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Biomedical subjects

R L Nolan

Publications and source records attributed to R L Nolan.

14 recordsLinked to original sources
PubMed1992

Pharmacologic modulation of interleukin-1 expression by amphotericin B-stimulated human mononuclear cells.

Fever and chills occur frequently with amphotericin B (AB) administration, but the mechanism that causes these reactions has not been definitively established. A variety of proinflammatory cytokines, including interleukin-1 (IL-1) and tumor necrosis factor, have been shown to be important mediators of fever. In order to clarify the cellular and biochemical responses associated with AB-induced fever, the experiments described sought to (i) establish whether human mononuclear cells exposed to AB in vitro expressed IL-1 beta, (ii) evaluate whether clinically used premedications for fever prophylaxis in AB-treated patients were effective in down-regulating IL-1 beta expression in vitro, (iii) evaluate whether methylxanthine agents with immunomodulatory actions effected in vitro IL-1 beta expression, and (iv) define the dose and time dependency of the modulating effects. Peripheral blood mononuclear cells were isolated by density centrifugation and resuspended to 10(6) cells per ml in culture wells of Linbro plates. When cocultured for 2 h with human mononuclear cells, both Escherichia coli lipopolysaccharide and AB stimulated IL-1 beta expression in a dose-related fashion. AB-induced IL-1 beta expression was suppressed by hydrocortisone (HC), pentoxifylline, and an investigational theobromine, A81-3138, in a linear, dose-related manner. In contrast, indomethacin, meperidine, and diphenhydramine had no effect on IL-1 beta expression. Our in vitro data indicate that serum HC concentrations of greater than 1 to 2 micrograms/ml may be sufficient to modulate IL-1 beta expression. Pentoxifylline and A81-3138 may also be effective in modulating IL-1 beta expression by mononuclear cells at concentrations achievable in serum. These new agents may prove to be effective alternatives to HC or may be added with HC to suppress febrile reactions secondary to AB administration. Clinical studies with pentoxifylline as a premedication for AB seem warranted.

Amphotericin B↗
PubMed1992

Cell sizing in chronic lymphoproliferative disorders: an aid to differential diagnosis.

AIMS: To determine if leucocyte volume distribution analysis (LVDA), obtained using a Coulter Counter Model S Plus IV, can be used to aid differentiation of chronic lymphoproliferative disorder (CLPD) subtypes. METHODS: Mean lymphocyte volume and lymphocyte distribution width were measured on each patient (n = 90) using a hard copy of an amplified LVDA histogram. The mean lymphocyte volume was taken as the mean of the values on either side of the peak at half maximum height. The lymphocyte distribution width was taken as the range of cell values between the two values used to calibrate the mean lymphocyte volume. A template showing typical histograms from commonly occurring CLPD was also produced on an acetate sheet. This was used to examine the histogram from each new patient to evaluate its usefulness as an alternative to the calculation of mean lymphocyte volume and lymphocyte distribution width. RESULTS: Mean lymphocyte volume and lymphocyte distribution width were significantly higher in B cell lymphocytic leukaemia of mixed cell type (B CLL/PL), B cell non-Hodgkin's lymphoma with peripheral blood spill, hairy cell leukaemia and T cell prolymphocytic leukaemia than in B cell chronic lymphocytic leukaemia (B CLL). The mean lymphocyte volume, but not the lymphocyte distribution width, was also significantly higher in T cell chronic lymphocytic leukaemia than in B CLL. The template gave an immediate preliminary indication of possible subtype(s) of disorder and could be used as an alternative to measurement of mean lymphocyte volume and lymphocyte distribution width. CONCLUSIONS: Electronic haematology analysers producing an LVDA provide a useful, cost effective cell sizing analysis which can aid the differentiation of subtypes of CLPD.

Cell Size↗
PubMed1991

Peritoneal blastomycosis.

Blastomycosis is a systemic fungal infection caused by Blastomyces dermatitidis. Involvement of the peritoneum is unusual, with only two previously reported cases that occurred in association with disseminated disease. A single case of histopathologically proven blastomycosis involving the peritoneum is presented, as well as a short overview of previously published cases on gastrointestinal and peritoneal blastomycosis. The case is unique in that chronic peritonitis was the only manifestation of disease. The diagnosis was made by laparoscopy.

Adult↗
PubMed1989

Alternate approaches to pelvic abscess drainage after cystectomy.

Pelvic abscesses and fluid collections are relatively common complications of major pelvic surgery. When a radical cystectomy has been performed, the ultrasonic acoustic window to normal anatomic landmarks is lost and bowel loops prolapse into the anatomic pelvis. This makes standard suprapubic ultrasonography (US) either difficult or nondiagnostic and often obscures significant pathology. The current use of high-frequency endocavitary US transducers permits an alternate view of the remaining pelvic structures. Coronal transgluteal scans also permit a limited view of the presacral area. These approaches were used in drainage of pelvic abscesses after cystectomy using the transrectal, transurethral, transperineal, and transabdominal routes under US guidance.

Abscess↗
PubMed1989

Subacute disseminated mucormycosis in a diabetic male.

Mucormycosis is an opportunistic invasive infection caused by fungi of the order Mucorales. Rhizopus, Absidia, and Mucor are the most commonly encountered genera. Disease is characterized by vascular invasion, thrombosis, and tissue necrosis. Rhinocerebral disease is the most common manifestation but pulmonary, cutaneous, gastrointestinal, and widely disseminated forms have been reported. Pulmonary and disseminated disease are usually seen in neutropenic patients with leukemia or lymphoma. Both present as fever and unexplained pulmonary infiltrates unresponsive to antibacterials and corticosteroids. Disease is usually fulminant and has a high mortality rate. Diagnosis is most commonly made at autopsy. A single case of disseminated disease is reported that is unusual in its subacute course and its occurrence in an otherwise healthy non-neutropenic diabetic male.

Diabetes Mellitus, Type 1↗
PubMed1989

Immunoglobulin light chains in common acute lymphoblastic leukaemia.

A single immunoglobulin light chain lambda was identified in the blast cells of two out of 12 patients with common acute lymphoblastic leukaemia (C-ALL) using the alkaline phosphatase/anti-alkaline phosphatase (APAAP) technique. Inhibition at the cell surface proved that the reaction was a genuine anti-lambda reaction. Immunoglobulin mu chain was not identified in these patients. Results of immunoglobulin typing in 103 patients with B chronic lymphocytic leukaemia (B-CLL) are cited to show the increased sensitivity of the APAAP technique as compared to the indirect immunoperoxidase technique for cellular immunoglobulin identification.

Female↗
PubMed1988

Castleman's disease with vascular encasement and renal sinus involvement.

Castleman's disease is a relatively rare entity. Approximately 4% of cases are located in the retroperitoneum or pelvis. The plasma cell variety accounts for 10% of all cases of Castleman's disease. A case of the plasma cell variant involving the renal sinus and retroperitoneum is presented.

Castleman Disease↗
PubMed1988

Percutaneous endourologic approach for transitional cell carcinoma of the renal pelvis.

A small mass was detected in the renal pelvis during investigation for hypertension and diminished renal function. Its presence was confirmed by computed tomography. Since the patient was not a candidate for nephrectomy, interventional percutaneous techniques were used to confirm the diagnosis of transitional cell carcinoma and ultimately permit endourologic access for resection and cure.

Aged↗
PubMed1988

Sonographic features of urinary bladder involvement in regional enteritis.

Three cases of regional enteritis (Crohn disease) with secondary involvement of the urinary bladder diagnosed by ultrasound are presented. The ability of ultrasound to simultaneously and noninvasively demonstrate the changes in bladder and adjacent bowel, unlike other radiologic or urologic investigations, is emphasized.

Abscess↗
PubMed1985

Tuberculous pseudotumour of the liver developing during antituberculous chemotherapy.

A 29-year-old Chinese woman presented with a liver mass 2 months after initiation of chemotherapy for disseminated tuberculosis. A percutaneous liver biopsy revealed tuberculous pseudotumour. Although acid-fast bacilli were seen in the biopsy specimen, no organism could be cultured. No changes were made in the antituberculous chemotherapy, and the mass subsequently resolved. The patient was still well 18 months after presentation. To the authors' knowledge, the features of tuberculous pseudotumour seen with ultrasonography and computerized tomography have not previously been described, nor has this condition previously been reported in patients already receiving antituberculous chemotherapy.

Adult↗