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Biomedical subjects

S J Gluckman

Publications and source records attributed to S J Gluckman.

At least 19 recordsLinked to original sources
PubMed2001

Eosinophilic meningitis due to Angiostrongylus cantonensis in a returned traveler: case report and review of the literature.

Angiostrongylus cantonensis, the rat lungworm, is the principal cause of eosinophilic meningitis worldwide, and the increase in world travel and shipborne dispersal of infected rat vectors has extended this parasite to regions outside of its traditional geographic boundaries. We report a case of eosinophilic meningitis due to A. cantonensis in a patient who recently returned from a trip in the Pacific.

Adult↗
PubMed1998

First human trial of a DNA-based vaccine for treatment of human immunodeficiency virus type 1 infection: safety and host response.

A DNA-based vaccine containing human immunodeficiency virus type 1 (HIV-1) env and rev genes was tested for safety and host immune response in 15 asymptomatic HIV-infected patients who were not using antiviral drugs and who had CD4+ lymphocyte counts of > or = 500 per microliter of blood. Successive groups received three doses of vaccine (30, 100, or 300 microg) at 10-week intervals in a dose-escalation trial. Vaccine administration induced no local or systemic reactions, and no laboratory abnormalities were detected. Specifically, no patient developed anti-DNA antibody or muscle enzyme elevations. No consistent change occurred in CD4 or CD8 lymphocyte counts or in plasma HIV concentration. Antibody against gp120 increased in individual patients in the 100- and 300-/microg groups. Some increases were noted in cytotoxic T lymphocyte activity against gp160-bearing targets and in lymphocyte proliferative activity. The safety and potential immunogenicity of an HIV-directed DNA-based vaccine was demonstrated, a finding that should encourage further studies.

AIDS Vaccines↗
PubMed1997

Histiocytic necrotizing lymphadenitis (Kikuchi's disease): in situ end-labeling, immunohistochemical, and serologic evidence supporting cytotoxic lymphocyte-mediated apoptotic cell death.

Histiocytic necrotizing lymphadenitis (Kikuchi's disease) is a benign, self-limited disorder that is sometimes confused with malignant lymphoma. Kikuchi's disease is characterized by collections of histiocytes and lymphocytes surrounding areas of necrosis containing fragments of karyorrhectic nuclear debris. Polymorphonuclear leukocytes are generally absent. The mechanism of cell death involved has not been extensively studied, and a definitive etiology has not been identified. Recent articles proposed that the mechanism of cell death is more characteristic of coagulative necrosis than apoptosis, but, to our knowledge, this has not been studied with the use of currently available assays of apoptosis. To study the mechanism of cell death in Kikuchi's disease, we employed an in situ end-labeling technique on formalin-fixed, paraffin-embedded sections of lymph nodes with Kikuchi's disease. These studies demonstrated that the lymphocytes and histiocytes within and surrounding the areas of necrosis showed nuclear DNA fragmentation, a feature characteristic of early apoptosis. Immunohistochemical studies revealed an increase in CD8(+)-T lymphocytes and lymphocytes containing TIA-1, a cytotoxic granule-associated protein, within foci of cellular debris, with a relative paucity of CD56+ cells. Moreover, TIA-1-positive granules were present within the cytoplasm of many apoptotic bodies. In one of the patients for whom acute phase serum was available, evaluation by enzyme-linked immunosorbent assay demonstrated that the serum concentrations of the T-cell activating cytokines interleukin-2 and interleukin-6 were increased; no such increase was noted in eight patients with other lymphoproliferative disorders. In contrast, the serum concentrations of the immunosuppressive molecules interleukin-10, soluble interleukin-2 receptor, and soluble tumor necrosis factor receptor were expressed at normal levels in the patient with Kikuchi's disease. These findings suggested that the predominate mechanism of cellular destruction in Kikuchi's disease was apoptosis mediated by cytolytic lymphocytes. These data supported the prevailing hypothesis of a viral or autoimmune pathogenesis in Kikuchi's disease.

Adult↗
PubMed1996

Kikuchi-Fujimoto disease: a benign cause of fever and lymphadenopathy.

PURPOSE: To describe 6 cases of Kikuchi-Fujimoto disease and to review the literature. PATIENTS AND METHODS: Review of 6 patients with biopsy-proven Kikuchi-Fujimoto disease detected at a university hospital over a 5-year period. RESULTS: Six patients presented with localized, mild lymph node enlargement. In 3 cases, dramatic fever, chills, weight loss and systemic complaints were present. These features prompted prolonged antibiotic therapy and extensive evaluations of fever of unknown origin before the diagnosis was made by biopsy of the minimally enlarged lymph nodes. The 3 remaining patients were otherwise asymptomatic and well. All 6 subjects recovered without specific therapy. CONCLUSIONS: Kikuchi-Fujimoto disease is a recently described cause of benign, self-limited lymphadenopathy that is easily confused histologically and clinically with lymphoma and systemic lupus erythematosis. Clinicians and pathologists must be aware of this condition. Although it is an uncommon cause of fever of unknown origin, early recognition of KFD will minimize potentially harmful and unnecessary evaluations and treatments.

Adult↗
PubMed1994

AIDS hot lines and information agencies. The consistency of their information.

OBJECTIVES: To determine the consistency of responses given by acquired immunodeficiency syndrome (AIDS) hot lines and AIDS information agencies to a standard set of questions related to human immunodeficiency virus (HIV) infection and to investigate the training of workers in these telephone information agencies. DESIGN: A two-part questionnaire that addressed issues of HIV transmission and testing (part 1) and sexual behavior, diet, alcohol use, and partner notification (part 2). SETTING: Thirty-three AIDS telephone information agencies. PARTICIPANTS: Information specialists at these agencies were contacted on multiple occasions over a 1-year period. INTERVENTION: Initially, 48 calls were made to these agencies. Responses were recorded in the words of the information specialists, categorized, and assessed for consistency. Two additional surveys using the same questionnaire were also performed, examining the variability of responses within an individual agency and the variability of responses from six agencies, three with and three without formal training of their information specialists. RESULTS: The initial survey revealed inconsistencies and inaccuracies in responses from AIDS telephone information agencies particularly in the areas of HIV testing, risk factor assessment, safe-sex recommendations, and life-style changes for infected persons. The second survey revealed variability in responses from six information specialists within a single agency. The third survey revealed that, overall, agencies with and without formal training of workers were equally inconsistent in their responses. CONCLUSIONS: There are identifiable deficiencies in the quality and consistency of information given by some AIDS telephone information agencies. Training procedures of information specialists at these agencies are variable and may be inadequate.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Evaluation of the painful prosthetic joint. Relative value of bone scan, sedimentation rate, and joint aspiration.

Seventy-two joint arthroplasties undergoing total hip or total knee surgery were studied prospectively with plain radiographs, three-phase bone imaging (3PBI), erythrocyte sedimentation rate (ESR), aspiration of the joint for culture, and multiple intraoperative cultures at the time of revision. Intraoperative cultures and the operative appearance were used to form a diagnosis of definite infection (unequivocal microbiology and gross sepsis), possible infection (positive microbiology or gross sepsis), or no infection (neither positive microbiology nor gross sepsis). For the preoperative diagnosis of infection, as opposed to aseptic loosening, 3PBI alone had a sensitivity of 33% and a specificity of 86%. In conjunction with plain radiographs, minimal improvement in accuracy was seen. A preoperative ESR greater than 30 had low sensitivity (60%) and a specificity of (65%). However, the ESR was statistically significantly higher in the joints with definite infection as compared to those joints without infection. The preoperative joint aspiration had a sensitivity of 67% and a specificity of 96% and, therefore, appears to be the most useful single test in the workup of a painful total joint arthroplasty.

Aged↗
PubMed1987

Treatment of the septic hip with total hip arthroplasty.

Forty-three patients, 23 with definite infection and 20 with probable infections before total hip arthroplasty (THA), were compared to 41 matched uninfected patients. The 43 infected patients were treated by 45 operative procedures: eight Girdlestone resections, 12 revisions of total hips, and 25 conversions from infected nontotal hip surgery to total hip arthroplasties. (Two revision THAs were converted to Girdlestones). The average follow-up period was 38.8 months, with a range of six-118 months. The statistically significant negative prognosticators were gross sepsis at surgery, number of previous operations, and elevated erythrocyte sedimentation rate (ESR). The type of infecting organism did not affect the outcome. The prosthesis survival rate for total hip arthroplasties revised for sepsis was 83%. The prosthesis survival rate for other infected hips treated by total hip arthroplasty was 100%. All groups except Girdlestone resections improved postoperatively. While Girdlestone resection offered acceptable pain relief, total hip arthroplasty provided unequivocally superior function (p = 0.0001).

Adult↗