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Biomedical subjects

A R Thomas

Publications and source records attributed to A R Thomas.

5 recordsLinked to original sources
PubMed1996

Coccidioidomycosis in patients infected with human immunodeficiency virus: review of 91 cases at a single institution.

We retrospectively evaluated the clinical manifestations, diagnosis, treatment, and outcome of coccidioidomycosis in 91 patients infected with human immunodeficiency virus (HIV) at a single institution. Coccidioidomycosis was the AIDS-defining illness in 37 patients. Fever and chills, weight loss, and night sweats were the most frequent symptoms. The lung was the most frequently involved organ (80%), followed by the meninges (15%). A diffuse reticulonodular infiltrate was seen in 59 patients (65%), and 13 (14%) had focal pulmonary disease; for 15 patients (16%), the chest radiograph was normal. Coccidioidal serologies were positive for 60 patients (68%), while for 23% with proven coccidioidomycosis such tests were negative Most patients were treated with systemic amphotericin B and then an oral azole. The mortality for the whole group was 60%. Patients with diffuse pulmonary disease had the highest mortality (68%), with a median duration of survival of 54 days (P < .05; 95% confidence interval, 147-175 days). The presence of diffuse pulmonary disease and a CD4 lymphocyte count of < 50/microL were independent predictors of death. In our experience, coccidioidomycosis is an important opportunistic infection that causes substantial morbidity and mortality among HIV-infected patients living in an area of endemicity.

AIDS-Related Opportunistic Infections↗
PubMed1995

Mitochondrial enzyme deficiency causing exercise limitation in normal-appearing adults.

Deficiencies of mitochondrial enzymes cause a number of severe neurologic syndromes in pediatric patients. Isolated myopathy secondary to enzymatic deficiency only rarely has been recognized and reported in adults. Three normal-appearing patients with unexplained dyspnea on exertion, tachycardia, and fatigue were studied with progressive incremental and constant load exercise testing with hemodynamic and gas exchange measurements. Subsequently, muscle biopsies were performed and enzymatic profiles determined. Exercise testing suggested altered cellular energy metabolism. Oxygen transport and gas exchange at rest and with exercise were normal. During exercise, ventilation increased excessively for the work performed, but it was appropriate for carbon dioxide production. Cardiac outputs increased significantly (196 to 305%), heart rates reached maximum levels, and lactic acid levels increased (385 to 833%) during exercise at 25 W. Muscle morphology was normal, but mitochondrial enzyme assays demonstrated one or more deficiencies in all three patients. Mitochondrial enzymatic deficiency can be a cause of unexplained exercise symptomatology and limitation in adults. Our experience would suggest the incidence of the disorder may be greater than that previously recognized or expected. Symptoms of exercise limitation associated with dyspnea, tachycardia, or muscle fatigue should alert the clinician to a possible abnormality in cellular energy metabolism.

Adult↗
PubMed1988

Independent developmental regulation of migratory granule neurons and their cerebellar ligand in the mouse.

Interactions between migratory granule neurons and the developing molecular layer of the mouse cerebellum were examined using an in situ binding assay. Single cell suspensions of postnatal granule neurons specifically adhere to unfixed frozen cerebellar tissue sections. We investigated the influence of postnatal age of granule neurons and of tissue on this interaction. Granule neurons from P10 (the time of peak migratory activity) bind preferentially to the molecular layer. Premigratory granule neurons, P5, do not bind age-matched cerebellar tissue. Postmigratory granule neurons, P14 and older, adhere to the molecular and internal granular layers of age-matched and older cerebellar tissue but not to younger tissue. These binding patterns are most simply explained as a single receptor-ligand system in which both elements exhibit independent developmental regulation. Although granule neurons lose the ability to bind with increasing age, the molecular layer ligand retains its capacity for this interaction into adulthood, long after normal migration has ceased.

Aging↗
PubMed1982

Pseudopneumothorax.

An asymptomatic 18-year-old man presented for treatment of alcohol and substance abuse. He related a history of a recent motor vehicle accident with chest trauma and remote history of colonic interposition for esophageal atresia. Radiographic investigation yielded an interesting set of roentgenograms.

Adolescent↗