Urinary transferrin excretion in type 1 (insulin-dependent) diabetes mellitus.

Urinary excretion of transferrin and albumin was studied by radioimmunoassay in 47 adult patients with Type 1 diabetes and 28 control subjects. Median (range) urinary transferrin excretion rate was significantly elevated in the diabetic group 0.58 (0.

The clinical presentation and diagnosis of invasive fungal infections.

The frequency of invasive fungal infections is increasing owing to the increasing numbers and improved survival of immuno-compromised patients. The fungi responsible for these infections are predominantly opportunistic pathogens. The clinical features and diagnosis of the four commonest infections (invasive candidosis and aspergillosis, cryptococcosis and mucormycosis) are discussed.

Recurrent nerve palsy due to parathyroid cyst.

Cysts of the parathyroid gland are uncommon neck masses and difficult to diagnose. They can cause symptoms by endocrinological function or by pressure on surrounding structures. A case of recurrent nerve palsy due to a parathyroid cyst is presented.

Epithelial cell type, clinical behaviour and AgNOR counts in thymic epithelial tumours.

The relationship between epithelial cell type, clinical behaviour and number of nucleolar organiser regions (AgNORs) was investigated in 37 thymomas and three thymic carcinomas. The thymomas were classified according to epithelial cell morphology as cortical (16 cases), medullary (8 cases) or mixed (13 cases). Seven cortical tumours had infiltrated the capsule or adjacent structures at the time of operation, whereas only one medullary and two mixed tumours showed evidence of invasion, the differences being statistically significant (P less than 0.

The incidence and value of rectal examination in children with suspected appendicitis.

Rectal examination is considered an important part of the examination of patients presenting with abdominal pain. However, children find anal digitation unpleasant and it was our impression that doctors were becoming less insistent on performing a rectal examination. We performed an audit of rectal examination and assessed whether this made any difference to the management of children with acute abdominal pain.

Endothelial cell seeding.

Endothelial cell seeding is a technique that has developed over the past 15 years in response to the need for a high performance synthetic vascular graft. This review details our present knowledge of seeding and examines the various problems that have hampered its introduction into clinical practice.

The management of peritonsillar sepsis by needle aspiration.

172 consecutive patients admitted with suspected unilateral peritonsillar sepsis were studied. Needle aspiration of the peritonsillar space was performed, and they were all then treated with intravenous antibiotics (usually benzylpenicillin). Any pus obtained was cultured.

Flumazenil in intensive care. The duration of arousal after an assessment dose.

The effect of an assessment dose of the benzodiazepine antagonist flumazenil was studied in 20 patients in an intensive care unit. The patients had been sedated with alfentanil and midazolam, and were ready to be weaned from mechanical ventilation. In 10 patients flumazenil was titrated just to produce full arousal whilst the midazolam infusion was continued; flumazenil administration was repeated one hour later after the infusion of midazolam had been stopped.

The effect of inducing agents on the numbers of interphase fibrillar centers in the U937 promonocytic cell line.

The mean numbers of interphase fibrillar centers have been determined in triplicate experiments, using the argyrophil (AgNOR) method. Promonocytic U937 cells were incubated with each of three inducing agents, namely, interleukin-6, granulocyte-macrophage colony-stimulating factor, and the phorbol ester 12-O-tetradecanoylphorbol-13-acetate. The cells were examined at 24, 48, and 72 h during the induction periods and their doubling time and mean AgNOR score were calculated.

Granulomatous enteropathy in common variable immunodeficiency: a cause of chronic diarrhoea.

Gastrointestinal disease is a well recognized feature in patients with common variable immunodeficiency, and is often due to infection with a variety of organisms. Symptoms usually improve with appropriate antibiotic therapy and replacement gammaglobulin. We describe three middle-aged female patients with common variable immunodeficiency who had protracted diarrhoea and weight loss.

Laser Doppler flowmetry, transcutaneous oxygen tension measurements and Doppler pressure compared in patients undergoing amputation.

The level of amputation continues to present a challenge for surgeons. In view of this, 24 patients who required an amputation of their ischaemic leg were studied prospectively using Laser Doppler flowmetry (LDF), TcpO2 measurements and Doppler ultrasound to assess the best level for amputation. In all patients gangrene of the leg and rest pain were the indication for an amputation.

Immunohistochemical demonstration of CD23 expression on lymphocytes in rheumatoid synovitis.

The leucocyte antigen CD23 is expressed by B lymphocytes following activation by a number of stimuli and functions as an IgE receptor, and in its soluble form, as a putative B cell growth factor. The expression of CD23 on the surface of lymphocytes in paraffin wax sections of synovial biopsy specimens was studied using a novel mouse monoclonal antibody, BU38. Specimens were investigated from nine cases of rheumatoid arthritis, six cases of osteoarthritis, and eight cases of chronic inflammation in articular and non-articular tissues.

Lymphoepithelial cyst of the pancreas.

A case of lymphoepithelial cyst of the pancreas is reported. The unilocular cyst was filled with keratin, lined by mature, keratinizing squamous epithelium and surrounded by lymphoid tissue.

A family with three sisters with the 4p- syndrome, originally reported as suffering from the Smith-Lemli-Opitz syndrome.

The authors further describe investigations of a family originally reported by Bundey & Smyth in 1974 with a diagnosis of the Smith-Lemli-Opitz syndrome. Chromosome studies performed for the fourth time revealed that the mother had a presumptive t(4;22) translocation. The importance of reviewing earlier diagnoses, including repeating the chromosome studies if indicated, in order to arrive at a more accurate diagnosis is stressed.

Post-laryngectomy stomal recurrence: tumour implantation or paratracheal lymphatic metastasis?

In the treatment of obstructing laryngeal cancer, an association has often been noted between emergency tracheotomy for airway relief and subsequent post-laryngectomy stomal recurrence. It is however unclear whether this is due to tumour implantation in the tracheotomy track, or paratracheal lymph node metastasis. To investigate the pathophysiology of stomal recurrence, the recurrence rate and clinical outcome of 26 cases of T3N0M0 glottic cancer treated with emergency tracheotomy and subsequent laryngectomy were analysed, and compared with 65 stage-matched cases treated with laryngectomy alone.

Comparison of the haemodynamic effects of dopexamine and dobutamine in patients with severe congestive heart failure.

Dopexamine hydrochloride is a novel compound with properties of DA1-dopaminergic and beta 2-adrenergic receptor agonism and neuronal noradrenaline uptake inhibition. It has been shown to produce beneficial renal and haemodynamic effects in patients with severe heart failure. We compared the haemodynamic effects of dopexamine (0.

Percutaneous insertion of subclavian Hickman catheters.

We have assessed the percutaneous insertion of Hickman catheters implanted directly into the subclavian vein; 116 catheters were inserted in 86 patients. The catheters were all inserted by members of the haematology staff. The majority of the catheters were inserted under local anaesthetic in a haematology ward with filtered positive pressure ventilation.

Assessment of oxygenation in the critically ill.

This paper reviews the physiology and pathology of oxygen transport from the atmosphere to the cells in critically ill patients. A thorough understanding of this allows a rational approach to monitoring and managing an hypoxic patient in the intensive care setting.

The effect of sustained-release theophylline in nocturnal asthma.

Nocturnal symptoms are common and often disabling in asthmatic subjects. Furthermore, they often persist, in spite of appropriate dosages of inhaled beta 2-agonists and topical steroids. In such a clinical situation, theophylline preparations may have a therapeutic role.

Five years experience with the Quinton Permcath for vascular access.

Over a five-year period 64 Quinton Permcaths were inserted into 51 dialysis patients (age range 17-72 years, mean 52.1 SD 12.83).

Measures of reversibility in response to bronchodilators in chronic airflow obstruction: relation to airway calibre.

A study was carried out to examine the independence from starting prebronchodilator FEV1 of four indices commonly used to express airflow (FEV1) reversibility in response to bronchodilators. In 121 patients with chronic airflow obstruction with a mean prebronchodilator FEV1 of 1.81 (43.

Herpes zoster and pain.

Pain is frequently the most distressing symptom of herpes zoster. Pain occurs in most patients during the acute phase and sometimes continues as postherpetic neuralgia (PHN) for months or years after the rash has healed. Both the acute pain and the incidence and duration of postherpetic pain are influenced by the age of the patient and the distribution of the rash.