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Biomedical subjects

L Ward

Publications and source records attributed to L Ward.

At least 19 recordsLinked to original sources

Association of antibody to human immunodeficiency virus type 1 core protein (p24), CD4+ lymphocyte number, and AIDS-free time.

Serum antibody to p24 (anti-p24) and p24 antigen, alone and in combination with CD4+ lymphocyte number, were evaluated as predictors of progression of human immunodeficiency virus type 1 (HIV-1) infection. Two hundred six HIV-1-prevalent seropositive men in the Multi-center AIDS Cohort Study since 1984-1985 were studied cross-sectionally and 84 seroconverters were evaluated longitudinally. Cross-sectional analyses revealed significant associations among titer of anti-p24, CD4+ cell count, disease status (Centers for Disease Control class), and progression to AIDS. A high titer of anti-p24 was associated with lack of p24 antigenemia. Longitudinal studies of seroconverters demonstrated that a low titer of anti-p24, low CD4+ cell count, and detection of HIV-1 p24 antigen are individually strong predictors of AIDS, but only low CD4+ cell count retains its independent predictive value in multivariate analysis of the three markers during the period immediately after infection with HIV-1.

Analysis of Variance

Progression of chronic renal failure on substituting a ketoacid supplement for an amino acid supplement.

Twelve patients with severe chronic renal failure (average initial GFR, 13 mL/min) were monitored for 4 to 23 months while receiving an essential amino acid supplement and were then switched to a ketoacid supplement for 6 to 40 months, while continuously receiving a very low-protein (0.3 g/kg), low-phosphorus (7 to 9 mg/kg) diet. Urinary urea N excretion indicated that actual dietary protein intake averaged 0.46 g/kg. Progression, estimated as the linear regression slope of radioisotopically determined GFR on time, slowed from -0.46 +/- 0.31 (SD) to -0.24 +/- 0.15 mL/min/month (P = 0.029). Serum urea N, creatinine, phosphate, and uric acid rose significantly as GFR fell; blood pressure, plasma lipids, and urinary urea excretion were unchanged. Urinary 17-hydroxy-corticosteroid excretion decreased 18%, but this change was only marginally significant (P = 0.087). There was no change in plasma or urinary cortisol or urinary aldosterone. Viewed in light of previous evidence that progression seldom slows when treatment remains constant, the results suggest that this ketoacid supplement slows progression by approximately half, compared with an essential amino acid supplement, with no change in diet.

17-Hydroxycorticosteroids

[Elementary precautions: past the principles].

Universal precautions assure maximum protection to patients, workers, and visitors in a health care institution. While establishing universal precautions is a laudable goal, the application is onerous and difficult if the administration is not convinced of the necessity of such a project. At Sainte Justine Hospital in Montreal, the administration has rallied around this project. A vast program of consultation was initiated in January 1988. Simultaneously, a team of physicians and nurses proceeded to revise standards of sterilization and disinfectation in the hospital. In the fall of 1988, a multidisciplinary team produced a document, Universal Precautions. The term used in French--elementary precautions--was developed to demonstrate the need to have these precautions in place at all times throughout the institution. A pilot project was initiated on the perinatal unit to assess the new standards. Results are very positive. The guidelines worked and people appreciated the diverse measures of protection available to them. A full description of the pilot project is given along with the operating budget.

Cross Infection

Cholesterol feeding following unilateral nephrectomy in the rat leads to glomerular hypertrophy.

Experimental glomerulosclerosis is associated with hyperlipidaemia and the deposition of lipid in glomeruli. Glomerulosclerosis is typically preceded by glomerular hypertrophy. To investigate a possible pathogenic role of lipids in glomerulosclerosis, glomerular structure and cellular composition were studied in rats fed either a control diet or one supplemented with 4% cholesterol and 1% cholic acid for 21 weeks following unilateral nephrectomy. On the cholesterol diet there were significant increases in glomerular cross-sectional area (13.11 +/- 0.39 x 10(3) vs. 11.13 +/- 0.44 x 10(3) mu 2, p less than 0.01) and mesangial area (1.81 +/- 0.07 x 10(3) vs. 1.50 +/- 0.08 x 10(3) mu 2, p less than 0.02). These changes were significantly correlated with proteinuria, which was significantly greater on the cholesterol diet (mean area under curve for duration of diet = 3.11 +/- 0.38 vs. 1.42 +/- 0.35 g, p less than 0.02). There was a significant increase in glomerular leukocytes on the cholesterol diet (4.10 +/- 0.44 vs 2.86 +/- 0.25 OX-1 positive cells/10(4) mu 2, p less than 0.05). Mesangial foam cells, derived from macrophages, were associated with adhesions to Bowman's capsule. These results demonstrate that hyperlipidaemia exacerbates the development of glomerular hypertrophy and that this may be mediated by factors released during the phagocytosis of lipoprotein deposits by macrophages.

Administration, Oral

Vasoactive intestinal polypeptide-, neurotensin-, substance P-, gastrin-releasing peptide-, calcitonin-, calcitonin gene related peptide-, and somatostatin-like immunoreactivities in human parathyroid glands.

We have found vasoactive intestinal polypeptide (VIP)-, neurotensin-, substance P-, gastrin-releasing peptide-, calcitonin-, calcitonin gene related peptide (CGRP-2)-, and somatostatin-like immunoreactivities in extracts of sporadic human parathyroid adenomas (n = 18). The content of CGRP-2, substance P, and somatostatin in adenomas correlated directly with that of parathyroid hormone. In addition, concentrations of VIP versus substance P and somatostatin versus CGRP-2 in adenomas were directly correlated. Neuropeptide content of parathyroid hyperplasias differed from that of adenomas. VIP was detected in only one of seven parathyroid hyperplasias, and neurotensin was undetectable (0/7), whereas substance P was present in six of seven cases and GRP in five of seven hyperplasias. In hyperplasias, content of substance P correlated directly with that of gastrin-releasing peptide. Peroxidase immunohistochemistry localized VIP-like immunoreactivity to 20% to 50% of both chief and oxyphilic cells and rare clear cells and capillary endothelium in 11 of 12 adenomas studied. Focal staining was present in glandular epithelium of the rim of adjacent normal parathyroid tissue and in two of three normal parathyroid glands removed with thyroid goiters. This staining was both cytoplasmic and apical membrane. By contrast, in adenomas, neurotensin- and substance P-like positivities were confined to scattered (5% to 10%) oxyphilic cells. Cytoplasmic positivity for parathyroid hormone, noted in 30% to 70% of cells in serial sections, confirmed that these tissues were indeed parathyroid glands.

Adenoma

Identification and opsonic activity of immunoglobulins recognizing Streptococcus zooepidemicus antigens in uterine fluids of mares.

A direct ELISA was used to measure immunoglobulin (Ig) isotypes G, Gt, A, and M recognizing Streptococcus zooepidemicus epitopes in uterine lavage fluids collected during the early post ovulatory period. A S. zooepidemicus isolate, used as the plate antigen in this assay, was inoculated into the uteri of 8 mares (3 resistant and 5 susceptible to endometritis) at oestrus prior to ovulation during Oestrous Cycles 1, 3 and 5. Resistant mares aged 2-5 years were nulliparous, with clinically normal reproductive tracts as determined by physical examination, bacteriological culture of the uterus, and endometrial biopsy. Susceptible, pluriparous mares, aged 16-24 years, had histories of endometritis and infertility and had chronic endometrial inflammatory changes detected by uterine biopsy. On Post ovulation Day 3 during Oestrous Cycle 1, on the day of ovulation during Oestrous Cycle 3 and on Post Ovulation Day 5 during Oestrous Cycle 5, uterine swab specimens were obtained for bacteriological culture and the uterus was irrigated with 50 ml sterile physiological saline solution containing tracer amounts of 125I-labelled human serum albumin (HSA). The titre of each Ig isotype was determined and the amount in uterine effluents was calculated from the dilution of the 125I-HSA. Total IgG concentration in uterine effluents was measured by radial immunodiffusion. Uterine fluids, either unheated or heated 30 min at 56 degrees C, were used to opsonize the S. zooepidemicus isolate in an assay of luminol-enhanced neutrophil chemiluminescence (CL). Mean peak CL generated was compared with CL generated by a control serum. Streptococcus zooepidemicus was isolated from 10 of 15 (67%) uterine specimens from susceptible mares.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals

Polyostotic hyperostosis associated with oviductal tumor in a cockatiel.

A 10-year-old female cockatiel in a thin and depressed condition and with a 1 X 2-cm soft abdominal swelling was hospitalized. Radiography revealed a well-circumscribed mass containing punctate areas of mineralization, displacing the gizzard cranially in the caudodorsal portion of the abdomen. There was bilateral, symmetric, generalized, increased medullary opacity of the radius, ulna, carpometacarpus, femur, tibiotarsus, and tarsometatarsus. These findings were compatible with polyostotic hyperostosis secondary to an estrogen-secreting tumor. Euthanasia and necropsy were requested. A small area of neoplastic cells in the oviduct was identified histologically, but most of the tissue mass consisted of necrotic cellular debris. There was no metastasis. Sagittal secretions of decalcified radiopaque bones revealed up to 60% filling of medullary cavities with bone spicules. Although clinical and radiographic findings were compatible with an estrogen-secreting tumor, osteopetrosis, metastatic neoplasia, hypertrophic osteopathy, and metabolic bone disease were included in the initial differential diagnosis. The absence of metastasis and the confinement of the tumor within the oviduct would have made surgical removal a possible approach to treatment.

Animals

Effects of the NMDA antagonists CPP and MK-801 on radial arm maze performance in rats.

The dose- and time-dependent effects of N-methyl-D-aspartate receptor/channel antagonists on radial 8-arm maze performance were examined in rats. Both CPP (1.0-30 mg/kg), a competitive NMDA antagonist, and MK-801 (0.1-1.0 mg/kg), a noncompetitive NMDA antagonist, produced dose-dependent increases in the number of errors made to sample all 8 baited arms. The effective doses of both drugs produced maximal performance impairments 2 hr after IP injection, and no effects after 24 hr. In a second radial arm maze task where only 4 arms were baited, CPP (10 mg/kg) had a somewhat greater effect on the number of working memory errors than on reference memory errors. MK-801 (0.1, 0.33 mg/kg) had no effects on either this task or on a task involving a 1-hr delay between correct choices 4 and 5 on the 8 choice task. CPP (10 mg/kg), however, impaired performance on this latter task. These results indicate that doses of NMDA antagonists, sufficient to block hippocampal long-term potentiation, also disrupt radial arm maze performance.

Animals

Two outbreaks of Salmonella enteritidis phage type 4 infection associated with the consumption of fresh shell-egg products.

In 1988 there were two outbreaks of infection with Salmonella enteritidis phage type 4 in adjacent local authorities. The first affected 18 of 75 helpers and guests who attended a private function. Investigations revealed that home-made vanilla ice-cream containing uncooked eggs was the vehicle of infection and the causative organism was identified at the premises of the egg producer. The second affected 84 of 422 delegates attending a conference dinner, and 12 of 50 hotel staff at risk. A dessert made with lightly-cooked egg yolk and raw egg white was associated with infection, and the epidemic strain was cultured from the shell of an egg and an environmental sample from the producer's farm. It is of interest that one outbreak involved free-range and one battery-produced eggs, and that in one the vehicle was prepared at home and in the other in commercial premises. In neither incident was any deficiency in standards of egg production or catering practice discovered.

Animals

A national outbreak of Salmonella typhimurium DT 124 caused by contaminated salami sticks.

An outbreak of Salmonella typhimurium DT 124 infection which affected 101 people in England in December 1987 and January 1988 was detected through surveillance of laboratory reports from medical microbiology laboratories of the NHS and PHLS. Within 1 week of noting the increase in reports, epidemiological and microbiological investigations identified a small German salami stick as the vehicle of infection and the product was withdrawn from sale. The epidemiological investigation highlighted the occurrence of a long incubation period, bloody diarrhoea. Prompt recognition and investigation of the outbreak prevented further cases of severe infection.

Adolescent

An outbreak of paratyphoid fever in the UK associated with a fish-and-chip shop.

An outbreak of Salmonella paratyphi B infection in the UK associated with a fish-and-chip shop is reported. The source of infection for the first three cases was believed to be a food handler who was infected overseas 6 years earlier. His wife whose faeces and urine were originally culture negative continued to run the shop but subsequently her faeces became positive on one occasion. She was considered to have been the source of two further cases, and secondary household spread of infection from these two cases resulted in one symptomatic and two asymptomatic infections. A second household contact of the proprietor also became a faecal excretor 2 months later. We recommend that food handlers living in households or in intimate contact with cases or carriers of S. paratyphi B should be put off work until all household contacts cease excreting the organism.

Adolescent

Salmonella enteritidis phage type 4 infection: association with hen's eggs.

Epidemiological and microbiological investigation of the four outbreaks of Salmonella enteritidis phage type (PT) 4 that occurred in Wales in 1988 implicated foods containing shell eggs from hens as the vehicle of infection. In a case-control study of sporadic cases there was a significant association between infection and egg consumption in the 3 days before illness. These findings provide data to support the warnings from the Departments of Health in the United Kingdom about risks of infection from eating raw or undercooked hens' eggs.

Adult

Increased circulating neutrophils with surface receptor activity for immunoglobulin G in polycythemia vera and myeloid metaplasia.

Reports of heterogeneity of IgG receptor activity of normal circulating neutrophils prompted measurements in myeloproliferative disease to determine if dysplasia of the hematic stem cell resulted in an abnormality of this membrane property. IgG receptors were assayed by rosette formation in suspension with human Rh-positive erythrocytes sensitized with high-titer Rh antiserum. IgG receptors were detected on 19 +/- 1.6% (mean +/- SEM) of neutrophils from 45 normal subjects. A significant increase in IgG-receptor-bearing neutrophils was found in polycythemia vera (PV) and myeloid metaplasia (MyM), with values of 70 +/- 3.6% and 69.7 +/- 4.3%, respectively. Normal values were observed in polycythemic states not due to myeloproliferative disease and in chronic myelocytic leukemia. Rosette-forming neutrophils were increased to 52.3 +/- 3.7% in infection and inflammatory disease, but this value was significantly lower than those in PV and MyM. Increased IgG receptors in PV and MyM may be related to the activated state of the neutrophil and may result from an intrinsic cellular abnormality of the proliferating clone or from altered bone marrow release. Quantitation of neutrophil IgG receptors may be of value in the differential diagnosis of PV and MyM and may offer insights into the derangement of hematopoiesis that underlies these myeloproliferative disorders.

Antibody Specificity