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Biomedical subjects

W M Butler

Publications and source records attributed to W M Butler.

At least 55 records · Page 3Linked to original sources

Skin metastases confined to a field of previous irradiation. Report of two cases and review of the literature.

Two cases of tumor recurrence within a previously irradiated skin area are reported. Typical lesions evolve from an erythematous base and progress to induration and tumor papules. A review of clinical literature indicates that irradiation does not increase the frequency of metastases. Experimental data suggest that irradiation does increase metastases as a result of both local mechanical factors and increased tumor-cell survival.

Adenocarcinoma↗

Prolongation of thrombin and reptilase times in patients with amyloidosis and acquired factor X deficiency.

A patient with acquired factor X deficiency due to amyloidosis had a prolonged thrombin time. Investigation of this abnormality suggested that an inhibitor of thrombin was present. A review of the literature demonstrated that prolonged thrombin time or reptilase time was present in many of the patients with acquired factor X deficiency due to amyloidosis. We were unable to relate prolongation of the thrombin time or reptilase time to the severity of bleeding. We believe that determination of thrombin and reptilase times should be part of the coagulation profile in all patients with acquired factor X deficiency.

Aged↗

Methyl-CCNU, 5-fluorouracil, vincristine, and streptozocin (MOF-STREP) in metastatic colo-rectal carcinoma.

Forty patients with metastatic colorectal carcinoma who had received no prior chemotherapy were entered onto a trial of methyl-CCNU, 5-fluorouracil, vincristine, and streptozocin (MOF-STREP). Ten of 40 (25%) responded. Two patients (5%) achieved a complete response and eight patients (20%) a partial response. In addition, 10 patients previously treated with chemotherapy received the MOF-STREP regimen; 1 of 10 (10%) responded. The duration of the complete responses were 5 and 16 mo, respectively. The median duration of the partial responses was 4 mo with a range of 1-16 mo. The median survival of the 11 responders was 14 mo. Median survival of the 39 nonresponders was 5 months. Responders lived significantly longer than nonresponders (p = 0.03, log-rank). Toxicity was severe with nausea and vomiting common after streptozocin and myelosuppression requiring dose reductions in 70% of patients. We compare our findings using this regimen to those of two previously reported trials.

Adult↗

The effect of bloodletting on exercise performance in a subject with a high-affinity hemoglobin variant.

We studied two young army recruits with erythrocytosis. One had a variant hemoglobin with high affinity for oxygen (hemoglobin Osler, also known as Fort Gordon and Nancy, beta 145 Tyr leads to Asp). The other had normal oxygen affinity and erythrocytosis of undetermined etiology. Both were asymptomatic. We studied exercise capacity on a cycle ergometer before and after hemodilution. In the subject with high oxygen affinity, hemodilution resulted in reduced maximal work and increased heart rate at every work level. In addition, minute ventilation and arterial lactic acid increased, while anaerobic threshold decreased, indicating diminished oxygen supply to tissues. In contrast, the subject with normal oxygen affinity had no significant changes in exercise performance after hemodilution. These results suggest that when blood oxygen affinity is high, loss of efficiency in tissue oxygenation can be expected after phlebotomy or hemodilution. Therefore, it may be useful to measure blood oxygen affinity and exercise performance in polycythemic subjects in whom such procedures are intended to ameliorate symptoms of hyperviscosity.

Adult↗

Molecular heterogeneity of hereditary pyropoikilocytosis: identification of a second variant of the spectrin alpha-subunit.

In hereditary pyropoikilocytosis (HPP), the red cell membrane skeletons exhibit a mechanical instability that can be correlated to defective self-association of spectrin heterodimers. To determine the underlying molecular defect, we have subjected HPP spectrin to limited tryptic digestion, followed by one- and two-dimensional separations of the peptides. Two of the HPP kindreds exhibited a marked decrease in 80,000-dalton peptide (previously identified as the spectrin dimer-dimer contact domain of the alpha-subunit) and a concomitant increase of the 74,000-dalton polypeptide (presumably derived from the 80,000-dalton domain) and a decrease in a 22,000-dalton polypeptide. We now report tryptic digests of two other HPP kindred that are characterized by a decrease or complete absence of the 80,000-dalton tryptic fragment, with a concomitant increase in fragments at 46,000 and 17,000 daltons. The 46,000-dalton fragment separated into multiple spots on isoelectric focusing, ranging in isoelectric point from 5.25 to 5.35, and the 17,000-dalton fragment focused to a single spot at 5.4. Minor fragments at 56,000 and 22,000 daltons were also decreased, while a 38,000-dalton fragment increased. Limited tryptic digestion of the separated alpha- and beta-subunits revealed that the 74,000-dalton fragment in the first group of patients and the 46,000-dalton fragment in the second group of patients were derived from the alpha-subunit. Both subtypes exhibited a similar defect of spectrin self-association, with 30%-38% of spectrin dimers in O degrees C extracts. The results indicate that at least two distinct forms of structurally defective spectrin may give rise to the clinical presentation of HPP.

Adolescent↗

Metastatic thymoma with myasthenia gravis: complete remission with combination chemotherapy.

A 29-year-old male developed myasthenia gravis 29 months after resection of a "benign" mediastinal thymoma. Metastatic thymoma was found in the pleura 45 months after the initial surgical resection. Combination chemotherapy with cyclophosphamide and doxorubicin produced a complete remission of the metastatic thymoma which has continued for 13 months. Concurrently, there has been a marked increase in neuromuscular function.

Adult↗

Idiopathic acquired sideroblastic anemia terminating in acute myelosclerosis.

Acute myelosclerosis is an unusual myeloproliferative syndrome characterized by pancytopenia, absence of massive hepatosplenomegaly, and an absence of tear-drop poikilocytes. The marrow is usually fibrotic with atypical megakaryocytic and trilinear dyspoiesis. Median survival is approximately six months from onset of symptoms. The authors report a case of acute myelosclerosis that evolved in a patient two and one-half years after the onset of idiopathic acquired sideroblastic anemia. A review of the other previously reported case of this unusual transformation and comments on the pathogenesis of the transformation from idiopathic acquired sideroblastic anemia to acute myelofibrosis are included.

Acute Disease↗

Prolymphocytic leukemia: treatment with combination chemotherapy to include doxorubicin.

Prolymphocytic leukemia (PL) is a clinically distinct leukemic disorder. Cytochemical and surface marker characteristics help to differentiate PL from other types of leukemia, including chronic lymphocytic leukemia (CLL). In contrast to patients with CLL, those with PL frequently require early therapeutic intervention. Standard treatment regimens for CLL as well as splenectomy and splenic irradiation have not been effective in the treatment of PL. Combination chemotherapy with cyclophosphamide, Doxorubicin, vincristine, and prednisone (CHOP) has produced impressive clinical responses in patients with PL. The treatment of a patient with PL is discussed and the literature is reviewed.

Aged↗

Hemoglobin Osler: report of a new family with exercise studies before and after phlebotomy.

Five members of a new family with hemoglobin Osler are described. Exercise studies were performed before and after phlebotomy in one patient. These studies demonstrated that anaerobic threshold was directly related to hematocrit. Our data suggest that the elevation of red cell mass seen with this high oxygen affinity hemoglobin is an appropriate physiologic response which improves tissue oxygen delivery. Despite the increase in whole blood viscosity associated with erythrocytosis, our data do not support the use of therapeutic phlebotomy to improve exercise performance in patients with hemoglobin Osler.

Adult↗

Giant lymph node hyperplasia involving the thymus with associated nephrotic syndrome and myelofibrosis.

Giant lymph node hyperplasia (GLH) is an unusual form of benign lymphoid hyperplasia which, although it often occurs in the mediastinum, has not previously been reported to involve the thymus. In this report, a case of GLH with involvement of the thymus and with associated nephrotic syndrome and myelofibrosis is presented. The significance of the association of these conditions with GLH is discussed, including the possibility that some or all of the patient's abnormalities may have been related via an abnormal immune mechanism.

Adult↗

Alveolar rhabdomyosarcoma associated with disseminated intravascular coagulation and a unique factor VIII antigen.

Disseminated intravascular coagulation (DIC) has been described in association with many tumors. We describe a patient with alveolar rhabdomyosarcoma in whom DIC developed with the initiation of chemotherapy. The patient achieved complete remission of his tumor for 14 months. An unusual factor VIII antigen was identified on crossed immunoelectrophoresis that was present at initial diagnosis, disappeared with remission, and returned with relapse of the tumor.

Adolescent↗

Increased heat sensitivity of red blood cells in hereditary elliptocytosis with acquired cobalamin (vitamin B12) deficiency.

Structural membrane proteins were studied from erythrocytes (RBC) of a patient with a nonhemolytic form of hereditary elliptocytosis (HE) who developed a microcytic anemia with fragmented RBC while cobalamin (B12) deficient. Evidence is presented for qualitative changes in the patient's RBC membranes not related to a loss of structural proteins. Sensitivity of RBC to heat treatment was studied as well as quantitative changes in proteins by densitometry of 1% SDS--10% PAGE gels. Fractions of RBC of various sizes from the patient while B12 deficient all possessed a marked degree of heat sensitivity when compared to RBC from the patient after B12 repletion, normal family members, HE controls, B12-deficient controls, anemic controls, and normal controls. Because loss of spectrin (bands 1 + 2) from heat-sensitive RBC membranes in hereditary pyropoikilocytosis has been reported, the amount of spectrin relative to band 3 was measured. No decrease in the ratio of bands (1 + 2)/3 was found. In addition, no chromatographically abnormal membrane proteins were found by SDS-PAGE of the patient's RBC while B12 deficient. Our findings indicate that B12 deficiency results in an abnormal membrane with enhanced instability in some forms of HE. Since protein loss was not found, we conclude that an alteration in membrane protein interaction may be involved.

Adult↗

Treatment experience with nonseminomatous testicular cancer in patients with stage II and stage III disease.

Thirty-eight patients with nonseminomatous testicular cancer were treated with cis-platinum, bleomycin, and vinblastine in combination without a prolonged maintenance phase. Twenty-Six patients with Stage III disease were treated. Seventy-six percent of those patients treated achieved complete remission. At a median survival time of 30 months, no patient who achieved a complete remission has relapsed. Twelve Stage II patients given adjuvant therapy remain free of disease at a median time of 23 months. Markedly elevated serum lactate dehydrogenase levels and massive disease were common findings in the patients who did not achieve complete remission. One drug death occurred secondary to sepsis. Symptoms of depression and anxiety were significant dose-limiting factors in this group of patients.

Adolescent↗