Systemic vasculitis in Goodpasture's syndrome.
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Anti-Glomerular Basement Membrane Disease↗
Biomedical subjects
S E Dean
Publications and source records attributed to S E Dean.
Cyclosporine-induced alterations in the hypothalamic hypophyseal gonadal axis in transplant patients.
We evaluated the response of 20 male patients, 13 cadaveric kidney and 7 heart transplant recipients, to the administration of 100 micrograms GnRH (gonadotropin-releasing hormone) and 500 micrograms TRH (thyrotropic-releasing hormone). All of the heart transplant recipients and 7 of the kidney transplant patients were receiving a combination of cyclosporine, azathioprine and prednisone; while the 6 remaining kidney transplant patients received azathioprine and prednisone. The patients receiving cyclosporine had decreased plasma levels of prolactin, and manifested a blunted response to TRH administration for prolactin and TSH. The heart transplant patients had a blunted response of LH and FSH to the administration of GnRH. The levels of testosterone were found to be low in all patients regardless of the immunosuppressant therapy. Despite the low testosterone levels, no increment in the concentration of LH or FSH was present. Intramuscular administration of HCG (human chorionic gonadotropin) (Ayerst Laboratories, New York, N.Y.) failed to increase the testosterone concentration in 5 of 6 patients with renal transplants, 3 taking cyclosporine and 3 taking azathioprine. This study suggests that cyclosporine has a selective effect on the hypothalamus and/or hypophysis, resulting in lower baseline levels of plasma prolactin and a pituitary insensitivity to TRH administration. In addition, FSH and LH were low or normal in the presence of low testosterone levels, suggesting that the hypothalamic pituitary gonadal axis is impaired. Furthermore, there may be a direct toxic effect of the immunosuppressant medications on the gonads, manifested as lower testosterone levels and inability to respond to the administration of HCG.
Adult↗
Spontaneous breathing with a T-piece circuit: minimum fresh gas/minute volume ratio which prevents rebreathing.
Thirty adults undergoing elective superficial surgery under enflurane-nitrous oxide anesthesia which intubated and breathing spontaneously via a modified Mapleson D (Brain) T-piece circuit were studied with their consent. Total fresh gas flows which were initially high were adjusted downward until minimal rebreathing (inspired CO2 tension of 5 to 10 mmHg) was present. At this point both fresh gas flow (VF) and minute volume (VE) were recorded, and the ratio of the two (VF/VE) was calculated. The mean VF/VE ratio was found to be 1.89 +/- 0.27 (SD). Linear regression was used to plot VF against VE breathing frequency, tidal volume, age, weight, and end-tidal CO2 tension. Significant correlation was found only with VE (r2 = 0.48, P less than 0.001) and frequency (r2 = 0.44, P less than 0.001). When the ratio VF/VE was plotted against the same variables, no significant correlations was found. This study showed a wide variability in the minimum VF/VE ratio which prevents rebreathing. The respiratory waveform, which was not studied, probably played a role in determining the VF/VE. Nevertheless, 87 per cent of our patients required a VF/VE ratio of 2.0 or less to prevent rebreathing. If one is especially concerned about rebreathing, VE should be measured in the VF adjusted to about twice the measured.
Adult↗
Regional hyperthermia for deep-seated malignancies using the BSD annular array.
Forty-four patients were treated using the BSD-1000 Annular Phased Array between April 1983 and December 1986. There were 32 pelvic, nine abdominal, two extremity, and one thoracic sites treated. Mean tumour volume was 646 cc. Thirty-nine patients had concurrent radiation therapy, receiving a mean dose of 38 Gy. Mean average temperature was 41.0 +/- 1.4 degrees C. Most patients experienced local or systemic toxicity, requiring temporary treatment interruption in 33 patients, and termination of treatment in eight. Chronic complications were seen in four, but these were in patients receiving high total radiation doses as well. There were six complete and five partial responses. Among the 32 patients with pelvic tumours, mean tumour volume was 317 cc, mean radiation dose was 42 Gy, and mean average temperature was 41.3 +/- 1.2 degrees C. There were five complete and four partial responses. Achieving tumour temperatures greater than or equal to 42 degrees C with the annular array is difficult, due to both systemic and local toxicity. To improve clinical hyperthermia for thoracic, abdominal, and pelvic tumours, new technologies such as steerable phased array microwave systems; scanned, focused ultrasound; and permanently implantable thermoregulating ferromagnetic seeds, or new approaches such as using drugs to alter blood flow, or combining hyperthermia with antineoplastic drugs or biological agents, will be necessary.
Clinical Trials as Topic↗