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Biomedical subjects

K B Roberts

Publications and source records attributed to K B Roberts.

At least 19 recordsLinked to original sources
PubMed1992

Combined chemotherapy and radiotherapy for Hodgkin's disease.

This paper reviews the treatment of advanced and intermediate stage Hodgkin's disease with combination chemotherapy alone and combined chemotherapy and radiation. Relapse following complete remission with chemotherapy occurs principally at initial sites of disease; its occurrence will be reduced by radiotherapy to those sites. There is disagreement regarding the frequency of relapse and hence the impact of consolidation radiotherapy. Our interpretation of the literature is that relapse occurs in approximately 25% to 50% of all patients achieving complete response with chemotherapy, and that consolidation radiation reduces relapse frequency with a resultant increase in survival. The addition of low dose, involved field radiotherapy is generally free of significant adverse effects. In particular, there appears to be no increase in second malignant neoplasms. The risk: benefit ratio for adding radiotherapy to chemotherapy in patients with advanced Hodgkin's disease is, therefore, quite favorable. We believe that combined modality therapy should become the standard treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Human situations: a course introducing physiology to medical students.

A block course of 12 days is described. It is considered to be appropriate for both physiologically naive and sophisticated students entering either a traditional or a problem-based curriculum. It is adaptable for medical schools in both developed and developing countries. Six problem-based small-group sessions, based on everyday human situations, are the core of the course. They are supplemented by a lecture series, laboratory experiments using student volunteers as subjects, laboratory demonstrations, and patient presentations. Student assessment is carried out by criterion-referenced examinations using take-home assignments, oral examinations, and a multiple-choice test containing context-dependent questions. The course is well received by students and faculty. Pre- and posttesting show that all students acquire a basic understanding of physiological control systems and of homeostatic mechanisms as they operate in intact human beings.

Curriculum↗
PubMed1991

Infectious mononucleosis in adolescents.

Infectious mononucleosis is a clinical manifestation of primary EBV infection in adolescents, characterized by a triad of clinical, laboratory, and serologic features. The classic signs and symptoms are not seen in every patient; rather, the presentations tend to fit into one of three clinical forms (pharyngeal, glandular, or febrile). Recognizing these syndromes provides a useful framework for anticipating the clinical course, complications, and differential diagnosis. Nonclassic presentations of IM include a wide variety of neurologic abnormalities, thrombocytopenic purpura, and splenic rupture. The laboratory features of IM include absolute lymphocytosis with a large percentage of atypical lymphocytes, and abnormal liver chemistries in 90% of patients. The diagnosis of IM is confirmed serologically, usually with the demonstration of heterophile antibodies; the test can conveniently be performed in office laboratories. If the heterophile antibody test is negative, EBV-specific serologic tests can identify whether the illness is due to primary EBV infection. Once the diagnosis of IM is made, appropriate guidelines for resumption of activity should be provided to patients, especially to those with evidence of splenomegaly. Medical management includes supportive therapy with adequate analgesia. Corticosteroids are indicated for patients with upper airway obstruction; they may be helpful in patients with neurologic, hematologic, or cardiac complications. Acyclovir may prove to be useful, but further studies are needed before its use can be recommended.

Acute Disease↗
PubMed1991

Ewing's sarcoma.

Explore the source record for details and available documents.

Bone Neoplasms↗
PubMed1990

HIV-associated autoimmune hemolytic anemia: report of a case and review of the literature.

While anemia and a positive direct anti-globulin test are each frequently observed in the clinical syndrome of human immunodeficiency virus (HIV) infection, autoimmune hemolytic anemia has rarely been reported in this setting. A case of severe warm autoimmune hemolytic anemia (AIHA) with reticulocytopenia in a patient with AIDS-related complex is reported. Laboratory and clinical findings of severe hemolysis were present, including anhaptoglobinemia, microspherocytosis, splenomegaly, and transfusion dependence. Azidothymidine (AZT) therapy may have exacerbated this patient's anemia. Splenectomy produced a delayed but complete remission of the AIHA despite continuation of AZT therapy. Review of other reports of positive direct antiglobulin tests and autoimmune hemolytic anemia in patients with HIV infections suggests that autoantibodies may be a significant cause of anemia in this population and that the frequent lack of reticulocytosis, despite bone marrow erythroid hyperplasia, may lead to the underdiagnosis of AIHA in HIV-infected patients.

AIDS-Related Complex↗
PubMed1988

Current and future delegation of pharmacy activities to technicians in Tennessee.

Pharmacists in charge of community and institutional pharmacies in Tennessee were surveyed to identify which activities they currently delegate to technicians and which activities they might consider delegating in the future. Survey questionnaires were mailed to all pharmacists-in-charge registered with the board of pharmacy. Respondents were asked to indicate which of 38 listed pharmacy activities were currently delegated to technicians and which currently undelegated activities would be delegated in the future if legal and policy barriers were removed and if technician training programs were available. Respondents also ranked six types of technician training programs in order of preference and were asked whether they thought technicians should receive official recognition through certification or licensure. A total of 947 questionnaires were returned, for a response rate of 62%. Of the 24 activities that were delegated by significantly different numbers of pharmacists in community and institutional settings, 23 were delegated more frequently by institutional pharmacists. Activities related to drug therapy were delegated least frequently by either group, although community pharmacists delegated the task of recommending nonprescription drugs more often than did institutional pharmacists. If barriers were removed and training programs were available, more pharmacists would delegate activities to technicians than currently do. Most respondents preferred a formal, in-house training program for technicians; more than 65% of pharmacists favored certification of technicians. Pharmacists in Tennessee currently delegate a number of activities to technicians, and more pharmacists would do so if barriers toward technician use were removed and if more trained technicians were available.

Pharmacies↗
PubMed1987

Relation between myocardial perfusion and left ventricular function following acute coronary occlusion: disproportionate effects of anterior vs. inferior ischemia.

This study examined the relation between left ventricular (LV) function and the severity of acute myocardial ischemia in a conscious dog model. The LV ejection fraction (EF) was measured by multigated equilibrium radionuclide angiography, and regional myocardial blood flow was measured with radioactive microspheres before and 10 minutes after distal and then proximal occlusion of the left anterior descending (LAD, 13 dogs) or left circumflex (LC, 13 dogs) coronary artery. Two methods were used to evaluate the extent of ischemia. The first method determined the mass of myocardium that was ischemic based on different degrees of reduced blood flow. The second method estimated the severity of ischemia expressed as blood flow deficit resulting from each coronary occlusion. Global LV function was very sensitive to ischemia, and the relation between change in function and the degree of ischemia were described best by linear functions. The best linear correlation between mass of ischemic myocardium and percent reduction in EF resulted from the ischemic region defined as all tissue with 25% or greater reduction in blood flow, r = 0.84 for LAD (Y = 0.96X + 1.8) and r = 0.75 for LC (Y = 0.53X + 2.0) occlusions. Defining ischemic mass by more severe reduction in blood flow resulted in exclusion of ischemic myocardium that affected function. The myocardial blood flow deficit also correlated linearly with percent reduction in EF, r = 0.89 for LAD (Y = 1.31X + 2.7) and r = 0.81 for LC (Y = 0.83X - 0.1) occlusions. The slope of the regression lines using both analyses of ischemia were significantly greater (p less than 0.01) for LAD than LC occlusions, indicating that for comparable degrees of ischemia LAD as compared to LC occlusion decreased EF to a greater extent. Calculation of EF from attenuated corrected volumes resulted in small changes in LAD, but not LC, EF and did not account for the disproportionate effects of LAD and LC ischemia. In a separate group of studies (n = 18) EF measured by radionuclide angiography after LAD or LC occlusions correlated well with biplane contrast angiography r = 0.93, SEE 5.1. These data suggest that disproportionately greater effects of LAD compared to LC ischemia on global EF in the dog are due primarily to different pathophysiologic responses to ischemia.

Animals↗
PubMed1979

Satellite streptococci. A major cause of "negative" blood cultures in bacterial endocarditis?

In three of the 20 patients with bacterial endocarditis in our institution since 1975, satellite streptococci were recovered from the blood stream (15%). These organisms do not grow under usual laboratory conditions and may only be demonstrable after fortuitous contamination of the media. Clinicians and microbiologists must be alert to the possibility of satellite streptococci in patients with suspected bacterial endocarditis, and measures should be instituted to identify the organism.

Adolescent↗
PubMed1977

Fever in the first eight weeks of life.

Sixty-one febrile infants in the first eight weeks of life were evaluated for serious, treatable illness. Infants with bacteremia could not be distinguished from non-bacteremic infants by height of fever, white blood cell count, absolute number of juvenile or mature polymorphonuclear leukocytes, or the presence of a focus of infection (meningitis excluded). The examiners' overall assessment ("clinical judgment") correctly identified eight of the nine infants with bacteremia as not being "well"; one 2-week-old with group B streptococcal bacteremia was "missed" clinically, This points up the limitation of clinical judgment in assessing febrile infants in the age group studied and supports an aggressive approach in the management of very young febrile infants.

Age Factors↗
PubMed1976

Inflammatory factors produced by sensitized guinea-pig peripheral blood lymphocytes.

The supernatants obtained from stimulated tuberculin-sensitive guinea-pig peripheral blood lymphocytes contain factors that induce a cutaneous inflammatory response in normal guinea-pigs similar to the tuberculin reaction and inhibit the migration of normal guinea-pigs peritoneal exudate cells. There appears to be a correlation between the presence of in vitro migration inhibitory activity and inflammatory activity in vivo.

Animals↗
PubMed1976

A comparison of the direct and indirect leukocyte migration tests in man.

In the Direct Leukocyte Migration Test, as few as 10% mononuclear cells are sufficient to produce antigen-specific inhibition of polymorphonuclear leukocyte migration in the presence of 100 mug of excipient-free PPD per ml. A clear distinction between tuberculin-positive and tuberculin-negative donors can be made. The inhibition of migration is blocked by the presence of actinomycin D. In the Indirect Test, significant inhibition of migration of pure polymorphs is produced by supernatants from stimulated tuberculin-sensitive lymphocyte cultures. Inhibition is maximal at 6 h and is of a similar degree to that obtained in the direct test.

Cell Migration Inhibition↗
PubMed1976

Inflammation-inducing factors from human lymphocytes. Correlation with polymorphonuclear leucocyte migration enhancement of inhibition.

Factors capable of inducing inflammatory reactions in the skin of normal guinea pigs have been demonstrated in culture supernatants from PPD-stimulated human mononuclear cells from tuberculin-positive donors. The reaction is characterised by erythema, induration and infiltration with mononuclear cells and some polymorphonuclear leucocytes. These supernatants either enhance or do not affect polymorph migration in the leucocyte migration test. Supernatants that inhibit migration in vitro produce a marked polymorph infiltration upon intradermal injection.

Animals↗
PubMed1976

The automobile and heat stress.

This study suggests that the thermal burden of poorly ventilated parked automobiles can be considerable, particularly when the automobiles are exposed to direct sunlight. Leaving the windows open two inches does not appear to be protective. The pratice of exposing infants and toddlers to such thermal risk appears to be common and the need for adequate ventilation unrecognized. Education measures stressing the use of carseats and other safety devices should include the potential hazards of high temperature in parked automobiles.

Accident Prevention↗