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Biomedical subjects

R Fitzsimons

Publications and source records attributed to R Fitzsimons.

14 recordsLinked to original sources
PubMed1993

Carcinoma of the thyroid gland and Gardner's syndrome.

A patient known to be suffering from Gardner's syndrome who developed carcinoma of the thyroid gland is presented. A review of the literature reveals that this relationship is not fortuitous and that it has the following characteristics: female predominance (89%), youth (< 30 years in 78%), papillary form (88%), multicentricity (70%) and thyroid carcinoma preceding diagnosis of hereditary polyposis in 30%. Hereditary polyposis patients affected by familial polyposis coli are at significant risk of developing extracolonic malignant tumours, and require life-long surveillance. Palpation of the thyroid gland and possibly ultrasound examination of the neck should be part of the routine follow up of these patients.

Adult↗
PubMed1990

Functional scoring of the field of binocular single vision.

Fifty-one patients with diplopia were investigated prospectively to assess the correlation between their subjective impression of disability from diplopia and an objective measurement obtained using a method of assessing the field of binocular single vision (BSV). The objective score generally exceeded the patient's own assessment and the scoring method has been modified to improve the correlation.

Activities of Daily Living↗
PubMed1989

The role of botulinum toxin in the management of sixth nerve palsy.

Fifty-five patients with sixth nerve palsy have been treated with Botulinum toxin injection to the antagonist medial rectus, either in isolation or in combination with rectus muscle surgery. Forty of these patients (72 per cent) obtained significant benefit from injection at some stage in their management. Botulinum toxin has a major role in conjunction with transposition muscle surgery for the treatment of complete unrecovered sixth nerve palsy. In less severe paresis, a functional cure may be obtained in a significant number of cases with the use of Botulinum toxin alone, 37 per cent in this series. No serious complications were observed. In view of the safety of this procedure it is reasonable to consider an injection of Botulinum toxin in any adult patient with a persisting sixth nerve palsy.

Abducens Nerve↗
PubMed1988

Treatment of sixth nerve palsy in adults with combined botulinum toxin chemodenervation and surgery.

This study reports the results of treating unrecovered sixth nerve palsy in adults with a combination of botulinum toxin and surgery. Twenty-two adults, 11 with unilateral and 11 with bilateral unrecovered sixth nerve palsy, were treated with injections of botulinum toxin to the contracted medial rectus followed by transposition surgery to the vertical rectus muscles. This management technique produced a satisfactory reduction in esotropia, averaging 46 prism diopters (PD), comparable with that achieved by conventional surgery in other series. The advantages of this form of treatment are discussed.

Abducens Nerve↗
PubMed1987

Specificity of immunoglobulin E and immunoglobulin G against human (recombinant DNA) insulin in human insulin allergy and resistance.

Using an enzyme-linked immunosorbent assay method, we have demonstrated immunoglobulin E (IgE) and immunoglobulin G (IgG) against human (recombinant DNA) insulin in serum samples of a patient whose insulin therapy was only with human insulin. Within 12 days of initiation of human insulin for gestational diabetes, large local reactions developed in the patient in association with high levels of IgE to human insulin. As the local reactions subsided, the levels of IgE to human insulin decreased. The patient's insulin requirement was unusually high for pregnancy and tended to decrease in parallel with falling levels of IgG to human insulin, suggesting an element of immunologic insulin resistance. In addition to IgE and IgG against human insulin, we were able to demonstrate the presence of IgE and IgG against porcine and bovine insulin in the serum samples of this patient. The patient had similar immediate cutaneous reactivity to each insulin. In inhibition studies, similar amounts of porcine insulin, bovine insulin, or human insulin were found to produce 50% inhibition of human insulin binding to IgE or IgG against human insulin. Excess porcine insulin or bovine insulin resulted in total inhibition of human insulin binding to IgE or IgG. Thus even in a patient whose initial form of insulin therapy was human insulin, there was development of insulin allergy and of IgG to human insulin that may have contributed to insulin resistance. Moreover, the antigenic determinants recognized by antibody induced by human insulin may also be present on bovine insulin and porcine insulin as demonstrated in this case.

Adult↗
PubMed1986

Miconazole and ketoconazole as a satisfactory first-line treatment for keratomycosis.

In 20 patients (11 males and nine females, 3 to 65 years old) with fungal keratitis, Fusarium was identified in eight cases, Aspergillus in four, Drechslera in three, and Curvularia, Candida, and Nocardia in one each. In two cases the organism was not identified. Treatment with topical and subconjunctival miconazole along with ketoconazole resulted in healing in 13 cases. Modification of this regimen produced healing in three additional cases. Four cases progressed to blindness despite therapy.

Adolescent↗
PubMed1986

Outcome of pregnancy in women requiring corticosteroids for severe asthma.

We report on the outcome of 56 pregnancies in 51 women with severe asthma requiring prednisone and/or beclomethasone dipropionate. There were no malformations, neonatal deaths, or maternal deaths. The overall incidence of premature (less than 37 weeks gestational age) and low birth-weight infants (less than or equal to 2500 gr) was slightly higher than would be expected in the general population. These findings appeared attributable in part to infants of gravidas whose asthma was complicated by emergency room visits or status asthmaticus. There was a statistically increased incidence of low birth weight and small size for gestational age infants in the eight infants born to women who experienced status asthmaticus when these infants were compared to the 41 infants born to women who did not require emergency room therapy or develop status asthmaticus. Our data confirm that prednisone and beclomethasone dipropionate are appropriate therapy for pregnant women with severe asthma and suggest that the prevention of status asthmaticus may result in a favorable outcome for the fetus. The current study confirms previous evaluations of pregnant women with severe asthma conducted by Northwestern University Allergy Service and extends the series to 171 pregnancies.

Adrenal Cortex Hormones↗
PubMed1986

A comparison of the immune response to immunotherapy with polymerized grass allergen and monomeric grass allergen.

This study compares the immune response of ten patients treated with polymerized grass (PG) immunotherapy with that of 12 patients treated with conventional monomer grass (MG) immunotherapy. The patients treated with PG immunotherapy received a mean cumulative dose of 44,840 protein nitrogen units (PNU), and those treated with MG immunotherapy received a mean cumulative dose of 46,083 PNU. Total antibody binding of perennial rye grass groups I, II, and III (RGGI, RGGII, and RGGIII) was measured in the serum of each individual. In addition, IgG titers to partially purified extracts of Bermuda, timothy, and orchard grass were also determined. A significant increase in the total antibody binding of RGGI, as well as an increase in the mean IgG titer to Bermuda, timothy, and orchard grass was demonstrated after treatment in the patients who had received PG immunotherapy. The mean total antibody binding of RGGII and RGGIII also increased in these patients, although not significantly. No significant difference in the mean total antibody binding of RGGI, RGGII, or RGGIII nor in the mean IgG titer to the three grass extracts was found in the sera of the two groups of patients. This study demonstrates a comparable immune response between immunotherapy with PG and MG, and retention of antigenic determinants during the polymerization process.

Allergens↗
PubMedDate not supplied

Prevalence of adverse effects in corticosteroid dependent asthmatics.

Eighty-five corticosteroid dependent patients with respiratory diseases requiring alternate day prednisone were studied for certain adverse effects that have been reported to be associated with corticosteroid therapy. The mean age of the patients was 52 years, the average years of prednisone therapy was 5.3, and the mean dose of alternate day prednisone was 26.2 mg. In this group of 85 patients the prevalence of hypertension, peptic ulcer disease, pathologic fractures and psychosis was not statistically increased over that of the general population. None of the patients was diagnosed as having steroid-induced psychosis, pancreatitis or tuberculosis. One patient developed aseptic necrosis of the hip; however, she received daily prednisone for approximately 3.2 years before being converted to an alternate day schedule. Our results demonstrate that alternate day corticosteroid therapy can be used without significant risk of adverse effects in patients in whom it is essential for control of respiratory disease.

Adult↗