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Biomedical subjects

N Hopkinson

Publications and source records attributed to N Hopkinson.

At least 19 recordsLinked to original sources
PubMed2001

A case ascertainment study of septic discitis: clinical, microbiological and radiological features.

We studied the spectrum of septic discitis presenting to two busy district general hospitals over 2.5 years (November 1996 to April 1999), surveying the case notes of all patients attending Royal Bournemouth and Poole Hospitals with probable septic discitis on magnetic resonance imaging (MRI). Twenty-two cases of septic discitis were identified, suggesting an annual incidence of 2/100 000/year. Seventy-three percent of patients were aged > or =65 years. In 91% of patients, back pain was the presenting symptom, with neurological signs evident in 45% of patients. Fever >37.5 degrees C was present in 68% of patients, and a marked elevation of erythrocyte sedimentation rate (ESR) in 91%. Diagnosis was originally by MRI in 86% of patients, with plain radiographs not diagnostic of discitis in the early stages of the infection. Staphylococcus aureus was the commonest pathogen (41%), but in 18% of patients, no organism was identified. The major predisposing factors to septic discitis were invasive procedures (41%), underlying cancer (25%) and diabetes (18%). Pre-existing degenerative spinal disease was found in 50% of patients. Four patients whose causative organism was not isolated had a poorer outcome: one death and three with increased morbidity. Our estimated incidence rate (2/100 000/year) is higher than that in previous studies and may be due to a higher detection rate with MRI and/or a genuine increase in the number of cases. Septic discitis should be considered in any patient who has severe localized pain at any spinal level, especially if accompanied by fever and elevated ESR, or in the immunosuppressed.

Adult↗
PubMed2001

Sexually-acquired reactive arthritis.

Reactive arthritis is the most frequent cause of acute peripheral arthritis in young men. The aetiopathogenesis of reactive arthritis is reviewed, together with the varied clinical features. Finally the treatment and prognosis of this challenging condition are discussed.

Adolescent↗
PubMed2000

Relapsing polychondritis, smouldering non-secretory myeloma and early myelodysplastic syndrome in the same patient: three difficult diagnoses produce a life threatening illness.

Multiple myeloma, relapsing polychondritis and myelodysplastic syndrome are all serious diseases in which making a clear diagnosis can be difficult. This case of a 72-year-old man found after extensive investigation to have all three of the above, demonstrates how difficult diagnosis and treatment can be, producing in this case a life threatening clinical syndrome. We also postulate that the association of these three diseases may be an immune-derived complication of myelodysplastic syndrome.

Aged↗
PubMed1998

Clinical associations of lymphopenia in elderly persons admitted to acute medical and psychiatric wards.

Lymphopenia is a common finding in old people admitted to medical and psychiatric wards. We describe a pilot study of the clinical associations, and prognostic significance of lymphopenia in elderly persons admitted to acute medical and psychiatric wards. Consecutive patients admitted to acute medical and psychiatric wards were prospectively selected according to initial peripheral lymphocyte count (PLC) into lymphopenic (PLC < 1.0 X 10(9)/litre, n = 41), and non-lymphopenic (PLC > 1.5 x 10(9)/litre, n = 23). Results of routine haematological and biochemical investigations were recorded, as well as drug history and medical diagnoses. Anthropometric measurements, assessment of functional ability (Barthel ADL Index), and cognitive function (Mini-Mental State Examination) were then performed by investigators blind to lymphocyte status. Patients were contacted between 3 and 6 months following recruitment into the study. Lymphopenia was associated with functional ability as measured by a lower Barthel score (p = 0.004), and cognitive impairment as measured by the Mini-Mental State Examination (p = 0.02). No association was found with medical diagnostic groupings, drugs known to cause lymphopenia, nutritional status, or survival. Lymphopenia may be a significant marker of vulnerability, and a larger study is required to elucidate the veracity and mechanisms of lymphopenia-associated debility.

Aged↗
PubMed1996

DIALOG: co-ordination of the annual review process through a District Diabetes Register linked to the FHSA database.

A working party was established by the Population Screening Project Board (UK), in conjunction with the Family Health Services Computer Unit, in order to develop a system for diabetes care (DIALOG) that would create a District Diabetes Register and prompt the process of diabetes annual review across both primary and secondary care. To simplify the creation and maintenance of the Diabetes Register, DIALOG has been designed to interface with the Family Health Services Authority population register to enable realtime download of demographic data. The system will also accumulate clinical information for the continuing audit diabetes services according to the data items specified in the standard UK diabetes dataset and can deliver detailed statistical analyses. Data input can be manual or electronic. DIALOG has been created to complement and integrate with existing diabetes information systems in primary and secondary care; it is not intended to be a clinic management system. It has the potential to become a National Diabetes Register.

Diabetes Mellitus↗
PubMed1994

An electron microscopic study of muscle capillary wall thickening in systemic lupus erythematosus.

Capillary vessel wall thickening may contribute to the muscle fibre atrophy and impaired pulmonary gas transfer notable in SLE/MCTD. Using electron microscopy we measured the thickness of unilaminar capillary basement membranes (CBM) and quantified basement membrane laminae and pericyte layers in the skeletal muscle biopsies of 31 patients with SLE, including 14 with MCTD, and 11 controls. Capillary basement membrane thickness was significantly increased in SLE compared with controls (P < 0.01) and was significantly associated with the level of C3dg (P < 0.01). Patients with MCTD had significantly greater layering of pericytes and laminae compared with patients with SLE alone (P < 0.0001 for both variables). Multiple stepwise regression analysis indicated that ANA titre was a good predictor of pericyte layering (R = 0.63, P = 0.003) and of basement membrane lamination (P < 0.0001), with steroid therapy having a significant negative association with the number of laminae (P < 0.02). A negative association between KCO and the number of layers of basement membrane (R = 0.51, P = 0.01) was documented. However, multiple regression analysis revealed no association between parameters of thickened vessel walls and the presence of muscle fibre atrophy.

Adult↗
PubMed1992

Migraine and headache in systemic lupus erythematosus and their relationship with antibodies against phospholipids.

It has been reported that migraine is common in systemic lupus erythematous (SLE) and an association with phospholipid antibodies has been suggested. The incidence of migraine and non-migrainous headache was prospectively studied in 90 patients with SLE and 90 age- and sex-matched controls. A history of migraine was commoner in SLE patients than in controls [31(34%) vs 15(16%); P less than 0.05], and the mean age of onset was higher in the SLE group (26.8 vs 17.2 years). Within the SLE group an association was found between migraine and SLE disease activity. Non-migrainous headaches were also more common (non-significant) in the SLE group, and there was a close temporal relationship between onset of both headache and SLE in many patients. Both migraine and non-migrainous headaches in SLE patients often responded to specific SLE treatment. No association was found between migraine or other headaches and antibodies to phospholipids.

Adolescent↗
PubMed1992

Evaluation of a method for clinically assessing osteoarthritis of the knee.

A system for assessing symptoms (pain, stiffness, gelling) and signs (local temperature, effusion, tenderness, synovial swelling, popliteal cyst, crepitus) of osteoarthritis of the knee has been developed. The system has been assessed for intra- and interobserver variation using normal and osteoarthritic knees. Intraobserver variability is low for all indices but interobserver variability is high for physical signs. It is suggested that the components within this system, when applied by a single observer, may provide a reasonable framework for clinical assessment of osteoarthritis of the knee.

Aged↗
PubMed1992

Neuropsychiatric systemic lupus erythematosus in elderly people: a case series.

Five elderly patients presenting with neuropsychiatric systemic lupus erythematosus were referred to the sectorised psychiatry service of the department of health care of the elderly. They represented 2% of patients admitted over a period of two years. Two patients presented with a subacute confusional state, two with dementia, and one with depression. Three patients responded well to treatment. This suggests that systemic lupus erythematosus (SLE) is more common in elderly people than was originally thought and is a potentially treatable cause of organic brain disorder. The absence of reports of elderly patients with SLE is likely to be due to the continued application of the American Rheumatism Association's revised 1982 classification criteria, which are inappropriate for this population.

Aged↗
PubMed1991

Nailfold capillary density as a possible indicator of pulmonary capillary loss in systemic lupus erythematosus but not in mixed connective tissue disease.

Nailfold capillary density was measured in 24 patients with systemic lupus erythematosus (SLE), 14 with mixed connective tissue disease (MCTD) and 21 healthy subjects. Pulmonary function tests were performed on all subjects and needle muscle biopsies on 12 patients with SLE and 9 with MCTD. A significant correlation was documented between nailfold capillary density and pulmonary gas transfer (KCO) in patients with SLE (p less than 0.001) but not in patients with MCTD. This suggests that in SLE poor gas transfer may be dependent on alveolar capillary loss and that nailfold capillary density may be a good indicator of alveolar capillary density. There was no significant correlation between skeletal muscle fiber atrophy and nailfold capillary density in SLE or MCTD. Additional studies to optimize the nailfold capillary counting method are described.

Adolescent↗