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Biomedical subjects

D S Shimm

Publications and source records attributed to D S Shimm.

64 records · Page 4Linked to original sources
PubMed1981

Felty's syndrome: effects of splenectomy upon granulocyte count and granulocyte-associated IgG.

Clinical parameters and laboratory studies including granulocyte-associated IgG were documented in 15 patients with Felty's syndrome treated by splenectomy. Five patients did not benefit from splenectomy, six responded partially, and four completely. Response to splenectomy could not be predicted from age, sex, splenomegaly, preoperative granulocyte count, platelet count, lymphocyte count, bone marrow lymphocytosis, or granulocyte bound IgG. In contrast, marked elevation in preoperative serum granulocyte binding IgG predicted response to splenectomy. Furthermore, a postoperative fall in serum granulocyte binding IgG was associated with response. Thus, one beneficial effect of splenectomy in some Felty's syndrome patients is reduction of serum granulocyte binding immunoglobulin.

Adult↗
PubMed1980

Ventricular tachycardia associated with removal of a Swan-Ganz catheter.

Swan-Ganz catheterization was performed because of persistent unexplained tachycardia in a patient with myocardial infarction. Although there was no premonitory arrhythmia, ventricular tachycardia developed as the catheter was removed. Direct-current cardioversion was required. The occurrence of ventricular tachycardia requiring cardioversion in a patient who experienced no ventricular ectopy earlier in his hospitalization shows that Swan-Ganz catheter removal may provoke potentially serious arrhythmia. Uninterrupted vigilance from the time the Swan-Ganz catheter is inserted to the time it is removed is essential. Therefore, we recommend that the catheter be removed under ECG monitoring by experienced personnel, with lidocaine and a defibrillator available.

Catheterization↗
PubMed1980

Recurrent thrombocytopenia following idiopathic thrombocytopenic purpura. The importance of platelet-bound IgG in establishing cause.

A 20-year-old man experienced two separate thrombocytopenic illnesses. The first episode represented classic idiopathic thrombocytopenic purpura (ITP) and was associated with elevated platelet-bound IgG values. Adequate control of thrombocytopenia could not be obtained with prednisone therapy, and splenectomy produced a clinical remission. Four weeks after splenectomy, an acute febrile illness typical of cytomegalovirus (CMV) infection developed, and CMV grew grom a sample of the patient's blood. Thrombocytopenia recurred during the CMV infection but was not associated with elevated platelet-bound IgG levels. Since the second episode of thrombocytopenia was associated with normal amounts of platelet-bound IgG, it was not ascribed to relapse of the ITP, and the thrombocytopenia resolved rapidly, without specific therapy. There are various therapeutic implications of an accurate causative diagnosis of thrombocytopenia.

Adult↗
PubMed1979

Medical management of chronic cancer pain.

Management of the chronic pain of cancer is a common and difficult problem. In addition to a medical examination of the patient, it is necessary to perform a psychological assessment of his premorbid personality, current mental status, and coping mechanisms to devise an individualized approach to his pain. The mainstay of cancer pain control are the narcotics, which differ primarily in potency and duration of action. Nonnarcotic analgesics are equianalgesic with the less potent narcotics. Antipsychotic drugs are useful as tranquilizers, antiemetics, and analgesic potentiators. Antidepressants and hypnotics permit the patient a more normal life-style. Stimulants such as cocaine and amphetamines both potentiate narcotic analgesia and reduce narcotic-induced somnolence and respiratory depression. Tetrahydrocannabinol offers no advantage over traditional analgesics. With care and patience, the physician can render practically any cancer patient pain-free.

Analgesics, Opioid↗
PubMed1979

Primary amyloidosis, pure red cell aplasia, and Kaposi's sarcoma in a single patient.

A patient who developed primary amyloidosis, pure red cell aplasia, and Kaposi's sarcoma is described. This is the second reported coincidence of Kaposi's sarcoma and pure red cell aplasia and the first coincidence of Kaposi's sarcoma and primary amyloid, thus enlarging the spectrum of plasma cell and immunoglobulin abnormalities seen in Kaposi's sarcoma. Because immunologic abnormalities have been described in all these diseases, it is felt that some primary immune dysfunction is the underlying cause of the three diseases in this patient.

Amyloidosis↗
PubMed1978

Transient monoclonal immunoglobulin G with anti-dextran activity.

A patient with regional enteritis had received iron dextran for treatment of iron deficiency. Subsequently he developed a large (3.1 g/100 ml) IgG-K serum spike which had precipitin activity against dextran sulfate but not a variety of other antigens. There has been no evidence of multiple myeloma and the spike gradually disappeared spontaneously over the course of 2 years. We speculate that the monoclonal protein may have developed as a response to the iron dextran injections under the immunologic stress of a chronic inflammatory disease.

Adult↗
PubMedDate not supplied

Regional hyperthermia for deep-seated malignancies using the BSD annular array.

Forty-four patients were treated using the BSD-1000 Annular Phased Array between April 1983 and December 1986. There were 32 pelvic, nine abdominal, two extremity, and one thoracic sites treated. Mean tumour volume was 646 cc. Thirty-nine patients had concurrent radiation therapy, receiving a mean dose of 38 Gy. Mean average temperature was 41.0 +/- 1.4 degrees C. Most patients experienced local or systemic toxicity, requiring temporary treatment interruption in 33 patients, and termination of treatment in eight. Chronic complications were seen in four, but these were in patients receiving high total radiation doses as well. There were six complete and five partial responses. Among the 32 patients with pelvic tumours, mean tumour volume was 317 cc, mean radiation dose was 42 Gy, and mean average temperature was 41.3 +/- 1.2 degrees C. There were five complete and four partial responses. Achieving tumour temperatures greater than or equal to 42 degrees C with the annular array is difficult, due to both systemic and local toxicity. To improve clinical hyperthermia for thoracic, abdominal, and pelvic tumours, new technologies such as steerable phased array microwave systems; scanned, focused ultrasound; and permanently implantable thermoregulating ferromagnetic seeds, or new approaches such as using drugs to alter blood flow, or combining hyperthermia with antineoplastic drugs or biological agents, will be necessary.

Clinical Trials as Topic↗
PubMedDate not supplied

Clinical evaluation of hyperthermia equipment: the University of Arizona Institutional Report for the NCI Hyperthermia Equipment Evaluation Contract.

Two-hundred and fifteen independent sites in 203 patients were treated with hyperthermia at the University of Arizona from 10/81 through 3/86 under the auspices of this contract. In the head and neck, a site dominated by superficial tumors, air-coupled and water-coupled microwave applicators yielded the best results. Similarly in the thorax, also dominated by superficial tumors, water-coupled microwave applicators were best. In the abdomen and pelvis, sites dominated by deep tumors, only interstitial radiofrequency (RF) heating, an invasive technique useful only in selected cases, was capable of consistently producing therapeutic temperatures. Toxicity appeared to be site-related, and treatment discomfort was especially common in abdominal and pelvic sites. In conclusion, while superficial sites were readily heated using propagative electromagnetic devices, these devices were ineffective and poorly tolerated at deeper sites. Effective deep hyperthermia was best produced with interstitial techniques, and further development of these techniques using RF electrodes, implantable microwave antennas and thermoregulating ferromagnetic seeds, as well as scanned, focussed-ultrasound techniques, holds promise for effective heating of deep visceral sites.

Clinical Trials as Topic↗
PubMedDate not supplied

Variation in the lung inhomogeneity correction factor with beam energy. Clinical implications.

In order to determine the magnitude of the dosimetry error introduced by failing to correct for increased transmission through lung tissue in treating thoracic malignancies, measurements in a phantom were taken using different field sizes, inhomogeneity thicknesses and photon qualities. The results indicate that the error introduced by neglecting the inhomogeneity correction is greatest at lower photon energies, smaller field sizes and greater thickness of inhomogeneity. Correction factors to account for the lung inhomogeneity were obtained from phantom measurements and were compared with those calculated using the tissue-air ratio and Batho-Young algorithms; correlation coefficients describing the relationship between measured and calculated values exceeded 0.995. The calculated values tended to overestimate the correction factor and differed most from the measured correction factors at lower energies, smaller field sizes, and greater inhomogeneity thicknesses. The importance of these results in clinical radiation therapy is discussed.

Cobalt Radioisotopes↗