A quadriplegic patient with borderline personality disorder.
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Adult↗
Biomedical subjects
M R Thomas
Publications and source records attributed to M R Thomas.
Muscle relaxation techniques: a therapeutic tool for family physicians.
Muscle relaxation techniques are important adjunctive therapy for anxiety-related conditions. Family physicians can learn to teach the techniques so as to try helping anxious patients themselves rather than automatically referring them to a psychiatrist. The exercises are generally acceptable to patients, are easy to learn and do not require expensive equipment. They are beneficial in insomnia and tension headache, of some value in chronic anxiety states and a useful adjunct in hypertension. In this paper the evidence supporting the value of muscle relaxation therapy is briefly reviewed, methods of teaching and of practising the techniques are described in detail, and answers to some of the questions and problems that may arise are presented.
Anxiety Disorders↗
Autologous marrow transplantation for patients with chronic myelogenous leukemia (CML) in blast crisis.
Even patients with chronic myelogenous leukemia (CML) in blast crisis were treated with chemotherapy, followed by infusion of autologous bone marrow that had been collected during the chronic phase of the disease and cryopreserved at -198 degrees C. The mean age of the nine females and two males in this study was 34 years with an average duration of the chronic phase of the disease of 5.5 years. Seven out of the 11 patients had a splenectomy prior to intensive chemotherapy. The median survival of the first four patients who received 6-thioguanine, cytosine arabinoside, daunorubicin (TAD) chemotherapy was 2.6 weeks and no patient reachieved the chronic phase of CML. The second group of seven patients received more intensive chemotherapy (MAdHAT), which included melphalan 30 mg/m2 days 1, 2, and 3; Adriamycin 50 mg/m2 intravenously (iv) day 1, hydroxyurea 1500 mg/m2 by mouth for 5-7 days, cytosine arabinoside 100 mg/m2 continuous infusion for 5-7 days, and VM-26 100 mg/m2 iv on day 3. Six out of these seven patients reachieved chronic phase CML after bone marrow reinfusion. The median survival was 29.9 weeks for all patients and 33 weeks for the six patients who reachieved chronic phase CML. All patients subsequently died of recurrent blast crisis. There was no correlation between the time of bone marrow storage and the duration of subsequent chronic phase CML. These studies have shown that autologous bone marrow transplantation after high-dose chemotherapy can result in bone marrow engraftment with reestablishment of chronic phase CML, and prolongation of survival.
Adult↗
Tumor lysis syndrome following VP-16-213 in chronic myeloid leukemia in blast crisis.
Several recent reports have emphasized the potentially serious and often fatal acute metabolic complications following cytotoxic chemotherapy in both solid tumors and leukemias. We present here a case of chronic myeloid leukemia in blast crisis who developed an acute tumor lysis syndrome following a single dose of VP-16-213 (Etoposide).
Adult↗
Infant adiposity and maternal energy consumption in well-controlled diabetics.
This study was designed to determine the relationship of maternal diet and infant adiposity in well-controlled diabetics. The relationship between the fat consumption pattern of the pregnant diabetic and the adiposity of her infant was investigated. Length, weight, and head circumference; triceps, subscapular, and anterior thigh skinfolds; and subcutaneous fat layer were obtained on ten infants of diabetic mothers and ten infants of nondiabetic mothers. Measurements were taken at 48 h, 2 weeks, and 1 month postpartum. Maternal dietary intakes were recorded for 6 days during the third trimester of pregnancy. Infants of diabetic mothers and infants of nondiabetic mothers exhibited differences in birth length, 2-week and 1-month head circumference, 2-week triceps skinfold thickness, and fat layer. However, measurements differing at birth were not consistant with those differing at repeated measurements throughout the first month of life. Only the dietary intake of linoleic acid as a percentage of energy intake differed between the two groups of women. The diabetic women consumed more linoleic acid. The fat consumption pattern in the pregnant diabetic was unrelated to the subsequent anthropometric measurements of her infant. The well-controlled diabetics in this study did not have large-for-gestational-age infants.
Adipose Tissue↗
Differential efficacy of biofeedback in headache.
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Adult↗
Detection of melanoma cells in bone marrow using monoclonal antibodies. A comparison of fluorescence activated cell sorting (FACS) and conventional immunofluorescence (IF).
Seven different human melanoma cell lines have been tested for the presence of melanoma associated antigen p97. The sensitivity of membrane immunofluorescence assays for the antigen was increased by using a mixture of antibodies to several epitopes of p97. Six of eight melanoma lines were strongly positive. Normal bone marrow was negative. When cultured p97-positive melanoma cells were added to normal marrow, the authors were able to detect 5% contamination, by fluorescence-activated cell sorting (FACS) and immunofluorescence (IF). No melanoma cells were found in one fresh and nine frozen bone marrow specimens of melanoma patients (including two with known positive marrow by routine histologic study) evaluated for autologous bone marrow transplantation after high-dose chemotherapy.
Antibodies, Monoclonal↗
Mega-doses of behaviour therapy for treatment-resistant agoraphobics.
This was a pilot project set up to test the feasibility of effectively and inexpensively treating agoraphobic patients who had not responded to adequate trials of behaviour therapy (and other therapy) in the past. We employed a quantitatively intensive program of exposure therapy, calisthenics and muscular relaxation, and have explained the rationales for the choice of each treatment. The results were gratifying in four of the five patients, with follow-up to three years. This pilot project enabled us to set up a cost-effective treatment for all forms of agoraphobia which is as efficient as other programs described. It has also highlighted the fact that some patients exist who may do poorly on schedules of behaviour therapy which are adequate for some patients, and yet may do well if the amount of treatment is drastically increased.
Adult↗
Screening criteria. Shortening the RFP process.
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Computers↗
Longterm effects of cyclophosphamide on granulocyte colony formation in patients with rheumatoid arthritis.
Longterm cytotoxic therapy, particularly with alkylating agents, is frequently associated with the development of second neoplasms, particularly acute myeloid leukemia. Twelve patients with classic, progressive rheumatoid arthritis (RA), treated with a cytotoxic agent, cyclophosphamide, from 1969 to 1974 at the University of Colorado Health Sciences Center were reassessed for current status of the granulocytic system. Bone marrow biopsies were investigated histologically and the number of granulocyte precursor cells judged using colony forming cells in culture (CFU-C). Control bone marrow biopsies were done on 8 patients with classic, progressive RA who had not taken cyclophosphamide as well as 16 healthy controls. Colony forming cell numbers in patients with RA who had been treated with cyclophosphamide were significantly lower compared to patients with RA who had not received cyclophosphamide and normal controls. These data suggest that cyclophosphamide may cause suppression of the hematopoietic system that does not totally recover even after long periods of time.
Aged↗
Bone mineral status of lactating mothers of different ages.
To determine the effect of age on the bone mineralization of lactating mothers, 48 healthy mothers were evaluated at 2 and 16 weeks post partum. All mothers were divided into three age groups: less than or equal to 18 years, 19 to 30 years, and greater than 31 years old. At 2 and 16 weeks post partum, blood was drawn for measurement of serum calcium, phosphorus, alkaline phosphatase, and 25-hydroxy vitamin D. Bone mineral content was measured by photon absorptiometry. Dietary history was also recorded. At both 2 and 16 weeks, there were no differences in the serum values or bone mineral content among the three age groups. However, there was a decrease in the bone mineral content between the 2 and 16 weeks' values in the less than or equal to 18 years age group, 1.049 +/- 0.088 versus 0.895 +/- 0.051 gm/cm (p less than 0.05). Dietary intakes were similar among the three groups, but only one of seven mothers less than or equal to 18 years of age met the recommended dietary allowance for calcium or phosphorus, as compared to six of seven older mothers who met the recommended dietary allowance for calcium or phosphorus (p less than 0.01). We conclude that young lactating mothers less than or equal to 18 years old at risk for bone demineralization because of low dietary intakes of calcium or phosphorus.
Adolescent↗
Decreased bone mineral status in lactating adolescent mothers.
To determine the calcium and bone mineral status of lactating adolescents, we compared 12 lactating adolescents with 11 nonlactating adolescents, 11 lactating adults, and 11 nulliparous adolescent control subjects. At two and 16 weeks, there were no differences in maternal serum concentrations of calcium, phosphorus, alkaline phosphatase, or calcidiol (25-hydroxyvitamin D). The bone mineral content at two weeks among the four groups was not different, but at 16 weeks the lactating adolescents' bone mineral content was lower than that in the other groups. The lactating adolescents' bone mineral content was decreased between two and 16 weeks (1.049 +/- 0.088 vs 0.887 +/- 0.054 gm/cm; P less than 0.02). Dietary intakes were similar among the groups for calories, protein, vitamin D, calcium, and phosphorus. However, only three of ten lactating adolescents met the recommended dietary allowance for calcium or phosphorus (1,600 mg/day), whereas eight of ten nonlactating adolescents, six of seven lactating adults, and seven of ten adolescents control subjects met the recommended dietary allowance for calcium or phosphorus (P less than 0.05). Our data suggest that during 16 weeks of lactation, the adolescent mother may be at risk for bone demineralization because of low dietary intakes of calcium or phosphorus.
25-Hydroxyvitamin D 2↗
Treatment of advanced malignant melanoma with high-dose chemotherapy and autologous bone marrow transplantation. Preliminary results--Phase I study.
Thirteen patients with advanced (Stage III) malignant melanoma have been treated with high-dose chemotherapy (nitrogen mustard or a combination of BCNU and melphalan) combined with autologous, nonfrozen, bone marrow transplantation. Three patients (24%) achieved a complete remission and are currently alive and free of disease without further therapy at 26, 60, and 73 weeks. Five patients (38%) achieved partial remissions and five patients (38%) had no response. There was no difference in the response rate to nitrogen mustard and the BCNU-melphalan combination. Severe side effects to nitrogen mustard, however, precluded its further use in this study. The major cause of death in patients was intracerebral metastases, raising the question of prophylactic brain irradiation in future studies. Studies of the recovery rate of peripheral blood neutrophil, platelet, and peripheral blood and bone marrow CFU-C suggest that autologous bone marrow infusion may be of benefit in shortening hematopoietic recovery following intensive chemotherapy.
Adolescent↗
Genetic contribution to agoraphobia?
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Adult↗
Agoraphobia.
The authors focus on the nature of agoraphobia and on treatments for it. A variety of myths about agoraphobia are examined such as those concerning the patient's childhood, sexual development, and marital history, and the conclusion is that none of these helps in understanding the nature of the condition. The recent notion that agoraphobia is merely a form of endogenous depression is refuted. Of the four traditional languages of psychiatry, the medical and behavioural models are currently more in vogue than the genetic or psychoanalytic, but there are limitations in all models. It is shown why the behavioural therapies for agoraphobia may not be as universally helpful as implied by the recent research literature. The apparent success of both pharmacotherapy and behaviour therapy leaves models of agoraphobia which are at variance with each other, and the authors suggest possible lines of research which might resolve the contradiction.
Agoraphobia↗
Autologous bone marrow transplantation in the therapy of small cell carcinoma of the lung.
Ten patients with small cell carcinoma of the lung were entered into a chemotherapeutic treatment program consisting of cyclophosphamide, vincristine, Adriamycin, and 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea. Two courses of combination chemotherapy were administered to each patient followed by a third course with the same doses of drugs used on Course 2 but with autologous bone marrow transplantation given 24 to 48 hr after drug infusion. No differences could be detected between Courses 2 and 3 in terms of the magnitude, timing, or degree of myelosuppression. Serial bone marrow biopsies documented a progressive decline in granulocyte-macrophage colony-forming units in culture per mg bone marrow medullary core from 138 +/- 179 (S.D.) prior to chemotherapy to 7 +/- 11 after the marrow transplant recovery (p = 0.05). These data suggest that autologous bone marrow transplantation does not reduce the myelosuppression seen following the drugs used in this study at the dosages used. Autologous bone marrow transplantation may be useful only in the setting of marrow lethal therapy. Its usefulness in shortening recovery time from nonlethal therapy appears questionable.
Antineoplastic Agents↗
The effects of ascorbic acid, vitamin B6, vitamin B12, and folic acid supplementation on the breast milk and maternal nutritional status of low socioeconomic lactating women.
In this double-blind study, the effects of ascorbic acid, vitamin B6, vitamin B12, and folate supplementation on the maternal nutritional status and vitamin content of breast milk in 16 low socioeconomic lactating women were studied. Nine subjects were administered a commercial multivitamin-multimineral supplement and seven were given placebos. Milk samples were collected four times per day at 4-h intervals from 5 to 7 and 43 to 45 days postpartum. Fasting blood samples were taken from all mothers at the end of each milk collection period. Dietary records of all foods consumed were kept from 4 to 7 and 42 to 45 days postpartum. There were no significant differences in milk or plasma levels of ascorbic acid between the unsupplemented and supplemented groups. Both the EGPT index and milk concentration of vitamin B6 were significantly different (p less than 0.01) between the unsupplemented and supplemented groups. The milk concentrations of vitamin B12 increased significantly (p less than 0.05) in the supplemented group, as did the milk concentrations of folate (p less than 0.01). Because of consistently low levels of dietary vitamin B6 and folic acid in this group of low socioeconomic lactating women, either dietary changes or supplements could be necessary to maintain recommended levels of these vitamins in the womens' breast milk.
Ascorbic Acid↗