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Biomedical subjects

C Neumann

Publications and source records attributed to C Neumann.

At least 217 records · Page 12Linked to original sources
PubMedDate not supplied

Mucocutaneous autoimmune syndrome following fludarabine therapy for low-grade non-Hodgkin's lymphoma of B-cell type (B-NHL).

A 40-year-old patient with low-grade B-NHL developed a generalized macular-papular rash following the first cycle of fludarabine treatment which progressed to a complete epidermal necrolysis following the second cycle. Clinical symptoms and the results of the direct and indirect immunofluorescence were consistent with a mucocutaneous autoimmune syndrome (pemphigus). Immunohistochemical analysis demonstrated a dense epidermal infiltration of CD8+ lymphocytes associated with the histological features of single-cell necrosis of keratinocytes. Early and aggressive immunosuppressive treatment with steroids, cyclophosphamide, and high-dose immunoglobulins resulted in regression of symptoms and complete reconstitution of epidermal integrity. The malignant lymphoma has completely regressed. The findings suggest a fludarabine-induced defect in immunosurveillance--resulting in the uncontrolled activation of autoaggressive T-cell clones--as a pathogenetic mechanism of this life-threatening dermatological complication.

Adult↗
PubMedDate not supplied

MR findings in asymptomatic shoulders: a blind analysis using symptomatic shoulders as controls.

We performed a blind prospective analysis of the shoulders of 20 asymptomatic volunteers, aged 25 to 55 years, to determine the frequency of magnetic resonance (MR) findings considered abnormal in symptomatic patients. Twenty symptomatic patients were used as controls. With regard to the asymptomatic shoulders, all 20 had intact rotator cuff tendons, although six (30%) of the tendons had abnormal internal signal, and one (5%) had abnormal morphology. Subdeltoid and subacromial fat planes were intact in 20 (100%) and 19 (95%) shoulders respectively. Subdeltoid or subacromial fluid was not present in any shoulder. Acromioclavicular osteophytes and supraspinatus depression were seen in seven (35%) and six (30%) respectively. The glenoid labrum was intact in all volunteers, although it had abnormal internal signal in 10 (50%). MR findings of abnormal signal in the glenoid labrum, and of abnormal signal and morphology of the rotator cuff tendons, supraspinatus depression, and acromioclavicular osteophytes have been reported as signs of instability, tendinitis, and impingement. Similar findings were seen in asymptomatic volunteers, indicating that these findings may not be a sign of clinically significant pathology.

Adult↗
PubMedDate not supplied

PROTECT interim results: a large multicenter study of patients with type II diabetes. Precose Resolution of Optimal Titration to Enhance Current Therapies.

The Precose Resolution of Optimal Titration to Enhance Current Therapies (PROTECT) study is an ongoing Phase IV clinical trial designed to assess the effectiveness, tolerability, and safety of acarbose tablets in patients with type II diabetes when the dosage is slowly titrated upward. This multicenter, open-label, 28-week trial will enroll approximately 7,000 type II diabetic patients. The present report describes the interim results for 2,139 patients who completed the trial as of November 1, 1996. Patients with type II diabetes enrolled in the study were inadequately controlled either with diet alone or with a sulfonylurea. The dosage of acarbose was titrated from 25 mg three times a day (TID) to 100 mg TID based on tolerability and efficacy. Efficacy of glycemic control was assessed by changes in glycated hemoglobin A1c (Hb A1c) and 1-hour postprandial plasma glucose (PPG) levels. Tolerability and safety were determined by patient reports of treatment-emergent adverse events and by review of laboratory tests. The PROTECT study confirms the previously demonstrated efficacy and safety of acarbose in improving glycemic control in patients with type II diabetes regardless of a patient's age, body weight, ethnic background, time since diagnosis, or severity of disease. mean 1-hour PPG levels declined throughout the entire treatment period, with a mean decrease from baseline of -47 mg/dL at the end of treatment. Hb A1c, the most reliable indicator of long-term glycemic control, decreased over the course of treatment, resulting in a mean decrease of -0.7% (P < 0.001). Although all patient types enrolled in the study responded positively to therapy, certain subgroups responded particularly well, such as those patients diagnosed with the disease less than 1 year ago, those treated with acarbose as monotherapy, and those with higher baseline Hb A1c levels. Adverse events were experienced by 36% of all patients and consisted primarily of gastrointestinal disturbances (flatulence, diarrhea, abdominal pain). Moderate renal insufficiency (serum creatinine levels between 1.5 and 2 mg/dL) was present in 259 patients, and no patients developed serum hepatic transaminase levels more than twice the normal range.

Acarbose↗
PubMedDate not supplied

A prospective comparison of computerized arthrotomography and magnetic resonance imaging of the glenohumeral joint.

Twenty-five patients with shoulder instability or shoulder pain of undetermined etiology were prospectively evaluated with magnetic resonance imaging and computerized arthrotomography. Actual lesions were determined by arthroscopy or at the time of open surgical repair. The images obtained were interpreted independently by three radiologists blinded to both surgical results and the results of previous diagnostic tests. Sensitivity, specificity, and accuracy were determined for each imaging technique for a variety of pathologic entities, including anterior and posterior labral abnormalities, capsular redundancy, biceps-labral complex abnormalities, humeral head (Hill-Sachs) impression lesions, and glenohumeral loose bodies. Analysis of imaging techniques also included construction of receiver operator curves for labral abnormalities. Magnetic resonance imaging showed better diagnostic results in the evaluation of glenoid labral and humeral head impression lesions (P < 0.05). Both imaging techniques were equally successful in identifying biceps-labral lesions and intraarticular loose bodies within the glenohumeral joint. Neither imaging technique was consistent in the evaluation of capsular redundancy. Receiver operator curve analysis confirmed that magnetic resonance imaging was the more accurate imaging study in evaluating anterior and posterior glenoid labral abnormalities.

Adolescent↗
PubMedDate not supplied

A risk/falls program.

Patient falls are a commonplace and costly occurrence in health care settings. Approximately two years ago, the professional nursing staff on an acute care, 28-bed division in Hanna Pavilion began developing a program to address the issue of patients at risk for falling. The need for such a program evolved as the elderly patient population increased in number. The acute psychiatric service showed an increase in patients over 65 years old, from 13 percent in 1983 to 19.8 percent in 1984. An increased number of falls was documented on the division as the numbers of elderly became larger. During 1984, patient falls constituted 42.8 percent of al reported incidents on this division. The critical concerns related to patient falls were, and still are, the potential for injury leading to chronic disability, prolonged hospital stay, need for extended care, and ultimately the catastrophic effects on the quality of life for the population.

Accident Prevention↗
PubMedDate not supplied

CD4+ CD56+ blastic tumor of the skin: cytogenetic observations and further evidence of an origin from plasmocytoid dendritic cells.

We here report on a case of a blastic tumor, recently described to belong to a new entity sharing phenotypic similarities with blood derived plasmocytoid dendritic cells and formerly regarded as belonging to the group of natural killer cell lymphomas. Besides immunophenotypic characteristics such as the absence of T- cell markers and almost complete absence of markers of the myeloid lineage, these tumors express CD4, CD56 and CD123, the receptor for interleukin-3. Moreover, using the comparative genomic hybridisation technique, CGH, we demonstrate a gain of chromosome 7q, 22 and a loss of chromosome 3p and 13q. Since this type of hematologic disorder often shows its primary manifestation in the skin and often runs a rapidly fatal course, it is important to distinguish this from other types of primary cutaneous lymphomas.

Aged↗