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Biomedical subjects

P Hollingworth

Publications and source records attributed to P Hollingworth.

At least 19 recordsLinked to original sources
PubMed1996

Back pain in children.

Pay attention to back pain reported by children. Half will have a specific or serious cause, the presenting symptoms of serious conditions may be misleadingly mild, and the spectrum of causes and mode of presentation differ from adults. Warning features include onset aged < 4 yr, symptoms persisting beyond 4 weeks, interference with function, systemic features, worsening pain, neurological features and recent onset of scoliosis. Scintigraphy is often useful where clinical features and plain radiographs fail to identify the diagnosis. Sports activities may cause stress reactions in the immature spine, particularly at the junction between spinal segments of differing mobility, the vascularity of the disc and vertebra predisposes to infection, spinal tumours presenting as pain tend to be primary and benign, congenital spinal anomalies causing pain tend to present in childhood, spondylitis presents differently from adults, and conversion hysteria, typically presenting with gross, bizarre and disabling symptoms, is not uncommon in adolescent girls.

Adolescent↗
PubMed1995

Differential diagnosis and management of hip pain in childhood.

Hip pain in children is always potentially serious. Different specialists see a different spectrum of hip diseases. Acute hip pain is usually referred to the surgeons, and the principal concern is to distinguish sepsis of the hip joint or pelvic bones from irritable hip: untreated sepsis can destroy the hip within days, but its presentation may be atypical or mild and investigations misleading. A reliable protocol for the management of acute hip pain in children is now available. Perthe's disease and slipped capital femoral epiphysis is usually evident on the initial radiograph. Hip disorders with a subacute or chronic presentation are usually referred to the paediatrician or rheumatologist. If examination shows restriction of hip movement or there are radiographic abnormalities, many will have a serious disorder requiring long-term management. The diagnosis is often apparent on the initial radiographs, although special imaging techniques may be needed. In a monoarticular presentation of juvenile arthritis, the hip radiograph will be normal but the diagnosis evident from other clinical features or blood investigations. Recognition of non-organic syndromes presenting with hip pain requires the exclusion of organic causes and an alertness to the incongruity of the physical signs.

Adolescent↗
PubMed1994

Hypertrichosis and algodystrophy: an hypothesis to explain this uncommon association.

Various skin changes have been described in algodystrophy, but the association of hypertrichosis with this condition is poorly documented. We describe a patient who developed algodystrophy after a mild inflammatory arthritis, in association with a number of skin manifestations, including hypertrichosis. We suggest a mechanism to explain this particular association.

Adult↗
PubMed1993

The use of non-steroidal anti-inflammatory drugs in paediatric rheumatic diseases.

The use of NSAIDs for arthritis differs in children from adults in their indications, uses and pharmacokinetics, and fewer are available. Children with arthritis are assessed differently, as they complain less of pain. Salicylates, indomethacin and ibuprofen are used for the fever of systemic JCA. For control of joint symptoms, diclofenac, ibuprofen, tolmetin and naproxen are equal in their efficacy and tolerance:salicylates and indomethacin are no more effective but more toxic. Children tolerate NSAIDs well. Gastrointestinal symptoms appear to be less common than in adults, but the evidence regarding endoscopic changes in conflicting. Renal toxicity is rare. Tolmetin can cause pseudoproteinuria and naproxen pseudoporphyria. The liver in systemic JCA is vulnerable to drug toxicity. A therapeutic trial of an NSAID should continue for 8 weeks. Interactions with methotrexate and carbonic anhydrase inhibitors for glaucoma complicating iridocyclitis may occur.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1989

Trismus and multifocal soft tissue ossification. A presentation of fibrodysplasia ossificans progressiva?

A 21-year-old female patient presented with trismus, initially diagnosed as related to pericoronitis. Computed tomography demonstrated heterotopic soft tissue ossification involving both medial pterygoids which was later followed by similar features in the submandibular muscles and right quadriceps. A variant of fibrodysplasia ossificans progressiva was considered the likeliest diagnosis. The computed tomographic features of the condition and the importance of early diagnosis are stressed.

Adult↗
PubMed1986

Multicentre study of piroxicam versus naproxen in juvenile chronic arthritis, with special reference to problem areas in clinical trials of nonsteroidal anti-inflammatory drugs in childhood.

Clinical trials of nonsteroidal anti-inflammatory drugs (NSAIDs) are necessary in juvenile chronic arthritis (JCA) but pose certain problems highlighted and discussed in this study, including recruitment, the assessment of efficacy, and the heterogeneity of the disease. In a multicentre 8-week double-blind cross-over study using the double-dummy technique, piroxicam was compared with naproxen in 47 children with seronegative JCA aged 5-16 years. No significant difference between the two treatments was found in either the clinical variables measured or the parent/patient and physician preference at the end of the study. Side-effect profiles of the two drugs were similar, mainly gastrointestinal disturbances. Piroxicam may be a useful alternative NSAID in JCA, particularly in view of its once-daily dosage.

Adolescent↗
PubMed1985

Double-blind trial of flurbiprofen and phenylbutazone in acute gouty arthritis.

Flurbiprofen has been compared with phenylbutazone in a double-blind study involving 33 patients with acute gout. Patients received either flurbiprofen 400 mg daily for 48 h followed by 200 mg daily, or phenylbutazone 800 mg daily for 48 h followed by 400 mg daily. The drugs were of comparable efficacy, while side-effects were uncommon and relatively mild. Flurbiprofen appears to be a satisfactory alternative to phenylbutazone in the management of acute gouty arthritis.

Adult↗
PubMed1985

The painful swollen sterno-clavicular joint.

Thirteen patients with isolated pain and swelling of a sterno-clavicular clavicular joint have been reviewed. Three groups were identified. Group 1 comprised four patients, all of whom had a short history of less than six weeks and suffered a pyarthrosis or malignant disease; group 2, four patients who were shown to have features of condensing osteitis of the clavicle (Cone et al, 1983); and group 3, five patients, had degenerative arthritis of a sterno-clavicular joint. The only difference between groups 2 and 3 were that patients in group 3 had a rather longer history, both articular surfaces were involved and showed a possible increase in the incidence of degenerative joint disease elsewhere. It is suggested that condensing osteitis is but a part of a spectrum of degenerative disease of the sterno-clavicular joints, akin to discogenic vertebral body sclerosis (McCarthy & Dorfman, 1982).

Adult↗
PubMed1985

Ten years' experience of an amyloid clinic--a clinicopathological survey.

The aetiology, clinical course and affected organs were studied in 124 patients with acquired systemic amyloidosis and seven patients with organ-limited amyloid deposits. Seventy-five patients had reactive systemic AA amyloidosis, which was associated with rheumatic disease in 55 and with chronic infection in 13 cases. Forty-nine patients had systemic AL amyloidosis. Thirteen of these cases were associated with myelomatosis and 11 with non-malignant immunocyte dyscrasias. In 25 patients with systemic AL disease no immunocyte dyscrasia was identified. Renal involvement dominated the clinical course of both forms of systemic amyloidosis, and renal failure was the most common cause of death. Gastrointestinal disturbance and hepatosplenomegaly were found in both AA and AL disease, although differences were noted in the distribution of amyloid protein within rectal biopsies. Amyloid cardiomyopathy, neuropathy and macroglossia were present in patients with AL amyloidosis only. These clinical patterns were reflected by tissue distribution at necropsy in 67 patients.

Adolescent↗
PubMed1983

Effects of immunosuppression on herpes simplex virus growth in lymphocytes of patients with connective tissue diseases.

The growth of herpes simplex virus (HSV) was measured in blood lymphocytes isolated from patients with connective tissue diseases receiving immunosuppressive drugs. Whereas lymphocytes from such patients were frequently nonpermissive for HSV before treatment, they became permissive in most patients after treatment. The exception was the persistence of nonpermissiveness in lymphocytes of treated patients whose disease was associated with malignant disease.

Adult↗
PubMed1983

Renal involvement in systemic amyloidosis.

In a study of 124 patients with systemic amyloidosis, renal involvement was the major presenting feature in 68 per cent of patients with AA and 42 per cent with AL disease. Renal failure contributed to the deaths of 72 per cent and 33 per cent of patients respectively. In 23 renal biopsies from patients with AA disease, quantitative glomerular amyloid infiltration correlated with urinary protein excretion and with serum creatinine. Seven of these patients had repeat biopsies; change in glomerular amyloid correlated with changes in both renal function and proteinuria. Four patients with end-stage renal amyloidosis have been successfully managed on CAPD for 37 patient months.

Adolescent↗
PubMed1982

Measurement of radiographic joint space in the rheumatoid knee: correlation with obesity, disease duration, and other factors.

A new and highly reproducible method for measuring radiographic joint space in the rheumatoid knee is described. The joint space was measured in radiographs of the knees of 120 patients with rheumatoid arthritis and correlated by computer analysis with age, sex, duration of disease, erosions, degenerative change, therapy and Quetelet's index (an index of obesity). Narrowing of both compartments of the knee correlated significantly with the duration of disease. Narrowing of the lateral, but not medial, compartment showed some degree of correlation with obesity as measured by Quetelet's index, but this did not achieve significance. The presence of erosions was associated with marked narrowing of joint space which frequently occurred early in the course of the disease; three-quarters of the patients showing even moderate erosions had at least one knee compartment narrowed to 2 mm or less and in half of these the changes had occurred in less than 10 years. Joint space narrowing also correlated strongly with degenerative change which was, however, remarkable for its infrequency.

Adult↗
PubMed1982

Frequency of chondrocalcinosis of the knees in asymptomatic hyperuricaemia and rheumatoid arthritis: a controlled study.

An association has been reported between urate gout and chondrocalcinosis. Chondrocalcinosis was detected in knee radiographs of 8 of 138 gouty patients compared with none of 142 age matched nongouty normouricaemic controls (p less than 0.025). To define this association further, knee radiographs were examined of 84 patients with asymptomatic hyperuricaemia who had been carefully age matched with the gouty and control groups. Chondrocalcinosis of the knees was detected in only one patient, the difference from the control group not being significant. It therefore appears that there is an association of chondrocalcinosis with gouty arthritis, but not with asymptomatic hyperuricaemia. An association between chondrocalcinosis and rheumatoid arthritis has been suggested, but the studies were not controlled for age. To re-examine this implied association, knee radiographs were inspected of 127 patients with rheumatoid arthritis who had been age matched with the control group. Chondrocalcinosis of the knees was detected in only one patient, a difference from the control group which is not statistically significant.

Adult↗