctional variants and the structural biology of the serpins.
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Liver transplantation for hepatic arteriovenous malformation in hereditary haemorrhagic telangiectasia.
Symptomatic hepatic involvement is a rare complication of hereditary hemorrhagic telangiectasia and most commonly consists of fibrosis or cirrhosis. We describe a 33-year-old woman in whom multiple hepatic arteriovenous malformations led to high output cardiac failure and liver failure due to biliary necrosis with refractory biliary sepsis, requiring orthotopic liver transplantation. Hepatic arteriovenous malformations were the first manifestation of the disease and a similar asymptomatic hepatic tumour was subsequently detected in her 60-year-old father who also had the classical cutaneous stigmata of the syndrome. Unrecognised genetic factors may determine the clinical spectrum of hereditary haemorrhagic telangiectasia including the hepatic manifestations.
Diagnosis of the painful hip by magnetic resonance imaging and arthroscopy.
We have compared the findings of MRI with those of hip arthroscopy in 23 hips in young adults with hip pain. Large deep cartilage deficiencies on the acetabulum or femoral head, the percentage of femoral head cover, and the presence of marginal osteophytes seen on MRI correlated well with those seen at arthroscopy, but chondral softening, fibrillation, or partial-thickness defects less than 1 cm in diameter were less consistently detected by MRI. Osteochondral loose bodies and labral tears were not well demonstrated by MRI, but were readily identified and treated at arthroscopy. Arthroscopy of the hip is a useful investigation for hip pain in young adults especially when standard non-invasive MRI fails to provide a clear diagnosis.
Fat necrosis. An unusual cause of polyarthritis.
Metastatic fat necrosis is a form of lobular panniculitis which together with synovitis is an unusual complication of pancreatic disease. It can precede an attack of pancreatitis. Pancreatic disease should therefore be remembered as a cause of panniculitis. Serum amylase and abdominal ultrasonography should be considered to exclude pancreatic disease in cases of panniculitis of uncertain etiology. We describe a case of metastatic fat necrosis and discuss the appearance on magnetic resonance imaging.
Assessment of soluble parameters in sputum.
The concentrations of soluble protein in lung secretions are dependent upon the degree of inflammation, local production and cell activation. Infections and corticosteroid therapy will alter the protein content of lung secretions as a result of their effect on lung inflammation.
Inflammatory indices for chronic bronchitis and COAD. Proteases and antiproteases.
The study of lung secretion proteinases and their inhibitors, both functionally and quantitatively, provide information concerning the degree of inflammation in the lung. Interpretation of individual parameters may be difficult in isolation. However, a general pattern of response provides supportive evidence of a reduction in lung inflammation, including 1) reduction in plasma inhibitor concentrations, 2) increase in local inhibitor concentrations, 3) increase in enzyme inhibition, and 4) reduction in enzyme activity. Thus such changes provide an objective basis for the assessment of drug therapy.
Medical imagery in the art of Frida Kahlo.
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The cost of acute asthma--how much is preventable?
Asthma is known to be widely under-treated, and unnecessary morbidity from the disease is common. This paper reports a prospective survey of hospital admissions for acute asthma and assesses the efficacy of pre-admission therapy in terms of preventing hospital admission. District and national costs were estimated for hospital admission of patients with acute asthma and, although the direct cost to the patients was not measured, a calculation was made of the number of working days lost annually. The results of this survey show the need for improved education of both doctors and patients, and in particular for improved clinical management. The findings also suggest that the cost to the patient, including those costs incurred by hospital admission, are potentially preventable.