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Biomedical subjects

R L Wall

Publications and source records attributed to R L Wall.

4 recordsLinked to original sources

Eosinophilic alveolitis in acute respiratory failure. A clinical marker for a non-infectious etiology.

Two patients with acute respiratory failure requiring mechanical ventilation were found to have eosinophilic alveolitis on bronchoalveolar lavage and lung biopsy studies. Neither patient had evidence of lung infection or parasitic disease and both rapidly improved following treatment with corticosteroids. Lung eosinophilia in this setting is unusual, since the stress reaction that accompanies severe illness usually causes a rapid drop in circulating eosinophil levels. Eosinophilic alveolitis in such patients may be a useful clinical marker for non-infectious acute lung injury that is responsive to corticosteroid therapy.

Acute Disease

Low-dose deoxycoformycin in lymphoid malignancy.

Deoxycoformycin (dCF), a potent inhibitor of adenosine deaminase (ADA), was explored for its antineoplastic potential in 28 patients with advanced lymphoid malignancy. Both normal and malignant B lymphocytes have low levels of ADA activity, and low doses of dCF profoundly inhibit this enzyme in the peripheral blood of patients with chronic lymphocytic leukemia (CLL). The low doses of dCF administered in this trial (4 mg/m2) were not associated with prohibitive toxicity. Five of 28 patients had an objective response. Four additional patients had clinical improvement. No significant difference in the pretreatment ADA activity existed between responding patients and treatment failures. The demonstration of responses to dCF following failure on standard alkylating agents suggests that dCF may not be cross-resistant with current agents used to treat CLL. Additional studies should be pursued using low-dose dCF in patients with advanced malignancy.

Adenosine Deaminase Inhibitors

Bladder involvement with lymphoma.

Two case reports of different ways lymphoma involves the bladder are presented, with a brief updating of diagnosis and management. Symptoms and cystoscopic and roentgenographic findings are discussed. While primary lymphoma of the bladder has been reported in a few instances, the disorder is generally considered a widespread lymphatic disease.

Aged

Carcinoma of the urinary bladder in patients receiving cyclophosphamide.

Hemorrhagic cystitis is a common side effect of cyclophosphamide therapy not observed with other alkylating agents. In five patients receiving cyclophosphamide by mouth for prolonged periods with large cumulative dosage urinary-bladder tumors fatal to four and requiring cystectomy in the lone survivor developed. These observations strongly suggest chemical carcinogenicity of this drug in the production of these tumors. Increasingly, cyclophosphamide is being used for non-neoplastic disease. These circumstances suggest careful follow-up observation of patients in whom hemorrhagic cystitis from this drug develops for evidence of bladder cancer, as well as restraint in use of cyclophosphamide for non-neoplastic diseases if alternative therapy is available.

Administration, Oral