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Biomedical subjects

J D Briggs

Publications and source records attributed to J D Briggs.

At least 127 records · Page 7Linked to original sources
PubMed1983

Effect of acute aluminium overload on calcium and parathyroid-hormone metabolism.

Accidental exposure of 25 patients on continuous ambulatory peritoneal dialysis to a high aluminium level in the dialysate for a month provided an opportunity to investigate the interrelation between the metabolism of parathyroid hormone (PTH), calcium, and aluminium. After exposure to the high-aluminium dialysate, the mean serum aluminium had risen from 1.85 to 7.11 mumol/l and serum calcium from 2.27 to 2.44 mmol/l, and serum PTH had fallen from 744 to 580 ng/l. After a further 2 months, during which time the dialysate was aluminium-free, the mean serum aluminium and calcium fell to previous levels. There were no changes in calcium or vitamin-D therapy which could have influenced these results. The rise in serum calcium and fall in PTH during a period of aluminium toxicity strongly support the hypothesis that aluminium suppresses PTH through an elevation of serum calcium.

Accidents, Home↗
PubMed1983

The detection of antibodies to cytomegalovirus in the sera of renal transplant patients by an IgM antibody capture assay.

An IgM antibody capture assay for detection of cytomegalovirus (CMV) IgM antibody (MACRIA) was developed. It was shown to be of similar sensitivity to the indirect immunofluorescence test but has the advantage that rheumatoid factor does not react in it and pretest fractionation of serum is not required. It does, however, give false results with some Paul Bunnell-positive sera. The assay was used to measure the IgM response in 28 renal transplant patients followed prospectively. Seven patients (100%) with primary infections and six of 13 (46%) patients with secondary infections developed IgM by MACRIA. Nine of 13 (69%) patients with CMV IgM-positive sera had symptoms other than pyrexia associated with CMV infections, while only one of seven (14%) IgM-negative infections were symptomatic. Four of seven irreversible rejection episodes were associated with CMV IgM. The possible significance of CMV IgM production is discussed.

Adolescent↗
PubMed1983

Medical research council trial of antilymphocyte globulin in renal transplantation. A multicenter randomized double-blind placebo controlled clinical investigation.

A total of 173 patients who received live donor or cadaveric primary or secondary renal transplants at five British hospitals were entered into a randomized double-blind controlled clinical trial of equine antilymphocyte globulin (ALG) administered prophylactically to prevent rejection. The ALG was prepared in the early 1970s and used cultured human lymphoblasts as antigen. Following transplantation all patients were treated with a standard immunosuppressant regimen of steroids and azathioprine and, in addition, were given either 30 mg/kg ALG or placebo daily for 10 days by intravenous infusion. In comparison with more recently produced materials, the ALG employed in this study was of moderate potency in prolonging skin graft survival in monkeys. Primary graft failure occurred in 27 patients (15/86 ALG and 12/87 placebo). At three to five years after transplantation 50 of the remaining patients had died, almost all from diseases relating to their renal condition, and 25 more had suffered complete graft failure. No significant differences were found between patients treated with ALG and placebo in the numbers with functioning grafts during the 3 years following transplantation, in the time between transplantation and the first rejection episode, or in the number of episodes during the first six months after transplantation. This applied whether live or cadaveric grafts were employed. Within the first 6 months of operation, infection was given as a major contributory cause of death in 12 patients treated with ALG and in 5 who received placebo (P greater than 0.1). Infections were also slightly more common during the two weeks following transplantation in those receiving ALG (13/86 ALG, 10/87 placebo). As expected, graft survival was significantly better in patients who received live donor grafts (P = 0.001) and in patients with the least donor-recipient histocompatibility mismatches (P = 0.008). The results of this multicenter trial show no therapeutic benefit to renal graft recipients from the administration of ALG, and suggest that the risks of fatal infection may have been aggravated. Use of such equine ALG in similar dose regimens is therefore, not, justified in renal transplantation, especially if some part of the apparent effects on fatal infections is real. It is stressed that these findings are relevant only to the equine ALG used in this study, which was raised with cultured human lymphoblasts as the antigen, and to ALG prepared in a similar way and of similar potency. It should not be inferred that these results are applicable to ALG prepared in other ways.

Adolescent↗
PubMed1983

Continuous ambulatory peritoneal dialysis and pulmonary function.

Pulmonary function tests were performed in ten patients established on continuous ambulatory peritoneal dialysis. A decrease in all lung volumes was observed after instillation of dialysate and a further decrease on change from the erect to the supine posture. This change was small and unlikely to have a functionally significant effect in patients with a healthy respiratory system. However, in patients with pre-existing lung disease, respiratory function might be further compromised.

Adult↗
PubMed1983

Early detection of obstructed ureter by ultrasound following renal transplantation.

Serial ultrasound examinations were carried out following 144 renal transplants. Eleven patients (8%) required surgery for ureteric obstruction and in all cases the ultrasound correctly identified the obstruction at an early stage. One false positive result was obtained with the ultrasound and this compared favourably with both the intravenous urogram (IVU) and isotope renogram. There were false positive and false negative results with both the IVU and renogram in addition to which neither of these techniques, particularly the IVU, is as simple or atraumatic for the patient as the ultrasound. Serial ultrasound examinations have a useful role in the detection of ureteric obstruction as well as being of value in the detection of perinephric fluid collections and acute rejection.

Diagnostic Errors↗
PubMed1983

The influence of aluminium on parathyroid hormone levels in haemodialysis patients.

In order to investigate the relationship between parathyroid hormone (PTH) and aluminium we studied 86 haemodialysis patients whom we separated into three groups according to their serum PTH values. Group I: PTH less than 600ng/L; Group II: PTH 600-900ng/L; Group III: PTH greater than 900ng/L. A significant difference was found between Groups I and III in the serum aluminium (Group I: 4.85 mumol/L; Group III: 2.84 mumol/L, p less than 0.003) and serum calcium (Group I: 2.43mmol/L; Group III: 2.32mmol/L, p less than 0.0125). The association of higher serum aluminium and calcium with lower PTH concentrations suggests that aluminium can suppress PTH release through an elevation of the serum calcium.

Adolescent↗
PubMed1982

Principal neuropathological and general necropsy findings in 24 renal transplant patients.

The principal neuropathological and general pathological findings in a group of 24 patients with renal transplants who died in a nine-year period at the Western Infirmary, Glasgow, are described. Opportunistic infections--bacterial, protozoal, and fungal--were the commonest causes of death. Other causes included cardiac and vascular lesions, upper gastrointestinal bleeding and neoplasia.

Adolescent↗
PubMed1981

Cell-mediated immunity during RDT and the outcome of transplantation.

Previous studies have demonstrated depression of cell-mediated immunity (CMI) in uraemia. We have measured CMI in a group of 248 patients on regular dialysis using a quantitative dinitrochlorobenzene (DNCB) skin test which gives a score of 0 to 15. Ninety-eight of these patients subsequently had first cadaver transplants and the relationship between the DNCB score and graft survival has been examined. Graft survival was found to decline progressively with higher DNCB scores. Blood transfusion also had a major influence on graft survival and the relation between the DNCB score and outcome was observed in all the blood transfusion groups.

Adolescent↗
PubMed1980

Survial from acute renal failure with and without multiple organ dysfunction.

A 10-year retrospective analysis has been carried out of 114 patients dialysed for acute renal failure. Fifty-eight patients, predominantly suffering from multiple organ failure, required treatment in an Intensive Therapy Unit (ITU); 56 less severely ill patients were treated in a Renal Unit. Overall survival in the former group was 36% and in the latter group 63%. In the first 5 years of the study, survival in the ITU patients was 31% and in the second 5 years, was 38% in spite of a trend towards increased severity of illness. These results challenge the view that haemodialysis is rarely worth-while in patients with multiple organ failure, and suggest that current management techniques have improved prognosis. The most important adverse factors continue to be old age, sepsis and gastrointestinal disease.

Acute Kidney Injury↗