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Biomedical subjects

J C Mitchell

Publications and source records attributed to J C Mitchell.

At least 19 recordsLinked to original sources

Renal transplantation in patients with diabetes mellitus--revisited.

Sixty-one patients with end-stage renal failure due to diabetic nephropathy received 68 renal allografts from June 1970 to February 1978. Patient and graft survival results equaled those for nondiabetic patients, as reported by the Human Renal Transplant Registry (HRTR). Renal allografts from siblings or pretreated cadaver donors had a significantly longer survival time than did allografts from nonpretreated cadaver donors. It is concluded that renal transplantation with living related and pretreated cadaver donor kidneys continues to be the treatment of choice and is superior to other forms of treatment in the insulin-dependent diabetic patient with end-stage renal disease.

Adult

Day 7 (D7) patch test reading - valuable or not?

Day 7 (D7) reading of 15,469 patch tests was carried out in 499 patients. In one fifth of them, positive reactions were observed at D7 having been judged negative at D2. The significance of the findings is discussed.

Adult

Chronic peritoneal dialysis in juvenile-onset diabetes mellitus: a comparison with hemodialysis.

Fourteen juvenile-onset diabetic patients accepted for renal transplantation and maintained on chronic peritoneal dialysis during a 3-year period were compared with a similar group of 43 patients accepted for renal transplantation and maintained on hemodialysis. The 1-year survival in each group was similar (52% on chronic peritoneal dialysis; 55% on hemodialysis), but there was a striking difference in progressive morbidity. Seven patients on chronic peritoneal dialysis were blind in one or both eyes at the onset, and visual acuity improved in two, including one bilaterally blind patient who achieved 20/35 vision bilaterally; none worsened. In the hemodialysis group, 12 patients were totally blind in one or both eyes and 11 additional patients became blind or had severe deterioration in vision; none improved. Neuropathy progressed in only 1 patient on chronic peritoneal dialysis, whereas it worsened in 17 patients on hemodialysis--9 to the extent that they needed braces or canes or were nonambulatory. All patients on chronic peritoneal dialysis were home trained and were dialyzed at night, with seven being able to work full or part time; virtually none of the patients on hemodialysis were able to work. Chronic peritoneal dialysis was relatively free of technical complication, and no significant difficulty was encountered in diabetic control, in the anephric state, or during abdominal surgery. Chronic peritoneal dialysis appears to have less associated morbidity than does hemodialysis in the treatment of chronic renal failure of juvenile-onset diabetes mellitus.

Adult

The role of sesquiterpene lactones in contact hypersensitivity to some North and South American species of feverfew (Parthenium-Compositae).

Sixteen taxa of the genus Parthenium from North and South America and 20 sesquiterpene lactones derived from plants of the Compositae family were used for patch testing six volunteers who were known to be contact sensitive to plants and lactones of this family. The patterns of cross-sensitivity and structure-activity relationships of the allergenic lactones are evaluated and the clinical and ecological relevance is discussed.

Cross Reactions

Multiple concomitant positive patch test reactions.

Thirty-five patients who showed 90 one plus (+) patch test reactions to 28 patch test chemicals at Day 2 (D2) were retested to the chemicals at D7. On retesting, 60% (54/90) reactions were positive but 42% (38/90) were negative at D9, suggesting that false positive patch test reactions were common when more than one positive reaction was obtained by concomitant patch testing. On retesting, the total % positivity was reduced from 344 to 241 suggesting that the true index of sensitivity was falsely exaggerated by concomitant testing.

Aged

End-stage renal failure in juvenile diabetes mellitus: a 5-year follow-up of treatment.

A group of 43 juvenile diabetic patients accepted for renal transplantation and followed up for as long as 5 years was studied. The cumulative survivial of the group was 66% at 1 year and 58% at 5 years. The 1-year survival of those receiving cadaveric renal allografts (65%) or of those on dialysis alone (55%) was less than the survival of those after living related donor transplantation (88%). The major morbid sequelae included retinopathy, neuropathy, and peripheral vascular disease. While patients were on dialysis, blindness increased, with 44% of the bilateral blindness and 27% of the unilateral blindness representing new cases. After transplantation, permanent unilateral or bilateral blindness developed in an additional 12% of the patients. Severe neuropathy progressed rapidly in patients on dialysis and improved after transplantation in all. Fifty percent of the patients who survived transplantation 1 year or more required amputation of one or more extremities. Only 25% of the patients who survived 1 year after transplantation were without blindness, severe peripheral vascular problems, or both.

Adolescent

Eruptive nevocytic nevi after severe bullous disease.

In two patients, hundreds of nevocytic nevi (melanocytic nevi) appeared in sites of severe bullous dermatoses that were considered to be toxic epidermal necrolysis and erythema multiforme exudativum, respectively. This phenomenon may result from benign melanocytic hyperplasia accompanying keratinocytic hyperplasia during the healing process of some of the denuded areas of the skin.

Child

Phytophotodermatitis from Heracleum mantegazzianum.

Five individuals developed striate bullous dermatitis two days after exposure on a clear day to Heracleum mantegazzianum, Umbelliferae (Parsnip) family. Photopatch testing confirmed phototoxicity from the plant. This and 28 other Heracleum species yield linear furanocoumarins.

Adult

Contact hypersensitivity to sesquiterpene lactones in Chyrsanthemum dermatitis.

In six persons with contact allergy to chrysanthemum of florists, patch tests were performed with 25 sequiterpene lactones. Positive responses were observed to 15 lactones. The most frequently encountered positive responses were to alantolactone (positive in all cases) and to arbusculin A, 8-deoxycumambrin, ambrosin, damsin and psilostachynin. The findings corroborate the assumption that an alpha-methylene group attached to the gamma-lactone ring is an essential prerequisite for allergenic activity of sesquiterpene lactones. Pyrethrum produced a positive reaction in one of the patients, pyrethrins gave negative reactions in all. Some of the chrysanthemum patients were also hypersensitive to turpentine and colophony and to garlic, primin and tars.

Adult