Biomedical subjects
R McIntyre
Publications and source records attributed to R McIntyre.
Immunotoxins of Pseudomonas exotoxin A (PE): effect of linkage on conjugate yield, potency, selectivity and toxicity.
Conjugates of monoclonal antibodies and Pseudomonas exotoxin A (PE) were formed with disulfide or thioether bonds. Thioether conjugates which formed with succinimidyl 4-(N-maleimidomethyl)-cyclohexane-1-carboxylate (SMCC) modified PE and reduced antibody formed with an 80% yield of equimolar conjugate within 30 min with an offering of one to one (toxin:antibody). The efficiency and kinetics of thioether formation were much higher with SMCC than with other maleimide reagents as well as more efficient than disulfide linkers. Thioether linkage resulted in immunotoxin consistently more potent and more selective in vitro than disulfide bonded conjugate. Thioether bonded conjugates also proved to have other favorable in vivo properties compared to disulfide conjugates: (1) a longer half-life in serum; (2) increased tumor localization; and (3) reduced toxicity. Toxicity of thioether linked holotoxin conjugates was directed at the liver hepatocyte but was easily monitored by serum liver enzymes. The conjugates are currently undergoing clinical evaluation for treatment of ovarian cancer with intraperitoneal administration. Research is ongoing to further decrease residual toxicity without reducing the potency of the conjugate.
Duodenal obstruction (Bouveret's syndrome) and jaundice due to a single large gallstone.
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Penetrating abdominal stab wounds: a plea for a more conservative policy.
This is a retrospective study of 107 penetrating abdominal stab wounds which have been reviewed on the basis of the clinical indications for surgery. Eighty-four patients underwent laparotomy. The unnecessary laparotomy rate was 35 per cent and the mortality 2.4 per cent. Important complications developed in 44 per cent of those undergoing surgery. Evaluation of clinical variables is presented and it is suggested that in the absence of shock, generalized peritonitis or evisceration, careful initial assessment, monitoring and regular re-examination would be a satisfactory method of treatment for many cases. This would result in a decrease in unnecessary laparotomies and associated excess morbidity.
An ecological approach to the prevention of injuries due to drinking and driving.
Among the many alcohol-related public health concerns, motor vehicle crashes account for nearly one-third of all deaths attributable to alcohol. Adolescents and young adults, particularly males, are important target populations for intervention efforts. Taking an ecological perspective of individuals within their social and physical environments, a diagnostic framework is employed in reviewing the literature on factors associated with drinking and driving injuries and on interventions to prevent injuries due to drinking and driving. Intervention planning is conceptualized according to a multilevel intervention framework, which consists of four phases: (1) health goals selection, (2) intervention planning, (3) intervention, and (4) evaluation. Possible intervention objectives, targets of the intervention actions, intervention approaches, and evaluation criteria are identified and discussed for three societal levels and four practice settings.
Nursing care study: emergency colectomy for toxic megacolon.
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Overview of four clinical studies of chemotherapy for stage III and IV non-Hodgkin's lymphomas by the Cancer and Leukemia Group B.
This paper presents an overview of four Cancer and Leukemia Group B studies in 1266 patients with stage III-IV non-Hodgkin's lymphoma. The cases were analyzed across protocols; the major prognostic determinants were prior chemotherapy, age, and histology. The four studies proved that cyclophosphamide maintenance was superior to no maintenance even after prolonged intensive induction chemotherapy. Furthermore, the reinforcement program of monthly pulse doses of vincristine and prednisone, whose value was established in the treatment of acute leukemia, led to highly significant improvement in remission duration and survival. Other facets of the chemotherapy programs are still being subjected to analysis, but this report sets out some preliminary conclusions.
Below-knee amputation in peripheral arterial disease.
A below-knee amputation will heal in most patients with atherosclerotic peripheral arterial disease, using no anterior flap and a long posterior myoplastic flap. The technique used by the authors is presented in detail, with their experience in 32 cases.