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Biomedical subjects

A C Douglas

Publications and source records attributed to A C Douglas.

At least 19 recordsLinked to original sources
PubMed1992

Wegener's granuloma. A series of 265 British cases seen between 1975 and 1985. A report by a sub-committee of the British Thoracic Society Research Committee.

In order to describe the British experience of Wegener's granulomatosis Hospital Activity Analysis was used to collect cases diagnosed in England, Wales and Scotland between 1975 and 1985. Where possible clinical details, histological material and chest radiographs were obtained. Two hundred and sixty five patients were considered to have Wegener's granulomatosis. In 109 a single pathologist confirmed the diagnosis by finding both granulomas and vasculitis in biopsy material. The diagnosis was made on clinical grounds or clinical grounds together with histological diagnosis in the local hospital in 156 patients. Wegener's granulomatosis was confined to the lung or upper respiratory tract in 22 per cent of patients and renal disease occurred in 58 per cent. Laboratory tests showed a pattern of mild anaemia, polymorph leucocytosis, eosinophilia and an elevated ESR and hypergammaglobulinaemia, with no specific pattern of changes. Histological confirmation was most frequently obtained by examination of nasal biopsy specimens, but multiple biopsies were often required. Renal biopsies showed focal proliferative glomerulonephritis but granulomatous glomerulonephritis was uncommon. Of available chest radiographs 61 per cent were abnormal, large opacities being most common. Small irregular opacities were found less often and other abnormalities were uncommon. Treatment varied widely and 10 per cent of patients received no drug therapy. This large series illustrates that even without specific treatment, patients with Wegener's granulomatosis can survive for several years and with modern treatment survival for more than a decade is possible. Conclusions about the effectiveness of the various therapies cannot be drawn from this retrospective study. Renal failure and disseminated vasculitis were the commonest causes of death; death was considered to result from complications of treatment with cytotoxic drugs or prednisolone in 6 per cent of patients.

Adolescent↗
PubMed1988

Hypothalamic malfunction in cerebral sarcoidosis with abnormalities in temperature regulation and vascular control.

A case of abnormal temperature and vascular regulation developing in a patient who had suffered from active hypothalamic sarcoidosis 10 years previously is described. His symptoms have responded to therapy with a beta adrenergic blocking agent and he remains well 2 years after the onset of symptoms. The contrast between this case and the previous reports of hypothalamic sarcoidosis affecting temperature control are discussed.

Adult↗
PubMed1987

Tuberculosis of the trachea.

A patient is described who presented with stenosis of the upper trachea causing respiratory distress. There was no evidence of tuberculosis elsewhere in the body but biopsy showed a granulomatous lesion and there was a good response to anti-tuberculosis chemotherapy. A temporary tracheostomy was needed.

Antitubercular Agents↗
PubMed1983

Amiodarone associated alveolitis and polyarthropathy. Treatment by plasma exchange.

In a case of severe alveolitis and polyarthropathy occurring within two to five months of starting amiodarone treatment high plasma concentrations of immune complexes were found, suggesting a drug mediated hypersensitivity reaction. Initial symptomatic response followed high dosage corticosteroid and immunosuppressant treatment, but reduction in the dosage of corticosteroids was achieved only by successive plasma exchange with concomitant reduction in plasma concentrations of both amiodarone and immune complexes.

Amiodarone↗
PubMed1982

Immunological parameters in midline granuloma.

Midline granuloma and Wegener's granulomatosis are thought to be variants of the same disease. We report studies on a patient with midline granuloma over a 14-month period from the presentation of the disease, in whom a raised serum IgE concentration and a depressed NBT test value were found. These parameters fluctuated with the course of the disease. In addition, a high percentage of IgE positive plasma cells were found in two different sites of the disease. These findings suggest that the aetiology of midline granuloma may be related to hypersensitivity with a concurrent depression in the functional capacity of neutrophils.

Blood Sedimentation↗
PubMed1978

Fluoroscopically controlled transbronchial biopsy of solitary peripheral pulmonary lesions using the fibreoptic bronchoscope.

Experience of fluoroscopically controlled transbronchial biopsy using the fibreoptic bronchoscope in 30 patients with solitary lesions in the peripheral lung fields beyond bronchoscopic vision is described. At the time of submitting this paper for publication (30 January 1978) no account of the technique has been reported in the British literature. In 21 patients with a final diagnosis of bronchial carcinoma a positive biopsy diagnosis was obtained in 14 (67%). Five of seven patients (71%) with a final diagnosis of an inflammatory condition showed evidence of acute or chronic inflammation on biopsy. There were no complications. The procedure is indicated when a definitive diagnosis is required for management planning in clinically inoperable patients, or when a tissue diagnosis is particularly desired in an attempt to obviate the need for thoracotomy. The relative safety makes this the biopsy technique of choice for the evaluation of isolated peripheral pulmonary opacities.

Biopsy↗
PubMed1977

Asthmatic pulmonary eosinophilia: a review of 65 cases.

In a series of 65 patients with asthma with pulmonary eosinophilia 54 were adequately investigated for allergic aspergillosis and this was present in 32 (59%). Asthma with pulmonary eosinophilia was found to carry a relatively poor prognosis in terms of permanent symptoms, impairment of pulmonary function and residual radiographic abnormality. The prognosis was least favourable when allergic aspergillosis was associated with long-standing asthma. On the other hand there was a group of patients with asthma with pulmonary eosinophilia who had relatively little permanent disability. These were mainly women with asthma of recent onset, and in these evidence of allergy to Aspergillus fumigatus was less apparent. Those patients who received long-term daily corticosteroid therapy were less likely to develop further radiographic opacities than those given intermittent corticosteroid therapy. To prevent recurrent pulmonary infiltrates it is probably necessary to give prednisolone in a daily dosage of at least 10 mg for an indefinite period.

Adolescent↗
PubMed1976

The Edinburgh spleen: source of a validated Kveim-Siltzbach test material.

Although it is true that some Kveim-Siltzbach test suspension may for reasons unknown behave in a totally nonspecific way and so be useless in the confirmation of active sarcoidosis, the experience with the Edinburgh spleen has shown that it is also true that a preparation can be made which acts specifically in the sarcoid context and fulfils all the Siltzbach criteria. The active principle probably resides in the membrane components of sarcoid tissue cells.

Antigens↗
PubMed1973

Sarcoidosis of the central nervous system.

Six patients with sarcoidosis of the central nervous system are described. Pathological confirmation was obtained by brain biopsy in two patients and at necropsy in two; in two patients the diagnosis was presumptive and was made on the evidence of multisystem involvement. The symptomatology, methods of diagnosis, and results of treatment are discussed.

Adolescent↗
PubMed1973

Symptomatic sarcoidosis of skeletal muscle.

Two patients with chronic sarcoid myopathy are described. Both were middle-aged females and both showed the features of pseudohypertrophy. In other aspects they contrasted markedly. In one (A.R.) the sheer volume of granuloma and its effect on muscle fibres was sufficient to explain the muscle weakness and electromyography confirmed a pure myopathy. In the other (J.W.) the muscle granuloma was sparsely distributed and an associated neuropathy contributed importantly to the disability. There was no clinical evidence of sarcoidosis of other organs in one (A.R.) but necropsy showed multisystem involvement. There was clinical and radiographic evidence of widespread sarcoidosis in the other (J.W.). Both patients showed an initial dramatic response to prednisolone. The reported literature of symptomatic muscle sarcoidosis is reviewed briefly.

Chronic Disease↗
PubMed1969

Miliary tuberculosis in adults.

Of 40 adults with miliary tuberculosis 24 had "overt" disease; in them miliary mottling was usually present on the chest radiograph, and tubercle bacilli were readily isolated from sputum, urine, or cerebrospinal fluid. In the remaining 16 patients the disease was termed "cryptic" because its usual clinical and radiographic features were absent. This cryptic type is as common as the overt type in patients over 60 years. In this series the peak age incidence was in the eighth decade, and possibly this increase in the incidence age is due to the breakdown of old tuberculous foci in patients with diminished immunological mechanisms.Cryptic miliary tuberculosis is a difficult diagnostic problem and should be suspected in any elderly patient, particularly a woman, who has an unexplained pyrexia, pancytopenia, or leukaemoid reaction. In 10 cases it was diagnosed by a therapeutic trial with para-aminosalicylic acid and isoniazid, a fall of temperature to normal (usually within a week), weight gain, a rise in haemoglobin, and increased well-being being the criteria of improvement The use of such a trial is strongly advocated as a specific method of diagnosing cryptic miliary tuberculosis.

Adult↗