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Biomedical subjects

J D Rain

Publications and source records attributed to J D Rain.

At least 91 records · Page 5Linked to original sources
PubMed1984

The 'spent' phase of polycythaemia vera: hypersplenism in the absence of myelofibrosis.

A clinical phase (spent phase) in the course of polycythaemia vera (PV) cases is described as enlargement of the spleen in spite of treatment, frequent cytopenia of one or several lines, persistent red cell hypervolaemia with considerable increase of plasma volume, persistence of myeloid hyperplasia with no collagen myelofibrosis or osteomyelosclerosis, absence of hepatosplenic erythroblastic metaplasia, as shown by radio-iron kinetics and/or 111In-transferrin scintigraphy. The frequency of this phase was 5% in a study where it was not systematically sought, but it could in fact be greater. Its occurrence is not related to the clinical and biological parameters of PV. On the other hand, it is significantly more frequent and earlier in patients treated by phlebotomies than in those treated by myelosuppression (32P). In four of the 12 cases, this phase was rapidly followed by an acute leukaemia. In eight cases there was a 1-5 year interval before a myelofibrosis with splenic myeloid metaplasia. This evolution could at this stage be delayed by chemotherapy. The efficacy of splenectomy should be studied.

Aged↗
PubMed1980

[Lymphoedema of the upper limb following surgery or radiotherapy. Investigation by indirect radioactive lymphography (author's transl)].

Indirect radioactive isotope lymphography using intravenous 99 m Tc-labelled colloidal antimony sulfide was performed on 76 patients with lymphoedema of the upper limb consecutive to surgery or radiotherapy. The time required to reach 50% of maximum radioactivity was taken as index of the lymphatic flow rate, and the patients were divided into 3 groups depending upon the index (< 20 min; 20-60 min; > 60 min). It appears that in huge lymphoedemas the lymphatic flow rate index may remain subnormal, owing to associated veno-occlusive oedema. This non-invasive method provides data on the site and, frequently, on the nature and importance of lymph blockade. It might also help to predict the efficacy of a new drug currently under study.

Arm↗
PubMed1980

Significance of bone-marrow scintigraphy in aplastic anemia: concise communication.

Tc-99m colloid and In-111 transferrin were used in a semiquantitative scintigraphic study of bone-marrow activity in 76 patients with aplastic anemia, the majority of which were severe cases. The results are compared with other known prognostic parameters and with a predictive index formulated from a prior multi-parametric analysis performed in 352 cases. In 47 cases parallel abnormality of Tc and In uptakes was noted and was well correlated with other prognostic factors. Indium uptake is apparently a good indicator of the severity of aplasia; extension of active erythroid tissue, demonstrated with this method, is correlated with prognosis. In nine cases, excessive In uptake is explained by dyserythropoiesis associated with granulo- and thrombocytopenia (Fanconi's anemia in most cases). In 20 of our patients, TcSC uptake was excessive compared with that of In and with other prognostic factors. Statistically, this phenomenon carries an unfavorable prognosis but its physiological meaning remains to be defined.

Anemia, Aplastic↗
PubMed1978

Maintenance therapy of 32P-induced remission in polycythemia vera. A clinical trial of chlorambucil and hydroxy-urea in 109 cases.

In 109 patients with polycythemia vera, previously treated by 32P without maintenance therapy, a trial was carried out to determine the best way to reduce the number of injections needed. Chlorambucil and hydroxy-urea have been used to lengthnen the remission. Both of them are well tolerated and compatible with follow-up at reasonable time intervals. Chlorambucil maintenance increases the mean duration of remission by 12 months, the best results being observed when the drug was used continuously, instead of an intermittent (3 consecutive days every fortnight) schedule. Hydroxy-urea does not produce statistically demonstrable advantage whatever it is given, continuously or intermittently. Our study shows that, if a long-term cooperative study of the possible advantage of maintenance therapy in P.V. was undertaken in the future, low-dosage maintenance by chlorambucil could be the treatment of choice.

Chlorambucil↗
PubMed1978

Principal clinical features and prognosis in chronic lymphocytic leukemia.

A prospective study of 102 patients with chronic lymphocytic leukaemia (CLL) on 30 parameters subdivided into 77 variables was analyzed by correspondence analysis, a variant of principal component analysis, which allows simultaneous graphical representation of patients and variables. This statistical method clearly defined three principal clinical features recognized at the time of diagnosis: lymph node proliferation, lymphoid infiltration and cytopenia. Cytopenia was clearly subdivided into peripheral and central types. Each of these clinical features were derived from clinical and laboratory observations which agreed with each other. Simple examination permitted an evaluation of these three syndromes. They seemed to be independent of each other except for a relationship between central cytopenia and lymphoid infiltration. Thus clinical staging at the moment of diagnosis must record three scales of severity corresponding to the three independant clinical features. Prognosis was essentially related to cytopenia, whatever the mechanism. In a further analysis of the subsequent progress of the disease, a "common path" for patients was found terminating in a region of the graph where marked splenomegaly and cytopenia were plotted. We conclude that it is necessary to consider the three clinical features independently in a clinical staging. This study emphasizes the poor prognosis of cytopenia and splenomegaly and indicates that follow up and treatment should take this feature into account.

Anemia↗
PubMed1978

[Double medular scintigraphy using 99mTc-colloids and 111In-transferrin in myeloid splenomegaly (author's transl)].

Simultaneously with bone marrow biopsy and 59Fe kinetic study, bone marrow scintigraphy using 99mTc-colloids and 111In-transferrin was performed in 15 patients with a documented diagnosis of agnogenic myeloid metaplasia. This rapid, simple and non-traumatic method permits visualization of changes in the reticular and the erythropoietic marrow which are not always the same. The technique can demonstrate diminution of active marrow in the axial skeleton, peripheral extension of bone marrow and its heterogeneity from site to site. These abnormalities, which vary from case to case, correlated well with the results of 59Fe external countings. The degree of splenic myeloid metaplasia, as judged by 111In uptake, is also well correlated with 59Fe uptake into the spleen. There was poor correlation between scintigraphic and iron kinetic data on the hand, and bone marrow cellularity assessed by marrow biopsy on the other. While scintigraphic studies are chiefly qualitative, they appear to provide useful information for diagnosis, and possibly for prognostic and therapeutic decision.

Aged↗
PubMed1976

Is there evidence for subclasses of chronic lymphocytic leukemia? A study using numerical classification techniques.

Various clinical and biological parameters were analysed among 95 chronic lymphocytic leukemia patients by two numerical classification techniques in an attempt to identify natural subdivisions in the disease. For each patient, a profile made up of 47 dichotomous variables was constructed and the distance between profiles computed with equal weight for each variable. No specific cluster of patients was identified by these techniques. However limited availability of data for some laboratory tests, particularly concerning the immune system, meant that these results had to be excluded from analysis. The profiles of patients who died from leukemia during a mean follow up period of 4 years apparently do not generate a distinct group from the other profiles in spite of some clustering.

Factor Analysis, Statistical↗
PubMed1976

[Gougerot-Sjögren syndrome in patients with sarcoidosis].

Three patients with eye and salivary dryness presenting the scintigraphic and histological features of Sjogren's syndrome and also suffering from sarcoïdosis, are reported. The authors stress the rarity of clinically indentifiable dry oculo-salivary syndromes whilst routine scintigraphy of the principle salivary glands using technetium 99 m often reveals altered salivary function. They consider that the primary feature in the development of this dry salivary syndrome consists of fibro-inflammatory lesions of the glandular interstitium, seen in specimens of the glands of the labial mucosae, which are sequelae of the initial sarcoid infiltration. They point out that Sjogren's syndrome occurring in relation with sarcoïdosis has certain special features. These include its appearance in relatively young subjects, the minimal symptoms, the non-essential presence of inflammatory signs and the absence of associated connective tissue disorder.

Adult↗
PubMed1975

[Study of proteins binding radioactive indium in vivo].

After in vivo infusion, radio-active indium is fixed by liver and bone marrow, but more slowly and less completely than iron. It does not incorporate to haem. It is found as labelled ferritin in the liver, after the fifth day. In the bone marrow, indium is almost exclusively found as labelled transferrin; several arguments suggest the intra-cellular site of the labelled protein. Using indium may enable a better knowledge of the intermediary iron pools.

Animals↗
PubMed1975

[Practical value of the measurement of red cell volume in polyglobulia].

The practical interest of the direct measurement of the red blood cell volume in clinical haematology remains a matter of discussion. A retrospective study of 385 cases with high haematocrit values shows that the measurement of RBC volume is useful for the diagnosis between true and spurious polycythemia only when the haematocrit value is slightly increased (until 52 p.cent in women and 55 p.cent in men). At the higher values of haematocrit, the direct measurement of the RBC volume does not help for the diagnosis between primitive and secondary polycythemia, but may be useful for the choice of the treatment.

Erythrocytes↗
PubMed1975

[Bone marrow scintigraphy in anemia caused by impaired hemopoiesis. Respective values of technetium colloids and indium-transferrin].

Thirty-six patients with different types of bone marrow failure have been studied by double scintigraphy, with 99mTc-colloids and 111In.-transferrin. The observed results are compared to those obtained by bone marrow biopsy and ferro-kinetic studies. Despite our imperfect knowledge of the physiology of indium, and the non-selectivity of this tracer for the erythropoietic line, the good correlation observed in most cases between scintigraphy with 111In. and ferro-kinetics and bone marrow histology is an argument which favours the clinical use of this tracer. A striking difference between the results of scintigraphy with Tc-colloids and scintigraphy with 111In. was noticed in chronic erythroblastopenias, and in most of the aplastic anemias, primitive or due to partial leukemic involvement of the bone marrow. It is suggested that this double study may have an interest for the prognosis in these cases. In patients with lymphoma, treated by radiotherapy and/or chemotherapy, In. and Tc scintigraphies show an extension of active bone marrow to normally inactive zones. It indicates a severe defect of the normally active zones, and appears to be a contra-indication for any supplementary chemotherapy. In myeloid metaplasias, this study may be useful for the choice of treatment, by giving precise indications on the degree of splenic erythropoiesis and of bone marrow cellular depletion.

Anemia, Aplastic↗
PubMed1975

Methods of evaluating the sequestration site of red cells labelled with 51Cr: a review of 96 cases.

Teh technical conditions for surface counting and the methods for splenic and liver sequestration after injection of 51Cr-labelled cells were studied in 96 patients. A comparative study of different sites of positioning of the detection probes leads us to recommend the mid-line at the third intercostal space for the precordial area, the point of maximum count-rate obtained at each measurement for the splenic area, with the patient in right lateral decubitus position and the probe vertical, and a point situated on the midclavicular line 4 cm above the right costal margin for the liver area. A comparative study of different methods of calculation leads us to recommend the method known as 'excess counts', but with a correction of the gross values based on the evolution of circulating radioactivity and not of the count-rate measured over the precordial area. Measurement of urinary excretion of radioactivity showed that only a minor part was due to the loss of the tracer from the sequestration sites, and that the level varied only slightly between subjects. Thus the loss of tracer does not interfere with the interpretation of external counting data. Much of the disagreement regarding interpretation of the results of external counting in clinical practice is due to technical problems. Standardization of techniques of measurement and interpretation of results, selecting those which this study indicates as the most reliable, would permit better exchange of information between laboratories and clearer conclusions as to the practical use of surface counting.

Chromium Radioisotopes↗