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Biomedical subjects

N B Allen

Publications and source records attributed to N B Allen.

At least 37 records · Page 2Linked to original sources
PubMed1996

Sociotropy, autonomy, and dysphoric emotional responses to specific classes of stress: a psychophysiological evaluation.

The aim of this study was to assess the ability of trait measures of sociotropy and autonomy to predict immediate emotional responses to imagery conditions depicting social rejection and achievement failure. Emotional responses were assessed by self-report techniques and by 2 putative psychophysiological measures of dysphoric mood: heart rate and facial muscle activity. Undergraduate volunteers (N = 100) were assessed for sociotropic and autonomous traits, general levels of depression, and sensory imagery ability, before performing a series of imagery trials depicting neutral and stressful (social rejection and achievement failure) scenes. Results provided support for the role of sociotropy as a vulnerability factor to dysphoric response to social rejection and to a lesser degree for achievement failure, but there was no support for autonomy as a vulnerability factor for either type of stressful script.

Achievement↗
PubMed1996

Orbital involvement by Wegener's granulomatosis: imaging findings.

OBJECTIVE: The purpose of this study was to define patterns of Wegener's granulomatosis (WG) orbital disease involvement. SUBJECTS AND METHODS: We evaluated the orbital examinations of 14 WG patients (CT for nine, MR imaging for three, and both CT and MR imaging for two) for the number of involved orbits, intraconal or extraconal location, involvement of the orbital apex, sinus involvement, bony erosion, and optic nerve compression. MR images were analyzed for signal characteristics and enhancement patterns. RESULTS: We found orbital disease to be unilateral in 12 patients (86%) and bilateral in two patients (14%) (total of 16 orbits). In 11 orbits (69%), coexistent orbital and sinus diseases with bony erosion were present. Orbital disease without sinus disease was seen in five orbits (31%). Intraorbital disease distribution was as follows: solely extraconal--seven orbits (44%) (four with involvement of muscle); intraconal with muscular involvement--one orbit (6%); combined intra- and extraconal--seven orbits (44%); and primarily orbital apex--one orbit (6%). Involvement of the apex was seen in six orbits. The WG mass was hypointense relative to orbital fat on three standard T2-weighted MR images. We saw homogeneous MR contrast enhancement in all four orbits studied on enhanced T1-weighted images. CONCLUSION: Intraorbital WG involvement is usually accompanied by paranasal sinus disease. A hypointense signal on T2-weighted MR images is helpful in suggesting the diagnosis.

Aged↗
PubMed1996

Patients with antiphospholipid antibodies: CT and MR findings of the brain.

OBJECTIVE: The purpose of this study was to determine the spectrum of neuroradiologic findings in patients with antiphospholipid antibodies (APA) and to compare findings in systemic lupus erythematosus (SLE) and non-SLE patients. MATERIALS AND METHODS: We identified 110 patients with APA who underwent CT or MR imaging, of whom 59 (54%) had abnormal studies. Of these 59 patients, abnormalities were categorized as large infarcts, cortical infarcts, lacunar infarcts, hyperintense white matter foci on T2-weighted images, or dural sinus thrombosis. White matter foci were designated as small (< 5mm) or large (> 5 mm). RESULTS: Large infarcts were the most common abnormality, seen in 24 of 110 (22%) patients, followed in frequency by hyperintense white matter foci, seen in 19 of 110 (17%) patients. Ninety-five percent of patients with hyperintense white matter foci had at least one large lesion, and 76% had five or more small foci, three or more large foci, or both. Small cortical infarcts and lacunar infarcts were seen in 11 of 110 (10%) and 10 of 110 (9%) patients, respectively. Dural sinus thrombosis was seen in five patients. The frequency of abnormalities was high in both the SLE (57%) and the non-SLE (41%) groups. Large infarcts were more common in the non-SLE group (26%) than in the SLE group (5%). Although hyperintense white matter foci and cortical infarcts were more common in SLE patients, the differences were not statistically significant. CONCLUSION: Infarcts of various sizes and hyperintense white matter foci are the most common abnormalities seen on CT and MR imaging in patients with APA. We found no significant differences in frequencies of abnormalities seen between non-SLE and SLE patients.

Adult↗
PubMed1996

Wegener granulomatosis: CT and MR findings.

PURPOSE: To demonstrate the spectrum of CT and MR imaging findings in patients with Wegener granulomatosis and to determine how often these findings could be attributed to either direct extension from paranasal or orbital disease sites, remote granulomas, or central nervous system (CNS) vasculitis. METHODS: We retrospectively reviewed the CT or MR studies of 15 patients with Wegener granulomatosis. RESULTS: Abnormal findings were seen in 7 patients (5 examined with MR imaging, 2 with CT). Findings included dural thickening and contrast enhancement (3 patients), infarcts (2 patients), regions of hyperintense signal on T2-weighted MR images (2 patients), and abnormal MR signal in the brain stem (2 patients). Three patients with imaging findings of dural enhancement and thickening were thought to have remote granulomatous lesions involving the dura. No patients had extension from sites external to the CNS or clinical findings suggestive of CNS vasculitis. CONCLUSION: The spectrum of CT and MR findings in Wegener granulomatosis includes dural thickening and enhancements cerebral infarction, and MR signal abnormalities in the brain stem and white matter. Presumed remote granulomatous lesions were the most common causes of CNS findings in this study. Complications related to non-CNS disease (eg, hypertension, endocarditis) also appear to have played a role in some patients.

Adult↗
PubMed1996

Clinical, biochemical and pathological predictors of poor response to intravenous cyclophosphamide in patients with proliferative lupus nephritis.

BACKGROUND: Reports in the literature on the outcome of lupus nephritis (LN) treated with intravenous (i.v.) cyclophosphamide have varied considerably. Previous studies have suggested that less than 25% of patients with LN will progress to end stage renal failure (ESRD) after 5 years. In addition it has been reported that serum creatinine and chronic histologic changes on kidney biopsy are useful markers of renal prognosis. Whether treatment with cyclophosphamide alters the predictive value of these markers in LN patients is not clear. The aim of this study was to review our experience of treating a large cohort of patients with LN treated with i.v. cyclophosphamide and to identify biochemical and histological features at the time renal biopsy which predict outcome in these patients. DESIGN: We retrospectively reviewed our experience with 43 consecutive patients who met criteria for either World Health Organization (WHO) classification III (focal proliferative) or IV (diffuse proliferative) LN and were treated with monthly i.v. cyclophosphamide. Biochemical indices of renal function and lupus disease activity were recorded. Renal biopsies, performed within two months of commencing therapy, were reviewed by two experienced pathologists and classified according to WHO classification as well as activity and chronicity index. The primary outcome variable for the analysis was the development of ESRD. RESULTS: Patients were followed for a mean of 2 years after renal biopsy. The mean dose of cyclophosphamide received by patients was 8.3 g. One patient died during follow up and 22 (51%) progressed to ESRD. A higher serum creatinine (p = 0.003) and higher score for interstitial fibrosis (p = 0.001) were associated with shorter renal survival. There was no significant association between activity index or its components or in the total chronicity score and survival free from the need for dialysis. CONCLUSION: In our experience more than half of patients treated with i.v. cyclophosphamide for LN progress to ESRD and a high serum Cr and a high degree of interstitial fibrosis on renal biopsy before treatment are associated with a worse renal prognosis.

Adult↗
PubMed1995

The role of antineutrophil cytoplasmic antibody (c-ANCA) testing in the diagnosis of Wegener granulomatosis. A literature review and meta-analysis.

PURPOSE: To summarize the literature on the clinical utility of antineutrophil cytoplasmic antibody (c-ANCA) as a diagnostic marker for Wegener granulomatosis. DATA SOURCES: A structured literature search was done using MEDLINE; this search, combined with a manual search, yielded 747 articles for potential inclusion. These articles passed through a 4-stage review. Studies were included if they had a specified reference standard and a systematic method of patient selection and if a 2 x 2 contingency table could be constructed from their results. Fifteen articles met these criteria. DATA EXTRACTION: 3 physicians reviewed all selected articles. Detailed data abstraction was done, and the quality of the study methods was assessed. Items abstracted included the method of patient selection, the study design, the reference standard, the c-ANCA testing technique, disease activity, and the test results. Disagreements among reviewers were resolved by consensus. Contingency tables were used to calculate the operating characteristics for Wegener granulomatosis overall and for active and inactive Wegener granulomatosis. RESULTS: The sensitivities of c-ANCA testing for overall Wegener granulomatosis ranged from 34% to 92%, and the specificities ranged from 88% to 100%. The pooled sensitivity was 66% (95% CI, 57% to 74%), and the pooled specificity was 98% (CI, 96% to 99.5%). Four articles provided data on disease activity. For active disease, the pooled sensitivity was 91% (CI, 87% to 95%), and the pooled specificity was 99% (CI, 97% to 99.9%). For inactive disease, the pooled sensitivity and specificity were 63% and 99.5%, respectively. CONCLUSIONS: Although c-ANCA test results may serve clinicians as adjunct evidence for the diagnosis of Wegener granulomatosis, these results must be viewed in the context of the patient's clinical picture and disease activity and the prevalence of Wegener granulomatosis in the clinical setting in which the patient is seen.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed1995

A prospective study of antineutrophil cytoplasmic antibody (c-ANCA) and clinical criteria in diagnosing Wegener's granulomatosis.

Antineutrophil cytoplasmic antibody (c-ANCA) has a reported sensitivity and specificity greater than 90% for active Wegener's granulomatosis in selected patients with previously-defined disease. Because of these reports, some clinicians believe that a positive c-ANCA result provides strong circumstantial evidence for the diagnosis of Wegener's granulomatosis in patients with compatible clinical symptoms. However, this approach has not been examined prospectively. We prospectively studied 346 consecutive patients suspected of having vasculitis; those with previously established Wegener's granulomatosis (n = 29) or receiving immunosuppressives other than corticosteroids (n = 65) at baseline were excluded. Measures included a baseline c-ANCA, blinded chart reviews to record symptoms, physical findings, and corticosteroid use at baseline, and 2 to 8 months later to record final diagnoses and biopsy results. Wegener's granulomatosis was defined using the 1990 American College of Rheumatology (ACR) criteria, which does not require a biopsy. Follow-up information was available for 212 (84%) of the 252 patients eligible for this study (no corticosteroids: n = 174; corticosteroids: n = 78). 25 patients with compatible symptoms were classified with Wegener's granulomatosis by ACR criteria; only 6 of the 25 had biopsy-proven disease. 14 of these 212 patients had positive c-ANCA results. The overall sensitivity and specificity of c-ANCA for ACR-defined Wegener's granulomatosis were 28% (95% CI, 10%-46%) and 96% (93%-99%) respectively. The positive and negative predictive values were 0.50 and 0.91. The specificity remained greater than 90% regardless of baseline corticosteroid use or disease activity; however, the sensitivity and positive predictive value remained poor. For Wegener's granulomatosis defined by biopsy criteria and compatible clinical symptoms, the sensitivity was 83% (53%-100%); however, the positive predictive value was 36%. These results raise serious questions about the use of positive c-ANCA tests in diagnosing Wegener's granulomatosis in patients with clinical symptoms alone.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed1995

Neuro-Behçet's disease: factors hampering proper diagnosis.

We reviewed the clinical course of nine patients with neuro-Behçet's disease to assess difficulties in making this diagnosis. Factors delaying proper diagnosis included lack of accurate history and physical examination, lack of recognition of an underlying systemic syndrome and its relationship to the neurologic symptoms, presence of intermittently normal CSF studies, and use of noncontrasted neuroimaging techniques.

Adolescent↗
PubMed1993

Primary systemic amyloidosis masquerading as giant cell arteritis. Case report and review of the literature.

Amyloidosis is a rare disease in which a fibrillar protein is deposited in multiple human tissues. Of the 4 subtypes, the most common type involving rheumatic disease features is hemodialysis-associated amyloidosis. Herein we describe an elderly man who presented with symptoms of giant cell arteritis or systemic vasculitis and was found to have amyloidosis as demonstrated on muscle, nerve, and temporal artery biopsy.

Aged↗
PubMed1993

Cyclosporin A therapy for Wegener's granulomatosis.

Five patients with active Wegener's granulomatosis were treated with the immunosuppressive agent Cyclosporin A, along with low dose prednisone. All five patients had previously taken cyclophosphamide, but further treatment with this agent was not desired, either due to patient choice, drug toxicity or malignancy. In initial doses of up to 5mg/kg/day, CyA showed efficacy but when lowered to 1-2mg/kg/day, mild disease flares occurred. CyA may provide an alternative to traditional therapy in selected patients with WG.

Adult↗
PubMed1993

The place of emotion in stories told by children: an exploratory study.

This study explored the relationship between developmental changes in children's understanding of emotions and their use of affective content (Wilkinson, Barnsley, Hanna, & Swan, 1980) and affective structure (Brewer & Lichtenstein, 1982) in the production of stories. We hypothesized that children with an advanced understanding of emotions would make more use of both affective content and affective structure. This relationship was found only for affective content, which was more advanced in girls than boys. Affective structure did not relate to affective understanding or sex but, rather, to verbal intelligence. The implications of these results for the part played by psychological processes in children's story telling are discussed.

Affect↗
PubMed1993

Miscellaneous vasculitic syndromes including Behçet's disease and central nervous system vasculitis.

Behçet's disease is a chronic, relapsing, inflammatory process with clinical features of aphthous oral and genital ulcerations, uveitis, cutaneous vasculitis, arthritis, and central nervous system involvement. Large-vessel vasculitis, thrombophlebitis, and gastro-intestinal ulcerations may occur. As in other rheumatologic diseases, a genetic predisposition coupled with a triggering event leads to alterations in immune function and response, with variable clinical disease manifestations. Mononuclear cell activation and cytokine release, neutrophil chemotaxis, and humoral immune response with elevations of circulating immune complexes contribute to the pathogenesis of Behçet's disease. Vasculitis and vascular involvement are highlighted. There is no single diagnostic test for Behçet's disease. Treatment is comprised of anti-inflammatory and immunosuppressive agents and, in selected individuals, anticoagulation. Isolated central nervous system vasculitis or noninfectious primary (granulomatous) angiitis of the central nervous system is reviewed briefly. This condition is rare, predominantly affects young women, and includes symptoms of headache, weakness, and confusion. Characteristically, erythrocyte sedimentation rate is normal, serologic studies are negative, and cerebral angiography shows multifocal and segmental vascular narrowing and beading. Typical histopathology is granulomatous in less than 50% of patients, followed by necrotizing or lymphocytic vasculitis, or both, often with thrombosis. Treatment with immunosuppressive agents improves symptoms and outcome.

Behcet Syndrome↗
PubMed1993

Hyperrenin-hyperaldosterone-dependent malignant hypertension in polyarteritis nodosa.

We have described a patient, subsequently found to have polyarteritis, whose renin activity was 60 times normal, a level associated with malignant hypertension and severe renal artery stenosis. The severe hypertension and its resistance to multiple medications in the face of a dramatic response to low-dose enalapril imply the renin-angiotensin system was the primary pathophysiologic mechanism. We believe renin activity should be measured in hypertensive patients with polyarteritis. Furthermore, PAN should be in the differential diagnosis of hyperreninemic hypertension. ACE inhibitors should be strongly considered in the management of classical PAN-induced hypertension.

Adult↗
PubMed1993

Cooccurrence of collagenous colitis with seronegative spondyloarthropathy: report of a case and literature review.

Collagenous colitis is an uncommon cause of chronic watery diarrhea, characterized by colonic deposition of collagen. Nonerosive, oligoarticular, peripheral arthritis has previously been noted in about 7% of patients with collagenous colitis. We describe a patient with collagenous colitis who concurrently developed erosive, seronegative spondyloarthropathy affecting peripheral and axial joints. Synovial histology was characterized by a conspicuous inflammatory infiltrate comprised of histiocytes, lymphocytes and plasma cells. Collagenous colitis is suggested to be a systemic autoimmune disorder, with extraintestinal features such as thyroiditis and arthritis.

Colitis↗
PubMed1992

Association of methotrexate, rheumatoid arthritis and lymphoma: report of 2 cases and literature review.

We describe 2 Caucasian men with rheumatoid arthritis (RA) who developed non-Hodgkin's lymphoma of identical histological type during treatment with low dose oral weekly methotrexate (MTX). Both patients had longstanding RA and had been treated with MTX for over 2 years at time of tumor diagnosis; neither had secondary Sjögren's syndrome. The oncogenic potential of MTX and RA arthritis is reviewed.

Administration, Oral↗