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1.  The potential role of Clostridium perfringens alpha toxin in the pathogenesis of acute pancreatitis. 
Journal of Clinical Pathology  1996;49(6):500-503.
BACKGROUND: Clostridium perfringens is a bowel commensal that can colonise the biliary tract. It produces the alpha toxin (phospholipase C), which can induce spontaneous tissue necrosis. AIMS: To investigate whether there is any evidence that Clostridium perfringens alpha toxin can be detected in acute pancreatitis. METHODS: Serum samples from 21 patients with acute pancreatitis and 22 controls were assayed for C perfringens phospholipase C as well as anti-phospholipase C IgG and IgM; IgG and IgM anti-toxins were measured by enzyme linked immunosorbent assay. RESULTS: In normal healthy controls there is a very high level of natural anti-toxin of both the IgG and IgM class. Of the 21 patients with acute pancreatitis alpha toxin was detected in five (23.8%). Levels of both IgG and IgM anti-toxin were significantly reduced in acute pancreatitis. CONCLUSIONS: The results suggest that there is an abnormality of the immune status to C perfringens alpha toxin in patients with acute pancreatitis. This may be the result of a release of alpha toxin, although it is difficult to state whether this is a primary or secondary phenomenon in these patients. These preliminary results merit further investigation.
PMCID: PMC500543  PMID: 8763267
2.  The role of a nested polymerase chain reaction in the diagnosis of Pneumocystis carinii pneumonia 
Clinical Molecular Pathology  1995;48(6):M347-M350.
Aim—To compare the techniques and results of a nested PCR and an immunofluorescence assay (IFA) for the detection of Pneumocystis carinii infection; to consider the role of the nested PCR in the diagnosis of P carinii pneumonia (PCP).
Methods—Serial dilutions of two known P carinii positive samples were tested by IFA and PCR to determine their relative sensitivities. Seventy eight respiratory samples (15 from 11 patients with HIV infection/acquired immunodeficiency syndrome (AIDS) and 63 from 42 patients with other forms of immunodeficiency) were tested using both assays, and the costs and technical requirements of each assay were assessed.
Results—The PCR had a greater relative sensitivity over the IFA of 2 × 101 to 2 × 103 fold in a postmortem lung sample and 2 × 105 to 2 × 106 fold in a bronchoalveolar lavage sample from a patient with PCP. P carinii was detected in all 15 samples from the patients with HIV/AIDS by both IFA and PCR. Of the 63 samples from the patients with immunodeficiencies other than HIV/AIDS, the PCR was more sensitive than IFA.
Conclusions—The nested PCR is a more sensitive assay than the IFA. It may be useful in the diagnosis of PCP in patients with immunodeficiencies other than HIV/AIDS. Similarly, PCR may be of benefit for this patient group as less invasive specimens are needed. PCR has an increasing role to play in the diagnosis of PCP in the routine laboratory.
PMCID: PMC408003  PMID: 16696036
Pneumocystis carinii; PCR; immunofluorescence assay; acquired immunodeficiency syndrome
4.  Antibody to selected strains of Saccharomyces cerevisiae (baker's and brewer's yeast) and Candida albicans in Crohn's disease. 
Gut  1990;31(5):536-538.
IgG serum antibody was measured by ELISA in patients with Crohn's disease (15), ulcerative colitis (15), and in normal controls (15) to 12 strains of Saccharomyces cerevisiae (baker's and brewer's yeast) and to the two major serotypes of the commensal yeast Candida albicans. Antibody to 11 of the 12 strains of S cerevisiae was raised in patients with Crohn's disease but not in patients with ulcerative colitis when compared with controls (p less than 0.001). The pattern of antibody response to these 11 strains was variable, however, suggesting the likelihood of antigenic heterogeneity within the species. Antibody to C albicans was not significantly different in patient and control groups. The specificity of this unusual antibody response in Crohn's disease for S cerevisiae suggests that it is not simply the result of a generalised increase in intestinal permeability. Furthermore, because brewing and baking strains detected the response, the relevant antigen(s) are presumably common in the diet. Hypersensitivity to dietary antigens may be involved in the pathogenesis of Crohn's disease, and the role of S cerevisiae requires further investigation.
PMCID: PMC1378569  PMID: 2190866
8.  Isolation of actinomycetes from cervical specimens. 
Journal of Clinical Pathology  1981;34(8):914-916.
Cervical smears from 30 women were examined. Fifteen of these had actinomycetes visible by direct smear examination and the organisms were isolated in 13. Of the remainder, all had negative smears and culture was similarly negative in 12, whilst in 3, the cultures were either positive (1) or suspicious (2).
PMCID: PMC493980  PMID: 7024316
9.  Actinomyces-like organisms in cervical smears from women using intrauterine contraceptive devices. 
British Medical Journal  1980;281(6239):534-537.
Cervical smears from 293 users of intrauterine contraceptive devices attending family planning clinics in East Fife, Dundee, and Angus were stained by Papanicolaou and Gram's methods and examined for actinomyces-like organisms. Of the 128 women using plastic devices, 40 gave smears positive for these organisms. In contrast only two positive smears were obtained from the 165 women using devices containing copper and none from a control group of 300 women taking oral contraceptives. Colonisation was more common in women whose plastic devices had been in situ for over two years. Correlations between the presence of these organisms and recorded incidences of pain and both clinical and cytological evidence of inflammation of the lower genital tract were highly significant (p = 0.00001, p < 0.00001, and p < 0.00001 respectively). The results suggest that plastic intrauterine contraceptive devices predispose to colonisation by actinomyces-like organisms, particularly after long-term use. Hence if the apparently bacteriostatic action of copper devices is confirmed these should probably be more widely used.
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PMCID: PMC1713471  PMID: 7427358
10.  Cell-mediated immunity in operable bronchial carcinoma: the effect of injecting irradiated autologous tumour cells and BCG. 
Thorax  1979;34(1):68-73.
In 52 patients undergoing tests of cell-mediated immunity before surgical resection of bronchial carcinoma a positive tuberculin test result was found in 71% compared with 68% of age- and sex-matched controls. Sensitisation to DNCB occurred in 52% of 37 patients but in 78% of controls. There was depression of lymphocyte transformation by PPD in 19 patients compared with controls (P=0.001), but there was no difference in lymphocyte transformation by PHA or pokeweed mitogen between 34 patients and controls. In a pilot study patients were randomly allocated to autograft (eight) or non-autograft (seven) groups. The autograft group were given an intradermal injection of a suspension of irradiated autologous tumour-cells mixed with intradermal BCG on the day of operation. Tests of cell-mediated immunity were repeated two weeks after operation. Five patients in each group received a course of radiotherapy to the mediastinum three weeks after operation. There was a rise in cutaneous tuberculin reactivity (P=0.08) and total leucocyte count (P=0.09) in the autograft group postoperatively with a fall in total lymphocyte and T lymphocyte counts in the non-autograft group (P less 0.05). These differences, however, were not followed by any difference in the frequency of tumour recurrence or the survival rate two years after operation. The results show that the immunological surveillance mechanism is impaired even in patients with early bronchial carcinoma and that it is possible to overcome postoperative immunological depression with specific immunotherapy combined with BCG. This treatment did not produce any clinical advantage in this small number of patients and the skin lesions caused the patients considerable discomfort.
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PMCID: PMC471010  PMID: 442002
11.  Determination of antibody levels to Candida albicans in healthy and hospitalised adults using a radioimmunoassay. 
Journal of Clinical Pathology  1978;31(12):1161-1166.
A radioimmunoassay for antibody to Candida albicans is described. The test used whole, killed organisms as the antigen and radiolabelled sheep anti-human globulins to quantitate different classes of antibody to C. albicans. The assay has been compared with an Ouchterlony precipitin method and found to be simpler, more rapid, and more sensitive than the latter. Results obtained from two groups of symptomless adults indicated that the range of antibody level was wider for a hospitalised group than for a group of blood transfusion donors, particularly in respect of IgG and IgA antibody. The reason for the increase of antibody in hospital patients was not clear but may have been related to antibiotic therapy. The difficulties in interpretation of Candida serology have therefore been re-assessed in the light of more detailed knowledge of the range and type of antibody to be expected in normal individuals.
PMCID: PMC1145524  PMID: 107198
12.  Improved diagnosis of farmer's lung using the fluorescent antibody technique 
Thorax  1974;29(4):417-420.
Boyd, G. and Parratt, D. (1974).Thorax, 29, 417-420. Improved diagnosis of farmer's lung using the fluorescent antibody technique. In the west of Scotland 20 of 40 farmers surveyed had symptoms of farmer's lung. Ten of this group (50%) gave positive precipitin reactions to Micropolyspora faeni. The fluorescent antibody test was positive in all those with symptoms and also in one who had no clinical evidence of farmer's lung. There was a close relationship between evidence of sensitization to M. faeni in the serum, demonstrated by the fluorescent antibody test, and the presence of symptoms compatible with farmer's lung. This test may detect the disease in milder form than is possible by conventional precipitin tests and this study confirms the value of this more sensitive technique as a screening procedure.
PMCID: PMC470173  PMID: 4277527
13.  A fluorescent antibody test in the diagnosis of farmer's lung 
Journal of Clinical Pathology  1972;25(10):846-849.
A test for farmer's lung is described employing the indirect fluorescent antibody technique. The test compared very favourably with standard precipitin tests, detecting 88% of a series of positive cases, as opposed to 38% detected by a precipitin test. The fluorescent antibody test, in addition, introduced some measure of quantitation of the serological response in the disease.
PMCID: PMC477532  PMID: 4119006

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