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Biomedical subjects

C M Stone

Publications and source records attributed to C M Stone.

16 recordsLinked to original sources
PubMed2001

Rhino-orbital mucormycosis in a patient with acquired immunodeficiency syndrome (AIDS) and neutropenia.

PURPOSE: To present a case of rhino-orbital mucormycosis in a patient with AIDS and neutropenia managed without exenteration. METHODS: Case report. RESULTS: A 60-year-old African-American man with AIDS developed neutropenia that was probably secondary to antiretroviral therapy. He developed right rhino-orbital mucormycosis and was treated with right partial ethmoidectomy with debridement and liposomal amphotericin B. The infection was cured without need for orbital exenteration, although visual acuity in his right eye ultimately was no light perception. CONCLUSION: Rhino-orbital mucormycosis is uncommon in patients with AIDS. When rhino-orbital mucormycosis occurs, patients require a careful search for an underlying metabolic derangement such as neutropenia. Treatment should be aggressive, but these patients may not require orbital exenteration.

Acquired Immunodeficiency Syndrome↗
PubMed1997

The safety and efficacy of cyclosporine A in the prevention of vasospasm in patients with Fisher grade 3 subarachnoid hemorrhages: a pilot study.

OBJECTIVE: To evaluate the safety and any potential effect of cyclosporine A (CycA) in preventing cerebral vasospasm. METHODS: Nine patients with Fisher Grade 3 subarachnoid hemorrhages were studied. After a loading dose of 7.5 mg/kg of CycA was administered every 12 hours for two doses, enteral treatment with CycA was started within 72 hours of the onset of the subarachnoid hemorrhage. Whole blood CycA levels were titrated to maintain levels of 50 to 400 ng/kg. Transcranial doppler ultrasonography was performed daily. Middle cerebral artery velocities were used to assess the degree of vasospasm. Angiography was performed to confirm the vasospasm in symptomatic patients, or it was performed if transcranial doppler ultrasonograms were unobtainable. Patients were treated with a standard pharmacological regimen of nimodipine. Induced hypertension, hemodilution, and hypervolemia were instituted at the discretion of the neurosurgical team. Intra-arterial papaverine was infused into the vasospastic vessels of three recalcitrant patients. Outcome was assessed at 6 months with the Glasgow Outcome Scale. RESULTS: All the patients displayed evidence of vessel narrowing, which was disclosed by transcranial doppler ultrasonography or angiography. Five patients developed ischemic deficits, two were treated with intra-arterial papaverine, and three died of complications secondary to vasospasm. No significant hepatic, renal, or infectious complication developed as a result of the administration of CycA. CONCLUSIONS: CycA proved safe to use but failed to prevent the development of cerebral vasospasm or delayed ischemic deficits in patients considered at high risk.

Adolescent↗
PubMed1996

"BM180": a novel basement membrane protein with a role in stimulus-secretion coupling by lacrimal acinar cells.

Regulated secretion requires the developmental coupling of neuronal or hormonal stimuli to an exocytotic response, a multistep pathway whose appearance may be linked with cellular adhesion to the newly formed exocrine cell basement membrane. We screened for adhesion-associated coupling activity using lacrimal acinar cells and have identified "BM180", a novel basement membrane protein enriched in guanidine HCl extracts of lacrimal and parotid exocrine secretory glands. BM180 resides primarily in a previously inexamined lower molecular-mass basement membrane peak (peak 2) that contains cell adhesion activity inhibitable with the anti-BM180 monoclonal antibody 3E12. Removal of peak 2 by gel filtration or preincubation of basement membrane with 3E12 decreased regulated peroxidase secretion by one-half without affecting constitutive secretion or the amount of cellular peroxidase available for release. Adding back peak 2 restored regulated secretion in a dose-dependent and 3E12-inhibitable manner and suggested a synergistic relationship between BM180 and laminin 1. BM180 has a mobility of 180 and 60 kDa in the absence or presence of dithiothreitol, respectively, and shows no immunological identity by competitive enzyme-linked immunosorbent assay with laminin 1, collagen IV, entactin, fibronectin, BM-40, perlecan, or vitronectin. We propose that BM180 is an important resident of certain glandular basement membranes where it interacts with the cell surface, thereby possibly signaling the appearance of a transducing element in the stimulus-secretion coupling pathway.

Animals↗
PubMed1992

Cell-specific expression of LBP-32 mRNA in retina and other locations of newborn mouse eye as revealed by in situ hybridization.

LBP-32 is a cell surface and cytoplasmic protein which is thought to both mediate cell attachment to laminin and play a role in translation initiation. In the present study, antisense RNA for LBP-32 was used to document its cellular mRNA expression pattern in newborn mouse eye. In situ hybridization revealed that LBP-32 was distributed uniformly through the retina as well as over anterior oblique muscle, in corneal and lens epithelial cells and in capillary endothelial cells of the choroid. This unique cell-specific expression raises interesting questions of the role of LBP-32 in eye development.

Animals↗
PubMed1991

Elevated 32-kDa LBP and low laminin mRNA expression in developing mouse cerebrum.

Several laminin receptors have been identified, originally a high-affinity 67-kDa laminin binding protein ('LBP-67'), and later galactosyltransferase and the low-affinity but functionally potent integrin receptors. Attempts at obtaining cDNA for LBP-67, although unsuccessful, have given rise to a full-length cDNA coding for an interesting 32-kDa protein, tentatively referred to as '32-kDa LBP', whose relationship to LBP-67 is unclear. Since no information is available on the in vivo expression of 32-kDa LBP mRNA nor of the three laminin chains during CNS development, appropriate 35S-antisense and -sense RNA probes were applied to developing mouse cerebral wall at embryonic day (E)10-16, birth and 1-3 weeks after birth. Expression was examined using Northern blot analysis and in situ hybridization. The 32-kDa LBP mRNA was found to be elevated during the embryonic and perinatal period, and then rapidly declined. At the cellular level, 32-kDa LBP mRNA was distributed throughout the embryonic cerebral wall and became concentrated during the perinatal period in the proliferative ventricular zone and in the cortical plate. By comparison, laminin B1, B2, and A chain mRNA expression was relatively low at all times examined, in keeping with the punctate distribution of laminin antigenicity previously observed by others in developing brain parenchyma. Whereas the functional characterization of 32-kDa LBP and the nature of its laminin and proposed nonlaminin ligands is incomplete, the elevated and unique distribution of 32-kDa LBP mRNA raises interesting questions of the role of 32-kDa LBP mRNA in CNS development.

Aging↗
PubMed1991

The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure.

On the basis of the known electrophysiologic mechanisms of atrial fibrillation, multiple surgical procedures were designed and tested in dogs to determine the feasibility of developing a surgical cure for human atrial fibrillation. These experimental studies culminated in a surgical approach that effectively creates an electrical maze in the atrium. The atrial incisions prevent atrial reentry and allow sinus impulses to activate the entire atrial myocardium, thereby preserving atrial transport function postoperatively. Since September 1987, this surgical procedure has been applied in seven patients, five with paroxysmal atrial fibrillation of 2 to 9 years' duration and two with chronic atrial fibrillation of 3 and 10 years' duration. All seven patients have been cured of atrial fibrillation and none is receiving any postoperative antiarrhythmic medications.

Adult↗
PubMed1990

Computerized activation sequence mapping of the human atrial septum.

To delineate the propagation of electrical activation in the atrial septum, atrial epicardial and atrial septal maps were recorded intraoperatively using a 156-channel computerized mapping system in 12 patients during sinus rhythm (n = 10), supraventricular tachycardia associated with septal pathways in Wolff-Parkinson-White syndrome (n = 3), atrioventricular (AV) node reentrant tachycardia (n = 4), and atrial flutter (n = 5). The epicardial and septal data were recorded simultaneously from 156 atrial electrodes, digitized, analyzed, and displayed as isochronous maps on a two-dimensional diagram of the atria. During sinus rhythm, the activation wave fronts propagated most rapidly along the large muscle bundles of the atrial septum. During supraventricular tachycardia associated with Wolff-Parkinson-White syndrome, the earliest site of retrograde atrial activation usually corresponded to the position of atrial insertion of the septal pathways. However, the earliest site of activation during orthodromic supraventricular tachycardia was different from that during ventricular pacing in 1 patient with a posterior septal accessory pathway localized by the epicardial mapping study. The data document the rationale for dividing the ventricular end of the accessory pathways (ie, the endocardial technique) rather than the atrial end (ie, the epicardial technique) in patients with Wolff-Parkinson-White syndrome. During AV node reentrant tachycardia, atrial activation data suggested that atrial tissue lying outside the confines of the anatomical AV node is a necessary link in this common arrhythmia. Thus, these atrial septal maps explain why surgical dissection, or properly positioned small cryolesions placed in the region of the AV node, can ablate AV node reentrant tachycardia without altering normal AV node function. The maps recorded during atrial flutter suggest the importance of the atrial septum as one limb of a macroreentrant circuit responsible for the arrhythmia, and imply that atrial flutter is amenable to control by surgical techniques. These studies demonstrate the details of normal atrial septal activation, the importance of the atrial septum in a variety of different atrial arrhythmias, and the basis of and potential for surgical ablation of the most common types of supraventricular arrhythmias.

Adolescent↗
PubMed1990

SIV, STLV-I and type D retrovirus antibodies in captive rhesus macaques and immunoblot reactivity to SIV p27 in human and rhesus monkey sera.

The prevalence of simian immunodeficiency virus (SIV), simian T-cell lymphotropic virus type 1 (STLV-I), and type D retrovirus (SRV-D) antibodies was determined for 1229 rhesus monkeys (Macaca mulatta) from two research colonies. Serum samples were tested by using enzyme-linked immunosorbent assay (ELISA), immunoblot (IB), and radioimmunoprecipitation assay (RIPA). Seropositive results for the three retroviruses tested were 0 for SIV, 270 (22%) for STLV-I, and 103 (8.4%) for type D retrovirus. Of the rhesus monkey sera, 61 (5.0%) were reactive to SIV gag p27 only, when tested by IB, but were negative when further tested by RIPA. Virus isolation was attempted from cultured peripheral blood mononuclear cells of 35 monkeys whose sera contained only p27 reactivity and none were positive by reverse transcriptase and core antigen assays to detect SIV. No overt clinical signs of immunodeficiency disease or unexplained deaths were evident in either monkey colony. Additionally, 63 of 165 (38%) human sera from various groups (primate center workers, normal donors, health care workers) had weak to moderate IB reactivity only to SIV p27, but 31 of 31 sera tested were negative by RIPA. These sera remained reactive to SIV p27 following absorption with an uninfected cell lysate, after blocking IB strips with various blocking solutions and were reactive to different SIV antigen preparations while remaining negative to human immunodeficiency virus type 1 (HIV-1) by IB and negative to HIV-2 by ELISA. These data underscore the need to adopt criteria for a positive SIV serologic test requiring reactivity against more than one viral gene product. These results also illustrate a potential problem in the testing of human sera for antibodies against simian retroviruses and demonstrate the need for caution in the interpretation of immunoblot results.

Animals↗
PubMed1989

Pericardiocentesis guided by a pulse generator.

This study was performed to compare pericardiocentesis guided by a pacing current applied through the pericardiocentesis needle with the traditional method of monitoring ST segment elevation from the needle tip electrogram. ST segment elevation was measured at 3 mm from the epicardium, after epicardial contact, after epicardial penetration and again at 3 mm from the epicardium after epicardial penetration. Two millivolts of ST segment elevation gave the highest combined positive (86%) and negative (79%) predictive value for epicardial contact by the pericardiocentesis needle between the two groups with the largest difference: 3 mm from the epicardium before contact and after epicardial penetration. Therefore, ST segment monitoring cannot reliably determine the point of epicardial contact. To determine the optimal stimulus strength for pulse generator-guided pericardiocentesis, pacing studies were performed using 2, 4, 6, 8 and 10 mA unipolar stimulus strengths. The pacing studies were performed both with and without a hemodynamically significant pericardial effusion to determine if increased pericardial pressure altered the pacing threshold. A 4 mA unipolar cathodal stimulus was chosen because it captured the ventricle only with direct contact of the epicardium. Ten dogs were instrumented and cardiac tamponade produced so that a subxiphoid approach to the epicardium with the pacing needle electrode could be attempted. During pericardiocentesis, needle tip electrograms were recorded, alternating with pacing attempts using a 4 mA unipolar stimulus. In all 10 dogs, the effusion was entered and epicardium was contacted as indicated by capture. No myocardial perforation or coronary artery or venous injuries were produced. These findings support the use of a pulse generator to guide pericardiocentesis.

Animals↗
PubMed1989

Surgery for atrial fibrillation.

The observations made under controlled experimental conditions provided us with a clearer understanding of the mechanisms involved in the generation and perpetuation of atrial fibrillation. The magnitude and rapidity of change that occurs in the activation patterns during atrial fibrillation were not appreciated, however, until the arrhythmia was studied in similar detail in humans. These studies provided the scientific basis for devising a surgical treatment for atrial fibrillation that has been successful in three patients. By converting the atrial fibrillation to normal sinus rhythm, all three of the detrimental sequelae of atrial fibrillation have been alleviated in each of these patients. Despite the fact that these clinical results are preliminary at this point, our experience documents that atrial fibrillation can be cured by surgical means. In the absence of other effective forms of therapy and in view of the devastating complications of the arrhythmia, surgical intervention should be considered a viable option for the treatment of atrial fibrillation.

Animals↗
PubMed1989

Potential mapping in septal tachycardia. Evaluation of a new intraoperative mapping technique.

A recently developed computer program is capable of rapidly (less than 5 minutes) constructing a series of potential-distribution maps (PDMs) for every msec of a 4-second window of ventricular tachycardia (VT). This study was performed to assess the ability of a series of PDMs to localize the site of earliest activation of VT originating in the interventricular septum. In 12 dogs, 13 morphologies of VT were initiated with programmed electrical stimulation 3-6 days after anterior septal coronary artery infarction. VT was mapped with endocardial and epicardial unipolar electrodes with a multipoint, computer-assisted mapping system. PDMs were compared with activation-time maps, and the former correctly identified the site of earliest activation of all 13 VT morphologies. When PDMs were viewed in sequence on a computer monitor, the site of earliest activation was signaled by abrupt development of a negative potential of less than -3.0 mV. The initial negative point subsequently expanded, and the spread of this negative-potential field correlated with activation sequence. PDMs provide an accurate, unambiguous, rapid means of analyzing large numbers of electrograms acquired with multipoint, computer-assisted mapping systems.

Action Potentials↗