Biomedical subjects
Publications and source records attributed to P Jacobs.
Mycobacterium kansasii musculoskeletal infections are unusual. The infection presents as either a tenosynovitis, monoarticular arthritis or generalized systemic spread. In 2 patients, vigorous surgical and antimycobacterial medical regimens controlled the infection and produced full return of function.
The infectious complications after induction of remission in 31 previously untreated adult patients with acute myeloid leukaemia are described. Clinically, most of the febrile episodes were associated with infection, and in 11 of the patients who died infection was the direct cause. In 6 out of these 11 the causal organism was diagnosed ante mortem. In 6 of the 15 patients who regenerated to clinical remission and who had fever the causal organism was isolated. The policy of management of fever in this group of patients is outlined.
Serum lysozyme (muramidase) concentrations were determined in 55 patients with inflammatory bowel disease, 6 with miscellaneous bowel disease, 40 with pulmonary tuberculosis, and in 20 normal subjects. The mean (+/- SE) lysozyme concentration for each group was as follows: controls 6,95 +/- 0,36 microgram/ml; ulcerative colitis 9,61 +/- 1,02 microgram/ml; inactive Crohn's disease 7,61 +/- 0,53 microgram/ml; active Crohn's disease 20,77 +/- 2,17 microgram/ml; sputum-negative tuberculosis 13,05 +/- 1,06 microgram/ml; and sputum-positive tuberculosis 20,35 +/- 2,08 microgram/ml. The mean enzyme levels were significantly higher in patients with Crohn's disease than in those with ulcerative colitis (P less than 0,05) or in normal controls (P less than 0,01). Our findings suggest that serum lysozyme levels may be useful in differentiating active Crohn's disease from ulcerative colitis, but the results overlap somewhat. However, the enzyme level may be a useful index of disease activity in following up patients with Crohn's disease. As tuberculosis is endemic in this country it must first be excluded, because patients with pulmonary tuberculosis have similarly high levels of serum lysozyme.
Explore the source record for details and available documents.
Patients who run a fulminating course in association with histologically proven myelofibrosis are distinctly unusual, since the natural history of this entity is characteristically one of slow progression. Because of its rarity and proteam manifestations, acute myelofibrosis may easily go unrecognized. We report 2 such patients. In one, rapid clinical deterioration was dominated by spreading skin lesions, and in the other by refractory intravascular haemolysis. There was no splenomegaly in the first patient, and it was minimal in the second. Although it is seen in frequently, it should be emphasized that myelofibrosis may arise de novo as an acute illness in which the usual degree of splenomegaly is absent.
Explore the source record for details and available documents.
We report a patient with systemic lupus erythematosus in whom resection of a completely atrophic spleen (weight 5 g) reversed steroid-refractory thrombocytopenia. The spleen plays a central role in the pathogenesis of autoimmune thrombocytopenia by synthesizing antibodies directed against autologous platelets and by sequestering these immunoglobulin-coated cells. Both functional disturbances occur without splenic enlargement, and splenectomy wll, in selected cases, improve thrombocytopenia. A similar rise in platelet count may follow resection of much smaller masses of splenic tissue such as splenunculi. We have, however, been unable to find documentation of this phenomenon after removal of a completely atrophic spleen.
Five patients suffering from non-Hodgkin's lymphoma associated with an intense infiltration of epithelioid histiocytes and even sarcoid-type granulomas in the involved tissue are described. A similar tissue reaction, at both involved and uninvolved sites, has been described in patients with Hodgkin's disease. The cause of this reaction may be immunological; its prognostic significance still awaits elucidation. In the case of non-Hodgkin's lymphomas, it may cause difficulty in diagnosis of lymphoma and hence may result in unnecessary delay in the initiation of therapy.
The effect of the sulphonylureas gliclazide (S 852) and glibenese on platelet function, blood lipid levels and the control of diabetes, was prospectively evaluated in 12 maturity-onset diabetic subjects by means of a double-blind crossover study. Including the pretrial period, platelet aggregation in response to collagen was uniformly lower than in matched normal controls, but neither drug produced any additional effect on platelet function. Control of blood glucose levels was no better than with comparable agents, and no measurable changes occurred in blood lipid levels. The drugs had no significant side-effects and were well tolerated. It is concluded that neither agent offers special advantages over other sulphonylureas, particularly in regard to platelet function.
Current concepts underlying the treatment of the acute leukaemias are presented. Improved drug regimens and ancillary services have been developed and their role in the management of acute leukaemia is reviewed.
Dysbaric osteonecrosis is a major hazard to compressed air workers and an increasing hazard to divers. Symptomless osteonecrosis is best recognised by radiology and it is of fundamental importance that interpretation be reliable and accurate. There is much controversy concerning the significance of bone islands and cystic areas; several authors report bone islands and cystic areas to be up to eight times more frequent in compressed air workers and divers and believe that these represent positive evidence of osteonecrosis. Skeletal radiographs of 100 Royal Navy divers, all of whom were at risk to osteonecrosis were matched for age and rank with 100 controls, none of whom had been exposed to high pressures. The radiographs were interpreted by three radiologists working independently without knowing whether the radiographs were in the diving or control group. It is concluded that bone islands, cystic areas and sclerotic areas, as described in this text, occur with equal frequency in divers as in the normal population and do not represent positive evidence of osteonecrosis. The report includes autopsy studies of the proximal femur and proximal humerus in six diving fatalities. Five bone islands in the proximal humerus and one in the femoral neck were studied in bones removed from five divers. In the sixth case a cyst was seen to develop radiologically in the femoral neck and then reduce in size over 3 years and 10 months. Slab radiographs and histological section in all cases show no evidence of osteonecrosis.
The fatty acid composition of whole bone marrow and that of isolated, disaggregated adipose cells from red and yellow marrow was examined by gas chromatography. Consistent and significant shifts from myristic and palmatic acids (in red marrow) to their respective monounsaturated derivatives myristoleic and palmitoleic acids (in yellow marrow) were found. These differences in the fatty acids correlate with histochemical studies and lend further support to the concept that the composition of lipid in the adipose cells of bone marrow may determine their relative stability in relation to haematopoietic requirements.
Van Buchem disease is a hereditary sclerosing dysplasia of bone. Both dominant and autosomal recessive modes of transmission have been described. The dominant form tends to be a benign disorder and symptoms are usually confined to those associated with the enlargement of the jaw. The recessive forms tend to have a greater morbidity and symptoms arise from pressure on cranial nerves by hyperostotic bone at the base of the skull. Patients of the dominant families have often had a torus palatinus. No haematological changes are found. The alkaline phosphatase may be raised--even if the total level is not elevated, the bone fraction may be increased. The radiological appearances are regarded as characteristic. The jaw is enlarged and thickened to an extent not seen in other bone dysplasias such as osteopetrosis. The cortices of the diaphyses are thickened and the medullary cavities are encroached upon but not obliterated. Abnormal modelling of the bone ends is not found in van Buchem disease. In long bones the distribution is predominantly diaphyseal but the bone ends are also affected.
The therapeutic success of inner ear lesions by acute acoustic trauma was examined by two statistically comparable groups of patients. 80 patients were attended by dextran 40 and 59 by xantinol nicotinate. The amelioration of hearing and tinnitus was statistically better after treatment with dextran 40.
Explore the source record for details and available documents.
Seventy-one patients with lymphoma underwent staging laparotomy. Fifty of the patients had Hodgkin's disease and the remainder, non-Hodgkin's lymphoma. One patient died from pulmonary embolism on the tenth postoperative day, one required temporary assisted ventilation, one required reoperation for hemorrhage and six patients had infectious complications which responded to appropriate antibiotic therapy. Despite extensive noninvasive procedures, including bone marrow trephine biopsy and lymphangiography, in approximately 30% of the patients, the disease was restaged as a result of the operation. Since primary management of these diseases is critically dependent upon accurate staging, we conclude that, at the present time, this procedure is indispensible for proper management, as it contributes information not available from other currently used investigational techniques.
A 45-year-old White man presented with multiple aneurysm formation and severe constitutional symptoms, the control of which entailed long-term corticosteroid therapy. Early in the patient's clinical course, two aneurysms were resected, and at subsequent postmortem examination the vascular lesions were found to be inactive and fibrosed, which suggested that the corticosteroids had been effective in controlling the inflammatory reaction. Of special interest was the development of diffuse lymphoma of the large cell type (histiocytic lymphoma) late in the course of the disease. This report emphasises the association between immunosuppressive therapy and subsequent neoplasia, and stresses the need for caution in the administration of these agents to patients whose condition is benign.
In a 5-year period 37 patients with auto-immune thrombocytopenic purpura (AITP) and 22 with agnogenic myeloid metaplasia (AMM) underwent splenectomy. In 26 of the patients with AITP (70%) a satisfactory response was obtained, although there was 1 death a year later as a result of infection. In 6 cases (16%) significant postoperative haemostatic problems were experienced. Seventeen of the patients with AMM (77%) improved as a result of the operation, but 3 of them (14%) died in the postoperative period. During the follow-up period a further 4 patients died (18%). Haemorrhagic complications occurred in 7 patients (32%), of whom 2 died immediately after the operation. Haemostatic screening procedures during this whole period failed to predict the risk of postoperative haemorrhage, and in neither group did prophylactic platelet infusion significantly reduce haemorrhagic complications.