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Biomedical subjects

D K Fischer

Publications and source records attributed to D K Fischer.

At least 19 recordsLinked to original sources
PubMed1994

Pernicious anemia manifesting as angina pectoris.

Here we describe a case of angina pectoris in a patient for whom an extensive cardiovascular workup was done, with negative results. Eventually, the cause of his symptoms was found to be pernicious anemia. Although angina is an uncommon manifestation of pernicious anemia, a review of the literature suggests that the correlation between anemia and angina has been well described. Our case highlights an important differential diagnosis to consider for patients with exercise-induced chest pain and serves to emphasize the attention that should be focused on simple screening laboratory studies. The emphasis in this case is the sequence in which the studies are done. A simple complete blood count with proper interpretation and intervention at the outset of evaluation could possibly have prevented a number of unnecessary, invasive, and costly studies.

Aged↗
PubMed1994

The atypical becomes typical: the work of oncology nurses.

PURPOSE: To describe a typical day for nurses who work with patients with cancer. DESIGN: Multi-institutional, descriptive, qualitative. SETTING: Six sites in different regions of the United States; rural and urban cancer and noncancer centers. SAMPLE: 38 oncology nurses (mean age = 35 years; average time in nursing = 10 years; and in oncology = 7 years; 47% bachelor of science in nursing, 29% diploma, 13% associate degree in nursing, and 11% master's prepared. METHODS: Phenomenological; content analysis of interviews. FINDINGS: There is no typical day for oncology nurses. As such, the atypical becomes typical. This dialectic influenced how the nurses organized and managed their work. Management became a paradox or a juggling act--an attempt to control the uncontrollable, to manage the unmanageable. Time was a central metaphor used in the descriptions. The amount of time available influenced nurses' abilities to perform a certain quality and quantity of work. Demands on time, whether legitimate or illegitimate, were the context for the day-to-day work. IMPLICATIONS FOR NURSING PRACTICE: It is necessary to recognize the value that nurses continually place on participation in patients' daily care, the unpredictability inherent in cancer and patient care, and the organizational routines that nurses use to accomplish their work.

Adult↗
PubMed1991

Paucity of humoral response in patients to glioma-associated antigen(s): antigen localization by immunofluorescence.

Xenogeneic immunization of freshly-prepared human glioma extracts into goats has yielded a polyclonal antiserum, which after multiple absorptions specifically identifies antigenic entities only in glioma extracts, and not in appropriate controls, both by radioimmunoassays (RIAs) and Western immunoblots. The results from the absorbed polyclonal antiserum have been confirmed by the successful generation of six stable murine monoclonal antibodies (MAbs) which recognize a subset of the same antigens with high specificity on immunoblots and with no apparent cross-reactivities by RIA to normal brain, serum, liver, muscle, kidney, spleen, or melanoma tissues. Moreover, the tested murine MAbs (B12C4) reveal a striking and abundant glial filament protein, possibly related to glial fibrillary acidic protein (GFAP) or other intermediate filament proteins, by frozen-section immunofluorescence. This is seen only in gliomas and is absent, or dramatically reduced, in normal human cortex. Use of potent immortalizing strain (FF41) of Epstein-Barr virus (EBV) to establish antibody-secreting human lymphoblastoid lines, and the generation of mouse-human chimeric fusions, have yielded lines possessing variable supernatant human antibody secretion. Radioimmunoassays using culture supernatants, and sera from glioma patients and an normal individual, have demonstrated surprisingly similar reactivity profiles, even after a sensitive sandwich RIA employing the B6C6 murine MAb. These results suggest that, although human glioma-associated antigens, including possibly the up-regulation of GFAP expression, clearly exist, there seems to be a muted humoral response as evidenced by a paucity of tumor-specific B-cells. This may be due to antigenic shielding by the blood-brain barrier, or due to a form of immunological compromise in patients harboring these malignancies.

Antibodies, Neoplasm↗
PubMed1991

Preparation and characterization of antisera and of murine monoclonal antibodies to human glioma-associated antigen(s).

Human glioma-associated markers can be exploited for the development of new diagnostic strategies and treatment modalities for these malignancies. A goat antiserum was first raised against human anaplastic astrocytoma (AC or AA) and glioblastoma multiforme (GB or GBM) extracts. Extensive sequential absorptions with normal brain tissue, normal serum, and human serum albumin (HSA) gave an antibody fraction specific for glioma. Balb/c mice were subsequently immunized with these glioma extracts. B-cell hybridomas from these mice were then cloned and subcloned by limiting dilution, yielding six monoclonal antibodies (MAbs) that were entirely specific for tumor tissues, and did not react with normal human serum or with normal human brain, liver, kidney, spleen, or muscle. Moreover, the murine MAbs did not cross-react with certain other human tumors, including melanoma. The fully absorbed antiserum and the murine MAbs both identify a polypeptide pattern possibly related to human glial fibrillary acidic protein (GFAP) or other intermediate filament proteins on immunoblots. These immunological reagents could serve as powerful tools for the diagnosis and possibly therapy of these uniformly fatal tumors.

Animals↗
PubMed1991

Epidemiological characteristics of subarachnoid hemorrhage in an urban population.

Several risk factors for unfavorable outcome from subarachnoid hemorrhage (SAH) have been identified. The prevalence of such risk factors varies among ethnic groups and among men and women. The influence of ethnic background and gender as factors in the outcome after SAH has not been adequately studied and is the focus of the present investigation. Outcome in 145 consecutive patients was dichotomized as good and moderately disabled vs severely disabled, vegetative, and dead. A multiple logistic regression model was used to examine the factors of gender, ethnic group (white and non-white), age, admission neurological grade, pre-existing hypertension, and intravenous drug abuse. Our data reveal that hypertensive, white males, with a history of intravenous drug abuse, have a high risk of unfavorable outcome following SAH. These observations are important for the design and interpretation of future studies relating to SAH.

Adolescent↗
PubMed1991

Shielding of the spinal cord by cervical and facial structures in penetrating trauma.

Penetrating trauma to the cervical spine can result in major neurological deficits due to spinal cord damage. Discussed are four civilian cases of dramatic penetrating cervical injuries without spinal cord involvement. These injuries occurred in the anteroposterior direction, and the facial structures and/or vertebral bodies appeared to have provided some protection to the spinal cord. It is proposed that the cervical spinal cord may be less vulnerable to penetrating injuries in the anteroposterior plane due to incrementally collapsible compartments of facial soft tissue and bony sinus structures which can absorb kinetic energy and dissipate momentum.

Adult↗
PubMed1991

The influence of diabetes mellitus on outcome from subarachnoid hemorrhage.

Diabetes mellitus (DM) has been shown to be a risk factor for subarachnoid hemorrhage (SAH). However, the influence of this disease on outcome from SAH has not been adequately studied. We retrospectively reviewed 150 patients with SAH, including 22 with and 128 without DM. Our results indicate that pre-existing DM does not significantly influence outcome from SAH when examined in conjunction with other chronic diseases and epidemiological factors.

Adult↗
PubMed1990

Intravenous cocaine abuse and subarachnoid haemorrhage: effect on outcome.

A retrospective study of subarachnoid hemorrhage associated with intravenous cocaine injection was undertaken in a large urban hospital. Patients who used intravenous cocaine had significantly poorer outcomes when compared with subarachnoid haemorrhage patients with no known exposure to the drug.

Adult↗
PubMed1989

Neurogenic hyperthermia in subarachnoid hemorrhage.

We have described a patient with neurogenic hyperthermia caused by a diencephalic infarction. His hypothalamic dysfunction was a consequence of cerebral vasospasm from aneurysmal subarachnoid hemorrhage. Persistent elevation of body temperature did not respond to standard therapy, but successful treatment was achieved with cyproheptadine and indomethacin, presumably through antagonism of serotonin and prostaglandin activity.

Adult↗
PubMed1989

Papillary carcinoma of the thyroid: additional evidence in support of a familial component.

Although a higher incidence of medullary carcinoma of the thyroid is well known to occur in families with syndromes of multiple endocrine neoplasia (MEN II and III), an epidemiologic familial component has only very rarely been ascribed to papillary carcinoma. In this report we describe a mother and daughter presenting with neck masses at an early age and subsequently found to have metastatic papillary thyroid carcinoma documented on pathology following thyroidectomy. The occurrence of the neoplasm at an advanced stage in closely related individuals early in life suggests that underlying genetic factors may predispose to this malignancy. Familial papillary carcinoma of the thyroid may have a hereditary basis independent of its association with the syndromes of multiple polyposis and of multiple hamartomas, and thus may represent a new entity with characteristics which distinguish it as a distinct subset of the more common disease.

Adolescent↗
PubMed1989

Anterior sacral meningocele and tuberculous spondylitis of the sacrum in a patient with neurofibromatosis. Case report and review of the literature.

We report a case of an adult male with neurofibromatosis and chronic low back pain. Evaluation revealed an anterior sacral meningocele, pulmonary tuberculosis, and later in the course of his illness, an osteolytic tuberculous mass in the sacrum. The patient was treated medically with a good outcome. The nature of anterior sacral meningoceles and tuberculosis spondylitis, the differential diagnoses, and relevant treatment options are discussed.

Adult↗
PubMed1988

Coexistence of multiple arteriovenous malformations and an anomalous aortic arch.

An unusual case of multiple congenital arteriovenous malformations (AVM) coexistent with an anomalous aortic arch is described. Our patient had been asymptomatic, with physical findings limited to a low grade systolic murmur, until the onset of acute subarachnoid hemorrhage. Arteriography was technically difficult and failed to demonstrate the origin of his hemorrhage or the configuration of his aortic arch. However, an AVM within the neck muscles was visualized. Magnetic resonance imaging of his chest revealed a right-sided, retroesophageal aortic arch with an anomalous pattern of branching. The intracranial AVM and the course of the great vessels was clearly revealed at autopsy. A possible embryologic mechanism underlying the origin and distribution of the arch vasculature is discussed.

Adult↗
PubMed1988

Shotgun injuries of the spine: neurosurgical management of five cases.

The role of neurosurgical intervention in penetrating spinal injury has not been clearly established. Functional outcome has not been shown to be influenced by operation. In fact, neurosurgical intervention has been shown to potentially increase the risk of serious complications. This paper examines a unique subset of patients with penetrating spinal injury-those secondary to shotguns. An analysis of five such cases and a review of the limited literature on the subject suggests that neurosurgical intervention is of limited value in such injuries and that initial management should focus primarily upon non-neurological injuries.

Adult↗
PubMed1988

Immunological and biochemical strategies for the identification of brain tumor-associated antigens.

Various strategies have been used to identify and characterize the antigens associated with human brain tumors. These approaches have included the raising of polyclonal and monoclonal antibodies against tumor antigens and, more recently, efforts toward the direct biochemical identification of such proteins. This review summarizes the progress made in this area, suggests reasons for the broad antigenic cross-reactivity and heterogeneity revealed by these studies, and proposes additional methods for deciphering the complex antigenic composition of human brain tumors.

Antibodies, Monoclonal↗
PubMed1986

Antigens of Borrelia burgdorferi recognized during Lyme disease. Appearance of a new immunoglobulin M response and expansion of the immunoglobulin G response late in the illness.

Using immunoblots, we identified proteins of Borrelia burgdorferi bound by IgM and IgG antibodies during Lyme disease. In 12 patients with early disease alone, both the IgM and IgG responses were restricted primarily to a 41-kD antigen. This limited response disappeared within several months. In contrast, among six patients with prolonged illness, the IgM response to the 41-kD protein sometimes persisted for months to years, and late in the illness during arthritis, a new IgM response sometimes developed to a 34-kD component of the organism. The IgG response in these patients appeared in a characteristic sequential pattern over months to years to as many as 11 spirochetal antigens. The appearance of a new IgM response and the expansion of the IgG response late in the illness, and the lack of such responses in patients with early disease alone, suggest that B. burgdorferi remains alive throughout the illness.

Antibody Formation↗