Complete sequence conservation of the human T cell leukaemia virus type 1 tax gene within a family cluster showing different pathologies.

We have amplified, through PCR, the full-length tax gene of human T cell leukaemia virus type 1 (HTLV-1) derived from proviral DNA of peripheral blood lymphocytes of five first degree relatives of Afro-Caribbean origin. One patient (the father) had adult T cell leukaemia (ATL), one (the mother) tropical spastic paraparesis (TSP), and three (children) were healthy asymptomatic carriers. All five family members had identical tax nucleotide sequences as determined by direct sequencing of PCR products.

Epidemic of Pseudomonas cepacia in an adult cystic fibrosis unit: evidence of person-to-person transmission.

An epidemic of Pseudomonas cepacia occurred in an adult cystic fibrosis center in the United Kingdom, despite a policy of segregation of infected and noninfected patients within the hospital. Investigation of the outbreak by ribotyping and pulsed-field gel electrophoresis to characterize P. cepacia strain genomes together with inquiry into social contacts between patients revealed evidence of person-to-person transmission outside the hospital environment.

Quantitation of vitronectin in serum: evaluation of its usefulness in routine clinical practice.

Aims: To make a preliminary assessment of the clinical relevance of serum vitronectin concentrations in various disease groups, using a recently available commercial radial immunodiffusion kit.

Methods: Serum vitronectin concentrations were measured in 80 control subjects and 144 patients with various diseases. The following characteristics were used to evaluate the test procedures: linearity of method, inter- and intrabatch precision, effect of storage, temperature and in vitro activation of the classical and alternative complement pathways on vitronectin concentrations.

Endurance exercise capacity in adults with cystic fibrosis.

We have compared the maximal and endurance exercise capacities in 22 (15 male) adult cystic fibrosis (CF) patients with a resting oxygen saturation (SaO2) > or = 90%, with age and sex matched controls (CON). The maximum oxygen uptake (VO2max) and heart-rate were lower for the CF group whereas the maximum ventilation reached a higher percentage of predicted. Furthermore, for the CF group there was a relationship between the % predicted VO2max and measures of lung function, confirming a ventilatory limit to maximum exercise in patients with more severe disease and a near normal maximum exercise capacity in those with mild disease.

Nedocromil sodium and sodium cromoglycate in patients aged over 50 years with asthma.

We conducted a double-blind parallel-group study to compare the efficacy of inhaled nedocromil sodium and inhaled sodium cromogylcate in patients aged 50 years or over with asthma. Seventy-seven patients were randomized, 38 to receive nedocromil sodium (4 mg q.d.

A large Q fever outbreak in the West Midlands: clinical aspects.

In the spring of 1989 the largest outbreak of acute Q fever recorded in the United Kingdom occurred in Solihull and surrounding areas of the West Midlands. The diagnosis was confirmed in 147 people, mainly males of working age. Windborne spread from farmland to the south of the urban area was the most likely route of infection.

The SHIELD scheme in the West Midlands Region, United Kingdom. Midland Thoracic Society Research Group.

Objective: To study the general and specific incidence of occupational asthma within a defined geographic area; to audit the diagnosis of occupational asthma; to determine proposed mechanisms of asthma; and to determine the employment state of workers at diagnosis.

Design: A surveillance scheme of physicians likely to see cases of occupational asthma.

Setting: The West Midlands Region of the United Kingdom.

Life-threatening right ventricular thrombosis in association with phospholipid antibodies.

An 18 year old man presented with cough and dyspnoea caused by pulmonary infarction. A large friable mass of organising thrombus in an anatomically normal right ventricle was identified as an embolic source. The acute illness was associated with raised titres of anticardiolipin antibodies, one of the antiphospholipid group.

Incidence of episodes of acute asthma and acute bronchitis in general practice 1976-87.

The incidence of episodes of acute asthma and acute bronchitis was analysed for an 11-year period and studied in relation to epidemiological data on viral illness and virus isolation data. Between 1976 and 1987, the weekly returns service estimates of the incidence of acute asthmatic episodes in England and Wales increased from 10.2 to 27.

Detection of HIV-1 by digoxigenin-labelled PCR and microtitre plate solution hybridisation assay and prevention of PCR carry-over by uracil-N-glycosylase.

An extremely sensitive and convenient microtiter plate solution hybridisation assay for the detection of HIV-1 PCR products was developed. The PCR product is labelled by direct incorporation of digoxigenin-dUTP and after denaturation is captured by a microtitre plate coated with a streptavidin-linked biotinylated probe. The PCR/probe hybrids are reacted with an alkaline phosphate conjugated anti-digoxigenin antibody and detected using an alkaline phosphatase enzyme amplification system.

Malignant change in dermatitis artefacta.

Dermatitis artefacta is a chronic skin lesion produced by self-trauma. Avoidance of further trauma, topical steroids and psychological therapy all play a part in the treatment of such lesions. Unresolved lesions may become large and disfiguring and subject to infection.

Dimensions of nursing knowledge in wound care.

There is continuing debate as to whether nursing is an art or a science. This seems to be further fuelled by discussion about whether nursing is a profession. If nursing could be called a research-based science, would it become a recognized profession and be taken more seriously? This article relates the art/science debate to the teaching of wound care in clinical practice.

Apocrine metaplasia: a new type of müllerian metaplasia.

Apocrine differentiation was an incidental finding in an ovarian cyst. This is considered to be a further example of Müllerian metaplasia that has not been described before and which, theoretically, could occur in any organ of Müllerian derivation (ovary, uterus, cervix or fallopian tube). It is suggested that sites of such metaplasia could in turn be the origin of primary apocrine carcinoma in any of the above locations.

Health, employment, and financial outcomes in workers with occupational asthma.

Objective: To study the health, employment, and financial outcome of occupational asthma.

Design: A follow study of workers with confirmed occupational asthma.

Setting: A specialist occupational lung disease clinic.

Penicillins. A current review of their clinical pharmacology and therapeutic use.

The penicillins are a large group of bicyclic ring compounds which contain a 4-membered beta-lactam ring (penams) fused to a 5-membered thiazolidine ring. Benzylpenicillin (penicillin G) was the first natural penicillin with potent activity against all Gram-positive pathogens, Gram-negative cocci and some spirochaetes and actinomycetes. For the last 50 years benzylpenicillin has been the mainstay of therapy for serious pneumococcal, streptococcal, meningococcal and gonococcal infections.

The use of proprietary medicines by patients presenting with peptic ulcer haemorrhage.

1. Medication, social and symptom histories were compared in patients with severe haemorrhage from a peptic ulcer (n = 71) and matched control subjects. Self-medication with proprietary agents was catalogued in addition to therapy prescribed by general medical practitioners.

Epidemiology of Pseudomonas aeruginosa infection in cystic fibrosis and the use of strain genotyping.

We describe a study of the epidemiology of Pseudomonas aeruginosa (PA) infection in a group of adults with cystic fibrosis who attended a week-long summer camp in the U.K. Sputum samples were collected from 17 patients at the beginning and at the end of the holiday period.

Neuromuscular diseases in children.

Our understanding of neuromuscular disorders has advanced considerably in recent years with developments in molecular genetic techniques. In some conditions we now know the basic pathological defect and, in many, prenatal diagnosis is now available. This review considers the common clinical problems that confront clinicians.

Effects of high dose inhaled beclomethasone dipropionate, 750 micrograms and 1500 micrograms twice daily, and 40 mg per day oral prednisolone on lung function, symptoms, and bronchial hyperresponsiveness in patients with non-asthmatic chronic airflow obstruction.

Background: The effect of treatment with inhaled corticosteroids in patients with non-asthmatic chronic airflow obstruction is still disputed. Whether any physiological improvements seen are accompanied by changes in bronchial responsiveness and symptoms and quality of life is also still unclear.

Methods: A sequential placebo controlled, blinded parallel group study investigating the effect of three weeks of treatment with inhaled beclomethasone dipropionate (BDP), 750 micrograms or 1500 micrograms twice daily, and oral prednisolone, 40 mg per day, was carried out in 105 patients with severe non-asthmatic chronic airflow obstruction (mean age 66 years, mean forced expiratory volume in one second (FEV1) 1.

Use of serial measurements of peak flow in the diagnosis of occupational asthma.

Occupational asthma is best verified by physiological measures, including (1) measurement of lung function on a single occasion with bronchodilator response, (2) measurement of lung function before and after a workshift, and (3) repeated measurement of PEF over long periods of time, including readings at and away from work. The author describes a qualitative method for distinguishing patterns of PEF change at and away from work which has been effective in the diagnosis of work-related asthma.

Primary gastrointestinal non-Hodgkin's lymphoma: a review of 175 British National Lymphoma Investigation cases.

A retrospective analysis was performed upon 175 patients with Non-Hodgkin's Lymphoma involving the gastrointestinal tract and entered into BNLI trials and studies between 1974-1988. Malignant histiocytosis of the intestine (MHI), which was present in 16 patients, was associated with a survival of less than 25% at 18 months, and probably accounted for the poor survival of patients with jejunal involvement. Histopathological evidence of tumour origin from mucosa-associated lymphoid tissue (MALT) was found in 50% of patients with gastric involvement and in 27% of those with intestinal involvement.