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Biomedical subjects

P J Thompson

Publications and source records attributed to P J Thompson.

At least 19 recordsLinked to original sources

Assessment of neutrophil chemotaxis by laser and video densitometry.

A laser densitometer and a video densitometer were used to evaluate neutrophil chemotaxis slides which were also assessed by the standard microscopic technique. A linear relationship was observed between cell number per high power field (HPF) and peak height by laser densitometry (r2 = 0.66) or peak area by video densitometry (r2 = 0.81). For wells containing more than 20 cells/HPF the least variability was observed with video densitometry. Quantitative results from neutrophil chemotaxis assays performed in 48-well microchambers can be obtained rapidly and conveniently by the use of commercially available video densitometers.

Chemotaxis, Leukocyte

A comparative study of allergenic and potentially allergenic enzymes from Dermatophagoides pteronyssinus, D. farinae and Euroglyphus maynei.

The presence of the enzymatically active allergens equivalent to Der p I (cysteine protease), Der p III (serine protease) and amylase in extracts of Dermatophagoides pteronyssinus, D. farinae and Euroglyphus maynei was determined using appropriate enzymatic techniques. Biochemical equivalents of all three allergens were present in each extract studied. Studies also showed that the mite extracts contained a variety of other biochemically active enzymes including trypsin, chymotrypsin, carboxypeptidase A and B, glucoamylase and lysozyme. Marked differences in the relative concentrations of some of these enzymes in different mite extracts were observed, particularly trypsin and carboxypeptidase A. The enzymes were physicochemically similar to equivalent enzymes from vertebrate and invertebrate sources. Chromatofocusing studies of faecal extracts derived from D. pteronyssinus and D. farinae showed that several isoforms of each enzyme were present. The data indicated that there were more trypsin isoforms, with pI over a wider range, in extracts prepared from D. pteronyssinus. Proteases and carbohydrases were also found in extracts prepared from faecally enriched material suggesting that they were endoperitrophic and associated with mite digestion. The data suggest that not only are the group I, III and amylase allergens a consistent feature of most pyroglyphid dust mites but also that other proteases and carbohydrases present in mite faeces are allergenic.

Allergens

Ventilatory requirements for respiratory distress syndrome in small-for-gestational-age infants.

Neonatal ventilatory requirements and outcome were examined in 135 very preterm, small-for-gestational age (SGA) infants to determine whether fetal growth retardation protects against severe respiratory distress syndrome (RDS) in very immature infants. Their results were compared to those from gestational age- and gender-matched controls. Although there was no significant difference in the median duration of mechanical ventilation between the two groups, more SGA infants required ventilation and were ventilated because of RDS. In a subgroup also matched for mode of delivery, there was no significant difference between the proportion of SGA infants requiring mechanical ventilation for RDS compared to their matched controls. The mortality was greater in the SGA group. We conclude that fetal growth retardation does not protect against severe RDS.

Birth Weight

Nosocomial bacterial infections in very low birth weight infants.

The occurrence of congenital and nosocomial bacterial septicaemia has been documented by identifying the number of positive blood cultures by reviewing the laboratory and clinical records of 394 very low birth weight infants who were consecutively admitted to a neonatal intensive care unit over a 40-month period. The incidence of congenital septicaemia was 6% and of nosocomial septicaemia 17%. The commonest causes of congenital infection were Streptococcus agalactiae Staphylococcus epidermidis and Enterococcus faecalis (each in 18% of cases). The commonest cause of nosocomial infection was S. epidermidis (51% of cases), except in infants of birth weight less than 750 g. Risk factors for nosocomial infection were extremely low birth weight, very preterm birth and prolonged ventilation. Nosocomial infection was associated with significantly lengthened hospital admission.

Cross Infection

The impact of chronic epilepsy on the family.

The emotional impact of intractable epilepsy on family members is a neglected topic, with the majority of studies confined to childhood epilepsy. Our clinical experience suggests that family members, particularly parents, may at times be under considerable emotional strain, especially when seizures are frequent and accompanied by injury. The purpose of this study was to explore the psychological and physical well-being, satisfaction with social circumstances and perceived level of support in families with an adult member with intractable epilepsy. Forty-four families were administered rating scales of mood and answered questions relating to their social situation and physical health. Levels of stress and dissatisfaction with their social situation was high, particularly in primary carers (the mother in most instances). Respite periods away from their caring role were few and the perceived level of support was low. Poor emotional adjustment was associated with severity of tonic and atonic seizures and episodes of status. Additionally, perceived low levels of support were associated with depression.

Acute Disease

Aetiology of chronic leg ulcers.

This study was undertaken to determine the relative prevalence of the factors causing chronic ulceration of the leg in the general population. Two hundred and fifty-nine patients with chronic ulceration of the leg were found on screening a Western Australian population of 238,000. (The prevalence of chronic ulceration of the leg was 1.1 per 1000 population.) Two hundred and forty-two of these patients (93%) with 286 chronically ulcerated limbs were fully assessed to determine the factors contributing to ulceration. In 239 limbs (84%) ulceration involved the leg; in these limbs venous disease was the most prevalent cause of ulceration (160 limbs). Arterial disease was found in 66 limbs, with both venous and arterial disease present in 35 limbs. Rheumatoid arthritis was a causative factor in 27 limbs and diabetes was found with 29 limbs with ulceration involving the leg. In 47 limbs (16%) ulceration was confined to the foot; arterial disease (35 limbs) and diabetes (23 limbs) were the most prevalent causes of ulceration in these limbs. Venous disease was infrequent (three limbs). No disorder of the circulation was found in 48 limbs (20%) with ulceration involving the leg, and in 58 (20%) of all ulcerated limbs. More than one aetiological factor was present in 93 limbs (33%). A cause for ulceration was not found in 10 limbs (3.5%).

Adult

Congenital bacterial sepsis in very preterm infants.

The results of body fluid and surface cultures from 148 preterm infants less than 33 weeks gestational age obtained routinely on admission to a neonatal intensive care unit were reviewed. The aim was to determine the occurrence of congenital bacterial sepsis in this population and to examine whether surface cultures yielded information helpful in management. Gastric aspirate and umbilical, nasal and ear swabs were cultured and the results were compared to those of blood cultures. Nine infants (5.4%) had congenital bacterial sepsis diagnosed by positive blood cultures. Only the results of microscopy of gastric aspirate were available within hours of birth and before the results of blood culture. Microscopy of gastric aspirate, demonstrating pus cells, alone had a sensitivity of 0.86 in predicting congenital sepsis but a specificity of 0.49; the specificity, however, rose to 0.80 if both organisms and pus cells were observed on microscopy. Thus, only this combination was a useful pre-indicator of congenital sepsis. In infants who did not develop septicaemia, treatment was modified only if Streptococcus agalactiae was cultured from surface sites; in all such cases, the organism was grown from the ear swab. Our results demonstrate that congenital bacterial sepsis is common amongst very preterm infants admitted for neonatal intensive care but routine screening of surface cultures should be restricted to an ear swab only.

Bacterial Infections

The effects of varying doses of aspirin on human platelet activation induced by PAF, collagen and arachidonic acid.

1. The effect of increasing doses of orally administered aspirin (30-900 mg) on platelet aggregation and ATP release induced by arachidonic acid (AA), collagen and platelet activating factor (PAF) was assessed in 12 normal volunteers. 2. Aspirin ingestion was associated with a significant increase in EC50 for AA (P less than 0.0001) and collagen (P less than 0.0001) but not for PAF (P greater than 0.495) although the normal biphasic aggregation response for the latter was abolished. Maximum ATP release was reduced by aspirin for all three agonists. 3. The mean maximum degrees of inhibition of platelet aggregation induced by aspirin for AA, collagen and PAF were 100%, 48% and 21% of baseline, respectively. The corresponding mean maximum inhibition of ATP release was 100%, 63% and 57%. The minimum cumulative doses of aspirin producing these effects were 240, 240 and 90 mg for AA, collagen and PAF respectively. For collagen alone, there was a significant decrease in the degree of inhibition of aggregation between the last dose on day 1 (150 mg) and the baseline measurement on day 2. 4. Platelets from female subjects were more sensitive to collagen (P less than 0.05) and AA (P less than 0.01) stimulation compared with males. However, prior to aspirin ingestion, PAF produced a greater maximum response in platelets from females (P less than 0.02) while following aspirin ingestion PAF-induced activation was inhibited to a greater degree in females (P less than 0.02). 5. These results indicate that collagen- and PAF-induced platelet activation are only partially dependent on cyclo-oxygenase and for PAF this seems related only to the second phase of aggregation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate

Xanthines inhibit human platelet aggregation induced by platelet-activating factor.

1. Platelet-activating factor (PAF) may be involved in the pathogenesis of asthma, and therefore the effects of the anti-asthma drugs theophylline and enprofylline on human platelet aggregation and adenosine triphosphate (ATP) release induced by PAF and adenosine diphosphate (ADP) were studied. 2. Enprofylline (50% inhibitory concentration [IC50] = 94.8 +/- 13.2 mumol/L) was more potent than theophylline (IC50 = 934.1 +/- 40.1 mumol/L) as an inhibitor of PAF-induced aggregation, and the xanthines were twice as potent as inhibitors of PAF-induced aggregation when compared with ADP-induced aggregation. ATP release was 1.4 times more sensitive to inhibition by the xanthines than aggregation. 3. Although high concentrations of xanthines inhibited platelet aggregation and ATP release induced by PAF, therapeutic concentrations are unlikely to inhibit PAF-induced effects.

Adenosine Diphosphate

Lung volume measured by functional residual capacity in infants following first trimester amniocentesis or chorion villus sampling.

OBJECTIVE: To determine the incidence of respiratory problems and lung volume abnormalities in babies born after first trimester amniocentesis or chorion villus sampling. DESIGN: A prospective randomized study. SETTING: Harris Birthright Research Centre for Fetal Medicine, Paediatric Respiratory Laboratory, King's College Hospital. SUBJECTS: Babies of mothers who had undergone first trimester amniocentesis (n = 74) or chorion villus sampling (CVS) (n = 86) for fetal karyotyping because of advanced maternal age, parental anxiety or family history of chromosomal abnormality in the absence of parental chromosome re-arrangement. MAIN OUTCOMES: Respiratory distress in the neonatal period and lung volume as assessed by measurement of functional residual capacity (FRC). RESULTS: CVS was associated with a significantly higher incidence of neonatal respiratory distress, six infants in the CVS group but none in the amniocentesis group required admission to the special care baby unit because of respiratory distress (P less than 0.05). Although there was no significant difference in the mean FRC between the two groups (amniocentesis 29.7 ml/kg vs CVS 29.6 ml/kg) the overall incidence of FRC values less than 2.5th centile of the normal range was 9%. CONCLUSION: Both amniocentesis and CVS performed in the first trimester of pregnancy may impair antenatal lung growth.

Amniocentesis

Hyperinflation in premature infants at preschool age.

Functional residual capacity was measured by helium gas dilution in 12 children born very preterm (gestational age 25-29 weeks). The children were studied at between 4.0 and 4.6 years of age. Their results were compared to those of 12 control children who were born at term without neonatal problems. The controls were matched to the children born preterm for age, race and gender. The children born preterm had significantly increased functional residual capacity values when compared to the control subjects (p less than 0.01). Eight children born preterm were hyperinflated (functional residual capacity greater than 120% of that predicted for height) compared to only one control subject (p less than 0.01). Five children born preterm and one control had a positive response to bronchodilator administration. These results suggest infants born very preterm may suffer from chronic hyperinflation.

Birth Weight

Tissue artefacts caused by sponges.

Artefacts which occur during the processing of small biopsy specimens can cause sufficient tissue distortion to impair interpretation and can be a considerable source of nuisance. Triangular artefacts were noted in renal and liver biopsy specimens which were caused by foam sponges in embedding cassettes. Scanning electron microscopic examination of the sponges showed they comprised a mesh of scimitar-shaped rigid spikes which closely match the artefacts seen in the tissues.

Artifacts

Histamine tachyphylaxis in human airway smooth muscle. The role of H2-receptors and the bronchial epithelium.

The role of airway epithelium and H2-receptors in the development of histamine tachyphylaxis was studied using human isolated bronchial smooth muscle strips obtained from 18 patients undergoing thoracotomy. In epithelium-intact strips, a 38% reduction in the maximal contractile response (Emax) (p less than 0.002) and a 2.14-fold increase in the EC50 (p less than 0.02; n = 18) was observed after three separate histamine cumulative concentration effect curves (CCEC). In contrast, significant differences were not seen for either Emax (p greater than 0.4; n = 10) or EC50 (p greater than 0.26; n = 10) in epithelium-denuded strips. In separate experiments, both intact and denuded muscle strips were treated with the H2-receptor antagonist ranitidine (60 microM), either 30 min prior to the first or 30 min prior to the second histamine CCEC. In epithelium-intact strips, pretreatment with ranitidine caused a 1.8-fold increase in Emax in the initial CCEC (p less than 0.02), and both ranitidine schedules prevented tachyphylaxis (n = 8). In epithelium-denuded preparations, ranitidine did not enhance the responsiveness to histamine beyond that seen in untreated epithelium-denuded strips (n = 6). These data suggest that histamine-induced tachyphylaxis occurs in human airway smooth muscle and is mediated, at least in part, via H2-receptors resident on airway epithelium. In vivo, this may function as a protective mechanism, but damage to the epithelium and loss of H2-receptors may be significant in the development of histamine bronchial hyperreactivity as seen in asthma.

Bronchi

Social nocturnal alcohol consumption and pharmacokinetics of theophylline.

Although moderate alcohol consumption is postulated to enhance theophylline metabolism, to our knowledge, the effect of casual nocturnal alcohol consumption has not been assessed. Eight normal volunteers, at the same time, one week apart, were given whiskey, 3 ml/kg of body weight, on one evening and on the alternate evening an equivalent volume of water. Each evening was followed by assessment of the pharmacokinetics of fast-release bibtheophylline, 5 mg/kg, taken the next morning at 9 AM. Alcohol taken the night before caused a statistically significant decrease in plasma clearance together with an increase in elimination half-life of 33 percent with consequent increases in plasma concentrations. These findings have potentially important implications for the accuracy of outpatient monitoring of serum theophylline and might explain intermittent toxic reactions occurring in some patients.

Adult

Elevation of prostaglandin levels in pregnancies complicated by premature rupture of the membranes.

Premature labour and infection (both maternal and neonatal) are common outcomes of pregnancies complicated by premature rupture of the membranes (PROM). Both conditions are associated with elevation of prostaglandin levels. It therefore seems likely that prostaglandins may be increased in patients with pregnancies complicated by PROM. The aim of this study was to test this hypothesis by comparing prostaglandin levels in pregnancies complicated by PROM to those from control pregnancies with intact membranes. Paired fetal and maternal samples were obtained from nine patients with pregnancies complicated by PROM. The median onset of PROM was 28 weeks (range 22-31 weeks). Fetal blood was obtained by cordocentesis, ultrasound guided puncture of the umbilical cord and this was performed at a median of 4 days (range 1-28) following rupture of the membranes. Delivery occurred at a median gestational age of 33 weeks (range 28-37). Paired samples were also obtained from 12 "control" pregnancies with intact membranes and no evidence of infection or premature labour. The indications for cordocentesis in this group were rapid fetal karyotyping following the ultrasonic detection of small fetal structural abnormalities or fetal blood grouping following the detection of high maternal haemolytic antibody titre. Sampling was performed at a median of 27 weeks of gestation (range 22-32). Prostaglandin levels were assessed by determination of the level of the metabolic compound bicyclo-PGEM by radioimmunoassay.(ABSTRACT TRUNCATED AT 250 WORDS)

Dinoprostone

Fetal breathing movements and prostaglandin levels in pregnancies complicated by premature rupture of the membranes.

We have previously demonstrated that maternal and fetal prostaglandin levels may be elevated in patients with pregnancies complicated by premature and prolonged rupture of the membranes (PPROM) compared to patients with intact membranes. In the fetal lamb, infusion of prostaglandin abolishes fetal breathing movements and in human pregnancies with PPROM and with poor outcome, fetal breathing movements are absent. The aim of this study was to determine fetal breathing activity in pregnancies complicated by PPROM which had elevated prostaglandin levels. One-hour ultrasound examinations were performed on nine fetuses whose mothers had had premature rupture of the membranes at 28 weeks gestation and a median of 4 days prior to the ultrasound examination. The number of fetal breathing movements (FBM) and percentage of time that each fetus spent breathing was documented and this was then related to control values. Following the completion of the ultrasound examination, cordocentesis was performed and blood sent for estimation of bicyclo PGEM levels. All of the fetuses made some breathing activity during the one-hour period, but the number of FBM varied from 1 to 181 (median 21). The percentage time that the fetuses spent breathing was much lower than that which would be expected for their gestational age, being a median of 1.3% (range less than 0.1 to 50.8%) of control values. As bicyclo PGEM levels were elevated in these nine fetuses, these data suggest that reduction in breathing activity in fetuses of pregnancies complicated by PPROM may be due to elevated prostaglandin levels.

Cordocentesis