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Biomedical subjects

D C James

Publications and source records attributed to D C James.

At least 19 recordsLinked to original sources
PubMed1990

The use of enzyme immunoassay (EIA) and radiobinding assay to investigate the cross-reactivity of Klebsiella antigens and HLA B27 in ankylosing spondylitis patients and healthy controls.

The binding of rabbit anti-Klebsiella antibodies to tissue-typed lymphocytes obtained from 30 ankylosing spondylitis (AS) patients and 54 healthy subjects has been measured by an enzyme immunoassay method. HLA B27 positive lymphocytes obtained from either AS patients (t = 3.60; p less than 0.001) or healthy subjects (t = 3.77; p less than 0.001) were found to bind Klebsiella antibodies to a significantly greater extent than non-B27 lymphocytes obtained from healthy controls. Absorption studies demonstrated that HLA B27 positive lymphocytes absorbed out significantly more anti-Klebsiella antibodies than HLA B27-negative lymphocytes (t = 6.76; p less than 0.005). These results are compatible with cross-reactivity or molecular mimicry between HLA B27 and epitopes on some Gram-negative bacteria such as Klebsiella.

Antigens, Bacterial↗
PubMed1988

Bone marrow transplantation for severe aplastic anemia from donors other than HLA identical siblings: a report of the BMT Working Party.

Data were obtained from 46 patients with severe aplastic anemia (SAA) who received bone marrow transplants (BMT) from donors other than genotypically HLA-identical siblings. The data were collected in the SAA Registry of the European Bone Marrow Transplant Group. The donors were non-HLA-identical siblings in six cases, parents in 28 cases, a son in one case and unrelated individuals in 11 cases. Fifteen donor-recipient pairs were HLA-A, -B and -DR identical and mutually non-reactive in mixed lymphocyte culture; nine were mismatched at one locus, 17 were mismatched at two or more loci and in five cases data were not available for D/DR determinants. Actuarial survival was predicted by the degree of mismatch. It was 45% for phenotypically HLA-identical grafts, 25% for grafts mismatched at one locus and 11% for graft mismatched at more than one locus. Whether the graft was derived from a family member or an unrelated donor seemed to be less important and results were comparable. Age, patient sex and year of transplant had no significant influence on survival. The use of cyclosporine (CSA) for graft-versus-host disease (GVHD) prophylaxis (n = 21, survival 34%) appeared superior to both methotrexate (n = 9, survival 11%) and to CSA with T cell depletion of donor marrow (n = 13, survival 14%). The causes of death were rejection (n = 15), GVHD (n = 13), pneumonitis (n = 5) and infection (n = 1). Twelve patients are alive at 16-84 months post-BMT.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Long term follow-up of patients with side to side choledochoduodenostomy and transduodenal sphincteroplasty.

From a consecutive series of 190 patients with choledochoduodenostomy (CDD) and 56 patients with transduodenal sphincteroplasty (TDS), there were 10 and 3 hospital deaths respectively. A long term follow-up study was performed on the remainder. Late deaths occurred in 35 CDD and 5 TDS patients. Serious long term complications occurred in 3.3% of CDD cases, comprising 5 cases of 'sump syndrome' and a further case of cholangitis in the presence of a clear biliary tree. Cholangitis occurred in 2 of the TDS patients (3.8%). Recurrent common duct stones were found in 3 of the 'sump syndrome' cases (1.6%) and one of the TDS patients with cholangitis (1.9%). Eighty-eight per cent of the CDD patients and 90.2% of the TDS patients, who were reviewed, were subjectively well. Serum alkaline phosphatase was raised in 21.6% of the CDD patients and only 3.4% of the TDS group (P less than 0.05). Radiological studies showed that the CDD stoma admitted air and barium more often than the TDS stoma (P less than 0.001). Neither the biochemical nor the radiological findings correlated with the long term symptomatic results of the two procedures. Dynamic HIDA scans showed a shorter time to peak activity in the common hepatic duct for both CDD (P less than 0.01) and TDS (P less than 0.05) as compared with endoscopic sphincterotomy (ES). These long-term clinical, biochemical and radiological results are similar to those reported following ES.

Adolescent↗
PubMed1986

Histocompatible unrelated volunteer donors compared with HLA nonidentical family donors in marrow transplantation for aplastic anemia and leukemia.

We treated 14 patients by transplantation of marrow from unrelated volunteer donors. Eight patients had severe aplastic anemia, 3 had chronic granulocytic leukemia, and 3 had Fanconi's anemia. The results are compared with those of a group of 14 similar patients transplanted concurrently from human leukocyte antigen (HLA)-mismatched family members: Sustained engraftment was achieved in 8 of 14 patients in both groups; one additional patient survived with autologous marrow reconstitution following an unrelated donor transplant. In the unrelated donor group, 6 of 9 evaluable patients developed grade III through IV acute graft-v-host disease, as compared with 4 of 9 patients after family-mismatched transplants. Overall survival was similar in the two groups. In the unrelated donor group 4 of 14 (29%) patients survived (median survival 1,299 days) as compared with 5 of 14 (36%) in the mismatched-family donor group (median survival 808 days). In both groups, patients with HLA phenotypically matched donors fared better than those with donors who were mismatched for one or more HLA antigen. Of the patients transplanted from HLA phenotypically matched donors 6 of 12 patients (50%) survived, as compared with 3 of 16 patients (19%) transplanted from HLA-mismatched donors. We conclude that unrelated donor bone marrow transplantation (BMT) should be considered in those cases of leukemia or bone marrow failure in which the chance of cure using conventional therapy is remote and a HLA genotypically or phenotypically matched family donor is not available.

Anemia, Aplastic↗
PubMed1985

Antibodies to proteus in rheumatoid arthritis.

Antibodies to proteus species were measured in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and in healthy controls by a Coombs agglutination method. The titres to Proteus mirabilis were higher in 30 RA patients being treated with gold than in 24 patients with active AS (p less than 0.001), 28 patients with inactive AS (p less than 0.001), and 41 healthy control subjects (p less than 0.001). Control studies with Klebsiella pneumoniae var oxytoca showed high antibody titres only in active AS patients.

Adult↗
PubMed1985

The accuracy of "pull-through" pressure measurements and papaverine testing.

Intra-arterial pressure measurements have been made in a group of vascular patients using two different methods. The pull-through method, without systemic pressure monitoring, is compared with a technique employing simultaneous radial and femoral arterial puncture. In both techniques, pressures are measured at resting flow and during papaverine induced hyperaemia.

Angioplasty, Balloon↗
PubMed1985

Use of donors sharing one genetic haplotype for bone marrow transplantation.

Matched sibling transplants enjoy over 95% survival of the grafting procedure, but are only available for 1:5 patients. A sibling sharing one genetic haplotype is today our next choice of donor (67% survival) faring better than other relatives (50% survival), providing total body irradiation (of the thymus) has been avoided. The latter, without increasing the attack rate (64%) of GvHD more than doubles the deaths (57% as against 27%) attributable to it. Rejection is avoided by (a) suicide of host responders to donor buffy coat; (b) Cyclosporin-A; (c) displacement induction; (d) a higher dose of marrow. Prevention of GvHD is essential, using either Cyclosporin-A or removing donor T-cells from marrow prior to infusion or, probably better, both. Autoblast immunisation should be further explored. Tolerization seems an active process, easier in the very young, and nonirradiation of the thymus is believed important. An assay to assess tolerization (to guide cessation of immunosuppressive measures) is badly needed. Selection of a donor whose lymphocytes can deal with intracellular infections of the host's fibroblasts is now possible. The required increased immunosuppressive measures appear to increase the risk of leukemic relapse, and perhaps should be first improved in the more cost-effective fields of inborn error transplants.

Bone Marrow Transplantation↗
PubMed1984

HLA-B27 and the immune response to enterobacterial antigens in ankylosing spondylitis.

Total serum immunoglobulins and class specific serum antibodies to Klebsiella pneumoniae, Salmonella typhimurium, Yersinia enterocolitica and Pseudomonas aeruginosa were measured in 107 patients with ankylosing spondylitis (AS) and 110 healthy tissue typed controls by enzyme linked immunosorbent assay (ELISA). The specificity of this technique was confirmed by the use of specific bacterial murine antisera and by cross-absorption of human sera by specific bacteria. Total serum IgA in AS patients correlated with both erythrocyte sedimentation rate (ESR) (P less than 0.001) and C-reactive protein (P less than 0.05) and was significantly elevated compared to healthy individuals (P less than 0.001). A significant elevation of IgA antibodies to K. pneumoniae was detected in the serum of AS patients with active disease when compared to healthy controls (P less than 0.01). These studies support the involvement of an enterobacterial micro-organism in the pathogenesis of AS and further relate to the role of HLA-B27 in this disease.

Antibodies, Bacterial↗