Improved detection of hereditary haemochromatosis.

Aims: There is high prevalence of hereditary haemochromatosis (HH) in North European populations, yet the diagnosis is often delayed or missed in primary care. Primary care physicians frequently request serum ferritin (SF) estimation but appear uncertain as how to investigate patients with raised SF values. Our aim was to develop a laboratory algorithm with high predictive value for the diagnosis of HH in patients from primary care with raised SF values.

Lercanidipine: a novel lipophilic dihydropyridine calcium antagonist with long duration of action and high vascular selectivity.

Lercanidipine is a new 1,4-dihydropyridine derivative with potent, long-lasting and vascular-selective calcium entry blocking activity. Animal models of hypertension have shown lercanidipine to be potent, with a slow rate of onset and long lasting action and to have minimal or no effects on cardiac contractility. There was no evidence of tolerance after repeated oral treatment, and no effects were found on the autonomic nervous, central nervous, gastrointestinal or respiratory systems at antihypertensive doses.

Tumefactive fibroinflammatory lesion of the neck.

Fibrosclerotic and fibroinflammatory diseases are pelicular and unusual conditions, which may present in any part of the body. Howeverm, in the region of the head and the neck they are seldom seen and hence easily misdiagnosed. To date, about twenty-two such cases have been reported in the head and neck region.

Vertebral artery dissection diagnosed by non-invasive magnetic resonance imaging.

A forty-year-old man developed right-sided neck discomfort whilst cycling to work. On admission to hospital he was found to have signs of bilateral cerebellar dysfunction. Magnetic resonance imaging of the brain demonstrated bilateral areas of cerebellar infarction.

Pulmonary artery pressure measurement during exercise testing in patients with suspected pulmonary hypertension.

It is recognized that exercise produces abnormally large increases in pulmonary artery pressure in patients with pulmonary vascular disease as a consequence of a variety of disorders, but the relationship between pressure and cardiopulmonary exercise performance is poorly understood. This lack of understanding is due (in part) to difficulty making measurements of pulmonary haemodynamics using conventional fluid filled catheters. This article seeks to improve understanding by comparing variables measured during formal exercise testing with simultaneous measurements of pulmonary artery pressure using a micro-manometer tipped catheter.

The value of the absent bow tie sign in MRI of bucket-handle tears.

Aim: To assess the accuracy of the absent bow tie sign in diagnosing bucket handle meniscal tears (BHT) of the knee menisci.

Materials And Methods: During a 3-year period, we correlated the MRI and arthroscopic findings and the presence of the various signs. One hundred and seven knees were reviewed: 74 where either MRI or arthroscopy had identified a BHT and 33 which were either normal (31), or a simple tear was identified (2).

Trandolapril does not improve insulin sensitivity in patients with hypertension and type 2 diabetes: a double-blind, placebo-controlled crossover trial.

Angiotensin-converting enzyme (ACE) inhibitors are increasingly used as first-line therapy for hypertension in type 2 diabetes mellitus and are widely believed to improve insulin sensitivity (M). However, the evidence for the latter effect does not stand close scrutiny. We have assessed the effect of the ACE inhibitor trandolapril on M in 16 patients (mean +/- SD age, 58 +/- 10.

Using a case-mix-adjusted pressure sore incidence study in a surgical directorate to improve patient outcomes in pressure ulcer prevention.

The Glasgow Acute Clinical Audit Sub-Committee on Pressure Sores has previously carried out studies of incidence of pressure ulcers in the medical directorates and case-mix-adjusted the figures for length of hospital stay and risk assessment score. Case-mix classification is 'classification of people or treatment placed into groups using characteristics associated with condition, treatment or outcome that can be used to predict need, resource, use of outcomes'. In this instance, crude pressure ulcer incidence figures may be adjusted for length of hospital stay and pressure sore risk assessment score, and stratified into groups, which allows like to be compared with like.

Effects of angiotensin II on remodelling of the airway and the vasculature in the rat.

Airway remodelling occurs in chronic asthma. Angiotensin II promotes growth in cardiovascular remodelling. Since the renin-angiotensin system is activated in acute severe asthma, we hypothesized that angiotensin II has a role in airway remodelling.

Sputum cellular and cytokine responses to inhaled endothelin-1 in asthma.

Background: Endothelin (ET)-1 is a 21-amino acid peptide which has potent bronchoconstrictor activity. Animal studies show elevation of ET-1 during experimental airway inflammation, and inhibition of inflammation by endothelin-antagonists, suggesting pro-inflammatory activity for ET-1.

Objective: We wanted to assess any acute influence that bronchoconstrictor doses of inhaled ET-1 might have on cells, tumour necrosis factor (TNF)-alpha, interleukin (IL)-1beta, nitrite (NO2) and albumin in induced sputum in asthma.

Vocal fold paralysis following carotid endarterectomy.

Injury to the vagus nerve or one of its branches during carotid endarterectomy (CEA) can result in vocal fold paralysis (VFP). This study assessed prospectively 73 patients undergoing CEA. A total of 76 procedures were performed in these patients over a one-year period.

Predictors of nocturnal oxygen desaturation in patients with COPD.

The aim of this study was to identify factors which might predict nocturnal desaturation (defined as a fall of > 4% from awake baseline level for > or = 5 min) in normoxic or mildly hypoxic patients with stable COPD [arterial O2 saturation (SaO2) > or = 91%]. The study was prospective in nature, had full ethical approval and was performed in the Respiratory Department of a city teaching hospital. Thirty-three patients [mean (SD) age 67.

Sputum endothelin-1 is increased in cystic fibrosis and chronic obstructive pulmonary disease.

Many patients with cystic fibrosis (CF) have airflow obstruction, with peribronchial and peribronchiolar fibrosis. Endothelin (ET)-1 is a potent bronchoconstrictor with mitogenic activity for airway smooth muscle. Do the levels of ET-1 in sputum support the putative role of ET-1 in contributing to airway remodelling with airflow obstruction in CF? The levels of ET-1 in plasma, saliva and sputum from 12 adult patients with CF not in exacerbation (spontaneous sputum), 17 normal control subjects (induced sputum) and as an additional control population, nine patients with stable chronic obstructive pulmonary disease (COPD) (seven spontaneous sputum) were measured.

Early referral, diagnosis, and treatment of rheumatoid arthritis: evidence for changing medical practice.

Objectives: To study the delay in starting disease modifying anti-rheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA), and any changes in medical practice between 1980 and 1997.

Methods: 198 consecutive RA patients attending the rheumatology clinics at a teaching hospital, for routine review, had their case sheet reviewed. The dates of symptom onset, general practitioner (GP) referral, first clinic appointment and first use of DMARD were recorded.

Use of permanent dual lumen catheters for long-term haemodialysis.

Permanent dual lumen catheters (PDLC) provide alternative vascular access in patients considered unsuitable for arteriovenous fistula, arteriovenous graft or peritoneal dialysis. Experience with their use for long-term haemodialysis is presented. Between January 1990 and April 1994, 101 catheters were inserted into 63 patients (median age 62 years).

The importance of radiometer angular response for ultraviolet phototherapy dosimetry.

The influence of the angular response of radiometer probes on measurements of irradiance in ultraviolet phototherapy has been studied. Irradiance measurements were made using nine ultraviolet (UV) radiometers employed by phototherapy centres in Scotland and Northern Ireland, and compared with measurements made using two spectroradiometers. The light sources used were UVB TL01 fluorescent lamps, arranged in different geometries.

Myasthenia gravis presenting with dysphagia and postoperative ventilatory failure.

We report a case of myasthenia gravis presenting to the department of otolaryngology with acute dysphagia on two separate occasions over a one-year period. Diagnosis of myasthenia gravis was made when the patient developed ventilatory failure after his second general anaesthetic for rigid oesophagoscopy. Our patient required emergency transfer to the intensive therapy unit for ventilation.

Percutaneous fibrin sleeve stripping of failing haemodialysis catheters.

Background: One of the most frequent reasons for failure of haemodialysis lines is catheter blockage caused by fibrin sheath formation. We report our experience of percutaneous fibrin sheath stripping in treating this problem.

Methods: A consecutive series of failing haemodialysis catheters underwent percutaneous fibrin sheath stripping in an attempt to retrieve and prolong the life of the catheter.

Pulmonary artery pressure variation in patients with connective tissue disease: 24 hour ambulatory pulmonary artery pressure monitoring.

Background: The specific contribution of secondary pulmonary hypertension to the morbidity and mortality of patients with underlying lung disease can be difficult to assess from single measurements of pulmonary artery pressure. We have studied patients with secondary pulmonary hypertension using an ambulatory system for measuring continuous pulmonary artery pressure (PAP). We chose to study patients with connective tissue disease because they represent a group at high risk of pulmonary vascular disease, but with little disturbance of lung function.

Reductions in finger doses for radiopharmaceutical dispensing afforded by a syringe shield and an automatic dose dispenser.

A gamma extremity monitoring system (GEMS) has been used to measure finger doses during radio-nuclide dispensing procedures. GEMS uses a small semi-conductor probe that can be attached to a finger from which a continuous read-out can be obtained that is related to dose rate. The pattern of dose accumulation can be analysed to allow doses received from individual operations within a procedure to be evaluated.

Measurement of image quality in diagnostic radiology.

The aim in radiology is to obtain images which are adequate for the clinical purpose with the minimum radiation dose to the patient. If optimum performance is to be achieved, assessments of image quality must be made to balance against patient dose. The subjective nature of image interpretation makes an objective approach to such assessment difficult.

Balancing patient dose and image quality.

The formation of images in diagnostic radiology involves a complex interdependence of many factors. The ideal balance is to obtain an image which is adequate for the clinical purpose with the minimum radiation dose. Factors which affect radiation dose and image quality can be grouped under three headings; radiation quality, photon fluence and removal of scattered radiation.

Effect of infused angiotensin II on the bronchoconstrictor activity of inhaled endothelin-1 in asthma.

Study Objectives: Endothelin (ET)-1 is a potent bronchoconstrictor, and asthmatics demonstrate bronchial hyperresponsiveness to ET-1 given by inhalation. Angiotensin II (Ang II) is increased in plasma in acute severe asthma, causes bronchoconstriction in asthmatics, and potentiates contractions induced by ET-1 in bovine bronchial smooth muscle in vitro, and contractions induced by methacholine both in vitro and in vivo. We wished to examine any potentiation of the bronchoconstrictor activity of inhaled ET-1 by infused Ang II at subbronchoconstrictor doses.

Diagnosis and prevention of fungal infection in the immunocompromized patient.

Profound and prolonged neutropenia following chemotherapy is a major risk factor for systemic fungal infections. Mortality associated with disseminated fungal infection is high and treatment with conventional amphotericin B is complicated by renal toxicity. Candida and Aspergillus are among the major pathogens in this patient population.