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Biomedical subjects

C M Shapiro

Publications and source records attributed to C M Shapiro.

At least 109 records · Page 6Linked to original sources
PubMed1986

Staging and therapy of orbital lymphomas.

Ten patients with non-Hodgkin's lymphoma primarily affecting the orbital region were evaluated at Michael Reese Hospital and Medical Center, Chicago, between 1976 and 1983. Diagnoses were based on the histopathologic classification systems of the Working Formulation of the Non-Hodgkin's Lymphomas and Rappoport. Sequential staging procedures performed at the time of diagnosis included liver-spleen scans, Technecium-99 bone scans, gallium 67 scans, computerized axial tomograms of the orbit and abdomen, bone marrow examination and cerebral spinal fluid analyses. Adverse prognostic factors included the following: orbital bone erosions, Stage IV disease, and large cell or mixed cell, diffuse histologic features. The type of histopathologic findings combined with the results of sequential staging procedures is useful in identifying those patients who would benefit most from systemic chemotherapy.

Actuarial Analysis↗
PubMed1986

Sodium cromoglycate in nocturnal asthma.

To investigate whether mast cell degranulation was important in producing nocturnal asthma, the effect of a single high dose of nebulised sodium cromoglycate on overnight bronchoconstriction, oxygen saturation, and breathing patterns in eight patients with nocturnal wheeze was examined. The study took the form of a double blind placebo controlled crossover comparison. Treatment with cromoglycate did not reduce the overnight fall in FEV1 or FVC, although it was associated with improved nocturnal oxygenation. This study suggests that mast cell degranulation may not be important in the pathogenesis of nocturnal asthma.

Adolescent↗
PubMed1986

Effect of sleep deprivation on overnight bronchoconstriction in nocturnal asthma.

Nocturnal cough and wheeze are common in asthma. The cause of nocturnal asthma is unknown and there is conflicting evidence on whether sleep is a factor. Twelve adult asthmatic subjects with nocturnal wheeze were studied on two occasions: on one night subjects were allowed to sleep and on the other they were kept awake all night, wakefulness being confirmed by electroencephalogram. Every patient developed bronchoconstriction overnight both on the asleep night, when peak expiratory flow (PEF) fell from a mean (SE) of 418 (40) 1 min-1 at 10 pm to 270 (46) 1 min-1 in the morning, and on the awake night (PEF 10 pm 465 (43), morning 371 (43) 1 min-1). The morning values of PEF were, however, higher (p less than 0.1) after the awake night and both the absolute and the percentage overnight falls in PEF were greater when the patients slept (asleep night 38% (6%), awake night 20% (4%); p less than 0.01). This study suggests that sleep is an important factor in determining overnight bronchoconstriction in patients with nocturnal asthma.

Adult↗
PubMed1985

Nephrotic syndrome in two patients with cured Hodgkin's disease.

Two cases of lipoid nephrosis (minimal change glomerulonephritis) in patients cured of Hodgkin's disease are reported and the literature is reviewed. Cases reported to date have shown a close temporal relationship between this renal lesion and the presence of Hodgkin's disease. The patients reported are 11 and 9 years without evidence of active malignancy after successful treatment for Hodgkin's disease. Each had abnormal immunologic parameters, depressed T4 (helper) cells and increased T8 (suppressor) cells, which may predispose to the development of the nephrotic syndrome. However, the advent of this complication is not necessarily a harbinger of recurrent lymphoma.

Adult↗
PubMed1985

Testicular neoplasms in Hispanic brothers.

Two hispanic brothers developed nonconcordant testicular malignancies in an interval of 11 months. They represent the 36th report of familial testicular neoplasia. The problems deriving from poor patient compliance are documented.

Adult↗
PubMed1985

Mechanism of transient nocturnal hypoxemia in hypoxic chronic bronchitis and emphysema.

In five patients with hypoxic chronic bronchitis and emphysema we measured ear O2 saturation (SaO2), chest movement, oronasal airflow, arterial and mixed venous gas tensions, and cardiac output during nine hypoxemic episodes (HE; SaO2 falls greater than 10%) in rapid-eye-movement (REM) sleep and during preceding periods of stable oxygenation in non-REM sleep. All nine HE occurred with recurrent short episodes of reduced chest movement, none with sleep apnea. The arterial PO2 (PaO2) fell by 6.0 +/- 1.9 (SD) Torr during the HE (P less than 0.01), but mean arterial PCO2 (PaCO2) rose by only 1.4 +/- 2.4 Torr (P greater than 0.4). The arteriovenous O2 content difference fell by 0.64 +/- 0.43 ml/100 ml of blood during the HE (P less than 0.05), but there was no significant change in cardiac output. Changes observed in PaO2 and PaCO2 during HE were similar to those in four normal subjects during 90 s of voluntary hypoventilation, when PaO2 fell by 12.3 +/- 5.6 Torr (P less than 0.05), but mean PaCO2 rose by only 2.8 +/- 2.1 Torr (P greater than 0.4). We suggest that the transient hypoxemia which occurs during REM sleep in patients with chronic bronchitis and emphysema could be explained by hypoventilation during REM sleep but that the importance of changes in distribution of ventilation-perfusion ratios cannot be assessed by presently available techniques.

Adult↗
PubMed1985

Breathing and oxygenation during sleep are similar in normal men and normal women.

Most patients with the sleep apnea syndrome are male, and it has been suggested that there is a fundamental sex difference in breathing during sleep. To explore this we measured overnight ear oxygen saturation (SaO2), breathing patterns, and electroencephalographic sleep stage in 21 healthy nonobese women (10 premenopausal, 11 postmenopausal) and in 19 healthy nonobese men of similar age. Sleep duration averaged 6 h 51 min (range 343 to 468 min). The 21 older (greater than 45 yr) subjects had more episodes of apnea and hypopnea (p less than 0.01) and became more hypoxemic (p less than 0.02) than did the 20 younger subjects, but there was no sex difference, either in the younger or older subjects, in irregular breathing or nocturnal hypoxemia. Seven subjects 51 to 68 yr of age (4 men and 3 women) had more than 30 episodes of apnea and/or hypopnea and/or SaO2 decreases below 90%, but the clinical importance of this finding is unclear, 6 of the 7 being alive and 5 asymptomatic at an average of 47 months (range 5 to 67) later. Thus, irregular breathing and hypoxemia during sleep are common in both sexes older than 50 yr of age. Previous reports of a sex difference are probably explained by poor matching of the men and women, particularly with regard to body weight.

Adult↗
PubMed1985

Almitrine improves oxygenation when both awake and asleep in patients with hypoxia and carbon dioxide retention caused by chronic bronchitis and emphysema.

Patients with chronic bronchitis and emphysema who are hypoxic when awake become more hypoxic during sleep, with a further rise in their preexisting pulmonary hypertension. Almitrine, a respiratory stimulant, improves arterial blood gas tensions in such patients when they are awake. We have used a double-blind, placebo-controlled, cross-over study to compare the effects of 50 mg almitrine given orally twice a day for 14 days on oxygen saturation (SaO2), respiratory movements, and sleep quality in 9 patients with hypoxic chronic bronchitis and emphysema (FEV1, 0.4 to 1.0 L; PaO2, 51 +/- (SEM) 2 mmHg; PaCO2, 49 +/- 1 mmHg). Almitrine improved arterial blood gas tensions when awake, mean PaO2 rising by 8 mmHg (p less than 0.001) and PaCO2 falling by 4 mmHg (p less than 0.01). Almitrine improved nocturnal oxygenation, mean SaO2 when awake rising from 83 +/- 4% to 89 +/- 3% (p less than 0.01), and the lowest SaO2 during sleep rising on average from 65 +/- 6% to 77 +/- 3% (p less than 0.02). The number of hypoxemic episodes (SaO2 falling by greater than or equal to 10% from the preceding stable baseline during sleep) and the time when SaO2 was below 80% (135 +/- 53 versus 46 +/- 35 min; p less than 0.01) also improved. Almitrine did not improve sleep quality. We conclude that almitrine improves arterial gas tensions when awake and reduces the frequency and severity of nocturnal hypoxemia without impairing sleep quality in patients with chronic bronchitis and emphysema who are both hypoxemic and hypercapnic when awake.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

Malignant feminizing Leydig cell tumor.

A patient with a feminizing malignant Leydig cell tumor is presented. Hormonal assays revealed increased production of prolactin, estradiol, and total estrogens. Eleven years after the onset of his disease he remains clinically well.

Aged↗
PubMed1984

Fitness facilitates sleep.

Eight army recruits were studied at the start, middle, and end of their initial 18-week training programme. At each point the subjects were studied for four consecutive nights in the sleep laboratory. Their sleep was characterized by the means of the recordings on the last two nights. Within 2 days of the sleep recordings (but never on the same day) each subject spent 2 non-consecutive days in the exercise laboratory. On the 1st day a maximum oxygen consumption (VO2 max) measurement was performed on a treadmill and on the 2nd day a 24-min progressive exercise bicycle ergometer test was carried out with simultaneous venous sampling (for lactic acid measurements) and oxygen consumption recordings from which the lactate turn point (LTP) was calculated. LTP was used as a measure of fitness. Approximately 1 week after the above measures lean muscle mass as calculated by total body potassium estimation was obtained for each subject. Slow wave sleep (SWS) as a percentage of total sleep time increased significantly between the start and the measurements at 9 and 18 weeks, being 21.9%, 29.9%, and 28.5% respectively. Anaerobic threshold increased significantly (P less than 0.05) over the first 9 weeks and continued to increase to the end of the training period (P less than 0.001) using VO2 when lactate level was 2 mmol/l as a percentage of VO2 max. With increase in fitness, sleep onset latency and wake time during sleep decreased and sleep efficiency improved. The results suggest that as fitness increases sleep quality improves.

Adolescent↗
PubMed1984

Effect of physical fitness and body composition on sleep and sleep-related hormone concentrations.

The study assessed the effect of physical fitness and body composition on sleep and the nighttime secretion of the hormones, human growth hormone (hGH), prolactin, and cortisol. Two groups of 17 subjects, one of fit athletes and the other of unfit nonathletes, were selected so that the groups were matched for weight, height, lean body mass (LBM), and fat levels. Subjects slept in a sleep laboratory for 3 nonconsecutive nights: 1 adaptation night and 2 experimental nights. On 1 experimental night blood samples were collected; on the other, baseline sleep was assessed and the catheter was not inserted. Weight and height were measured and LBM assessed by 24 h urinary creatinine. The effect of physical fitness was tested by a comparison of the two groups; body composition was assessed by correlation analyses. Physical fitness did not have a significant effect on either sleep or hormone levels, although in the latter case the results were marginal. In contrast, body composition was related to both sleep and hGH. Percentage LBM was negatively correlated with slow-wave sleep and positively correlated with hGH levels. These results were significant for all subjects combined and for the fit group, although not the unfit group alone.

Adipose Tissue↗
PubMed1984

Physiological changes and sleep responses during and following a world record continuous walking record.

Physiological changes, and subsequent sleep responses, were recorded in a male subject during and following 338 miles of continuous walking and consequent sleep deprivation. One hundred and thirty hours of walking and a seventy-two hours post-walk recovery period were monitored. The subject walked at approximately 55% of maximum oxygen uptake (VO2 max), heart rate ranged between 102-106 b/min, and blood lactate (LA) remained below the 2 mmol/l level. No electrocardiograph abnormalities were observed either during the walk or pre- and post-functional diagnostic graded exercise test (FDGXT). Creatine kinase (CK) and creatine kinase isoenzyme (CK-MB) levels rose throughout the walk but exhibited differing depletion patterns. The ratio of CK-MB to CK (MB/CK%) did not exceed levels which are suggestive of myocardial ischaemia. Haematological variables demonstrated signs of anaemia towards the end of the walk. Catecholamine levels rose throughout the walk, with greater rises being observed in nor-adrenaline and dopamine. During the post-walk recovery phase, adrenaline concentration remained elevated. Following this extreme period of exertion, the subject demonstrated very short sleep latency and rapid entry into slow wave sleep (SWS). These sleep patterns were compared to sleep recordings made over a similar period (72 h) six months post-walk, when the subject was not exercising. Nocturnal growth hormone (GH) levels were significantly raised on the post-walk nights.

Anemia↗
PubMed1984

Heat production during sleep.

Heat production during sleep was studied by continuous indirect calorimetry with simultaneous electroencephalographic monitoring. Controlling for gross influences on heat production, comparisons of heat production during different sleep stages showed heat production in stage 4 sleep to be significantly lower than in other sleep stages. There appeared to be a gradation in heat production in non-rapid-eye-movement stages of sleep with stage 2 higher and stage 4 lower than stage 3. Heat production in stage 4 was less variable than in any other sleep stage. Both the level and variability of heat production was similar in stage 2 and rapid-eye-movement sleep. Heat production during the night was 9% lower than during resting wakefulness. The average heat production in stage 4 sleep was 14.4% lower than resting wakeful values.

Adult↗
PubMed1984

Nocturnal cough in patients with chronic bronchitis and emphysema.

Patients with respiratory disease commonly report that their sleep is disrupted by nocturnal cough. We have recorded cough during the night in 10 patients with severe chronic bronchitis and emphysema (forced expiratory volume in one second, 1.0 +/- SEM 0.1/L) who complained of nocturnal cough and correlated cough with electroencephalographic sleep stage and arterial oxygenation. Cough was recorded using a directional microphone and an auto-editing tape recorder system. Each cough was subsequently verified by a listener. There was a mean of 14.6 +/- 4.5 bouts of coughing per patient per night, each bout lasting on average 3.9 +/- 0.2 s. Eighty-five percent of coughing bouts occurred during electroencephalographically confirmed wakefulness (p less than 0.02 versus sleep), and coughs during true sleep were rare, with only 1 patient coughing during rapid eye movement sleep and none during Stages 3 and 4 sleep. Cough was only once followed by arousal. There was no correlation between cough and either apneas or hypoxemia during sleep. We conclude that spontaneous cough is suppressed during sleep and only rarely awakens patients.

Adult↗
PubMed1984

Breathing, sleep, and diabetic autonomic neuropathy.

Sudden, unexplained deaths are relatively common in diabetic autonomic neuropathy. As disturbed autonomic function has been associated with sleep apnea, and sleep apnea with sudden death, we recorded breathing patterns, arterial oxygen saturation, and EEG during sleep in 8 male diabetic subjects with severe autonomic neuropathy and 8 age-matched, male diabetic subjects without autonomic neuropathy. None of the patients with autonomic neuropathy had more than 11 apneic episodes per night, and there were no significant differences between the two groups in the number of sleep apneas, the duration of individual apneic episodes, the total duration of irregular breathing during sleep, or the duration and quality of sleep. The arterial oxygen saturation when awake and the lowest arterial oxygen saturation during sleep were also similar in both groups. Thus, diabetic patients with severe autonomic neuropathy have normal breathing patterns and oxygenation during sleep, and it is unlikely that sleep apnea causes these unexpected deaths.

Adult↗
PubMed1983

Response to secondary therapy in patients with adenocarcinoma of the breast previously treated with adjuvant chemotherapy.

The response to secondary therapy, chemotherapy or hormonal, is examined in 26 patients with adenocarcinoma of breast who failed adjuvant chemotherapy. Response rates to tamoxifen or combination chemotherapy, cyclophosphamide, methotrexate, and 5-FU (CMF) or Adriamycin and vincristine (AV) were similar to response rates reported for Stage IV patients, never exposed to cytotoxic agents. Survivals in these 26 patients were similar to those reported for Stage IV patients never exposed to cytotoxics. It is concluded that adjuvant chemotherapy does not lessen future response to secondary therapies or decrease survival.

Adenocarcinoma↗