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Biomedical subjects

R Patterson

Publications and source records attributed to R Patterson.

At least 109 records · Page 6Linked to original sources
PubMed1989

Diphenylmethane diisocyanate hypersensitivity pneumonitis: a serologic evaluation.

We describe the clinical and immunologic evaluation of a steel plant maintenance supervisor who had clinical symptoms consistent with hypersensitivity pneumonitis. No antigen was obvious but after a thorough occupational history and review of the industrial hygiene data, the most likely antigen appeared to be diphenylmethane diisocyanate. Precipitating antibodies were not detected in the worker's serum; however, significant antibody levels of IgG specific for diphenylmethane diisocyanate-human serum albumin were detected by other immunoassays. This case highlights the importance of a thorough occupational history and an aggressive laboratory immunologic evaluation in identifying the offending agent in a worker with hypersensitivity pneumonitis. Hypersensitivity pneumonitis due to an inhaled reactive chemical may be present without precipitins demonstrated in vitro due to the nature of the haptenized chemical protein conjugate or the concentration of IgG antibody.

Alveolitis, Extrinsic Allergic↗
PubMed1989

Baker's asthma: report of an unusual case.

Using immunologic techniques recently available, we report the evaluation of baker's asthma due to wheat flour and demonstrate the usefulness of these techniques in occupational asthma. The diagnosis of baker's asthma was very important in this case, as even a trial of avoidance of work exposure was not possible because of the social and economic factors involved. A commercial wheat extract was obtained and the wheat flour actually used at the work site was extracted. Prick skin testing with each of these extracts resulted in positive wheal and flare responses. Enzyme linked immunosorbent assay and inhibition assays were performed to assess the worker's antibody response to wheat flour and wheat extracts. Significant specific IgE and IgG levels to the wheat flour and wheat extracts were detected in the worker's serum. Because of unique psychosocial and educational factors, this worker was unable to change occupations. Even with respiratory protection, she continued to be symptomatic. She is currently controlled on bronchodilators and inhaled steroids.

Antibody Specificity↗
PubMed1989

Effect of capsulectomy on the hemodynamics and viability of random-pattern skin flaps raised on expanded skin in the pig.

Skin flaps constructed on expanded skin usually include the underlying capsular tissue. It has been hypothesized that capsulectomy may jeopardize the viability of the expanded skin flap. The experiments reported herein were designed to test this hypothesis. Specifically, we studied the hemodynamics and viability of random-pattern skin flaps (8 X 20 cm) raised on delayed bipedicle flaps (group A) and on expanded skin pockets with capsulectomy at the time of flap elevation (group B) or with intact underlying capsular tissue (group C). Each group was randomly assigned to each flank in 16 pigs. Skin pockets were expanded by inflation of subcutaneous silicone tissue expanders with sterile saline (299 +/- 7 ml; X +/- SEM) over a period of 3 weeks. At the end of this period, the bipedicle flaps were constructed. Eight days later, random-pattern skin flaps were raised on bipedicle flaps and skin pockets. The length and area of skin flap viability, judged by the fluorescein dye test performed 1 day postoperatively, were not significantly different (p greater than 0.05) among groups A, B, and C (n = 31 to 32). There also were no significant differences (p greater than 0.05) in total skin capillary blood flow measured 1 day postoperatively (A = 2.6 +/- 0.4, B = 2.4 +/- 0.4, and C = 2.7 +/- 0.6 ml/min per flap; n = 15 to 16) and in skin viability assessed 7 days postoperatively (A = 74 +/- 2, B = 75 +/- 2, and C = 76 +/- 2 percent; n = 16) among delayed skin flaps and skin flaps raised on expanded skin pockets with or without capsulectomy. The results of this flap viability study were confirmed in 5 minipigs in a separate experiment. We conclude that capsulectomy did not have a detrimental effect on the hemodynamics and viability of random-pattern skin flaps raised on expanded skin. Furthermore, we hypothesize that skin flaps raised on expanded skin are similar to delayed skin flaps in that the skin blood flow is optimally augmented; therefore, the capsular tissue does not add significant blood supply to the overlying skin.

Animals↗
PubMed1989

Outcomes of pregnancy in adolescents with severe asthma.

Asthma in adolescent pregnancies is not rare and may make patient management difficult, especially since mortality from asthma is of particular concern in the adolescent age group. We present a series of 21 pregnant adolescents with severe asthma. During 28 pregnancies, there were 56 exacerbations of asthma, including 22 hospitalizations and 20 emergency room visits. For 18 (64%) of the 28 pregnancies, outpatient systemic corticosteroids were administered, and inhaled corticosteroids were prescribed for 8 (29%). Factors associated with exacerbations included respiratory tract infections (59%) and noncompliance with medical regimens (27%). There were no maternal or fetal deaths or evidence for intrauterine growth retardation. Two infants were premature, with one experiencing acute respiratory distress syndrome. Aggressive treatment of asthma and associated respiratory tract infections, as well as careful ambulatory care, to encourage patient compliance are advisable to achieve a favorable maternal-fetal outcome.

Adolescent↗
PubMed1988

Idiopathic anaphylaxis: classification, evaluation, and treatment of 123 patients.

The manifestations, evaluation, treatment, and course of 123 patients with idiopathic anaphylaxis (IA) are described for a total of 374 patient years of our management. Observation of this group of patients resulted in the description and classification of IA as one or more episodes of generalized IA with multiple systemic manifestations or IA with life-threatening angioedema of the tongue or larynx. Therapy is based on the frequency of episodes. Acute therapy is appropriate for infrequent episodes, but prophylactic therapy is indicated for frequent episodes. In patients with frequent episodes, remissions can be induced and maintained with prednisone. Prolonged remissions may occur after prednisone is stopped. There have been no deaths from IA in patients managed by our service. By definition, there is no identifiable antigen responsible for episodes of IA, and there is no underlying disease in these patients. A mast cell basophil-activation mechanism is suggested. IA may represent the most severe form of a spectrum of diseases that include idiopathic urticaria and angioedema.

Adolescent↗
PubMed1988

Antibody response to trimellityl hemoglobin in trimellitic anhydride-induced lung injury.

Sprague-Dawley rats were exposed to trimellitic anhydride by inhalation, and the antibody response to trimellityl (TM)-conjugated hemoglobin (HB) and TM rat serum albumin (RSA) was compared. Groups of rats were exposed to trimellitic anhydride by inhalation 6 hours per day for 2, 6, or 10 days at 100 micrograms/m3 and compared to a control group exposed to filtered air. The IgG antibody response to TM-HB in both serum and bronchoalveolar lavage (BAL) fluid was measured with ELISA. IgG antibody levels to TM-HB rose significantly throughout the exposure. A positive correlation was found between IgG to TM-HB in serum and BAL fluid. In addition, this response in both serum and BAL fluid correlated with the IgG antibody response to TM-RSA. Cross-inhibition studies indicated the existence of shared antigenic determinants on TM-RSA and TM-HB. The IgG antibody to both antigens was specific for new antigenic determinants and not for the TM hapten.

Animals↗
PubMed1988

Woodman's disease: hypersensitivity pneumonitis from cutting live trees.

A 28-year-old man developed multiple episodes of fever, cough, shortness of breath, and leukocytosis several hours after cutting live oak and maple trees. Fungal cultures of wood chips from oak and maple trees were positive for Penicillium (three species), Paecilomyces sp., Aspergillus niger, Aspergillus sp., and Rhizopus sp. Gel-immunodiffusion studies demonstrated serum precipitins to extracts of oak chips, Penicillium sp., and Paecilomyces sp., and suggested that Penicillium sp. and Paecilomyces sp. shared cross-reactive antigens that were the significant antigens in the oak chips. ELISA studies demonstrated elevated serum levels of IgG to an oak chip extract, inhibition of that ELISA by preincubation of serum with Penicillium sp., and absence of elevated IgG levels to an extract of freshly cut oak wood that had been stripped of bark to minimize mold contamination. The case analysis indicates that the patient likely had hypersensitivity pneumonitis on exposure to Penicillium sp., when he was cutting trees, and identifies cutting live trees as another occupational exposure that may cause hypersensitivity pneumonitis.

Adult↗
PubMed1988

The laboratory evaluation of IgE antibody to metabisulfites in patients skin test positive to metabisulfites.

An immediate-type hypersensitivity reaction has been proposed as one possible mechanism in which metabisulfites (MBSs) cause reactions. As demonstrated with certain occupational chemicals, we proposed that MBS might conjugate with human proteins, such as human serum albumin, and then cause an immunologic response. Because we had identified no reactions to MBS at the Northwestern Allergy Service, we used sera from four patients reported elsewhere as having positive skin tests and positive oral challenges to sulfites. We attempted to demonstrate, both in vitro by ELISA and in vivo by passive cutaneous transfer to monkey, evidence for IgE-mediated hypersensitivity to MBSs. Our results demonstrated that there is evidence of IgE antibody by passive transfer for one patient studied, but no evidence of IgE antibody by ELISA to an MBS-albumin conjugate in any of the four patients. This study illustrates the complexities involved in the evaluation and mechanism of MBS-induced disease and the caution with which results must be interpreted.

Animals↗
PubMed1988

Prospective immunologic and clinical study of a population exposed to hexamethylene diisocyanate.

We have prospectively evaluated 150 workers exposed to hexamethylene diisocyanate (HDI) and its trimer (THDI) during an 18-month period. The evaluation consisted of periodic serum antibody studies and a questionnaire that was designed to attempt to identify symptoms compatible with work-related syndromes of allergic rhinitis, allergic conjunctivitis, hypersensitivity pneumonitis, asthma, or irritant reactions. The study population was divided into seven groups on the basis of job classification. The groups differed in exposure levels but were similar in terms of age, sex, smoking history, and duration of work with isocyanates. IgE and IgG against HDI and THDI conjugated to human serum albumin (HSA) (HDI-HSA and THDI-HSA) were determined by ELISA. There were no instances of immunologically induced disease among the 21% of workers in this sample with antibody; however, there is insufficient evidence at this time to make judgments about the relationship between antibody and clinical disease. The antibody was generally low-level IgG that may be a sensitive indicator to detect exposure to certain reactive chemicals. The level of antibody was not different among job classes or between smokers and nonsmokers. Moreover, there was no correlation between antibody level and exposure duration in these workers whose exposure levels are all well below National Institute for Occupational Safety and Health recommendations. Further evaluation will extend these observations.

Antibodies↗
PubMed1988

Minimal complications in a surgical population with severe asthma receiving prophylactic corticosteroids.

Sixty-eight patients with asthma followed by the Northwestern Allergy Service underwent a total of 92 surgical procedures from July 1973 to December 1986. In 41 of 92 procedures outpatient prednisone was administered, and in 92 procedures a pretreatment regimen of 100 mg hydrocortisone parenterally every 8 hours beginning the night before surgery was administered. Postoperatively, the overall incidence of pulmonary complications (either pulmonary infection or asthma) was 9.7%. Three patients developed pneumonia, demonstrated by an infiltrate on chest x-ray examination, and two patients developed wheezing requiring epinephrine, giving a complication rate of 5.4%. In addition, four patients developed mild wheezing postoperatively. Statistical analyses to compare the overall infection rate in this asthmatic population with that in two other surgical populations showed no statistical differences. There were no deaths and no patient developed any wound complication or adrenocortical insufficiency. These results indicate that patients with asthma in optimal respiratory condition who have received preoperative clinical evaluation and a hydrocortisone pretreatment regimen can undergo surgery with minimal complications.

Asthma↗