PubMed Health⌕ Search

Biomedical subjects

J D Briggs

Publications and source records attributed to J D Briggs.

At least 109 records · Page 6Linked to original sources
PubMed1987

Bactericidal activity of peritoneal macrophages from continuous ambulatory dialysis patients.

A radiometric assay is described for measuring phagocytosis and intracellular killing of Staphylococcus epidermidis by peritoneal cells from continuous ambulatory peritoneal dialysis (CAPD) patients. Using this method it is possible to determine simultaneously and independently, in a single assay, whether peritoneal cells from CAPD patients possess defects in either ingestion or intracellular killing. Assays were performed on peritoneal cells obtained from 28 samples of spent dialysis fluid from CAPD patients. In the majority of cases these cells were able to efficiently phagocytose and kill opsonised Staph. epidermidis, although the degree of intracellular killing was slightly reduced compared with peritoneal cells obtained from eight normal controls undergoing laparoscopy. Overall there was no correlation between the degree of phagocytosis or intracellular killing and susceptibility of patients to peritonitis, although cells from two patients with a high incidence of peritonitis did show abnormally poor ingestion and/or killing. In a number of samples only low numbers of cells (less than 10(6)) were recovered in total from the overnight bags, and there was a significant inverse correlation between the number of cells in the fluid and the length of time on CAPD.

Adult↗
PubMed1987

Relationship of IgG, C3 and transferrin with opsonising and bacteriostatic activity of peritoneal fluid from CAPD patients and the incidence of peritonitis.

IgG, C3 and transferrin in peritoneal dialysis effluent of patients undergoing continuous ambulatory peritoneal dialysis (CAPD) were 1%-2% of those in serum. In contrast, the values in normal peritoneal fluid were not significantly different from those in serum. The three proteins correlated with each other in peritoneal dialysis effluent, but were independent of the amount in the corresponding patients' sera. There was also an overall inverse correlation between total protein in peritoneal dialysis effluent and time on CAPD during the first 6 months of treatment but not thereafter, which suggests that changes in membrane permeability occur during the early months. In peritoneal dialysis effluent, but not in normal peritoneal fluid, there was a correlation between opsonising capacity and IgG or C3 concentrations. An inverse correlation between opsonic activity of peritoneal dialysis effluent and frequency of peritonitis was also found. Peritoneal dialysis effluent permitted significantly faster multiplication of Staphylococcus epidermidis than sera or normal peritoneal fluid, and the growth rate correlated inversely with the transferrin levels in peritoneal dialysis effluent. Overall IgG, C3 and transferrin in peritoneal dialysis effluent are inadequate for optimal opsonising and bacteriostatic activity, and the peritoneal cavities of CAPD patients are therefore immunocompromised sites.

Adult↗
PubMed1987

In vitro analysis of B lymphocyte function in uraemia.

We have investigated the immune responses in vitro of uraemic patients undergoing regular haemodialysis or continuous ambulatory peritoneal dialysis. Twenty-five healthy subjects were also studied as controls. In uraemic patients, the number of T and B lymphocytes were within the normal range, but proliferative responses to phytohaemagglutinin (PHA) were impaired. Spontaneous immunoglobulin plaque forming cell (PFC) responses by peripheral blood mononuclear cells (PBMC) from uraemic patients were significantly lower than those of healthy subjects. The PFC response of uraemic PBMC to the T cell independent polyclonal B cell activator (PBA) Epstein-Barr virus (EBV) was comparable to the response of the healthy subjects, indicating that uraemic B cells are still capable of synthesizing immunoglobulin. Pokeweed mitogen (PWM) induced PFC responses of uraemic PBMC were also normal, whereas the response to another T cell dependent B cell activator, Staphylococcus aureus Cowan I (SAC), was very low. Addition of indomethacin to PWM- and SAC-activated cultures of uraemic PBMC enhanced the PFC response to SAC, but had little effect on the PWM response. As full differentiation of B cells in response to SAC depends on helper T cells, we conclude that a defect in T lymphocyte function accounts for the reduced spontaneous and SAC induced production of immunoglobulin by uraemic PBMC. This defect may be mediated by an indomethacin-sensitive mechanism.

Adolescent↗
PubMed1986

Continuous ambulatory peritoneal dialysis: a three year experience.

During a three year period 66 patients with end-stage renal failure were commenced on continuous ambulatory peritoneal dialysis (CAPD) at the Western Infirmary, Glasgow. The patient survival and the technique success rates were 86 per cent and 64 per cent at two years respectively. Biochemical and blood pressure control were very satisfactory on a relatively free diet and usually without the need for antihypertensive drugs. The complications next in frequency to peritonitis were catheter obstruction, postural hypotension and excessive weight gain. The mean hospitalisation period per patient per annum was 33 days, with half of this due to peritonitis. Despite selection criteria favouring older patients, diabetics and those with vascular complications, one third of the patients were able to work.

Adolescent↗
PubMed1986

Peritonitis in continuous ambulatory peritoneal dialysis.

The main complication of continuous ambulatory peritoneal dialysis (CAPD) is peritonitis. This paper describes our experience in the diagnosis and management of this complication in 66 patients during the three years to October 1982. The overall incidence of peritonitis was one episode every 6.75 patient months. Staphylococcus albus and Staphylococcus aureus together accounted for 46 per cent of the episodes, and 24 per cent were culture negative. Catheter exit site infections due to Staphylococcus aureus were common and they may have predisposed to peritonitis with gram -ve organisms as well as to staphylococcal peritonitis. Antimicrobial therapy was effective in 60 per cent of peritonitis episodes. The culture negative episodes usually responded to treatment while those due to fungi, though uncommon, did not. Twenty-nine per cent of these CAPD patients were transferred to haemodialysis because of peritonitis which failed to respond to treatment or which recurred repeatedly.

Adolescent↗
PubMed1986

Intravascular haemolysis and acute renal failure induced by nomifensine.

Nomifensine is a widely used antidepressant agent with few side-effects but haemolytic anaemia with acute renal failure has been reported with both intermittent therapeutic dosage and self-inflicted overdose. We report here a case of acquired immune haemolytic anaemia with acute renal failure induced by second exposure to a single capsule of nomifensine.

Acute Kidney Injury↗
PubMed1986

Autonomic function in uremic patients treated by hemodialysis or CAPD and in transplant patients.

Tests of autonomic nerve function have been performed in patients receiving dialysis and following transplantation. These tests, consisting of blood pressure and heart rate response to standard stimuli were carried out in four groups of subjects: 10 patients were receiving continuous ambulatory peritoneal dialysis (CAPD), 12 hemodialysis, 11 had functioning transplants and there were 12 healthy subjects. The heart rate responses to the Valsalva maneuver, deep breathing and standing were equally reduced in the hemodialysis and CAPD patients while the responses in the transplant patients were not significantly different from those in the control subjects. Peroneal nerve conduction velocity was used to measure the degree of peripheral neuropathy and while in most patients there was a positive relationship with the autonomic studies, in five patients the results were clearly dissociated. Plasma parathyroid hormone (PTH) levels were elevated in both the dialysis groups but not in the transplanted patients and there was no correlation between the PTH levels and any of the neurological tests. This study has confirmed the presence of autonomic neuropathy in dialysed uremic patients and has demonstrated almost complete resolution of this following transplantation but has failed to show any benefit of CAPD over hemodialysis in protecting against neuropathy.

Adult↗
PubMed1985

Dinitrochlorobenzene skin testing predicts response to hepatitis B vaccine in dialysis patients.

The pattern of seroconversion and anti-HBs titres after 3 doses of hepatitis B vaccine was studied in 40 haemodialysis patients who had been grouped on the basis of their cell-mediated immune (CMI) response into strong or weak reactors. CMI response was determined by means of a dinitrochlorobenzene (DNCB) skin test. Titres of anti-HBs were comparable to those in healthy controls in 13 of 14 (93%) strong reactors but in only 9 of 26 (35%) weak reactors. Strong reactors had an equally satisfactory seroconversion rate with either 20 micrograms or 40 micrograms of vaccine whereas weak reactors had a negligible seroconversion rate with the 20 micrograms dose. In terms of hepatitis B prophylaxis, haemodialysis patients with a well preserved CMI response require only 20 micrograms of vaccine, with a consequent saving in cost. In contrast, it will be necessary to devise more effective immunisation schedules for most patients with a poor CMI response.

Adult↗
PubMed1985

Renal transplantation in the United Kingdom and Ireland--the centre effect.

A detailed audit was done of eight of the twenty-nine transplant centres serving the UK and Ireland. These 8 centres account for one-third of the total renal transplant operations in these two countries. Information was obtained from each centre by means of a comprehensive questionnaire, a 1 1/2 day visit by the three authors, and an analysis of 50 consecutive first cadaver transplants. The 8 centres were chosen in the knowledge that 4 had high and 4 had low 3-month graft-survival rates. Our audit confirmed a centre effect, with a range in 1-year patient survival of from 82% to 96% and of first cadaver graft survival of from 54% to 82%. The two main factors affecting success rate were the rate of irreversible acute rejection and death with a functioning kidney. Our investigations suggested that the centre variation in acute rejection was influenced by blood transfusion and the variation in mortality by steroid dose and recipient age. Careful and well-organised clinical management cannot be easily quantified but was thought to have an important influence. Widespread adoption of pre-transplant blood transfusion and increasing use of cyclosporin will probably contribute to the further lessening of the centre effect which has already been observed over the past few years.

Aged↗
PubMed1985

Osteonecrosis and fractures following renal transplantation.

Skeletal radiological surveys in 161 renal transplant recipients identified 36 patients with 115 lesions of osteonecrosis. A further two patients with osteonecrosis found at autopsy had had no radiographic abnormality. The total incidence of osteonecrosis was, therefore, 38 (24%) out of 161. The lesions were frequently multiple and bilateral with structural failure being the most common initial abnormality and the femoral head the most frequent site. Lesions also occurred in the femoral condyles, the talus, the humeral heads and the metatarsals, many being symptom-free. Calcification was demonstrated in the femoral and tibial shafts. The initial radiological abnormality appeared at a mean interval of 19 months after transplant but could occur as late as 75 months. Significantly fewer patients, three (7%) out of 41, developed osteonecrosis following a low-dose prednisolone regimen (0.8 g) compared with a high-dose group (2.8 g) where 35 (29%) out of 120 were affected. More females than males developed osteonecrosis, but no correlation could be demonstrated with regard to age, primary renal disease, number and type of transplant and duration of dialysis prior to transplant. Osteonecrosis is a complication which can be reduced with a low-dose prednisolone regimen. Most lesions will be demonstrated by radiological survey undertaken during the second and fourth years after transplantation.

Adolescent↗
PubMed1985

Measurement of urine prostaglandin E2 as a predictor of acute renal transplant rejection: preliminary findings.

A radioimmunoassay for prostaglandin E2 (PGE2) in urine was developed and validated. It was used to provide serial measurements in eight renal transplant patients. Urine PGE2 concentration was increased between 1 and 7 days before any changes in the conventional biochemical indicators of acute rejection, serum creatinine and creatinine clearance. The increases in PGE2 concentration varied from 3 to 50 times that of the previous day. These results suggest that measurement of urinary PGE2 may be useful as an early indicator of acute renal transplant rejection.

Acute Disease↗
PubMed1985

Ischaemic optic neuropathy and retinopathy associated with acute pancreatitis.

A man with previously undiagnosed chronic renal failure developed acute pancreatitis. He had severe abdominal pain and simultaneous loss of vision. Ophthalmoscopy showed pale, swollen optic discs, soft exudates and superficial retinal haemorrhages similar to that of Purtscher's retinopathy. We suggest that the ocular changes may be due to fat microemboli secondary to acute pancreatitis.

Acute Disease↗
PubMed1984

Cancer, warts, and sunshine in renal transplant patients. A case-control study.

94 renal transplant patients were examined for the presence of cutaneous malignancies, actinic keratoses, warts, and cutaneous fungal infection, and a history was taken of infection with herpes simplex and herpes zoster. Each patient had a control matched for age, sex, and sun exposure. Of the 17 patients with high exposure to sunshine (more than 3 months in a tropical or subtropical climate or more than 5 years in an outdoor occupation), 2 had squamous cell carcinoma and 7 actinic keratoses. These lesions did not occur in the other renal transplant patients or the control group. The immunosuppressive effect of ultraviolet radiation in the sunburn spectrum (290-320 nm) in man and animals may be related to the increased incidence of cutaneous malignancy, actinic keratoses, and warts. Transplant patients should be under regular surveillance for the early detection and treatment of premalignant cutaneous lesions, and they should receive advice on avoiding sun exposure.

Adult↗