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P Atkinson

Publications and source records attributed to P Atkinson.

At least 37 records · Page 2Linked to original sources
PubMed2000

Restrictive left ventricular filling pattern after myocardial infarction: significance of concomitant preserved systolic function.

Restrictive left ventricular (LV) filling identifies a high risk subgroup, following myocardial infarction (MI). The extent and significance of systolic dysfunction in this group is not clear. The aim of our study was to determine the incidence and extent of systolic dysfunction in patients with restrictive filling and nonrestrictive filling examining the prognostic implications. Doppler parameters of LV diastolic function were measured in 102 post-MI subjects within 4 days. Restrictive filling was defined as the presence of E:A ratio > 2 or E:A ratio 1-2 with MDT < or = 140 msec. Follow-up was to a median of 11 months. Restrictive filling (group A) was found in 19 (19%) of 102 patients. Patients with this pattern were more likely to have systolic dysfunction than those without (group B); 63% and 35%, respectively, P = 0.024. Eight (42%) of 19 patients in group A had relatively preserved systolic function. At 11 months 14 patients had developed heart failure (HF), 6 in group A (32%) and 8 in group B (10%), P = 0.012. There were two deaths (11%) in group A and 7 (8%) in group B, P = ns. Seven (88%) of 8 patients in group A with relatively preserved systolic function were alive and free of heart failure at follow-up compared to 4 of 11 patients (36%) in group A with systolic dysfunction (P = 0.026). Restrictive filling can be associated with relatively preserved systolic function after MI and these patients have a relatively good outcome. Patients with restrictive filling post-MI are a heterogeneous group emphasizing the evaluation of both systolic and diastolic function.

Aged↗
PubMed1999

Enterovirus infections in England and Wales: laboratory surveillance data: 1975 to 1994.

Microbiology laboratories in England and Wales reported 40,366 culture confirmed isolates of echovirus (24,628; 61%) and coxsackievirus (B 11,714; 29%, A 4024; 10%) infections to the PHLS Communicable Disease Surveillance Centre (CDSC) in the 20 years from 1975 to 1994. Nearly half of the organisms were isolated from faeces, and 5741 were isolated from cerebrospinal fluid (75% of them echovirus, 13% coxsackie B, and 12% coxsackie A). Isolation rates for all enteroviruses were highest among infants aged 1 to 2 months. Sixty per cent of patients were aged under 5 years, 10% 5 to 9 years, and only 6% 35 years or over. Predominant serotypes were similar to those reported in other countries including the United States, Finland, and Belgium. Seventy-one per cent of reports were made between July and mid December. Periodicity varied between groups and serotypes: some demonstrated peaks at intervals of two to five years. There was evidence of spread of epidemic serotypes across Europe in certain years. Data collected between March and May each year enabled the strains circulating in the following 'season' to be predicted. Such information might be used to warn clinicians to anticipate particular clinical presentations.

Adolescent↗
PubMed1998

Is food poisoning a clinical or a laboratory diagnosis? A survey of local authority practices in the south Thames region.

An audit of South Thames infectious disease surveillance systems in 1995 revealed large inconsistencies between the numbers of food poisoning records held on local databases and the numbers of food poisoning notifications reported to the Office for National Statistics (ONS), then called the Office of Population Censuses and Surveys. In March 1996 a questionnaire sent to each local authority in South Thames asked what action was usually taken when a laboratory report of cryptosporidium, campylobacter, salmonella, or giardia was received unsupported by a notification of food poisoning. All 51 local authorities responded to the questionnaire. Forty-eight reported salmonella to ONS, 38 reported cryptosporidium, 38 campylobacter, and 37 giardia. Some local authorities considered whether a food or water source was evident or suspected before reporting. Patterns of notification varied between geographical areas. Differences between local authorities' interpretations of the requirement to report to ONS the isolations of food poisoning organisms from patients make it difficult to analyse food poisoning statistics. We would recommend the adoption of a simple approach, in which laboratory reports and notifications are reconciled locally. A case should be reported to ONS only if the doctor who notified or arranged for an examination of stool suspected food or waterborne transmission initially.

Disease Notification↗
PubMed1997

Lone parent families are an independent risk factor for lower rates of childhood immunisation in London.

The aim of this study was to determine associations between indicators of social deprivation and the uptake of primary immunisation in London. Correlation coefficients were calculated between immunisation coverage in London for each of the 28 inner and outer London district health authorities in November 1991 and a range of possible explanatory variables from small area statistics data from the November 1991 census. The proportions of children under 5 years of age, lone parent families, unemployed members of the workforce, domestic overcrowding, ethnic minorities, and unskilled workforce were correlated significantly with the coverage of primary immunisation for third dose diphtheria (D3) and pertussis (P3) at 12 months. A significant correlation with measles, mumps, and rubella (MMR) at 24 months existed only for lone parent families. Multiple linear regression weighted by population size was used to identify independent predictors of variation in immunisation cover. The proportion of lone parent families in each district health authority was the only significant independent risk factor consistently associated with variation in immunisation coverage for D3, P3, and MMR. The proportion of lone parent families explained 42% of the variation in coverage for D3 in November 1991. This study has identified lone parenthood as an important independent risk factor in London for failure to complete immunisation.

Adult↗
PubMed1997

Insulin resistance prevented by portal delivery of insulin in rats with renal subcapsular islet grafts.

We determined the metabolic effects of insulin derived from renal subcapsular islet grafts, either with systemic delivery of insulin through renal venous drainage (REN) or with portal delivery of insulin after renal vein-to-superior mesenteric vein anastomosis (RMA), in streptozotocin-induced diabetic Lewis rats, in comparison with normal rats. After gavage glucose, the plasma glucose responses were similar to normal in REN and RMA rats; however, hyperinsulinemia occurred in REN rats (area under the concentration curves [AUCs] of insulin, 27 +/- 3 nmol x 1(-l) min) in comparison with RMA (14 +/- 2) and normal rats (19 +/- 2), P < 0.003, with no difference in C-peptide responses. The ratio of AUC C-peptide to AUC insulin was lower in REN (2.0 +/- 0.2) than in RMA (3.4 +/- 0.3) and normal animals (3.2 +/- 0.3), P < 0.0005. In euglycemic-hyperinsulinemic clamp studies using the same insulin infusion rate (10 pmol x kg(-1) x min(-1), insulin resistance was found in REN animals (mean glucose infusion rate [GIR], REN: 7.5 +/- 1.2; RMA: 12.0 +/- 1.2; normal: 12.7 +/- 1.0 mg x kg(-1) x min(-1); P < 0.008), with higher steady-state insulin levels in REN (554 +/- 63 pmol/l) than in RMA (291 +/- 26) and normal rats (269 +/- 60), P < 0.0001. With matching steady-state insulin levels in RMA and REN rats during infusion of insulin at 20 pmol x kg(-1) x min(-1) in RMA rats (steady-state insulin 623 +/- 64 pmol/l), GIR was 15.7 +/- 0.7 mg x kg(-1) x min(-1). Thus, systemic delivery of insulin from islet grafts is associated with hyperinsulinemia, insulin resistance, and decreased metabolic clearance of insulin. These abnormalities are prevented by portal delivery of insulin from islet grafts in the same site. The findings are consistent with the hypothesis that portal delivery of insulin is important in maintenance of normal whole-body insulin sensitivity.

Anastomosis, Surgical↗
PubMed1996

Comparison and reproducibility of visual echocardiographic and quantitative radionuclide left ventricular ejection fractions.

Left ventricular (LV) ejection fraction (EF) is commonly assessed by equilibrium radionuclide angiography and echocardiography. These methods are presumed to be interchangeable for this purpose. This study (1) compares quantification of LVEF by equilibrium radionuclide angiography with visual estimation of LVEF by echocardiography, (2) determines the reproducibility of both methods, and (3) evaluates whether differences in determinations of LVEF are of clinical relevance. Seventy-three clinically stable patients had both equilibrium radionuclide angiography and echocardiography performed within a 4-day period. LVEF by both techniques was compared after blinded analysis by 3 echocardiographers and 3 nuclear technologists. Reproducibility was assessed by blinded repeat analysis after a 1-week interval. The frequency of differences in repeat assessments of EF that the authors considered to be of potential clinical relevance (i.e., difference > or = 10% EF units) was assessed for both techniques. Correlation of LVEF determined by both methods was good (r = 0.81, SEE = 3.5) but with substantial differences in individual patients (limits of agreement, 23.6%). Intra- and inter-observer reproducibility was good for both methods, but better for radionuclide LVEF than for echocardiographic LVEF. Limits of agreement were substantially better for radionuclide LVEF than for echocardiographic LVEF (1.8% to 3.6% versus 13.4% to 17.4%, respectively). Clinically relevant differences did not occur on repeat processing of equilibrium radionuclide angiography. In contrast, potentially clinically relevant differences occurred in 8% to 26% of studies on repeat analysis of echocardiography. Thus, LVEF determined by equilibrium radionuclide angiography and echocardiography show good agreement. Both methods provide clinically valuable measurements for LV function. However, when a precisely reproducible measurement is required for patient management decisions, equilibrium radionuclide angiography is the method of choice.

Adult↗
PubMed1996

Extra-articular features of benign joint hypermobility syndrome.

To define the phenotype of patients with benign joint hypermobility syndrome (BJHS), we studied 58 consecutive patients (mean age 37 yr) presenting to a rheumatology clinic and 30 controls. Patients underwent rheumatological and ophthalmic examination, hypermobility scoring, echocardiography, measurement of bone mineral density (BMD), and skin thickness, elasticity and light transmissibility. The median hypermobility score was 5/9 Beighton and 31/56 Contompasis. Eighteen (31%) patients complained of significant arthralgia. Six (10%) patients and two (7%) controls had mitral valve prolapse (MVP) (chi(2) = 0.27, P = NS). Neither MVP nor aortic diameters showed a correlation with hypermobility score. There was no significant reduction in BMD. There was a significant correlation between hypermobility and light transmissibility of the skin (r = 0.71, P < 0.0001 Contompasis; r = 0.47, P < 0.05 Beighton) and skin stretchiness (r = 0.49, P < 0.05 Contompasis; r = 0.39, P < 0.05 Beighton). On ophthalmic examination, 14 (41%) patients had upper eyelid laxity. Thus, patients with BJHS do not have an increased prevalence of significant cardiac, bone, skin or eye abnormalities, helping differentiate BJHS from other more serious hereditary disorders of connective tissue.

Adolescent↗
PubMed1995

Sickle retinopathy in patients with sickle trait.

Sickle trait is traditionally considered a benign condition by ophthalmologists. Three cases of sickle retinopathy in subjects with sickle trait are reported. In all cases the onset of retinopathy was related to other contributing factors: in one case a traumatic hyphaema and raised intraocular pressure, in two others diabetes mellitus. Patients with sickle trait are at risk of retinopathy if coincident ocular or systemic disease is present.

Adolescent↗
PubMed1995

Ecstasy induced hepatitis mimicking viral hepatitis.

Three cases of jaundice after ingestion of 3,4-methylenedioxymetamphetamine (MDMA), known as 'ecstasy', are reported and the complications associated with the misuse of this drug, which was initially misrepresented as 'safer than alcohol' are described. Ingestion of 'ecstasy' should be considered when investigating unexplained jaundice in younger patients.

Adult↗
PubMed1994

Cutaneous cryptococcal infection without immunodeficiency.

A case of cutaneous cryptococcosis (encapsulated strain) in a 67-year-old female, with no evidence of immune suppression (normal cell surface marker analysis and mitogen proliferation studies) and which responded to treatment with oral fluconazole is reported. To date her clinical progress remains satisfactory after 12 months of follow-up.

Aged↗
PubMed1993

Antibody responses to P0 and P2 myelin proteins in Guillain-Barré syndrome and chronic idiopathic demyelinating polyradiculoneuropathy.

Immunisation with the peripheral nerve myelin proteins P0 or P2 induces inflammatory neuropathy in animals. We sought antibodies with an ELISA to these proteins in 38 patients with acute Guillain-Barré syndrome (GBS), 32 patients with chronic idiopathic demyelinating polyradiculoneuropathy (CIDP), 31 patients with other neuropathies (ONP) and 26 normal control (NC) subjects. We discovered IgM antibodies to human P0 protein in the sera of 18.5% of the patients with GBS, 15.6% with CIDP, 6.4% with ONP and 3.8% of NC subjects. Of the sera which reacted with P0, sera from 4/7 of GBS, 3/5 of CIDP, 1/2 of ONP patients and 0/1 of NC subjects reacted with a synthetic P0 peptide representing residues 150-169 from the cytoplasmic portion of the molecule. IgG antibodies to P0 were slightly less common than IgM antibodies, being present in only 7.9% of GBS, 0% of CIDP and 3% of ONP patients and 0% of NC subjects. We found antibodies to bovine P2 protein more commonly than antibodies to P0. IgM antibodies were present in 39.5% of GBS, 34.4% of CIDP, 16.1% of ONP patients and 15.4% of NC subjects. IgG antibodies were present in 18.4% of GBS, 12.5% of CIDP, 3.2% of ONP patients and 7.6% of NCs. Of the sera which contained antibodies to P2 protein, only a few reacted with P2 peptides 14-25 or 58-81, but without any consistent pattern of reactivity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Subacute idiopathic demyelinating polyradiculoneuropathy.

Seven cases of subacute idiopathic demyelinating polyradiculoneuropathy had a monophasic illness characterized by progressive weakness of all four limbs that evolved during 4 to 8 weeks. Neurophysiological investigations implied demyelination in all seven cases. In two patients, sural nerve biopsy specimens that were taken showed macrophage-associated demyelination. All patients made substantial or complete recoveries with oral prednisolone (four cases) or without treatment (three cases). None of the patients required ventilation or had autonomic complications. These cases provide a link between the acute idiopathic demyelinating form of Guillain-Barré syndrome and chronic idiopathic demyelinating polyradiculoneuropathy.

Adult↗
PubMed1992

Sural nerve biopsies in Guillain-Barre syndrome: axonal degeneration and macrophage-associated demyelination and absence of cytomegalovirus genome.

T-cell infiltration was detected by immunohistochemistry in only 2 of 10 sural nerve biopsies from patients with Guillain-Barré syndrome (GBS). The number of endoneurial macrophages, identified by the monoclonal antibody MAC 387, was increased, compared with the number in 10 cases of axonal neuropathy. Macrophage-associated demyelination was identified in 7 and axonal degeneration in 8 cases. Cytomegalovirus (CMV) genome was not detected with the polymerase chain reaction.

Adult↗