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Biomedical subjects

C E Anderson

Publications and source records attributed to C E Anderson.

At least 37 records · Page 2Linked to original sources

The efficacy of indium-111-polyclonal IgG for the detection of infection and inflammation.

UNLABELLED: The purpose of this study was to determine the efficacy of 111In-polyclonal immunoglobulin (IgG) for the diagnosis of infection or inflammation. METHODS: Fifty-three patients with suspected infection were prospectively studied. Each underwent an 111In-polyclonal IgG study; biopsy, surgery, additional nuclear medicine scans and radiographic studies were used to confirm the IgG scan results. RESULTS: The polyclonal IgG scan had a sensitivity of 97.9% and a specificity of 94% for infection or inflammation. When only infection or severe inflammation such as bowel infarction was considered, the sensitivity remained the same but the specificity fell to 83%. Chronic infections were detected equally as well as acute infections. Antibiotics, steroids, anti-inflammatory agents, diabetes and diminished renal function did not affect scan sensitivity. There were no adverse reactions to the radiopharmaceutical. Three patients underwent extended imaging. Their scans stayed positive for an average of 8 days. Three patients treated for infection had their scans turn negative on repeat study, confirming the efficacy of their antibiotic therapy. CONCLUSION: Indium-111-polyclonal IgG is an effective imaging agent of infection and/or inflammation that is useful in a variety of infections and in severe inflammatory diseases. The ease of preparation and safety make it an attractive alternative to labeled leukocytes.

Adult↗

Nasoendotracheal tube obstruction secondary to inferior turbinate impaction.

This case report discusses one of the unusual complications of nasoendotracheal intubation, amputation of the inferior turbinate with its subsequent impaction of the nasoendotracheal tube. A healthy 19-year-old male underwent surgery for an open reduction and internal fixation of a fractured mandible. Several minutes after nasoendotracheal intubation, airway pressures increased, end-tidal carbon dioxide levels increased, and the patient became difficult to ventilate. The patient was extubated and then reintubated with a smaller-diameter nasoendotracheal tube through the same naris without further sequelae. After examination the tube was found to be occluded with an inferior turbinate. The increased airway pressure and elevated carbon dioxide levels were early signs of partial airway obstruction. Capnography was an important early warning device to provide information prior to changes in other vital signs. It allowed rapid detection of a potentially disastrous obstruction of the airway before the patient experienced severe cardiopulmonary complications. These facts should assist the anesthetist in focusing attention on the possible obstruction of the airway with a foreign body after nasoendotracheal intubation.

Adult↗

Keeping babies warm: have we got it right?

Concern has recently centred on the risks of babies overheating in their cots at night. We review the conditions under which babies sleep at home, and their effects on body temperature. Parents do not choose room heating, clothing and wrapping at random, but according to a 'formula' based on perceived risk to the infant of cooling. This formula allows 95 per cent of 3-4 month babies to produce controlled fall in body temperature at night, but most have to cooly by active thermoregulation, which relies heavily on the head as a route of heat loss. We conclude with some general recommendations about room heating and wrapping of babies which may reduce the risk of thermal stress during sleep.

Body Temperature Regulation↗

Indium 111-labeled platelet deposition in woven and knitted Dacron bifurcated aortic grafts with the same patient as a clinical model.

A study was designed to compare platelet deposition between knitted and woven Dacron grafts in the same patient. Twenty patients received aortoiliac or aortofemoral bifurcated Dacron grafts, each composed of one woven and one double-velour knitted limb. External nuclear graft imaging was carried out after injection of autologous platelets labeled with indium 111. The patients were studied postoperatively in time periods ranging from 6 days to 42 months. Platelet accumulation was almost identical in knitted and woven limbs in all patients. This study appears to indicate that there is no difference in thrombogenicity between knitted and woven bifurcated Dacron grafts in the aortoiliac or aortofemoral positions measured by platelet accumulation.

Aorta, Abdominal↗

Preferential transmission of diabetic alleles within the HLA gene complex.

Several studies suggest a higher incidence of insulin-dependent diabetes mellitus (IDDM) among the offspring of men with the disease than among those of female diabetics. Differential transmission by the father of genes that predispose to diabetes may explain this phenomenon. To test this hypothesis, we examined parent-to-offspring transmission of HLA haplotypes and DR (D-related) alleles in 107 nuclear families in which a child had IDDM. We observed that fathers with a DR4 allele were significantly more likely to transmit this allele to their diabetic or nondiabetic children than were mothers with a DR4 allele (72.1 vs. 55.6 percent, P less than 0.001). No differences between parents were observed for HLA-DR3; however, DR3 was transmitted significantly more than 50 percent of the time from either parent (P less than 0.001). These data suggest that differential parental transmission of the HLA-DR4-linked diabetes-predisposing allele may explain the higher risk of diabetes among children of diabetic fathers than among those of diabetic mothers. In addition, the excess transmission of diabetogenic HLA alleles from parent to offspring may explain how these deleterious genes continue to recur at such high frequencies in the general population.

Alleles↗

HLA-dependent GM effects in insulin-dependent diabetes: evidence from pairs of affected siblings.

In a recent study of GM allotype frequencies in HLA-defined subsets of patients with insulin-dependent diabetes mellitus (IDDM) and similarly defined healthy sibling controls, we found evidence for an HLA-dependent GM effect on IDDM susceptibility. To circumvent problems inherent in such patient-control studies of complex diseases, we have now examined sharing of genes in the HLA and GM regions in 26 informative pairs of siblings who were both affected with IDDM. We found that: (1) in the total sample of affected sib-pairs, sharing of two HLA haplotypes was increased compared to Mendelian expectations, in agreement with many previous studies; (2) in the total sample, sharing of GM region genes (as measured by GM phenotype concordance) was not different from Mendelian expectations, given the distribution of parental mating types; and (3) affected sib-pairs who shared two HLA haplotypes showed significantly increased sharing of GM region genes compared to affected sib-pairs who shared one or zero HLA haplotypes (P = .018). These results provide new evidence for HLA-dependent effects of a locus at or near GM on susceptibility to IDDM.

Diabetes Mellitus, Type 1↗

Suspected genetic disease.

To formulate an accurate diagnosis and provide adequate management of genetic problems associated with ear malformations or hearing loss, the otolaryngologist must have an awareness of possible genetic causes of these disorders. Careful evaluation of the family history as well as examination or testing of family members might be required to arrive at a correct diagnosis. The clinical geneticist can provide assistance to the clinician with contemporary information about additional useful diagnostic studies, the possibility of prenatal diagnosis of the disorder, or in the process of genetic counseling so as to enhance the family's overall adjustment to the problem.

Abnormalities, Multiple↗

Marker chromosomes: cytogenetic characterization and implications for prenatal diagnosis.

Satellited marker chromosomes were identified in four individuals from unrelated families; one was first encountered in cultured amniotic fluid cells obtained for prenatal diagnostic studies. We present cytogenetic characterization of these marker chromosomes and clinical findings in the individuals carrying them. Identification of a marker chromosome in amniotic fluid cell cultures presents problems in genetic counseling, as it is often difficult to determine the clinical significance of such a finding. Chromosome-banding techniques now allow the precise identification of satellited marker chromosomes originating from chromosome 15. Presence of a supernumerary bisatellited der(15) marker chromosome containing the proximal long arm of 15 has been associated with mental and developmental retardation. Application of chromosome-banding techniques was useful in characterization of the marker chromosomes and providing prenatal genetic counseling.

Adult↗

Characterization and partial purification of a neutral protease from the serum of a patient with autosomal recessive pulmonary emphysema and cutis laxa.

Serum enzyme activity in 81 patients with various medical and dermatologic problems was determined with succinyl-(L-alanyl)3-p-nitroanilide as substrate. Values exceeding the limit of mean +/- 3 SD in healthy controls were detected in 16 patients. The highest activity, greater than 80 times the mean in the controls, was found in a 20-year-old patient with severe pulmonary emphysema and cutis laxa. The enzyme activity in the patient's serum was enhanced by Ca2+ and was inhibited by metal chelators but not by serine protease inhibitors. The pH optimum of the enzyme was 7.6. The enzyme was partially purified by gel filtration chromatography. Enzyme activity eluted in two major peaks with apparent molecular weights of greater than 10(7) daltons (peak I) and approximately 2.5 X 10(5) daltons (peak II). When compared with the elution patterns in the patient's mother and a healthy control, the elevated enzyme activity in the patient's serum was associated with peak I. The partially purified enzyme in peak I was not complexed with alpha 2-macroglobulin. The peak I enzyme was capable of degrading tropoelastin and a synthetic dinitrophenyl peptide at a glycyl-isoleucyl sequence, but not native or denatured collagen.

Adult↗

No evidence for linkage between an insulin-dependent diabetes mellitus-susceptibility locus and immunoglobulin loci KM or GM.

We studied 52 families having more than one member affected with insulin-dependent diabetes mellitus (IDDM) for linkage of an IDDM-susceptibility locus to the immunoglobulin loci KM and GM. Linkage was analyzed by the LOD score method using single-locus recessive and dominant models of IDDM inheritance, with penetrances of the disease-susceptible genotypes being dependent on age and reaching a maximum of 20% by age 40. We found no evidence for linkage of IDDM to KM or GM. Close linkage (recombination fraction less than 5%) was rejected for KM under the recessive model and for GM under both models. These results suggest either that there are no IDDM-susceptibility loci closely linked to KM or GM or that use of a single-locus model of IDDM (which ignores the effects of the susceptibility locus in the HLA region) is inadequate for their detection.

Adult↗

Interaction of HLA and immunoglobulin antigens in type 1 (insulin-dependent) diabetes.

We analyzed 88 unrelated subjects with Type 1 (insulin-dependent) diabetes and 64 sibling controls (maximum one per diabetic) for associations between immunoglobulin allotype antigens (GM and KM) and Type 1 diabetes. None were found. However, we did find interactions between GM, HLA-DR, and Type 1 diabetes (significant or of borderline significance after considering the effect of multiple tests): possession of Glm(2) appeared to increase susceptibility to diabetes in individuals who had HLA-DR3 but not HLA-DR4, while possession of G3m(5) appeared to increase susceptibility in individuals who had HLA-DR4 but not HLA-DR3. These results suggest that genetic predisposition to Type 1 diabetes is partially determined by alleles at the GM locus (or a locus in linkage disequilibrium with GM) interacting with alleles at the HLA-DR locus (or a locus in linkage disequilibrium with HLA-DR).

Adult↗

Association of hemolytic anemia and early-onset pulmonary emphysema in three siblings.

Three of four siblings born to nonconsanguineous parents of Italian origin were affected with severe congenital hemolytic anemia of unknown cause, and early-onset pulmonary emphysema. Two of the three affected siblings died of septic shock after splenectomy, at the ages of 7 and 3 1/2 years, respectively. The remaining affected sibling was shown to have cutis laxa and severe pulmonary emphysema at 15 years of age. Assay of serum components indicated that alpha 1-antitrypsin and alpha 2-macroglobulin levels were normal or slightly elevated. However, there was markedly elevated activity of an elastase-like serum enzyme. The relation of the hemolytic anemia to the pulmonary findings in this family is not clear; pedigree analysis suggests a recessively inherited defect.

Adolescent↗

Estimating the recombination frequency for the MN and the Ss loci.

Linkage analysis of 146 informative families for MN and Ss resulted in an estimate of the recombination frequency greater than previously reported. Our total is 7 recombinant children out of 467 individuals, including 1 confirmed recombinant (retested and HLA-compatible) and 6 not verified. The 95% confidence interval of our estimate of recombination is 0.0033-0.0167. Our results are compared with two earlier studies.

Female↗

The search for heterogeneity in insulin-dependent diabetes mellitus: evidence for familial and nonfamilial forms.

Using five different published sets of data, we looked at the distribution of HLA-DR genotypes among diabetic probands. It was possible to reject dominant inheritance at the HLA-associated locus, but some of the data were compatible with recessive inheritance while some were not. An attempt to reconcile the conflicting data by proposing a three-allele model apparently failed. It proved possible to resolve some of the conflicting data by proposing that simplex families represent primarily a recessive form of insulin dependent diabetes mellitus (IDDM) while multiplex families represent primarily two other subforms: one showing three-allele inheritance and one not. We also propose that the HLA locus involved in IDDM mediates the effect of an environmental agent on a second disease locus.

Diabetes Mellitus, Type 1↗

Association studies between Type 1 (insulin-dependent) diabetes and 27 genetic markers: lack of association between Type 1 diabetes and Kidd blood group.

One hundred and three unrelated patients with Type 1 (insulin-dependent) diabetes were typed for HLA, properdin factor B (BF), glyoxalase 1 (GLO), Kidd blood group, and 24 other genetic markers. Observed distributions of marker phenotypes among these patients were compared with those expected according to population frequencies, in an attempt to detect associations between Type 1 diabetes and the markers. Strong associations between Type 1 diabetes and both HLA and properdin factor B were confirmed, as was a lack of association between Type 1 diabetes and glyoxalase (GLO). There was an apparent deviation from Hardy-Weinberg equilibrium at the GLO locus, and statistically significant distortions in the distributions of pancreatic amylase (AMY2), galactose-1-phosphate uridyl transferase (GALT), and group-specific component (GC) among Type 1 diabetes patients, but these results are not significant when corrected for performance of multiple tests. An increase in the Lewis-negative phenotype reported elsewhere was observed here but was not statistically significant. A distortion in the distribution of Kidd types reported elsewhere was not confirmed.

Blood Group Antigens↗