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Biomedical subjects

R L Edwards

Publications and source records attributed to R L Edwards.

At least 37 records · Page 2Linked to original sources
PubMed1999

Hemolytic transfusion reaction due to anti-Tc(a).

BACKGROUND: Anti-Tc(a) detects a high-incidence antigen in the Cromer blood group system. Cromer system antibodies have not usually been associated with hemolytic transfusion reactions or hemolytic disease of the newborn. CASE REPORT: Anti-Tc(a) (initially identified in the patient's serum in 1982) was not detected when she was admitted to the hospital with upper gastrointestinal. bleeding. Three units of red cells were administered. The patient was discharged, but was readmitted to the hospital after her hemoglobin fell to 7.1 g per dL. Antibody detection tests remained negative and three additional units were transfused. Over the next 7 days, her hemoglobin steadily fell to 5.5 g per dL. The level of lactate dehydrogenase rose to 1257, the plasma hemoglobin rose to >16 mg per dL, and the haptoglobin decreased to <6 mg per dL. Five days after transfusion, her direct antiglobulin test was weakly reactive with complement-specific antiglobulin reagents. Eluates were nonreactive. Anti-Tc(a) was detected in her serum; no other antibodies were detected. Differential typing failed to detect any circulating Tc(a+) red cells. The antibody was strongly reactive in a monocyte monolayer assay. CONCLUSION: Although Cromer system antibodies have generally not been proven to be clinically significant in transfusion therapy, the destruction of red cells from six units of transfused Tc(a+) red cells in this patient indicates that anti-Tc(a) may have destructive potential in some patients.

Adult↗
PubMed1999

Regional thrombolysis with urokinase for central venous catheter-related thrombosis in patients undergoing high-dose chemotherapy with autologous blood stem cell rescue.

Fifty-one of 300 patients undergoing high-dose chemotherapy with (n = 245) or without (n = 55) autologous stem cell rescue developed central venous catheter-related thrombosis diagnosed by Doppler sonography or contrast venography. Eighteen of these individuals underwent regional thrombolysis defined as the infusion of urokinase into a superficial vein of the ipsilateral upper extremity in a dose not sufficient to produce systemic fibrinolysis by laboratory criteria. Urokinase was administered at a dose of 75,000-150,000 U/hour for 24 to 96 hours and contrast venography was performed to assess response. All individuals had a partial or complete resolution of clinical signs and symptoms. Fifty percent of patients also achieved a partial radiographic response defined as clot lysis with irregular canalization of the vein. Therapeutic doses of heparin for 5 to 7 days and warfarin for at least 3 months were commenced at the conclusion of urokinase therapy. Twelve catheters were salvaged and utilized subsequently until no longer required. Six catheters were removed because of poor catheter function or rethrombosis. The median interval from diagnosis of the thrombus until extraction of the 12 salvaged catheters was 3 months (range 1-8 months). Only a single patient who developed gastrointestinal bleeding required discontinuation of urokinase. Regional thrombolysis is safe, easy to administer, effective in many instances, less costly than the doses of antifibrinolytic agents required to induce systemic fibrinolysis, and should be considered in patients receiving high-dose chemotherapy with autologous stem cell rescue who develop central venous catheter-related thrombosis.

Adolescent↗
PubMed1998

Streptococcus viridans bacteremia following autologous peripheral blood stem cell transplantation.

A retrospective evaluation of 200 consecutive recipients of autologous peripheral blood stem cell transplantation was conducted to ascertain the incidence and outcome of Streptococcus viridans bacteremia as well as to determine the role of prophylactic ampicillin therapy in the peri-transplant setting. Viridans streptococci were isolated from the blood of 35 individuals at a median of 6 days (range 2-8 days) following stem cell infusion. The most common isolates were S. sanguis and S. mitis. All patients received ciprofloxacin orally during the peri-transplant period. Additionally, 79 patients received oral ampicillin prophylactically against gram-positive cocci. Although none of the patients suffered a fatal outcome, three individuals developed respiratory compromise requiring mechanical ventilation. Female sex proved to be the only independent risk factor for viridans streptococcal bacteremia (P=0.04). The shorter duration of neutropenia observed after stem cell transplantation did not impact on the incidence of S. viridans infections. Moreover, the prophylactic use of ampicillin failed to decrease the incidence of viridans sepsis and selected out organisms that were resistant to beta-lactam antibiotics.

Adolescent↗
PubMed1998

Acanthamoeba meningoencephalitis following autologous peripheral stem cell transplantation.

Amoebic meningoencephalitis is an unusual complication of bone marrow transplantation. We report a case of Acanthamoeba meningoencephalitis in a patient with non-Hodgkin's lymphoma after autologous stem cell transplantation. Leg weakness, fever and urinary retention developed 69 days following transplantation. The patient then developed fever, generalized tonic clonic seizure, rapid deterioration of mental functions and hypercapneic respiratory failure. Magnetic resonance imaging demonstrated a ring enhancing lesion at the level of the thoracic spines 11 and 12. Examination of the cerebrospinal fluid revealed pleocytosis. Despite empiric therapy with broad-spectrum antimicrobial agents, the patient's condition worsened and she died 11 days following admission. Autopsy findings revealed a subacute meningoencephalitis secondary to Acanthamoeba culbertsoni.

Acanthamoeba↗
PubMed1997

Stomatococcus mucilaginosus meningitis in a patient with multiple myeloma following autologous stem cell transplantation.

Bacterial meningitis is an unusual complication of bone marrow transplantation. We report a case of Stomatococcus mucilaginosus meningitis in a patient with multiple myeloma shortly after an autologous peripheral blood stem cell transplant. The infection resolved with a combination of intravenous penicillin G and chloramphenicol, and intrathecal vancomycin.

Bone Marrow Transplantation↗
PubMed1995

When community resources fail. Assisting the frightened or angry parent.

The failure to receive expected community services or specialized in-home medical care can be upsetting for some parents. This article is designed to help pediatricians interpret inappropriate family behaviors and to therapeutically defuse verbal anger, unrealistic expectations, and unfounded fears.

Adaptation, Psychological↗
PubMed1994

Meeting the change challenge: managing growth in the nonprofit and public human services sectors.

The current economic climate has been particularly hard on non-profit and public human services organizations, frequently resulting in managing organizational decline. The authors believe that the dominant concern should be with fostering organizational growth. To this end, they suggest that nonprofit board members and executives, as well as public sector leaders, need to concern themselves with the concurrent management of two agendas: Running the Shop and Meeting the Change Challenge. This can be done effectively through the use of strategic issue management, which is a set of techniques that represents a blend of traditional strategic management and change management approaches.

Efficiency, Organizational↗
PubMed1992

Hemostatic alterations in cancer patients.

Nearly all patients with cancer manifest laboratory evidence of hypercoagulability and some develop clinical thromboembolic disease (TED). Routine laboratory studies of blood coagulation have been performed in several large, prospective trials of the use of anticoagulant drugs in cancer treatment. The results of these studies, as well as data from several smaller studies of more sensitive tests of hypercoagulability [e.g. fibrinopeptide A (FPA); thrombin-antithrombin (TAT) complexes; prothrombin fragment F1 + 2)], indicate that the levels of some clotting proteins parallel disease activity. However, no studies of sound methodologic design have yet been performed to indicate that any of these tests of blood coagulation can serve as adequate predictors of TED in patients with cancer. In addition to the important role played by tumor-related procoagulants, several other mechanisms may be involved in the pathogenesis of thromboembolic events in patients with cancer, including stasis and endothelial damage. Considerable variability in the relative importance of these mechanisms in the pathogenesis of TED may exist among patients with different types of cancer. The risk for TED associated with surgical procedures in cancer patients is substantial and prophylactic antithrombotic therapy should be considered for most of these patients. Chemotherapy and hormonal therapy of cancer probably increases the likelihood of TED, particularly in those subjects with indwelling venous catheters. This risk has been particularly well-studied in patients with breast cancer treated with tamoxifen plus cytotoxic drugs. The pathogenic mechanisms may be complex but vascular injury is likely as a proximate cause of venous access catheter thrombosis and can be prevented with low dose coumadin therapy. The utility of low dose coumadin anticoagulation in reducing the risk for TED during breast cancer treatment is unknown but is currently being tested in a large, multiinstitutional study. Since chronic coumadin anticoagulation of cancer patients, and single pulse dose heparin prior to intravenous chemotherapy, both prevent thrombin generation, these agents may be of use in reducing the risk of chemotherapy-associated thrombosis. Prophylactic anticoagulation should be considered for high risk patients.

Antineoplastic Agents↗
PubMed1992

Prognostic significance of blood coagulation tests in carcinoma of the lung and colon.

Blood coagulation test results were collected prospectively in patients with previously untreated, advanced lung or colon cancer who entered into a clinical trial. In patients with colon cancer, reduced survival was associated (in univariate analysis) with higher values obtained at entry to the study for fibrinogen, fibrin(ogen) split products, antiplasmin, and fibrinopeptide A and accelerated euglobulin lysis times. In patients with non-small cell lung cancer, reduced survival was associated (in univariate analysis) with higher fibrinogen and fibrin(ogen) split products, platelet counts and activated partial thromboplastin times. In patients with small cell carcinoma of the lung, only higher activated partial thromboplastin times were associated (in univariate analysis) with reduced survival in patients with disseminated disease. In multivariate analysis, higher activated partial thromboplastin times were a significant independent predictor of survival for patients with non-small cell lung cancer limited to one hemithorax and with disseminated small cell carcinoma of the lung. Fibrin(ogen) split product levels were an independent predictor of survival for patients with disseminated non-small cell lung cancer as were both the fibrinogen and fibrinopeptide A levels for patients with disseminated colon cancer. These results suggest that certain tests of blood coagulation may be indicative of prognosis in lung and colon cancer. The heterogeneity of these results suggests that the mechanism(s), intensity, and pathophysiological significance of coagulation activation in cancer may differ between tumour types.

Blood Coagulation Tests↗
PubMed1991

Multisite microprobes for neural recordings.

Multisite, passive microprobes have been developed to allow simultaneous recording of action potential activity from multiple neurons at different locations in the brain. The microprobes were fabricated using standard integrated circuit techniques. The probe is a planar structure that consists of gold electrodes sandwiched between two polyimide dielectric layers and bonded to a molybdenum structural support. Windows in the top dielectric layer expose the electrode sites and bonding pads. In two distinct versions of the probe four or six recordings sites, respectively, of approximately 25 microns 2 are arranged on a dagger-shaped structure which can penetrate the pia. The bonding pads and interconnect wires at the probe head are entirely encapsulated in a tubular fixture that is packed with silicone RTV and sealed with epoxy to protect the interconnections from contact with body fluids. The site impedances at 1 kHz are typically between 2 and 4 M omega. Probe lifetimes for continuous immersion in physiological saline solution, as measured by impedance, have exceeded 750 h. The failure mechanism is believed to be due to moisture and ion absorption in the top dielectric layer. In acute neurophysiological experiments using the four site probes, action potential activity was recorded from physiologically identified neurons in the dorsal column nuclei of anesthetized rat.

Action Potentials↗
PubMed1990

The platelet count in carcinoma of the lung and colon.

Platelet counts were evaluated in 714 patients with advanced non-small cell lung cancer (N-SCLC), small cell carcinoma of the lung (SCCL), and colon cancer entered to a clinical trial. Patients had not received prior chemotherapy. Platelet counts were not different in patients who had received radiation therapy prior to entry to the study. In comparison to the other tumor types, patients with N-SCLC demonstrated an increased prevalence of thrombocytosis (counts greater than 400,000/mm3), higher platelet counts at the time of entry to the study, higher over all mean platelet counts, relative preservation of high platelet levels during disease progression, and no relationship between platelet numbers and the amount of chemotherapy given. By contrast, platelet counts in patients with SCCL were negatively correlated with the absolute amount of cyclophosphamide and adriamycin given, and declined most dramatically with disease progression and death. Platelet numbers did not correlate with fibrinopeptide A or fibrin split product levels suggesting that disseminated intravascular coagulation or fibrinolysis may have had less influence on platelet numbers than certain other factors. By contrast, significant correlations were found for all three tumor types between platelet numbers and other indicators of bone marrow function including anemia, total leukocyte count, and absolute neutrophil count; and the fibrinogen level. Based upon these findings, we postulate that the host response to malignancy, possibly in the form of production of bone marrow-stimulating cytokines, may play a prominent role in regulation of platelet counts in these (and perhaps other) neoplasms, and that a particularly prominent and persistent degree of marrow stimulation exists in patients with N-SCLC.

Carcinoma, Non-Small-Cell Lung↗
PubMed1990

Heparin abolishes the chemotherapy-induced increase in plasma fibrinopeptide A levels.

PURPOSE, PATIENTS, AND METHODS: Blood coagulation abnormalities are common in patients with cancer, particularly after treatment with chemotherapeutic agents. Chemotherapy has been associated with an increased incidence of thromboembolic events, and patients treated with chemotherapy often develop evidence of local phlebitis, which may lead to loss of venous access. We have utilized the radioimmunoassay for plasma fibrinopeptide A (FPA) and in vitro FPA generation to assess the rate of in vivo blood coagulation and the level of plasma thrombin activity in 16 cancer patients treated with chemotherapy. Eight patients were treated twice, once with chemotherapy alone and once with chemotherapy after an intravenous infusion of heparin (5,000 U). RESULTS: Our results confirm that FPA levels are elevated in most cancer patients. Following chemotherapy, FPA levels were further increased within 45 minutes (mean FPA = 5.2 ng/mL before chemotherapy versus 8.3 ng/mL after chemotherapy, p less than 0.01) and were accompanied by an increase in the FPA generation rate. Infusion of heparin prior to chemotherapy significantly lowered plasma FPA levels and abolished post-chemotherapy FPA generation. CONCLUSION: These data suggest that patients receiving chemotherapy express thrombin-like activity in plasma and, therefore, may be at risk for clinically significant intravascular activation of coagulation. Heparin diminished the laboratory evidence of this chemotherapy-related coagulopathy and may have a role in the prevention of thromboembolic disorders in some cancer patients undergoing cytotoxic therapy.

Antineoplastic Agents↗
PubMed1990

Pleuropulmonary fibrosis due to bromocriptine treatment for Parkinson's disease.

Pleuroplumonary fibrosis is an uncommon but potentially serious adverse effect of bromocriptine used in the treatment of Parkinson's disease. Two cases of this reaction, which occurred 12 months and 5 months respectively after commencing therapy are here reported. In both instances prompt clinical and radiological improvement occurred when bromocriptine intake was ceased. Fibrotic reactions to bromocriptine may be mediated by a serotonergic mechanism. Periodic monitoring of pulmonary symptoms is warranted in patients receiving bromocriptine treatment for Parkinson's disease.

Aged↗