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Biomedical subjects

R E Johnson

Publications and source records attributed to R E Johnson.

At least 325 records · Page 18Linked to original sources
PubMed1976

Pathological staging of 100 consecutive untreated patients with non-Hodgkin's lymphomas: extramedullary sites of disease.

One hundred consecutive untreated cases of non-Hodgkin's lymphomas were reviewed according to Rappaport's classification. There were 49 males and 51 females, almost evenly distributed between nodular (49) and diffuse (51) patterns. Only diffuse lymphomas were seen in patients under age 20 and they were twice as common as nodular lymphomas in patients over 60. Nodular lymphomas were predominantly lymphocytic (61%) or mixed (35%) while diffuse lymphomas were commonly histiocytic (43%). Standardized pathological staging was based upon the serial performance of bone marrow needle biopsy, percutaneous hepatic biopsy, peritoneoscopic hepatic biopsies and exploratory laparotomy. For all patients this sequence terminated with the first positive biopsy. Hepatic involvement was documented in 40 patients by either percutaneous biopsies,18 peritoneoscopic biopsies,9 or wedge biopsy at laparotomy.13 Thirty-seven of 49 patients who underwent laparotomy had biopsy-proven abdominal involvement. Overall incidence of biopsy-proven abdominal disease was 64%. Positive spleens varied widely in weight but all negative spleens weighed less than 270 g. Constancy of histologic type in multiple sites was observed in 90% of cases.

Age Factors↗
PubMed1976

Split-course radiotherapy of Hodgkin's disease: local tumor control and normal tissue reactions.

One hundred and thirty-six consecutive patients with Stage I-II Hodgkin's disease treated between 1965 and 1969 received a standard tumor dose of 40000 rads to clinically recognized disease using daily fractions of 200 rads given 4 or 5 times per week. Continuous and split-course irradiation, the latter with a 2-2 1/2 week interuption midway through the treatment, were employed in 82 and 54 patients, respectively. "Boost" doses were never given to residual masses at the completion of treatment with either schedule. No loss of therapeutic effectiveness resulted from split-course irradiation, only a single local recurrence having been observed to date. However, patient tolerance with the latter method was substantially better than with continuous irradiation and resulted in fewer subsequent complications. Furthermore, the low incidence of local recurrence fails to support a practice of administering supplementary irradiation to adenopathy which has not completely resolved after a tumor dose of 40000 rads.

Adult↗
PubMed1976

Total body irradiation of chronic lymphocytic leukemia. Relationship between therapeutic response and prognosis.

There is lack of evidence to date that treatment of chronic lymphocytic leukemia (CLL) alters the natural history of disease or influences survival. In the present series, total body irradiation (TBI) produced a range of therapeutic responses among patients with active, progressive CLL. One-third of patients experienced virtually complete clinical and hematologic remissions with the initial course of TBI. These patients did not differ from the less complete responders with respect to age or sex, degree of lymphocytosis in the peripheral blood, incidence of anemia and/or thrombocytopenia, or the frequency of constitutional symptoms. However, the patients with complete remissions noted a return to normal performance status, had fewer serious infections, demonstrated recovery from depressed immunoglobulin levels, and had significantly longer survival. These data indicate that TBI is capable of inducing remissions which modify the course of disease in patients with CLL and that prognosis has a direct correlation with the response to therapy.

Female↗
PubMed1976

Effects of environment on morphology of rat cerebral cortex and hippocampus.

Cortical depth differences were found between male rats exposed to enriched or impoverished environmental conditions for successively shorter times, i.e., for 15 days (from 25 to 40 days of age), for seven days (25 to 32 days of age), and for four days (26 to 30 or 60 to 64 days of age). If the experiments began at weaning (at 25 days of age), the cortical depth changes were caused primarily by impoverishment. If the animals were young adults (60 days of age), upon entering their respective conditions, the cortical changes were induced by enrichment. No cortical depth differences were found between enriched and impoverished rats after one day of differential experience, from 60 to 61 days of age. In every age group and for every duration, except for the one day group, the dorsal-medial segment of the occipital cortex responded to the environmental conditions. No significant hippocampal depth differences were noted between enriched and impoverished animals.

Age Factors↗
PubMed1976

Dietary protein, fat, and minerals in nephrocalcinosis in female rats.

Young female rats fed semipurified diets containing casein or a soy protein isolate had extensive nephrocalcinosis at the junction between the outer and inner stripe of the outer medullary zone after 5 wk on the diets, whereas rats fed a diet containing a lactalbumin concentrate did not. Although the percentages of actual protein and of total ash were similar in all three diets, the concentrations of individual minerals were not, owing to methods used in isolating the proteins. Comparison of the individual mineral contents of these diets with those in other laboratories as compiled from the literature suggested that factors other than minerals, including protein, are also implicated. Dietary fat appeared to be another such factor in a series of experiments in which saturated medium-chain triglycerides and corn oil were included in diets containing soy protein isolate. Although these diets had identical mineral compositions, the rats fed medium-chain triglycerides had less severe lesions.

Animals↗
PubMed1976

Studying the impact of patient drug profiles in an HMO.

The objectives of the study were to determine if a drug profile quantitatively and qualitatively influenced various aspects of drug utilization. A group of 1,632 medically indigent persons enrolled in the Kaiser Health Plan constituted the study population. This population received completely prepaid medical care including drug services from the Kaiser Medical Care Program. A computer-based chronological and monthly updated listing of drugs ordered and prescriptions received was provided as the front page of the centralized outpatient medical chart for a randomly selected half of the study population for a full year. Duplicate and bound copies of these patient drug profiles were also provided each outpatient pharmacy. The findings indicated the presence of the drug profile did not quantitatively or qualitatively affect prescription receipt of the group with the profile. Although the findings must be viewed in the contexts of the population served and the medical care setting, the findings strongly indicate the need for additional research to assess additional forms of drug profiles and under conditions not addressed by this study.

Adult↗
PubMed1976

Radiation therapy of midline granuloma.

During a 15-year period, 10 patients with well-documented midline granuloma were treated with high-dose, deep local irradiation and followed for extended periods of time. Long-term remissions were achieved in 7 patients, with a mean (+/- SEM) survival postirradiation of 7.4 (+/- 1.4) years in the 6 patients still alive. True midline granuloma, which is a localized, destructive, inflammatory process of the upper airways, can be distinguished from Wegener's granulomatosis and neoplasms of the upper respiratory tract by several clinicopathologic criteria. The cause of midline granuloma is unknown, but it most likely represents an abnormal accelerated hypersensitivity reaction to an unknown antigen(s). Although serious complications of high-dose local irradiation to the upper airways can occur, the risk is warranted because of the high, long-term remission rate in this previously uniformly fatal disease.

Adolescent↗
PubMed1976

Sequential nonsurgical and surgical staging of non-Hodgkin's lymphoma.

The yield of specific diagnostic procedures in the staging of non-Hodgkin's lymphoma was assessed in 170 consecutive patients who were evaluated with a sequence of diagnostic procedures. Stage III or Stage IV disease was established in 141 of 170 patients (80%) by nonsurgical procedures, including lymphangiography (positive in 78%), bone-marrow biopsy (positive in 39%), percutaneous liver biopsy (positive in 21%), and peritoneoscopy-directed liver biopsy (positive in 29% of those tested). Staging laparotomy showed disease outside conventional nodal irradiation fields in 21 of 26 patients with a positive lymphangiogram, but in only three of 17 patients with a negative lymphangiogram. The yield of staging procedures was highest in patients with nodular lymphomas, only 6% of whom were Stage I or Stage II after staging, but was lowest in patients with histiocytic lymphoma, 30% of whom had localized disease. This study shows that the presence of disseminated disease can be detected in the majority of patients with non-Hodgkin's lymphoma without the use of staging laparotomy.

Adult↗
PubMed1976

Adriamycin and enhanced radiation reaction in normal esophagus and skin.

Clinical evaluation of 10 patients with small cell carcinoma of the lung treated with radiotherapy and periodic cycles of combination chemotherapy with cyclophosphamide, vincristine, and adriamycin showed frequent and occasionally severe esophageal and skin reactions. Eight of the 10 patients had esophagitis, four required supportive intravenous fluids, and two subsequently developed esophageal narrowing and stricture formation. Recurrent esophagitis with augmentation of injury in the recently irradiated esophagus was observed 11 times in eight of the 10 patients after cycles of chemotherapy, and contributed to the sustained toxicity seen in two patients. Dermatitis in the form of moist desquamation was observed in five of the patients at very low doses of supervoltage radiation therapy. Acute pulmonary reactions was notably absent. This combination of chemotherapy, particularly adriamycin, potentiates the effect of radiotherapy on the normal esophagus and skin, and further implicates the radiosensitizing property of adriamycin.

Carcinoma, Small Cell↗
PubMed1976

Similarities of surface characteristics of neoplastic well-differentiated lymphocytes from solid tissues and from peripheral blood.

Cells from spleens and lymph nodes infiltrated with neoplastic well-differentiated lymphocytes (WDLT) were investigated for the presence of receptors for unsensitized sheep red blood cells, complement (IgM EAC), and antigen-antibody complexes, as well as for the presence of surface immunoglobulins. In addition, the cells were examined by scanning electron microscopy (SEM). The surface markers and ultrastructure of WDLT cells were compared with those of cells obtained from peripheral blood of patients with chronic lymphocytic leukemia (CLL). Like the CLL populations, most WDLT samples showed a low percentage of unsensitized sheep red blood cell-binding cells and a concomitantly high percentage of IgM EAC-binding cells. Furthermore, a substantial number of WDLT cells in several instances showed a lower binding affinity for IgM EAC than normal lymphocytes, as demonstrated by the poor attachment of the IgM EAC reagent to the WDLT cells in suspension and to frozen tissue sections. Weak IgM EAC binding capacity was demonstrated in the CLL cells as well. WDLT and CLL cells bound the IgG EA complex only when certain sensitive techniques were applied (pelleting). A variable percentage of cells with surface immunoglobulins was found among WDLT and DLL populations. However, accurate counting of surface immunoglobulin-bearing neoplastic cells was very difficult in most cases due to the extremely faint surface fluorescence as compared to normal. SEM did not reveal specific changes in WDLT or CLL cells that would permit their identification as neoplastic lymphocytes. No major differences were found between WDLT and CLL cells and no correlation could be established between SEM appearances and surface markers. As previously observed with other cell populations, the conditions under which the cells were manipulated before fixation (in particular the environmental temperature) seemed to play a major role in the final SEM appearance of both WDLT and CLL cells. The results of our studies indicate that WDLT cells represent a population of B-cells whose surface properties are very similar to those of circulating CLL cells. The poor capacity of WDLT cells and CLL cells to bind IGM EAC or to stain with fluorescein-conjugated antihuman immunoglobulin suggests low density or poor affinity of the surface receptors. In this regard, these neoplastic cells are different from those of follicular lymphomas, also of B-cell origin.

Adult↗
PubMed1976

Reported use of nonprescribed drugs in health maintenance.

The reported use of nonprescribed drugs and its relationship to other reported illness and heal-related activities of subscribers within a prepaid comprehensive medical care system were examined. The data analyzed were abstracted from a household survey of 2603 Kaiser Health Plan subscribers. The survey gathered sociodemographic, economic, attitudinal and behavioral information. The health-related information collected included reported symptom experiences, behavior when ill, and customary health and health-related practices. The findings indicate that the use of nonprescribed drugs is a frequent and in some instances, an extensive activity. Some association was found between reported self-medication activities and selected symptom experiences, use of certain health practitioners, prescribed drug use and certain health maintenance activities and perception. It is concluded that use of nonprescribed drugs appeared to be related to other health-related behaviors, but not just randomly. Also, the use of nonprescribed medicine does not appear aberrant from the perspectives of contemporary health care.

Health↗
PubMed1975

Second malignancies complicating Hodgkin's disease in remission.

The incidence of second tumours occurring in the course of Hodgkin's disease has been investigated in a series of 452 patients treated with standard chemotherapy or radiotherapy, combination chemotherapy alone, intensive radiotherapy alone, or both intensive radiotherapy and combination chemotherapy administered in sequence. 16 tumours were noted. When analysed according to mode of treatment, 6 cases occurred in a group of 62 patients who received both modalities. When analysed for age, sex, and man-years of follow-up, this group appears to have 14-5 times the risk of developing a second tumour. However, that subgroup which had a complete remission after intensive radiotherapy followed by a relapse of disease, prior to receiving combination chemotherapy, had the highest risk with 18-5 times greater incidence of second tumour than expected. It is noteworthy that, of the 16 second tumours, 2 were acute myeloid leukaemia; in both cases a similar chromosomal abnormality (45 chromosomes, C-group deletion) was noted. The mechanism of oncogenesis may represent a combination of the immunosuppressive effects and cellular effects of those forms of treatment.

Adolescent↗
PubMed1975

Hodgkin's Disease, tonsillectomy and family size.

The association of tonsillectomy and Hodgkin's disease was investigated by comparison of 136 young adult patients with their 315 siblings and 78 spouses. On the basis of a case-spouse comparison, the risk ratio of Hodgkin's disease among tonsillectomized persons was 3.1 (1.5 to 7.7, 95 per cent confidence limits); on the basis of a case-sibling comparison it was 1.4 (0.8-2.6). The case-sibling analysis was repeated according to sibship size, and increased risk of disease was associated with tonsillectomy only within the 37 sibships of size two. A similar variation of risk ratio with sibship size was found in data from a prior study. The range of the association implies that the relation beteeen tonsillectomy and Hodgkin's disease either is noncausal or is complex and modified by family size. Risk of Hodgkin's disease was found to increase as a sibship size decreased, suggesting that a cause of Hodgkin's disease is correlated with childhood social class.

Adolescent↗
PubMed1975

Symposium theme: a conceptual approach to integrated cancer therapy.

The term "integrated cancer therapy" reflects treatment in which the decision making process is disease oriented rather than specialty or modality oriented. Two phases of integrated cancer therapy can be defined, the first being a determination of the treatment failure mechanisms for each of the variable clinical presentations of specific neoplasms. The second phase, integration of the available treatment modalities, is aimed at neutralizing the inherent weakness of any one method with the strength of other methods. A general strategic approach is presented.

Decision Making↗