Pretreatment of high-risk patients requiring radiographic contrast media studies.
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Anaphylaxis↗
Biomedical subjects
P Lieberman
Publications and source records attributed to P Lieberman.
Exercise-induced urticaria, angioedema, and anaphylactoid episodes.
Six subjects with exercise-induced anaphylactoid symptoms were evaluated by exercise challenge. Five of the six patients developed symptoms during free running. One subject developed only periorbital angioedema; another developed giant urticaria, wheeze, and hypotension; and three subjects developed cholinergic urticaria. One of the subjects with cholinergic urticaria also became hypotensive. Both of the subjects who developed hypotension also exhibited elevations in plasma histamine (11.2 and 23.2 ng/ml). Subjects who exhibited only cutaneous or subcutaneous manifestations failed to develop elevated levels of plasma histamine. Serum complement determinations (C'3, C'4) remained normal in all subjects at all time intervals. Thus exercise-induced anaphylactoid reactions can appear with a variety of cutaneous manifestations, including angioedema only, giant urticaria, and cholinergic urticaria. Elevated levels of plasma histamine are found only when systemic symptoms such as hypotension occur concomitantly.
Adolescent↗
Human hematopoietic tumors in nude mice.
Despite the difficulty in establishing human hematopoietic tumors in nude mice, four human lymphomas were successfully heterotransplanted and passaged serially in our laboratory. Additional immunosuppression with chemotherapy, whole-body radiation or splenectomy was not required for establishment of these tumors. All four of these tumors were of the non-Hodgkin's lymphoma type. In each case the tumors in the nude mice were histologically identical to the biopsy specimens from the patient in whom they were derived. Attempts to transplant tumor from 17 patients with Hodgkin's disease or 4 patients with immunoblastic lymphadenopathy were unsuccessful. Tumors from 2 patients with chronic myelogenous leukemia and 1 with hairy cell leukemia could be grown in nude mice conditioned with whole-body radiation or cytosine arabinoside, but these tumors could not be passaged to other nude mice. Cell surface markers were determined on the four serially passaged lymphomas. These surface markers were similar to the markers on the original tumors, even after long periods of mouse-to-mouse passage. In 1 patient with fevers, night sweats and mediastinal mass in whom a diagnosis had not been made after several biopsies, examination of tumor tissue that had been transplanted from the patient to the nude mouse clearly established the diagnosis of lymphoma.
Animals↗
A data-oriented approach to controlling health care costs.
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Data Collection↗
Small-cell carcinoma of the esophagus: treatment by chemotherapy alone.
Small-cell carcinoma of the esophagus is a rare tumor. In most reported cases, surgery has been the major mode of therapy. Most patients have relapsed rapidly with disseminated disease. We treated a patient with small-cell carcinoma of the esophagus with a multi-drug regimen being used in small cell-carcinoma of the lung. Within two months of beginning therapy, the primary lesion, as evaluated by barium esophogram, had completely resolved. Residual disease was seen on panendoscopy. The patient was considered to be in partial remission. She relapsed nine months after starting therapy and died with widespread metastases. Small-cell carcinoma of the esophagus should not be treated surgically but rather in the same fashion as is small-cell carcinoma of the lung, i.e., with multi-drug chemotherapy and radiation therapy.
Aged↗
Humidifier lung. An outbreak in office workers.
Symptoms consistent with hypersensitivity pneumonitis (HP) occurred in 26 of 50 employees working in a localized area of a large factory. This area was served by a single heating-cooling unit utilizing a water humidification system. The illness consisted of flu-like symptoms with fever, chills, headache, cough, dyspnea. Most of the subjects affected demonstrated precipitating antibodies to a variety of organisms associated with HP, and inhalation challenge with water from the humidification system resulted in the reproduction of symptoms in one employee with a history suggestive of HP. Removal of the humidification system has resulted in a "cure" in that symptoms have not recurred during a one year followup period since the removal.
Alveolitis, Extrinsic Allergic↗
A multiple-dose study of sustained-release theophylline and aminophylline.
This study evaluated the relative bioavailability of a sustained-release capsule of theophylline, an elixir of theophylline, and a sustained-release tablet of aminophylline. Twelve healthy, nonsmoking, adult male subjects received nine doses of each of the three products in a crossover study conducted over a ten-day period. Each dosage form contained approximately 250 mg of theophylline and was administered every eight hours. Concentrations of theophylline in the plasma at steady state demonstrated the equivalence of the three dosage forms in terms of the percent of drug absorbed, including the tablet which had exhibited reduced bioavailability in an earlier single-dose study of only five subjects. The steady-state average concentrations of theopylline in the plasma were 9.8 micrograms/ml, 10.3 micrograms/ml and 10.8 micrograms/ml for the tablet, capsulse, and elixir, respectively. The areas under the curves of the plasma level vs time for the three dosage forms were within 9 percent of each other. These data indicate that a significant reduction in fluctuations of the plasma level of theophylline was achieved with the two sustained-release dosage forms, compared to the elixir.
Adult↗
Complement activation following intravenous contrast material administration.
Untoward reactions to iodinated contrast material (ICM) continue to be a significant medical problem. Complement components were assayed in patients having reactions to evaluate the possibility of complement activation in these reactions. Reactor group samples were drawn from patients during the contrast reactions and then 2 weeks later to provide the equivalent of preinjection baseline samples, Control patient values were determined from blood samples drawn from patients before and 20 minutes after ICM injections without reaction. There were consistent falls in total hemolytic complement (CH50) as well as C3, C4, and C5 in both the control group and the reactor group. These falls in the complement reached statistical significance only for CH50 in the reactor group. The results indicate that complement activation occurs after ICM injection. This activation can occur independent of clinical reactions; however, falls in total hemolytic complement and low hemolytic complement titers prior to ICM infusion may be related to the presence of anaphylactoid symptoms.
Adolescent↗
Hominid evolution, supralaryngeal vocal tract physiology, and the fossil evidence for reconstructions.
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Adaptation, Physiological↗
IgE mediated hypersensitivity to pancreatic extract (PE) in parents of cystic fibrosis (CF) children.
On exposure to pancreatic extract (PE), four parents of cystic fibrosis (CF) children developed immediate hypersensitivity-like symptoms: i.e. rhinoconjunctivitis, asthma, and/or anaphylaxis. IgE to PE was demonstrated in the subjects by skin testing, leucocyte histamine release and radioallergosorbent test (RAST). No serum precipitating antibodies were found. Bronchial challenge caused an immediate asthmatic response. No delayed asthmatic response or hypersensitivity pneumonitis-like reaction occurred. The responsible antigen for PE induced asthma is unknown; trypsin failed to inhibit PE-RAST and is therefore not responsible in these subjects. Caution should be exercised in using PE for skin testing and bronchial challenge in subjects with suspected hypersensitivity to PE. Certain measures were found useful in preventing the occurrence of symptoms in the four subjects.
Adult↗
Recurrent idiopathic anaphylaxis.
Eighteen patients with recurrent episodes of life-threatening anaphylaxis of unknown cause were studied. Each patient had repeated detailed histories taken and had repeated physical examinations, hypersensitivity skin tests to foods, and complete blood cell counts. In addition, each patient underwent stringent dietary manipulation. Seventeen of the 18 patients underwent a series of studies. Three patients were hospitalized for study. Results of all tests were essentially normal except for an elevated plasma histamine level during attacks in two patients. Episodes could not be prevented with antihistamine therapy. Attacks were treated successfully by instructing the patients in the self-administration of epinephrine. It thus appears that recurrent episodes of anaphylaxis due to nonimmunologic histamine release of anaphylaxis due to nonimmunologic histamine release can occur without discernible cause and can be lifethreatening.
Adult↗
Anaphylactoid reactions to iodinated contrast material.
A review of the literature involving anaphylactoid reactions to iodinated contrast material (ICM) suggests that the reactions are nonantibody-mediated but that a complex activation of inflammatory mediators occurs. Histamine release and/or complement activation has been demonstrated in both in vitro and in vivo experimental systems. It appears that pretreatment of selected cases (those patients previously exhibiting an anaphylactoid reaction) is effective in reducing the frequency and severity of subsequent reactions when readministration is necessary.
Adrenal Cortex Hormones↗
Radiographic contrast media studies in high-risk patients.
Patients with prior anaphylactoid reactions (AR) to radiographic contrast media (RCM) are at increased risk for another reaction upon repeat exposure to RCM. One hundred one patients, who had prior AR to RCM, who gave informed consent, and who had an essential need for a repeat RCM study, were pretreated with prednisone, 50 mg orally every 6 hours for 3 doses ending one hour prior to RCM study, and diphenhydramine, 50 mg intramuscularly, one hour prior to RCM study. The repeat RCM study was then carried out using standard procedures with resuscitation equipment readily available. Ninety-six patients had no reaction. Five of the 101 (4.95%) developed AR. These AR consisted only of mild urticaria or pruritus. No significant or life-threatening reactions occurred. Pretreatment decreases the risk in this population of patients and is recommended as standard prophylaxis for patients requiring RCM who have had a previous AR.
Adult↗
Localized heat urticaria.
The pathophysiology of localized heat urticaria was studied by performing a heat challenge on a patient with this disease. Serum levels of total hemolytic complement, C3, and factor B decreased following heat challenge, whereas levels of C4 and C5 did not. Plasma histamine levels remained unchanged. Electron microscopic studies of affected tissue revealed endothelial cell damage and neutrophilic degranulation in the affected area. Mast cells remained intact. These data imply that activation of the alternative complement pathway is involved in the pathogenesis of localized heat urticaria and that mast cell histamine release does not play a significant role in this disease.
Adult↗
A review of untoward reactions to iodinated contrast material.
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Bronchial Spasm↗
Pulmonary function following the adult respiratory distress syndrome.
Fifteen patients (range of ages, 18 to 35 years) who survived an acute episole of the adult respiratory distress syndrome caused by mechanical or thermal injuries, sepsis, and shock were studied during 1 to 30 months after recovery. The patients had had no previous pulmonary diseases, and only two had been smokers. All of the patients were asymptomatic, and their chest x-ray films were normal on follow-up examination. Tests of pulmonary function revealed mild abnormalities which consisted of reduction of pulmonary volumes, decreased carbon monoxide diffusing capacity, and a mild increase of alveolar-arterial oxygen pressure gradients in the early stage ofter recovery. Improvement was noted after a few months, but eight patients still had mild reduction of pulmonary volume after one to two years. No correlation could be established between the severity of the adult respiratory distress syndrome, therapy with mechanically assisted ventilation, the duration of exposure to supplemental oxygen, the fractional concentration of oxygen in the inspired gas, and the degree of residual functional defect.
Adolescent↗
Infantile agammaglobulinemia and immediate hypersensitivity to penicillin G.
A case of X-linked infantile agammaglobulinemia with preserved synthesis of IgE and resultant normal serum levels of IgE is described. The patient had manifestations of atopy and an anaphylactic reaction following the administration of penicillin G. Because he had multiple respiratory tract infections with Gram-positive organisms and did not respond adequately to prophylactic gamma-globulin administration, penicillin therapy was deemed desirable. Therefore, after successful desensitization, therapy with prophylactic ampicillin was started with a resultant decrease in both number and severity of infections.
Adolescent↗
Studies of urticaria and acute serum sickness with the C1q precipitin test.
The C1q precipitin test was performed in serum samples from five groups of patients: (1) 20 patients with acomplementemic systemic lupus erythematosus glomerulonephritis (SLE), (2) 2 patients with serum sickness due to the administration of horse serum, (3) 2 patients with serum sickness preceding hepatitis B, (4) 50 patients with chronic urticaria, and (5) 30 normal controls. Positive C1q precipitin tests were found in all patients with SLE and the four cases of serum sickness. Positive tests correlated with depressed serum complement (C3 and C4) levels and were found only in the early phase of serum sickness. Urticaria patients uniformly had negative C1q precipitin tests and normal serum complement levels.
Acute Disease↗