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J Harvell

Publications and source records attributed to J Harvell.

10 recordsLinked to original sources
PubMed2001

Heteroduplex analysis of T-cell receptor gamma gene rearrangement as an adjuvant diagnostic tool in skin biopsies for erythroderma.

BACKGROUND: Erythroderma, defined as red skin covering most of the body surface often accompanied or followed by exfoliation, is the clinical manifestation of at least six different underlying etiologies with allergic or irritant contact dermatitis, atopic/asteotic dermatitis, pityriasis rubra pilaris (PRP), psoriasis, and seborrheic dermatitis accounting for the majority of cases. Approximately 10% of cases are due to adverse drug reactions with roughly another 10% due to cutaneous T-cell lymphoma (CTCL), predominantly mycosis fungoides, or leukemia. It is clear from multiple studies that the clinical diagnosis of the underlying entity is often difficult, as these diseases can present in a very similar fashion. A skin biopsy is usually employed in this setting as a diagnostic tool. However, the histopathologic diagnosis of the underlying cause is complicated by the subtlety of the distinguishing histologic features. In this situation, an ancillary technique demonstrating the presence of a monoclonal T-cell proliferation could help to rule in or out CTCL in cases that clinically and histopathologically do not allow a definitive diagnosis. METHODS: We retrospectively studied 25 biopsies from sixteen patients who presented to the Stanford Dermatology Clinic with erythroderma. We examined the specimens morphologically and analyzed the gamma chain of the T-cell receptor (TCR- gamma) by polymerase chain reaction (PCR) followed by heteroduplex analysis for clonality. We then correlated the results of our PCR and heteroduplex analyses with the patients' clinical outcomes. RESULTS: Four biopsies, from three patients, contained clonal TCR-gamma rearrangements; the four biopsies, all of which were equivocal histologically, correlated to diagnoses of mycosis fungoides (MF) or Sézary syndrome (SS). Twenty-one biopsies contained polyclonal T-cell populations. Eighteen of these biopsies represent patients with inflammatory dermatoses. Three of these biopsies, all of which were taken from a single patient, correlate to a diagnosis of MF. CONCLUSION: TCR-gamma PCR heteroduplex analysis seems to represent an important adjuvant diagnostic tool that, used in conjunction with histopathology and clinical history, could help to clarify the underlying etiology of erythroderma.

Aged↗
PubMed1999

Association of morbidity with markers of nutrition and inflammation in chronic hemodialysis patients: a prospective study.

BACKGROUND: Numerous studies suggest a strong association between nutrition and clinical outcome in chronic hemodialysis (CHD) patients. Nevertheless, the pathophysiological link between malnutrition and morbidity remains to be clarified. In addition, recent evidence suggests that nutritional indices may reflect an inflammatory response, as well as protein-calorie malnutrition. In this study, we prospectively assessed the relative importance of markers of nutritional status and inflammatory response as determinants of hospitalization in CHD patients. METHODS: The study consisted of serial measurements of concentrations of serum albumin, creatinine, transferrin, prealbumin, C-reactive protein (CRP), and reactance values by bio-electrical impedance analysis (BIA) as an indirect measure of lean body mass every 3 months over a period of 15 months in 73 CHD patients. Outcome was determined by hospitalizations over the subsequent three months following each collection of data. RESULTS: Patients who required hospitalization in the three months following each of the measurement sets had significantly different values for all parameters than patients who were not hospitalized. Thus, serum albumin (3.93 +/- 0.39 vs. 3.74 +/- 0.39 g/dl), serum creatinine (11.0 +/- 3.7 vs. 9.1 +/- 3.5 mg/dl), serum transferrin (181 +/- 35 vs. 170 +/- 34 mg/dl), serum prealbumin (33.6 +/- 9.2 vs. 30.0 +/- 10.1 mg/dl), and reactance (50.4 +/- 15.6 vs. 43.0 +/- 13.0 ohms) were higher for patients not hospitalized, whereas CRP (0.78 +/- 0.89 vs. 2.25 +/- 2.72 mg/dl) was lower in patients who were not hospitalized. All differences were statistically significant (P < 0.05 for all parameters). When multivariate analysis was performed, serum CRP and reactance values were the only statistically significant predictors of hospitalization (P < 0.05 for both). When a serum CRP concentration of 0.12 mg/dl was considered as a reference range (relative risk 1.0), the relative risk for hospitalization was 7% higher (relative risk = 1.07) for a CRP concentration of 0.92 mg/dl and was 30% (relative risk = 1.30) higher for a CRP concentration of 3.4 mg/dl. When a reactance value of 70 ohms was considered as a reference range with a relative risk of 1.0, the relative risk of hospitalization increased to 1.09 for a reactance value of 43 ohms and further increased to 1.14 for a reactance value of 31 ohms. CONCLUSIONS: The results of this study strongly indicate that both nutritional status and inflammatory response are independent predictors of hospitalization in CHD patients. CRP and reactance values by BIA are reliable indicators of hospitalization. Visceral proteins such as serum albumin, prealbumin, and transferrin are influenced by inflammation when predicting hospitalization. When short-term clinical outcomes such as hospitalizations are considered, markers of both inflammation and nutrition should be evaluated.

Aged↗
PubMed1998

The histopathology of pathergy: a chronologic study of skin hyperreactivity in Behçet's disease.

BACKGROUND: Many patients with Behçet's disease (BD) demonstrate hyperreactivity (pathergy), and the induced skin lesions may serve as a model for the disease. OBJECTIVE: This study examined the sequence of histopathologic changes after needle prick trauma. METHODS: Eight patients fulfilling the International Study Group Criteria for Behçet's Disease, two patients with recurrent aphthous stomatitis, and two healthy controls each underwent intradermal injections with subsequent biopsies at 0, 4, 24, and 48 h. Hematoxylin and eosin sections were evaluated in a blinded fashion according to 11 histopathologic criteria. RESULTS: At time zero, normal skin was seen. By 4 h, neutrophils were present usually admixed with lymphocytes (8 out of 10). The inflammatory cell density peaked by 24 h in 8 out of 10 patients and at 48 h in 2 out of 10 patients. Sparse leukocytoclasis was identifiable from 4 to 48 h, but was not associated with fibrin. True vasculitis (as evidenced by fibrin within vessel walls and/or intraluminal thrombi) was not seen. Intraepidermal pustules (IEPs) and polymorphonuclear (PMN) aggregates within the needle tract were seen as early as 4 h. The control patients and three out of eight of the BD patients failed to develop clinical lesions. Among this group histopathologic IEPs were lacking in all but two BD patients. CONCLUSIONS: These data suggest that early pathergy is mediated by PMNs and lymphocytes without vasculitis. Hyperchemotaxis may explain the rapid accumulation of PMNs along the injection site.

Adult↗
PubMed1996

Increased energy expenditure in hemodialysis patients.

Malnutrition is prevalent in chronic hemodialysis patients and is related to multiple factors; the hemodialysis procedure itself has been suggested as a catabolic factor. To examine the possible role of hemodialysis on energy metabolism, resting energy expenditure and respiratory quotient in ten chronic hemodialysis patients was measured in this study, using a whole-room indirect calorimeter. Measurements were done continuously: for 2 h before hemodialysis, during 4 h of hemodialysis, for 2 h after hemodialysis, and separately on a nondialysis day after 12 h of fasting. Age-, sex-, and body mass index-matched healthy volunteers were used as control subjects. Chronic hemodialysis patients have a significantly higher resting energy expenditure on a nondialysis day (1.18 +/- 0.15 kcal/min; P < 0.01) as compared with control subjects (1.10 +/- 0.16 kcal/ min). Resting energy expenditure further increased significantly during the hemodialysis procedure (1.32 +/- 0.18 kcal/min, averaged over the 4 h of hemodialysis; P < 0.01 versus predialysis) and was also significantly higher compared with the postdialysis period and nondialysis day resting energy expenditure (P < 0.001 for both). This effect was most pronounced during the first (1.37 +/- 0.19 kcal/min) and second (1.33 +/- 0.18 kcal/min) hours of hemodialysis (P < 0.001 for both). Respiratory quotient was not significantly affected by hemodialysis. It was concluded that chronic hemodialysis patients have higher than normal resting energy expenditure levels, which is further increased during hemodialysis. This process may significantly potentiate the protein-calorie malnutrition seen in this patient population.

Adult↗
PubMed1994

Contact urticaria and its mechanisms.

This paper reviews the syndrome of contact urticaria in terms of current knowledge regarding pathophysiological mechanisms. The three mechanistic categories into which contact urticants are grouped include: (1) immunological contact urticaria, (2) non-immunological contact urticaria and (3) uncertain-mechanism-mediated contact urticaria. Within this schema, the clinical manifestations, diagnosis and therapy of contact urticaria are presented.

Adult↗
PubMed1992

Changes in transepidermal water loss and cutaneous blood flow during the menstrual cycle.

This study quantified irritant susceptibility and blood vessel reactivity in normal women over the course of the menstrual cycle. Such alterations were studied by observing vasodilation from topical application of methyl nicotinate (MN) on the following days of the menstrual cycle: (i) the day of putative maximal estrogen secretion; (ii) the day of maximal progesterone secretion; (iii) the day of minimal estrogen/progesterone secretion. These responses were evidenced by changes in the following dose response characteristics: the initial response (IR), the peak response (PR) and the area under the curve (AUC). Baseline laser Doppler velocimetry (LDV) blood flow values and transepidermal water loss (TEWL) values on normal skin were also obtained. No significant differences existed for any of the dose-response characteristics (IR, PR, AUC) when the values for the 3 testing days were compared to one another. Significant differences did exist for baseline TEWL values when comparing the day of maximal estrogen secretion to the day of minimal estrogen/progesterone secretion. TEWL was higher on the day of minimal estrogen/progesterone secretion as compared to the day of maximal estrogen secretion on both back (p = 0.037) and forearm (p = 0.021) sites, suggesting that the skin barrier function is less complete on the days just prior to the onset of the menses as compared to the days just prior to ovulation. Significant differences in baseline blood flow also existed for the day of maximal estrogen secretion as compared to the day of maximal progesterone secretion, with higher baseline blood flow recorded on the day of maximal progesterone secretion on both the back (p = 0.021) and forearm (p = 0.009) sites.

Adult↗