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Biomedical subjects

A M Hendrick

Publications and source records attributed to A M Hendrick.

14 recordsLinked to original sources

Auto-immune haemolytic anaemia--a high-risk disorder for thromboembolism?

An audit of the effect of anticoagulant prophylaxis in acute exacerbations of severe autoimmune haemolysis was undertaken. All cases of this disorder presenting to one institution over a 16 year period were reviewed. There were 28 patients who had a total of thirty six exacerbations of haemolysis. Anticoagulant prophylaxis had been introduced from 1992 following three cases with fatal pulmonary emboli. Venous thromboembolism occurred in 5 of 15 exacerbations without prophylaxis but in only one of 21 in which prophylaxis was given. It is suggested that auto-immune haemolysis increases the risk of thromboembolism but further studies are required to quantify the risks and to define optimal prophylactic regimens.

Adult↗

The effects of independent living on persons with chronic mental illness: an assessment of the Section 8 certificate program.

The feasibility of the Section 8 certificate program for individuals with chronic mental illness (CMI) and the outcomes associated with independent housing are examined. The analysis is based on data from a longitudinal survey of Section 8 certificate users in Baltimore and Hamilton County (Cincinnati) and on information from Section 8 application forms in each site. A pre-post research design was used to examine changes in hospitalization, residential stability, and mental health service outcomes. Four key dimensions of the CMI certificate program are examined: affordability, housing conditions, neighborhood conditions, and service gaps. Results suggest that the certificate program has a positive effect on independent living, that certificate use is associated with positive mental health outcomes, and that there is no evidence of "creaming" among program applicants.

Activities of Daily Living↗

Verapamil with mitoxantrone for advanced ovarian cancer: a negative phase II trial.

Fourteen patients with advanced epithelial ovarian cancer were treated with oral verapamil 240 to 480 mg daily for 3 days and intravenous mitoxantrone 12 to 14 mg/m2 on the second days of verapamil administration. Courses were repeated at 21 day intervals to a maximum of 4 courses. Most patients had cancers refractory to prior cisplatin or carboplatin, or had cancers which recurred quickly after such treatments. This poor prognostic profile of patients probably accounted for the lack of objective responses to verapamil plus mitoxantrone. Despite maximally tolerated daily oral verapamil doses (480 mg daily) our inability to achieve in vivo levels of verapamil that in vitro have an optimum cytotoxic potentiating effect mitigate against further clinical exploration of verapamil as a sole enhancing agent.

Aged↗

Plasma prostaglandins in lung cancer.

Plasma levels of three stable prostaglandin (PG) metabolites were measured in 29 patients with lung cancer. The mean level of 6-keto-PGF1 alpha, the hydrolysis product of prostacyclin, was significantly elevated in cancer patients compared to a control group with non-malignant respiratory disorders, although an overlap in values between the groups was seen. Levels correlated inversely with survival and showed a significant fall in 14 patients with tumour regression. The mean level of 11-deoxy-3,14-dihydro-15-keto-11,16-cyclo-prostaglandin E2 was also significantly elevated in cancer patients, but did not correlate with tumour response. 13,14-Dihydro-15-keto prostaglandin F2 alpha levels did not differ in lung cancer patients and controls. Contrary to previous reports we could not support a role for the metabolites of PGE2 and PGF2 alpha as tumour markers in lung cancer but plasma 6-keto-PGF1 alpha should be further evaluated in this regard.

6-Ketoprostaglandin F1 alpha↗

Paraproteins in primary biliary cirrhosis.

Paraproteins have rarely been described in primary biliary cirrhosis. Eighteen patients were identified as having both antimitochondrial antibodies, and a significant paraprotein by screening 950 patients with either a previously known paraprotein or documented antimitochondrial antibodies. The clinical spectrum included 11 patients with proven or probable primary biliary cirrhosis and five with a plasma dyscrasia, of whom two also had primary biliary cirrhosis Antimitochondrial antibody activity appeared polyclonal and unrelated to the paraprotein class. Whilst in patients with primary biliary cirrhosis antimitochondrial antibody activity was predominantly of IgG3 subclass with normal levels, there was no subclass restriction shown in the remainder and IgG3 levels were lowered.

Aged↗

Comparison of peripheral blood lymphocyte C3 receptor capping properties in patients with chronic lymphocytic leukemia and lymphoma.

Bacteria-antibody complexes were used to study capping of receptors for the activated third component of complement on peripheral blood lymphocytes. The impairment of C3d receptor capping improves in patients with chronic lymphocytic leukemia responding to therapy, but this does not necessarily correspond to the fall in peripheral lymphocytosis. Following lymphapheresis, increased capping appears to be due to selective removal of noncapping cells, but the mechanisms of improvement remain unexplained following other therapeutic measures. Lymphoma capping at 37 degrees C was normal in untreated patients but impaired after treatment, suggesting that this is related to the therapy itself. A high proportion of lymphocytes had receptors in the capped configuration in the basal state before incubation. In non-Hodgkin's lymphoma this was unrelated to treatment status, but it occurred only in untreated patients with Hodgkin's lymphoma with no further increment in capping after incubation. These receptors may exist in the aggregated state without the addition of exogenous ligand.

Complement C3↗

Infective complications of prolonged central venous (Hickman) catheterization.

We reviewed infectious complications during 7,671 days of central venous (Hickman) catheter use in 47 patients receiving intensive cytotoxic and supportive therapy for malignant disease. Colonization of the catheter was identified in eight cases of septicemia, two associated with endocarditis. Septicemia was successfully treated in four of five patients after removal of the catheter and in two of three in whom the catheter remained in situ. Infection of the exit site occurred in five patients but in only one was there associated septicemia. Poor patient compliance with the recommended regimen for catheter care was suspected. Thus, the overall rate of catheter-related infection was 1.6 per 1,000 days. Guidelines are discussed for removal of the catheter for suspected catheter-related infection.

Adolescent↗

Platelet dysfunction in acute megakaryoblastic leukemia.

Acute megakaryoblastic leukemia occurred in an adolescent. There was considerable bleeding despite only moderate thrombocytopenia, and both platelet structure and platelet function were abnormal. To our knowledge, platelet dysfunction has only once been documented in this acute leukemia, although in other leukemias with megakaryocytic predominance, notable bleeding has been observed in the absence of thrombocytopenia.

Adolescent↗

Ocular complications following blast transformation in chronic myelogenous leukemia.

A number of ocular problems compromising vision occurred in a patient with chronic myeloid leukemia following blastic transformation. Hemorrhagic retinopathy developed with systemic relapse and resolved with control of systemic disease. Optic nerve involvement occurred with meningeal leukemia and was controlled with intrathecal cytosine arabinoside and methotrexate. Leukemic retinal infiltrates developed despite control of systemic and meningeal disease and were successfully treated with radiation therapy. Finally, bilateral vitreous hemorrhages occurred, severely impairing vision. Leukemic infiltration of the eye may occur with increasing frequency in CML as the survival following bastic transformation improves. Infiltration should be recognized and treated promptly if serious loss of vision is to be avoided. Central nervous system prophylaxis should be considered in patients achieving a complete response following therapy for transformation.

Adult↗

Induction of labour by different methods in primiparous women. I Some perinatal and postnatal problems.

A personal prospective study was made of some perinatal and postnatal problems associated with induction of labour by three different methods in primiparous women with unripe cervices. The methods of induction were: (A) amniotomy followed by intravenous oxytocin [49], (B) amniotomy followed by intravenous prostaglandin E2 [39], (C) prostaglandin E2 by the extra-amniotic route [42]. A spontaneous group (D) comprising 54 mother--infant pairs was also studied. Length of gestation was between 37 and 42 wk in all but 2 cases. There was no perinatal mortality, and no infant had hyaline membrane disease. A close association was found between method of delivery and method (or absence) or induction. The caesarean section rate was highest in group C and lowest in group D. The spontaneous vaginal delivery rate was lowest in group C and highest in group D. More infants in the three induction groups were admitted to the Special Care Baby Unit (SCBU) than in the spontaneous group. No significant associations were found between the severity of the conditions leading to induction and caesarean section rates, low Apgar scores, admissions to SCBU, or the favourability of the cervix before induction. Among those who intended to breast feed fewer infants in the spontaneous group changed from breast to bottle while in hospital and after discharge from hospital than in the combined induction groups. Success in breast-feeding was not significantly associated with method of delivery or whether the infant was admitted to SCBU or not.

Apgar Score↗

Induction of labour by different methods in primiparous women. II. Neuro-behavioural status of the infants.

The infants of primiparous women in whom labour had been induced by three different methods were studied, together with a fourth group (D) who had laboured spontaneously. The methods of induction were: amniotomy followed by intravenous oxytocin (A), amniotomy followed by intravenous prostaglandin E2 (B), and prostaglandin E2 by the extra-amniotic route (C). Neurological assessments were made on the first day after birth, 4 days later, and at the age of 2 mth. No significant associations were found between method of delivery and neurological scores at any age. On day 1 infants with a lower Apgar score at 1 min had a lower neurological score than those with a high Apgar score (P < 0.05). On day 5 infants with a high serum bilirubin level (> 207 mumol/l) had a lower mean neurological score than those with a lower recorded serum bilirubin level (P < 0.05). By the age of 2 mth this difference had increased still further (P > 0.001). No differences were found in the mean neurological scores of infants in the four groups during the neonatal period, but at the age of 2 mth the mean score for infants in group A was significantly lower than that for infants in group C (P > 0.05) and D (P > 0.01). Among those children seen again at the age of 18 mth fine-motor adaptive performance was poorer for infants in group A than in groups B (P > 0.05), C (P > 0.005) and D (P > 0.01).

Bilirubin↗

The first-born child: patterns of development.

209 first-born infants and their mothers were studied at birth and again two months later in order to learn how they had adapted to post-natal life. Only a small minority had escaped ill-health and also achieved the ideal of a contented breast-fed baby with an established routine. At two months 33-5 per cent were still breast feeding. Difficulties with feeding were reported by 55 per cent of mothers. 24-4 per cent of the babies were having a night feed at two months and 24-8 per cent had not yet established a daytime routine. The daily number of feeds ranged from three to seven, with a median of five. Medical problems had occurred in 46-5 per cent of the babies. Bottle-fed babies had more infections, and were more likely to use a dummy than breast-fed babies. Wakefulness during the daytime ranged from less than four hours to more than 10 hours. Many of these women were over-anxious. The primary care teams and paediatric services face a major task in helping today's primiparous mothers and their infants make a good start in life together.

Birth Order↗