A 41-year-old woman presented with a short history of blurred vision. She had a 6-year history of refractory hypertension which had been treated with a variety of drug regimens. She was found to have bilateral branch retinal vein occlusion. Retinal vein occlusion is a recognised complication of hypertension but simultaneous involvement of both eyes is extremely rare. Following this episode, blood pressure control has improved without change in drug therapy, suggesting that treatment compliance may partly explain the previous difficulties.
A large and continuing increase in medical emergency admissions has coincided with a reduction in hospital beds, putting the acute medical services under great pressure. Increasing specialization among physicians creates a conflict between the need to cover acute unselected medical emergencies and the pressure to offer specialist care. The shortage of trained nursing staff and changes in the training of junior doctors and the fall in their working hours contribute to the changing role of the consultant physician. The organization of the acute medical service is of paramount importance and requires multi-disciplinary teamwork on an admissions unit with full support services. Excellent bed management is essential. There must be guidelines for all the common medical emergencies and all units must undertake specific audits of the acute medical service. Continuing professional development (CPD) and continuing medical education (CME) should reflect the workload of the physician; that is, it must include time specifically focused on acute medicine and general (internal) medicine, as well as the specialty interest.
A 49-year-old woman had a vena caval filters inserted having suffered multiple pulmonary emboli and a large upper gastrointestinal bleed. She re-presented five years later with loin pain and obstructive uropathy. She was found to have a right pelvi-ureteric obstruction due to inferior vena caval wall perforation from the vena caval filter.
As part of the management of an outbreak of meningococcal infection, 119 school contacts of an index case were swabbed for nasopharyngeal carriage. In a cohort study, risk factors for Neisseria meningitidis carriage were ascertained by means of a questionnaire, completed by 114 (96%) of those swabbed. Twenty five (21%) cultures were identified as "neisseria positive'; of which there were 18 (15%) Neisseria meningitidis isolates, 2 (2%) Neisseria lactamica isolates and 5 (4%) showed contaminants only. Two (2%) carriers were identified as harbouring the implicated outbreak strain. Single variable analysis identified six statistically significant risk factors for meningococcal carriage; increasing age, female sex, manual social class, personal smoking, regular attendance at a discotheque and rhinorrhoea. Multivariate analysis, using logistic regression modelling, found that of these six variables only age, sex and social class remained statistically significant when the other factors were controlled for. Nevertheless the role of smoking, social events and respiratory/viral infections in nasopharyngeal carriage, and other plausible mechanisms whereby age, sex and social class might exert their effect, could usefully be investigated further.
Albright hereditary osteodystrophy (AHO) is an autosomal dominant disorder characterised by the presence of brachymetaphalangism, short stature, obesity, and mental retardation. Variable biochemical changes many represent either pseudohypoparathyroidism (PHP) owing to resistance to parathormone (PTH) or pseudopseudohypoparathyroidism (PPHP) with no hormone resistance. In most cases of AHO, reduced levels of Gs alpha have been found and a number of deactivating mutations in the gene for Gs alpha located on chromosome 20q13 have been described. Recently a number of people with an AHO-like phenotype have been reported in whom a deletion of chromosomal region 2q37 has been found in the absence of biochemical abnormalities or a reduction in Gs alpha activity. We present a further female patient with a cytogenetically visible deletion of 2q37, an AHO-like phenotype, and unusual biochemistry suggesting moderate PTH resistance. The vasoactive intestinal peptide receptor (RDCI) has recently been mapped to 2q37 and we propose that this is a candidate gene, hemizygosity of which affects signal transduction and leads to the AHO-like phenotype found in patients with 2q37 deletions.
Umbilical cord serum samples (380), an average of 10 per month for 3 years (1990 to 1992), were tested by indirect immunofluorescence assay for group C rotavirus immunoglobulin G. Thirty percent were positive, suggesting that approximately one-third of women of childbearing age in western New York have experienced group C rotavirus infection.
Following an episode of water contamination with sewage in a rural Irish town, a community-wide survey of gastrointestinal-associated illness and health service utilization was conducted. Random sampling of households yielded residents who were surveyed using a self-administered questionnaire. Of 560 respondents from 167 (84%) households, equal proportions lived in areas known to have been exposed and unexposed to the contaminated water, although 65% of subjects reported using contaminated water. Sixty-one percent of subjects met the case definition. The most common symptoms among cases were abdominal cramps (80%), diarrhoea (75%), appetite loss (69%), nausea (68%) and tiredness (66%). Mean duration of illness was 7.4 days. Only 22% of cases attended their general practitioner. Drinking unboiled water from the exposed area was strongly associated with being a case. A substantial degree of community illness associated with exposure to contaminated water was observed. The episode ranks as one of the largest reported water-borne outbreaks causing gastrointestinal illness in recent times.
Thirty two eyes of 19 patients with capillary non-perfusion from preproliferative and early proliferative diabetic retinopathy underwent visual field testing on the 30-2 program of the Humphrey visual field analyser. The mean defect (MD) p value was < 5% in 30 (94%) eyes and the corrected pattern standard deviation (CPSD) was < 10% in 31 (97%) eyes. Areas of capillary non-perfusion demonstrated by fundal fluorescein angiography were closely associated with areas of reduced retinal sensitivity in these 31 eyes. More severe visual field defects were present in non-insulin dependent diabetics and in older patients. MD and CPSD p values of less than 0.5% and 1% respectively were found to be associated with non-insulin dependent diabetes (p < 0.05 and p < 0.01 respectively) and with the older age group (p < 0.05). There was no correlation between severity of field defects with hypertension and degree of retinopathy.
The characteristics of fusion of respiratory syncytial virus (RSV) with HEp-2 cells were studied by the R18 fluorescence dequenching assay of membrane fusion. A gradual increase in fluorescence intensity indicative of virion-cell fusion was observed when R18-labeled RSV was incubated with HEp-2 cells. Approximately 35% dequenching of the probe fluorescence was observed in 1 h at 37 degrees C. Fusion showed a temperature dependence, with significant dequenching occurring above 18 degrees C. The dequenching was also dependent on the relative concentration of target membrane. Thus, increasing the concentration of target membrane resulted in increased levels of dequenching. In addition, viral glycoproteins were shown to be involved in this interaction, since dequenching was significantly reduced by pretreatment of labeled virus at 70 degrees C for 5 min or by trypsinization of R18-labeled virions prior to incubation with HEp-2 cells at 37 degrees C. The fusion of RSV with HEp-2 cells was unaffected over a pH range of 5.5 to 8.5, with some increase seen at lower pH values. Treatment of HEp-2 cells with ammonium chloride (20 and 10 mM), a lysosomotropic agent, during early stages of infection did not inhibit syncytium formation or progeny virion production by RSV. At the same concentrations of ammonium chloride, the production of vesicular stomatitis virus was reduced approximately 4 log10 units. These results suggest that fusion of the virus with the cell surface plasma membrane is the principal route of entry.
In a retrospective study we have examined all diabetics (66 operated eyes) and an equal number of non-diabetic matched controls who underwent extracapsular cataract extracation (ECCE) with intraocular lens (IOL) implantation over a two-year period ending in December 1987. Of the diabetic patients' 76% eyes improved by at least two lines of Snellen acuity postoperatively. Of these patients 68% eyes and of the control eyes 83% achieved an acuity of 6/12 or better. In the diabetics the visual outcome depended on the state of the retinopathy and in particular the maculopathy. The diabetic group had a greater incidence of postoperative inflammation, but the major complications were related to continuing neovascularisation. Early postoperative laser photocoagulation may help to prevent these proliferative complications, and, provided a large, adequate capsulotomy is performed for capsular thickening, the presence of an IOL does not interfere with this photocoagulation. We also advise early postoperative assessment, and treatment if necessary, of any maculopathy. Diabetic retinopathy should no longer be regarded as a contraindication to intraocular lens insertion.
Liposomes were constituted with affinity-purified Sendai virus glycoproteins HN and F and phosphatidylcholine (PC) or phosphatidylethanolamine: phosphatidylserine (PEPS). The glycoprotein-bearing recombinant vesicles (RV) were used to modify the surface of P815 mastocytoma cells (H-2d) or EL4 lymphoma cells (H-2b). The cells treated with HN-F-PCRV, HN-PEPSRV, or F-PEPSRV were shown by surface immunofluorescence to retain antigen for at least 2 h at 37 degrees C after treatment. The modified cells were used in cytotoxicity assays with effector spleen cells from either DBA/2 (H-2d) or C57BL/6 (H-2b) immunized by inoculation of active Sendai virus. Cells modified by treatment with HN/F-PCRV showed susceptibility to cytolysis similar to that in actively infected cells. Cells modified with HN-PEPSRV or with F-PEPSRV were also susceptible. The sum of reactivities of the anti-HN component and the anti-F components was close to that seen with HN- and F-bearing targets. Syngeneic but not allogeneic target cells expressing Sendai virus glycoproteins were bound and lysed by the effector cells, which was expected if the interactions were major histocompatibility complex restricted. The activity was attributed to cytotoxic T lymphocytes, since it was depleted by treatment with anti-Thy 1.2 antibody and complement.
The glycoproteins HN and F and the lipids were solubilized from Sendai virus envelopes by using the nonionic detergent beta-D-octylglucoside. When beta-D-octylglucoside was removed by dialysis, the glycoproteins and lipids reassociated to form vesicles. These vesicles displayed hemagglutinating, neuraminidase, and hemolysin activities comparable to those expressed by the intact virus. The vesicles were used as carriers to transfer the glycoproteins to the surface of P815 cells. The recipient cells were tested for the acquisition of the glycoproteins by demonstration of surface neuraminidase, hemadsorption activity, and antigens. The modified cells were used as targets for natural cell-mediated lysis and were found to be sensitive.
The clinical and microbiological findings in a chronic case of lacrimal canaliculitis due to Arachnia propionica are described. Bacterial culture and identification should be performed in the investigation of the disease in order to establish the role of A. propionica and other specific actinomycetes at the acute as well as at the chronic stage.
Established neovascular glaucoma in the presence of clear media can be treated by panphotocoagulation followed by drainage surgery. Three cases are described, and the advantages of this procedure as opposed to others available are discussed. Photocoagulation must be performed early before the development of opaque ocular media obscures the retina.
Sera collected from 90 multiple sclerosis patients and 148 age-matched normal subjects were examined for the presence of antibodies against human coronaviruses (HCV) 229E and OC43 by enzyme immunoassay (EIA). The results demonstrated no significant difference between the MS patients and the normal subjects in their antibody titer to HCV 229E and HCV OC43. Further analysis of these 238 sera indicated that a stronger EIA reaction was generally observed against HCV OC43 (mean EIA value at an optical density of 492 nm = 0.896) than against HCV 229E (mean EIA value at an optical density of 492 nm = 0.346).
BGM/MV cells carry measles virus antigens and nucleocapsid-like structures in their cytoplasm. There is no infectious virus demonstrable, and measles virus-induced cell surface changes detectable by hemadsorption (HAD) are absent. Treatment of cells with actinomycin D or cycloheximide or enucleation of cells with cytochalasin B induced surface changes in that the cells became HAD positive. 6-Azauridine treatment of cells did not inhibit the induction of HAD, suggesting that RNA synthesis was not required. Cycloheximide treatment of cells induced by enucleation inhibited the development of HAD, suggesting a requirement for protein synthesis.
Serological methods of mixed agglutination and indirect immunofluorescence showed the BGM/MV cell line to possess monkey antigens. As a means of further characterizing the species constitution of the BGM/MV cell line, the species specificity of viral-induced interferon from these cells, as well as the response of these cells to exogenous interferons, was determined. Low titers of spontaneously elaborated interferon capable of protecting monkey but not mouse cells were detected in BGM/MV culture fluids. Interferon induced by Newcastle disease virus infection of BGM/MV cells was capable of conferring an antiviral state on monkey and, to a lesser extent, on mouse cells. Exogenous interferons of both homologous (BGM/MV) and heterologous sources failed to confer an antiviral state on BGM/MV cells. BGM/MV cells were found to be partially refractive to superinfection with measles virus but freely replicated mumps and vesicular stomatitis virus.
The parameters of a persistent-state measles virus infection in BGM/MV cells were examined. The BGM/MV cell line was established by cocultivation of measles virus-infected primary C3H mouse brain cells with a stable line of African green monkey kidney cells (BGM). Initially, a morphologically mixed population of cells existed:BGM-like (epithelioid) and fibroblasts. Gradually the fibroblasts were replaced by BGM-like cells, resulting in a morphologically homogeneous population. Measles cytopathic effect was noted 2 days after initiation of this culture and persisted for approximately 290 days. The time of disappearance of viral cytopathic effect corresponded to the time at which morphological homogeneity was reached. Low titers of infectious measles virus were detected in the BGM/MV culture up to 20 days postseeding; thereafter none was observed. After 440 days in culture, 100% of BGM/MV cells demonstrated intractyoplasmic measles antigen by immunofluorescence. Nuclear fluorescence was never observed. Electron microscopy revealed the presence of measles virus mucleocapsid within the almost completely filling the cytoplasm of BGM/MV cells. The plasma membrane of these cells appeared normal; no maturing or budding particles were observed. Measles virus hemagglutinin was not detected in either clarified cell lysates or in supernatant culture fluids. Cell membrane alteration by measles virus was detected in less than 1% of these cells by hemadsorption and by membrane immunofluorescence. The hemadsorption activity of the cells could be enhanced (30 to 70%) by treatment with actinomycin D or enucleation with cytochalasin B; these treatments, however, were unsuccessful in inducing detectable levels of measles hemagglutinin. Treatment of BGM/MV cells with 5-bromo-2'-deoxyuridine (BUdR) at 5 to 50 mug/ml and cytosine arabinoside at 1 to 50 mug/ml failed to enhance hemadsorption activity. Doses of 5-bromo-2'-deoxyuridine ranging from 5 to 200 mug/ml and of actinomycin D ranging from 0.1 to 10 mug/ml were ineffective in inducing the synthesis of infectious virus. Various physical methods of induction of infectious virus was also unsuccessful.
Nineteen rhesus monkeys were inoculated with mumps virus by retrograde ductal instillation into the parotid gland. Evidence of infection was obtained in all instances. Virus was isolated from buccal swabbings and parotid biopsies for 1 week after inoculation. A vigorous serum-neutralizing antibody response occurred within 3 weeks, and there was marked monocytic infiltration of the parotid stroma. The monocytic infiltrate comprised as much as 60% of the total gland volume 1 week after infection. The predominant inflammatory cells were non-immunoglobulin-containing mononuclear cells resembling lymphocytes. Plasma cells containing immunoglobulin G (IgG), IgA, IgM, and IgE increased in numbers in the gland after infection, the greatest increase occurring in IgG-containing cells. Neutralizing antibodies and interferon were found in extracts prepared from the infected glands. Neutralizing activity was highest in samples taken 3 weeks after infection but was detectable in samples taken as soon as 36 to 48 h after infection. Interferon activity was detected in significant amounts 36 to 48 h after infection. Challenge of previously infected animals resulted in an increase in the monocytic infiltrate as well as an increase in numbers of immunoglobulin-containing plasma cells. However, reinfection did not occur as evidenced by the inability to culture shed virus after challenge. This model should be useful for in vivo study of biochemical mediators which evoke inflammatory cell infiltration and which may be significant both in protection and in tissue damage.