Biomedical subjects
L B Travis
Publications and source records attributed to L B Travis.
Occupational skin cancer. Four major carcinogens that put workers at risk.
Explore the source record for details and available documents.
Short-term protein loading in diabetics with a ten-year duration of disease.
The concept of renal functional reserve has recently been introduced. To test this ability of the kidneys to increase the glomerular filtration rate (GFR) above the baseline level, the GFR response to short-term protein load was measured. Recent studies have provided conflicting data concerning the GFR response to a protein load in insulin-dependent diabetics who are known to have increased baseline GFRs. Thus, we studied nine insulin-dependent diabetics with a disease of at least a ten-year duration (none were hypertensive or proteinuric) and compared their data with those of five nondiabetic controls with normal renal function. All the diabetics, except one, showed a significant increase in GFR (mean +/- SEM, 60 +/- 9 to 74 +/- 14 mL/min/sq m); the controls also had increased GFRs (mean +/- SEM, 53 +/- 6 to 69 +/- 6 mL/min/sq m). The one patient who demonstrated no rise in the GFR had the lowest GFR measured, 33 mL/min/sq m. To explore the mechanism of this response, we measured the plasma levels of putative mediators glucagon and human growth hormone. Although glucagon showed the expected rise after the protein meal, the variability was so large that no statistically significant relationship could be identified. Human growth hormone remained constant and low in the controls and showed more variability and was higher in the diabetics; again, no relationship to the GFR could be demonstrated. Thus, our data demonstrated a normal response to a short-term protein load by a group of well-defined diabetic subjects who would be at risk to show subtle renal abnormalities.
Mast cell leukemia: report of a case and review of the literature.
We report the clinical and pathologic findings in one case of mast cell leukemia observed in a series of 60 patients with systemic mast cell disease. The leukemic variant of systemic mast cell disease is rapidly fatal (mean duration of survival, less than 6 months) in contrast to most nonleukemic cases, which follow an indolent clinical course. On the basis of our case and eight previously reported cases, mast cell leukemia is characterized by a substantial increase in atypical mast cells in the peripheral blood, diffuse infiltration with atypical mast cells in the bone marrow, a strong association with peptic ulcer disease, prominent constitutional symptoms, and hepatosplenomegaly. These cases should be distinguished from malignant mastocytosis without a substantial number of circulating atypical mast cells and also cases of acute nonlymphocytic leukemia that arise in the background of systemic mast cell disease.
Ph1-negative chronic granulocytic leukemia: a nonentity.
Clinical, hematologic, and prognostic differences between Philadelphia chromosome (Ph1)-positive and Ph1-negative chronic granulocytic leukemia (CGL) have been described. However, Ph1-negative disease may be a mixture of other entities. The authors identified 24 patients given the diagnosis of Ph1-negative CGL after evaluation by the Hematology Department of the Mayo Clinic between January 1976 and August 1984. Each patient was Ph1-negative, and a bone marrow examination was interpreted as CGL. Initial peripheral blood and bone marrow samples were available for review in 22 patients. Their disorders were reclassified as chronic myelomonocytic leukemia (13 patients), chronic myelomonocytic leukemia in transformation (1 patient), preleukemic syndrome (3 patients), and undifferentiated chronic myeloproliferative disease (5 patients). Median survival for the 22 patients was 17 months.
The clinical significance of stool isolates of aeromonas.
The purpose of this study was to determine the clinical significance of different Aeromonas species isolated from stool. During a 17-month period, 29 strains of Aeromonas were isolated and identified to species with the following results: 22, A. caviae, 5, A. hydrophila, and 2, A. sobria. Clinical significance was determined independently of knowledge of speciation result. Nineteen isolates represented colonization, implying that Aeromonas can be recovered from the gastrointestinal tract without causing primary disease. The remaining 10 isolates were of indeterminate significance and may have played a role in infection, but pertinent tests to rule out other enteric pathogens had not been done. A correlation between species and clinical significance could not be established. Antimicrobial susceptibility testing was performed on the 29 isolates. A. caviae showed an unexpected resistance to cefazolin and cefoxitin, whereas representatives of all three species displayed resistance to trimethoprim/sulfamethoxazole.
Q fever. A clinicopathologic study of five cases.
Bone marrow and liver biopsy specimens from five patients with documented Q fever were reviewed. Eight bone marrow and two liver specimens had been obtained from eight days to two months after the onset of symptoms in the five patients. Three had Q-fever hepatitis; one had Q-fever endocarditis. The classic "doughnut" granulomas of Q fever were present in either the liver or initial bone marrow biopsy in all four of the untreated patients. It was recognition of the classic granulomas that prompted serologic studies for Q fever in three of the four patients.
Percutaneous renal biopsy in infants and young children.
Records of 55 percutaneous renal biopsies performed in 53 children aged 5 days to two years were reviewed. Radiographic or ultrasound imaging techniques were not utilized during the biopsy procedure. Forty-nine of 55 biopsy attempts yielded sufficient tissue for histologic evaluation (89.1%). Transient gross hematuria not requiring intervention was the sole complication and was noted in 6 of 55 biopsy attempts (10.9%). Percutaneous renal biopsy can be performed safely in very young children and the success of the procedure is comparable to that in older children.
Clinical significance of Pseudallescheria boydii: a review of 10 years' experience.
Pseudallescheria boydii is a recognized cause of mycetoma, a chronic fungal disease that usually affects the extremities. Isolated case reports have also implicated P. boydii in infections of other sites. We report the first large series (83 isolates) of P. boydii in 46 patients, including the second report of P. boydii brain abscess and disseminated infection in a noncompromised host. Between 1974 and 1984 at our institution, P. boydii was cultured from a variety of sites: respiratory tract, 36; soft tissue, 25; bone, 9; gastric aspirate, 4; maxillary sinus, 2; wound, 2; urine, 2; brain abscess, 1; ear, 1; and toenail, 1. Pulmonary colonization proved to be the most common form of pseudallescheriasis of the lung (34 of 36 cultures in this category); 28 of the 32 patients with pulmonary infections had received immunosuppressive therapy or had an underlying disorder. The importance of isolation of P. boydii from bone and soft tissue is supported in this series because all 9 cultures from bone and 21 of 25 cultures from soft tissue were associated with infection. Of 10 cases of infection, 5 were osteomyelitis and 2 were infected wounds; in addition, maxillary sinusitis, disseminated infection, and a lung abscess occurred in 1 patient each.
The histopathologic spectrum in Mycobacterium marinum infection.
Review of nine culture-positive cases of Mycobacterium marinum infection revealed a broad range in the histopathologic features of lesions produced by this organism. Four synovial lesions and five cutaneous infections were observed. A range of inflammatory changes were seen in both synovial and skin lesions, varying from mostly acute inflammation with suppuration to a more chronic process with numerous, well-formed granulomas. Organisms were observed in the biopsy sections of only one of the nine cases. Therefore, culture of the biopsy tissue at 30 degrees C is crucial in establishing the diagnosis. These cases emphasize the importance of considering mycobacterial infection and performing cultures even when granulomatous changes in the synovium or skin are subtle.
Response of urinary N-acetyl-beta-D-glucosaminidase to rapid decreases in blood glucose.
Urinary N-acetyl-beta-D-glucosaminidase (NAG) has been shown to be a sensitive indicator of blood sugar control. Twelve insulin-dependent diabetics whose blood glucoses were being controlled with the artificial pancreas had concurrent urinary NAG activity measured. Blood glucose dropped markedly from 198 +/- 22 mg/dl (x +/- SEM) to 121 +/- 7 mg/dl during the 25 h on the artificial pancreas. For the entire group UNAG: UCr dropped from 14.9 +/- 4.4 to 7.25 +/- 1.68 units. In order to determine if larger decreases in blood glucoses over the course of the study resulted in larger decreases in UNAG: UCr, an arbitrary division at 180 mg/dl was made. Six patients with blood glucoses at or above this level at the start of the study showed a drop in both blood glucoses and UNAG: UCr (261 +/- 24 to 134 +/- 12 mg/dl and 21.1 +/- 6.1 to 7.29 +/- 1.53 U, respectively). Even though the other six patients had blood glucoses below the renal threshold, both blood glucoses and UNAG: UCr declined (136 +/- 4 to 110 +/- 4 mg/dl; 8.89 +/- 2.4 to 6.2 +/- 1.64 U, respectively). Thus not only may urinary NAG activity reflect long-term control and renal complications of diabetes, but this enzyme is also responsive to acute changes in blood glucose.
Implications of psychological and family factors in the treatment of diabetes.
The authors delineate and discuss in detail those psychological and familial factors that have implications in treatment and in fostering the optimal emotional and physical health of children and adolescents with diabetes mellitus.
Camps for children with diabetes: a philosophy and its application.
Explore the source record for details and available documents.
Hyperlipidemia in uremic children: response to peritoneal dialysis and hemodialysis.
Explore the source record for details and available documents.
Management of the child with diabetes.
Explore the source record for details and available documents.
Membranous glomerulonephropathy with tubular dysfunction and linear tubular basement membrane IgG deposition.
Explore the source record for details and available documents.
Idiopathic membranous nephropathy in children.
To determine the prognosis in children with membranous nephropathy, we reviewed the clinicopathologic features and outcome of 22 patients, 11 male and 11 female, age 11 months to 19.9 years (mean 12.0 years). Patients had biopsies within six months of onset of symptoms and were divided into two groups according to the biopsy findings: group 1 (Stages I and II) and group 2 (Stages III and IV). Follow-up time was identical in both groups (mean 4.8 years). The nephrotic syndrome was present in 13 of 16 patients in group 1 and in all six patients in group 2. In group 1, eight of the 16 patients had repeat biopsies one to 11 years (mean three years) after onset. Of these, two progressed to Stages III and IV, whereas progression to renal insufficiency occurred in only one. In group 2, two of the six patients had repeat biopsies two years after onset and remained in the same group; progression to renal insufficiency occurred in five of the six patients. The difference in progression to renal insufficiency between the two groups is significant (P = 0.001). The stage of glomerular lesion at the time of onset seems to be a factor in predicting the prognosis of membranous nephropathy in pediatric patients.
Immune deposits and mesangial hypercellularity in minimal change nephrotic syndrome: clinical relevance.
Occasional patients with nephrotic syndrome and minimal histologic change demonstrate glomerular deposition of small amounts of immunoglobulin and complement. Some consider this a disease distinct from MCNS. To investigate the clinical importance of immune deposits and mesangial hypercellularity in the initial biopsy, the clinical records, follow-up data, and renal biopsies of 68 patients (ages 6 months to 16 years) with MCNS by light microscopy were reviewed. Among 68 patients followed a mean of 6.2 years, eight of 25 patients with immune deposits on initial renal biopsy were steroid nonresponsive. Only one of 43 patients without immune deposits was steroid nonresponsive (P = 0.00005). Of 44 patients with normal mesangial cellularity, 31 experienced fewer than three relapses a year, whereas of 15 patients with mesangial hypercellularity, only six experienced fewer than three relapses a year (P = 0.035). The data suggest that immune deposits and increased mesangial cellularity in children with NS and minimal light microscopic change may predict the clinical course.