Showing papers by "Rush University Medical Center published in 1983"

New diagnostic criteria for multiple sclerosis: guidelines for research protocols.

Abstract: Several schemes for the diagnosis and clinical classification of multiple sclerosis (MS) have been advanced [l}. The best known is that published by Schumacher et alC31. The criteria for this scheme were established in order to select patients for participation in therapeutic trials, and pertain only to what might be called definite MS. No provision was made for incorporating supportive laboratory data into the diagnostic criteria. As no reliable specific laboratory test for the diagnosis of MS has been discovered, the diagnosis remains a clinical one, and there is still a need for clinical diagnostic criteria. However, several laboratory and clinical procedures have been developed within the last decade which aid greatly in demonstrating neurological dysfunction attributable to lesions, and even the lesions themselves. One problem with the various published diagnostic classifications is their discrepant terminology: what is considered “probable” in one is called “definite” in another. Another problem is that all the proposed schemes require much subjective judgment, a difficulty which cannot be completely overcome but can be diminished by adding to the clinical evaluation the results of laboratory, neuroimaging, neuropsychological, and neurophysiological procedures. Today there is a need for more exact criteria than existed earlier in order to conduct therapeutic trials in multicenter programs, to compare epidemiological surveys, to evaluate new diagnostic procedures, and to estimate the activity of the disease process in MS. Method and Procedure

Quantitative analysis of the high-frequency components of the terminal portion of the body surface QRS in normal subjects and in patients with ventricular tachycardia.

Abstract: Quantitative analysis of the high-frequency components of the terminal portion of the surface QRS was performed in 42 normal subjects (group 1, ages 18-67 years, mean +/- SEM 34.7 +/- 2.2 years) and in 12 patients with symptomatic, sustained ventricular tachycardia (VT) (group 2, ages 48-76 years, mean 59 +/- 2.3 years). Signal averaging and high-pass, bidirectional digital filtering were used for analysis. The total duration of the QRS, the duration of the low-amplitude signals (less than 40 microV) in the terminal portion of the QRS and the amplitude of the signals in the last 40 and 50 msec of the QRS were measured at filter settings of 25 and 40 Hz. Reproducibility of the measurements was tested in 15 normal subjects by comparing results obtained from two consecutive recordings. Significant differences were found between normal subjects and VT patients for all four indexes at both 25- and 40-Hz filters. Specific values for each of the indexes were identified at the 40-Hz filtering, which could separate normal subjects from VT patients (20 microV for the amplitude of last 40 msec; 30 microV for the amplitude of last 50 msec; 120 msec for the total duration; and 39 msec for the low-amplitude signal of the filtered QRS). Using these values for the four indexes, respectively, 90%, 98%, 100% and 90% of the normal subjects and 83%, 83%, 58% and 83% for the VT group were correctly classified. The results show that the high-frequency analysis of the signal-averaged body surface QRS is a reliable, reproducible, noninvasive method for distinguishing patients with VT from normal subjects.

Activation of basophil and mast cell histamine release by eosinophil granule major basic protein

Abstract: Major basic protein (MBP) is a primary constituent of eosinophil granules. In this report, we demonstrate that MBP from human eosinophil granules initiates a nonlytic histamine release from human leukocytes. A direct effect of MBP on basophils was confirmed using purified human basophils. The kinetics of release were similar to those reported for poly-L-arginine, although MBP was less potent than poly-L-arginine of similar molecular weight. Reduction and alkylation of MBP diminished both the potency and efficacy of the molecule. Native MBP also stimulated histamine secretion from purified rat peritoneal mast cells in a manner characteristic of other polycations. These results emphasize the bidirectional nature of the basophil/mast cell-eosinophil regulatory axis.

Carcinoma of the Anal Canal

Abstract: Carcinoma of the anal canal accounts for 1.5 percent of digestive-system cancers in the United States, with an estimated 3400 new cases in 2000.1 Thirty years ago, anal cancer was believed to be caused by chronic, local inflammation of the perianal area2,3 and was treated with an abdominoperineal resection, necessitating a permanent colostomy.4 As the result of a series of epidemiologic studies, it is now apparent that the development of anal cancer is associated with infection by human papillomavirus, which is usually sexually transmitted. Moreover, in the majority of patients, the condition can be cured by concurrent chemotherapy and . . .

Significance of ventricular tachycardia in idiopathic dilated cardiomyopathy: observations in 35 patients.

Abstract: To evaluate the significance of ventricular tachycardia (VT) in idiopathic dilated cardiomyopathy (IDC), 35 consecutive patients seen between 1976 and 1980 were studied. The criteria for diagnosis of IDC were based on clinical, laboratory, and cardiac catheterization findings. All patients had right and left heart catheterization, left ventriculography, and coronary cineangiography. Long-term ambulatory electrocardiograms (Holter) were obtained in all patients at the time of diagnosis. There were 24 male and 11 female patients aged 22 to 72 years (mean ± standard deviation [SD] 51 ± 12). Frequent ventricular premature beats (VPB) (30/h) were observed in 29 patients (83%): complex VPB (Lown grades 3, 4, and 5) in 93% and simple VPB in 7%. Twenty-one patients (60%) had nonsustained VT consisting of 3 to 46 beats (8 ± 5) with rates from 75 to 210/min. No difference between patients with and those without VT was observed in regard to the presenting symptoms, functional classification, electrocardiographic findings, heart size on chest X-ray, and the hemodynamic measurements including cardiac index, left ventricular end-diastolic pressure, and ejection fraction. Patients with VT were older (p

Tumor invasion and host extracellular matrix.

Abstract: In this review some of the major mechanistic pathways by which tumor cells are thought to invade host tissues are discussed. Tumor invasion has been conceived to be the result of pathological, close-range interactions between malignant cells and host stroma. The sequence of events that characterize invasion can be summarized as follows: (a) Tumor cell clusters break from the confinement of the primary tumor. Loss of intercellular junctions (desmosomes), alterations in the chemical composition and physical properties of the cell surface coat (loss of fibronectin and heparan sulfate; excessive amounts of hyaluronate), and loosening of cell-substrate interactions (loss of hemidesmosomes, fibronectin, and heparan sulfate), are among the most frequently listed causes of tumor cell shedding. (b) Increased proteolytic activities at the invasion front cause focal alterations in the surrounding extracellular matrix, thereby changing its physical properties. Collagenases and cathepsins, as well as elastase and other neutral proteinases are the enzymes most frequently associated with matrix destruction and invasion. In some tissues this process is effectively regulated by inhibitors of matrix-degrading, proteolytic enzymes. (c) Tumor cells migrate into the altered matrix, possibly moving as aggregates along guidance tracks provided by host structures (blood vessels, lymphatics, nerves) or matrix macromolecules (collagen and fibronectin tracks). Migration seems to be preceded by increased swelling of glycosaminoglycan (i.e., hyaluronate) in the matrix, ahead of the migrating cell population. Various host cell types (mast cells, fibroblasts, endothelial cells, macrophages, etc.) may participate in these events.

16,16-dimethyl prostaglandin E2 increases survival of murine intestinal stem cells when given before photon radiation

Abstract: A variety of prostaglandins (PG) protect the gastric and intestinal mucosa when given before damaging agents such as absolute ethanol, acidified taurocholate, boiling water, or nonsteroidal anti-inflammatory agents (NSAI). A synthetic prostaglandin, 16, 16-dimethyl PGE2, shown to be cytoprotective at physiologic levels to the above agents was given to mice 1 hr before or 15 min after 137Cs gamma (gamma) whole-body irradiation. The survival of intestinal stem cells measured by their ability to form in situ colonies of regenerating epithelium was increased when 16, 16-dimethyl PGE2 was given before but not after 137Cs gamma irradiation. The maximum degree of 16, 16-dimethyl PGE2-induced radioprotection was seen when the drug was given 1 hr before irradiation. No radioprotection was seen when the interval between drug and irradiation was 3 hr or longer. When the time between 16, 16-dimethyl PGE2 and irradiation was kept at 1 hr, the degree of radioprotection was dependent on the PG drug dose. There was a steep rise in the number of surviving cells at low doses of PG. These results imply that tumors which secrete PGE2 may in part be protected from the lethal effects of ionizing photon radiation.

A randomized comparison of melphalan versus melphalan plus hexamethylmelamine versus adriamycin plus cyclophosphamide in ovarian carcinoma

Abstract: A prospective randomized study was conducted in women with suboptimal (greater than or equal to 3 cm residual) Stage III, Stage IV, and recurrent ovarian adenocarcinoma to determine if combination chemotherapy is more effective than melphalan alone in achieving remission and improving survival. Of 233 evaluable patients with measurable disease, there were 64 treated with melphalan alone, of whom 20% achieved a clinical complete response and 17%, a partial response. Of the 97 patients receiving melphalan plus hexamethylmelamine, 28% achieved complete response compared with 32% of 72 patients given Adriamycin plus cyclophosphamide. The partial response rates for the combinations were 24% and 17%, respectively. The effect of these treatments was assessed in an additional 136 evaluable patients without measurable disease by progression-free interval and duration of survival. After statistically adjusting for distribution of cell type and grade, the clinical complete response rate for Adriamycin and cyclophosphamide (32%) in measurable cases was significantly higher (P = 0.04) than for melphalan alone. However, this combination did not improve median survival (12.3, 13.5, and 14.2 months, respectively, for M, M + H, and A + C). None of the other parameters showed a statistically significant advantage for combination chemotherapy, but the combinations caused more hematologic and gastrointestinal toxicity.

Urinary phenyl acetate: a diagnostic test for depression?

Abstract: The compound 2-phenylethylamine is an "endogenous amphetamine" which may modulate central adrenergic functions. 2-Phenylethylamine is mainly metabolized by monoamine oxidase to form phenyl acetate (PAA). The 24-hour urinary excretion of PAA was measured in normal healthy volunteers and depressed patients. Patients were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, edition 3. In 70 percent of healthy volunteers of both sexes, the excretion of PAA ranged between 70 and 175 milligrams per 24 hours (mean = 141.1 +/- 10.2). Inpatients with major depressive disorder (unipolar type) (N = 31) excreted less PAA (68.7 +/- 7.0 milligrams per 24 hours) and 55 percent of them excreted less than 70 milligrams per 24 hours; there were no significant differences in the PAA excretion between untreated patients (N = 13) and those treated with antidepressants that were not effective (N = 18). The PAA excretion was reduced to a lesser extent in 35 less severely depressed unipolar outpatients (drug-free for 1 week) (86.3 +/- 11.8 milligrams per 24 hours). These results suggest that low PAA urinary excretion may be a reliable state marker for the diagnosis of some forms of unipolar major depressive disorders.

Fast neutron irradiation of metastatic cervical adenopathy: The results of a randomized RTOG study☆

Abstract: Between 1977 and 1982, 199 evaluable patients with measurable cervical adenopathy were entered on a prospective, randomized RTOG study evaluating the use of fast neutrons in treatment of advanced, inoperable squamous cell carcinomas of the head and neck region. One hundred-eleven patients were randomized to receive mixed beam radiation therapy, and 88 were randomized to the photon control treatment. The complete response rates were 86% for mixed beam vs 75% for photons for Stage N, nodes, 62% for mixed beam vs 48% for photons for Stage N2 nodes, and 63 % for mixed beam vs 53 % for photons for N, nodes. The percents of patients remaining free of their adenopathy for two years were 78 % for mixed beam vs 55 % for photons for Stage N, nodes, 39 % for both mixed beam and photons for N2 nodes and 24 % for mixed beam vs 13 % for photons for N, nodes. The median disease-free status was 20.3 months for mixed beam treated patients and 6.4 months for photon-treated patients. Patients who had clearance of cervical adenopathy survived significantly longer than those who did not.

Nesidiodysplasia and nesidioblastosis of infancy: structural and functional correlations with the syndrome of hyperinsulinemic hypoglycemia.

Abstract: Subtotal pancreatectomy specimens of seven infants with persistent hyperinsulinemic hypoglycemia were studied; all showed the characteristic light microscopic picture of nesidioblastosis. Specimens were studied by electron and conventional light microscopy and by light microscopic immunohistochemistry for insulin, glucagon, somatostatin, and HPP (human pancreatic polypeptide); double staining and quantitative methods were also used. Findings were compared with those in age-matched controls.In the hyperinsulinemic hypoglycemic infants, an increase in total endocrine cell volume was found; however, the typical features of nesidioblastosis were also found in the controls. In both groups, immunohistochemistry and electron microscopy suggested that some endocrine cells are capable of producing synchronously more than one hormone. Amphicrine (”composite” or “intermediate”) cells with exocrine and endocrine differentiation were found in three hypoglycemic infants.Observations are discussed in relation to current...

Chronic dopaminergic sensitivity after Sydenham's chorea

Abstract: we studied psychometric performance on the Minnesota Multiphasic Personality Inventory (MMPI) mini-mult and drug-induced choreic reactions in a group of patients with a history of Sydenham9s chorea. Action tremor, motor signs, and residual chorea were common. One-half of the patients reported adverse choreic reactions to one or more agents. Patients with adverse reactions to central stimulants and anorectics had statistically significant elevations in the psychotic tetrad of the MMPI. Sydenham9s chorea in childhood seems to confer persistent sensitivity to agents that augment central dopaminergic activity, which may be expressed as acute chorea. Central dopaminergic sensitivity may explain earlier reports of psychologic difficulties in survivors of rheumatic chorea.

Cognitive rehabilitation two and one-half years post right temporal lobectomy

Abstract: A 45-year old radiologist, who underwent a right temporal lobectomy to remove a tumor, sought treatment for difficulties with attention/scanning, sustained concentration, leisure reading, driving, and self-monitoring in social situations. A neuropsychological evaluation conducted 2.5 years postsurgery revealed impaired visual-spatial memory, inefficiency in general visual scanning, a mild left-sided neglect, and diminished social perception. The patient subsequently underwent a 4-month cognitive retraining program, which was tailored to his specific neuropsychological deficits. At the termination of treatment, improvements were observed on follow-up neuropsychological data, behavioral observations made by the patient's wife, and efficiency on work-related tasks. This case illustrates the ecological validity of cognitive rehabilitation procedures and emphasizes the need to tailor the procedures to specific cognitive deficits revealed on neuropsychological testing.

Chronic low back pain and depression

Abstract: It is not clear whether the psychological disturbances associated with chronic low back pain are the cause or the result of the chronicity It is also not clear whether increasing duration of low back pain is associated with depression Three groups of patients (N = 148), with recent (0-6 months), relatively longstanding (6-24 months) and chronic (more than 24 months) low back pain were given the MMPI, Multiple Affect Adjective Check List (MAACL), State Trait Anxiety Inventory (STAI) and Low Back Pain Questionnaire (LBPQ) Increasing chronicity is associated with significant increases on MMPI Hs, D, HY, PT and MA scales, and on STAI Trait Anxiety scale These results suggest that chronicity leads to the development of psychopathological characteristics and that these characteristics include a heightened awareness of somatic functioning and the vegetative aspects of the depressive syndrome, but that there is no increase in depressive mood or in the perception of the pain itself

The influence of surgery and radiation therapy on patients with brain metastases

Abstract: The place for operation and for radiation therapy in the management of brain metastases is reviewed from the experience of 1895 patients treated in two studies of the Radiation Therapy Oncology Group. Operative removal may be of benefit to patients with solitary peripheral lesions in non-critical brain locations. Operation is also appropriate when the diagnosis is in doubt. Radiation therapy with appropriate steroid management is of benefit to patients with multiple metastases or where operative intervention is not reasonable. Short course low-dose treatment has been as beneficial as more aggressive prolonged radiation therapy.

The application of multiple scattering theory to therapeutic electron dosimetry

Abstract: Fermi–Eyges multiple scatteringtheory for electrons is explained, and a general three‐dimensional formalism is developed for its application to problems of therapeutic electron dosimetry. The formalism is illustrated by a number of elementary examples: a rectangular beam, an isotropic point source, and a scanning line source.

The band 3-rich membrane of llama erythrocytes: studies on cell shape and the organization of membrane proteins.

Abstract: The erythrocyte membrane of the llama was characterized in comparison to that of the human. The llama erythrocyte was an elliptical disk that resisted shape alterations in hyperosmotic buffers and following metabolic depletion, both of which induce spiculation of the human red cell. Lysophosphatidylcholine incorporation produced minor serrations of the edge of the llama disk but no spicules, whereas human red cells became sphero-echinocytes. The polypeptide profiles in the membranes of the two species were similar, except for several noteworthy differences: a marked elevation in the relative content of band 3; the absence of membrane-bound band 6; and simpler glycoprotein pattern in the llama. The concentration of band 3 in llama was about two and a half to three times that in the human and intramembrane particles in the protoplasmic leaflet of freeze-fractured llama membrane were correspondingly increased. The selective solubilization of bands 1, 2 and 5 in low ionic strength buffer, and all of the peripheral proteins in high alkaline buffer were similar except for increased retention of ankyrin by the llama membrane. These data suggest a similar disposition of membrane proteins. The llama membrane was markedly resistant to the solubilization of integral proteins by the nonionic detergent, Triton X-100. This property and the general resistance to shape changes may be related to the high concentration of band 3.

Node-like axonal specialisations along demyelinated central nerve fibres: Ultrastructural observations

Abstract: Ultrastructural examination of long-term (1 month to 1 year) demyelinated axons of the central nervous system (CNS) has revealed the presence of certain features typical of nerve fibres at the node of Ranvier. Focal regions of dense undercoating of the axolemma were observed and these always extended along regions which were intimately associated with the processes of gial cells. In many cases the glial cells were astrocytes, but in some cases the cells resembled Schwann cells. The astrocytic and Schwann cell processes were sometimes finger-like and they thus resembled the normal projections of these cells onto the nodal axolemma of central and peripheral nerve fibres, respectively. Since the undercoated regions which were associated with astrocytic processes were also often remote from any oligodendrocyte or Schwann cell processes, it seems that certain node-like specialisations may form or be sustained in the absence of myelin-forming cells.