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Biomedical subjects

Lawrence E Gibson

Publications and source records attributed to Lawrence E Gibson.

12 recordsLinked to original sources
PubMed2003

Membrane barrier of a porcine hepatocyte bioartificial liver.

Pores in the membrane of a bioartificial liver (BAL) allow it to function as a semipermeable barrier between its contents (i.e., liver cells) and components of the recipient's immune system. This study is designed to assess the influence of pore size on immune response to a BAL containing porcine hepatocytes. Sixteen healthy dogs were divided into four groups (four dogs per group) based on pore size of the BAL membrane and level of exposure to porcine hepatocytes. Group 1 dogs were administered porcine hepatocytes by intraperitoneal injection and served as positive controls. Group 2 dogs were exposed to porcine hepatocytes in a large-pore (200-nm) BAL, and group 3 dogs were exposed to porcine hepatocytes in a small-pore (10-nm) BAL. Group 4 dogs were exposed to a no-cell (unloaded) BAL and served as negative controls. Intraperitoneal injection of hepatocytes or 3 hours of BAL hemoperfusion was performed day 0 and 3 weeks later on day 21. Biochemical, humoral, and cellular measures of immune response were collected until day 44. The initiation of BAL hemoperfusion was associated with a rapid decline in CH(50) levels of complement and transient neutropenia and thrombocytopenia during all BAL exposures. Xenoreactive antibody response to BAL was increased by use of membranes with large pores and secondary exposures. Skin testing on day 42 showed a delayed-type hypersensitivity response to porcine hepatocytes that also correlated with level of previous antigen exposure. BAL treatment was associated with both immediate and elicited immunologic responses. The immediate response was transient and not influenced by membrane pore size, whereas elicited responses were influenced by pore size of the BAL during previous exposures.

Albuminuria↗
PubMed2002

Cutaneous palisaded allergic granuloma associated with rheumatic disease.

A 62-year-old man presented with a 5-year history of symmetric, hard papules on both of his elbows. These lesions were completely asymptomatic, but they were of cosmetic concern to the patient. Summer and trauma reportedly exacerbated the appearance of new papules, which tended to evolve spontaneously, harden, and subsequently ulcerate. The patient's main medical problem was a long-standing history of rheumatoid arthritis treated with low-dose oral prednisone. Physical examination revealed multiple scattered papules bilaterally on the extensor surfaces of the forearms. These were 2-10 mm in size, red to violaceous, and hard. Some of the lesions had ulcerated centers or slight umbilication (Fig. 1A,B). Histologic examination revealed several granulomas in the mid- to deep dermis with central basophilic fibrillar collagen necrosis (Fig. 2A). The necrotic areas were interspersed with bands of neutrophils, lymphocytes, and leukocytoclastic debris. The periphery of these basophilic granulomas was lined by palisading histiocytes (Fig. 2B).

Arthritis, Rheumatoid↗
PubMed2002

Cryptococcal infection in sarcoidosis.

A 48-year-old man with a history of sarcoidosis was transferred to the Mayo Clinic for evaluation and management of progressive neurologic decline. Two years before admission, he was admitted to a local hospital with mental status changes accompanied by ataxia and severe headache. A diagnosis of pulmonary and central nervous system sarcoidosis was made based on computed tomography of the head, lumbar puncture, and chest radiography. A mediastinoscopy with lymph node biopsy exhibited noncaseating granulomas and negative stains for microorganisms. Prednisone therapy was initiated at 80 mg/day. Clinical improvement was apparent for 13 months during steroid therapy until the slow taper reached a dosage of 20 mg/day. At that time, the patient was readmitted to the local hospital with severe confusion and skin lesions. When intravenous methylprednisolone therapy for presumed central nervous system sarcoidosis did not improve the patient's mental status, he was transferred to the Mayo Clinic. Physical examination of the thighs revealed large, well-marginated, indurated, irregularly bordered, violaceous plaques and rare, umbilicated, satellite papules with central hemorrhagic crusts (Fig. 1A). Superficially ulcerated plaques with a similar appearance to the thigh lesions were coalescing around the lower legs (Fig. 1B). A skin biopsy specimen of the thigh demonstrated abundant numbers of encapsulated organisms and minimal inflammatory response (Fig. 2). Skin, blood, and cerebrospinal fluid cultures confirmed the presence of Cryptococcus neoformans. Amphotericin and flucytosine combination therapy was initiated, and steroid dosages were gradually tapered. A test for human immunodeficiency virus was negative. The patient was dismissed from hospital after a complicated 2-month course resulting in improved mental status but progression of the lower extremity ulcerations as a result of polymicrobial infection.

Amphotericin B↗
PubMed2002

Fulminant group A streptococcal necrotizing fasciitis: clinical and pathologic findings in 7 patients.

BACKGROUND: Necrotizing fasciitis is a rapidly progressive soft tissue infection with high morbidity and mortality rates. Examination of deep incisional biopsy specimens can provide prompt diagnosis and improve survival. We describe 7 patients with necrotizing fasciitis caused by group A Streptococcus species. OBJECTIVE: Our purpose was to describe the unique dermatopathology and clinical features in 7 patients with necrotizing fasciitis caused by group A Streptococcus. METHODS: We conducted a retrospective review. RESULTS: The average age of the patients was 47 years. Fasciitis occurred on an extremity in all cases. All 5 patients with streptococcal toxic shock syndrome died of their disease. The histopathologic findings from early fascial disease revealed superficial epidermal necrosis, edema, and hemorrhage with few inflammatory cells, whereas clinically advanced, necrotic skin lesions revealed diffuse necrosis, thrombosis, neutrophilia, and numerous gram-positive diplococci. CONCLUSIONS: Patients with clinical features of necrotizing fasciitis should have a deep incisional biopsy specimen obtained from the central area of ecchymotic, necrotic plaques to confirm the diagnosis. Immediate surgical intervention is necessary to reduce the morbidity and mortality rates associated with necrotizing fasciitis.

Adult↗
PubMed2002

Effect of insulin-dependent diabetes mellitus on response to extracorporeal photopheresis in patients with Sézary syndrome.

BACKGROUND: Extracorporeal photopheresis (ECP) has become a primary therapy for selected forms of cutaneous T-cell lymphoma, especially Sézary syndrome. Variability in response of patients with Sézary syndrome to ECP has been reported. OBJECTIVE: Our purpose was to determine whether underlying medical conditions influence the efficacy of ECP in patients with Sézary syndrome. METHODS: We retrospectively reviewed the medical records of 55 patients with Sézary syndrome who received ECP between 1987 and 2000. Efficacy criteria included decrease in Sézary cell count, erythroderma, lymphadenopathy, organomegaly, and pruritus. RESULTS: Thirty-four patients responded well and 10 patients responded partially to ECP; 11 patients had no response. Nine patients with no response to ECP had insulin-dependent diabetes mellitus (IDDM). IDDM was documented in only 2 patients with a good response and in no patients with a partial response to ECP. CONCLUSION: Patients with Sézary syndrome and IDDM typically respond poorly to the standard ECP treatment regimen.

Adult↗
PubMed2002

Primary follicular mucinosis: long-term follow-up of patients younger than 40 years with and without clonal T-cell receptor gene rearrangement.

Since the original descriptions of follicular mucinosis, accumulating experience shows that patient age, distribution of lesions, and duration or extent of disease do not reliably distinguish benign primary follicular mucinosis from secondary follicular mucinosis, associated with cutaneous lymphoma. More recently, it has been suggested that individuals with follicular mucinosis demonstrating a clonal T-cell receptor gene rearrangement may be at higher risk for the development of lymphoma. Long-term follow-up of 7 patients younger than 40 years with primary follicular mucinosis are reported. In all cases, there was no clinical or histologic evidence of associated dermatoses or lymphoma at the time of diagnosis. Five of the patients have clonal T-cell gene rearrangement as determined by Southern blot analysis. Clinically, at the time of diagnosis, lesions of primary follicular mucinosis ranged from papules confined to the face to widespread cutaneous plaques. After a mean follow-up of 10 years (range, 5-23 years) from the onset of disease, the majority of patients continue to have cutaneous manifestations of follicular mucinosis despite various treatments. There is no evidence of progression to cutaneous T-cell lymphoma in any patient despite the presence of a clonal T-cell receptor gene rearrangement. Continued prolonged follow-up of patients with clonal primary follicular mucinosis is necessary to determine the significance of infiltrates harboring a T-cell receptor gene rearrangement. However, in our experience with this group of selected patients, primary follicular mucinosis has been a clonal disorder with limited or "benign" cutaneous manifestations.

Adult↗
PubMed2002

Risk factors for the development of psoriatic arthritis: a population based nested case control study.

OBJECTIVE: To identify factors influencing the development of psoriatic arthritis (PsA) in a population-based, inception cohort of psoriasis (PS) patients. METHODS: Using the population-based data resources of the Rochester Epidemiology Project. which ensures virtually complete ascertainment of all clinically defined conditions, we previously identified all incident cases of PsA and prevalent cases with PS from 1/1/1982 to 12/21/1991. In this nested case-control study, we assessed potential factors influencing the development of PsA in this cohort using medical record and patient survey information. Each case of PsA was matched with 2 PS controls on age, gender and PS duration/date of onset. Factors influencing the development of PsA were identified, adjusting for the influence of other variables using conditional logistic regression for medical record data and logistic regression for survey data. RESULTS: Sixty incident PsA cases were matched with 120 controls with PS. The median age at onset of PS was 31.7 (3.0-78.3) years, and 49% of subjects were male. There were 67% (n = 40) survey responders among cases and 48% (n = 58) among controls. Corticosteroids were used by 10 cases and 6 controls in the 2 years prior to onset of PS through to the development of PsA, and increased the risk of developing PsA (odds ratio 4.33, 95% CI = 1.34-14.02). Pregnancy occurred in 2 cases and 12 controls in the same period, and decreased the risk of developing PsA (odds ratio 0.19, 95% CI = 0.04-0.95). These associations remained significant after adjusting for the influence of gender, age, and duration of psoriasis. CONCLUSION: Corticosteroid use and pregnancy, both of which modulate the immune response, may influence the development of PsA in patients with PS.

Adolescent↗
PubMed2002

Treatment of late-stage Sézary syndrome with 2-Chlorodeoxyadenosine.

BACKGROUND: 2-Chlorodeoxyadenosine (2-CdA), a purine adenosine analog, is safe and effective chemotherapy for patients with hairy cell leukemia and low-grade lymphomas. Adverse effects include neutropenia, lymphocytopenia, and infectious complications. Our objective was to evaluate the efficacy of 2-CdA (2-6 seven-day cycles) in the treatment of late-stage, recalcitrant Sézary syndrome. METHODS: Retrospective review of medical records of six patients with Sézary syndrome who had received 2-CdA cycles at Mayo Clinic, Rochester between March 1995 and March 2000. Variables assessed from the records included improvement in global appearance, extent of erythroderma, size of lymph nodes, pruritus, and leukocyte, lymphocyte, and absolute Sézary cell counts. RESULTS: Two patients, both with stage III Sézary syndrome, whose previous treatment consisted of only two modalities, responded well to the treatment, with moderate to total clearing of erythroderma and pruritus associated with a significant decrease in Sézary cell counts. The other four patients had only a partial response (one patient) or no response (three patients) to 2-CdA. The mortality rate was 50%. All three patients died of Staphylococcus aureus sepsis. However, only one patient was receiving 2-CdA treatment when he died. The other two patients died 8 and 9 weeks after the last 2-CdA cycle. This high mortality rate is attributed to infectious complications after 2-CdA treatment in patients with recalcitrant disease. CONCLUSION: 2-Chlorodeoxyadenosine shows efficacy in stage III Sézary syndrome, but it also carries a substantial risk of septic complications and mortality. It can be used if no other suitable alternatives are available. Caution should be exercised in all these patients regarding skin care and avoidance of infections or sepsis.

Aged↗