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Biomedical subjects

J D Richards

Publications and source records attributed to J D Richards.

At least 55 records · Page 3Linked to original sources
PubMed1986

Lymphocyte function after autologous bone marrow transplantation (BMT): a comparison with patients treated with allogeneic BMT and with chemotherapy only.

T- and B-cell function after autologous bone marrow transplantation (ABMT) was assessed and compared with that found after allogeneic BMT and after chemotherapy only. In all 16 patients with acute leukaemia in remission treated with high-dose chemotherapy and single or double ABMT, T-helper numbers and function in an assay measuring PWM-induced Ig synthesis were grossly defective and closely resembled the defects observed after allo-BMT involving chemoradiotherapy (six patients). T-helper activity was more variable after chemotherapy only (eight patients), but in individual patients the defect was as great as that observed after BMT. In contrast, suppressor activity was comparably increased in all patient groups and increased numbers of Leu 15+ Dr+ Tac- suppressor T cells were consistently observed, suggesting chronic activation of suppressor T cells, the cause of which remains unknown. B-cell function was also uniformly impaired in all patients tested. It is therefore concluded that defective immune function after BMT is not due to alloimmune or radiotherapy-mediated effects. Furthermore, since many patients were studied a prolonged period after BMT and had no T cells with a thymic phenotype and no evidence of infection, it is unlikely that the defects are secondary to cellular immaturity following marrow regeneration or to superadded infection. The gross immune defects observed after various forms of BMT are likely, therefore, to be directly attributable to the chemotherapy involved.

Acute Disease↗
PubMed1986

Automated leucocyte differential counts in acute leukaemia: a comparison of the Hemalog D, H6000 and Coulter S-plus IV.

The automated peripheral blood differential counts produced by the Hemalog D, H6000 and Coulter S-plus IV were analysed in 32 cases of acute leukaemia (22 AML (acute myeloblastic leukaemia); 10 ALL (acute lymphoblastic leukaemia], all with greater than 30% circulating blast cells. All three machines were highly effective in recognizing the presence of an abnormality. With the Hemalog D and H6000, the presence of increased LUC and HPX cells, together with an LPX alarm, was suggestive of acute leukaemia. With the Coulter S-plus IV, multiple alarms indicated the need for further investigation but, since alarms occur in many other situations, their presence was not necessarily suggestive of acute leukaemia. All the machines were of value in distinguishing AML from ALL since 'lymphocytes' were predominant in all cases of ALL and 'neutrophils' the majority cell type in most patients with AML. However, the presence in a minority of cases of AML of large numbers of micromyeloblasts recognized as 'lymphocytes' limited the discriminating power of all three machines. The Hemalog D allowed some definition of subtypes of AML, but the H6000 and Coulter S-plus IV were of no value in this regard.

Automation↗
PubMed1985

T-cell acute lymphoblastic leukaemia in adults.

Of 27 consecutive adult patients with acute lymphoblastic leukaemia (ALL), 7 had T-cell variants on the basis of sheep erythrocyte (E) rosette formation; in 5, a characteristic thymic phenotype was demonstrated by the use of appropriate monoclonal antibodies. All patients were treated with prednisone, vincristine, 1-asparaginase and adriamycin and the peripheral blood cleared of circulating lymphoblasts in a median of 8 days (range 6 - 45 days), a figure which does not differ significantly from that of 7 days (range 3 - 59 days) in those with the common ALL (P greater than 0,5). The complete remission rates were 71% for the patients with T-cell leukaemia and 75% for the E rosette-negative patients; median durations of remission were 35 and 26 weeks respectively and the actuarially predicted median durations of survival were 49 and 39 weeks respectively. Therefore the presence of T-cell markers in adult ALL does not seem to affect the prognosis in the same way that it does in children, and this is likely to be the result of the more aggressive clinical course of ALL of all phenotypes in adults.

Adolescent↗
PubMed1985

Life-threatening haemolytic anaemia and infectious mononucleosis. A case report.

A 36-year-old man with infectious mononucleosis presented with massive intravascular haemolytic anaemia. The diagnosis was established by a positive Paul-Bunnell test, the demonstration of IgM antibodies against Epstein-Barr virus capsid, and IgG antibody to early antigen. The direct and indirect antiglobulin tests were negative; the pathogenesis of the severe haemolysis was attributed to the temporary synthesis of anti-i cold agglutinin having a high thermal amplitude. Although life-threatening, the episode was short-lived and responded to supportive therapy with blood transfusion and folate administration only. This case illustrates a rare association between severe haemolytic anaemia and infectious mononucleosis, it emphasizes the value of IgM-specific fluorescent antibody tests in diagnosis when patients have otherwise unexplained haemolysis.

Adult↗
PubMed1985

Hemibody irradiation in multiple myeloma.

Eighteen patients with multiple myeloma were treated by hemibody irradiation using large single fractions, usually to a dose of 10 Gy (lower half) and 7.5 Gy (upper half). All except one patient had previously been treated by multiple courses of conventional chemotherapy with melphalan and prednisone, and were considered to be resistant to further chemotherapy. In most cases, local field irradiation had also been given for symptomatic bone pain. Of the 13 patients who had symptoms at the start of hemibody irradiation, 11 improved sufficiently for their analgesia requirement to be reduced. In eight patients, there was a significant fall in circulating immunoglobulin but no patient with Bence-Jones proteinuria had complete resolution of this biochemical abnormality. Although thrombocytopenia and neutropenia were common, only two patients required platelet transfusion and the treatment was in general extremely well tolerated. Survival following hemibody irradiation was similar to the survival reported from the use of "second-line" chemotherapy and we feel that hemibody irradiation is a more acceptable alternative for most patients.

Humans↗
PubMed1984

The coloured elderly in Cape Town--a psychosocial, psychiatric and medical community survey. Part IV. Haematological values.

One hundred and fifty randomly selected individuals aged 65 years and over voluntarily participated in haematological studies which formed part of a comprehensive survey of the psychiatric and physical health of elderly Coloured persons in Cape Town. Complete haematological information was available for 139 of the respondents and showed that values for a standard profile of screening tests did not differ from those in groups of White subjects living in Cape Town or Western Europe or from those in subjects from the same ethnic group but aged between 20 and 60 years. In 16 cases (11,5%) the initial haematological studies showed some abnormality. In 7 subjects (5%) the total white cell counts were raised, in 4 they returned to normal and in 3 remained elevated with normal differential distributions of the cells; no explanation for this has been found. Three respondents (2%) had a raised mean cell volume attributable to alcoholism. Eight (6%) had hypochromic microcytic anaemia due to iron loss resulting from occult gastro-intestinal tract bleeding. In 1 case this was due to a hiatal hernia and in the remaining 7 to carcinoma. The study shows that in this population nutrition is generally satisfactory and emphasizes the importance of investigation to determine the cause of anaemia in the elderly.

Black or African American↗
PubMed1983

Large-cell lymphocytic lymphoma.

Progress in the treatment of large-cell lymphocytic lymphoma during the last decade has been such that cure has replaced palliation as the objective of treatment. In pathologically proven stage I or II disease appropriate radiotherapy is adequate. It is of major importance to recognize that even in stage III or IV disease cure is possible, and it is therefore in the patient's best interests that initial assessment take into account the morphological and immunobiological features of the tumour as well as other prognostic factors, and that a chemotherapeutic regimen of established efficacy be prescribed. Newer challenges are a need to define optimum chemotherapy and explore the roles of bone marrow transplantation and immunological manipulation of the tumour with monoclonal antibodies.

Humans↗
PubMed1983

High-dose cyclophosphamide with autologous marrow transplantation for small cell carcinoma of the bronchus.

Twenty-five patients with previously untreated small cell carcinoma of the bronchus have been treated with cyclophosphamide 160-200 mg/kg and subsequent radiotherapy to the primary site. Eighty-four percent of patients responded to the single cycle of chemotherapy, with 56% attaining a complete response. Median duration of remission was 43 weeks and median survival 69 weeks. 2-Mercaptoethane sulphonate was given to prevent urothelial toxicity. Autologous bone marrow transplantation was used to mitigate bone marrow depression but sequential delay in reinfusing cryopreserved bone marrow did not alter the period of cytopenia. Other toxicities were mild. The procedure proved safe and manageable. High-dose chemotherapy may prove to be useful in the initial management of this tumour.

Adult↗
PubMed1982

High-dose cyclophosphamide with autologous marrow transplantation as initial treatment of small cell carcinoma of the bronchus.

Sixteen patients with untreated small cell carcinoma of the bronchus received cyclophosphamide in a total dose of 160-200 mg/kg. Autologous marrow transplantation was used to minimise the period of hypoplasia and 2-mercaptoethane sulphonate to prevent urothelial toxicity. The procedure was well tolerated, with predictable and manageable toxicity. Complete radiological and bronchoscopic response was achieved in seven patients and partial response in a further seven. High-dose cyclophosphamide may be a useful initial treatment for this disease.

Adult↗
PubMed1982

Increased neutrophil peroxidase activity in acute myeloid leukaemia.

A case of acute myeloid leukaemia (AML) (M2 type) is described in which the neutrophil population contained markedly increased peroxidase activity. The increased peroxidase activity was initially detected during routine counting with the Hemalog D automated differential counter and the increased enzyme staining was confirmed by manual and ultrastructural cytochemistry. The abnormal neutrophil population persisted after blast cells had disappeared from the blood and until marrow hypoplasia was induced by chemotherapy. When remission emerged, the peroxidase activity of the neutrophil population was normal. At subsequent relapse, the neutrophil population with increased peroxidase activity reappeared and with the induction of second remission neutrophil peroxidase again returned to normal. In 8 other cases where sufficient neutrophils were present for analysis by the Hemalog D, neutrophil peroxidase was normal or not increased in 7 cases, but was markedly reduced in 1 case of AML (M6 type). It is suggested that abnormalities of neutrophil peroxidase activity detected by the Hemalog D may serve as useful leukaemic markers.

Bone Marrow↗
PubMed1981

Plasma exchange in systemic lupus erythematosus.

Eight out of 10 patients studied longitudinally received benefit from plasmapheresis. The patients were used as their own controls, being treated in a steady state as far as was possible. Levels of circulating complexes did not bear a close relationship with clinical results. On the evidence plasma exchange alone does not appear to represent an important part of the long-term management of patients with systemic lupus erythematosus but may well be of value in combination with other therapy.

Adult↗
PubMed1981

A hemalog D analysis of chronic lymphocytic leukaemia and other lymphoproliferative disorders affecting the blood.

A correlative clinical and Hemalog D study of 80 cases of chronic lymphocytic leukaemia (CLL) was performed and the results compared with those in other lymphoproliferative disorders affecting the blood (eight cases of hairy-cell leukaemia, HCL; three cases of prolymphocytic leukaemia, PLL: two cases of lymphoplasmacytoid proliferation, LPP; and one case of Sézary's syndrome, SS). In CLL the mean percentage and absolute counts of large unstained cells (LUC) were 8.7% and 6.2 x 109/1 (6200/mm3), and the percentage of LUCs was not substantially affected by treatment; there was no correlation between LUCs and Rai clinical stage. SS and LPP were characterised by a similar percentage of LUCs, but both HCL and PLL were distinguished by a higher mean percentage of LUCs. Stage IV CLL was associated with monocytopenia, but other stages of CLL, PLL, LPP, and SS showed no consistent reduction of absolute numbers of non-lymphoid cell types. In contrast, HCL was characterised by a consistent absolute neutropenia and monocytopenia which distinguished its Hemalog D profile from that of PLL.

Humans↗
PubMed1980

Domiciliary visits by pathologists: an evaluation.

DOMICILIARY VISITS BY PATHOLOGISTS MAY CONFER BENEFITS OF VARIOUS KINDS: enabling many illnesses to be managed safely at home rather than by admission to hospital or attendance at the outpatient department; reassurance of patients, relatives, and family practitioners; the mutual education of family practitioners and pathologists; and the improvement of outcome of disease by early investigation.An analysis of the financially definable costs and benefits of 1,182 domiciliary visits by two pathologists during an eight-year period shows that the savings are much greater than the costs.

Child↗
PubMed1979

Assessment of thrombocytopenic patients for splenectomy.

Platelet survival and splenic sequestration patterns were studied in 32 patients with thrombocytopenia using donor platelets labelled with chromium-51. A shorter mean platelet lifespan was observed in immune thrombocytopenia (ITP) (mean 12 hours) than in hypersplenism (mean 56 hours) or marrow hypoplasia (mean 102 hours). There was no such correlation between diagnosis and splenic sequestration. A biphasic survival curve was seen in nine of 22 patients with ITP. Thirteen patients underwent splenectomy with complete (9) or partial (4) response, but no consistent pattern of results was manifest. It is concluded that in vivo isotope studies are of little value in predicting the benefit of splenectomy in thrombocytopenic patients, although they may demonstrate the mechanism of the thrombocytopenia, in particular the biphasic survival curve revealing separate 'immune' and 'hypersplenic' components of platelet destruction in ITP.

Adolescent↗