Failure to recognise the association of life-threatening angio-oedema and angiotensin-converting enzyme inhibitor therapy.
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Aged↗
Biomedical subjects
J M Weiner
Publications and source records attributed to J M Weiner.
Is allergen immunotherapy effective in asthma? A meta-analysis of randomized controlled trials.
A meta-analysis of clinical trials of allergen immunotherapy was undertaken to assess the efficacy of this controversial form of therapy in asthma. A computerized bibliographic search revealed 20 randomized placebo controlled double-blind trials of allergen immunotherapy for asthma. The results extracted included asthmatic symptoms, medication requirements, lung function, and bronchial hyperreactivity (BHR). Categorical outcomes were expressed as odds ratios and continuous outcomes as effect sizes. The combined odds of symptomatic improvement from immunotherapy with any allergen were 3.2 (95% CI 2.2 to 4.9). The odds for reduction in medication after mite immunotherapy were 4.2 (95% CI 2.2 to 7.9). The combined odds for reduction in BHR were 6.8 (95% CI 3.8 to 12.0). The mean effect size for any allergen immunotherapy on all continuous outcomes was 0.71 (95% CI 0.43 to 1.00), which would correspond to a mean 7.1% predicted improvement in FEV1 from immunotherapy. Although the benefits of allergen immunotherapy could be overestimated because of unpublished negative studies, an additional 33 such studies would be necessary to overturn these results. Allergen immunotherapy is a treatment option in highly selected patients with extrinsic ("allergic") asthma.
Asthma↗
Vega testing in the diagnosis of allergic conditions. The Australian College of Allergy.
Vega testing (the Vega test method) is an unorthodox method of diagnosing allergic and other diseases. It has no established scientific basis and there are no controlled trials to support its usefulness. Vega testing may lead to inappropriate treatment and expense to the patient and community.
Electroacupuncture↗
Unorthodox methods of diagnosis and treatment of allergic diseases.
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Australia↗
Tracing expert thinking in clinical trial design.
This paper describes a method for the analysis of the clinical trial design process used by experts. With this procedure, the scientific ideas and their sources can be identified and related to the clinical trial protocol actually prepared by the experts. An example is given using the work of the Intergroup Rhabdomyosarcoma Study Committee (IRS). That committee has been the primary contributor of information dealing with the treatment of rhabdomyosarcoma in children. The IRS-III protocol was used in this analysis of expert behavior because the protocol was adopted by the leading pediatric oncology clinical trial groups in North America and Europe. The analysis showed that the experts rely heavily, for much of the design, on ideas presented in numerical displays in published documents. Further, those aspects of the design which are innovative can be traced and better understood by applying the new procedure.
Clinical Trials as Topic↗
Combination versus sequential single agent chemotherapy in advanced breast cancer: associations with metastatic sites and long-term survival. The Western Cancer Study Group and The Southeastern Cancer Study Group.
Two hundred and twenty-two patients with advanced breast cancer were randomised in two separate trials of similar design to either concomitant combination treatment or sequential use of the same drugs given as single agents changed only at disease progression. Both trials used cyclophosphamide, methotrexate, 5-fluorouracil and prednisone; the WCSG using triiodothyronine and the SECSG using vincristine as the remaining agent. A common data base was generated for these trials and combined for analysis. Considering all patients, combination treatment was associated with a significantly increased response (46 versus 25%, P less than 0.05) but not survival improvement. For the 141 patients without liver involvement, survival was closely comparable in both treatment arms. Combination therapy did result in significant survival benefit for patients with liver involvement (P less than 0.05). These studies demonstrate: (1) in the majority of breast cancer patients, sequential single agent therapy can result in survival comparable to combination treatment; and (2) sole consideration of response frequency does not represent the optimal criterion to compare therapeutic approaches in advanced breast cancer.
Adenocarcinoma↗
Anterior ischemic optic neuropathy: classification of field defects by Octopus automated static perimetry.
Visual fields of patients with anterior ischemic optic neuropathy (AION) were classified according to quantitative criteria, using the Octopus perimeter. Although a significant altitudinal pattern of field loss was found in 55% of perimetric examinations, the "spared" hemifields routinely showed some loss of sensitivity. This finding, along with the diffuse loss of sensitivity in a high percentage of visual fields, indicates more extensive involvement of the circulation of the anterior optic nerve head than has previously been suggested. Furthermore, patients with diabetes mellitus alone were found to have a statistically separable pattern of visual field loss. The pathophysiologic implications of the visual fields in AION and their relationship to the clinical findings were investigated.
Adult↗
Red blood cell distribution width in untreated pernicious anemia.
The red blood cell distribution width (RDW) was studied in 26 unselected patients with untreated pernicious anemia. RDW changes were also sequentially followed after therapy in 12 patients. The mean (+/- 1 SD) RDW values were significantly higher in pernicious anemia patients than in controls (21.7 +/- 9.1% vs. 13.2 +/- 1.1%, P less than 0.0001). Nevertheless, 31% of the patients had normal RDWs. There were no consistent findings among those who had normal RDW. Most of them were in the early stages of deficiency, but some had advanced deficiency. Over half of those with normal RDW also had normal mean corpuscular volume (MCV). Overall, 9 of the 26 patients (35%) had normal MCV. Of eight patients whose RDW fell with therapy, some showed a steady fall while others had a transient rise followed by a progressive drop. Despite current advocacy that a high RDW is a sensitive and consistent finding in vitamin B12 deficiency, our findings show that a large proportion of untreated pernicious anemia patients have normal RDWs and that in contrast to iron deficiency, elevation of RDW is not necessarily the earliest indicator of vitamin B12 deficiency.
Adolescent↗
Long-term survival following levamisole or placebo adjuvant treatment of colorectal cancer: a Western Cancer Study Group Trial.
In 1976, the Western Cancer Study Group initiated a prospectively randomized, double-blind trial of an 18-month adjuvant program comparing levamisole with placebo treatment following surgical resection in patients with colorectal adenocarcinoma. After stratification for site of disease (colon vs. rectum) and stage (B vs. C), 78 patients were entered. The levamisole schedule was 2.5 mg/kg/day given on days 1 and 2 of each week. The median follow-up of entered patients is now 7.5 years. Toxic effects of treatment were minimal. However, no long-term survival advantage was associated with levamisole compared to placebo administration in this population with resected large-bowel adenocarcinoma.
Adenocarcinoma↗
Prostitutes and AIDS: a health department priority?
With increasing competition for resources, health departments are faced with the question of whether to target female prostitutes as a high priority component of AIDS prevention strategy. Prostitutes are considered to be a reservoir for transmission of certain sexually transmitted diseases (STDs). However, a variety of studies suggest that human immunodeficiency virus (HIV) infection in prostitutes follows a different pattern than that for STDs: HIV infection in non-drug using prostitutes tends to be low or absent, implying that sexual activity alone does not place them at high risk, while prostitutes who use intravenous drugs are far more likely to be infected with HIV. Emerging data from heterosexual groups similarly suggest a low rate of heterosexual transmission, particularly from women to men. Prostitutes who do not use intravenous drugs probably face their highest risk from steady partners who may be infected with HIV and other STDs and with whom barrier protection is generally not used. Nevertheless, there are good reasons for health departments to place high priority on prevention efforts directed to prostitutes: 1) prostitutes often have other risky behaviors such as drug use; and 2) prostitutes are reachable, being a group which is already in the health care system administered by health departments.
Acquired Immunodeficiency Syndrome↗
Neurologic abnormalities in cobalamin deficiency are associated with higher cobalamin "analogue" values than are hematologic abnormalities.
Serum cobalamin "analogue" levels were estimated by the discrepancy in cobalamin results with radioassays done with pure intrinsic factor and R binder in 364 patients with low cobalamin levels. No differences were found among the various causes of low cobalamin levels, except for the lower "analogue" levels among pregnant women. However, 76 patients with low cobalamin levels and primarily neurologic (spinal cord, neuropathic, cerebral, or a combination of these) symptoms had significantly higher "analogue" levels than 19 patients with primarily hematologic abnormalities. Moreover, the "analogue" levels correlated with hemoglobin values and were significantly higher in patients without megaloblastic changes in their bone marrow than in patients with megaloblastosis. An analysis limited to 47 patients with pernicious anemia yielded similar findings. The seven patients with only neurologic abnormalities had higher "analogue" levels than did the nine patients with only hematologic abnormalities. Because of the higher "analogue" levels, the assay done with R binder failed to register low cobalamin levels in 33 of 76 patients with low cobalamin levels and primarily neurologic abnormality (compared with only two of 19 with hematologic abnormality) and in 10 of 20 patients with pernicious anemia who had neurologic abnormalities (compared with only two of 12 without such abnormalities). These differences between patients with hematologic disturbances and patients with neurologic disturbances, and the inverse relationship of "analogue" level with severity of anemia, suggest that the disproportionate accumulation of analogues may explain why some patients with cobalamin deficiency display neurologic abnormalities while others do not.
Adult↗
Iron deficiency occurs frequently in patients with pernicious anemia.
We assessed iron status in patients with pernicious anemia. Iron deficiency coexisted as a presenting finding in 25 (20.7%) of 121 patients for whom data could be evaluated. Another 27 patients (22.3%) developed iron deficiency one month to 14 years later (median, two years). It was impossible to predict such a development in these 27 patients from any of their initial findings. The cause of the iron deficiency was identified in 17 of the 52 iron-deficient patients and suspected in another four. These findings show that patients with pernicious anemia are at high risk for iron deficiency, both at initial presentation and subsequently. Although the cause of the iron deficiency is often not identifiable, clinically important entities are detected often enough to warrant routine investigation for iron deficiency in such patients.
Adult↗
Effect of posture on ventilation and breathing pattern during room air breathing at rest.
We measured minute ventilation (VE), tidal volume (VT), mean inspiratory flow (VT/TI), and occlusion pressure (P.1) in 10 resting subjects breathing room air, in sitting, supine, right and left lateral positions, and compared them with corresponding data on static lung compliance [Cst(l)], dynamic lung compliance [Cdyn(l)], and pulmonary flow resistance [R(l)]. Highest values for VT, VE, VT/TI, P.1, and effective inspiratory impedance [P.1/(VT/Ti)] were observed in the supine posture. Values for P.1 and P.1/(VT/TI in lateral decubitus were intermediate to those obtained when seated and supine. While the increases in P.1 and P.1/(VT/TI) in recumbent postures were qualitatively similar to the decrease in Cdyn(l) and increase in R(l), there was no significant correlation between them, probably reflecting the complex relationship between P.1/(VT/TI) and lung compliance and resistance, as the former, in addition to lung mechanics, also depends on the shape of the inspiratory driving pressure wave, the active inspiratory impedance, the mechanics of the chest wall, and the duration of inspiration.
Adult↗
Platelet counts in three racial groups.
Documented differences exist in red blood cell (RBC) and granulocyte counts between black and white people. However, little comparative information is available on differences in platelet counts in the two racial groups. Therefore, this study was performed to compare platelet counts in healthy white (94), black (92), and Latin-American (63) persons. Black women had significantly higher platelet counts than did white women (P less than 0.025). Latin-American women were between the other two groups. No differences were noted among men. Black women also had a significantly higher prevalence of iron deficiency and microcytosis of RBCs than did white women. After exclusion of women with either microcytosis or iron deficiency, racial differences in platelet counts were no longer evident. The authors conclude that the differences in the platelet counts between black and white women were secondary to common RBC differences (such as iron deficiency and other causes of microcytic anemia) and were not intrinsic to the platelets. These and other factors that can affect platelet counts should be excluded before determining the reference ranges for proper interpretation of the platelet counts.
Black or African American↗
Indications for penetrating keratoplasty: a clinicopathological review of 511 corneal specimens.
During the four-and-a-half year period from January 1982 to June 1986, 511 penetrating keratoplasty specimens were submitted to the Pathology Department of The Royal Victorian Eye and Ear Hospital. Seventy per cent were from patients of the RVEEH and the remainder were submitted from outside the Hospital. The cases were classified both clinically and pathologically. The most frequent diagnosis was keratoconus, followed by scarring, regrafts, bullous keratopathy, acute or chronic ulceration, corneal dystrophies and a small miscellaneous group. Post-herpetic scarring was the most common cause of scarring. Bullous keratopathy was usually aphakic in origin in 1982, but after 1983 pseudophakic bullous keratopathy (PBK) was the most common cause of bullous keratopathy. Acute ulceration was usually bacterial in origin, not infrequently with hypopyon.
Adolescent↗
Doxorubicin and methotrexate on a weekly schedule in patients with sarcomas.
Fifty-five sarcoma patients with advanced measurable disease were treated with a doxorubicin and methotrexate combination in which both drugs were given on a weekly schedule. Patients received doxorubicin and methotrexate at three prospectively evaluated treatment levels with doxorubicin dosage ranging from 0.5 to 0.725 mg/kg/week and methotrexate dosage ranging from 0.25 to 0.375 mg/kg/week. Objective responses were seen in 11 of 39 (28%) patients receiving the two higher doxorubicin-methotrexate treatment levels where doxorubicin dose was greater than 0.5 mg/kg/week compared to only 2 of 16 (12%) patients receiving lower doxorubicin levels (p less than 0.05), suggestive of a dose-response relationship. Toxicity of this regimen was manageable but stomatitis was appreciable, seen in 30% of patients. These results support the activity of weekly doxorubicin in sarcoma therapy. However, no apparent improvement was associated with addition of conventional dose methotrexate to weekly doxorubicin treatment.
Adolescent↗
Variability in arteriographic assessment of the carotid bifurcation.
We evaluated interobserver and intraobserver variability in the arteriographic assessment of the carotid bifurcation. Two neuroradiologists evaluated area stenosis and lumen surface morphology for 60 biplane carotid arteriograms in two reading sessions. Absolute interobserver differences for area stenosis averaged 8.8%, and interobserver differences were statistically significant for arteries of at least 50% stenosis. Analysis of observations for lumen surface morphology revealed statistically significant interobserver differences, averaging 29.5% disagreement. Intraobserver differences were not statistically significant. Observer variability for arteriography should be considered in the process of evaluating patients for carotid endarterectomy.
Carotid Arteries↗
Pernicious anemia in Latin Americans is not a disease of the elderly.
Pernicious anemia is widely regarded as a disease of the elderly. However, it is expressed differently in black women, among the most striking differences being their younger age at presentation of the disease compared with whites. We now compared 92 Latin-American patients with 115 white and 100 black patients to see if similar age differences occur in other racial groups. Latin-American men and women were both significantly younger than white men and women, and were similar in age to blacks. Only 21% of Latin-American patients were 70 years of age or older, compared with 49% of whites. It is apparent that pernicious anemia is indeed predominantly a disease of the elderly in whites but that this is not the case in other racial groups.
Adolescent↗