Immunologic aspects of granulomatous and interstitial lung diseases and of cystic fibrosis.
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Biomedical subjects
Publications and source records attributed to K J Kelly.
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The effects of cimetidine, an H2 receptor antagonist, on subpopulation of splenic lymphocytes were studied in mice. Cimetidine (50 mg/kg) was given to groups of mice by intraperitoneal injection. The splenic mononuclear cells from treated and control animals were evaluated for relative number of lymphocyte subpopulations (i.e. LYT1, LYT2, L3T4 and GAM cells) by flow cytometry. The percentages of LYT2 cells (suppressor equivalent) were significantly lower (5.5 vs 12.0%) in mice who were treated with cimetidine vs control animals. The percentages of L3T4 (helper equivalent) were not statistically different in any of the experimental groups.
Henoch-Schönlein purpura is a common vasculitic syndrome of childhood. Pulmonary hemorrhage is a rare complication, which resulted in death in three of four previously reported cases. We report concerning four additional patients with Henoch-Schönlein purpura and pulmonary hemorrhage. Three survived the episode. Aggressive and supportive care may improve survival.
To minimize the exposure of health care workers to aerosolized ribavirin, we designed a double tent containment system with circulating mist and suction applied between the tents and we evaluated the ability of this system to contain and evacuate aerosolized ribavirin. While the drug was administered with this system at three institutions, three air sampling pumps at different locations in the room and one worn by the investigator (personal breathing zone) collected air samples onto filters for assay of ambient ribavirin. Ribavirin determinations were made by high performance liquid chromatography. A 5- to greater than 20-fold decrease in ambient ribavirin concentrations was observed with the containment system compared with those detected with a single oxyhood in use. The personal breathing zone concentration was 566.0 micrograms/m3 with the oxyhood alone and fell to a mean concentration of 43.81 +/- 33.40 micrograms/m3 with the containment system. Though the risk to exposed health care workers is unknown, this system offers a simple way to decrease significantly occupational exposure to ribavirin.
The types of midfacial fractures and their complexity were evaluated in admissions to the Maryland Institute of Emergency Medical Service Systems (MIEMSS) during the years of 1984 to 1988. Two hundred and sixty-eight LeFort fractures were treated and followed (3.2 percent of admissions). One half (50 percent) had skull fractures and 40 patients (15 percent) had LeFort, skull and mandibular fractures. Isolated nasoethmoidal fractures were observed in 176 patients and in 107 patients (39 percent) of patients with LeFort fractures. Isolated mandibular fractures were observed in 321 patients and in 104 patients with LeFort fractures (39 percent). Eleven percent of patients had midfacial, nasoethmoidal and frontal sinus fractures. Six percent of patients had midfacial, frontal bone, frontal sinus and nasoethmoidal fractures (Cranial Base Crush Syndrome). Twenty two percent of patients had LeFort and frontal sinus fractures. Reconstruction of multiple area injuries is simplified by a highly organized treatment sequence that conceptualizes the face in two groups of two units. Each unit is divided into sections, and each section is assembled in three dimensions. Sections are integrated into units and units into a single reconstruction. Conceptually, in each unit, facial width must first be controlled by orientation from cranial base landmarks. Projection is then (and often reciprocally with width) established. Finally, facial length is set both in individual units and in the upper and lower face. Soft tissue is considered the "fourth dimension" of facial reconstruction. Bone reconstruction should be completed as early as possible to minimize soft tissue shrinkage, stiffness and scarring of soft tissues in nonantomic positions.(ABSTRACT TRUNCATED AT 250 WORDS)
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Previous studies have documented a 75 to 80 percent mortality rate in infants (less than 12 months) with cystic fibrosis who present with RF/MV. We investigated the current outcome of these patients by comparing the outcome of five infants with cystic fibrosis and RF/MV between the years 1980 and 1986 with that of age-matched control subjects with cystic fibrosis and no respiratory failure. Recent Shwachman scores and the number of hospitalizations during the study period were used to assess outcome. All study cases were alive one to six years after the episode of RF/MV. Their mean Shwachman score (83 [range: 70 to 95]) did not differ from the recent mean Shwachman score (78 [range: 50 to 95]) of the control group. Number of hospitalizations did not differ between groups. We conclude that the outcome of infants with cystic fibrosis whose initial presentation is RF/MV is not as grave as once thought. If indicated, infants with cystic fibrosis and respiratory failure should be ventilated.
Severe rhabdomyolysis following an influenza B infection developed in a previously well 13-year-old girl. There was no history of trauma. Her course was complicated by episodes of severe hyperkalemia, hypocalcemia, hyperphosphatemia, and myoglobinuria. Renal failure, hypertension, and life-threatening arrhythmias developed; she died. Muscle biopsy revealed that this girl had carnitine palmityl transferase deficiency. An asymptomatic sister was demonstrated to have the same disorder. Although carnitine palmityl transferase deficiency is usually associated with mild bouts of rhabdomyolysis that become apparent only in adulthood, severe forms of this disorder may be seen in children. Life-threatening rhabdomyolysis and myoglobinuria may follow any infection associated with decreased intake. If carnitine palmityl transferase deficiency is diagnosed in a proband, other siblings should be evaluated so that proper preventative measures can be undertaken to help prevent the development of symptoms in susceptible individuals who have not been recognized to have the disease.
Inoculation of golden Syrian hamsters with Venezuelan encephalitis (VE) virus results in a sustained diminution in glucose-stimulated insulin release that is correctable by cyclic (c) AMP analogs and phosphodiesterase inhibitors. This suggested the importance of directly measuring cAMP content in VE-infected and control islets in response to insulin secretagogues. The basal cAMP content of VE-infected islets (0.14 +/- 0.02 pmol/micrograms islet DNA) was approximately half that of control islets (0.27 +/- 0.02 pmol/micrograms islet DNA) (P less than 0.05). In the presence of 10 microM glucagon (and 3 mM glucose), the rate of cAMP generation in VE-infected islets was only half that of control islets. With 10 mM alpha-ketoisocaproic acid, the rates of cAMP generation were indistinguishable between control and experimental groups. In response to 20 mM glucose and 3-isobutyl-1-methylxanthine (IBMX) (a phosphodiesterase inhibitor), cAMP generation in VE-infected islets was 81% (NS) of the control rate. When a more specific phosphodiesterase inhibitor, RO 20-1724, was used with 20 mM glucose, cAMP generation in the infected islets was only 44% (P less than 0.001) of the control value. Insulin secretion over the perifusion period paralleled the cAMP levels. In the presence of 10 mM alpha-ketoisocaproic acid, there was no difference in insulin secretion between VE-infected and control islets, while there was a statistically significant (P less than 0.05) difference with 10 microM glucagon or 20 mM glucose (in 1 mM RO 20-1724). These data point to a defect in the cAMP generation system of VE-infected islets, although additional factors involved in insulin secretion may also be impaired by the virus.
Two latex antigens, one extracted from surgical gloves (GE) and the other from the sap of Hevea brasiliensis plant (RPE) were characterized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and two-dimensional gel electrophoresis. These antigens were used to detect latex specific IgE and IgG antibodies by enzyme-linked immunosorbent assay (ELISA) in the sera of patients with meningomyelocele (spina bifida) and of normal controls. Of the 36 patients studied, 26 had wheal-and-flare skin-prick test reactivity to latex antigen with 11/26 having had a history of anaphylaxis to latex products. Twenty three of the 26 sera from skin-test positive patients and 10/11 patients with history of anaphylaxis demonstrated significant levels of latex specific IgE and IgG in the sera, whereas only 1/14 normals showed significant antibodies to latex. The remaining 10 patients, all skin-test negative with latex antigens, showed only low levels of antibodies. The findings indicate that the ELISA used in the present study employing partially characterized antigens has sensitivity and specificity to detect latex specific antibodies in the sera of suspected patients and can be used for presumptive diagnosis of latex allergy.
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Methods and measures to determine adequate productivity levels for nursing staff development are needed to demonstrate to an institution's administrators the quantitative contribution made by the nursing staff development department. This article describes a management utilization approach used to develop a rational, yet simple to calculate, productivity formula. The formula was refined through 5 years use in one setting and tested in several others. Detailed explanations, rationales, and calculations are provided to help staff development specialists further test this formula.
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