Biomedical subjects
Publications and source records attributed to R Patterson.
We describe strategies that resulted in measurably high quantitative and qualitative contributions by medical staff to selection of a Patient Care Information System.
This paper describes computer-assisted instruction designed for medical students on their clinical surgery rotation. Patient care systems continue to evolve; incentives for physician participation should include educational benefits and clinical practice guidelines. Sometimes overlooked in the rush to develop expert systems are medical students, who do not have the depth of knowledge inherent in decision support. Foothills Hospital in Calgary, Canada, uses the TDS HC4000 patient care system, where physicians and medical students enter their orders directly on the terminals. The Surgical Patient Care Program was developed to help students learn the basics of peri-operative patient management. The Program runs on the HC4000 and consists of a collection of order sets with appended educational information to guide students in their automated order selection. Unlike other instructional programs, which use fictitious patients, students enter real orders on real patients. Tracking of usage indicates that the Program is popular with students, who each access it an average of 20 times per week. An ongoing study will determine any educational benefit by measuring student performance at Foothills Hospital against a control group at another hospital, which does not have a computerized patient care system.
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Allergic bronchopulmonary aspergillosis (ABPA) is a complex disease occurring in 1-2% of patients with asthma involving hypersensitivity to Aspergillus species. The diagnosis is made correlating clinical history and supporting serologic tests. Over many years various serologic tests have been used to both diagnose and follow disease activity. Initial serology from patients with all four positive tests (total serum IgE, IgE and IgG antibody indices, serum precipitins to Aspergillus fumigatus) were compared with the patients' most recent serology. The total serum IgE, IgE antibody index and serum precipitins had the most initial positive tests which stayed positive throughout treatment. The IgG antibody index was the most inconsistent. There were no significant differences between all four tests. We concluded that all four serologic tests are important in the diagnosis of ABPA.
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The Klippel-Trenaunay-Weber syndrome is a complex developmental disorder of the vascular and skeletal systems. While many features of the syndrome are congenital, it has not been diagnosed often before birth. This paper describes a case of Klippel-Trenaunay-Weber syndrome diagnosed at 19 weeks' gestation on the basis of sonographic findings and family history. The clinical variability of the syndrome is emphasized and the importance of family history in differential diagnosis is stressed.
Currently, no protocol exists that can assess the metastatic potential of prostate adenocarcinoma. The reason for this is partly due to the lack of information on cellular changes that result in a tumor cell's becoming metastatic. In this investigation, attempts were made to devise a method that correlated with the metastatic potential of AT-1, Mat-Lu, and Mat-LyLu cell lines of the Dunning R-3327 rat prostatic adenocarcinoma system. To accomplish this, we applied BioQuant biometric parameters, i.e., area, shape factor, and cell motility. AT-1 had a lower shape factor and a greater area as compared with the more highly metastatic Mat-Lu subline. No significant difference in area or shape factor was detected between the AT-1 cell line and the highly metastatic Mat-LyLu line. However, the lowly metastatic AT-1 line had less motility as compared with the Mat-Lu and Mat-LyLu lines. This study revealed that metastatic potential could be partially predicted via area and shape factor and accurately predicted via cell motility.
Across four experiments, this study investigated properties of the stereoscopic motion aftereffect (adaptation from moving retinal disparity information). The results showed that stereoscopic motion can induce an adaptation aftereffect across a wide range of conditions and observers, provided that the duration of adaptation is sufficiently long and a perceptually salient test pattern is viewed. Motion adaptation was found to transfer between the stereoscopic and luminance domains [replicating a previous report by Fox, Patterson and Lehmkuhle (1982) Investigative Ophthalmology and Visual Science (Suppl.), 22, 144], suggesting that motion perception from stereoscopic (second-order) and luminance (first-order) attributes is mediated by a common neural substrate.
The range of spatial displacements over which cyclopean (stereoscopic) apparent motion is perceived was investigated. The cyclopean stimuli were created from retinal disparity embedded in dynamic random-dot stereograms. In one experiment, the displacement range for crossed-disparity cyclopean motion was compared with that for luminance-domain motion. The results showed that cyclopean motion was perceived over spatial displacements that were about two to three times larger than the displacements over which luminance motion was perceived. In a second experiment, the displacement range for crossed-disparity cyclopean motion was compared with that for uncrossed-disparity cyclopean motion. The results revealed that the displacement range was restricted (motion quality was poor) for uncrossed motion relative to crossed motion. It is inferred that cyclopean motion from crossed disparity is represented at a coarse spatial scale, relative to luminance motion, and that cyclopean motion from uncrossed disparity is suppressed due to occlusion cues present when uncrossed stimuli are seen behind a textured background.
BACKGROUND: Cough variant asthma is defined as a persistent nonproductive cough with minimal wheezing or dyspnea. The uncontrolled coughing may interfere with sleep, work, and social activities. Cough precipitating fecal or urinary incontinence can be extremely distressing. The diagnosis is established within 1 to 2 weeks by a trial of prednisone, 30 mg a day. The cough will be controlled within that time and subsequent management can consist of inhaled corticosteroids. OBJECTIVE: To evaluate the course of ten patients with cough variant asthma and their response to inhaled corticosteroids. METHODS: Retrospective analysis of the presentation, diagnosis, course, and response to oral and inhaled steroids in ten patients with cough variant asthma. RESULTS: Ten patients whose chief complaint was persistent debilitating cough for periods of 2 months to 20 years underwent a diagnostic and therapeutic trial of prednisone as previously described. At a mean follow-up period of 28 months all were free of debilitating cough. Eight of ten patients were still receiving inhaled steroids and two needed low dose alternate day oral steroid therapy. Two patients had complete remission of symptoms. None required daily inhaled or oral bronchodilators and there were no hospital admissions for respiratory symptoms. CONCLUSIONS: Inhaled corticosteroid therapy after a diagnostic trial of oral steroids is effective for long-term control of cough variant asthma.
Evaluation of therapy for Stevens-Johnson syndrome was initiated as a retrospective analysis and then extended to a prospective series of patients treated with corticosteroids. This report extends the initial prospective study of patients with Stevens-Johnson syndrome treated with corticosteroids and evaluates the total series of 41 patients relative to outcome and the presumptive etiology. We propose that management of Stevens-Johnson syndrome requires corticosteroid therapy and that the survival of patients with Stevens-Johnson syndrome may depend on this therapy. No fatalities or adverse effects due to corticosteroids were noted. Stevens-Johnson syndrome due to a drug, a drug metabolite or viral infection may mimic a graft-versus-host reaction in which the patient rejects skin, mucous membrane, kidney or liver cells to which the drug, drug metabolite, or virus has bound. Corticosteroids suppress the inflammatory rejection until the activating agent has been eliminated.
Rhinitis is a problem causing significant morbidity. The etiology of rhinitis is varied. The pathophysiology of rhinitis is just beginning to be elucidated. Allergic rhinitis is primarily understood as an inflammatory disease with a neurogenic component. Disease states such as responses to cold dry air are primarily considered to be neurogenic in origin, but inflammatory cells and mediators play a significant role in the development of symptoms in these patients. Our understanding of these complex interactions is reflected in the pharmacologic interventions currently available. Most rhinitis therapy addresses the symptoms of rhinitis not the underlying disease state. Future research in the field of rhinitis should increase our knowledge of the pathophysiology and therefore assist in new drug development.
A naturally occurring model of immunoglobulin E (IgE) antibody-mediated hypersensitivity in canine and rhesus monkey species to environmental allergens is described. Cutaneous responses to a dust mite mix (Dermatophagoides farinae/pteronyssinus) and to four storage mite extracts (Aleuroglyphus ovatus, Blomia tropicalis, Chortoglyphus sp., Lepidoglyphus destructor) occurred in the canine species. Rhesus monkeys had IgE antibody-mediated hypersensitivity to dust mite on cutaneous challenge, but to a lesser degree than the canine species. Biologic relevance was verified by eliciting positive airway challenges in both species. The IgE antibody-mediated basis of these responses was confirmed by passive transfer technique. Demonstration of dust mite allergy provides a naturally occurring model of IgE antibody-mediated hypersensitivity in the canine and rhesus monkey species. Storage mite IgE antibody-mediated hypersensitivity exists in the canine species.
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BACKGROUND: We describe the evaluation of a worker with clinical symptoms compatible with bronchospasm caused by formaldehyde exposure. METHODS: The worker was evaluated by means of enzyme-linked immunosorbent assay, cutaneous tests, and methacholine and formaldehyde inhalation challenges. The worker's serum was injected intradermally into the skin of a normal rhesus monkey to determine whether hypersensitivity could be transferred from human to primate. RESULTS: An enzyme-linked immunosorbent assay showed that the worker had positive IgE and IgG titers to formaldehyde-human serum albumin. The worker had a positive cutaneous test for formaldehyde-human serum albumin, and this cutaneous reactivity was transferred to a rhesus monkey through the worker's serum. The worker had a negative methacholine challenge at 25 mg/ml and negative formaldehyde inhalation challenges at 0.3, 1, 3, and 5 ppm for 20 minutes. It is possible that the worker would have had a positive result if a higher concentration of F were used for the challenge, but it is more probable that the worker's symptoms were not caused by immunologically mediated asthma. We have studied individuals exposed to formaldehyde, their clinical syndromes, and serologic results for a decade. This worker is the one subject with the most compatible history and immunology, but the worker had a negative challenge. CONCLUSION: Immunologically mediated asthma caused by formaldehyde is extremely rare, if it exists at all.
BACKGROUND: Anecdotes and single case reports have suggested that the high-intensity sweetener, aspartame, may be associated with allergic/hypersensitivity-type reactions. METHODS: We conducted a multicenter, placebo-controlled clinical study to evaluate individuals who had experienced urticaria and/or angioedema allegedly associated with ingestion of an aspartame-containing product. Despite extensive recruiting efforts over 4 years, only 21 subjects could be enrolled. After admission to clinical research units, subjects were given aspartame and placebo in a randomized, double-blind, crossover fashion. Subjects received, on different days, increasing doses (50, 300, 600 mg) of aspartame and placebo at 8:00 AM, 10:00 AM, and noon. Subjects who weighed less than 40 kg received one half of these doses. Conversion products of aspartame, aspartyl-phenylalanine diketopiperazine and beta-aspartame, were also included in the aspartame arm of the study. Positive reactions were defined as urticaria (hives with wheals 4 mm or more in diameter with a collective diameter of at least 15 mm or one or more hives with a wheal of 4 mm or greater with a flare of 8 mm or greater) or as angioedema. RESULTS: According to these criteria, four reactions were observed; two followed aspartame ingestion and two followed placebo ingestion (p = 1.00). The incidence of other adverse experiences was no different after aspartame versus placebo ingestion (p = 0.289). CONCLUSION: These results indicate that aspartame and its conversion products are no more likely than placebo to cause urticaria and/or angioedema reactions in subjects with a history consistent with hypersensitivity to aspartame.