Communication of results of necropsies.
Explore the source record for details and available documents.
Autopsy↗
Biomedical subjects
J Spencer
Publications and source records attributed to J Spencer.
Psychiatric diagnostic profiles in hospitalized adolescent and adult Navajo Indians.
Diagnostic profiles of 400 adolescent and 1159 adult Navajo Indians consecutively admitted to a psychiatric unit between 1980 and 1989 are presented in this paper. The major discharge diagnoses for adolescents were as follows: adjustment reaction, mixed, and depression, not otherwise specified (NOS), with females accounting for two-thirds of either diagnosis; schizophrenia, with males accounting for 68% of all diagnoses, and personality disorder, NOS, with no gender differences. The four major discharge diagnoses for adults were schizophrenia and depression, NOS, in which there were no gender differences; alcohol withdrawal, syndrome, in which males accounted for 76% of those discharged; and adjustment reaction, mixed, in which females constituted 60% of those discharged. Over the 10-year period, there was a decrease in adult and an increase in adolescent admissions. During the last 2 years (1988 and 1989) adolescents accounted for almost 30% of all admissions compared with 14% during the first 2 years (1981 and 1982).
Adolescent↗
The intraoperative localization of the obscure bleeding site using fluorescein.
Despite visceral angiography and radiolabeled gastrointestinal scintigraphy, the localization of gastrointestinal bleeding can still be a challenge. Even preoperative localization with visceral angiography is no guarantee of successful intraoperative localization or subsequent pathological confirmation. We report a case of obscure gastrointestinal bleeding of small bowel origin, which was localized intraoperatively by fluorescein injected via a superselectively placed catheter.
Angiography↗
Surgery in Barrett's oesophagus.
Surgical treatment for a columnar-lined oesophagus (CLO) may be considered in terms of indications, procedures and risks. Reflux may be an indication for surgery, but does not lead to reversal of epithelium, nor does it eliminate malignant potential. Whether it reduces such potential is not certain. Anti-reflux surgery is therefore based on reflux-related criteria, and not as a treatment for a CLO. Dysplasia is a possible indication for surgery, but as progression to carcinoma may be slow, must not be considered an absolute indication in an elderly, frail patient. Malignancy is a clear indication for operation in a patient deemed fit enough to withstand it. Anti-reflux operations have been standardized over recent years, and aim at exclusion of gastric juice from the oesophagus. Another approach is to alter refluxed material qualitatively by a duodenal diversion procedure. This eliminates bile and pancreatic juice from the oesophagus, with dramatic effects on inflammation but without reversal of a CLO. Reversal of inflammation may facilitate endoscopic surveillance. Either dysplasia or carcinoma are treated by oesophagogastric resection. Newer forms of laparoscopic or thoracoscopic dissection may be particularly applicable with dysplasia or early carcinoma in CLO. Palliative surgery for advanced tumours is not often required today. Risks of anti-reflux surgery must be balanced against symptoms. Risks are reduced if splenectomy is avoided, and operations avoided where possible in the elderly. Resection for dysplasia or carcinoma is high-risk surgery. In the young there is much to gain, and the risks are lower. In the elderly, in the absence of other treatment, risks must be balanced against general health and life expectancy.
Barrett Esophagus↗
Paraneoplastic follicular hyperkeratosis responsive to etretinate.
Explore the source record for details and available documents.
Adenocarcinoma↗
Phakomatous choristoma of the orbit: a case report.
We report the case of a 3-month-old infant with a rare phakomatous choristoma of the orbit. This lesion is believed to be a congenital neoplasm of lenticular anlage. The clinical, radiological, and histopathological findings are presented.
Choristoma↗
Duodenal ulcer: a model of impaired mucosal defence.
There is a new model of chronic duodenal ulcer in which the ulcer is generated by irradiating the lower mediastinum of mice with a single dose of 18 Gy 250 kV x rays. Single ulcers develop in the proximal duodenum of about half the animals. Previous studies have shown a remarkable morphological and behavioural similarity to duodenal ulcer in man. Ulceration occurs because of an imbalance between aggressive and defensive forces within the duodenum and an attempt has been made to elucidate the pathomechanism of this ulcer by determining acid and pepsin secretion. The basal and pentagastrin stimulated secretion of acid, pepsin, and histamine were measured and no changes in acid or pepsin secretion were shown to occur (risk of type II error < 1%). It is therefore concluded that this chronic ulcer is a model of impaired duodenal defence.
Animals↗
Schizophrenia following prenatal exposure to influenza epidemics between 1939 and 1960.
Explore the source record for details and available documents.
Disease Outbreaks↗
CT evaluation of lymph node status at presentation of prostatic carcinoma.
Computed tomographic (CT) studies performed within a general oncology service in 104 consecutive patients with prostatic carcinoma were reviewed retrospectively to assess the incidence and distribution of lymphadenopathy. All patients were staged with CT at initial presentation, had normal skeletal scintigrams and were candidates for radical radiotherapy. The likelihood of lymphadenopathy was associated with increasing T-stage. 57 of the 92 (62%) patients without lymph node enlargement had local disease confined to the prostate (T2 or less) compared with only two of the 12 (17%) patients with enlarged nodes. Lymph node enlargement was more likely with a primary tumour of poorly differentiated histology. 12 patients (11.5%) had lymphadenopathy by established CT criteria; six with pelvic nodal enlargement alone and six with enlargement of pelvic and retroperitoneal nodes. In all patients pelvic nodal enlargement predominated and no patient had isolated retroperitoneal lymphadenopathy. Our findings indicate that CT staging studies of prostatic cancer do not need to include the retroperitoneum if there is no lymphadenopathy at or below the aortic bifurcation.
Adult↗
Language and complex phenomena.
Explore the source record for details and available documents.
Australia↗
Effects of interferon-gamma and tumour necrosis factor-alpha on epithelial HLA class-II expression on jejunal mucosal biopsy specimens cultured in vitro.
HLA class-II molecules present antigen to the immune system and are expressed by normal villous enterocytes. Increased expression occurs in inflammatory bowel and coeliac disease, and it is suggested that cytokines may mediate such increased expression. The effects of the cytokines IFN-gamma and TNF-alpha on epithelial HLA class-II expressions have been studied in adult human jejunal mucosal biopsy specimens cultured in vitro. Specimens from nine patients with normal jejunal histology were cultured for 24 h with IFN-gamma, TNF-alpha, or both. Six of nine patients showed increased HLA-DR and HLA-DP expression after culture with the cytokines. We have demonstrated that these cytokines induce increased epithelial HLA class-II expression in adult jejunal mucosal specimens cultured in vitro, a model that most closely resembles the in vivo state. This provides further evidence that such increased expression occurs secondarily to the products of immunologic activation.
Biopsy↗
Antibody response to canine distemper vaccine in African wild dogs.
Antibody levels against canine distemper virus were measured by means of an immunofluorescent antibody test prior to, and after, administration of a modified-live virus booster vaccine to seven African wild dogs (Lycaon pictus). Positive seroconversion with no harmful side-effects was seen in all the animals.
Animals↗
Value of scintigraphic localization of obscure gastrointestinal bleeding.
A total of 51 technetium-99m (99mTc)-labelled autologous red cell (LRC) scans performed on 49 patients for the localization of obscure gastrointestinal bleeding over a 5-year period was reviewed. The sensitivity for LRC scanning was 72.7% with a positive predictive value of 84.2%. Forty patients underwent both LRC scanning and visceral angiography during the same admission; angiography had a sensitivity of 38.9% compared with 66.7% for LRC scanning and the positive predictive values were 77.8% and 85.7%, respectively. Overall, the site of bleeding was located in 22 (45%) of 49 patients, but LRC scanning alone was successful in identifying the lesion in 16 (33%) cases. In patients who continue to bleed to the point of requiring operation, a combination of scintigraphy and angiography will localize a source in 70% of patients.
Aged↗
Cell-mediated immune injury in the intestine.
Epithelial adaptation clearly occurs during the course of intestinal cell-mediated immune responses to alloantigens. The adaptive response is similar to that seen in a number of enteropathies, namely villus atrophy, crypt hypertrophy, and crypt cell hyperplasia. In human fetal gut, polyclonal activation of lamina propria CD4+ T cells produces the same epithelial adaptive responses. Although these data provide overwhelming evidence that cell-mediated immune responses can cause enteropathy, the demonstration of antigen-specific T cells in the lamina propria of patients with enteropathy is still lacking, even in a disease as well-characterized as celiac disease. Epithelial adaptation in experimental and clinical situations, however, must involve a change in the mechanisms and mediators involved in normal intestinal homeostasis, such as epidermal growth factor and transforming growth factor-alpha and -beta, and in the interactions between epithelial cells and the underlying stromal cells.
Animals↗
Properties of human thymic B cells.
B cells, distinct from those seen in myasthenia gravis, are present in normal human thymic medulla, concentrated around the Hassall's corpuscles. We have shown that they constitute 33 +/- 4.8% of the total cells in the thymic medulla. In tissue sections they were often seen to have rosettes of thymocytes around them, a relationship which was maintained when the cells were isolated from the thymus. Thymic B cells expressed cytoplasmic immunoglobulins IgD, IgM and IgG but only rarely IgA. Unlike murine thymic B cells, human thymic B cells were CD5-. Freshly isolated thymic B cells were activated cells, but they rapidly became quiescent and died in culture over a 10-day period unless stimulated with mitogens. Thymic B cells responded to polyclonal B-cell activators SAC and TPA and when stimulated, maintained their relationship with thymocytes. Electron microscopic studies showed that two morphologically different thymocyte populations associated with the B cells. The plasma membranes of larger thymocytes were juxtaposed to the B-cell membrane, but smaller thymocytes with darker cytoplasm were associated with the B cells via cytoplasmic strands. Studies in mice have suggested that B cells are involved in thymic negative selection. The close association between activated B cells and thymocytes observed in this study supports this hypothesis.
B-Lymphocytes↗
Ontogenetic aspects of the intestinal immune system in man.
The development of the mucosal immune system in the human fetus has been studied in some detail. Aggregates of T and B cells form early Peyer's patches by 16 weeks gestation and by 19 weeks organised Peyer's patches with T and B cell zones are seen. T cells populate the mucosal lamina propria and epithelium from 11 weeks gestation and increase in number thereafter. As in the adult, most intraepithelial lymphocytes are CD8+ and most lamina propria T cells are CD4+. By 20 weeks, villus epithelial cells are HLA-DR+ and secretory component is also expressed. In the absence of lumenal stimulation in the fetus there is no intestinal secretory IgA antibody response. A few IgA plasma cells are present in fetal salivary glands but the number does not dramatically increase until after birth.
Embryonic and Fetal Development↗
Immediate hypersensitivity in colon of children with chronic Trichuris trichiura dysentery.
There are few data on mucosal immune responses to intestinal helminths in human beings, especially those involving the IgE system, which is thought to be important in parasite expulsion. We sought evidence of an immediate hypersensitivity reaction in the colon of children with chronic dysentery due to Trichuris trichiura. 28 children with Trichuris dysentery syndrome (TDS) were compared with 16 control children (with no TDS or worms visible on colonoscopy). All children were aged 1-11 years. Rectal biopsy samples were taken before and after expulsion of the worms by means of mebendazole treatment. Children with TDS had significantly greater numbers than controls of mast cells (mean [SD] 10.9 [1.3] vs 3.9 [0.6]% of all cells; p less than 0.0003) and of cells with surface IgE (median [range] 11.1 [7.5-11.6] vs 1.0 [0-1.5]%; p less than 0.001) in the subepithelial region of the mucosa. On electronmicroscopy, degranulating mast cells were prominent in parasitised children. In culture, rectal biopsy samples from parasitised children showed high rates of spontaneous histamine release, but only low rates of antigen-specific release. After treatment, spontaneous histamine release was significantly reduced and antigen-specific histamine release could be provoked. Thus, an IgE-mediated immune mucosal response to a helminth infection does occur in human beings but is not sufficient to cause appreciable parasite expulsion.
Anaphylaxis↗
Acid blockade by omeprazole or ICI 162846 in a chronic duodenal ulcer model.
Oral treatment with the H2-antagonist ICI 162,846 or omeprazole for five days inhibited both basal and pentagastrin stimulated acid secretion by 50% or more in mice. Either treatment increased the luminal secretion of histamine in the basal (12-fold) and stimulated (9-fold) states. Mice treated with the H2-antagonist had a 27% reduction (p less than 0.05) in mural histamine in the acid-producing area of the stomach. Mice were treated so as to induce duodenal ulcers (abscopal model) and were then treated with the H2-antagonist ICI 162,846, omeprazole or vehicle, orally for one week. Fewer duodenal ulcers were found in animals receiving drug treatments than in the oral vehicle group. Both the H2-receptor antagonist and the proton pump blocker inhibit acid production; acid blockade by either drug is accompanied by a massive increase in secretion of histamine. This rise was associated with depletion of the gastric histamine store only with H2-receptor blocker. Both means of acid inhibition reduce the formation of ulcers in this model.
Adenosine Triphosphatases↗