Biomedical subjects

P G Briggs

Publications and source records attributed to P G Briggs.

4 recordsLinked to original sources

PubMed1992

Who needs a hospice?

OBJECTIVE: Rapid evolution of palliative care programs in Australia over recent years has brought the role of traditional inpatient hospices under review. This study attempts to define the clinical characteristics of patients referred for inpatient palliative care. DESIGN: A retrospective chart survey was performed of 432 consecutively referred patients. SETTING: The study was undertaken in a 60-bed hospice providing intensive nursing and medical care to patients with terminal illness. OUTCOME MEASURES: Demographic characteristics, diagnosis, length of stay, outcome and use of analgesics are presented. Patients not using regular analgesia at admission were studied to determine their major symptom complexes and their use of medication. RESULTS: Public hospitals referred 67.6% of patients and 25% came from home. While 83.8% of patients died in hospice care, 16.2% were discharged, usually to home or a nursing home. At admission, 16.9% of patients could walk unassisted, 20.6% were chair-bound and 62.5% were bed-bound. The median length of stay in the hospice was 16 days. Ambulant status, female sex, non-use of opioids and a diagnosis of brain or breast cancer were all associated with longer stay. At admission, 39.1% of patients were taking potent opioids regularly, 22.9% were taking mild analgesics and 38.0% were taking no regular analgesia. Of those taking no analgesia, cachexia (55.9%), confusion (35.4%), impaired conscious state (19.9%) and impaired motor neurological function (21.7%) were the major clinical problems. CONCLUSIONS: The data show that patients selected for hospice care were highly dependent, with major functional impairments and short life expectancy. The medical, social and economic implications of these findings are discussed.

Activities of Daily Living↗

PubMed1991

T-lymphocyte response to cytokines in B-chronic lymphocytic leukemia.

The mechanisms underlying abnormal T-cell function in B-chronic lymphocytic leukemia (B-CLL) are unknown. We have studied B-CLL T-cell activation pathways in the rigorous absence of leukemic cells and with controlled numbers of accessory cells present. The responsiveness to added recombinant IL-1 and IL-2 was assessed. We have found that under optimal culture conditions B-CLL T cells had a normal PHA-induced proliferative response in terms of incorporated 3H-thymidine per T cell. Also the capacity of mitomycin-C treated B-CLL monocytes to support autologous T-cell mitogenesis was normal. However, a subtle difference between normal and B-CLL T cells emerged with respect to cytokine responsiveness. While the PHA response of purified normal T cells in the absence of monocytes was augmented by rIL-1, this could not be demonstrated for B-CLL T cells. A much greater degree of augmentation occurred with added rIL-2 in the case of both normal and B-CLL T cells. In the presence of 20% autologous monocytes rIL-1 and rIL-2 had no effect on mitogenesis. We conclude that B-CLL T cells have an abnormal profile of cytokine responsiveness which is consistent with observed abnormalities of subset distribution, and which may contribute to the clinical immunodeficiency in B-CLL.

Cytokines↗

PubMed1990

T cells and CD45R expression in B-chronic lymphocytic leukemia.

A major secondary immunodeficiency exists in B cell derived chronic lymphocytic leukemia (B-CLL) which involves both humoral and cellular immunity and is largely unexplained. Several T cell subset redistributions have been noted in B-CLL. We therefore examined in more detail the immunophenotype of T cells by assessing CD45R expression using a two-colour immunofluorescence technique. The proportion of CD45R+ cells among CD3+, CD4+ and CD8+ cells in B-CLL was significantly (p less than 0.001) higher than in corresponding normal cell populations. We also sought relationships between major T cell subsets and progress of disease and found strongly positive correlations between the total leukocyte count in B-CLL and numbers of CD3+, CD4+, CD8+ cells and monocytes. Further, in patients with clinically more advanced disease, CD3+ and CD4+ cells were present in higher numbers than in patients with less advanced disease (p less than 0.05). CD8+ cells, CD4/CD8 ratio, monocytes and total leukocyte count were not significantly different when comparing the less advanced and more advanced disease patients. An excess of CD45R+ suppressor-inducer T cells has implications for both B and T cell dysfunction and for disease progression.

Antibodies, Monoclonal↗

PubMed1987

Familial hairy cell leukemia.

A mother and son are reported who both developed hairy cell leukemia. The mother aged 74 presented with pancytopenia and responded well to splenectomy. Four years later her son aged 48 presented with pancytopenia; splenectomy was less effective but he improved after treatment with interferon-alpha. Histological examination of the splenic tissue in both cases showed changes characteristic of hairy cell leukemia. This is the third report of this rare disease occurring in family members.

Aged↗