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Biomedical subjects

D Green

Publications and source records attributed to D Green.

At least 289 records · Page 16Linked to original sources
PubMed1987

The spectrum of human immunodeficiency virus infection in patients with factor IX deficiency (Christmas disease)

Early reports suggested that hemophiliacs with factor IX deficiency (Christmas Disease) may be at less risk for developing the acquired immunodeficiency syndrome (AIDS) than patients with classic hemophilia. We evaluated 12 factor IX deficient patients for clinical and immunologic abnormalities related to infection with the human immunodeficiency virus (HIV). Antibody to HIV was not detected in these patients prior to 1982. By 1985, 66 percent (eight of 12) patients were seropositive. All three concentrates available commercially before 1985 were associated with seropositivity. Furthermore, seropositive hemophiliacs had received on average significantly more factor IX concentrate than seronegative hemophiliacs (27,825 +/- 17,976 (S.D.) versus 1,250 +/- 1,500 factor units/year, (p less than 0.02). Half of the seropositive individuals had generalized lymphadenopathy with splenomegaly. Two seropositive patients have developed AIDS, one with cryptococcal meningitis and another with a large cell immunoblastic lymphoma. Infection with HIV has occurred with high frequency in hemophiliacs who received unmodified factor IX concentrates.

AIDS-Related Complex↗
PubMed1987

Fibrinopeptide A increases after chorionic villus sampling.

Fibrinopeptide levels were measured in 20 women during transcervical chorionic villus sampling (CVS). Fibrinopeptide A, a sensitive indicator of fibrinogen cleavage by thrombin, significantly increased in five subjects, whereas there was no change in B beta peptide, an indicator of fibrinolysis. The data suggest that modest fibrin formation, uncompensated by fibrinolysis, may be induced in some women by CVS.

Adult↗
PubMed1987

Protein C deficiency in splanchnic venous thrombosis.

Deficiencies of protein C activity and antigen were observed in eight consecutive patients with splanchnic venous thrombosis. There was a significant reduction in the ratio of protein C to factor X. Six of the eight patients had a decrease in antithrombin III, but free protein S antigen was within normal limits in all but two subjects. It is proposed that a thrombogenic stimulus such as stasis, altered hormonal milieu, or failure of hepatic clearance of activated coagulants results in consumption of protein C and antithrombin III, predisposing to splanchnic venous occlusion. This further impairs hepatic function, prevents restitution of protein C and antithrombin levels, and promotes continuing venous thrombosis. Thus, a vicious cycle of thrombosis and hepatic damage is perpetuated.

Adult↗
PubMed1987

A comparison of stutterers and nonstutterers on masking level differences and synthetic sentence identification tasks.

Ten stutterers and ten nonstutterers, matched for sex, were tested for Masking Level Differences (MLDs) at 500 Hz, and were evaluated on the Synthetic Sentence Identification test with Ipsilateral Competing Message (SSI-ICM) under message-to-competition ratios (MCRs) of 0, -10, and -20 dB. No significant differences on the SSI-ICM task were seen between groups, but the stutterers did produce significantly (p less than .01) poorer MLDs than the nonstutterers. This may be interpreted as support for Kent's (1983) hypothesis that stutterers may be poorer at temporal processing. In addition, the present results support the concept of a continuum of auditory processing ability, with normals and stutterers of different degrees of disfluency revealing decreasing performance measures.

Adult↗
PubMed1987

Adolescent exhibitionists: theory and therapy.

In the absence of an agreed etiology or preferred treatment for exhibitionism the author reviews his clinical experience in working with adolescent boys who have indecently exposed themselves. A retrospective analysis indicates that the implicit theories that informed clinical practice construed exhibitionism as social behaviour rather than psychological symptom and placed it in a clear development context. It is argued that adolescent exhibitionism can be viewed as a "strategic interaction" that is characteristically adolescent. Using the individual adolescent's account of his misconduct it may be possible to determine the particular "game" in which he is engaged. This formulation can lead to clinical interventions which will best foster a future change of strategy and reduce the prospects of re-offending. Three clinical vignettes illustrate this model in action. Finally the theoretical limitations and practical difficulties associated with this way of understanding adolescent exhibitionists are discussed.

Adolescent↗
PubMed1987

Hypoprothrombinemia associated with cefoperazone therapy.

Cefoperazone, a beta-lactam antibiotic with a methylthiotetrazole side chain, has been reported infrequently to cause hypoprothrombinemia and hemorrhage. We retrospectively analyzed the records of 80 patients who had been given this drug for more than 72 hours. Nine patients received vitamin K1 (phytonadione) prophylaxis and had no evidence of hemorrhage. Of the remaining 71 patients, 32 had prothrombin times measured; 14 of them had hypoprothrombinemia. Prothrombin times ranged from 14.8 to 97.3 seconds at a mean of 6.2 days after initiation of therapy. Seven of the 14 patients had clinically significant hemorrhage and five required transfusions. Two patients with clinically evident hemorrhage died during or immediately after cefoperazone therapy. Prothrombin times rapidly returned to normal in all patients treated with phytonadione. We believe hypoprothrombinemia is a more common complication of cefoperazone therapy than is generally acknowledged, and is preventable. Unless clinically contraindicated, we recommend that all patients treated with cefoperazone receive phytonadione prophylaxis.

Aged↗
PubMed1987

Chemotherapy for small cell lung cancer: induction and reinduction with VOCA.

Sixty-five patients with small cell lung cancer were treated with VP16, vincristine, cyclophosphamide, and doxorubicin (VOCA) intravenously at three-week intervals. Patients with limited disease received four cycles with responders receiving radiation to the primary site and prophylactic cranial irradiation. Patients with extensive disease received chemotherapy only. Of 59 patients evaluable for chemotherapy response, eight (14%) achieved complete remission and 30 (51%) partial remission. Major side-effects included myelosuppression, alopecia, nausea, and vomiting. Reinduction with VOCA at relapse yielded objective or subjective response in four of seven patients. This regimen is active in small cell lung cancer and was well tolerated by patients. Reinduction of response was possible in a small number of patients retreated and may provide useful palliation for those who relapse when treatment is discontinued.

Adult↗
PubMed1987

Rehabilitating severely head-injured adolescents: three case reports.

The case reports of 3 severely head-injured adolescents, who developed psychiatric sequelae after the trauma, are presented. All 3 cases displayed various socially disinhibited behaviours. Individually tailored treatment programmes helped these young people manage their maturational tasks of adolescence. Several issues, central to this rehabilitative work, are discussed, including the personal significance of the adolescent's injury, identity issues and defence mechanisms; a family perspective on coping with the injured adolescent and the components of a therapeutic package.

Adolescent↗
PubMed1987

Combination chemotherapy followed by surgery or radiotherapy in patients with locally advanced cervical cancer.

Forty-seven patients with locally advanced cervical cancer at high risk of relapse received three cycles of chemotherapy with PVB (cisplatin, vinblastine and bleomycin) before definitive local treatment with either radical surgery or radiotherapy. Thirty-one of the 47 patients (66%) responded to initial chemotherapy, and 11 of them have relapsed compared with 13 of the 16 non-responders. Median time to recurrence was 31 weeks for PVB non-responders but has not yet been reached for PVB responders. After a median follow-up of 128 weeks, 14 of the 31 responders (45%) are alive and disease free compared with 3 of the 16 non-responders (19%). There was a positive correlation between response to chemotherapy and subsequent response to radiotherapy. PVB was in general well tolerated although one death is probably attributable to chemotherapy. A randomized study comparing radiotherapy alone with initial PVB chemotherapy followed by radiotherapy is in progress.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Functional electric stimulation to enhance systemic fibrinolytic activity in spinal cord injury patients.

Functional electric stimulation (FES) of muscle has been used to decrease the incidence of postoperative deep vein thrombosis (DVT) in neurologically intact individuals. This study was undertaken in order to determine whether a large-scale trial should be initiated using FES to prevent DVT in spinal cord injury (SCI) patients. The goals of this pilot study were to demonstrate the value of FES of calf musculature in (1) increasing plasma fibrinolytic activity and (2) promoting venous blood flow in the lower extremities. Plasma fibrinolytic activity was monitored in ten SCI patients before, immediately after, and 100 minutes after 60 minutes of calf FES. A significant increase in plasma fibrinolytic activity was noted using whole blood and platelet-rich plasma clot lysis assays. Continuous photoplethysmographic and Doppler ultrasound monitoring of venous flow was attempted during FES in four spinal cord patients, and a mild to moderate increase in flow was achieved. FES was not as successful as manual compression in promoting venous emptying of the lower extremity. FES may be a useful tool in the prevention of DVT in SCI patients due to a significant increase in fibrinolytic activity and a mild to moderate increase in venous blood flow. FES merits full-scale clinical evaluation for this purpose.

Electric Stimulation Therapy↗
PubMed1986

The interaction of the factor VIII/von Willebrand factor complex with hematin.

Intravenous infusion of hematin, used in the treatment of acute porphyria, induces a decline in the plasma factor VIII/von Willebrand factor complex (VIII/vWF) and thrombocytopenia. We investigated this problem by studying the interaction between hematin, purified VIII/vWF, and platelets in vitro. Hematin was labeled with either 59Fe or 3H and characterized by gel chromatography. Hematin self-aggregated, forming a complex with an average molecular weight of approximately 10,000 daltons. When incubated with VIII/vWF for 30 min at 37 degrees C and applied to Sepharose CL-4B, the hematin eluted with the VIII/vWF in the void volume. Hematin inhibited the dissociation of factor VIII antigen (VIII:Ag) from the von Willebrand antigen (vWF:Ag) in 0.25 M CaCl2, and reversed the aggregation of VIII:Ag induced by 0.1 M 6-aminocaproic acid. Both hematin and the hematin-VIII/vWF complex bound to washed normal platelets and to platelets from a patient with Bernard-Soulier syndrome. Thrombasthenic platelets were not aggregatable by hematin, and bound significantly less hematin-VIII/vWF than normal platelets suggesting that hematin-induced platelet activation was required for binding. Likewise, binding was inhibited by PGE1 which also prevented aggregation. We conclude that hematin forms complexes with VIII/vWF, alters the functional activity and dissociation of this compound, and participates in the binding of VIII/vWF to platelets.

Blood Platelets↗
PubMed1986

Early supradiaphragmatic Hodgkin's disease. High-dose gallium scanning obviates the need for staging laparotomy.

Experience with 16 sequential patients with Stage IA/IIA supradiaphragmatic Hodgkin's disease who had no evidence of intra-abdominal disease using high-dose gallium and computerized tomography scanning is reported. Subsequent staging laparotomy also was negative in all these patients and did not alter management decisions. It is suggested that high-dose, whole-body gallium scanning and other noninvasive staging procedures give reliable data for therapeutic decisions.

Adult↗
PubMed1986

Increased fibrinolytic activity in patients undergoing cardiopulmonary bypass operation.

The influence of cardiopulmonary bypass on fibrinolytic activity was assessed by a sensitive clot lysis assay in eight patients undergoing coronary artery bypass operations. Fibrinolytic activity increased immediately after cardiopulmonary bypass was begun and remained elevated throughout the period of extracorporeal circulation. At the conclusion of the operative procedure, fibrinolytic activity returned to the normal range in all patients, and no subject had postoperative bleeding.

Blood Cell Count↗
PubMed1986

Is sickle cell crisis a thrombotic event?

Although large vessel thrombi are occasionally reported in patients with homozygous sickle cell disease, the role of intravascular coagulation in typical pain crises is controversial. Therefore, we studied 24 sickle cell patients during and between episodes of pain crisis, using several sensitive tests of hemostasis. Fibrinogen was measured by a clotting assay, beta-thromboglobulin (beta-TG) and fibrinopeptide A (FPA) were quantitated by radioimmunoassay, and protein C was determined by absorbing the zymogen from test plasma, activating it with thrombin-thrombomodulin complex, and measuring activity with a selective synthetic substrate. Fibrinogen was elevated in asymptomatic patients (355 +/- 145 mg/dl) but was no different from the value in these same patients during crisis (333 +/- 180 mg/dl, p greater than 0.1). Similarly, beta-TG 136 +/- 52 ng/ml vs 118 +/- 56; FPA 3.7 +/- 4.8 ng/ml vs 5.2 +/- 4.5, and protein C 71 +/- 20% vs 66 +/- 19 showed no important changes during crisis. However, all these values were significantly different from those in age- and sex-matched healthy controls. beta-TG, fibrinogen, and FPA were elevated (p less than 0.001, 0.005, and 0.05, respectively), and protein C was decreased (p less than 0.003). We conclude that while chronic intravascular coagulation is common in patients with sickle cell disease, there is no evidence that the pain crisis per se is a thrombotic event.

Adolescent↗
PubMed1986

Long-term follow-up of prosthetic joint replacement in hemophilia.

We evaluated the outcome of seven severe hemophilic patients who underwent four total hip and four total knee arthroplasties since 1976. These patients have been followed at regular intervals over a period of 2.5-9.5 years (mean 5.8). Of the four total hip replacements, one had to be removed because of loosening and secondary infection 3 years after the initial surgery but was salvaged by pseudoarthrosis; the other three are pain-free and radiologically stable and have an excellent range of motion 2.5, 5, and 7 years postoperatively. Of the four total knee replacements, one had to be removed because of infection but was successfully salvaged by arthrodesis; one patient has loose components, but the prosthesis is still functional; and the final patient with bilateral knee prostheses is pain-free with limited but functional range of motion. Clotting-factor replacement therapy was effective in controlling intraoperative bleeding, even in a patient with an inhibitor, and only one procedure was complicated by hematoma formation. We conclude that prosthetic joint replacement may be safely performed in hemophilic patients but should be reserved for those who have limited function because of severe pain, joint destruction, and deformity. Total hip arthroplasty is as successful in these patients as in nonhemophiliacs. Total knee arthroplasty provides relief of pain, reduces the frequency of hemarthroses, and corrects most of the deformity, but it is usually associated with a limited range of motion.

Evaluation Studies as Topic↗