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Biomedical subjects

R Strauss

Publications and source records attributed to R Strauss.

At least 73 records · Page 4Linked to original sources

Large cell lymphoma complicating acute lymphoblastic leukemia.

Non-Hodgkin's lymphoma (NHL) is a very rare complication of acute lymphoblastic leukemia (ALL). We present the pathologic, clinical, immunologic, and ultrastructural features of the third reported example of NHL following successfully treated ALL. This white girl developed ALL with predominantly L1 cells at 3.5 yr of age. The lymphoblasts were terminal deoxynucleotidyl transferase (TdT) positive and were non-B, non-T cells. She achieved a complete remission with standard induction therapy and has remained in continuous complete remission. Four and one-third years after the onset of ALL, she developed multifocal, pleomorphic large cell lymphoma of the small bowel, which resulted in episodes of intussusception and obstruction. These pleomorphic and frequently multinucleated lymphoma cells lacked TdT, common ALL antigen, and all tested markers of B cell, T cell, and histiocyte differentiation. Following three small bowel resections, systemic multiagent chemotherapy, and abdominal irradiation, she is currently free of disease.

Bone Marrow↗

Human respiration at rest in rapid compression and at high pressures and gas densities.

Ventilation (V), end-tidal PCO2 (PACO2), and CO2 elimination rate were measured in men at rest breathing CO2-free gas over the pressure range 1-50 ATA and the gas density range 0.4-25 g/l, during slow and rapid compressions, at stable elevated ambient pressures and during slow decompressions in several phases of Predictive Studies III-1971 and Predictive Studies IV-1975. Inspired O2 was at or near natural O2 levels during compressions and at stable high pressures; it was 0.5 ATA during decompressions. Rapid compressions to high pressures did not impair respiratory homeostasis. Progressive increase in pulmonary gas flow resistance due to elevation of ambient pressure and inspired gas density to the He-O2 equivalent of 5,000 feet of seawater was not observed to progressively decrease resting V, or to progressively increase resting PACO2. Rather, a complex pattern of change in PACO2 was seen. As both ambient pressure and pulmonary gas flow resistance were progressively raised, PACO2 at first increased, went through a maximum, and then declined towards values near the 1 ATA level. It is suggested that this pattern of PACO2 change results from interaction on ventilation of 1) increase in pulmonary resistance due to elevation of gas density with 2) increase in respiratory drive postulated as due to generalized CNS excitation associated with exposure to high hydrostatic pressure. There may be a similar interaction between increased gas flow resistance and increase in respiratory drive related to nitrogen partial pressure and the narcosis resulting therefrom.

Adult↗

Current status of the biology and treatment of acute non-lymphocytic leukemia in children (report from the ANLL strategy group of the Children's Cancer Study Group.

Major advances have been made in the past 10 yr in both the understanding of the biologic characteristics of acute nonlymphocytic leukemia and in the treatment of patients with this disease. Advances in the biologic characteristics include: a better understanding of the nature of leukemic cell proliferation and differentiation; a clearer description of the morphological, histochemical, and ultrastructural characteristics of leukemic cells; a recognition that a high percentage of patients may have specific cytogenetic abnormalities; and a recognition that biochemical differences exist between acute nonlymphocytic leukemia (ANLL) and acute lymphoblastic leukemia (ALL). Today, over 70% of children with ANLL can be induced into a complete remission and over 25% are remaining in a continuous remission for over 2 yr. In spite of these improved results, the best method of extending remissions is unknown. It is unlikely that better results of therapy will be achieved in the future by tailoring the treatment according to the biologic characteristics of the patient, since it appears that ANLL is a heterogeneous group of diseases.

Acute Disease↗

Hemangiopericytoma of the colon: report of a case and review of literature.

A patient with a hemangiopericytoma of the colon is discussed. This is the second such case reported in the English medical literature. Soon after discovery of the tumor, the patient presented with a colonic intussusception with the tumor serving as the lead point. This was reduced by a hypaque enema, but the intussusception recurred twice more, being reduced again by hypaque enema and finally having to be reduced by colonoscopy. At surgery a left hemicolectomy with primary anastomosis was performed. The microscopic, ultrastructural, and pathologic aspects of hemangiopericytoma are discussed with special attention to lesions of the gastrointestinal tract.

Adult↗

Splenic pseudocyst associated with hypersplenism.

A patient with hypersplenism, who was found to have a splenic pseudocyst containing an organized hematoma, is described. There are only two patients with splenic pseudocyst and hypersplenism and an additional two patients with splenic cysts and hypersplenism reported in the world literature. The hypersplenism associated with splenic cysts and pseudocysts is explained on the basis of an expansion of the plasma volume and the total blood volume, an increased destruction of red blood cells and a pooling of blood in the enlarged spleen. The combined use of ultrasonography and computerized tomography has increased the accuracy of noninvasive diagnosis and made more invasive examinations unnecessary. When the ultrasound is technically unsuccessful or when it shows a mixed echo pattern, one should resort to computerized tomography with which it is possible, almost invariably, to differentiate between cysts and neoplasms.

Adult↗

Health outcomes of a community-based therapy program for children with cancer--a shared-management approach.

Critical to providing cancer therapy to children in rural areas is finding dependable sources of therapy near the patients' homes. In this study, comparison was made of 668 visits by 24 patients to nearby private practitioners, who carried out 70% of the therapy, with 712 visits by 22 other patients for whom all care was managed by pediatric hematologist-oncologists. There was no significant difference by Wilcoxon rank sum test between the two groups in the accuracy with which protocol rules were followed, in the incidence of neutropenia, infection, fever, thrombocytopenia, drug toxicity, or the proportion of days hospitalized. The findings indicate that the private practitioners participating in a shared-management system were a dependable resource for providing 70% of the total cancer therapy to these patients.

Antineoplastic Agents↗

Subglottic mucocele in an infant.

A subglottic mucocele caused partial obstruction of the upper airways. The radiologic findings were asymmetrical narrowing of the subglottic area with a mass arising from its posterior wall simulating a subglottic hemangioma. Surgical treatment was successfull.

Glottis↗

Allergic alveolitis caused by home humidifiers. Unusual clinical features and electron microscopic findings.

Allergic alveolitis (hypersensitivity pneumonitis) developed in two patients who were exposed to home humidifiers contaminated by thermophilic actinomycetes. Diagnosis was difficult because severe dyspnea was chronic and not easily associated with specific environmental exposure. Furthermore, chest roentgenograms were normal for long periods despite severe physiologic abnormalities. After several years of disabling symptoms, open lung biopsy findings suggested allergic alveolitis rather than sarcoidosis because a mononuclear interstitial infiltrate overshadowed the granulomas. Also, plasma cells were prominent and there was an intense bronchiolitis. Cultures of the humidifier water grew thermophilic organisms to which the patient's sera formed precipitins. Both patients experienced notable subjective and objective improvement following removal of the contaminated appliances. The ultrastructure of alveolar macrophages and basement membranes was similar to that described in animal models, suggesting cell-mediated hypersensitivity in the patients.

Actinomycetales↗

Detection of bacteriuria by automated electrical impedance monitoring in a clinical microbiology laboratory.

An apparatus capable of rapidly detecting changes in electrical impedance was utilized for the continuous monitoring of bacterial growth in routine urine specimens in a clinical laboratory. In a trial study, 200 clinical specimens analyzed by the electrical impedance method resulted in an average detection time of 2.5 h for 41 clinically significant specimens, whereas conventional methods for bacterial isolation required overnight culture. Those specimens positive by the electrical impedance monitoring but negative by conventional bacteriological methods accounted for less than 2% of the total number of positive specimens, whereas electrical impedance-negative but conventional culture-positive specimens accounted for ca. 4%. Electrical impedance apparatus in clinical microbiology laboratories could provide rapid screening of clinical urine specimens as well as accurate detection of bacterial growth.

Bacteria↗

Rapid detection of bacterial growth in blood samples by a continuous-monitoring electrical impedance apparatus.

A growth detection method utilizing an automated apparatus capable of rapidly detecting bacterial growth by measuring changes of electrical impedance in bacteriological medium was utilized with "mock" blood cultures containing various gram-negative and gram-positive bacteria. Measurement of changes of electrical impedance was found to ba as accurate and comparable for time of growth detection as the radiometric method for detection of the same bacteria using mock blood cultures. In a limited clinical trial the use of the electrical impedance apparatus detected in 1 positive specimen from 40 clinical blood specimens as rapidly as by radiometric measurement. Both methods were considerably faster for detecting bacterial growth as compared with conventional culture methods. The selected species of gram-positive and -negative organisms tested were all detected by the electrical impedance method, including aerobes and anerobes. However, addition of 5% CO2 to the incubation atmosphere enhanced detection of gram-positive organisms.

Aerobiosis↗

Ileorectal anastomosis in patients with Crohn's disease of the colon.

Thirty-seven patients were studied who had an ileorectal anastomosis performed for Crohn's disease of the colon. Twenty-nine were done as a primary procedure and in eight the anastomosis was made after previous total or segmental colectomy. Three patients developed anastomotic leaks and all three patients died. No patient who had a diverting loop ileostomy performed at the time of ileorectal anastomosis developed anastomotic leaks before or after the ileostomy was closed. Of the 37 patients, three died postoperatively and another five have had less than a one year follow-up. Of the remaining 29 patients, 12 (41%) had recurrences in either the rectum or ileum. Half of the recurrences took place five or more years after surgery. Seven of the 12 patients with recurrences have had their anastomoses taken down. When this recurrence rate of 41% is compared with the recurrence of ileitis in patients after total colectomy and ileostomy for Crohn's disease of the colon, the incidence of recurrence is, as shown in many reports, not markedly dissimilar. Of the patients who develop a recurrence after ileorectal anastomosis, only about half will have to have their anastomoses taken down. In our study, 59% of the patients had no recurrence and another 20-5% had a recurrence but did not require 'take down' of the anastomosis. Thus, almost 80% of our patients at the time of this report have been able to lead a life unencumbered by an ileostomy, making ileorectal anastomosis for this disease a desirable procedure to consider in selected patients.

Adolescent↗