Biomedical subjects
S Lynch
Publications and source records attributed to S Lynch.
Early intervention in psychiatric emergencies: a controlled clinical trial.
In the UK, psychiatric care of patients with acute and chronic disorders has increasingly moved from hospital to the community. We have evaluated in a controlled trial patients with severe mental illness, who were assigned to early intervention by community services or to standard hospital treatment. 100 patients aged 16 to 65 years presenting as psychiatric emergencies to an inner London teaching hospital were randomly allocated to a multidisciplinary community-based team (n = 48) or conventional hospital-based psychiatric services (n = 52) and assessed over a 3-month period. Ratings of psychopathology and social functioning were made before treatment and after 2, 4, and 12 weeks by independent assessors. 85 patients completed all assessments, and all patients had evaluable data beyond 2 weeks. 3 patients died during the study, 2 from natural causes and 1 from an accident. Patients referred to the community service showed greater improvement in symptoms and were more satisfied with services than those in the hospital-based service. Patients treated in the hospital-based service spent eight times as many days as psychiatric inpatients as those treated in the community-based service. Patients both prefer and seem to benefit from community-based psychiatric care, and our early-intervention community service might be a good model for such care.
Absorption of human calcitonin across the rat colon in vivo.
1. We studied the absorption of human calcitonin across the colon of juvenile female rats in vivo. Both pharmacokinetic and pharmacodynamic parameters were monitored to measure absorption. 2. Intracolonically administered human calcitonin at doses of 0.1-5.0 mg/kg resulted in a dose-dependent reduction in plasma calcium levels. 3. The bioavailability of intracolonically administered human calcitonin at doses of 5.0, 1.0 and 0.1 mg/kg was 0.5%, 0.9% and 0.2%, respectively. 4. Immunohistochemistry showed that human calcitonin transport across the rat colon was rapid and that a significant amount was via a transcellular pathway. 5. We conclude that human calcitonin crosses the gastrointestinal tract of rats in significant amounts and that this demonstrates the feasibility of an oral form for clinical use.
Piroxicam induced submassive necrosis of the liver.
Several widely used non-steroidal anti-inflammatory drugs have been reported as causing severe hepatitis. Three cases of severe acute hepatitis have been reported in association with piroxicam. A fatal submassive necrosis that occurred in a 68 year old lady who had received piroxicam for 15 months is described. A 48 year old man who developed submassive hepatic necrosis six weeks after beginning piroxicam but was successfully treated with orthotopic liver transplantation is also reported. Piroxicam may induce submassive necrosis of the liver, probably as an idiosyncratic reaction.
Liver transplantation in the 1990s.
Liver transplantation is now the therapy of choice for advanced, irreversible, progressive liver disease. The authors look at who should have a transplant and explain that the predicted outcomes of surgery depend on the pre-operative disease. A brief overview of post-operative care is given.
Magnesium measurement interference in a liver-transplant patient.
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Chronic fatigue syndrome.
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Pregnancy-associated hypoplastic anemia: a review.
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Predicting cholangiocarcinoma in patients with primary sclerosing cholangitis before transplantation.
Patients with primary sclerosing cholangitis are at an increased risk of developing cholangiocarcinoma, which is difficult to diagnose because the biliary tree is already distorted. Eleven patients with primary sclerosing cholangitis who underwent orthotopic liver transplantation at this hospital were evaluated. Four patients had coincidental histologically proved cholangiocarcinoma. Patients with cholangiocarcinoma in contrast to patients without tumour presented with rapid onset of persistent jaundice, pruritus, and weight loss associated with an appreciable rise in bilirubin (8x v 2x) and alkaline phosphatase (3.5x v 1.2x) over one year. Cholangiography and computed tomography showed appreciably dilated intrahepatic bile ducts (3/4 v 0/7). The diagnosis of cholangiocarcinoma could only be established before operation in one patient by fine needle aspiration cytology. Tumour was recognised at operation in one other. Histological examination of hepatectomy specimens showed that patients with cholangiocarcinoma had less advanced histological features of primary sclerosing cholangitis. Multiple areas of carcinoembryonic antigen positive epithelial atypia and carcinoma in situ were found in all patients with cholangiocarcinoma. Cholangiocarcinoma recurred in two patients at 14 and 39 months after transplantation. Superimposed cholangiocarcinoma can be predicted in most patients with cholangitis before transplantation, although a definitive diagnosis is difficult to make. Their prognosis after successful transplantation is guarded.
Psychiatric illnesses in patients with HIV infection and AIDS referred to the liaison psychiatrist.
All referrals made to the liaison psychiatric service for HIV and AIDS patients over one year were reviewed. ICD-9 and CDC diagnoses were applied to each case at presentation. Sixty HIV-positive patients were assessed, of whom 35 had affective disorder, which was significantly associated with CDC group IV disease (AIDS). Adjustment reaction was seen in nine patients, paranoid states in six, dementia in four, personality changes in four and paranoid schizophrenia in two. CT scans of the brain were performed on 23 of the patients: 17 of these showed abnormalities. The proportion of registered AIDS patients who were referred was five times the proportion of HIV patients.
Definition of chronic fatigue syndrome (CFS)
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Antidepressant therapy in the chronic fatigue syndrome.
The chronic fatigue syndrome is a condition receiving increasing recognition. Symptoms of depression are not infrequent and may be persistent and severe enough to warrant treatment. The controversy over the use of antidepressant therapy in this condition may present a dilemma for the general practitioner considering possible treatments. This paper draws on the literature and on the authors' own observations of patients with the chronic fatigue syndrome to suggest guidelines for the use of antidepressant therapy.
Improvement in chronic hepatocerebral degeneration following liver transplantation.
Chronic progressive hepatocerebral degeneration with spastic paraparesis, dementia, dysarthria, ataxia, tremor, and neuropsychiatric symptoms follows long-standing portal-systemic shunting, is associated with structural changes in the central nervous system, and does not respond to conventional therapy for hepatic encephalopathy. A case of advanced chronic liver disease with severe, progressive hepatocerebral degeneration after 23 yr of portal-systemic shunting is reported in whom there was significant objective improvement in intellectual function and in the chronic neurological signs 3 mo after orthotopic liver transplantation and further improvement 12 mo after transplantation.
Depression and myalgic encephalomyelitis.
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Postviral fatigue syndrome and the VP-1 antigen.
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Liver transplantation in Australia: the Queensland experience.
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Results of 1000 kidney transplants in Brisbane.
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