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Biomedical subjects

D G James

Publications and source records attributed to D G James.

At least 109 records · Page 6Linked to original sources
PubMed1984

Hepatic granulomas.

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Acquired Immunodeficiency Syndrome↗
PubMed1983

Adverse ocular reactions to drugs.

Drugs acting on various parts of the body may also affect the eye insidiously. Increased awareness of such drug toxicity by the prescribing doctor should encourage him to consider effects on the cornea, lens, retina, optic nerve and elsewhere when checking the patient's progress. The following review concerns adverse ocular effects of systemic drug administration.

Eye Diseases↗
PubMed1983

The distribution of lymphoid and macrophage like cell subsets of sarcoid and Kveim granulomata: possible mechanism of negative PPD reaction in sarcoidosis.

Immunohistological observations of lymphoid and non-lymphoid cell subsets in biopsies of sarcoid skin granulomas have been compared with positive Kveim tests and the sites of PPD injection in sarcoid patients. Monoclonal antibodies have been used in indirect immunofluorescence often in combination with histochemical methods for the detailed characterization of the cells involved. The antibodies used included two new reagents, RFD-1 and RFD-2, which react with interdigitating cells and acid phosphatase positive macrophages, respectively. Sarcoid granulomas had a distinctive pattern of organization though there was a heterogeneity of macrophage like and T lymphoid cells. In the centre, predominantly HLA-DR+, acid phosphatase positive macrophages (RFD-2+) were seen and the lymphoid cells were almost exclusively T4+. At the periphery of the granulomas the HLA-DR+ dendritic cells were ACP negative and RFD-1+. Here T8+ cells were admixed with the T4+ population. The Kveim granuloma had fewer RFD-2+, macrophages and therefore the RFD-1+ cells were more evenly distributed, but the other cells showed a similar distribution to the established lesions. The PPD injection sites contained fewer T cells than the normal control infiltrates in PPD positive healthy individuals. The T4+/T8+ ratios were about 3:2. The most likely explanation for the PPD anergy in sarcoidosis is the sluggish traffic of T4+ cells which could be due to the sequestration of T4+ cells in sites of ongoing inflammation.

Adult↗
PubMed1983

Prognostic factors predicting the outcome of sarcoidosis: an analysis of 818 patients.

A computerised, retrospective study of 818 patients with sarcoidosis was analysed to study the prognosis of each individual manifestation of the disease. The good prognosis of erythema nodosum, acute arthritis and bilateral hilar lymphadenopathy was confirmed, though 16 per cent of patients presenting with erythema nodosum pursued a chronic course. Cor pulmonale and nephrocalcinosis reflected the poorest prognosis while lupus pernio and sarcoidosis of the mucosa of the upper respiratory tract rarely resolved. Bone sarcoidosis also implied chronicity but in four of 31 patients there was no clinical evidence of disease activity two years after the initial diagnosis, although naturally the bone radiograph was still abnormal. Hepatomegaly carried a worse prognosis than splenomegaly, or indeed, than the finding of pulmonary mottling without hilar glands--a stage three chest radiograph.

Adult↗
PubMed1982

Sarcoidosis of the upper respiratory tract (SURT).

A series of eight hundred and eighteen patients with histologically-confirmed multisystem sarcoidosis was analysed; within this series were 53 (6 per cent) patients with sarcoidosis of the upper respiratory tract (SURT). Two-thirds presented with predominantly upper respiratory tract symptoms when the systemic disorder was minimal or unrecognized. Women were affected twice as often as men. SURT is commonly associated with lupus pernio and other manifestations of chronic fibrotic sarcoidosis, and it follows the same indolent course. When granulomas are found on biopsy of the upper respiratory tract, there should be a management plan to determine whether they are due to multisystem sarcoidosis or other granulomatous disorders including tuberculosis, Wegener's granulomatosis and leprosy. About one-half of patients with SURT will need oral steroids, either alone or in combination with topical steroids or chloroquine.

Adolescent↗
PubMed1982

Chronic intrahepatic cholestasis due to sarcoidosis.

Two West Indian patients with Kveim-biopsy proven sarcoidosis developed chronic cholestatic liver disease, clinically and biochemically similar to primary biliary cirrhosis. Liver histology revealed multiple granulomas with reduction in bile ducts and, in one patient, progression to biliary cirrhosis. Portal hypertension was present in both patients leading to severe variceal haemorrhage in one. Mitochondrial antibody was negative in both patients and when used in conjunction with the Kveim-Siltzbach skin test serves to differentiate chronic intrahepatic cholestasis secondary to sarcoidosis from primary biliary cirrhosis.

Biopsy↗
PubMed1980

Biochemical findings in sarcoidosis.

The majority of patients with sarcoidosis in this large series have had a number of biochemical investigations performed. Abnormal calcium metabolism was demonstrated in 40% of the patients but permanent renal damage due to nephrocalcinosis as a result of persistent derangement of calcium metabolism was rare. Raised immunoglobulin levels were seen. Half the white and two-thirds of the West Indian patients had elevated IgG levels. Abnormal immunoglobulin levels carried no obvious diagnostic or prognostic significance. Raised alkaline phosphatase levels reflected space-occupying hepatic granulomas and occurred in 23% of patients. Serum angiotensin converting enzyme (SACE) was elevated in half the patients. The highest SACE activity was found in patients with severe parenchymal lung infiltration due to sarcoidosis, and the lowest levels in those with inactive disease or after successful management with steroid drugs. SACE levels were not significantly elevated in four other granulomatous conditions: Crohn's disease, primary biliary cirrhosis, Hodgkin's disease, and active tuberculosis.

Adult↗