Biomedical subjects
Publications and source records attributed to S Cook.
Paediatric admissions to a general ITU are briefly reviewed. Although it may not be an ideal arrangement it is suggested that children can be safely cared for in such a unit. The problems created by the child with acute upper airway obstruction are discussed to demonstrate the way in which the unit is organized to receive acutely ill children.
Six consecutive patients with multiple sclerosis and lesions contrast enhancing on computed tomographic scan were treated with high-dose intravenous infusions of methylprednisolone. Double-dose delayed computed tomographic scans were repeated at varying intervals during corticosteroid treatment. Contrast enhancement of sclerotic plaques was reduced or eliminated within as little as 8 hours after the first infusion. Rapid associated partial clinical improvement was noted in four patients with recent exacerbations of disease activity. Similar attenuation of contrast-enhancing plaques and clinical improvement were less predictable following oral corticosteroid therapy in conventional dosage. These studies suggest that the dose, route of administration, and duration of corticosteroid therapy in multiple sclerosis may partially determine the effect of treatment.
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The plasma levels of 5 alpha-dihydrotestosterone, testosterone, delta 5-androstene-3 beta-17 beta-diol, delta 4-androstenedione, dehydroepiandrosterone, estrone, estradiol, dehydroepiandrosterone sulfate, follicle stimulating hormone, luteinizing hormone and prolactin were measured in normal post-menopausal women and in post-menopausal women with proven breast cancer. The mean prolactin level was significantly higher (p less than 0.01) and the mean 5 alpha-dihydrotestosterone level lower (p less than 0.05) for the women the breast cancer. There were no significant differences for any of the other hormones. As well, there were no significant differences for the extent of binding of testosterone and delta 5-androstene-3 beta, 17 beta-diol to plasma proteins between the two groups of subjects.
Although there have been reports of the results of treating trichomoniasis with metronidazole 2 g in a single dose, no randomised double-blind comparison of this treatment with a multiple-dose regimen has been reported. In such a comparison, 96 women were treated with metronidazole 2 g in a single dose and 96 women with metronidazole 400 mg twice daily for five days. Forty-eight of 52 women followed for 14 days after the single dose were cured, as were 61 of 66 women followed for 14 days after the start of the five-day regimen. These results compare favourably with previous reports. Side effects were trivial, and we recommend the single 2-g dose, for it is effective, economical, and can be given under supervision in the clinic.
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A new method for the detection of precipitating antibody to cytomegalovirus by counterimmunoelectrophoresis (CIEP) is described. Fourteen of 15 adult sera (95%) with IgM-specific antibodies (as detected by immunofluorescence) and complement-fixing antibodies to cytomegalovirus in high titers gave positive reactions by this method. Control sera from 156 patients and 40 normal subjects were negative by CIEP. One of 32 individuals acutely infected with other members of the herpesvirus group gave a positive reaction (3%). False-positive reactions were restricted to a group of sera containing rheumatoid factor (10 of 31), but this activity could be eliminated by preliminary absorption of the sera with aggregated gamma-globulin. The present findings demonstrate that CIEP is useful for the detection of precipitating antibodies to cytomegalovirus in sera from acutely infected patients and promises to be a rapid, inexpensive screening procedure of diagnostic value.
Herpes simplex virus (HSV) has veen associated with a variety of inflammatory neurologic disorders. Recently we studied a patient with Guillain-Barré syndrome (GBS) following acute herpes vaginalis infection. Since IgM virus-specific antibody is thought to be a reliable indicator of acute viral infection, we employed a 2-h serologic assay for serum IgM antibodies to HSV using an indirect immunofluorescent technique. This patient demonstrated high serum IgM titers to HSV type 2 during the acute phase of her neurologic syndrome. The titer dropped substantially as convalescence progressed. A search for similar elevations in HSV-IgM specific antibody was made on sera from more than 70 other GBS patients. No other significant IgM antibody titers to either HSV type 1 or type 2 were found in this GBS series and a large number of neurologic controls. However, sera from two patients with a presumptive diagnosis of acute herpes encephalitis based on clinical and cerebrospinal fluid findings were positive, showing high titers in our test. The results of this study suggest that associated acute HSV infection is uncommon in GBS and an immunofluorescent seroassay of the type reported here may be a valuable noninvasive technique enabling the clinical laboratory to rapid confirm a diagnosis of herpes encephalitis.
The effectiveness of counterimmunoelectrophoresis (CIEP) for detecting human precipitating antibodies to mcyoplasma antigen was compared with the conventional complement fixation (CF) method in a double-blind experiment. Fifty-one sera from patients suspected of having acute mycoplasma infection were tested by both techniques. Dense precipitin lines to mycoplasma antigen developed in 28 sera with CIEP. Twenty-six of 28 had elevated CF titers to this antigen. No precipitin bands were observed in sera with low antibody titers to mycoplasma. These findings indicate that the CIEP test is a specific method for reliably detecting elevated serum CF antibody levels in patients with acute or recent mycoplasma infection.
Cytomegalovirus, measles, and adenovirus antibodies were measured in the sera of 92 Guillain-Barré patients and 120 controls. Thirty patients (33 percent) had markedly elevated levels of complement-fixing antibody to cytomegalovirus and in 21, a fourfold or more alteration in titer was demonstrated. Diagnostic falls in titer were seen in most instances and no significant elevation to the other viral agents was found. The serologic findings reported here suggest that cytomegalovirus may be a common agent involved in the pathogenesis of the Guillain-Barré syndrome.
Using a new quantitative immunofluorometric procedure, we measured cerebrospinal fluid immunoglobulin G levels in 59 patients and compared the results with values obtained by the most precise currently available method--the immunoprecipitin method of Kabat--and a radial immunodiffusion technique. The absolute immunoglobulin G values determined by the fluorometric assay correlated closely with the other methods. This technique offers several advantages over most conventional techniques for measuring low levels of immunoglobulin G: (1) Small, drop-sized (5 to 10 micronl) samp les of cerebrospinal fluid are used, (2) a large number of samples can be tested, (3) the range of sensitivity is sufficiently wide that cerebrospinal fluid and serum levels can be determined simultaneously, and (4) the technique is fast, requiring 3.5 hours to perform. The fluorometric method is rapid, reproducible, and easy. It suitability for laboratories engaged in the measurement of cerebrospinal fluid immunoglobulin G appears promising.
A new method for the determination of serum creatine, based on its reaction with 3,5-dinitrobenzoyl chloride in an organic medium is described. Various analytical parameters are studied and comparisons are made with the routine picrate procedures, as well as the dinitrobenzoic acid methods reported in the literature. On the basis of the data submitted, the proposed method is recommended for routine clinical use.
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