Managing TMD.
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Biomedical subjects
Publications and source records attributed to W Guthrie.
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This study evaluated the relationship between benzene exposure and low white blood cell (WBC) and red blood cell (RBC) counts. Hematologic screening data collected over a 35 year period at a rubber hydrochloride manufacturing plant were analyzed; an increased risk of leukemia had been demonstrated previously among workers at the plant [Infante et al. (1977).' Lancet 2:76-78; Rinsky et al. (1981): Am J Ind Med 2:217-45 (1987): NEJM 316:1044-1050/. Hematologic screening data were available for 657 of 1,037 (63.3%) individuals employed at the plant from 1939 through 1976. There was a total of 21. 710 blood test records (range per individual 1-354). The study utilized a case-control design and estimated benzene exposures using the job exposure matrix developed by Rinsky et al. (1987): NEJM 316:1044-1050]. The effects of benzene exposure in the 30, 90, and 180 days before the blood test date, as well as cumulative exposure up until the blood test date, were examined using conditional logistic regression. For WBCs there was a strong exposure response and all of the exposure metrics selected showed a significant relationship with low blood count. For RBCs there was a weak positive exposure-response, which was significant (p = 0.03) for one of the dose metrics. The finding of an exposure-response relationship in the range of exposures represented in this study, where the maximum daily benzene exposure estimate was 34 ppm, is consistent with findings of several animal studies demonstrating a decrease in peripheral lymphocyte counts at benzene exposures as low as 10 ppm, and a stronger effect of benzene exposure on lymphocytes (as reflected in total WBC count) than on red cells. There was no evidence for a threshold for the hematologic effects of benzene exposure, suggesting that even exposure to relatively low levels of benzene (e.g., <5 ppm) may result in hematologic suppression.
Audit is now part of any laboratory service. Histopathology is no exception, and we have set up a system which allows us to review 4% of our specimens. These specimens are identified using a random number generator and reviewed by a consultant pathologist. Both slides and wet specimens are reviewed and graded according to a set scheme. The results from the first year of operation (1990) show a high rate of accuracy with no serious diagnostic disagreements between the auditor and the reporting pathologist. However, some errors which we would wish to prevent were detected and the audit has allowed us to take corrective measures. In our opinion, this form of audit is useful and necessary to maintain good clinical practice. The cost is considerable--histopathology is by its nature labour intensive. Recognition of this fact by health boards is essential if such systems are to continue.
A prospective autopsy study of deaths of women who had been diagnosed previously as having cancer of the breast was performed between October 1986 and December 1990. During the study period 28 deaths occurred and nine of these (32%) were attributable directly to breast cancer; a figure similar to that found in our earlier retrospective study. In this study the autopsy findings in both the breast cancer and non-breast cancer deaths were recorded and five cases underwent post-mortem radiological skeletal survey to detect metastases. The findings confirm the role of the post mortem in modern medicine as a method of auditing clinical practice. Of particular importance, is the finding that the clinical presumption of disseminated breast cancer as a cause of 'terminal' illness in some patients may be misleading and dangerous, possibly denying some patients treatment of potentially remedial conditions by the institution of inappropriate terminal care.
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Two siblings with homozygous ZZ alpha-1-antitrypsin deficiency were discovered to have primary liver tumours (both cholangiocarcinomas). This lends support to the view that alpha-1-antitrypsin deficiency plays a role in the development of some primary liver tumours.
Medical calcification of arteries is common in chronic renal failure. We report on a patient with extensive calcification of the arterial media who developed symmetrical acral gangrene and severe cardiac failure shortly after cadaveric renal transplantation. At necropsy, the medial calcification was found to be accompanied by extensive intimal proliferation and multiple antemortem fractures, some healing by callus formation. Such medial calcification, which is similar to Monckeberg's sclerosis, affected all systemic arteries except the aorta, pulmonary artery and transplanted renal artery. Six years before this terminal illness he had undergone total parathyroidectomy for osteitis fibrosa associated with ruptured tendons. We review previous reports of patients with the syndrome of acral gangrene in azotaemic renal failure and discuss the histopathological features and pathogenesis in relation to the unusual features of our patient.
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Orbital mucormycosis is reported in a healthy patient with maturity onset diabetes who was treated with orbital exenteration, amphotericin B, and ketoconazole. A six-year follow-up shows no evidence of recurrence.
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The histological and ultrastructural appearances of a galactocoele are illustrated and compared with previous descriptions. For the first time, microscopic evidence is presented to show that a galactocoele arises from dilated ducts filled with milk produced in the surrounding breast.
We report the clinical presentation and management of 34 patients with a histologically proven chordoma, treated in the neurosurgical departments in Edinburgh and Dundee, over the past 50 years. Although these tumors are commonly regarded as being locally invasive with a variable, but generally slow growth rate, they can metastasize, and this may precede surgical intervention, as in one of our patients. Our cases are compared to those in previously published series, and a comprehensive review of the treatment modalities for tumors at various sites is presented. The optimal treatment to be recommended from our own experience, and that of others, is aggressive operation and radiotherapy. A combination of hyperthermia and chemotherapy has shown some promise, but remains untested, and highlights the need for a multicenter trial with long follow-up to allow the evaluation of new therapeutic approaches.
All patients with chordomas that have been treated in the Dundee neurosurgical unit are reviewed. Five intracranial and two sacral chordomas have presented since the unit opened in 1966. Survival has ranged from one to fifteen years following treatment. The difficulties in diagnosis and in assessing treatment of these rare slow growing neoplasms are discussed.
We report a case of fatal adriamycin cardiomyopathy in a 12-year-old boy treated for Ewing's sarcoma. At necropsy, in addition to the typical changes of advanced cardiotoxicity in the myocardium there was endocardial fibroelastosis, mainly affecting the left ventricle.
A case of malignant granular cell tumour (myoblastoma) which metastasized from the vulva to the regional lymph nodes is presented. Electron microscopy of the metastases demonstrated the presence of numerous intra-cytoplasmic lysosomes, a feature characteristic of these neoplasms, and the neoplasm was shown to stain strongly for carcinoembryonic antigen (CEA) using the immunoperoxidase technique. Previous reports in the literature of malignant granular cell tumours are reviewed and discussed.
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A diabetes prevalence study on an isolated urbanized Central Pacific Island has established a prevalence rate of 34.4% in individuals aged 15 years and over. Of these, 10.4% had previously known diabetes; in the others the diagnosis was made on the basis of a plasma glucose level of at least 160 mg/100 ml 2h after a 75 gm oral glucose load. A further 11.3% of the subjects had borderline diabetes as judged by a 2-h plasma glucose of between 140 and 159 mg/100 ml. Of the diabetics, 72% had a positive family history of diabetes. The high prevalence rate appears to be related to a number of factors including a diabetic genotype, urbanization, and obesity.