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Biomedical subjects

R Patterson

Publications and source records attributed to R Patterson.

At least 361 records · Page 20Linked to original sources
PubMed1984

Processing of the external transcribed spacer of murine rRNA and site of action of actinomycin D.

The primary rRNA transcript contains a large external transcribed spacer (ETS) approximately 4,000 nucleotides in length. We have used subcloned DNA probes derived from the 5' end of the ETS in conjunction with Northern blot analysis of murine nuclear RNA to examine processing of this region. In agreement with the results of previous investigators, we find that the large rRNA precursor lacks part of the ETS region. These ETS sequences are also missing from subsequent rRNA processing intermediates. Experiments using actinomycin D confirm that the excision of portion of the ETS is an early event in rRNA processing. In addition, in the presence of actinomycin D small RNA species accumulate which hybridize to a probe specific for the 5' end of the ETS. The length of these abbreviated transcripts defines a region of rDNA which is probably a target for this drug.

Animals↗
PubMed1984

Anaphylactic reactivity to streptokinase.

Streptokinase is used worldwide as a thrombolytic agent. Allergic reactions have been observed to streptokinase; however, the immunologic mechanisms have not been described. In a case of an anaphylactic reaction to intravenously administered streptokinase during the evolution of a myocardial infarction, the patient had elevated specific IgE and IgG levels to this agent demonstrated by in vitro methods. In vivo testing demonstrated cutaneous immediate-type hypersensitivity with a typical wheal and flare reaction. Critically ill patients receive short-term treatment with streptokinase. Because of the potential danger of anaphylaxis in these patients, we provide an approach that may identify those at risk. The urgency of the requirement for immediate administration of streptokinase is such that an in vitro test cannot be used; thus, results of appropriate skin testing must be evaluated.

Anaphylaxis↗
PubMed1984

Cutaneous allergy to human (recombinant DNA) insulin.

p6 report two cases of cutaneous allergy to human (recombinant DNA) insulin. Each patient had a history of systemic allergic reactions to porcine insulin and was at least as reactive to human as to porcine insulin by end-point cutaneous titration. Both patients' insulin allergy was managed with animal insulins and both have done well. Our experience with these two patients indicates that human insulin (rDNA) should not be expected to be efficacious in all patients with systemic allergy to insulin.

Adult↗
PubMed1984

Daunomycin in the treatment of experimental proliferative vitreoretinopathy: retinal toxicity of intravitreal daunomycin in the rabbit.

The retinal toxicity of daunomycin, a drug that effectively suppresses experimental proliferative vitreoretinopathy (PVR), was studied in the rabbit by clinical examination, electroretinography (ERG), light microscopy, and electron microscopy. Although no toxicity was observed at the therapeutically effective dose of 10 nmol per eye, the safety margin is too small to recommend this drug for therapy of proliferative vitreoretinopathy in man.

Animals↗
PubMed1984

Stereopsis during continuous head motion.

This study investigated the degree to which the processing of stereoscopic information is degraded by side-to-side head rotations of amplitudes and frequencies known to disrupt binocular correspondence. Forced-choice recognition thresholds were obtained for a briefly presented stereoscopic test stimulus, formed from a dynamic random-element stereogram, under conditions of active head rotation. Thresholds were not impaired by such head movements, a result consistent with the hypothesis that precise binocular correspondence is not essential for the processing of stereoscopic information.

Depth Perception↗
PubMed1984

The effect of testing method on stereoanomaly.

Previous tests of stereoanomaly (a deficit in stereopsis for a given disparity direction, crossed or uncrossed) have employed stimuli in which physical contours are presented with large disparities at exposure durations too brief for eye movements. This study investigated stereoanomaly using alternative testing methods with two types of stimuli: (1) stereoscopic contours formed from dynamic random-element stereograms presented both briefly and continuously, and (2) afterimages of retinally disparate physical contours. The results from three experiments show that most subjects who are classified as stereoanomalous under conditions of brief exposure perform normally under conditions that allow long inspection periods while eliminating eye movements. These results suggest that anomalies in stereopsis previously reported may depend on the method of testing rather than on deficits in underlying neural mechanisms.

Afterimage↗
PubMed1984

Serum IgE as an important aid in management of allergic bronchopulmonary aspergillosis.

Differentiating patients with allergic bronchopulmonary aspergillosis (ABPA) from patients with asthma who have immediate skin reactivity to Aspergillus fumigatus may be difficult when the characteristic clinical and laboratory findings of ABPA are absent. This article describes the response of ABPA patients to corticosteroid therapy. After treatment of the acute stage of the disease with corticosteroid therapy, all ABPA patients had greater than or equal to 35% reduction of the total serum IgE within 2 mo. In 30 exacerbations of ABPA in 15 patients, there was greater than or equal to 35% reduction total serum IgE, in 24 exacerbations within 2 mo. Of the six exacerbations with less than 35% reduction of total serum IgE, noncompliance to medical therapy was clearly documented in three exacerbations. In one exacerbation with a slowly resolving pulmonary infiltrate, 6 mo of corticosteroid therapy was required before the total IgE decreased 35%. The total serum IgE and its response to corticosteroid therapy is a sensitive marker in ABPA and can be considered an important aid in management of ABPA. Failure to achieve greater than 35% reduction of total serum IgE by 2 mo with the administration of corticosteroid therapy in patients highly suspected of ABPA should make one either question the diagnosis of ABPA or consider noncompliance of the patient to medical management with corticosteroids.

Adolescent↗
PubMed1984

Proteins: chymopapain and insulin.

We studied clinical and immunologic aspects of the reactions to two newly introduced drugs, chymopapain and human recombinant deoxyribonucleic acid insulin (HI), in patients demonstrating allergies to one of these two drugs. We then used this information to improve our ability to diagnose and prevent chymopapain allergy and to further our understanding of systemic insulin allergy and its management. Of the patients who were sensitive to chymopapain, one had severe anaphylaxis to intradisc injection while the other had rhinitis, asthma, and urticaria with occupational exposure. The latter demonstrated cutaneous reactivity to papain; the former refused skin testing. Both demonstrated immunoglobulin (Ig) E and IgG to chymopapain as measured by enzyme-linked immunosorbent assay. We have prospectively skin tested 61 patients with chymopapain. Sixty-one patients have had negative skin tests and have tolerated the intradisc injection of chymopapain without incident. We are continuing our prospective skin test study in order to identify a population at risk for allergy to chymopapain. Two patients with systemic allergic reactions to animal insulin have at least as much cutaneous reactivity and IgE and IgG antibodies to HI as to porcine insulin. A large local reaction occurred during an attempt to desensitize one of them to HI; the patient was subsequently desensitized without difficulty to porcine insulin, to which she was less skin reactive. We conclude that HI will not eliminate insulin allergy in patients with systemic allergy to animal insulin and that such patients will continue to require the usual therapeutic measures for insulin allergy.

Adult↗
PubMed1984

Recurrence of allergic bronchopulmonary aspergillosis after seven years of remission.

A staging system has been presented previously to assist in the evaluation and management of allergic bronchopulmonary aspergillosis (ABPA). One of these stages is a remission stage in which patients are free from pulmonary infiltrates. It had been uncertain whether patients with ABPA in remission were at risk for recurrences. We now present a patient in whom recurrence of ABPA developed after 7 yr of remission that demonstrates that patients with ABPA are at risk for recurrences for a prolonged period of time.

Adult↗
PubMed1984

Persistence of efficacy after a brief course of polymerized ragweed allergen: a controlled study.

Immunotherapy with PRW has been demonstrated to be safe and effective. To determine whether the efficacy would remain in successive ragweed seasons without further therapy, a trial was conducted comparing PRW to histamine placebo therapy in patients that had received courses of PRW previously. Those patients were also compared to previously untreated ragweed-sensitive patients. In a double-blind fashion, 21 previously treated patients were treated before the 1982 ragweed season with four injections of PRW therapy, whereas 21 previously treated patients were treated with four injections of placebo therapy. An additional control group of 21 previously untreated ragweed-sensitive patients received no injections. Daily symptom and medication score sheets were completed by patients each day of the ragweed season. Blocking antibody rose elevenfold with treatment (p less than 0.0001) in the PRW group. There was a statistically significant difference in symptom score mean between untreated patients (1007 +/- 174) and previously treated patients whether they received supplemental injections (554 +/- 180) (p less than 0.01) or whether they did not (650 +/- 168) (p less than 0.03). In summary the efficacy of 15 injections of PRW immunotherapy persists at least several years without need for supplemental immunotherapy.

Clinical Trials as Topic↗
PubMed1984

Two pretreatment regimens for high-risk patients receiving radiographic contrast media.

The risk of anaphylactoid reaction (AR) developing from radiographic contrast media in patients who previously have had an AR to radiographic contrast media ranges from 17% to 60%. Pretreatment with prednisone plus diphenhydramine or prednisone and diphenhydramine plus ephedrine decreased the reaction rate to 9.0% and 3.1%, respectively, during 657 procedures in 563 patients. No deaths occurred, and only three episodes of transient hypotension developed, one of which was treated with epinephrine. Pretreatment consisted of prednisone, 50 mg, 13 hr, 7 hr, and 1 hr before the procedure and diphenhydramine, 50 mg, 1 hr and or ephedrine, 25 mg, 1 hr before the procedure. The addition of ephedrine provided a statistically significant reduction in reaction in 192 procedures (chi 2 = 5.4996, p = 0.019). In 138 procedures in patients whose initial AR was considered serious, pretreatment was as effective as for patients with histories of mild to moderate reactions. Emergency equipment should be available for all procedures.

Anaphylaxis↗
PubMed1984

IgE against ethylene oxide-altered human serum albumin in patients who have had acute dialysis reactions.

Serum samples obtained from seven hemodialysis patients with immediate-type allergic reactions, from six hemodialysis patients without reactions, and from three nonatopic control subjects were analyzed for IgE against human serum albumin exposed to ethylene oxide (ETO-HSA). ETO is used to sterilize medical equipment like dialyzers that cannot withstand heat sterilization. IgE to ETO-HSA, measured by a polystyrene tube technique was found in six of seven dialysis reactor patients but in only one of six nonreactor patients (p less than 0.05 two-tailed Fisher's exact test). No control sera from three nonatopic individuals had antibody. The reactor patients had 2.0 +/- 8.0 ng (SD) of ETO-HSA bound per milliliter of serum, whereas nonreactor patients had 0.2 +/- 8.0 ng per milliliter bound (p less than 0.05 one-tailed Student's t test on log transformed values). We suggest that there is an association between the presence of IgE to ETO-HSA and immediate-type allergic reactions to dialysis in this group of patients.

Antibody Specificity↗
PubMed1984

Allergic bronchopulmonary aspergillosis in cystic fibrosis.

One hundred patients with CF were screened for ABPA. Forty-eight male patients and 52 female patients with age range of 2 to 34 yr (mean 14.2) were studied. Patients were evaluated for skin reactivity and serum precipitating antibodies to Af, predominant sputum organisms, total blood eosinophil levels, total serum IgE, and Af-specific IgE and IgG, as well as abnormalities of pulmonary function and chest x-ray films. Careful evaluation of all patients with CF demonstrated that 10% had features indicative of ABPA, which is another potentially destructive pulmonary disorder. Thus careful evaluation of patients with CF, especially those with asthma, may be rewarding in uncovering a disorder that may slow progression of CF when it is appropriately treated.

Adolescent↗
PubMed1984

Asthma as a variable in a study of immunotherapy for allergic rhinitis.

Fifty patients recruited with ragweed allergic rhinitis were studied. Twenty-three of these patients had asthma. On the basis of cutaneous end point titration to ragweed, patients were randomly assigned to polymerized ragweed (PRW), placebo, or untreated groups. PRW patients received the equivalent of 1200 micrograms AgE in 15 weekly injections. All patients were followed through the ragweed season with daily rhinitis symptom-medication diaries. All patients had determinations of IgE against AgE and total (blocking) antibody to AgE before and after the injection series. In these patients selected for allergic rhinitis, the presence or absence of asthma did not significantly influence rhinitis symptom-medication scores or the values of immunologic parameters. Moreover, whether or not patients had asthma, those who received PRW had an increase in total AgE binding with no increase in IgE-a-AgE and significantly lower rhinitis scores than those who did not.

Adult↗
PubMed1984

The role of surgical resection when combined with chemotherapy and radiation in the management of pelvic rhabdomyosarcoma.

With the development of combined chemotherapy and radiation therapy for embryonal rhabdomyosarcoma, the role and extent of surgical resection of these pelvic tumors need to be defined. Thirty-six children with pelvic genitourinary rhabdomyosarcoma seen at St. Jude Children's were managed on protocols combining surgical resection and radiation, and chemotherapy. Ten children presented with cervical-vaginal tumors, which were managed with combined therapy; the surgical resection was histovaginectomy in eight and pelvic exenteration in one. Eight of the ten are free of disease from 1 to 14 years. Twelve children presented with bladder and prostate tumors, which were resected with segmental cystectomy in four cases, biopsy in five, and pelvic exenteration in three. All received combination therapy and six of the twelve are surviving free of disease from 6 months to 16 years. Fourteen children presented with paratesticular rhabdomyosarcoma. Chemotherapy was combined with radical orchiectomy in all cases. Retroperitoneal node dissection was done in nine and five had inguinal node dissection. Nine of the 14 are surviving NED from 2 to 16 years. One patient died, free of disease, with complications of combination therapy. The results of this review supports the approach of combining chemotherapy, radiation, and complete surgical resection.

Adolescent↗
PubMed1984

Polymerization of individual species of tree pollen allergens.

This report describes the preparation of individual tree pollen allergen polymers in contrast to our previous description of the polymerization of a mixture of tree pollens.. These individual polymers may be used for immunotherapy as indicated by the IgE-mediated reactivity of each patient. A modified chromatographic fractionation process was used which results in tree polymers with skin reactivity 1,000- to 10,000-fold less from monomers and with a defined lower molecular weight limit. The modified preparative methodology results in polymer preparations as safe but with greater ease of production than polymers prepared with previous methodologies.

Allergens↗
PubMed1984

Varying presentations of allergic bronchopulmonary aspergillosis.

The diagnosis of allergic bronchopulmonary aspergillosis (ABPA) may be difficult when the major criteria are not present or when the clinical, laboratory, and radiographic findings have been altered by prior corticosteroid therapy. However, the early diagnosis of ABPA is important because it may lead to the prevention of evolution to the corticosteroid-dependent asthma stage (stage IV) or fibrotic lung disease stage (stage V). The clinical histories of 3 ABPA patients are reviewed to demonstrate that these patients may appear in different stages of ABPA and with markedly varied presentations. The high index of suspicion required for diagnosis of ABPA deserves emphasis as does the importance of excluding a diagnosis of ABPA in all asthmatics with immediate skin reactivity to Aspergillus fumigatus.

Adult↗