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Biomedical subjects

T Quinn

Publications and source records attributed to T Quinn.

At least 91 records · Page 5Linked to original sources
PubMed1986

ALG treatment of steroid-resistant rejection in patients receiving cyclosporine.

Thirty-one episodes of biopsy-proved acute rejection (R) in 28 patients maintained on cyclosporine did not respond to high-dose steroids and were treated with antilymphocyte globulin (ALG). Cyclosporine was discontinued in all but three during ALG administration. (A) Twenty-four patients received 26 courses of ALG within 90 days of transplant (11 1st R, 15 2nd or 3rd). Seven treatment courses were cut short due to infection (4), ongoing R (2) and a combination of infection and rejection (1). Only 1 of 7 has a functioning graft. Of the remaining 19 full ALG courses (17 patients) (8 1st R, 11 2nd or 3rd), 13 (11 patients) responded (7 1st R, 6 greater than 1st). The remaining 6 patients lost their grafts to ongoing acute rejection. (B) Five patients were treated after 6 months posttransplant; two responded but no grafts currently function. (C) Overall 7 patients developed systemic infection (7 viruses, 1 Candida) with 1 death, and 2 additional patients developed severe thrombocytopenia and leukopenia. Patients responding to their ALG course were restarted on cyclosporine. We conclude that ALG is not as effective in reversing steroid-resistant rejection in patients maintained on cyclosporine as it has been in patients maintained on azathioprine. However, more than 50% of steroid-resistant rejection episodes are reversed.

Adolescent↗
PubMed1986

Definition, diagnosis, and management of rejection in the second to sixth months posttransplant--an overview.

CsA immunosuppression has resulted in decreased graft loss from rejection. However, rejection episodes do occur and, in fact, rejection remains as the major cause of graft loss in the CsA-treated patient. CsA, itself, has added to the differential diagnosis of renal dysfunction following transplantation. In the majority of circumstances, rejection can be differentiated from CsA nephrotoxicity as well as other causes of renal dysfunction by a combination of clinical presentation, renal scan and sonography, CsA levels, and percutaneous allograft biopsy. In some circumstances, a therapeutic trial of lowering the CsA dose may be indicated before extensive laboratory study. Most acute rejection episodes will respond to increased steroid doses. In patients with low CsA levels, increasing the CsA dose may be advised. Steroid-resistant rejection frequently responds to ALG. Patients with repeated episodes of renal dysfunction may be stabilized by using the combination of prednisone, azathioprine, and CsA.

Adrenal Cortex Hormones↗
PubMed1986

A correlative study of Papanicolaou smear, fluorescent antibody, and culture for the diagnosis of Chlamydia trachomatis.

A prospective study of 300 patients undergoing therapeutic termination of pregnancy was conducted. A Papanicolaou smear was obtained and a clinical evaluation of the cervix was made. Specimens from the cervix were examined by both direct fluorescent antibody and culture techniques for the presence of Chlamydia trachomatis. The presence of inflammation on Papanicolaou smear could be correlated with C trachomatis isolation. Papanicolaou smear findings consistent with C trachomatis lacked both sensitivity and specificity when compared with direct fluorescent antibody and/or culture techniques. A correlation was found between the clinical diagnosis of cervicitis and C trachomatis. This interrelationship was absent when the component findings of cervicitis (ectopy, friability, and purulent mucus) were examined independently.

Adolescent↗
PubMed1985

Genomic heterogeneity of AIDS retroviral isolates from North America and Zaire.

In an analysis of the genomic variation of AIDS retroviral isolates from patients living in New York, Alabama, and Zaire, restriction maps were constructed by using seven enzymes, each known to cleave the proviral DNA more than once, in conjunction with Southern blot analysis. The maps of LAV, HTLV-III, and ARV-2 as deduced from their published nucleotide sequences were included in this analysis. The results demonstrated that (i) several "signature" restriction sites were common to all isolates; (ii) with the exception of LAV and HTLV-III, the North American and European isolates were all different from one another and showed no geographical specificity; (iii) the African isolates as a group were more diverse than those from North America and Europe; and (iv) the genomic variability was concentrated within the env gene.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Structural characterization of the avian retrovirus reverse transcriptase and endonuclease domains.

The enzymatic domains of the avian retrovirus polymerase (pol) gene have been mapped by the use of peptide antibodies and COOH-terminal amino acid analysis. The processed pol beta polypeptide is cleaved in vivo to yield alpha and pp32. Rabbit antibodies were directed against synthetic peptides whose sequence was deduced from the known pol sequence of Rous sarcoma virus, Prague C (Schwartz, D.E., Tizard, R., and Gilbert, W. (1983) Cell 32, 853-869). The RNase H active site of pol was located in the NH2-terminal region of the alpha DNA polymerase subunit. The COOH terminus of the alpha subunit was found to be immediately adjacent to the NH2 terminus of the pp32 pol protein. COOH-terminal amino acid analysis of pp32 revealed that this protein is also processed. From the deduced amino acid sequence of pol, it appears likely that pol encodes an additional 4100-dalton polypeptide located at its extreme COOH terminus. The enzymatic domains on beta appear to map in the following order: RNase H-DNA polymerase-DNA endonuclease. Hydrophilicity analysis and secondary structure predictions of wild type Rous sarcoma virus pol products and mutated pp32 possessing single amino acid changes permit further structural evaluation of the multifunctional pol protein.

Amino Acid Sequence↗
PubMed1985

Treatment of renal transplant rejection episodes in patients receiving prednisone and azathioprine. A cost-effective approach.

Antilymphocyte globulin (ALG) has been advocated for the treatment of renal transplant rejection episodes in patients maintained on prednisone and azathioprine. Treatment with steroids (outpatient) is considerably less expensive than with ALG (inpatient), so we studied whether routine ALG was necessary. Between 3/82 and 11/83, 54 cadaver transplant recipients maintained on prednisone and azathioprine who developed a first rejection episode were randomized to receive--for treatment of their first, and if necessary second, rejection--methylprednisolone (MP) plus ALG (n = 24), or MP alone, with ALG added if treatment failed (n = 30). Treatment failure was defined as continuing deterioration on T131 iodohippuran scan, rising serum creatinine level, or lack of improvement within 7 days. There was no significant difference in patient survival, graft survival, mean number of rejections, and infection rate between the two groups: 60% (18/30) of first and 50% (10/10) of second rejection episodes responded to MP alone. We conclude that patients are not penalized by initial rejection treatment with MP. Many rejection episodes respond to steroids alone; elimination of routine ALG use will save hospitalization time and expense.

Adult↗
PubMed1985

The value of needle renal allograft biopsy. III. A prospective study.

Previous studies of the value of percutaneous renal transplant biopsy have been retrospective. We prospectively studied whether biopsy affected patient management. Thirty-five patients with elevated serum creatinine level underwent 44 biopsies in situations in which the diagnosis was in doubt. At the time of biopsy, all clinical and laboratory data were reviewed, and a proposed treatment plan was outlined. Biopsy results were available within 24 hours. We evaluated whether biopsy influenced treatment. Other than hematuria (less than 24 hours), there were no complications. Nine biopsy specimens (20.5%) were inadequate for evaluation. Forty-six percent of adequate biopsy specimens (36% of total biopsy specimens) influenced patient management. Adequate biopsy specimens resulted in a change in treatment in 10 of 19 patients receiving prednisone and azathioprine and 6 of 16 receiving prednisone and cyclosporine. The remaining biopsy specimens, although not changing management confirmed the treatment plan in ambiguous clinical situations. We conclude that percutaneous biopsy is an important aid in patient management.

Acute Disease↗
PubMed1983

A gene affecting accumulation of the RNA moiety of the processing enzyme RNase P.

The level of 10Sb (M1) RNA, the RNA of RNase P, is very low in growing cultures of rnpB mutants. Northern transfer experiments suggested that these strains accumulate no more than 10% of the wild-type level of 10Sb RNA. However, there is no indication that there is a limiting amount of RNase P activity in these mutants in vivo. A plasmid that directs the synthesis of 10Sb RNA does not complement the rnpB mutants, even though there is only a single gene for 10Sb RNA in the Escherichia coli genome. The 10Sb RNA synthesized from this plasmid is equivalent to wild-type 10Sb RNA since it can replace it in the reconstitution of RNase P. The 10Sb RNA, which is a rather stable molecule, is unstable in the presence of the rnpB mutation. This could explain why rnpB mutants do not accumulate 10Sb RNA. An F' plasmid that contains DNA from the rnpB region of the chromosome complements an rnpB mutant in vivo and in vitro, and it also contains the 10Sb RNA gene. A number of possible explanations for these phenomena are discussed.

Endoribonucleases↗
PubMed1980

Selective management of high risk patients with an abdominal aortic aneurysm.

One hundred and eighty-seven patients with abdominal aortic aneurysm seen during a 15 year period were denied operation at the time of initial evaluation because of the small size of the aneurysm or serious medical contraindications, or both. Seven patients were operated upon because of rupture, 16 because of symptomatic expansion, 13 because of increase in size to greater than 6 centimeters and six because of improvement in medical status. Operative related deaths occurred in five of the seven patients operated upon for rupture, four of the 16 patients operated upon because of symptomatic expansion and one of the 19 patients operated upon electively. Of the 153 patients selectively observed, 74 died during the follow-up period; 20 deaths were aneurysm related. while 54 deaths were due to associated disease. Sixteen of 18 patients with a rupture of the aneurysm died as a result. In the entire group of 187 patients, the cumulative survival rate was 44 per cent at five years and 27 per cent at ten years. Results of this study support the current management of high risk patients with abdominal aortic aneurysms but suggest that there is a need for an even more aggressive approach to patient selection.

Adult↗
PubMedDate not supplied

A radiolucent spine frame: a modification of the Relton-Hall spine frame.

A radiolucent spine frame for obtaining intraoperative spine radiographs while performing surgery for scoliosis has been designed at the Alfred I. duPont Institute and is described here. This frame, constructed of strong radiolucent plastic compounds, is easy to use and maintain.

Child↗
PubMedDate not supplied

Cardiopulmonary resuscitation: new European guidelines.

Cardiac arrest is the ultimate medical emergency. Without rapid action by witnesses and responding health professionals, chances of survival are remote. In this article the key evidence-based aspects of resuscitation, basic life support and early defibrillation are discussed in light of the recent publication of revised guidelines from the European Resuscitation Council. The importance of calling for skilled help at the earliest opportunity is emphasized, facilitating rapid access to emergency services (in the community) and the cardiac arrest team (in hospital). The advent of the automated external defibrillator (AED) presents additional opportunities to save lives and it is recommended that registered nurses are trained in, and authorized to use, AEDs in their professional practice.

Algorithms↗