Biomedical subjects
Publications and source records attributed to H Lander.
Two case histories are presented which illustrate the fact that acute functional psychoses may simulate delirium. It is suggested that the term "pseudodelirium" may alert clinicians to this possibility, and facilitate the earlier diagnosis and treatment of psychiatric illness.
Lymphocytes lacking receptors for sheep erythrocytes and surface immunoglobulin were present in the blood in large numbers at some stage in four cases of chronic lymphocytic leukaemia (which included a mother and son), and formed a substantial proportion of the circulating lymphocytes in other cases. These null cells possessed receptors for mouse erythrocytes. Other B-cell markers were also found on these cells. Serial studies showed a great variation in the number of null cells during the course of the disease (which may be associated with treatment), suggesting variation in the the maturation of leukaemic cells, and indicating that the surface marker complement may not reflect the constitution of the cell undergoing the original malignant change.
A retrospective evaluation of stories told to three Thematic Apperception Test (TAT) cards by children at risk isolated six characteristics that were associated with functioning six to 10 years later. The characteristics included lack of individual initiative, denial of mother-child relationships, denial of negative outcomes, and lack of autonomy. The TATs of children at risk (due to one parent's hospitalization for a psychotic illness) who subsequently suffered major decompensation themselves (requiring hospitalization or intensive outpatient therapy) could be discriminated from those of children at risk with apparently normal development. The TAT characteristics were independent of the level of adjustment at the time the TATs were administered, not related to the child's IQ, socioeconomic status, race, or other family characteristics, and moderately negatively correlated with story length.
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A method has been developed for the estimation of iron, copper, zinc, calcium and magnesium in human platelets using atomic absorption spectrophotometry. Fe and Cu are either absent or present in very low concentration approaching the limit of detection: Zn, Ca and Mg are readily detectable. EDTA is preferable to ACD(A) or heparin as the anticoagulant for collection in that the platelet yield is reliable: however, slightly low results for Ca and Mg are obtained. Corrections for residual plasma and contaminating red cells are essential. Plasma and platelet metal levels in 33 normal subjects are reported together with the findings in four studies undertaken on platelets obtained from subjects with polycythemia vera.
Technetium-99m-pyridoxylideneglutamate (99mTc-PG) is a nontoxic radiopharmaceutical that was found to undergo rapid biliary excretion in normal humans. The biliary tree and gallbladder were seen within 10-15 min of injection and by 20 min marked accumulation of radioactivity was noted in the gallbladder and gastrointestinal tract. Of ten "control" volunteers, seven had normal 99mTc-PG-cholescintigrams. In the remaining three, the gallbladder was not visualized. Gallbladder disease was not excluded in these three subjects. Of 24 patients referred for investigation of right upper quadrant abdominal pain, 13 proved to have gallbladder disease. All seven patients with acute cholecystitis and one of four patients with chronic cholecystitis had nonvisualization of the gallbladder on the cholescintigram whereas five patients with chronic cholecystitis or cholesterolosis had normal cholescintigrams. Six of the eight patients with nonvisualization of the gallbladder on cholescintigram had contrast radiologic studies (oral cholecystogram or intravenous cholangiogram or both), and in all six, nonvisualization of the gallbladder was also reported on the contrast study. cholescintigraphy was found to be greatly inferior to contrast radiologic studies in the detection of gallbladder stones. Eleven patients had complete extrahepatic biliary obstruction and this diagnosis was correctly made in all 11 by the cholescintigram. Fourteen patients had incomplete extrahepatic biliary obstruction. The correct diagnosis was made on the cholescintigram in seven but in the remaining seven it was not possible to distinguish between incomplete extrahepatic biliary obstruction and hepatocellular disease. Malignant lesions (carcinomas of head of pancreas, gallbladder, common bile duct or ampulla of Vater) were the cause of obstruction in 10 of the 25 patients with complete or incomplete obstruction and the diagnosis of obstruction due to malignancy was correctly made in 8 of these 10 by means of a scintigraphic equivalent to Courvoisier's sing. Finally, 11 patients had hepatocellular disease and a nonspecific pattern consistent with either imcomplete biliary obstruction or hepatocellular disease was observed on the cholescintigram in all 11. The 99mTc-PG cholescintigram is suggested for a role complementary to that of contrast radiologic studies in the preoperative investigation of patients with possible surgical disease of the biliary tract. Contrast radiologic techniques are advocated as being more appropriate in the nonjaundiced patient with suspected gallbladder disease whereas the 99mTc-PG cholescintigram is advocated as being more appropriate in the patient with jaundice. The value of the 99mTc-PG cholescintigram lies in the confidence with which complete extrahepatic biliary obstruction can be diagnosed. The "scintigraphic Courvoisier's sign" seems a useful indicator of malignant obstruction.