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Biomedical subjects

R B Patterson

Publications and source records attributed to R B Patterson.

At least 37 records · Page 2Linked to original sources
PubMed1989

The limitations of impedance plethysmography in the diagnosis of acute deep venous thrombosis.

We reviewed our experience with impedance plethysmography (IPG) and duplex scanning in the diagnosis of acute deep venous thrombosis (DVT) to determine their respective accuracy and current role in our noninvasive vascular laboratory. During a recent 22-month period 1776 patients were evaluated in our laboratory for DVT. Sixty patients (64 limbs) underwent ascending venography within 48 hours of testing (49 limbs were evaluated by all three modalities). With the venograms used as the reference standard, B-mode scanning correctly identified the presence of acute thrombus in 24 of 27 limbs (88.8%) and the absence of thrombus in 31 of 34 limbs (91.2%), for an overall accuracy of 90.6%. IPG alone was less sensitive (75%) and less specific (44.8%), with an overall accuracy of only 57.1%. Twenty-eight IPGs were performed on patients with negative venous scans. Two positive IPGs were the result of chronic venous occlusion and two others detected clinically significant isolated iliac vein thrombi, but 13 patients had false positive IPGs. One false negative IPG occurred. The difference in the sensitivity of scan alone vs scan plus IPG was not significant (chi 2 = 0.045; difference not significant), but the decrease in specificity was chi 2 = 17.3; p less than 0.001). The rarity of isolated iliac vein thrombosis and the high false positive rate for IPG do not justify its continued use if B-mode venous scanning is available. Although positive scan results may be used confidently to institute therapy without the need for venography, in high-risk patients with a strong clinical suspicion of proximal DVT despite a negative scan venography should be obtained before withholding anticoagulation.

Acute Disease↗
PubMed1989

A simple method for preventing blood-borne contamination to operating room personnel during vascular reconstructive operations.

Although the risk of infection with hepatitis or HIV remains low, and the effectiveness of steps to reduce even this small risk is difficult to assess, the sequelae of the infection with either virus are often devastating. We described herein the use of a sterile Petri dish to inspect vascular anastomoses during arterial reconstructive operations. This simple, inexpensive precaution has been in use at the University of Cincinnati for two years and has proved so effective in preventing the contamination of operating room personnel with blood from a patient that it has recently become a routine part of all vascular reconstructive operations.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Insertion of peritoneal dialysis catheters: the lateral approach.

Potential complications of peritoneal dialysis catheters include ventral herniation, dialysate leakage, and catheter dysfunction. Using local anesthesia and a paramedian, muscle-splitting approach, we have significantly reduced the morbidity of the procedure. Security of fascial closure and identification of the peritoneum, even in obese patients, has been facilitated through this technique.

Catheterization↗
PubMed1987

tdic(9;12): a nonrandom chromosome abnormality in childhood B-cell precursor acute lymphoblastic leukemia: a Pediatric Oncology Group Study.

In a review of 432 children with newly diagnosed acute lymphoblastic leukemia (ALL), we identified a new nonrandom translocation, tdic(9;12)(p1?1;p1?2), in the leukemic marrow cells of eight patients. Seven had hypodiploid karyotypes that lacked chromosomes 9 and 12 and contained a der(12), tdic(9;12); the eighth had a pseudodiploid karyotype with two normal 9 chromosomes, one normal 12 and the der(12), tdic(9;12). Abnormalities involving chromosomes other than 9 and 12 were noted in four of the eight patients. All cells with the tdic(9;12) expressed both the common ALL antigen and HLA-DR. Cytoplasmic immunoglobulin, a marker of pre-B ALL, was detected in one case with the tdic(9;12) but was absent in the other seven. Our results suggest that the tdic(9;12)(p1?1;p1?2) rearrangement is specifically associated with leukemic B cell precursors.

B-Lymphocytes↗
PubMed1986

Novantrone for childhood malignant solid tumors. A pediatric oncology group phase II study.

One hundred one patients with advanced pediatric malignant solid tumors, refractory to conventional chemotherapy, were given Novantrone in a Phase II study. A dosage of 18 mg/m2 was administered as a short intravenous infusion every 3 weeks. One complete and 2 partial responses were observed among 26 patients treated for rhabdomyosarcoma; one of 22 patients with neuroblastoma developed a partial response. Nausea and vomiting were uncommon. Leukopenia and/or granulocytopenia developed in 90 of 98 evaluable entries. Two patients developed fatal congestive heart failure, which may have been related to the fact that these patients previously had received doxorubicin; 3 other patients developed evidence of changes in cardiac function, without congestive heart failure. Evidence of activity of this agent in patients who had previously received doxorubicin suggests that Novantrone should be evaluated in pediatric subjects with malignant solid tumors who have had no prior exposure to anthracyclines.

Adolescent↗
PubMed1983

Comparison of intermediate-dose methotrexate with cranial irradiation for the post-induction treatment of acute lymphocytic leukemia in children.

We compared two regimens with respect to their ability to prolong disease-free survival in 506 children and adolescents with acute lymphocytic leukemia. All responders to induction therapy were randomized to treatment with 2400 rad of cranial irradiation plus intrathecal methotrexate or to treatment with intermediate-dose methotrexate plus intrathecal methotrexate, as prophylaxis for involvement of the central nervous system and other "sanctuary" areas. Patients were then treated with a standard maintenance regimen. Complete responders were stratified into either standard-risk or increased-risk groups on the basis of age and white-cell count at presentation. Among patients with standard risk, hematologic relapses occurred in 9 of 117 given methotrexate and 24 of 120 given irradiation (P less than 0.01). The rate of central-nervous-system relapse was higher in the methotrexate group (23 of 117) than in the irradiation group (8 of 120) (P = 0.01). Among patients with increased risk, radiation offered greater protection to the central nervous system than methotrexate (P = 0.03); there was no difference in the rate of hematologic relapse. In both risk strata the frequency of testicular relapse was significantly lower in the methotrexate group (1 patient) than the radiation group (10 patients) (P = 0.01). Methotrexate offered better protection against systemic relapse in standard-risk patients and better protection against testicular relapse overall, but it offered less protection against relapses in the central nervous system than cranial irradiation.

Adolescent↗
PubMed1982

Extraneural metastases from cerebellar medulloblastoma.

Six of 19 patients treated for medulloblastoma over an 8-year period developed extraneural metastases. The most common sites of metastatic disease were bone (5 patients), and bone marrow (4 patients). Radionucleotide bone scans and/or bone marrow aspirates detected disease in all such cases. Four patients also had recurrence within the central nervous system. Four of six patients relapsed within one year of initial treatment. All recurrences were treated with radiotherapy and/or chemotherapy with symptomatic improvement. The use of bone scans and bone marrow aspirations in the follow-up of patients with treated medulloblastoma would seem to be indicated.

Adolescent↗
PubMed1981

Reactivation of Hand-Schüller-Christian disease six and thirteen years after discontinuation of systemic therapy.

We present two cases of reactivation of Hand-Schüller-Christian disease or multifocal eosinophilic granuloma 6 and 13 years after discontinuation of systemic therapy. Both patients received oral therapy with methotrexate and prednisone continuing for 2--3 years after the disease was thought to be in remission. Relapses were detected because of disease symptoms and treated with surgery with or without radiation. Neither patient has required reinstitution of systemic therapy. These cases are cited as evidence of the chronicity of the disorder and as a reminder that reactivation is possible after years of disease inactivity. Therefore, long-term clinical follow-up of patients in remission is indicated.

Child, Preschool↗
PubMed1981

Mucinous adenocarcinoma developing in chronic anal fistula: report of two cases and review of the literature.

Mucinous adenocarcinoma developing in a chronic anal fistula is a rare tumor of the anus of which there are less than 150 reported cases. There has been some debate as to whether the fistula is the source of the tumor, or whether the fistula is the presenting feature of a slow-growing, indolent carcinoma. Two recent cases seen at our hospital are presented, along with a review of the literature and what we feel to be strong evidence that the fistula and associated anal glands are indeed the source of this unusual tumor.

Adenocarcinoma, Mucinous↗
PubMed1981

Evaluation of a home visitation program for families of children with cancer.

This paper presents the results of a preliminary evaluation of a home visitation program for families of children with cancer. The visitation program has been well received by the parents and a statistical comparison of visited and nonvisited families suggested favorable effects of the program with respect to helping parents control feelings of anger and in enhancing or maintaining positive interaction with spouse, children, and grandparents. Comments by the parents indicated that the visits create an atmosphere which facilitates communication between members of the health care team and the family. Interviews with parents of deceased children revealed that a particularly important aspect of the program is the contact maintained with the family after the child has died. Overall, the results indicated that the visits can be a valuable addition to the total program of care for the chronically ill child.

Adult↗
PubMed1978

Vincristine, prednisone and L-asparaginase in the induction of remission in children with acute lymphoblastic leukemia following relapse.

Two hundred and twenty-seven children with recurrent acute lymphoblastic leukemia were treated with various combinations of vincristine, prednisone, cyclophosphamide and L-asparaginase in an approach to the induction of remission. The combination of L-asparaginase 1,000 mu/kg iv q.d. x 10, vincristine 2.0 mg/m2iv q.w. x 4 and prednisone 40 mg/m2 p.o.q.d. x 28 days was found to be highly effective. The incidence of remission was 73%. No significant improvement was achieved when cyclophosphamide was added to this regimen. Various combinations of cytosine arabinoside, cyclophosphamide, vincristine, prednisone, BCNU or CCNU failed to maintain remission duration for more than two or three months. Neither BCNU nor CCNU prevented the development of CNS leukemia.

Adolescent↗