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Biomedical subjects

T J Marshall

Publications and source records attributed to T J Marshall.

11 recordsLinked to original sources

Regional migratory osteoporosis: a review illustrated by five cases.

Regional migratory osteoporosis is an uncommon self-limiting disease characterized by an arthralgia which migrates between the weight-bearing joints of the lower limb. The radiological features of the disease obtained by conventional radiography, CT, MRI and radionuclide scintigraphy are illustrated by means of five case reports. These range from the most common presentation of sequential, proximal to distal spread in the lower limb to the rare intra-articular form, and disease involving the axial skeleton is also recognized. Clinical and radiographical features often overlap with those of diseases such as transient osteoporosis of the hip and transient bone marrow oedema syndrome, which is reflected in confusing terminology. Histological sampling is usually unnecessary; the radiological features are characteristic and the histological findings are not specific. Regional migratory osteoporosis is associated with systemic osteoporosis. This association is probably under-recognized, and has implications for the pathophysiology of the disease and for treatment.

Adult↗

A swollen leg unmasks longstanding SLE.

We report a case of long-standing SLE which presented with symptomatic muscle vasculitis on a background of photosensitivity, arthralgia and myalgia. The diagnosis was complicated by cardiomyopathy, nephrotic syndrome and diabetes. We highlight the benefits of aggressive treatment in severe disease and the importance of recognising and treating comorbidity especially ih relation to atherosclerosis.

Adult↗

Vascular intervention in the thorax: bronchial artery embolization for haemoptysis.

Massive haemoptysis is defined as the expectoration of more than 600 mls of blood in 48 h. Many patients are not surgical candidates because of the presence of severe bilateral pulmonary disease and these individuals are best managed by bronchial artery embolization. Occlusion of both the bronchial arteries and hypertrophied non-bronchial systemic arteries is essential if bleeding is to be controlled. A pulmonary arterial source of haemorrhage is uncommon but should always be considered in a patient who has further haemoptyses shortly after a technically successful embolization of bronchial and non-bronchial systemic arteries. The immediate control of haemorrhage is achieved in the majority of patients although subsequent rebleeding on longterm follow-up is not uncommon.

Bronchial Arteries↗

Diffuse pleural thickening: percutaneous CT-guided cutting needle biopsy.

PURPOSE: To assess the diagnostic yield of computed tomography (CT)-guided percutaneous cutting needle biopsy of diffuse pleural thickening. MATERIALS AND METHODS: In 42 consecutive adult patients with diffuse pleural disease seen, 45 CT-guided percutaneous biopsies were performed with an 18-gauge cutting needle powered by a hand-held, spring-operated biopsy instrument. Results were assessed retrospectively. RESULTS: Sufficient pleural tissue for histologic diagnosis was obtained in 42 of the 45 biopsies, with a correct histologic diagnosis made in 39 of the 42 specimens. Specificity and sensitivity for helping differentiate malignant from benign disease were 100% and 83%, respectively. Positive and negative predictive values were 1.0 and 0.60, respectively. By combining findings at biopsy and at CT (presence or absence of pleural thickness greater than 1 cm, mediastinal-circumferential involvement, irregular contour), sensitivity and negative predictive values reached 100% and 1.0, respectively. CONCLUSION: Combined findings of CT-guided percutaneous cutting needle biopsy and CT are useful in first-line investigation of diffuse pleural thickening.

Adenocarcinoma↗

Gamma interferon-mediated cytotoxicity related to murine Chlamydia trachomatis infection.

After infection with the mouse pneumonitis agent (MoPn; murine Chlamydia trachomatis), heterozygous (nu/+) but not nude athymic (nu/nu) mice produced enhanced amounts of gamma interferon (IFN-gamma) in vitro in response to MoPn antigen that exhibited cytotoxic activity when added to host cells already infected with chlamydiae. Antibody-complement lysis showed the cytotoxic activity to be dependent, at least in part, on L3T4+ T cells for production. The cytotoxic responses were directed primarily against Chlamydia-infected target cells, but a second type of toxicity was demonstrable against uninfected target cells after treatment of the generating cell population with anti-Lyt-2 antibody plus complement at certain time points after infection. This additional nonspecific cytotoxic activity was presumably due to a second factor (factor X) acting in concert with IFN-gamma. Lyt-2+ cells, however, also were shown to play a role in IFN-gamma production and cytotoxicity directed against infected targets at later time points after infection. Neutralization of IFN-gamma in the samples containing cytotoxic activity abrogated the cytotoxicity against both infected and uninfected targets, but cloned murine IFN-gamma exhibited toxicity in a dose-dependent manner only against infected target cells. The data provides evidence that cytotoxicity against infected targets is due to antigen-specific induction of IFN-gamma, but other cytokine activity, most demonstrable after removal of Lyt-2.2+ cells and cytotoxic to uninfected targets, also is present.

Animals↗