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Biomedical subjects

R Patterson

Publications and source records attributed to R Patterson.

At least 235 records · Page 13Linked to original sources
PubMed1987

Prolonged evaluation of patients with corticosteroid-dependent asthma stage of allergic bronchopulmonary aspergillosis.

Eight cases with stage IV allergic bronchopulmonary aspergillosis (ABPA) (corticosteroid-dependent asthma stage) were observed for a total of 82 patient years with individual patients observed for 7 to 19 years (mean 10.2) years. One case is the first case of ABPA diagnosed in the United States in 1967. A second case has been observed through four stages of ABPA. None of these eight cases has demonstrated pulmonary deterioration by clinical, chest roentgenogram, or pulmonary function analysis. After diagnosis, the maintenance dose of prednisone in seven of eight cases was a low to moderate dose alternate-day prednisone. These results suggest that continuous observation and management of episodes of pulmonary consolidation or asthma exacerbations may prevent the progression of ABPA to stage V (fibrotic end stage). The total IgE may remain elevated in these patients, and therapy should not attempt to reduce total serum IgE to normal levels. After prolonged therapy with prednisone for asthma and control of ABPA, the IgE and IgG antibody indices against Aspergillus fumigatus may remain elevated or may be below the levels that are of diagnostic value.

Adolescent↗
PubMed1987

Management of drug allergy in patients with acquired immunodeficiency syndrome.

Management of patients with acquired immunodeficiency syndrome (AIDS) is complicated by a high frequency of adverse drug reactions to trimethoprim-sulfamethoxazole and pentamidine. Because of the lack of suitable alternative antiparasitic drugs, some patients who have experienced previous allergic-type reactions to antimicrobial agents may require readministration with incriminated drugs. We report the outcome of seven drug-allergic patients with AIDS evaluated from 1982 to 85. Readministration of pentamidine was carried out without repeated reactions in three patients, and sulfadiazine and sulfamethoxazole-trimethoprim were readministered after very cautious test dosing in two other patients. A generalized maculopapular rash developed after 10 days of sulfadiazine therapy for Toxoplasma chorioretinitis but has been managed with prednisone, 20 to 30 mg/day for 3 months, and sulfadiazine has been continued. The administration of prednisone, 100 to 200 mg daily for treatment of severe cutaneous vasculitis from azulfidine in another patient, did not result in suprainfection. The complexities and potential legal risk of readministration of drugs in the drug-allergic patient with AIDS are emphasized in that coincidental deaths occurred in two patients 48 and 96 hours after readministration of pentamidine.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Iatrogenic pseudoanaphylaxis.

A nurse exposed accidentally to chymopapain by ocular exposure was treated vigorously for chymopapain anaphylaxis. Retrospective analysis of the case indicates that there was no evidence of IgE antibody against chymopapain, and the clinical events were inconsistent with anaphylaxis and could be explained by a vasovagal reaction and the cardiorespiratory effects of repeated intravenous epinephrine. Our assessment is that the nurse is currently in a state of good health; however, she did not accept our absence of allergic disease diagnosis and has sought "clinical ecology therapy." Although no litigation in this case has arisen, the legal implications of this case report are reviewed.

Adult↗
PubMed1987

Allergic bronchopulmonary candidiasis: case report and suggested diagnostic criteria.

A patient with an illness consistent with allergic bronchopulmonary candidiasis is described. The patient had asthma, atelectatic pulmonary infiltrates on three occasions, immediate cutaneous reactivity as low as 10(-7) (wt/vol) to Candida albicans extract, and precipitating antibody to this organism. C. albicans was the only organism cultured from two bronchial lavage specimens. Total serum IgE was elevated to 5745 ng/ml and decreased rapidly with corticosteroid therapy. Serologic studies were not consistent with allergic bronchopulmonary aspergillosis. Serum IgE to C. albicans, measured by ELISA after adsorption of IgG from the serum samples by incubation with staphylococcal protein A, was found to be 575% to 650% above control values. The serum IgE antibody activity against Candida decreased with clinical improvement after corticosteroid therapy.

Adolescent↗
PubMed1987

Are stereoacuity and binocular rivalry related?

Several lines of evidence suggest that the processes of excitation and inhibition associated with good stereoacuity may also underlie binocular rivalry, implying that performance on these two tasks could be related. To test this possibility, we measured stereoacuity and rivalry under similar stimulus conditions in 40 observers. To estimate stereoacuity, a two-alternative, forced-choice procedure was used, wherein observers determined which of two sinusoidal grating patterns appeared displaced in depth. To measure rivalry, observers reported the occurrences of exclusive right- and left-eye dominance; dominance durations and alternation rates were recorded. The results showed that stereoacuity was significantly correlated with binocular rivalry, suggesting that stereoacuity and rivalry may share, at least in part, common neural mechanisms.

Depth Perception↗
PubMed1987

IgE against ethylene oxide-altered human serum albumin (ETO-HSA) as an etiologic agent in allergic reactions of hemodialysis patients.

Ethylene oxide (ETO) is used to sterilize hemodialyzers and other medical equipment. In an attempt to confirm a link between ETO and hypersensitivity reactions during hemodialysis (HD) we quantitated IgE and total antibody directed against ETO-altered human serum albumin (ETO-HSA) in the sera of 65 hemodialysis patients. In 24 patients who had experienced anaphylaxis during HD, the levels of IgE and total antibody against ETO-HSA were significantly higher than the corresponding levels in 41 patients who had not. Our data demonstrate an association between the presence of IgE and total antibody against ETO-HSA and immediate anaphylactic reactions to HD. In further studies we characterized the ETO-HSA antigen by immunoelectrophoresis, gel filtration chromatography, and cross-inhibition immunoassay. Our results suggested that ETO gas can alter HSA and induce new antigenic determinants on the molecule. Recently, we encountered a peritoneal dialysis patient with rash and eosinophilia. Suspecting ETO allergy, we measured serum IgE and total antibody to ETO-HSA and found both to be present. The data suggest that, in addition to the familiar HD reactions, ETO sensitization might cause other allergic diseases as well.

Anaphylaxis↗
PubMed1987

Toluene diisocyanate respiratory reactions. I. Reassessment of the problem.

A series of workers with exposure to and respiratory symptoms from toluene diisocyanate (TDI) was compared with a group of exposed, asymptomatic workers and with normal controls using immunologic and clinical evaluations. Improved understanding of TDI-induced respiratory disease may best be achieved by categorizing the symptomatic workers into at least 3 and possibly 4 groups: immunologic TDI asthma; pre-existing chronic respiratory disease exacerbated or unaffected by TDI; asthma coincidental with TDI exposure, and possibly TDI respiratory disease secondary to toxic or inflammatory mechanisms.

Adult↗
PubMed1987

The bronchoconstrictor properties of platelet-activating factor in humans.

Platelet-activating factor (PAF) is an inflammatory mediator that causes bronchial smooth muscle contraction in vitro and in vivo in experimental animals. To characterize the effect of PAF on human airways, 6 normal subjects and 6 subjects with mild asthma inhaled PAF using a standard bronchoprovocation protocol and nebulizer concentrations ranging from 0.1 to 1000 micrograms/ml. Aerosolized PAF produced bronchoconstriction in 5 of 6 normal and 3 of 6 asthmatic subjects as defined by at least a 35% decrease in specific airway conductance (SGaw). However, in these same subjects, flow rates measured at 30% of vital capacity from a partial forced expiratory maneuver (V30P) did not decrease at least 30% nor did the FEV1 decrease by 20%. The 8 PAF responders were 5 to 836 times more sensitive to PAF than to methacholine when SGaw was used to assess the airway response. The relative airway sensitivity of the PAF nonresponders could not be assessed. Normal and asthmatic subjects could not be differentiated by their airway response to PAF, and there were no clinical features that differentiated PAF responders from nonresponders. The maximal airway response to PAF occurred within 2 to 3 min and lasted 15 to 45 min. There were no late reactions. Both normal (p less than 0.01) and asthmatic (p less than 0.05) subjects exhibited tachyphylaxis to PAF. Finally, PAF sensitized the airways of all normal subjects to methacholine, including the one PAF nonresponder (p less than 0.02), but it did not sensitize the airways of the asthmatic subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Histological evaluation of the vascular system for the severity of atherosclerosis in hyper and hypotensive male and female turkeys: comparison between young and aged turkeys.

Relationships among age, blood pressure, and atherosclerosis were studied in turkeys genetically selected for high and low systolic blood pressure ranging in age from 2 days to 104 weeks. Relationships between sex and atherosclerosis were studied only at 104 weeks of age. Abdominal aortas were examined in all birds in each age group. The left and right internal, external, and common carotid arteries, cranial and caudal thoracic aortas, area of coeliac orifice, sciatic junction, left and right sciatic arteries, left and right coronary arteries, and left and right deep branches of the coronary arteries were examined in the 104-week-old group. Mean abdominal aortic plaque scores for the different age groups increased linearly to the age of 12 weeks; after this time scores reached a plateau. Except for the first and last time period, the hypertensive group of males showed a significantly greater abdominal aortic plaque score than the hypotensive group. The right sciatic artery was the only other blood vessel in the 104-week-old group that had a significantly greater plaque score in the hypertensive line when compared with the hypotensive line. In the 104-week period, only the left and right sciatic arteries showed significantly higher plaque scores in the males than in the females. Also, only the male turkeys showed an increase in plaque scores with a concomitant rise in systolic pressure. In 104-week-old females there was no evidence of intimal change in either the left and right internal carotids, left and right common carotids, cranial thoracic aorta, or the right coronary artery. The hypertensive line had significantly greater blood pressure and greater ventricular weight, length, and sagittal width than the hypotensive line. The 104-week-old turkeys had more lipid staining material within the plaque than the younger birds, and calcification was evident in two of the older turkeys.

Aging↗
PubMed1987

The management of asthma during pregnancy and lactation.

The optimal management of asthma during pregnancy and lactation requires a cooperative approach between the physician managing asthma, the obstetrician-gynecologist, and the patient. Goals of therapy include: 1) avoidance of repeated episodes of asthma, 2) avoidance of emergency room visits, 3) avoidance of status asthmaticus, 4) prevention of death in the mother, 5) use of minimal medications in the gravida, and 6) avoidance of maternal medication use with uncertain or deleterious effects on the fetus. Because acute severe asthma may have it onset during pregnancy, the physician must be prepared to diagnose and treat the gravida to avoid or reduce episodes of maternal hypoxemia, hypocarbia or hypercarbia. Status asthmaticus has been associated with maternal and fetal deaths as well as intrauterine growth retardation. Although it is logical to assume that prevention of repeated episodes of asthma would be associated with a more favorable outcome in pregnancy, only recently was this actually documented. The purpose of this manuscript is to review issues in diagnosis and management of asthma during pregnancy and lactation.

Asthma↗
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↗
PubMed1987

Stage V (fibrotic) allergic bronchopulmonary aspergillosis. A review of 17 cases followed from diagnosis.

A review of the records of 17 patients with stage V (fibrotic stage) allergic bronchopulmonary aspergillosis observed since initial diagnosis (mean observation period, 4.9 years) demonstrated that, of the 11 surviving patients, four have very severe respiratory impairment. The other seven patients have mild or moderate functional impairment, but most of these have not shown clinical deterioration during the observation period. The occurrence of new roentgenographic infiltrates after the time of diagnosis was observed in only one patient in this series. Serum IgE and IgG levels against Aspergillus fumigatus, when compared with those of a control pool of serum samples from asthmatic patients with immediate cutaneous reactivity to Aspergillus, were the most useful immunologic studies diagnostically. Lung biopsy specimens obtained in five patients were of relatively little diagnostic value. All patients have required long-term prednisone therapy for control of asthma. Those patients whose forced expiratory volume in 1 s (FEV1) remained less than or equal to 0.8 L after initial corticosteroid treatment demonstrated a poor prognosis. When only moderate lung damage has occurred at the time of diagnosis, a stable subsequent course may be expected even in patients with stage V disease.

Adult↗
PubMed1987

Occupational immunologic lung disease.

Occupational immunologic lung diseases either asthma or hypersensitivity pneumonitis, can occur in a wide variety of occupations from numerous antigens. New OILD syndromes and antigens are being reported constantly. In the case of some occupational agents that have been reported like isocyanates, formaldehyde, and Western red cedar, there is current investigation into the incidence of disease, mechanisms, and appropriate diagnostic criteria. A key principle in OILD is that prevention or at least early treatment by environmental control should be the goal. Determination of threshold limits for sensitization and adherence to these limits would be useful, for instance. In manufacturing processes in which this is not possible, workers and management in high risk industries should be educated so that affected workers are recognized early and avoidance can be instituted. Currently, there are no pre-employment screening criteria that have been shown to be very useful in predicting OILD. Prospective studies of animal handlers are underway and may provide useful information. In the case of TMA-exposed workers, prospective studies have demonstrated that serial immunologic studies are useful in predicting workers at risk for OILD and that reduction of airborne exposure will reduce prevalence. This sort of approach will probably be useful in studying other occupational agents. Such studies are complex and, to succeed, generally require cooperation and collaboration of physicians, industry, labor, industrial hygiene, and governmental agencies.

Alveolitis, Extrinsic Allergic↗
PubMed1987

Allergic bronchopulmonary aspergillosis. Model of bronchopulmonary disease with defined serologic, radiologic, pathologic and clinical findings from asthma to fatal destructive lung disease.

Allergic bronchopulmonary aspergillosis (ABPA) complicates asthma and results in immunologic lung destruction. Respiratory failure or fatalities from end-stage fibrotic lung disease have occurred in patients in the third and fourth decades of life. Allergic bronchopulmonary aspergillosis may be confirmed in patients with varying severity of asthma from minimal to corticosteroid-dependent and has been reported to occur in approximately 10 percent of patients with cystic fibrosis. It has been documented in infants and children, the geriatric patient with asthma, in the presence of a normal chest roentgenogram, in the corticosteroid-dependent asthmatic patient, and on a familial basis. The pathogenesis of ABPA is unclear, but may be related to the array of immunologic abnormalities including: elevation of total serum IgE, not all of which is directed to Aspergillus fumigatus (Af); elevated serum IgE-Af, IgG-Af and IgA-Af; precipitating antibodies to Af; hyperreactivity of peripheral blood basophils to Af and other molds; and sensitized lymphocytes. Research in ABPA should be multidisciplinary and initially should include investigators in allergy-immunology, mycology, pulmonary, and epidemiology.

Aspergillosis, Allergic Bronchopulmonary↗
PubMed1987

Strength testing with a portable dynamometer: reliability for upper and lower extremities.

This study was designed to determine intraobserver and interobserver reliability of maximal muscle strength for upper and lower extremity muscle groups. Four healthy subjects were tested with a portable muscle dynamometer on two separate occasions by three separate examiners to determine maximal isometric strength of lateral pinch between thumb and index finger, elbow flexion, elbow extension, shoulder flexion, hip flexion, hip extension, hip abduction, knee flexion, and ankle dorsiflexion. A break test was also used to evaluate the strength of cervical flexor muscles and extensor hallucis longus. Pearson correlation coefficients for inter- and intraexaminer testing was good for upper extremity test values from 0.85 to 0.99. The variation coefficient of the methodology error (CV) in all upper extremity muscle tests was between 5.1% and 8.3%. These results seemed reliable for clinical muscle strength testing. However, correlation coefficients for lower extremity testing were poor, with values ranging from -0.20 to 0.96. The CV in these tests was much greater than in the upper extremities and ranged from 11.3% to 17.8%. Both break tests also had high CV, with each being greater than 17%. Our results demonstrate that although the dynamometer is reliable for testing upper extremity muscle groups, it is unreliable for testing lower extremity muscle groups. Further work is needed to evaluate muscle strength quantitatively in the clinical setting in an accurate, valid, and reliable manner.

Arm↗
PubMed1987

Hyperparathyroidism in pregnancy.

Two cases of primary hyperparathyroidism in pregnancy are described. One was treated by parathyroidectomy in the late third trimester with good outcome. It appears that parathyroidectomy, although traditionally performed in the second trimester, may in selected cases be a reasonable treatment option in late pregnancy. The other patient was treated successfully with large doses of oral phosphosoda. Hypokalemia in association with this form of therapy, and not related to diarrhea or other known etiologies, is described for the first time.

Adult↗