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Biomedical subjects

R A Barbee

Publications and source records attributed to R A Barbee.

At least 37 records · Page 2Linked to original sources
PubMed1986

The prevalence of cellular immunity to coccidioidomycosis in a highly endemic area.

Intradermal skin test reactivity to spherulin and coccidioidin and in vitro spherulin-induced lymphocyte transformation were used to assess cellular immunity in healthy subjects and patients with acute, self-limited coccidioidomycosis (cocci). The objectives of this study were to evaluate the relative sensitivities of the two assays in assessing cellular immunity to cocci, especially in long-term residents of an endemic area (Tucson) and, based on data from both assays, determine the prevalence of detectable cellular immunity to cocci in this highly endemic area. The lymphocyte transformation assay appeared to be more sensitive than the skin test in assessing long-term immune status, and the prevalence of detectable immunity to cocci in this highly endemic area was only 75% in long-term residents. This is much lower than previous prevalence estimates (90%) in other endemic areas. The absence of a demonstrable cell-mediated immunity may indicate either no prior antigen exposure (infection) or previous remote exposure with a diminished immune response (no reexposure to boost immunity). A possible explanation for the lower prevalence of immunity to cocci in this endemic area may relate to the increased urbanization of the Southwest in the past several years. Therefore, the clinical suspicion of acute cocci should not be restricted to recent arrivals to endemic areas.

Arizona↗
PubMed1985

Methodological considerations of epidemiological diagnoses in respiratory diseases.

Since epidemiological research depends extensively on questionnaire responses, a comparison of such responses with a standardized medical evaluation was conducted. It was found that standardized questionnaires do well in comparison for certain kinds of information on chronic conditions. However, clinical evaluations will elicit more information, specifically of a milder nature. It was concluded that standardized epidemiological questionnaires are satisfactory for survey of chronic conditions.

Adolescent↗
PubMed1985

The epidemiology of asthma.

Significant strides have been made in recent years in the epidemiologic study of obstructive lung diseases including asthma. Community population samples are being evaluated prospectively and followed up longitudinally to document the appearance of morbidity and clinical diagnoses. Also, a variety of environmental, physiologic, and immunologic variables are being collected on a serial basis to correlate changes with the appearance (or disappearance) of recognizable disease. Unfortunately, until the semantics and diagnostic labeling of airway abnormalities becomes more precise, especially in the older population, the incidence and prevalence of disease will lack the precision it should have.

Adolescent↗
PubMed1983

Interactions of smoking and immunologic factors in relation to airways obstruction.

The relationships of smoking, allergy skin test reactivity, and serum IgE to ventilatory function have been analyzed in 1,182 subjects from a general population sample. The study group consisted of subjects aged 35 or more who deny previous lung surgery, old tuberculosis, or a current diagnosis of heart disease in the absence of chronic bronchitis or emphysema. Impairment of the forced expiratory volume in one second (FEV1) shows a definite relationship to total serum IgE. However, this relationship is significant only for a low FEV1 which is accompanied by symptoms suggesting asthmatic or a chronic bronchitis type disease. Allergy skin test reactivity to a battery of common aeroallergens shows no overall relationship to FEV1. However, after accounting for total serum IgE, positive allergy skin tests tend to be associated with high rather than low FEV1 values. The findings suggest that some type of IgE which is not specific for aeroallergens but which is associated with smoking, may be important in the pathogenesis of the "chronic asthmatic bronchitis" syndrome.

Adult↗
PubMed1982

Ketoconazole treatment of nonprimary coccidioidomycosis. Evaluation of 60 patients during three years of study.

Sixty patients with coccidioidomycosis were treated with ketoconazole rather than with another antifungal agent, and their responses were evaluated in relation to the predominant site of involvement. For the three main groups, improvement occurred in 12 of 19 patients with chronic pulmonary infections, in 20 of 23 with soft tissue lesions and in six of 11 with skeletal involvement. Infections in soft tissues improved most rapidly (average of 34 days) and often with 200 mg per day, whereas pulmonary and skeletal infections improved more slowly (63 and 165 days, respectively), usually requiring 400 mg per day. Of 12 patients with response in whom therapy has been discontinued, seven have had relapses. Recurrence was apparent usually within the first month and after six months or less of treatment. Patients in remission had received ketoconazole for six to 17 months. Untoward drug effects included abdominal complaints (23 percent) and gynecomastia (8 percent). Therapy was discontinued in only three patients for side effects. Our findings support the use of ketoconazole in the treatment of certain forms of chronic coccidioidal infections.

Bone Diseases↗
PubMed1982

The relationship of serum immunoglobulin E, allergy skin tests, and smoking to respiratory disorders.

In this study of a general population sample in Tucson, Ariz., smokers showed higher levels of serum IgE despite having a lower rate of allergy skin-test reactivity to common aeroallergens than nonsmokers. The prevalence of rhinitis was closely related to the level of serum IgE in atopic subjects regardless of smoking habits. In nonatopic smokers, elevated IgE levels were not associated with high rhinitis rates. However, high IgE levels in nonatopic smokers were related to increased rates of diagnosed asthma, wheeze, and chronic cough and/or sputum (C/S). These relationships were especially striking in subjects over the age of 54. In older nonatopic smokers, reported prevalences of "chronic bronchitis" and of functional impairment also increased in relation to the level of serum IgE. Reduced ventilatory function showed this relationship to IgE only when accompanied by C/S. It is suggested that the excess IgE related to smoking is qualitatively different than that found in subjects reacting to aeroallergens, is not important in the pathogenesis of upper respiratory tract disease, but may play a role in the development of some lower respiratory tract disorders.

Adolescent↗
PubMed1982

Serum IgD in subjects with and without chronic obstructive pulmonary disease: a previous finding restudied.

A previous study of matched pairs of subjects with and without COPD showed higher geometric mean values of serum IgD among the affected subjects. In an attempt to replicate this finding in another sample a cooperative study was undertaken to measure IgD in subjects from an epidemiologic study of airway obstructive disease from a different geographic region. The relationship between serum IgD (Ine scale) and % FEV1, was identical in the 2 samples. The lack of statistical significance when analyzing the Arizona sample in a matched pair fashion is attributed to an underrepresentation of subjects with very low % FEV1, and smaller sample size.

Adult↗
PubMed1981

Allergen skin-test reactivity in a community population sample: correlation with age, histamine skin reactions and total serum immunoglobulin E.

Allergen skin reactivity to 14 common local antigens was studied in a community population sample. Differences in the prevalence of positive reactions were related to both the specific antigen itself and the age of the subjects. For most allergens, peak prevalence occurred in the 20- to 34-yr age group, falling thereafter with increasing age. The frequency distribution of reactions revealed a bimodal curve, peaks occurring among nonreactors and those with eight positive reactions out of the 14 tests that were applied. The major contributor to this age--skin test relationship was the level of total serum IgE that was highest in young people and decreased progressively with age. Histamine skin reactions, which were smallest in younger subjects compared with all three older age groups, also contributed to the age-related prevalence of allergen skin-test reactions.

Adolescent↗
PubMed1981

Distribution of IgE in a community population sample: correlations with age, sex, and allergen skin test reactivity.

The distribution of total serum IgE determined by the paper radioimmunosorbent test (PRIST) is examined in a large random stratified community population. Prior to logarithmic conversion the distribution of this immunoglobulin is not normal, with almost 40% of values below 20 IU/ml. A normal distribution occurs following such conversion, with a geometric mean value of 32.1 IU/ml. Both age and sex, in addition to atopic status, relate to IgE level. In both sexes highest levels occur among 6- to 14-year-olds, and males have higher levels than females at any given age. Women over age 75 yr have the lowest levels (geometric mean 9.2 IU/ml). Subjects with positive skin test results have several times the concentration of IgE as their nonatopic counterparts.

Adolescent↗
PubMed1981

The relationship of serum immunoglobulin E to cigarette smoking.

Data from adults enrolled in a general population study in Tucson, Arizona, indicated that smokers have higher serum IgE concentrations than nonsmokers, despite a lower rate of allergy skin test reactivity, at least after 35 yr of age. After 15 yr of age there was a significant decline in serum IgE with age in both allergy skin test positive and skin test negative nonsmokers but no significant age decline was noted in similar groups of smokers. Ex-smokers showed a decline in serum IgE concentrations since quitting cigarettes. Also, the marked increase in geometric mean IgE that was seen in nonsmokers during the spring was not observed in smokers. The data suggested that smoking leads, directly or indirectly, to an increase in serum IgE and that this excess IgE may be qualitatively different from that seen in nonsmokers. Possible mechanisms for the effect are discussed. The observations raised the possibility that some of the adverse health effects of smoking might be immunologically mediated.

Adolescent↗
PubMed1980

Epidemiologic observations on eosinophilia and its relation to respiratory disorders.

The percentage of eosinophils (%EOS), determined from a differential blood smear, was measured in 2,311 subjects enrolled in a general population study in Tucson, Arizona. A subgroup of 290 subjects was tested in more detail during a later evaluation in which absolute eosinophil counts, leukocyte counts, and nasal smears for eosinophils were obtained. In men, but not in women, there was a significant tendency for the %EOS to decrease with age. The highest %EOS was noted during the months of February through May, the time when most plants in this region are in bloom. Blood eosinophils were significantly related to allergy skin test reactivity, circulating IgE concentrations, several respiratory symptoms and disease diagnoses, as well as to reduced ventilatory function. Among subjects younger than 55 yr of age, however, ventilatory function was significantly low, and symptom rates increased only when there was allergy skin test reactivity in addition to eosinophilia. Neither allergy skin test reactivity nor eosinophilia alone was related to ventilatory function in this age group. Among older subjects, blood eosinophilia was associated with definite impairment of ventilatory function, regardless of skin test reactivity and independent of smoking habits. The presence of eosinophilia identified a predominantly female group of elderly nonsmokers with markedly impaired ventilatory function. These subjects appeared to fall into the clinical category of "asthmatic bronchitis".

Adolescent↗
PubMed1979

Large airway obstruction secondary to endobronchial coccidioidomycosis.

When clinically apparent, coccidioidomycosis usually presents either as an interstitial pulmonary infiltrate or, later in its course, a parenchymal nodule often with cavitation. The present report concerns a young adult woman whose presentation was one of shortness of breath with wheezing and stridor, secondary to a localized endobronchial coccidiodal granuloma producing nearly complete obstruction of the right mainstem bronchus. Such a presentation has not been reported previously in an adult. The possible association of serious fungal disease with previous jejunoileal bypass surgery is discussed.

Adult↗
PubMed1979

Kinetics of theophylline; variability and effect of arterial pH in chronic obstructive lung disease.

The pharmacokinetic behavior of theophylline was determined in 12 patients during an acute exacerbation of their chronic obstructive pulmonary disease. A 5.6 mg/kg loading dose of aminophylilne was administered, followed three hours later by a 0.9 mg/kg/hr continuous infusion. The loading dose increased the serum theophylline level an average of only 5.77 microgram/ml. After the loading dose, only five patients had levels greater than 10 microgram/ml. Mean initial drug clearance was 0.77 L/kg/hr, half-life 9.1 hr, and apparent volume of drug distribution .887 L/kg. Wide inter- and intrapatient pharmacokinetic variability was observed. The variability of drug distribution was inversely correlated with the arterial pH. These patients with chronic obstructive pulmonary disease appeared to require more theophylline when acidemic than when alkalemic to achieve similar serum theophylline concentrations.

Aged↗
PubMed1979

Arizona's three-year medical curriculum: a postmortem.

The College of Medicine at the University of Arizona was among many medical schools instituting a course of study leading to graduation in three years. Students and faculty found the three-year program to be an unsatisfactory educational experience. Among the major problems were excessive intensity of classroom work, insufficient vacation time, and inadequate time to teach important basic science material. Objective measures of student performance demonstrated no differences between graduates of the new program and students graduating from a traditional four-year curriculum. A process of curriculum review involving students, faculty, and administrators ultimately resulted in several curricular improvements and establishment of a new four-year program.

Arizona↗