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Biomedical subjects

C Pollard

Publications and source records attributed to C Pollard.

At least 37 records · Page 2Linked to original sources
PubMed1995

Allogeneic bone marrow transplantation for primary myelofibrosis.

The published experience of allogeneic bone marrow transplantation for primary myelofibrosis (PMF) is limited. Three patients (24-49 years) with PMF received allogeneic marrow grafts from HLA-identical sibling donors after conditioning with 110 mg/m2 melphalan and 1050 cGy total-body irradiation (TBI). Donor marrow was not depleted of T cells, and graft-versus-host disease (GVHD) prophylaxis comprised cyclosporine and methotrexate. None of the patients was splenectomized prior to the transplant. Two patients received G-CSF post-transplant to hasten neutrophil recovery. One patient died of multi-organ failure 23 days post-transplant. Hematopoietic recovery was relatively slow in the other two who had gradual resolution of the marrow fibrosis over several months. One of the two died of overwhelming pneumococcal sepsis within 2 weeks of stopping prophylactic penicillin 31 months post-transplant. The other patient is alive and well 20 months post-transplant with a Karnofsky score of 100% and no fibrosis of the marrow. We conclude that PMF is correctable by allogeneic BMT. Hematologic recovery post-transplant is slow, but counts may normalize with time without the need for splenectomy.

Adult↗
PubMed1994

Bacillus Calmette-Guérin immunotherapy for refractory interstitial cystitis.

OBJECTIVE: To determine whether or not patients with refractory interstitial cystitis who had failed conservative therapy might benefit from intravesical bacillus Calmette-Guérin (BCG) immunotherapy. METHOD: Five patients with refractory interstitial cystitis who had failed conservative therapy underwent six weekly treatments with intravesical BCG. All 5 patients were evaluated before therapy and quarterly thereafter by water cystometry and symptom questionnaire. RESULTS: The average number of medications used daily per patient decreased from 3.2 to 1.2 after therapy. Average volumes of both first desire to void and cystometric capacity doubled after BCG. Improvement in cystometric capacity, average daytime urinary frequency, nocturia, and global pain/discomfort were statistically significant (P = 0.0277, P = 0.0131, P = 0.0199, and P = 0.0317, respectively). Three patients experienced near total relief of their symptoms with six to twelve months' follow-up (average follow-up equals 33.6 weeks). CONCLUSIONS: Although the mechanism of action of BCG in interstitial cystitis is unknown, we recommend a double-blind placebo controlled trial to confirm these results and determine an optimal dosage and treatment schedule.

Adult↗
PubMed1994

[The "Soft Approach": a program of rehabilitation of chronically mentally ill elderly patients].

The authors report on "The Soft Approach", a program for chronic mentally ill elderly patients, which they have implemented in a gero-psychiatric unit in New York City. Using a professional team, their approach treats the medical problems, and the various degrees of dementia encountered, in a positive and coordinated effort centered around daily recreational and socializing activities; these include off-ward events and outings away from the hospital. The goals of the program are increased independence and eventual community living. The importance of their medication regime is stressed with patients throughout the program.

Activities of Daily Living↗
PubMed1994

Identifying speech and language delay.

Publication of the Hall report has prompted many health authorities to cut back on the range of routine child health screening programmes. In some areas health visitors are playing a less central role in child health surveillance. James Law and Carrie Pollard argue the need for routine screening of all children for speech and language delay, and that health visitors--with more adequate specialist training--should carry out these checks. Problems may persist for many years if not tackled in the pre-school years, they warn.

Child, Preschool↗
PubMed1992

Professional challenges in the coming decade.

Last month, as part of our observance of the 15th anniversary of Physician Assistant journal, members of our Editorial Board offered their views on turning points in the history of the PA profession. In this issue, we jump from the past to the future, with perspectives on the main crises or changes facing the profession in the coming decade. You may agree or disagree with these viewpoints. Diversity of opinion keeps the PA profession dynamic and strong--which is exactly why Physician Assistant journal provides an open forum for letters and guest editorials.

Forecasting↗
PubMed1991

Storage artifact increases helper T lymphocytes and helper-to-suppressor T lymphocyte ratio to normal levels in a patient with acquired immune deficiency related complex.

An increase in both the helper/suppressor T lymphocyte ratio and the absolute number of helper T lymphocytes from subnormal to normal values was observed on overnight storage of a lymphocyte preparation from a patient with acquired immune deficiency related complex. Storage of lymphocyte preparations did not significantly alter the helper/suppressor ratio for four additional patients with acquired immune deficiency related complex but produced increases for one patient with Crohn's disease and two patients with sickle cell disease. Overnight storage of heparinized blood at room temperature did not alter the helper/suppressor ratio for one healthy volunteer and one patient with acquired immune deficiency related complex but produced increases for one patient with Crohn's disease and one patient with acute infectious mononucleosis, resulting in a change from a subnormal to a normal value in the latter patient. We suggest that physicians and laboratory directors consider storage artifacts when evaluating results of tests for absolute numbers of helper T lymphocytes or helper/suppressor T lymphocyte ratios performed on patients.

AIDS-Related Complex↗
PubMed1989

Response to pneumococcal vaccine among asymptomatic heterosexual partners of persons with AIDS and intravenous drug users infected with human immunodeficiency virus.

Antibody responses to pneumococcal vaccine were studied in asymptomatic heterosexual partners of persons with AIDS and intravenous drug users seropositive for human immunodeficiency virus (HIV). Serum antibodies to 12 pneumococcal capsular antigens were measured by radioimmunoassay. Eleven intravenous drug users seropositive for HIV, 13 seronegative intravenous drug users, and 10 each seropositive and seronegative sexual partners received 23-valent pneumococcal vaccine. Additional unvaccinated matched seropositives served as controls. Antibody responses were significantly lower among subjects seropositive for HIV (P less than .05). Fourteen (88%) of 16 seropositive subjects with baseline type-specific antibodies to one or more pneumococcal antigens less than 300 ng of antibody nitrogen/ml (ngAbN/ml) demonstrated a rise in one or more of these antibodies to greater than 400 ngAbN/ml. No clinical deterioration or decrease in T4 cells attributable to vaccination was found. Although antibody responses to pneumococcal vaccine among HIV-infected subjects were impaired, most with antibody levels less than 300 ngAbN/ml developed titers of one or more type-specific antibodies to levels greater than 400 ngAbN/ml without notable adverse effects.

Acquired Immunodeficiency Syndrome↗
PubMed1988

AIDS counseling on the front lines.

Skill at patient education is crucial to the battle against the spread of human immunodeficiency virus (HIV). The fight is not confined to one segment of society or to a few geographic areas. Counseling patients at risk about HIV-antibody (HIV-Ab) testing requires a full understanding of the available tests; a psychosocial profile of the patient; candid, nonjudgmental exchanges between patient and clinician; and an ability to deal with significant emotional stress. All PAs should use their talents at patient education to help contain HIV infection.

AIDS Serodiagnosis↗
PubMed1984

Lack of T cell antigen expression on hairy cells of B cell origin after in vitro exposure to PHA.

The malignant monoclonal population in hairy cell leukemia (HCL) has been variously ascribed to be of myeloid, B, or even T cell origin. Recent data have been interpreted as suggesting that hairy cells (HC) may concomitantly or serially express both B and T surface determinants, a phenomenon which, if verified, would be unique among the lymphoproliferative malignancies. Data described here, however, demonstrate that (1) at least the majority of HCL are phenotypically of B cell derivation, and (2) the initial B cell phenotype is retained and solely expressed on cultured as well as phytohemagglutinin (PHA) activated monoclonal malignant HC.

Adult↗
PubMed1983

Non-Hodgkin's lymphoma phenotyping: problems in the use of heterologous and monoclonal antibodies.

Cell suspensions or frozen sections of lymph node biopsies from 32 patients with non-Hodgkin's lymphoma (NHL) were studied for sheep erythrocyte (E)-binding under three conditions (Estandard, EAET, Egravity), Fc and C receptors, immunoglobulin (Ig) heavy and light chain class and reactivity with heterologous antisera to T cells (T-LCL), HLA-D (Ia-like) and common acute lymphocytic leukemia (c-ALL) antigens. Selected B and T cell lymphomas were also tested for reactivity with the monoclonal antibodies OKT 3, OKT 4, OKT 6, OKT 8, OKT 11A, Leu-1, Leu-2a, Leu-3a, Leu-4 and Leu-7. There were 26 B and 6 T lymphomas. Most B lymphomas were mu+ (81%), kappa+ (77%) and 31% were mu+ delta+. One of the T lymphomas arose in a patient with antecedent follicular small-cleaved (B) cell lymphoma. The most accurate marker for characterizing the immunologic phenotype in NHL was the clonal excess of kappa+ or lambda+ cells. Neither Estandard, EAET, Egravity or T-LCL were consistently reliable as sole reagents in identifying T-cell lymphomas, their individual scores often being lower than those of monoclonal pan-T cell reagents. HLA-D (Ia-like) antigen was noted in 89% of B and 50% of T lymphomas. The corresponding values for c-ALL antigen were 12 and 33%, respectively. The comparative scores in T-lymphomas between OKT 4 and Leu-3a for "helper-inducer" (HE) cells and OKT 8 and Leu-2a for "suppressor-cytotoxic" (SU) cells were not uniformly consistent. Four T lymphomas had a mixed HE/SU cell phenotype, one was HE, and another SU. Anti-T reactivity was detected in the neoplastic follicles of six of seven follicular lymphomas. The percentage of anti-T reactive cells within positive neoplastic follicles was usually small (5-15%) and of the same order as that noted within reactive lymphoid follicles (5-30%). High numbers (50-100%) of cells from five small lymphocytic B, three diffuse small cleaved cell B and six T cell lymphomas were also positive with one or more anti-T reagents, suggesting the presence of cross-reactive antigens that make phenotyping of lymphomas with monoclonal antibodies problematic. Reactivity with the monoclonal antibody Leu-7 (HNK-1), a putative NK-specific reagent, was seen in one of five B and three of five T lymphomas.

Antibodies, Monoclonal↗
PubMedDate not supplied

Follicular mantle zone cell subpopulations detected by monoclonal antibody SN3.

A monoclonal antibody, SN3, has been prepared against a cell membrane fraction of the pre-B leukemic cell line NALM-1. By radioimmunoassay, SN3 reacted with four of four non-T/non-B, two of two pre-B and one of three leukemic B cell lines. The reagent was unreactive, however, with established leukemic T and myelomonocytic cell lines or normal B cell lines. On immunohistochemical assays on frozen sections of nine reactive lymph nodes and three spleens, SN3 showed a preferential binding to 50-95 per cent mantle zone (MZ) cells and 5-20 per cent interfollicular or red pulp B-lymphocytes. This was uninhibited by pre-incubation with heterologous anti-HLA-DR or anti-delta reagents. SN3 was unreactive with normal germinal centre (GC), epidermal or Langerhans cells but did react with less than 1 per cent thymic B-lymphocytes. In eight follicular small cleaved cell lymphomas tested SN3 exhibited three patterns of reactivity: peripheral follicular, combined peripheral and central follicular, and combined follicular and interfollicular. Three follicular lymphomas were essentially SN3-. In three diffuse small lymphocytic lymphomas, SN3 showed patchy areas of reactivity unassociated with proliferation centres. In four diffuse B-cell lymphomas (one mixed small and large cell, two large non-cleaved cell, and one small non-cleaved (Burkitt) cell), SN3 reactivity was uniformly distributed in the majority (60-90 per cent) of the cells. SN3 was unreactive with one diffuse B-large cell lymphoma, three nodal T-cell lymphomas and three cases of mycosis fungoides. The findings indicate that SN3 detects an antigen that is present in subpopulations of normal MZ cells, the antigen is also detected in GC cells undergoing lymphomatous transformation but is not readily detected in normal GC cells, and the antigen is also expressed in subpopulations of diffuse B- but not T-cell lymphomas.

Adult↗
PubMedDate not supplied

The risks of total pancreatectomy and splenic islet autotransplantation.

The intraportal site is the most common site for islet transplantation. Many other sites have been tried experimentally, including the spleen, which has successfully lead to insulin independence in a number of animal models. Nevertheless, there are no detailed reports of total pancreatectomy and splenic islet autotransplantation in humans. Five patients underwent total pancreatectomy and splenic islet autotransplantation for chronic pancreatitis. Four patients had a pylorus-preserving total pancreatectomy and one patient a duodenal-preserving pancreatectomy. In three cases islets were embolized into both the portal vein and spleen. Two patients received splenic islet transplants alone. Islets were transplanted by retrograde venous infusion via the short gastric veins (n = 3), splenic vein stump (n = 1), and the left gastroepiploic vein (n = 1). The total volumes of transplanted pancreatic digest in those receiving combined intraportal and splenic autografts (n = 3) were 15.8, 13.0, and 13.5 ml. The volumes in those receiving a splenic-alone autograft (n = 2) were 12.0 and 5 ml. The mean rise in portal pressure was 18 cm of water. Complications related to the splenic autograft included a wedge splenic infarct, an emergency splenectomy, and a portal vein thrombosis in one patient having a combined intraportal and splenic autograft. Two patients developed insulin independence. two patients were still insulin independent at 1-year follow-up, and all had normal HbA1c levels (mean 5.6, range 5.2-6.3). Splenic islet autotransplantation, after total pancreatectomy, does lead to insulin independence. However, in our experience the combined procedure has a high morbidity because of splenic infarction and venous thrombosis.

Adult↗