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Biomedical subjects

G J Hardy

Publications and source records attributed to G J Hardy.

At least 19 recordsLinked to original sources
PubMed1997

Massive osteolytic bone metastases from a primary aortic sarcoma: a case report.

We present an unusual case of an aortic intimal sarcoma, which originally manifested itself by the presence of extensive radiologically osteolytic lesions in the long bones of the lower limbs. The histology of these was puzzling and was first considered to represent a low grade sarcoma of vasoformative tissue and subsequently skeletal angiomatosis. Despite a good initial clinical response to disodium etidronate, the patient ultimately developed small bowel infarction and the true diagnosis only came to light at autopsy. This revealed a tumour in the lower thoracic aorta which, unusually for aortic sarcoma, consisted of loosely packed bland spindle cells with no necrosis and infrequent mitoses. Immunocytochemistry was unhelpful but electron microscopy suggested myofibroblastic differentiation. The majority of previous reports of the tumour in the literature lack information on electron microscopy and immunocytochemistry and have suggested that these tumours are generally pleomorphic in appearance. Embolic phenomena and post mortem diagnosis are usual although occasional antemortem diagnosis has been made using computed tomography (CT) and magnetic resonance imaging (MRI) scanning with the latter being the investigation of choice.

Aorta, Thoracic↗
PubMed1992

Case report 745: Synovial lipoma arborescens.

A case is presented of lipoma arborescens of the knee with an atypical, sudden onset. Arthrography and ultrasound confirmed a synovially based lesion in the suprapatellar pouch. CT enabled a preoperative diagnosis of lipoma arborescens to be made, which was confirmed by surgical excision of a fronded fatty mass. Histological studies showed hyperplastic villi with mature adipose cells in the subsynovial layer. Resection of the synovium is considered curative, with only one case of recurrence after synovectomy having been reported [4].

Diagnostic Imaging↗
PubMed1992

A flow cytometric, clinical, and histological study of stromal neoplasms of the gastrointestinal tract.

Histological sections of 102 stromal neoplasms of the gastrointestinal tract occurring in 100 patients have been assessed for 23 clinical and histological parameters and the corresponding paraffin embedded (archival) material processed for flow cytometry. Where possible, information as to clinical presentation and survival was obtained. The only absolute criterion for malignancy was the presence of spread of tumour beyond the organ of origin at the time of diagnosis. Of the remaining tumours (i.e., tumours locally confined at diagnosis), those found incidentally at operation and those of a small size (less than 60 mm diameter) behaved in a generally benign fashion. Of the histological parameters, six correlated with malignant behaviour: high mitotic count, high cellularity, marked nuclear pleomorphism, rounded as opposed to spindle cell shape, bizarre mitoses, and vascular invasion. The presence of DNA aneuploidy as shown by flow cytometry correlated strongly with a poor prognosis (p less than 0.0005). Tumours with a high mitotic count [greater than 9 per 10 high-power fields (hpf) (1.59 mm2)] behaved in an almost uniformly malignant fashion. Those with a low mitotic count [less than 3/10hpf (1.59 mm2)], behaved in a benign fashion apart from one case where no mitoses were discernible yet the tumour metastasised and killed the patient. The intermediate group of tumours (3-9 mitoses per 10 hpf inclusive) were difficult to predict, although the majority behaved in a malignant fashion. Within this group the presence of DNA aneuploidy appeared most useful in predicting prognosis.

Adolescent↗
PubMed1990

Primary tumors of the axial skeleton. Experience of the Leeds Regional Bone Tumor Registry.

Primary tumors of the axial skeleton are rare and a survey of the Leeds Regional Bone Tumor Registry found them to constitute only 55 of the 1950 cases (2.8%). Chordoma was the most frequent tumor in the cervical and sacral regions as well as the most common diagnosis overall and osteosarcoma ranked second. Pain was the most frequent presenting symptom but over half the patients developed some neurological abnormality. In spite of treatment survival was poor in patients with malignant lesions or neurological involvement. The establishment of Bone Tumor Registries is the only way that sufficient data on large numbers of these rare tumours can be amassed to provide a valuable and otherwise unavailable source of information for research, education and service.

Adolescent↗
PubMed1989

The Lemierre syndrome: suppurative thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection.

We present 2 cases of the Lemierre syndrome (also called postanginal septicemia), along with 36 other cases from a review of recent literature. A review of the literature during the preantibiotic era is also included. This disease is caused by an acute oropharyngeal infection with secondary thrombophlebitis of the internal jugular vein complicated by multiple metastatic infection. The majority of cases are caused by anaerobic gram-negative organisms, most frequently Fusobacterium necrophorum. An enhanced computed tomographic scan of the neck is the technique of choice to demonstrate the thrombosis of the internal jugular vein. Prolonged intravenous administration of antimicrobial agents known to have a good antianaerobic coverage, along with drainage of purulent collections, will usually be successful in the overwhelming majority of patients.

Adult↗
PubMed1982

Osteomalacia, vitamin D deficiency and cholestasis in chronic liver disease.

Twenty-nine patients with chronic liver disease, nine of whom had symptoms suggesting bone disease, were studied by bone histology. Nine had osteomalacia; six associated with cholestatic liver disease and three with primarily hepatocellular disease. Two of these had clinical and biochemical features of cholestasis for at least a year and the other had alcoholic cirrhosis associated with severe malnutrition. Excluding the latter patient, histological osteomalacia was significantly associated with presence and duration of cholestasis. Plasma 25-hydroxyvitamin D was low and fasting urine hydroxyproline/creatinine ratio was high in all patients with osteomalacia but were abnormal also in some patients who did not have histological osteomalacia. Serum calcium, phosphate, alkaline phosphatase, vitamin D-binding protein and radiology were unhelpful in many patients with osteomalacia. Vitamin D-deficiency correlated significantly with deficiency of other fat-soluble vitamins and those patients with rachitic levels of plasma 25-hydroxyvitamin D showed no seasonal variation, suggesting a combination of malabsorption of vitamin D and reduced sunlight exposure. We suggest that patients with chronic liver disease with cholestasis for at least a year are at risk from osteomalacia and that those likely to have this complication may be identified by plasma 25-hydroxyvitamin D and/or fasting urine hydroxyproline/creatinine ratio measurements. The diagnosis can only be made with certainty by bone biopsy.

25-Hydroxyvitamin D 2↗
PubMed1981

The seeing-eye dog: an infection risk in hospital?

Because an increasing number of blind people are using guide dogs, hospital administrators may receive more frequent requests to allow a guide dog to accompany its blind owner during visit with a hospital patient. This article considers the risks and problems for all concerned if seeing-eye dogs are permitted in hospitals, and proposes a reasonable set of guidelines for hospital personnel to apply when considering these requests.

Animals↗
PubMed1981

Evidence for secondary hyperparathyroidism in the osteomalacia associated with chronic liver disease.

Previous reports have suggested that secondary hyperparathyroidism is extremely uncommon in hepatic osteomalacia. This, together with other findings, has led to suggestions that in chronic liver disease there may be selective resistance of bone to vitamin D or a specific bone mineralization defect unrelated to Vitamin D. To examine these possibilities, twenty-five patients with chronic liver disease have been studied by bone biopsy, serum calcium and inorganic phosphate, plasma 25-hydroxyvitamin D, plasma immunoreactive parathormone (iPTH), fasting urine cAMP, fasting renal tubular maximal reabsorptive capacity for phosphate (TmP/GFR) and fine grain hand x-rays. Nine of the patients had osteomalacia on bone biopsy, eight of these had subnormal levels of plasma 25-hydroxyvitamin D and the other had a borderline result. Based on the consensus of all the tests, five of these had evidence of secondary hyperparathyroidism. Plasma iPTH was higher in patients with osteomalacia than in patients without osteomalacia (P less than 0.01) or controls (P less than 0.01). Urine cAMP was higher in patients with osteomalacia than in patients without osteomalacia (P less than 0.001) or controls (P less than 0.01). TmP/GFR was significantly lower in patients with osteomalacia than in controls (P less than 0.05) but not significantly different from patients without osteomalacia. The findings of this study indicate that hyperparathyroidism occurs in a substantial proportion of patients with the osteomalacia of chronic liver disease. Moreover, osteomalacia in chronic liver disease is clearly related to reduced levels of plasma 25-hydroxyvitamin D. We conclude that hepatic osteomalacia is a vitamin D deficiency state and there is no need to suggest an unusual aetiology.

25-Hydroxyvitamin D 2↗
PubMed1981

Gastritis and cirrhosis--no association.

Endoscopically sited gastric mucosal biopsies were taken from 98 patients with hepatic cirrhosis, and from 48 control patients. Nineteen patients with cirrhosis were found to have gastric ulcers, including eight with multiple erosions. In four of these eight, erosions were shown to arise in histologically normal mucosa. Among the remaining 79 patients with cirrhosis, the prevalence of chronic gastritis was not increased compared with controls of the same age-group. There was no increase in chronic gastritis in patients with alcoholic cirrhosis compared with either controls or patients with chronic active hepatitis and cirrhosis. The increased proneness of patients with cirrhosis to acute and chronic gastric mucosal lesions cannot be explained on the basis of an underlying chronic gastritis.

Adult↗
PubMed1981

Engelmann's disease and the effect of corticosteroids. A case report.

A 13-year-old girl presented with a two-year history of pain in the right thigh and right forearm. Engelmann's disease was diagnosed on the basis of radiological appearances and histological examination of the bone. Her symptoms subsided after biopsy of the bone, but two weeks later she developed severe pain in the left tibia and was unable to walk. Radiological features of Engelmann's disease were found in the left tibia and other long bones although these bones had been radiologically normal one month previously. Treatment with prednisolone gave rapid relief of pain and allowed the patient to become mobile again. Four months later the radiological appearances showed significant improvement. The use of corticosteroids in this disorder is discussed.

Adolescent↗
PubMed1981

Polymicrobial purulent pericarditis.

A 63-year-old man had polymicrobial purulent pericarditis secondary to a silent esophageal perforation into the pericardium. His hospital course was complicated and prolonged. Defunctioning of his esophagus was needed to cure his pericarditis. The authors recommend an aggressive approach to his rare condition, emphasizing the importance of early defunctioning of the esophagus.

Bacterial Infections↗
PubMed1978

Therapeutic experience with netilmicin.

Netilmicin, a new aminoglycoside antibiotic, was used to treat 19 patients with urinary tract infection and 5 with systemic infection. The causal organisms were Escherichia coli (in 2), Klebsiella pneumoniae (in 4), Serratia marcescens (in 12) and Pseudomonas aeruginosa (in 7); 1 patient was infected with two of these organisms. All the isolates of causal organisms except one of Serratia were initially sensitive to netilmicin but many were resistant to other aminoglycosides. Sixteen of the urinary tract infections responded to netilmicin therapy, although relapse occurred in three patients. Two of the three patients with musculoskeletal infection responded to combined therapy with surgery and netilmicin; the other patient responded to the same regimen but with carbenicillin added. Netilmicin cured pneumonia in one patient but failed in the other patient with pneumonia, who had leukemia. Superinfection occurred in five patients with urinary tract infection. Adverse reactions to netilmicin were minor. Netilmicin may prove to be a useful agent, particularly for infections due to multiresistant Klebsiella or Serratia, or when prolonged aminoglycoside therapy is required.

Adolescent↗
PubMed1975

Involvement of the small intestine in systemic mast cell disease.

A patient is reported with mast cell infiltration of the small intestine in the absence of the skin involvement characteristic of mast cell disease. She also had subtotal villous atrophy responsive to a gluten-free diet. Criteria for diagnosing mast cell disease of the small intestine are proposed. The literature of small intestinal mast cell disease is reviewed and the relationship to coeliac disease is discussed.

Adult↗