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Biomedical subjects

J Armstrong

Publications and source records attributed to J Armstrong.

At least 145 records · Page 8Linked to original sources
PubMed1991

Limited small-cell lung cancer: do favorable short-term results predict ultimate outcome?

Advances in the treatment of limited small-cell lung cancer (L-SCLC) have led to improved short-term outcome. However, it is not clear how well this predicts the ultimate fate of the patients. This may be affected by late relapse of SCLC, the development of second malignancies, and the long-term toxicity of therapy. To address this issue we report follow-up in excess of 5 years on a cohort of 36 patients who had high short-term survival resulting from treatment with chemotherapy combined with cranial and thoracic irradiation. All patients were followed until death or the time of analysis. The initially promising result of 31% survival at 3 years, was reflected in survival from SCLC of 27% at 5 years, and 23% at 9 years. However, when death from all causes was analyzed, survival was only 19% at 5 years and 7% at 9 years. There were 2 survivors disease-free at 7 and 8 years; 7 patients died of other causes without any evidence of SCLC. Among those not dying of SCLC, 4 patients developed second malignancies with a risk of 22% at 3.2 years and 50% at 8 years. Clinical neurotoxicity developed in 3 patients. These data suggest that cure of SCLC is possible in a modest proportion of patients with limited disease, but that the survivors are at significant risk of developing second malignancies which emerge as the most common cause of death during prolonged follow-up. Successful outcome of treatment is further hampered by the occurrence of neurotoxicity. Clinical strategies to prevent these sequelae of therapy are discussed.

Adult↗
PubMed1991

The psychological organization of multiple personality disordered patients as revealed in psychological testing.

The reader familiar with the borderline literature may see a correspondence between certain of our MPD/DD Rorschach results and typical borderline characteristics. Most notably, both groups reason and view others in unusual but not psychotic ways and demonstrate certain difficulties in affect integration. On the other hand, the MPD/DD group exhibits many attributes that contradict predictions one would make from a borderline perspective, and which support Kluft's assertion that the majority of these patients have a more complex and structured personality system. Rather than holding oversimplified attitudes, they are attuned to the subtleties of experience. Their generally introversive personality style reflects a capacity for internalization, for ideational organization of anxiety, for taking analytic distance from themselves, and for viewing and relating to others in a complex and empathetic fashion. To return to our metaphor of the explorer, we can conclude that the borderline personality concept gives us too broad and blurred a view of the MPD/DD terrain. It lacks the level of specificity needed to describe the test phenomena that appear on these MPD/DD Rorschachs. The special test instructions, behavior ratings of extra-test dissociative phenomena, and the posttest process questions enable us to see that although at gross level certain vulnerabilities resemble borderline characteristics, the processes underlying these phenomena are quite distinct. Moreover, unexpected areas of strength and maturity also exist. These findings suggest that we are not viewing a developmental arrest, but rather, are seeing the signs of what developmental psychologists call a "strange" development i.e., an atypical developmental pathway created by unusual interactions with the world. It may well be that much of the difficulty in establishing the validity of BPD test criteria has been due to the unwitting inclusion of DD patients within these studies. If so, the distinction between borderline and dissociative test characteristics will lead to more accurate and refined studies of both groups. The concept of PTSD has been a particularly useful dimension for elucidating MPD test phenomena. As we further investigate commonalities and differences within the MPD/DD continuum, it will be interesting to examine in what way the severity of these patients' PTSD relates to their personality characteristics, symptom patterns, and treatment response. The strength of psychological assessment has long been its ability to describe the organization of psychological processes to gain a detailed knowledge of the individual. As such, in the hands of well-trained clinicians, psychological assessment has been one of the most powerful tools for predicting long-term treatment outcome.(ABSTRACT TRUNCATED AT 400 WORDS)

Borderline Personality Disorder↗
PubMed1990

Prognostic factors in childhood acute lymphoblastic leukaemia.

58 patients under the age of 14 years with acute lymphoblastic leukaemia were managed from 1971 to 1985. We analysed their overall survival from diagnosis to assess the prognostic significance of clinical and laboratory features present at diagnosis. Factors which were statistically significant included white blood count, platelet count, palpable lymph node enlargement, mediastinal widening on chest x-ray and palpable splenic enlargement. The purpose of this study was to identify that subset of patients which might have benefitted from more intensive treatment.

Adolescent↗
PubMed1990

Prospective computer-assisted voice analysis for patients with early stage glottic cancer: a preliminary report of the functional result of laryngeal irradiation.

In January 1987 we began a prospective study aimed at evaluating objective parameters of vocal function for all patients treated with RT for early glottic cancer. All patients underwent vocal analysis using a voice analyzer interfaced with a computer. This allowed for the determination of percent voicing (%V) (normal = presence of phonation = 90-100%V). Other parameters such as breathiness (air turbulence or hoarseness) and strain (vocal cord tension) were also measured. Patients were recorded before RT, weekly during RT, and at set intervals after RT. There have been 25 patients studied. Eighteen (18) are evaluable at 9 months after treatment. All patients were male and ranged from 45-84 years old. Fourteen (14) and T1 lesions and received 66 GY/33 fractions to their larynx and 4 had T2 tumors and received 66-70 Gy/33-35 fractions. To date, all patients are locally controlled. Three distinct patterns of %V changes have been encountered. However, all patients demonstrated normal phonation pattern by 3 months after RT, and this is sustained at 9 months follow-up. In addition, 94% of patients have had significant decrease in breathiness after RT, which objectively documents diminished hoarseness. In 83%, breathiness is normal after RT. Most patients have had increased strain after RT, which documents increased vocal cord tension. However, strain remained within normal limits in 89%. Our preliminary analysis suggests that the majority of patients irradiated for early glottic cancer demonstrate a decrease in breathiness and an increase in strain after RT, and enjoy a resultant voice that has normal phonation maintained at 9 months after RT. Our data also demonstrate three distinct phonation patterns. Further follow-up will allow us to determine the prognostic significance, if any, of these patterns, and to continue to follow objective vocal parameters on larger numbers of patient.

Aged↗
PubMed1990

A semiquantitative microassay for measurement of relative number of blood mononuclear cells infected with human immunodeficiency virus.

A simple semiquantitative microassay was developed for the measurement of relative number of infected peripheral blood mononuclear cells (PBMC) from individuals infected with human immunodeficiency virus (HIV). The assay is based on cocultivation of serially diluted PBMC of a seropositive person with phytohemagglutinin-stimulated normal PBMC. The microassay has comparable sensitivity with the standard virus culture method in detecting positive HIV cultures. Since the microassay uses only 2-3 x 10(5) patients' PBMC, the assay is also most suitable for HIV isolation from HIV-infected infants or from AIDS patients with extremely low T-cell counts. The microassay can also be used to measure antiviral effects of a drug on persistent HIV infection in vitro. Because the microassay measures the relative number of infected PBMC, it can be readily used for following the quantitative antiviral effect of a drug in a clinical trial.

AIDS-Related Complex↗
PubMed1990

Lactated Ringer's solution versus 3% albumin for resuscitation of a lethal intestinal ischemic shock in rats.

Previously, we determined that a colloid concentration of about 3% was optimal for resuscitation of lethal ischemic intestinal shock model in rats. Maximal volumes of lactated Ringer's solution (RL) alone only expanded plasma volume (PV) to 80% of preshock level, while increasing volumes of 3% albumin (ALB) in RL linearly expanded PV up to twice the preshock level. This study compares the effect of RL and ALB on survival and PV in 175 rats. The solutions were given in volumes to induce suboptimal PV expansion, requiring 10 and 44 ml/100 g body weight (bwt) of ALB and RL, respectively. ALB (20 ml/100 g bwt) was then given to induce a PV above the preshock level. Shock was induced by exteriorizing the small intestine and occluding the superior mesenteric vessels for 75 min. PV was estimated using Hct. Therefore, infusions were given continuously for 6 h in volumes that maintained a stable Hct. Untreated shocked animals developed hemoconcentration (Hct 58%) corresponding to a PV of 56% of preshock level, with 2% (1/53) of the animals surviving 24 h. The maximum effect of RL (44 ml/100 g bwt) was to expand PV to 80% of preshock level, with a 32% 24-h survival rate. Only 23% as much ALB (10 ml/100 g bwt) was needed to induce similar blood volume expansion with 24-h survival rate of 46%. When the larger volume of ALB (20 ml/100 g bwt) was used, PV expanded to 115% of preshock level, and 24-h survival to 76%, greater than that achieved with either the smaller volume of ALB or RL alone (p less than .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Lysosomal sorting mutants of coronavirus E1 protein, a Golgi membrane protein.

As a model for the intracellular sorting of Golgi membrane proteins, we are studying the E1 protein of the coronavirus Mouse Hepatitis Virus A59. The wild-type protein, when expressed from synthetic RNA, is localised in the Golgi complex. When the second and third of the three predicted membrane-spanning sequences were deleted from the protein, the resulting mutant was retained in the endoplasmic reticulum. In contrast, removal of the first and second membrane-spanning sequences allowed the protein to pass through the Golgi complex and reach the lysosomes. Likewise, when 40 amino acids were deleted from the C-terminal cytoplasmic part of E1, the truncated protein was transported to the lysosomes. We discuss the implications of these results for the structure of the E1 protein and the mechanism by which it is localised in the cell.

Amino Acid Sequence↗
PubMed1990

Immunogenicity of a new Haemophilus influenzae type b conjugate vaccine (meningococcal protein conjugate) (PedvaxHIB).

Haemophilus influenzae type b is responsible for an estimated 15,000 to 20,000 cases of meningitis per year in the United States, mainly in children 2 months to 5 years old. The mortality rate from meningitis due to H influenzae type b infections ranges from 5% to 10%. Despite antibiotic treatment, up to 35% of survivors have permanent neurologic sequelae. In addition to meningitis, H. influenzae type b is responsible for other invasive infections, including epiglottitis, septicemia, cellulitis, septic arthritis, osteomyelitis, pneumonia, pericarditis, and otitis media; approximately 30,000 cases H influenzae diseases occur annually in the United States. The diseases peak in incidence between 6 and 12 months of age, with almost one half of the cases occurring before 1 year of age. About 75% of disease caused by H influenzae type b occurs in children younger than 24 months old. The incidence of disease is higher in children of certain groups, including blacks, Hispanics, Eskimos and Native Americans, young children attending day-care facilities, patients with asplenia or antibody-deficiency syndromes, and children of lower socioeconomic status. There is considerable evidence that antibody to the capsular polysaccharide (polyribosylribitol-phosphate [PRP] of H influenzae type b is protective.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

No association between herpes simplex virus type-2 seropositivity or anogenital lesions and HIV seroconversion among homosexual men.

Recent reports have suggested that HSV-2 infection and associated anogenital ulcerations represent an important risk factor for acquisition of HIV infection. Although this is an appealing biological hypothesis, inferences drawn for homosexual men, as well as other at-risk populations, must be made after careful consideration of methods to control for potential confounding data. This report utilized a nested case-control study in which 49 homosexual HIV seroconverters were compared to 49 homosexual seronegative men matched on the prior level of receptive anal intercourse. No differences were observed for prior HSV-2 infection, since 21/49 (43%) of matched HIV seronegative men were HSV-2 antibody positive and 21/49 (43%) of HIV seroconverters were HSV-2 antibody positive at the visit 6 months before HIV seroconversion (odds ratio of 1.0, 95% confidence limits of 0.3-2.9) Similar findings were also observed for prior HSV-1 infection. Both self-reported symptoms and physical exam findings suggestive of HSV infection were rare during the 12 months prior to seroconversion and not associated with HIV seroconversion. These data do not support HSV-2 as a risk factor for seroconversion to HIV among homosexual men studied. These results should not be generalized to heterosexual transmission of HIV, particularly in Africa, where both an increased prevalence of genital ulcerative diseases and different etiologies have been observed.

Adult↗
PubMed1989

Carcinoma of major salivary glands. Recent trends.

We have reviewed a 44-year experience with previously untreated carcinomas arising in major salivary glands to compare 319 patients treated before 1966 with 155 who received therapy between 1966 and 1982. Actuarial analysis indicates that five- and ten-year survival of our more recently treated patients was 80% and 65%, compared with 60% and 50% in patients treated before 1966. Explanation for this includes the higher proportion of patients with less aggressive histologic subtypes seen in recent years, as well as the fact that many of our patients treated before 1966 had surgical procedures considered inadequate by current standards. We also believe that adjunctive radiation oncology enhanced survival, but it could not be proved in this retrospective study. Multivariate analysis confirms that the clinical stage was the most important prognostic variable.

Adenocarcinoma↗
PubMed1989

Development of early swimming in Xenopus laevis embryos: myotomal musculature, its innervation and activation.

The development of the axial musculature, its innervation and early locomotion in Xenopus laevis embryos are described. Between stages 17 and 40 some 45 myotomes are formed on each side of the body. During this period the animals develop from non-motile to free swimming embryos. Using fluorescein-conjugated bungarotoxin the acquisition of acetylcholine receptor-sites was studied. At stage 25 (early flexure stage) bound bungarotoxin was confined to the first seven intermyotomal clefts, in free swimming embryos (stage 33) to the first 20 clefts. Application of horseradish peroxidase to the intermyotomal clefts in embryos ranging from stages 25 to 37/38 revealed that primary motoneurons were usually situated 100-400 microns, i.e. 0.5-1.5 myotomes, rostral to the cleft they innervated. The motor axons left the spinal cord at the caudal side of each spinal segment where neural crest was present between the cord and the myotomes. At stage 25 ventral root activity could be recorded extracellularly from only the first three intermyotomal clefts, at stage 32/33 from the first 16 clefts. The first spontaneous rhythmic swimming-like activity could be recorded around stage 28. Between stages 27 and 32/33 the initial swimming frequency and the swimming episode duration increased at least three-fold. Comparable results were obtained with high-speed cinematography and measurements with a photoelectric transducer. Between stages 17 and 40 the number of myotomes increased by 0.9 myotome h, approximately 11.4 h later followed by the innervation of the myotomes at 0.7 cleft/h. About 3.6 h after this, ventral root activity appeared at the rate of 0.6 cleft h. This study shows that the early swimming pattern generating neuronal network, located within the rostral spinal cord, reaches a state of "critical mass" around stage 27, at which the first rhythmic swimming activity occurs. At least 6-10 functional spinal segments and adjacent myotomes are required for early swimming.

Animals↗
PubMed1989

A port film marker.

A device is described consisting of brass strips embedded in a plastic plate. When inserted in a radiation beam, it produces an image of a cross centered in the field. Cuts in the brass at defined intervals project a scale on the film used to determine a magnification factor. A marker in the lower right-hand quadrant provides rapid, unequivocal orientation of the film. This capability of orientation to a beam's-eye-view makes anatomical markers redundant.

Equipment Design↗
PubMed1989

Prevention of detrimental effect of cyclosporin A on vascular ingrowth of transplanted pancreatic islets with verapamil.

The revascularization of pancreatic islet clusters transplanted beneath the renal capsule was studied in a syngeneic mouse model. The degree of vascular ingrowth was visualized by in vivo fluorescence microscopy (fluorescein isothiocyanate-dextran) and judged by a semiquantitative method from coded video recordings. The recipients of isografts were divided into four groups, depending on their daily immunosuppressive treatment: 1) none (controls), 2) 15 mg/kg cyclosporin A (CsA), 3) 0.4 mg/kg verapamil + 15 mg/kg CsA, and 4) 20-30 mg/kg methylprednisolone. In control animals, capillary ingrowth was first demonstrated on day 6, followed by progressive vascularization up to day 34. After 6 mo, the vascular architecture was similar to that seen in normal islets in situ. CsA alone significantly decreased vascular ingrowth on day 14 compared with controls (P less than .02). Verapamil prevented the detrimental effect of CsA (P less than .01), probably by improving renal subcapsular blood flow. Methylprednisolone did not affect revascularization compared with control animals at day 14. We conclude that CsA inhibits vascular ingrowth into transplanted pancreatic islets, which is likely to have clinical implications. The prevention of CsA vascular ingrowth inhibition by a calcium antagonist indicates a possible approach to the correction of this problem, particularly when the renal capsule is used as the recipient's transplant site.

Animals↗