Perioperative management of asthma and idiopathic anaphylaxis.
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Anaphylaxis↗
Biomedical subjects
R Patterson
Publications and source records attributed to R Patterson.
Anaphylaxis and asthma in a scrimshander due to deer bone dust.
A boilermaker who engraved deer bone (scrimshaw) as his artistic vocation developed recurrent anaphylaxis while scraping deer bones. These bones has been boiled in NaClO and dried, leaving residual NaOH and altered deer protein. He had recurrent episodes of anaphylaxis when exposed to the bone dust. The anaphylaxis appears to be the result of exposure of traumatized skin to NaOH and antigen with sufficient absorption of antigen to result in anaphylaxis, although inhalation may have been contributory. The most severe, near fatal episode of anaphylaxis may have been worsened by captopril. The patient's reaction by prick test to protein extracted in buffered saline from the deer bones boiled in NaClO and NaOH but not to natural deer protein suggested IgE antibody against deer protein altered by boiling in alkali. The scrimshander is now working with deer bone after prophylactic therapy and control of exposure.
Anaphylaxis↗
Asthmatic patients with panic disorders: report of three cases with management and outcome.
Panic disorders, a subgroup of the primary anxiety disorders, have an estimated worldwide prevalence of 2.5% to 5%. Although the causes of these disorders have not been completely elucidated, it seems that environmental and genetic factors in addition to central nervous system biochemical abnormalities play important roles. Mild to moderate anxiety levels may prove advantageous in the management of asthmatics but when their anxiety level becomes maladaptive, as in the case of panic attacks, their medical care is placed in jeopardy. Herein are three case reports of asthmatics who also exhibited panic disorders and their clinical outcome. It is concluded that a team approach, involving the primary physician and psychologist or psychiatrist, is beneficial in the long-term management of these patients.
Adult↗
The allergic patient who is noncompliant and abusive: dealing with the adverse experience.
The field of Allergy-Immunology is involved with the care of patients with chronic illness. The care of these patients is enhanced when the physician has established good rapport with the patient. The noncompliant, disruptive behavior of some patients can try the patience of even the most understanding physicians and, in turn, impede the delivery of care. Interactions with this type of patient may leave the physician with feelings of guilt, frustration, and helplessness. We review such an encounter with the purpose of describing how to deal with this type of patient and to guide the physician in responding to this adverse behavior. Such patients will usually require limits to be set on behavioral acting out for their own best interest. Further, it is often necessary to make continued care contingent on compliance with the ground rules set. The physician must be aware of his or her adverse feelings toward the patient and be able to interpret the behavior in the context of the psychiatric disorder so that appropriate psychologic help for the patient can be provided.
Administration, Inhalation↗
The Le Fort fractures: René Le Fort and his work in anatomical pathology.
René Le Fort (1869-1951) was a French army surgeon who conducted a series of thorough, if somewhat macabre, experiments on the heads of cadavers. The results of his work gave rise to a system of classifying facial fractures, now known as Le Fort types I, II and III. Le Fort had a distinguished career in surgery and teaching and served in both world wars.
Facial Bones↗
Schweitzer's example still shines.
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Africa↗
Favorable prognosis associated with hyperdiploidy in children with acute lymphocytic leukemia correlates with extra chromosome 6. A Pediatric Oncology Group study.
Pretreatment bone marrow cytogenetic studies were included for 1664 patients with acute lymphoblastic leukemia (ALL) accrued to Pediatric Oncology Group (POG) 8035 laboratory classification study from May 1981 through January 1986. There was a significant difference (P = 0.0001) in distribution of stem-line karyotype (normal, hypodiploid, pseudodiploid, or hyperdiploid) among children with early pre-B, pre-B, or T-cell ALL, with early pre-B patients demonstrating a higher proportion of hyperdiploid karyotypes with modal chromosome numbers greater than 51. Cytogenetic classification of 1216 patients with early pre-B or pre-B ALL evaluable for duration of event-free survival (EFS), with median follow-up of 42 months, showed a significant prolongation of five-year EFS associated with hyperdiploidy greater than 51 (75%; standard error [SE] = 5%) compared with hyperdiploidy 47 to 51 (46%; SE = 7%), hypodiploidy (55%; SE = 11%), and pseudodiploidy (45%; SE = 7%) (P = 0.0001). Five-year EFS was intermediate for patients with normal (58%), constitutionally abnormal (66%), or unsuccessful analyses (66%). The breakpoint defining hyperdiploidy associated with better prognosis was best defined as greater than 51 (P = 0.0002). Of 239 children with hyperdiploid karyotypes, analysis of the contribution of each chromosome to EFS duration showed a significant association between improved EFS and additional chromosome(s) six (P = 0.02). Chromosome translocation was associated with shorter EFS (P = 0.0001).
Antineoplastic Combined Chemotherapy Protocols↗
Severe angioedema related to ACE inhibitors in patients with a history of idiopathic angioedema.
Angiotensin converting enzyme (ACE) inhibitors have been associated with the onset of angioedema in a small subset of treated patients. The angioedema commonly involves the face and oropharyngeal tissues and may result in life-threatening airway compromise. The mechanism by which ACE inhibitors precipitate angioedema has not been well-defined, and retrospective analysis of reported cases has failed to identify a group of patients at high risk. We report four cases of ACE inhibitor-related angioedema that required immediate medical intervention. All four cases occurred in patients with a prior history of idiopathic angioedema, an otherwise uncommon clinical entity. These observations suggest that patients with a history of idiopathic angioedema are at increased risk for the development of ACE inhibitor-related angioedema and should be treated cautiously with this class of drugs.
Adult↗
Idiopathic anaphylaxis. A clinical summary of 175 patients.
One hundred seventy-five patients with idiopathic anaphylaxis, treated by the same team of physicians, were retrospectively evaluated. The diagnosis of idiopathic anaphylaxis was made only after a careful evaluation had failed to identify an allergen or underlying disease. Before our care of these patients, there were a total of 76 hospital admissions, including 21 intensive care unit admissions and 291 emergency department visits. Prophylactic treatment with maintenance antihistamines and prednisone was appropriate for frequent episodes, and short-term treatment was given for infrequent episodes. No fatalities were reported from idiopathic anaphylaxis in the 124 patients who were available for follow-up. With the appropriate treatment, remissions can be induced in a substantial number of patients. Significant reductions in the frequency of emergency department visits and hospitalizations have been shown, which, in turn, are accompanied by decreases in overall medical costs. In this disease, the period before treatment serves as a control period for comparison after therapy.
Adolescent↗
Metacontrast masking between cyclopean and luminance stimuli.
This study investigated the functional equivalence between cyclopean (global stereoscopic) and luminance (local stereoscopic) stimuli. To do so, a metacontrast masking paradigm was employed to determine the level of perceptual interaction between the two stimulus domains. Four target and mask combinations were used: cyclopean target-cyclopean mask, luminance target-luminance mask, cyclopean target-luminance mask, and luminance target-cyclopean mask. Substantial intradomain masking occurred, with the form of masking being similar for both domains. Moreover, significant interdomain masking also occurred, in equal measure for the cyclopean and luminance stimuli, although the magnitude of masking was one-half that of intradomain masking. These results imply that there is a functional equivalence at some stage of the visual system between the mechanisms representing cyclopean and luminance stimuli.
Adult↗
Clinical and serologic follow-up of four children and five adults with bird-fancier's lung.
We report the clinical and serologic findings in four children and five adults with chronic avian hypersensitivity pneumonitis. All subjects were treated with corticosteroids and bird exposure was reduced or eliminated. After a variable period, ranging from 6 months to 10 years, their clinical and serologic findings were reassessed. In terms of symptomatology, chest findings, and pulmonary functions, all four children improved and four adults improved, whereas one adult had a progressive clinical deterioration, ultimately resulting in her death 5 years later. In terms of serologic data, precipitating antibody tended to persist, and antibody to avian antigens, as determined by ELISA, remained positive, although the titer declined. We conclude that, while serologic positivity remains, the prognosis for children and adults with chronic avian hypersensitivity pneumonitis is very good, provided that irreversible damage has not already occurred at the time of diagnosis.
Adult↗
Malignant idiopathic anaphylaxis.
A patient with idiopathic anaphylaxis (IA), classified as generalized IA with frequent episodes, had original episodes in 1985 and has been managed and studied by the authors since 1987. Although her episodes of IA appear to have been controlled by prednisone, progressively larger doses of prednisone have been required. The patient was classified as a patient with corticosteroid-dependent IA, a subset of patients with IA in whom a remission cannot be induced with prednisone and in whom prednisone cannot be stopped. A trial of ketotifen is in progress without definitive effect on prednisone requirement. Because this corticosteroid-dependent patient with IA, which is potentially fatal, cannot be managed on less than 90 mg of alternate-day prednisone, we propose the term malignant IA to categorize such severe cases of IA.
Acute Disease↗
Clinical and immunologic evaluation of 37 workers exposed to gaseous formaldehyde.
Thirty-seven workers exposed to formaldehyde (F) were evaluated to determine whether any of their respiratory or ocular symptoms were mediated by an immunologic response to F. Because there has never been a case of defined immunologically mediated respiratory or ocular disease as a result of exposure to gaseous F, we used clinical and immunologic criteria developed for immunologic respiratory diseases that result from inhalational exposure to trimellitic anhydride. A clinical assessment included review of a medical summary of history, physical examination, chest x-ray films, and pulmonary function studies. Serologic assessment was made with an ELISA for IgE and IgG to F human serum albumin. The final evaluation for immunologically mediated disease was based on both the clinical and serologic assessments. None of the workers had IgE or IgG antibody to F-human serum albumin or an immunologically mediated respiratory or ocular disease caused by F; however, some of the workers appeared to experience irritant symptoms caused by workplace exposure to F or other irritant chemicals.
Adult↗
The use of an immunoassay index for antibodies against isocyanate human protein conjugates and application to human isocyanate disease.
Serum IgG and IgE to isocyanate haptenized human serum albumin (HSA) were estimated by ELISA in 55 isocyanate workers who underwent isocyanate inhalation challenge studies in Montreal, Canada. The challenges were negative in 29 workers and positive in 26 workers. Isocyanate antibodies were estimated by ELISA index. The mean IgG indices were found to be significantly higher in the challenge-positive workers, and there was a similar trend for the IgE indices. Antibody specificities for toluene diisocyanate-HSA, diphenylmethane diisocyanate-HSA, and hexamethylene diisocyanate-HSA were determined by inhibition studies with a variety of isocyanate haptenized carriers. The other isocyanate substituted carriers were either noninhibitory or caused only partial inhibition as contrasted with the complete inhibition achieved by HSA conjugated to the isocyanate to which the worker was exposed. We interpret these specificity studies as indicating that the inhalation of isocyanates results in production of antibody that recognizes new antigenic determinants that develop from the coupling of isocyanates to homologous proteins.
Antibodies↗
Immunoblot analysis of sera from patients with allergic bronchopulmonary aspergillosis: correlation with disease activity.
Immunoblot analysis was used to evaluate the IgG, IgE, and IgA responses to Aspergillus fumigatus antigen with the sera of five patients with allergic bronchopulmonary aspergillosis (ABPA) before, during, and after suspected exacerbation of their disease. The results revealed a heterogenous antibody response, unique for each patient, to specific Aspergillus fumigatus antigens that correlated with the molecular weights of previously well-characterized antigens of importance in the immunopathogenesis of ABPA. A rating scale was devised for measuring band intensity that allowed the patient's antibody responses to be reproducibly semiquantitated. Immunoblot analysis demonstrated qualitative and semiquantitative information that is not available with other in vitro assays used in the study of patients with ABPA, such as ELISA. These initial results emphasize the need for additional evaluation of this technique to assess its potential clinical application in this disease.
Antigens, Fungal↗
Medial (hamate) facet of the lunate.
One hundred sixty-five cadaveric wrists were dissected to assess the incidence of a medial (hamate) facet on the lunate and any associated pathologic conditions. Forty-seven of these specimens and 137 clinical patients' radiographs were reviewed to attempt to recognize and further assess the incidence of a medial (hamate) facet on the lunate. Two types of lunate were identified. Type I, in which there was no medial facet, was evident in 34.5% of the dissected specimens and type II, in which there was a medial facet, was evident in 65.5% of the dissected specimens. The medial facets in the type II lunates ranged from a shallow 1 mm facet to a deep 6 mm facet. Significant cartilage erosion with exposed subchondral bone at the proximal pole of the hamate, which was not identifiable by radiograph, was evident at dissection in 44.4% of the type II lunates, while none (0%) of the type I lunates had such associated hamate pathologic conditions. This type II lunate, with the high incidence of associated hamate pathology, may be an unidentified cause of wrist pain on the ulnar side.
Adolescent↗
Spatiotemporal properties of stereoacuity.
This study investigated the effects of spatial and temporal luminance variations on stereoacuity across three experiments. In Experiment 1, the effect of counterphase flicker on performance was examined at five spatial frequencies. Flicker impaired performance at a high spatial frequency, whereas it improved performance at a low spatial frequency. In Experiment 2, the effect of sustained vs. transient temporal modulation on performance was investigated at four spatial frequencies. Relative to sustained modulation, transient modulation impaired performance at high spatial frequencies, but it affected performance little at low spatial frequencies. In Experiment 3, the effect of exposure duration on performance was examined at three spatial frequencies. Decreasing duration impaired performance at a high spatial frequency, but it affected performance less at low spatial frequencies. These results show that spatial and temporal variables interact to govern stereoacuity performance; stereoacuity is good only when tested with high spatial- and low temporal-frequencies.
Depth Perception↗