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Biomedical subjects

G Slavin

Publications and source records attributed to G Slavin.

At least 73 records · Page 4Linked to original sources

Immunocytochemical studies of blood group A, H, I, and i antigens in gastric mucosae of infants with normal gastric histology and of patients with gastric carcinoma and chronic benign peptic ulceration.

Indirect immunofluorescence studies of blood group A, H, I, and i antigens were performed on the gastric mucosae and tumor tissues of patients with gastric carcinoma, on the mucosae of patients with chronic benign gastric ulceration, and on the mucosae of infants who had died of causes other than gastrointestinal disease. The following findings were of particular interest: (1) Normal 'secretor' type mucosae were distinguishable from 'non-secretor' type mucosae by the uniform staining of the A or H antigens at the surface and in the pits. Normal 'non-secretor' type mucosae showed little staining of the H or A antigens but, instead, there was staining with anti-I(Ma) antibody. Staining with anti-I(Step) and anti-i(Den) did not show a clear correlation with the 'secretor'/'non-secretor' status of the normal mucosae. (2) Apparently normal areas of gastric mucosae of patients with gastric carcinoma or the normal part of gastric mucosae of patients with benign gastric ulcer frequently showed focal areas of loss or gain of the blood group antigens as is often seen in gastric carcinoma tissues. (3) In the mucosae of patients with intestinal metaplasia there was marked loss of A/H antigens in 'secretors' and I(Ma) antigen in 'non-secretors'. (4) Staining characteristics of tissues from gastric carcinoma were:(a) Focal loss of the expected A/H or I antigens was observed with much variation in staining from area to area, but only a minority showed complete loss of the expected staining. (b) A majority of the carcinomas from 'secretors' showed foci of substantial staining with anti-I(Ma) in contrast to normal 'secretor' mucosae. This is probably due to incomplete biosynthesis of A/H determinants. (c) Incompatible A-like staining by a rabbit anti-A serum was observed in one out of nine adenocarcinomas from blood group B or O persons. (d) A few cases showed substantial i antigen staining. The aberrant expression of blood group A, H, I, and i antigens in neoplastic as well as in some areas of morphologically normal mucosa of patients with benign and malignant diseases of the stomach is discussed in the context of current biochemical knowledge.

ABO Blood-Group System↗

Jejunal mucosal morphometry in children with and without gut symptoms and in normal adults.

Nineteen diagnostic peroral biopsy specimens from 18 children without diarrhoea, vomiting, or abdominal pain ('control' children) were compared with those taken from 23 children with diarrhoea of varying aetiology to establish the morphometric characteristics of jejunal mucosa in childhood. Comparison was also made with normal jejunal mucosa from adults. Statistical analysis of each characteristic individually showed no significant difference between the 'control' children and those with diarrhoea, but there were significant differences between the mucosae of 'control' children and those of adults; the villi tended to be shorter and the crypts longer in children. Thirty-seven per cent of specimens from the 'control' children showed a partial villous atrophy, that is, they were abnormal by adult criteria. Discriminant analysis of the features measured showed effective separation of the following groups: normal histology from partial villous atrophy in children, healthy adults from 'control' children, and normal histology in adults from normal histology in children.

Adult↗

Fibre type changes in striated muscle of alcoholics.

Striated muscle from patients taking more than 80 g of alcohol each day shows selective atrophy of the type II fibres which are dependent on glycogenolytic pathways. This atrophy is associated with an excess of glycogen and lipid within the fibres and may represent a selective metabolic insult.

Adult↗

Hypothyroid myopathy. A clinical and pathologaical study.

Ten patients with varying degrees of hypothroid myopathy were studied clinically and by serial percutaneous needle muscle biopsies before and during treatment with L-thyroxine. The biochemical evidence of hypothyroidism was related to the severity of the myopathic and signs before treatment. The severity of myopathic symptoms before and during treatment correlated with the biochemical evidence of hypothyrodism, a type II fibre atrophy and increased central nuclear counts. Likewise, the clinical evidence of a myopathy before and during treatment was correlated with both a type II fibre atrophy and loss and increased central nuclear counts but was not related to the biochemical parameters of hypothyroidism, except the level of thyroid stimulating hormone. In the muscle, before and during treatment, of the two most severely affected patients, intracellular glycogen inclusions were seen in scattered muscle fibres. On light microscopy and on electronmicroscopy, numerous mitochondria were seen responding to L-thyroxine with accumulations of subsarcolemmal honey-combing. Vesicular abnormalities, an electron dense matrix or occasional crystalline deposits were seen in muscle mitochondria from less severely azffected patients. Severely myopathic muscle contained excessive glycogen, membrane bound glycogen and excess lipid in a mainly perinuclear distribution. Occasional myelin and membranous bodies were seen and satellite cells during the recovery phase. A group of patients with hypothyroid myopathy who are likely to have a delayed recovery of full muscle strength on L-thyroxine may be recognised by the presence of severe proximal muscle weakness and characteristic changes on histochemical and electronmicroscopic examination of muscle. The spectrum of histochemical and electronmicroscopic abnormalities of muscle revealed with increasing degree of hypothyrodism, suggests that a generally reversible acquired glycogen storage and mictochondrial disorder is an important feature in the pathogenesis of this condition.

Adult↗

Posterior intercostal nerve block for pain relief after cholecystectomy. Anatomical basis and efficacy.

The human intercostal space has been studied by excision of the posterior part of the rib cage at autopsy, followed by fixation, decalcification, section and staining. Injection of India ink was used to simulate local anaesthetic. At a point 7 cm from the midline, the distance from the posterior aspect of the rib to the pleura averaged 8 mm. The intercostal nerve usually comprises a number of small bundles without any enclosing fascial sheath. The bundles lie in a triangular space bounded by the rib, the posterior intercostal membrane and the intercostalis intima muscle. The first two appear impervious to the spread of an injected solution, but the last permits spread of the injection round the internal aspect of the rib to gain access to the intercostal spaces above and below that into which the injection has been made. An injection of 3 ml will also spread medially to enter the paravertebral space and surround the sympathetic chain. A small clinical study gave excellent analgesia after operation for a mean duration of 12.3 h following unilateral intercostal block with 3 ml of bupivacaine 0.5% (with adrenaline) into each of the intercostal spaces T5-11, before cholecystectomy through a subcostal incision. There were no complications in the series.

Cholecystectomy↗

Muscle biopsy in polymyositis and dermatomyositis: a clinicopathological study.

The initial muscle biopsies of 30 patients with active polymyositis or dermatomyositis have been assessed histologically and morphometrically. Only 1 patient (3.3%) had a normal biopsy, while 3 had a normal electromyograph and 8 had a normal serum CPK level. No significant morphological differences were found between the various diagnostic subgroups. Sequential biopsies of 11 of these patients treated either with corticosteroids only or with intensive immunosuppression were studied. With response to treatment atrophy factors, variability coefficients, internal nuclei count, and the various histological changes improved in the whole group of patients. However, there was no consistent correlation between any of the morphological features or between these and clinical parameters in individual patients. The percentage of fibres with internal nuclei in the initial biopsy was lower (P < 0.001) in patients responding to up to 60 mg prednisolone per day than in those who eventually required cytotoxic drugs in addition.

Adolescent↗

Measurement in jejunal biopsies by computer-aided microscopy.

A method of morphometric analysis of jejunal mucosa using computer-aided microscopy is described. It is based on the technique of interactive computer graphics with definition by the observer of areas and lengths for measurement, but it also includes automatic measurements based on grey-level segmentation. The analyses are performed rapidly and efficiently. The technique is applicable to the analysis of biopsy tissue from many sites.

Adult↗

Two populations of type I fibres in striated muscle from a case of neutral lipid storage disease.

Percutaneous needle biopsy of the vastus lateralis muscle was performed in a patient with a generalised accumulation of neutral triglyceride. Light microscopy revealed a type I fibre predominance, with neutral lipid droplets in both fibre types but larger and with a greater quantity of lipid per unit area in the type I fibre population. Within type I fibres there were at least two populations based on the lipid droplet size and total accumulated lipid per cell. These observations are discussed, and it is concluded that they support the hypothesis of metabolic differences within the type I fibre population with respect to the use of free fatty acids as a fuel source.

Adult↗

Fractured neck of femur in the elderly: an attempt to identify patients at risk.

1. During a 15-month period, 110 elderly patients admitted with fractured neck of femur were studied in comparison with 72 elderly control patients undergoing elective surgery admitted over the same period to the same orthopaedic wards. 2. A striking finding was the marked similarity of all variables measured in the fracture and control groups. The principal differences between the two populations were that the fracture patients had a lower mean forearm bone mineral content, and that their serum concentrations of albumin, globulin and phosphate were reduced. 3. Neither measurements of radioisotopic calcium absorption, nor those of the serum concentrations of calcium, 25-hydroxy-vitamin D3 nor alkaline phosphatase provided satisfactory discrimination between the groups. 4. Several indices were devised, based on linear combinations of the test results obtained, in an attempt to predict the liability to future fractures of patients being considered for prophylactic therapy with oestrogens or other drugs. However, further work is required to define an index of improved predictive power and to evaluate it prospectively.

Aged↗

Central nuclear counts in muscle fibres before and during treatment in hypothyroid myopathy.

Serial percutaneous needle muscle biopsies of vastus lateralis were studied in 10 patients who had varying degrees of hypothyroid myopathy. The biopsies were taken before and during treatment with l-thyroxine. Before treatment the most severely clinically affected patients showed type II muscle fibre atrophy and loss, together with increased central nuclear counts preferentially affecting the type II muscle fibre. Both the type II muscle fibre atrophy and loss and the increased central nuclear counts tended to return towards normal values during treatment with l-thyroxine. The severity of myopathic symptoms before and during treatment correlated with the biochemical evidence of hypothyroidism, a type II fibre atrophy, and increased central nuclear counts. The severity of myopathic signs before and during treatment was correlated with both a type II fibre atrophy and loss and increased central nuclear counts. There was no evidence that the myopathic signs before and during treatment were related to the biochemical parameters of hypothyroidism, except the level of thyroid stimulating hormone. It is suggested that sequential studies of muscle fibre percentages, diameters, and central nuclear counts may provide an additional method of assessing the response to treatment in hypothyroid and possibly other types of myopathy. When increased central nuclear counts are confined to a specific muscle fibre type, this may suggest a hitherto unsuspected specificity of muscle fibre damage.

Adult↗

Alveolar-capillary membrane permeability. Correlation with functional, radiographic, and postmortem changes after fluid aspiration.

An index of permeability of the alveolar-capillary membrane was derived from the relative extraction from the lung into arterial blood of 2 tracers, 125I-antipyrine and 51Cr-ethylenediaminetetraacetate. The effect on this index of aspirating 2 ml of isotonic saline, distilled water, or 10(-1) M hydrochloric acid per kg of body weight was studied in 3 groups of rabbits. The severity and time course of changes in the permeability index were correlated with changes in lung mechanics, gas exchange, serial chest roentgenograms, ratio of extravascular lung water to dry weight, and histologic findings. Aspiration of saline produced no change in the permeability index; aspiration of water produced a large mean +/- SEM increase in the index, from a baseline of 0.025 +/- 0.002 to 1,050 +/- 0.054 (P less than 0.001), but this value returned to baseline 15 min later. After hydrochloric acid, the permeability index increased from a baseline of 0.027 +/- 0.003 to 1.068 +/- 0.098 (P less than 0.005), with no evidence of resolution after 60 min. Changes in lung mechanics, gas exchange, and roentgenograms were smallest after aspiration of distilled water and greatest after aspiration of hydrochloric acid. The functional changes after aspiration of water and saline recovered at a rate proportional to the known clearance rates of these liquids from the lung. The changes after hydrochloric acid either showed no tendency toward recovery or, in the case of the roentgenograms, worsened with time. There were no detectable histologic abnormalities or an increase in the ratio of extravascular lung water to dry weight after aspiration of water or saline, but there were extensive histologic abnormalities and a 70 per cent increase in lung water after acid. The increase in the permeability index after aspiration of water was too transient to exert a deleterious effect. In contrast, the persistence of the increase in the permeability index after hydrochloric acid was associated with persistent functional changes attributable to the considerable increase in lung water.

Animals↗

'Big ACTH' and calcitonin in an ectopic hormone secreting tumour of the liver.

A young man presented with rapidly developing Cushing's syndrome which was due to the ectopic secretion of ACTH and beta-MSH-like material from hepatic tumour deposits, possibly originating from biliary radicals. This association of the ectopic ACTH syndrome has not previously been described. During the 22 month course of the illness the plasma immunoreactive ACTH and 'beta-MSH' concentrations rose by logarithmic progression. The plasma calcitonin concentration was also raised but did not change during the last 12 months. At any stage of the illness the plasma concentration of the ecotopically produced hormones was stable except that after hydrocortisone there were inconstant variations. During the course of the illness the ectopic ACTH became biologically less potent. This ineffectural ACTH was present in the plasma, in the tumour, and in the medium in which the tumour was cultured, in a large molecular weight form. This 'big ACTH' differed from the normal ACTH found in the patient's pituitary and from authentic ACTH in its immunochemical character: the C-terminal antigenic determinant (33-39 region of ACTH) was masked in the large molecular weight form but was uncovered after extraction in neutral buffer and this 'big ACTH' was more readily extracted from the tumour at pH 7.0. The tumour tissue also contained immunoreactive beta-MSH-like material and immunoreactive calcitonin which resembled calcitonin M chromatographically.

Adolescent↗

Nodular lymphoid hyperplasia of the bowel in primary hypogammaglobulinaemia: study of in vivo and in vitro lymphocyte function.

In vitro and in vivo lymphocyte function was studied in six patients with primary hypogammaglobulinaemia and nodular lymphoid hyperplasia (NLH) of the bowel. Lymphocyte transformation, numbers of circulating T and B lymphocytes, and delayed hypersensitivity skin tests did not significantly differ when compared with hypogammaglobulinaemic patients without NLH. However, patients with NLH had higher jejunal juice IgM concentrations and a tendency to higher serum IgM concentrations than those without NLH. The morphological features of NLH are similar to the germinal centres of lymph nodes but more closely resemble the follicle zone of Peyer's patches. These findings suggest that NLH represents a local immune response to antigens originating in the gut lumen.

Adolescent↗