I recall a discussion with a practice nurse about a request for an unusual clutch of expensive (but orthodox) tests, some of which required special collection arrangements. It was unclear what the clinical reasons were and I suggested that the GP should refer the patient to the appropriate consultant, who would then request appropriate tests.
She said "Oh, these tests have been requested by a consultant", so I asked for the specialty.
"A consultant trichologist" she said
Dr MJ Pearson
Department of Clinical Biochemistry & Immunology
Old Medical School
Leeds General Infirmary (Leeds Teaching Hospitals NHS Trust)
LEEDS LS1 3EX
UK
tel (44)-[0]113-392-3945
fax (44)-[0]113 392-3453.
http://www.leedsth.nhs.uk
>>> IAN WATSON <[log in to unmask]> 22/12/2009 13:51 >>>
This is a clear case of gobbaldygookitis the most marked symptom is
willingness to believe anything and has the marked side-effect of
reducing your bank balance in a reciprocal relationship to your
hypochondria!
Dr Ian D Watson
Consultant Biochemist & Toxicologist
Dept Clinical Biochemistry
University Hospital Aintree
Lower Lane
Liverpool
L9 7AL
Tel +44 151 529 3575
Fax +44 151 529 3310
Fundamentals of Analytical Toxicology recently published:
http://eu.wiley.com/WileyCDA/WileyTitle/productCd-0470319356.html
________________________________
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On Behalf Of Jones Alison
Sent: 22 December 2009 13:44
To: [log in to unmask]
Subject: Re: Some weird and wonderful tests
I should have made it clear that the GP isn't being asked to treat the
patient on the basis of these results - the private hospital which asked
for them will follow her up.
The GPs concern (and mine) is whether neither of us know anything about
the tests because they are 'quack' medicine or because they are at the
cutting edge of scientific investigation. She phoned me because she
wants to know what she should be saying to her patient as the patient is
now booked in for a 5 day stay at this hospital for futher
investigation, at not inconsiderable expense.
The overwhelming response from the mailbase so far is that there is
probably very little clinical utility in these tests. Is that just
because no-one has heard of any of the tests and as we are the
'experts', if we haven't heard of them, they can't be any good? I
would be interested to hear from anyone who does know anything about
this field of biochemistry to counterbalance the arguement.
And I don't know which laboratory the tests were performed in.
Thanks for all you help
Alison
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]]On Behalf Of Jones Alison
Sent: 22 December 2009 12:34
To: [log in to unmask]
Subject: Some weird and wonderful tests
To the collective ACB Mailbase brain
I have been contacted by one of our GPs this morning who has a
patient being investigated at a private hospital for ?ME. They have
perfomed a panel of tests - some of which neither the GP nor myself have
heard of, or at least have no idea how to interpret. Can anyone help me
out with indications and significance of any of the following?
* Lymphocyte sensitivity test. The patient showed definite
sensitivities to aluminium, formaldehyde and salicylate. Borderline
sensitivity to petrol exhaust and metabisulphite. Intracellular calcium
was high at 315 nmol/L
* DNA Adducts (genomic DNA from leucocytes) investigation
implicated aluminium (sulphate) and methyresorcinol. DNA-assocaited
Zinc was normal
* Cardiolipin studies in mitochondrial membranes showed some
blocking of the manganese sites on CL-synthase by calcium but not
significantly lowering CL synthesis. Mild reduction in ion-gating
efficiency.
I could go on. If anyone knows anything about these areas of
biochemistry, or has any thought or feelings about their clinical
utility, and is kind enough to get in touch with me directly, I may then
pick your brain further about some of the other investigations performed
on this patient. I hope the private hospital investigating this patient
will write to her GP with a bit more clarity / direction when they have
completed their investigations, but in the meantime, the GP has no idea
what to say to / do with her patient.
Any help greatly appreciated
Alison Jones
Principal Clinical Biochemist
Kettering General Hospital
01536 493385
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