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Biomedical subjects

R Patterson

Publications and source records attributed to R Patterson.

At least 37 records · Page 2Linked to original sources
PubMed1992

Different patterns of relapse associated with three intensive treatment regimens for pediatric E-rosette positive T-cell leukemia: a Pediatric Oncology Group study.

One hundred and ninety-three children with T-cell acute lymphocytic leukemia (T-ALL) whose leukemia cells were E-rosette positive were treated on a Pediatric Oncology Group study (1979-1986) designed specifically for patients with T-ALL. The results of modified LSA2L2 therapy with or without intensified intrathecal chemotherapy and cranial irradiation (radiotherapy) were compared with those obtained using a simpler multi-agent protocol which included radiotherapy (T-cell 2). The complete remission (approximately 90%) and 3-year event-free survival rates (approximately 40%) were similar in the three treatment groups. However, the pattern of extramedullary relapse varied according to specific treatment regimen. Patients who received LSA2L2 therapy with less intensive intrathecal chemotherapy and no radiotherapy had a central nervous system (CNS) relapse rate (i.e. isolated CNS +/- other site) of over 20%, compared to only 10% for patients receiving the same systemic chemotherapy with intensified intrathecal therapy and radiotherapy, and less than 5% for those receiving T-cell 2 therapy. In contrast, males receiving T-cell 2 therapy had a testicular relapse rate of greater than 20% compared to less than 10% for patients receiving either regimen (i.e. +/- intensified intrathecal chemotherapy and radiotherapy) of modified LSA2L2 therapy. We conclude that, in the context of these therapies, central nervous system irradiation plus intensive triple (hydrocortisone, methotrexate, cytarabine) intrathecal chemotherapy is more effective than CNS preventative therapy comprised of intrathecal low-dose methotrexate only, and that the more complex multi-agent chemotherapy used in the modified LSA2L2 regimens appeared to be more effective in prevention of testicular leukemia, indicating that the effectiveness of sanctuary site treatment was therapy-specific.

Adolescent↗
PubMed1992

Malignant idiopathic anaphylaxis: three additional cases and extended evaluation.

Northwestern University's Division of Allergy and Immunology (NUAI) has evaluated and treated 225 patients with idiopathic anaphylaxis (IA) over a period of 16 years. Four patients have been identified with malignant IA. The term "malignant" is used to identify those patients with the most severe form of IA that is resistant to standard therapy. The diagnosis of malignant IA is made in patients with IA whose controlling oral corticosteroid dose was not able to be reduced below 60 mg of prednisone (or its equivalent) every other day or 20 mg of prednisone (or its equivalent) every day without an exacerbation of IA. Presented here is the long-term evaluation of one patient as well as three additional patients with malignant IA managed by our service. At the time of this report we have had no deaths due to IA in patients treated with pharmacologic regimen.

Adrenal Cortex Hormones↗
PubMed1992

Herpes simplex virus associated with recurrent Stevens-Johnson syndrome. A management strategy.

We describe a 36-year-old man with recurrent Stevens-Johnson syndrome, which became progressively more severe over a 13-year period. His episodes were apparently preceded by herpes simplex virus oral mucosal infections. A management protocol, including immediate therapy with acyclovir and prednisone at the onset of herpes simplex virus oropharyngitis, is outlined. This management strategy has successfully prevented four subsequent episodes of progression to Stevens-Johnson syndrome. Thus, Stevens-Johnson syndrome associated with herpes simplex virus may be prevented by early use of acyclovir and prednisone.

Acyclovir↗
PubMed1991

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Attitude of Health Personnel↗
PubMed1991

Outcome of prophylactic therapy for idiopathic anaphylaxis.

OBJECTIVE: To determine the efficacy of a prophylactic regimen (prednisone, H1 blockade, and sympathomimetic amine therapy) in patients with idiopathic anaphylaxis. DESIGN: Clinical trial before and after treatment. SETTING: Referral-based allergy clinic at a major medical center. PATIENTS: Fifty-three patients with a history compatible with idiopathic anaphylaxis for at least 6 months before presentation to the allergy service and with subsequent management by the service for at least 6 months. INTERVENTIONS: Patients with frequent life-threatening symptoms were treated with a prophylactic regimen. Patients with infrequent episodes of idiopathic anaphylaxis were only treated acutely for each episode of anaphylaxis. MEASUREMENTS AND MAIN RESULTS: The results favored prophylactic treatment with prednisone for patients who were classified as generalized-frequent in the clinical outcome measures of frequency (per patient per year) of episodes (mean before treatment, 7.31 +/- 6.46; after treatment, 3.61 +/- 4.73; P less than 0.02) and emergency room visits (mean before treatment, 1.94 +/- 3.42; after treatment, 0.21 +/- 0.44; P less than 0.005) and for patients classified as angioedema-frequent in the frequency of episodes (mean before treatment, 14.93 +/- 15.89; after treatment, 2.58 +/- 2.18; P less than 0.003) and emergency room visits (mean before treatment, 0.76 +/- 1.01; after treatment, 0.07 +/- 0.11; P less than 0.025). No statistically significant difference was found for patients classified as generalized-infrequent in the frequency of episodes (mean before treatment, 2.01 +/- 1.30; after treatment, 1.36 +/- 1.79) or of the emergency room visits (mean before treatment, 0.56 +/- 0.71; after treatment, 0.32 +/- 0.75) or for patients classified as angioedema-infrequent in the frequency of episodes (mean before treatment, 1.94 +/- 1.55; after treatment, 2.03 +/- 2.16) or of emergency room visits (mean before treatment, 0.27 +/- 0.44; after treatment, 0.37 +/- 0.59). CONCLUSIONS: Prophylactic treatment with prednisone and H1 antihistamines with or without sympathomimetic amines improves clinical outcome in patients who are classified as idiopathic anaphylaxis-angioedema frequent and idiopathic anaphylaxis-generalized frequent.

Adolescent↗
PubMed1991

The cyclopean ternus display and the perception of element versus group movement.

This study investigated the perception of bistable stroboscopic motion (Ternus display) with cyclopean stimuli created from retinal disparity embedded in dynamic random-element stereograms, the responses to which arise at binocular-integration levels of the visual system. To provide comparison data, observers were also tested with luminance-domain stimuli matched as closely as possible to their cyclopean counterparts. The results showed that the perception of element vs group movement was similar for both stimulus domains: element movement predominated at short interstimulus intervals (ISIs) while group movement predominated at long ISIs, and there was a tendency for a greater percentage of group movement to occur with a longer frame duration. These results cast suspicion on the interpretation of bistable motion that assumes element movement is a signature of a lower-level, short-range motion system whereas group movement is a signature of a higher-level, long-range system; both percepts are engendered at binocular-integration levels of vision.

Depth Perception↗
PubMed1991

The prevention of immediate generalized reactions to radiocontrast media in high-risk patients.

The use of lower osmolality radiocontrast media (RCM) has been associated with satisfactory radiographic opacification and a reduced incidence of severe reactions. The higher cost without clearly established benefit of these media have limited their use. This investigation assessed the incidence of immediate generalized reactions (IGRs) to repeated RCM IGRs in pretreated high-risk patients who received iopamidol or iohexol during 200 procedures (181 intravascular). All patients had experienced a previous IGR to a conventional RCM. Pretreatment consisted of prednisone, 50 mg, 13, 7, and 1 hour before the procedure and diphenhydramine, 50 mg, 1 hour before the procedure in 140 intravascular infusions. Ephedrine, 25 mg, 1 hour before the infusion was added to prednisone-diphenhydramine in 41 cases. Only one (0.7%) urticarial reaction occurred in 141 procedures with prednisone-diphenhydramine. No repeated IGR occurred with the three-drug regimen. The reaction rate after pretreatment with prednisone-diphenhydramine or prednisone-diphenhydramine-ephedrine and use of conventional contrast media during 800 intravascular procedures was 9.1%, and with pretreatment and lower osmolality contrast media in 181 intravascular infusions, it was 0.5% (chi 2 = 14.35; p less than 0.001). Lower osmolality contrast media should be the contrast media of choice for patients with a prior IGR to conventional contrast media. In addition, patients should receive prednisone-diphenhydramine-ephedrine or prednisone-diphenhydramine prophylaxis.

Contrast Media↗
PubMed1991

Serum IgE and IgG to formaldehyde-human serum albumin: lack of relation to gaseous formaldehyde exposure and symptoms.

Fifty-five subjects were studied to determine if the presence of IgE or IgG antibodies to formaldehyde (F)-human serum albumin (HSA) was associated with exposure to gaseous F or with respiratory or conjunctival symptoms from such exposure. The study population included cohorts exposed to F in the workplace, smokers, and normal subjects. IgE antibody specific for F-HSA was detected by ELISA in three subjects; immediate-type skin testing was negative in two of these subjects, and not interpretable because of dermatographism in one subject. One of these subjects had a history of respiratory symptoms when the subject was working in a histology laboratory that contained ambient F and xylene; a respiratory challenge with F at concentrations of up to 2 ppm failed to produce respiratory symptoms or significant changes in pulmonary function. Serum from the three subjects with IgE to F-HSA by ELISA failed to passively transfer skin reactivity to F-HSA to rhesus monkey recipients. These three subjects and two other subjects had IgG to F-HSA by ELISA, although this was of generally low titer. We could not define a relationship between the presence of antibodies and (1) a history of F exposure or (2) a history of adverse respiratory or conjunctival symptoms from F. This study is a continuum of 5 years of study in our laboratory attempting to define allergy to gaseous F, and the current study does not support an immunologic basis for respiratory or conjunctival symptoms from gaseous F exposure. Based on the findings of this and our other studies, it is possible that clinical IgE-mediated allergy to gaseous F does not exist, or if it does exist, it is extremely rare.

Adult↗
PubMed1991

The effect of the oral leukotriene antagonist, ICI 204,219, on leukotriene D4 and histamine-induced cutaneous vascular reactions in man.

Eighteen normal male subjects were recruited for a double-blind, placebo-controlled, randomized, two-period crossover study to determine the effects of a new, potent, highly selective, oral peptide leukotriene antagonist (ICI 204,219) on cutaneous vasculature. Skin testing for leukotriene D4 (LTD4) and histamine was performed at three different time intervals after receiving ICI 204,219 or placebo. The LTD4 threshold dose responses were recorded in duplicate to verify reproducibility. These data confirm known remarkable dose-response variation of cutaneous vascular reactions to LTD4 since some subjects reacted to a dose as low as 0.001 fmol. Twelve subjects (67%) demonstrated a more than one-half log increase in their threshold response after receiving ICI 204,219. Five of these 12 subjects (28%) had greater than 1 log-dose response after ICI 204,219. Two of these subjects (11.1%) had a 5 or 10 log increase in their threshold response after receiving ICI 204,219. Given the role of leukotrienes as potentially important mediators in immediate-type reactions, our results raise the possibility for additional investigation of the antagonistic effect of ICI 204,219 in nonallergic and allergic cutaneous diseases.

Adolescent↗
PubMed1991

A comparison of cutaneous testing and ELISA testing for assessing reactivity to ethylene oxide-human serum albumin in hemodialysis patients with anaphylactic reactions.

In five patients who have experienced anaphylaxis and in 29 patients who have not had such episodes during hemodialysis, we have performed two immunologic studies: cutaneous testing with ethylene oxide-human serum albumin (ETO-HSA) and ELISA for IgE against ETO-HSA. Four of five patients with reactions had positive cutaneous tests, whereas only one nonreactor had a positive skin test (p less than 0.0002). The same four of five patients with reactions also had positive ELISA results, whereas three nonreactors has positive ELISA results (p less than 0.003). In this group of patients, the positive predictive value of cutaneous testing (80%) is somewhat higher than that of ELISA testing (57%). However, the sensitivity, specificity, and negative predictive values are similar. We conclude that cutaneous testing with ETO-HSA probably offers a small advantage over IgE against ETO-HSA as determined by ELISA.

Anaphylaxis↗
PubMed1991

Antibodies to toluene diisocyanate in patients with and without dialysis anaphylaxis.

In a majority of patients with anaphylaxis to dialysis, ethylene oxide has been identified as an etiologic agent. In a significant minority of patients sustaining such reactions, the antigen remains unidentified. Conflicting results have been published with regard to isocyanates as a possible antigen. The authors studied 19 hemodialysis patients with anaphylaxis in whom IgE against ethylene oxide-human serum albumin (ETO-HSA) was not identified (Group 1) and 25 peritoneal dialysis patients without anaphylaxis (Group 2). IgE against toluene diisocyanate-human serum albumin (TDI-HSA) was found in one patient in Group 1, and a similar incidence of IgG against TDI-HSA in Group 1 (16%) and Group 2 (12%) was noted. The results do not suggest that IgE against TDI-HSA is an important cause of dialysis anaphylaxis.

Anaphylaxis↗
PubMed1991

Control of asthma with emphasis on prevention of fatalities.

The airway disease termed asthma has been recognized for centuries but is now receiving increased attention because of chronicity, high incidence in the population and rising mortality rate. Asthma is now recognized as a disease of unknown etiology characterized by a hyperactive airway which can be demonstrated by research techniques or is readily apparent during clinical observations. The role of bioactive mediators in inducing asthma or its basic abnormality, the hyperactive airway, is a major research target as are the roles of neurokinins and inflammation. Management of asthma varies with experience, training and locale of the physician, and various types of available pharmacologic preparations are suitable for control of the intermittent wheezing of the mild asthmatic. As more severe asthma is encountered in individual patients, a more experienced physician and more intense therapy is required. The most severe form of asthma, characterized as PFA, requires intense therapy, close patient physician contact and further intense study, particularly of the psychosocial and economic patterns which interfere with optimal management.

Asthma↗
PubMed1991

Potentially fatal asthma and syncope. A new variant of Munchausen's syndrome in sports medicine.

We report a case of Munchausen's syndrome in a 19-year-old female college athlete who presented with potentially fatal asthma and recurrent syncopal episodes. Failure to control her asthma with the appropriate medications and the lack of objective findings on both physical examination and diagnostic testing raised the possibility of factitious disease. Munchausen's syndrome, although not described with any frequency in asthmatic patients, should be considered in the differential diagnosis of those patients refractory to aggressive medical management.

Adult↗
PubMed1991

Thirty-minute continuous sitting force measurements with different support surfaces in the spinal cord injured and able-bodied.

Able-bodied, paraplegic, and quadriplegic subjects sat for 30-minute intervals on various surfaces in a wheelchair with a forceplate mounted on the seat in order to determine factors that could contribute to the formation of decubitus ulcers. All three groups of subjects sat on ROHO and Jay cushions; in addition to sitting on the two cushions, the able-bodied subjects sat on a hard surface. Factors studied were: normal and shear seat forces, the location of the center of mass, and armrest force. The forceplate was under the cushions; therefore, the values reflect average forces over the buttocks and posterior thighs. These factors were compared between disability levels as well as between surface types. Larger, normal, and forward shear forces and a more anterior position of the center of mass were observed with the ROHO cushion. More frequent and larger lateral weight shifts occurred with the Jay cushion. The armrests tended to support from 5 percent of the body weight for quadriplegics to 9 percent for paraplegics. The results suggest that armrests reduce seat forces by carrying some of the body weight.

Adult↗
PubMed1991

Potentially fatal asthma: the problem of noncompliance.

In spite of available pharmacologic therapy that controls even the most severe cases of asthma, the mortality rate from asthma continues to rise. Patients with potentially fatal asthma (PFA) must be identified and then treated in a manner that will prevent potentially fatal episodes of asthma. Such management will not result in control of patients with PFA when the patient is not compliant with the medical regimen. We report and classify ten PFA patients according to the apparent psychologic abnormality that resulted in, or contributed to the noncompliance. Some of these psychologic abnormalities in patients with PFA such as adolescent noncompliance, prednisonephobia or bipolar affective disorders may be responsive to a combination of medical and psychiatric management. Other psychiatric diseases that may occur in patients with PFA, such as antisocial personality disorders or schizophrenia, may have a poor prognosis even with combined medical and psychiatric care. The managing physician should be aware of the grave prognosis in such cases.

Adolescent↗
PubMed1991

Efficacy of ketotifen in corticosteroid-dependent idiopathic anaphylaxis.

To assess the potential benefit of ketotifen in the treatment of patients with corticosteroid-dependent idiopathic anaphylaxis, ketotifen was administered in an open trial to nine patients with idiopathic anaphylaxis who required maintenance prednisone for control of their disease. A double-blind trial was not done for reasons of patient safety. After a period of management with prednisone and establishment of the minimal dose of prednisone that controlled idiopathic anaphylaxis, ketotifen was initiated and cautious reduction of prednisone was attempted. The prednisone requirement was not altered in two patients, but prednisone was either substantially reduced or terminated in seven patients. Of these seven, three patients developed recurrent symptoms of idiopathic anaphylaxis after tapering and discontinuation of ketotifen, and ketotifen had to be resumed. The statistical analysis of prednisone reduction was highly significant (P less than .004) and we conclude ketotifen was of significant benefit in seven of nine patients with corticosteroid-dependent idiopathic anaphylaxis.

Adult↗