The autopsy, 1983: can it be revived?
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Biomedical subjects
Publications and source records attributed to M J Robinson.
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A randomized, double-blind study of procaine/haematoporphyrin (KH3) has been carried out over two years in a selected population of healthy elderly subjects. The period of study exceeds 500 patient years. The trial population was weighted to contain a larger proportion of subjects aged over 75 years than a standard population; those receiving active KH3 had similar characteristics on entry to those receiving placebo. Over the course of two years, KH3 was shown to be an active substance in that: (a) decrement in the consolidation of new learning was prevented in the treatment group (less than 1.0%, as against 38% in the placebo group); (b) the prevalence of incontinence increased significantly in the placebo group, but not in the active group (P less than 0.05); (c) there was a significant increase in grip strength in the active treatment group (+22%, P less than 0.01 v. placebo); (d) more adverse reactions were observed on treatment with KH3 (P less than 0.005).
Multicentric angiofollicular lymphoid hyperplasia occurred in a brother and a sister. This is the first report of familial incidence of this disease, which raises the possibility of a hereditary or environmental factor in its pathogenesis.
We have described a 25-year-old man with infestation of the feet by the burrowing flea Tunga penetrans, acquired in Brazil. We have also presented the microscopic characteristics of the flea and the histologic differential diagnosis.
The RapID NH system (Innovative Diagnostics Systems, Inc., Decatur, Ga.) is a 4-h test used in the identification of Neisseria and Haemophilus species. The system was evaluated for accuracy and reliability and compared with conventional (cystine proteose peptone agar; Prepared Media Laboratory, Tualatin, Ore.) carbohydrate degradation tests with Neisseria gonorrhoeae and N. meningitidis, as well as a variety of Neisseria, Branhamella, and Moraxella species. The RapID NH system correctly identified all N. gonorrhoeae, N. meningitidis, and N. lactamica isolates, but the level of accuracy varied considerably for the remaining organisms. One strain of N. subflava was misidentified as a pathogenic Neisseria strain. The RapID NH tests were concluded in 4 h, whereas the cystine proteose peptone agar tests required up to 48 h for results to be useful. The RapID NH system is an accurate, reliable, and useful method for the identification of pathogenic Neisseria species. It has been proven that it shortens identification time and specimen turnaround time by at least 24 h.
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The perinatal mortality rates of mothers who delivered at St. Thomas's Hospital from 1969 to 1976 have been examined. The rate in the West Indian population was significant higher than in the United Kingdom white population. The increased West Indian mortality was confined to infants with a birth weight of more than 2.0 kg and a gestational age of more than 37 weeks. The relative risk of perinatal death for West Indian mothers compared with UK white mothers was 1.4 at birth weights of 2.5 kg to 2.9 kg, rising to 4.3 at 4.0 + kg. West Indian perinatal mortality in term babies of normal birth weight was higher in all maternal age and parity groups except parity 3, but the difference was greatest in women aged 30 or over. The African perinatal mortality rate was not significantly greater than the UK white rate although it followed the West Indian trends. Pre-eclampsia and forceps delivery were associated with a greatly increased perinatal mortality in West Indian babies. The excess West Indian mortality could not be explained completely by differences in the proportions of stillbirths and early neonatal deaths nor by the distribution of births by parity, maternal age, or social class. Possible explanations for the differences in mortality are discussed.
We used pharmacologic and histologic techniques to investigate the role of mast cells in the mediation of hypoxic pulmonary vasoconstriction in conscious sheep. Breathing a hypoxic gas mixture (13%, 02, 87% nitrogen) caused hypoxic pulmonary vasoconstriction (HPV) with increases in mean pulmonary artery pressure and pulmonary vascular resistance by 97 and 90%, respectively. Intravenous pretreatment with the mast cell membrane stabilizing agent cromolyn sodium (3 mg/kg/min) completely blocked HPV, whereas the H1-histamine receptor antagonist chlorpheniramine, alone or in combination with the H2-receptor antagonist metiamide and the prostaglandin synthetase inhibitor indomethacin, failed to prevent HPV. Cromolyn sodium failed to modify the pulmonary pressor response to infusions of norepinephrine (alpha-agonist), tyramine (catecholamine-releasing agent), and histamine, indicating the specificity of cromolyn sodium action on the mast cells. Electromicroscopic studies of pulmonary perivascular mast cells showed that a 90-min exposure to the hypoxic gas mixture reduced the total number of granules per mast cell to 75% of control. This was blocked by cromolyn sodium pretreatment. We conclude that in conscious sheep], HP[V is initiated by the liberation of a mast cell product (other than histamine) that either directly or indirectly causes pulmonary vasoconstriction.
Lung function tests were performed on 14 infants 22 to 67 wk following mechanical ventilation of 6 h to 51 days and on 5 infants of comparable age who had been treated with continuous positive airway pressure (CPAP). Airway resistance increased (P less than 0.01) and specific airway conductance decreased (P less than 0.001) in the ventilated infants compared with the CPAP-treated group who were normal. The airway resistance and specific airway conductance were normal in two ventilated infants and in one CPAP-treated infant who were studied earlier in the neonatal period. There were no significant differences in thoracic gas volume between groups of ventilated and nonventilated babies studied initially or at follow-up. There was no relationship between lung damage and the following: peak inspiratory pressure, the duration of high pressure ventilation, the level of CPAP or its duration, or the duration of greater than 60% oxygen administration. The degree of lung damage was not related to the maximum ventilatory frequency used, but there was a significant correlation with the duration of rapid frequency ventilation. This study supports the view that barotrauma is a major cause of lung disease following neonatal intensive care.
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A patient is reported with unusually severe variance of a prosthetic Beall fabricated Teflon disc valve in the tricuspid position. Foreign material was found in the vessels, vessel walls, and parenchyma of the lung associated with a foreign body type of inflammatory reaction. This material was identified by scanning electron microscopy and high energy dispersive x-ray analysis as Teflon that was embolic from the eroded valve.
Plasma 25-hydroxy-cholecalciferol (25-OHD) was measured serially in two groups of preterm infants receiving either 400 IU or 1000 IU oral vitamin D3 daily. All the babies were able to absorb and hydroxylate vitamin D3 adequately by 36 weeks' gestational age. The higher daily supplement had no advantage over the lower dose.
We investigated the acute pulmonary hemodynamic effects of intravenous copper sulfate (CuSO4) infusion and its mechanism of action in six groups of conscious sheep (total 40). After 300 mg CuSO4 alone, mean pulmonary artery pressure (Ppa) increased from 10.3 to 22.5 Torr and pulmonary artery wedge pressure (Ppaw) from 3.5 to 7.6 Torr, whereas systemic arterial pressure (Psa) increased from 95 to 102 Torr. Cardiac output (Qp) decreased from 4.7 to 3.3 l/min. Pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR) increased to 320 and 160% of base line, respectively. The hemodynamic changes correlated well with serum copper, which increased from a base-line value of 0.12 to 3.5 mg/dl after the CuSO4. Serum dopamine beta-hydroxylase increased from 3.2 U/l before CuSO4 injection to 5.7 after its administration, signifying activation of adrenergic nervous system. H1-histamine receptor blockade with chlorpheniramine failed to prevent the effects of CuSO4. Pretreatment with methysergide, a serotonin antagonist, partially attenuated the effects of CuSO4. Phenoxybenzamine, an alpha-adrenergic receptor blocker, and 6-hydroxydopamine, a catecholamine depleting agent, completely blocked the effects of CuSO4. beta-Adrenergic receptor blockade with propranolol enhanced the effects of CuSO4. We conclude, that, in conscious sheep, acute infusion of CuSO4 caused a marked reversible increase in PVR with a slight transient increase in SVR, and this pulmonary hypertension was produced by stimulation of the alpha-adrenergic nervous system.
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Auditory nerve-brainstem responses (ABR) to click stimuli were recorded in 26 normal infants when they were neonates and again in the same infants when they were 3 months old. The cochlear microphonic potential was also recorded in several of the neonates. The following response parameters were studied: latency and amplitude of the auditory nerve response, amplitude of the brainstem response elicited from the region of the interior colliculus, the ratio of the amplitudes of these two waves and brainstem transmission time (BTT): the time interval between these two responses. It was found that the auditory nerve response is only slightly prolonged in neonates with respect to adults and shortens by a small amount from birth to the age of 3 months. The latency of the auditory nerve response in neonates is only about 0.3 ms longer than in adults. BTT is longest in neonates and shortens significantly in 3-month-old infants.