Biomedical subjects
Publications and source records attributed to W Gordon.
A 47-year-old multiparous woman presented with endometriosis, true urinary incontinence, and the mucosal and skin lesions of pyoderma gangrenosum. The subsequent investigations, treatment and course are discussed, as well as the possible causal interrelationship between the above three conditions.
The results of radiation therapy in the management of 27 patients with malignant mesothelioma were reviewed. Eight patients were treated with a curative intent combining attempted surgical excision of tumor (thoracic in 6 and peritoneal in 2), aggressive radiation therapy, and combination chemotherapy using an adriamycin-containing regimen. One patient achieved a 2-year disease-free interval followed by recurrence of tumor above the thoracic irradiation field. This patient was retreated with localized irradiation and is disease-free after 5 years of initial diagnosis. One patient has persistent abdominal disease at 18 months; the other 6 patients suffered local recurrence within 8-13 months of initiation of treatment. Radiation therapy was used in 19 other patients who received 29 courses for palliation of dyspnea, superior vena cava syndrome, dysphagia, or neurological symptoms of brain metastasis. A palliation index was used to determine the effectiveness of irradiation and revealed that relief of symptoms was complete or substantial in 5 treatment courses, moderately effective in 6 courses and inadequate in 18 treatment courses. Adequate palliation strongly correlated with a dose at or above 4,000 rad in 4 weeks. The management of patients with mesothelioma requires new and innovative approaches to increase the effectiveness of radiation therapy and minimize the significant potential combined toxicity of pulmonary irradiation and adriamycin.
Thirty-five right brain-damaged (RBD) stroke patients, enrolled in active rehabilitation programs, participated in this study. Patients were selected on the basis of their evidenced deficits in performing complex visuo-cognitive tasks and the absence of overt evidence of unilateral visual-spatial neglect. Seventeen of the 35 patients were randomly chosen to receive a training program (lasting approximately 1 month) designed to establish a systematic strategy of organizing complex visual material. The remaining 18 patients were re-examined after 1 month, and served as controls. The design of the treatment program was based on the hypothesis that nonneglected RBD patients fail to appreciate and synthesize elements of complex visual material due to a breakdown in compensation for a persistent lateral bias in visual-spatial attention. Upon posttesting, it was found that those patients who received training exhibited significantly improved performance, as compared to controls, on a subgroup of visuo-cognitive tasks. These results are discussed in terms of: (1) offering indirect support for the argument that pathological asymmetries in attention play a significant role in the failure of RBD patients on many visuo-cognitive tasks; and, (2) offering a basis for extending the treatment of perceptual problems in RBD patients.
Eight of 57 patients (14%) with malignant astrocytomas lived at least 2 years. The mean survival time was 143 weeks (range, 104 to 250 weeks). All of the patients were treated with operation, radiation, and chemotherapy. Four of the 8 patients died because of tumor recurrence, 1 died from a second primary tumor, 2 died of cases unrelated to the tumor, and 1 is still alive. Diffuse cortical dysfunction associated with cortical atrophy that could not be related to tumor regrowth and was not explained by focal deficits, psychotic of depressive thought disorders, metabolic or endocrine abnormalities, or hydrocephalus developed in the 3 longest-surviving patients. The diffuse dysfunction was initially apparent only through psychometric testing, but eventually became so disabling as to result in 2 of the 3 patients retiring from work. Although small, but gratifying, gains have been made in the treatment of patients with malignant brain tumors, accompanying these gains have been problems of a magnitude that is only now beginning to be appreciated.
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We determined by trichometry the rate of hair growth in ten hirsute patients receiving a combination of cyproterone acetate (CA) 50 mg/daily and 'Diane' (CA 2 mg + ethinyl oestradiol 0.05 mg). In two patients there was a prompt and persistent reduction in hair growth; in three the response was less marked, and in the remaining five patients the rate of hair growth fluctuated during therapy. However, there was an overall reduction in hair growth in all but one patient during the 12 months of treatment and all patients noticed that their hair became softer, thinner and lighter in colour.
A group of 61 unselected patients with psoriasis attending a dermatology clinic were studied to determine the prevalence of psoriatic arthritis. On defined criteria arthritis was present in 41.6%. Peripheral arthritis was present in 15.5%, and sacroiliitis in 43%. A strong association of distal interphalangeal arthritis with psoriasis and nail dystrophy was confirmed. Tissue typing showed a strong association of B23, 17, in Caucasoid psoriatics, while the haplotype A1/B8 was increased in mixed Caucasoid--Negroid psoriatics.
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A patient with multiple enterocutaneous fistulae who developed the skin manifestations of acrodermatitis enteropathica while on total parenteral nutrition is described. The value of monitoring the serum alkaline phosphatase to demonstrate zinc deficiency is shown. The skin manifestations responded rapidly to the re-introduction of zinc to the diet.
Four patients with unusual features of acute febrile neutrophilic dermatosis (Sweet's syndrome) are reported. This syndrome is more common than is apparent from the small number of case reports. It has well-defined clinical and histological criteria, but may be considered within the erythema multiforme spectrum of reaction patterns. The clinical presentation and course can vary, as illustrated by these 4 case reports.
The bacterial enzymes beta-glucuronidase, azoreductase, and nitroreductase, all implicated in the etiology of colon cancer, were measured in the fecal microflora of rats and humans. The effect of a high-beef diet and advanced age on the activities of these microbial enzymes were determined in the rat. Rats shifted from a grain to a meat diet showed a 1.5- to 2.5-fold increase in activity of all three fecal enzymes. Animals over 20 months of age, consuming a meat diet, showed a further increase in fecal beta-glucuronidase activity, while the levels of all three microbial enzymes increased in old rats fed a grain diet. Fecal microbial enzyme activities were also measured in humans eating a diet supplemented with bran or wheat germ. Humans receiving fiber supplements consisting of 30 g of bran or wheat germ added to their customary diets did not show significant changes in fecal enzyme activity.