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Biomedical subjects

J S Davis

Publications and source records attributed to J S Davis.

At least 163 records · Page 9Linked to original sources

Rheumatoid vasculitis: effect of cyclophosphamide on the clinical course and levels of circulating immune complexes.

A study of five patients with severe rheumatoid vasculitis treated with cyclophosphamide was undertaken to determine whether immune complexes were present in serum and if their levels correlated with disease activity and response to treatment. Circulating immune complexes were measured by various techniques including the Clq binding and Raji cell radioimmunoassays and determination of the presence of cryoglobulins. Elevated levels of circulating immune complexes, hypocomplementemia, and high titer rheumatoid factor were present during active vasculitis. Clinical and serologic remissions were induced in all patients on cyclophosphamide. In two patients in remission, a rise in rheumatoid factor titer and immune complex levels was associated with an exacerbation of vasculitis and resolved on increased cyclophosphamide dosage. The Clq binding assay and rheumatoid factor titer correlated best with clinical activity. Thus, circulating immune complexes appear to be involved in the immunopathogenesis of rheumatoid vasculitis, which can be successfully treated with cyclophosphamide.

Antigen-Antibody Complex↗

Simultaneous gout and pyarthrosis.

Although infrequently reported, the simultaneous occurrence of gout and infection in the same joint has been noted recently in three patients at the University of Virginia Hospital. Our report suggests that gout and pyarthrosis may coexist more often than is generally recognized and emphasizes the necessity of carefully searching for both conditions in an inflamed joint. The importance of adequately treating gout occurring with infection is also illustrated. Although speculative, factors such as synovial fluid pH, endotoxin, and enzymatic digestion of articular cartilage may predispose an infected joint to acute gout.

Aged↗

Fibrous histiocytoma of the parotid gland.

Fibrous histiocytomas are not uncommonly found in the head and neck region. These tumors, arising from the tissue histiocyte, generally behave in a benign fashion. An unusual case of a fibrous histiocytoma arising in the parotid gland is presented. The histopathology of these lesions as well as parotid neoplasms in children is reviewed. Wide local excision without sacrifice of important structures is the treatment of choice.

Histiocytoma, Benign Fibrous↗

Gastrointestinal angiodysplasia associated with aortic valve disease: part of a spectrum of angiodysplasia of the gut.

Twelve patients with angiodysplasia of the gastrointestinal tract were seen at The Mary Imogene Bassett Hospital are presented. Six share the features of gastric or duodenal angiodysplasia, advanced age, and aortic valve disease. Of these 6 patients, 4 who bled repeatedly were treated with endoscopic coagulation of areas of gastric and duodenal angiodysplasia. Six patients with other types of gastrointestinal angiodysplasia are presented for comparison. Two had gastric angiodysplasia and no aortic valve disease, 2 had hereditary hemorrhagic telangiectasia, 1 had received irradiation, and 1 could not be classified. We suggest that angiodysplasia of the gastrointestinal tract can be regarded as a spectrum with a clearly inherited etiology on one extreme and an acquired etiology on the other. A subset of these patients may be associated with aortic valve disease. Angiodysplasia of the upper gastrointestinal tract may account for a significant fraction of previously unexplained bleeding. It is hoped that this paper will aid in their more frequent recognition.

Aged↗

A prospective study of plasma DNA in the diagnosis of pulmonary embolism.

To assess the usefulness of plasma deoxyribonucleic acid (DNA) detection in the diagnosis of pulmonary embolism (PE), we prospectively studied the frequency and duration of the occurrence of free plasma DNA in 23 patients with PE and in 49 patients with pneumonia, myocardial infarction, thrombophlebitis, or normal lung scans. Plasma DNA was detected in 19 of the 23 patients (83 per cent) with PE and in none of the 49 patients with other diagnoses. Eighteen of the 19 PE patients with free DNA had persistence of DNA on all subsequent sampling for up to 5 days. In this series, plasma DNA had a sensitivity of 83 per cent in the diagnosis of PE and was extremely specific for PE. Thus, detection of free plasma DNA may be useful as a rapid, noninvasive test to aid in the diagnois of PE.

DNA↗

Hepatic sensitivity to imipramine.

A case of significant hepatic reaction related to imipramine is presented, documented by challenge with imipramine and liver biopsy. The mechanism, while not entirely clear, is presumed to involve hypersensitivity or induction of toxic metabolites.

Adult↗

Biosynthesis of the third component of complement (C3) in vitro by monocytes from both normal and homozygous C3-deficient humans.

Human monocytes synthesized the third component of complement (C3) up to 5 wk in vitro. Evidence for net C3 synthesis was based on (a) incorporation of 14C-labeled amino acids into C3 protein, (b) indentity of the allotype of C3 produced in vitro with that of the doner's serum C3, even in the presence of carrier C3 protein of a different allotype; (c) correspondence of electrophoretic mobility, size, and subunit structure of C3 protein produced in vitro with serum C3; (d) inhibition of C3 production with cycloheximide. Monocytes from two unrelated C3-deficient patients were studied under conditions that supported C3 synthesis by normal monocytes. Serum from each of the patients contained less than 1% of the normal C3 concentration, buth their monocytes produced C3 at approximately equal to 25% of the normal rate when studied after 2 wk in vitro. The C3 produced in vitro by monocytes from one of the patients had the molecular weight of normal serum C3 and dissociated appropriately under reducing conditions. Monocytes from C3-deficient patients could not be distinguished from normals on the basis of morphology, rosetting with C3-coated erythrocytes, or rates of C2, and total protein synthesis.

Blood Proteins↗

Anomalous origin of a single coronary artery from the innominate artery.

This is the third reported case of the origin of a single coronary artery arising from the innominate artery (brachiocephalic trunk). Associated cardiovascular malformations were truncus arteriosus and a single ventricle. The term infant died 12 hours after birth. Heart failure, evidenced by severe pulmonary and hepatic congestion found at necropsy, was probably the immediate cause of death. The origin of a single coronary artery from sites other than the aortic or pulmonary sinuses is extremely rare and is always associated with other severe cardiac malformations. Truncus arteriosus and cor bioculare or trioculare are the usual associated abnormalities.

Brachiocephalic Trunk↗

Gastroscopic removal of a partial denture.

This report of an ingested dental prosthesis is submitted to emphasize the need for incorporation of radiopaque material in dental appliances and also to report the safety and efficacy of fiberoptic endoscopy in the nonsurgical treatment of accidental ingestions.

Adolescent↗

HLA-B27 antigen in women with ankylosing spondylitis.

Twenty-three (85.2%) of 27 female patients with ankylosing spondylitis were positive for HLA-B27 antigen, including 15 of 18 white women (83.3%) and eight of nine black women (88.9%). Ankylosing spondylitis in women appears to have the same high association with HLA-B27 antigen as that reported in predominantly male studies (88% to 96%). Determination of this antigen may be useful in the evaluation of female patients suspected of having ankylosing spondylitis.

Black People↗

Pancarditis in Whipple's disease: electronmicroscopic demonstration of intracardiac bacillary bodies.

The advent of electron microscopy has repeatedly confirmed Whipple's original postulate that bacterial infestation might be the cause of intestinal lipodystrophy (Whipple's disease). We have recently studied two patients, a 67-year-old man and a 38-year-old woman, who died of untreated Whipple's disease, and both were found to have clinically unrecognized pancarditis. Histologically, PAS-positive histiocytes in foci of chronic inflammation were demonstrable in several organs, including the heart. Electron microscopy of autopsy tissues showed numerous intracellular and extracellular rod-shaped bacillary bodies and serpiginous membranes. The bacillary bodies, some sectioned transversely and others longitudinally, were about 0.2 mum wide and 2 mum long; each had a double-layered cell wall. These bacillary bodies have not been previously identified in the heart, and may be casually related to cardiac lesions occurring in many untreated cases of Whipple's disease.

Adult↗

Polyarthritis, polyarteritis and hepatitis B.

An association between viral hepatitis and two rheumatic disease syndromes has been observed. Twenty-nine patients manifested a transient polyarthritis, sometimes associated with a rash (Group I). Ten patients were seen with a multisystem disease (Group II). Histologic evidence of arteritis or glomerulonephritis was present in seven of ten patients with multisystem disease. Liver tissue from 18 patients showed morphologic evidence of hepatitis with viral features in 9 of 10 patients in Group I and in 6 of 8 patients in Group II. Hepatitis B surface antigen (HBsAg) and/or antibody to HBsAg were detected in sera of all 39 patients. Abnormal liver functions were present in 36. Twelve Group I patients and 2 Group II patients became jaundiced. Rheumatoid factor was present in sera of seven patients in each group. The third component of complement (C3) was depressed in 13 patients in Group I and 7 patients in Group II. The fourth component of complement (C4) was decreased in 8 of 21 Group I and 3 of 7 Group II patients. Synovial fluid C3 was decreased in 2 of 11 Group I and 1 of 4 Group II patient's fluids. Articular inflammation in patients with transient polyarthritis responded in three to seven days to aspirin, acetominophen and/or bedrest alone and rashes disappeared spontaneously. Patients with multisystem disease generally had a prolonged illness and responded somewhat unpredictably to prednisone or a combination of prednisone and cyclophosphamide.

Adolescent↗