45 results on '"Howe RB"'
Search Results
2. Treatment of refractoriness to platelet transfusion by protein A column therapy
- Author
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Christie, DJ, primary, Howe, RB, additional, Lennon, SS, additional, and Sauro, SC, additional
- Published
- 1993
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3. Reducing teacher burnout by increasing student engagement. A children's rights approach.
- Author
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Covell K, McNeil JK, and Howe RB
- Abstract
Teacher burnout has long been understood to have significant negative effects on teaching efficacy. Research has indicated that student misbehaviour, often a result of disengagement, is a major predictor of teacher burnout. In part to address student disengagement, Hampshire County in England has undertaken a whole-school rights-based reform initiative called Rights, Respect and Responsibility (RRR). This study was designed to examine the effects of RRR on student engagement and teacher burnout over a three-year period. The sample initially comprised a total of 15 schools (four infant, five primary and six junior) and 127 teachers. At the second time of measure, one year later, the sample was reduced to 69 teachers from 13 of the schools. At both times teachers completed the following measures: the Maslach Burnout Inventory, the perceived effect of RRR on teaching, and student engagement. In the third year of the study we obtained data on the Maslach Burnout Inventory from 100 teachers at 12 of the schools. Findings suggest that RRR can improve student engagement and reduce teacher burnout. Of particular note was the predictive power of student participation in the classroom and school in reducing teacher burnout. [ABSTRACT FROM AUTHOR]
- Published
- 2009
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4. ETHER-SOLUBLE BILIRUBIN1
- Author
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Pinto Sd and Howe Rb
- Subjects
chemistry.chemical_compound ,chemistry ,Bilirubin ,business.industry ,Organic chemistry ,Medicine ,Ether ,General Medicine ,business - Published
- 1966
5. Hereditary dyserythropoiesis with abnormal membrane folate transport
- Author
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Howe, RB, Branda, RF, Douglas, SD, and Brunning, RD
- Abstract
Dyserythropoiesis, which morphologically and serologically resembles congenital dyserythropoietic anemia type III but is not accompanied by anemia, is described in a young man. In addition to striking gigantism and multinuclearity of erythroid precursors, electron microscopy revealed widening of nuclear pores, nuclear clefts, and cytoplasmic inclusions. Membrane transport of 5-methyltetrahydrofolate by the patient's red cells was markedly reduced; total uptake, uptake velocity, and maximal velocity of uptake were all significantly less than in controls. In contrast, red cell uptake of pteroylglutamic acid was normal. Bone marrow cells in culture also showed decreased 5- methyltetrahydrofolate uptake, as well as very low thymidine incorporation. Because folate uptake by mitogen-stimulated lymphocytes was normal, the defect apparently does not involve all cell lines. These results suggest that a specific membrane defect, affecting the carrier system for reduced folate compounds, is present in this patient's erythrocytes, and perhaps, their bone marrow precursors.
- Published
- 1979
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6. Studies of 'benign' serum M-components
- Author
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Williams Rc, Bailly Rc, and Howe Rb
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Adult ,Liver Cirrhosis ,Male ,Pathology ,medicine.medical_specialty ,Immunodiffusion ,Peptic Ulcer ,Blood Protein Disorders ,Lung Neoplasms ,Nephrotic Syndrome ,Lymphoma ,Neurotic Disorders ,Arteriosclerosis ,Pulmonary Fibrosis ,Fluorescent Antibody Technique ,Breast Neoplasms ,Gallbladder Diseases ,M Components ,Diabetic Neuropathies ,Stomach Neoplasms ,Intestinal Neoplasms ,medicine ,Humans ,Bronchitis ,Cryoglobulins ,Aged ,Leukemia ,Nephritis ,business.industry ,Carcinoma ,Anemia ,General Medicine ,Middle Aged ,Thrombophlebitis ,Blood Protein Electrophoresis ,Pulmonary Emphysema ,Female ,Kidney Diseases ,gamma-Globulins ,business - Published
- 1969
7. Community sharing: Contextualizing Western research notions of contamination within an Indigenous research paradigm.
- Author
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Allen S, Held S, Milne-Price S, McCormick A, Feng D, Inouye J, Schure M, Castille D, Howe RB, Pitts M, Keene S, Belone L, and Wallerstein N
- Subjects
- Chronic Disease, Humans, Universities, Health Services, Indigenous, Population Groups
- Abstract
Báa nnilah is a chronic illness self-management program designed by and for the Apsáalooke (Crow) community. Arising from a collaboration between an Indigenous nonprofit organization and a university-based research team, Báa nnilah's development, implementation, and evaluation have been influenced by both Indigenous and Western research paradigms (WRPs). Báa nnilah was evaluated using a randomized wait-list control group design. In a WRP, contamination, or intervention information shared by the intervention group with the control group, is actively discouraged as it makes ascertaining causality difficult, if not impossible. This approach is not consonant with Apsáalooke cultural values that include the encouragement of sharing helpful information with others, supporting an Indigenous research paradigm's (IRP) goal of benefiting the community. The purpose of this paper is to address contamination and sharing as an area of tension between WRP and IRP. We describe how the concepts of contamination and sharing within Báa nnilah's implementation and evaluation are interpreted differently when viewed from these contrasting paradigms, and set forth a call for greater exploration of Indigenous research approaches for developing, implementing, and evaluating intervention programs in Indigenous communities. (Improving Chronic Illness Management with the Apsáalooke Nation: The Báa nnilah Project.: NCT03036189), ClinicalTrials. gov: NCT03036189)., (© 2021 Society for Community Research and Action.)
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- 2022
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8. First molar radicular bone near the maxillary sinus: a comparison of CBCT analysis and gross anatomic dissection for small bony measurement.
- Author
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Howe RB
- Subjects
- Aged, Aged, 80 and over, Humans, Maxilla anatomy & histology, Organ Size, Reference Values, Alveolar Process anatomy & histology, Cone-Beam Computed Tomography standards, Maxillary Sinus anatomy & histology, Molar anatomy & histology, Tooth Root anatomy & histology
- Abstract
Objectives: This study assessed agreement of cone-beam computerized tomography (CBCT) measurements against those obtained by gross dissection and physical calipers for dimensions of maxillary bone around first molar roots in cadaveric specimens., Study Design: A total of 37 human maxilla pairs with 69 first molars were analyzed by CBCT with a resolution of 200 microm and the results compared with gross dissection. Matched data sets of 414 data points (6 data points per tooth) were compared using Bland-Altman statistics. An operational definition of clinical accuracy was proposed., Results: The data sets displayed a Pearson correlation coefficient of r = 0.85. Analysis revealed a positive bias for CBCT of 0.4 mm with a standard deviation of 1.1 mm relative to gross dissection. Less bone around first molar roots was demonstrated than reported in available literature., Conclusions: High-resolution CBCT measurements were acceptable for clinical accuracy and study of the maxillary sinus.
- Published
- 2009
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9. Red cell aplasia and autoimmune hemolytic anemia following immunosuppression with alemtuzumab, mycophenolate, and daclizumab in pancreas transplant recipients.
- Author
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Elimelakh M, Dayton V, Park KS, Gruessner AC, Sutherland D, Howe RB, Reding MT, Eastlund T, van Burik JA, Singleton TP, Gruessner RW, and Key NS
- Subjects
- Adult, Alemtuzumab, Anemia, Hemolytic, Autoimmune epidemiology, Antibodies, Monoclonal therapeutic use, Antibodies, Monoclonal, Humanized, Antibodies, Neoplasm therapeutic use, Autoimmune Diseases epidemiology, Bone Marrow pathology, Daclizumab, Female, Humans, Immunoglobulin G therapeutic use, Immunosuppressive Agents therapeutic use, Incidence, Kidney Transplantation statistics & numerical data, Lymphocyte Activation immunology, Male, Middle Aged, Mycophenolic Acid adverse effects, Mycophenolic Acid therapeutic use, Opportunistic Infections epidemiology, Opportunistic Infections etiology, Pilot Projects, Postoperative Complications epidemiology, Purpura, Thrombocytopenic, Idiopathic chemically induced, Purpura, Thrombocytopenic, Idiopathic epidemiology, Red-Cell Aplasia, Pure epidemiology, Retrospective Studies, T-Lymphocytes immunology, Anemia, Hemolytic, Autoimmune chemically induced, Antibodies, Monoclonal adverse effects, Antibodies, Neoplasm adverse effects, Autoimmune Diseases chemically induced, Immunoglobulin G adverse effects, Immunosuppressive Agents adverse effects, Mycophenolic Acid analogs & derivatives, Pancreas Transplantation statistics & numerical data, Postoperative Complications chemically induced, Red-Cell Aplasia, Pure chemically induced
- Abstract
Background and Objectives: Acquired red cell aplasia (RCA) is a rare disorder and can be either idiopathic or associated with certain diseases, pregnancy, or drugs. In exceptionally rare cases, it has been reported to co-exist with other autoimmune cytopenias. We report a high incidence of RCA and autoimmune hemolytic anemia (AIHA) in pancreas transplant recipients on alemtuzumab-based maintenance therapy., Design and Methods: Between February 2003 and July 2005, 357 pancreas transplant recipients were treated with immunosuppressive regimens containing the lymphocyte-depleting antibody alemtuzumab, the T-cell activation inhibitor daclizumab, and the anti-metabolite mycophenolate mofetil (MMF). We retrospectively reviewed medical records, blood bank data and bone marrow biopsy specimens of patients with a Transplant Information Services database diagnosis of RCA and AIHA from February 2003 to November 2005., Results: Severe RCA, AIHA, and idiopathic thrombocytopenic purpura (ITP) occurred independently or in combination, in 20 out of 357 (5.6%) pancreas transplant recipients, 12 to 24 months following the initiation of the aforementioned immunosuppressive regimens. Severe opportunistic infections developed late in 14/20 (70%) of these patients. Atypical morphologic features, including variable dysgranulopoiesis, variable megakaryocytic hyperplasia with normal or low peripheral platelet counts, and atypical lymphoid aggregates were found in bone marrow trephine sections of 11 patients in whom the diagnosis of RCA was made., Interpretation and Conclusions: We hypothesize that the combination of alemtuzumab, daclizumab and MMF can result in immune dysregulation thereby permitting autoantibody formation. Because the use of these three immune suppressants is becoming increasingly common, it is important to recognize the severe hematologic complications that can arise.
- Published
- 2007
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10. Antiapoptotic role of growth factors in the myelodysplastic syndromes: concordance between in vitro and in vivo observations.
- Author
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Tehranchi R, Fadeel B, Schmidt-Mende J, Forsblom AM, Emanuelsson E, Jadersten M, Christensson B, Hast R, Howe RB, Samuelsson J, Zhivotovsky B, and Hellström-Lindberg E
- Subjects
- Adult, Aged, Aged, 80 and over, Anemia, Refractory pathology, Anemia, Sideroblastic pathology, Bone Marrow Cells cytology, Bone Marrow Cells metabolism, Caspases metabolism, Cytochromes c metabolism, Enzyme Activation drug effects, Erythroid Precursor Cells pathology, Erythropoietin pharmacology, Glycophorins metabolism, Granulocyte Colony-Stimulating Factor pharmacology, Humans, In Vitro Techniques, Middle Aged, Monosomy, Receptors, Granulocyte Colony-Stimulating Factor metabolism, Recombinant Proteins, Trisomy, Anemia, Refractory drug therapy, Anemia, Sideroblastic drug therapy, Apoptosis drug effects, Erythroid Precursor Cells drug effects
- Abstract
Purpose: Erythroid apoptosis in low-risk myelodysplastic syndrome (MDS) maybe mediated via mitochondrial release of cytochrome c and subsequent caspase activation. In the present study, we compared the in vitro and in vivo effects of proerythroid treatment with erythropoietin + granulocyte colony-stimulating factor (G-CSF) on myelodysplastic erythropoiesis regarding apoptosis and preferential growth of clones with cytogenetic abnormalities., Experimental Design: We enrolled 15 refractory anemia (RA) and 11 refractory anemia with ringed sideroblasts (RARS), including 5q- aberration, monosomy 7, and trisomy 8, before initiation of treatment and followed nine patients after successful treatment. The effects of G-CSF and erythropoietin were assessed. The expression of G-CSF receptor (G-CSFR) was explored during erythroid maturation. The relative growth of erythroid progenitors with cytogenetic aberrations in presence of erythropoietin was investigated., Results: Significant redistribution of cytochrome c was seen before treatment at all stages of erythroid differentiation. This release was blocked by G-CSF during the whole culture period and by erythropoietin during the latter phase. Both freshly isolated glycophorin A+ bone marrow cells and intermediate erythroblasts during cultivation retained their expression of G-CSFR. Cytochrome c release and caspase activation were significantly less pronounced in progenitors obtained from successfully treated nonanemic patients and showed no further response to G-CSF in vitro. Moreover, erythropoietin significantly promoted growth of cytogenetically normal cells from 5q- patients, whereas no such effect was observed on erythroblasts from monosomy 7 or trisomy 8 patients., Conclusion: We conclude that growth factors such as erythropoietin and G-CSF can act both via inhibition of apoptosis of myelodysplastic erythroid precursors and via selection of cytogenetically normal progenitors.
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- 2005
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11. The WHO classification of MDS does make a difference.
- Author
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Howe RB, Porwit-MacDonald A, Wanat R, Tehranchi R, and Hellström-Lindberg E
- Subjects
- Classification methods, Drug Therapy, Combination, Erythropoietin therapeutic use, Follow-Up Studies, Granulocyte Colony-Stimulating Factor therapeutic use, Humans, Myelodysplastic Syndromes epidemiology, Myelodysplastic Syndromes mortality, Observer Variation, Predictive Value of Tests, Prognosis, Retrospective Studies, Survival Rate, Treatment Outcome, Myelodysplastic Syndromes classification, World Health Organization
- Abstract
The purpose of this study was to determine the facility and reliability of the World Health Organization (WHO) classification of myelodysplastic syndromes (MDSs) with several observers reviewing the same diagnostic specimens. We also wanted to determine if the WHO classification provided additional information about predictability of clinical response outcome. To accomplish these goals we reviewed 103 previously diagnosed cases of low-risk MDS. We found 92% interobserver agreement (P <.001). Sixty-four of these patients had been entered into clinical trials using growth factors by the Nordic MDS Study Group. The WHO classification reliably predicted therapeutic response to the combination of granulocyte colony-stimulating factor (G-CSF) and erythropoietin (Epo). The response rate differed significantly between refractory anemia with ringed sideroblasts (RARS) and refractory anemia with multilineage dysplasia and ringed sideroblasts (RCMD/RS) with regard to therapeutic response (75% versus 9%; P =.003). Also, in the group of patients with less than 5% marrow blasts, there was a difference in median survival between patients with unilineage dysplasia (51% surviving at 67 months) and those with multilineage dysplasia (median survival, 28.5 months; P =.03).
- Published
- 2004
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12. Youth justice reform and the rights of the child: a step forward or backward?
- Author
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Howe RB and Covell K
- Subjects
- Adolescent, Canada, Child, Humans, Child Advocacy legislation & jurisprudence, Criminal Law legislation & jurisprudence, Juvenile Delinquency legislation & jurisprudence
- Abstract
Our purpose is to examine Canada's new Youth Criminal Justice Act in light of Canada's obligations under the UN Convention on the Rights of the Child and in contrast to the Young Offenders Act. After reviewing the Convention and the Young Offenders Act, we examine the new act to determine its consistency with the Convention. We conclude that the new act is a step forward because of its greater focus on rehabilitation and social reintegration. However, it is an inadequate step because it does not fully ensure the protection, provision, and participation rights of the child as defined by the Convention.
- Published
- 2001
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13. Case 4-2001: acute sarcoidosis.
- Author
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Howe RB
- Subjects
- History, 18th Century, Humans, Male, Erythema Nodosum history, Famous Persons, Music history
- Published
- 2001
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14. Treatment of plasma refractory thrombotic thrombocytopenic purpura with protein A immunoabsorption.
- Author
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Gaddis TG, Guthrie TH Jr, Drew MJ, Sahud M, Howe RB, and Mittelman A
- Subjects
- Adult, Female, Humans, Immunosorbent Techniques, Immunotherapy, Male, Middle Aged, Plasma Exchange, Purpura, Thrombotic Thrombocytopenic therapy, Staphylococcal Protein A therapeutic use
- Abstract
The objective of this study was to assess the effect of protein A immunoabsorption in terms of response rate and toxicities in patients with classical thrombotic thrombocytopenic purpura (TTP) refractory to therapeutic plasma exchange. The study included nine females and one male with a diagnosis of classical TTP treated at multiple university hospital centers with protein A immunoabsorption (PAI) after having failed plasma exchange. The 10 patients had an age range 17-62 years. Prior to PAI, the patients had failed to respond to a mean of 15 (range 6-39) therapeutic plasma exchanges. Three patients had previous episodes of TTP. Evaluation for response to PAI included serial measurements of serum creatinine, lactate dehydrogenase (LDH), hemoglobin, hematocrit, and platelet count before, during, and up to 18 months post-PAI treatment. Seven of 10 study patients had resolution of their TTP. Six of the patients required six or fewer therapeutic PAIs and one required 12 treatments. All responding patients had evidence of improvement by the third PAI treatment. Three patients demonstrated no response to PAI, with two patients expiring from complications of TTP and one patient demonstrating a complete response to a subsequent therapy. No significant toxicity was noted with the use of PAI in this setting. Protein A immunoabsorption in patients with classical TTP refractory to plasma exchange can produce durable complete remissions and warrants comparative studies.
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- 1997
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15. Clinical applications of protein A immunoadsorption in thrombocytopenic disorders.
- Author
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Howe RB and Christie DJ
- Subjects
- Humans, Immunotherapy, Treatment Outcome, Immunosorbent Techniques, Staphylococcal Protein A, Thrombocytopenia therapy
- Published
- 1994
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16. Protein A immunoadsorption treatment in hematology: an overview.
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Howe RB and Christie DJ
- Subjects
- Humans, Hematologic Diseases therapy, Immunosorbents therapeutic use, Staphylococcal Protein A therapeutic use
- Abstract
Staphylococcal protein A efficiently binds immunoglobulins and circulating immune complexes (CIC) and provides an effective medium to remove immunoglobulins and CICs from plasma while sparing albumin and most coagulation proteins. Although it activates the complement system its clinical use abrogates the need for plasma expanders necessitated by plasma exchange. Despite anecdotal reports of utility in several hematologic syndromes, publications of clinical trials are available only for autoimmune thrombocytopenic purpura (AITP) and refractoriness to platelet transfusions (RFT) associated with alloimmunization. In the former situation Snyder et al. (Blood 79:2237-2245, 1992) reported on 72 patients with AITP all of whom had failed at least two previous therapies including splenectomy in 68%. Forty-six percent achieved improved platelet counts following treatment. The response was durable (8-26 mo) in all but 10%. Spleen-intact patients could not be differentiated from those who had been splenectomized. Both responders and nonresponders showed significant decreases in CIC and platelet-directed immunoglobulin (PDIG), but responders achieved near-normal levels. The beneficial response of these factors, particularly in spleen-intact patients, warrants a prospective study. In our studies at the University of Minnesota twelve patients with thrombocytopenia secondary to bone marrow failure who were refractory to platelet transfusion were treated with protein A immunoadsorption. Ten had demonstrable antiplatelet Abs (Anti-HLA, HPA, ABO). Seven of 12 demonstrated improved platelet counts and post-transfusion corrected count increments after treatment. This was associated with decreased platelet utilization and clinical bleeding. A prospective controlled clinical trial is justified.
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- 1994
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17. Mathematical modeling of reproductive and developmental toxic effects for quantitative risk assessment.
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Kodell RL, Howe RB, Chen JJ, and Gaylor DW
- Subjects
- Animals, Dose-Response Relationship, Drug, Fetal Death chemically induced, Litter Size, Models, Biological, Models, Theoretical, Risk Factors, Growth drug effects, Reproduction drug effects, Teratogens toxicity
- Abstract
A new mathematical dose-response model for reproductive and developmental risk assessment is proposed. The model includes the possibility of an exposure threshold as well as a litter-size effect. Correlation of responses of offspring from the same litter is taken into account through the use of the beta-binomial distribution. Confidence limits for low-dose extrapolation are based on the asymptotic distribution of the likelihood ratio. An empirical comparison of the proposed procedure to that of Rai and Van Ryzin demonstrates the improvement that can be achieved with the new procedure.
- Published
- 1991
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18. Analysis of trinomial responses from reproductive and developmental toxicity experiments.
- Author
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Chen JJ, Kodell RL, Howe RB, and Gaylor DW
- Subjects
- Abnormalities, Drug-Induced, Animals, Female, Fetal Resorption, Fetus drug effects, Mathematics, Models, Statistical, Pregnancy, Reproduction drug effects, Teratogens toxicity
- Abstract
This paper presents a Dirichlet-trinomial distribution for modelling data obtained from reproductive and developmental studies. The common endpoints for the evaluation of reproductive and developmental toxic effects are the number of dead fetuses, the number of malformed fetuses, and the number of normal fetuses for each litter. With current statistical methods for the evaluation of reproductive and developmental effects, the effect on the number of deaths and the effect on the number of malformations are analyzed separately. The Dirichlet-trinomial model provides a procedure for the analysis of multiple endpoints simultaneously. This proposed Dirichlet-trinomial model is a generalization of the beta-binomial model that has been used for handling the litter effect in reproductive and developmental experiments. Likelihood ratio tests for differences in the number of deaths, the number of malformations, and the number of normals among dosed and control groups are derived. The proposed test procedure based on the Dirichlet-trinomial model is compared with that based on the beta-binomial model with an application to a real data set.
- Published
- 1991
19. Effect of therapy on T cell subpopulations in patients with chronic lymphocytic leukemia.
- Author
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Kay NE, Howe RB, and Douglas SD
- Subjects
- Follow-Up Studies, Humans, Leukemia, Lymphoid surgery, Leukocyte Count, Rosette Formation, Splenectomy, T-Lymphocytes immunology, Time Factors, Leukemia, Lymphoid drug therapy, T-Lymphocytes drug effects
- Abstract
We have previously demonstrated functional and quantitative imbalances in two human thymic (T) cell subpopulations, T gamma and T mu, in chronic lymphocytic leukemia (CLL) patients. Serial evaluations of the numbers of T gamma and T mu subsets in CLL were performed in order to delineate more completely the patterns of T cell abnormalities two groups of CLL patients were studied: (I) previously untreated (n = 3) and (II) stable CLL on chemotherapy (n = 12). In Group I, two of three patients had significantly increased percentages of T gamma cells (mean +/- S.E.M. = 57 +/- 5 vs 18 +/- 2 for controls). There was defective in vitro appearance of T mu cells in both groups. In Group II, repeated studies of T cell subsets revealed persistently elevated T gamma cells despite various modes of oral chemotherapy. In three CLL patients who required splenectomy a dramatic decrease in the percentages of T gamma cells was noted post-splenectomy (51 +/- 3 to 15 +/- 3). In all cases the spleen was diffusely involved with CLL. These findings indicate: (1) abnormalities of T cell subsets are present early in CLL, (2) chemotherapy does not affect the levels of T gamma cells in stable patients and (3) removal of infiltrated CLL spleens results in a dramatic decrease in the proportion of T gamma cells. This latter finding plus the increase in T gamma cells in progressive disease post-splenectomy suggest T gamma cells may be an important determinant of the course of CLL.
- Published
- 1982
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20. High-resolution chromosomes as an independent prognostic indicator in adult acute nonlymphocytic leukemia.
- Author
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Yunis JJ, Brunning RD, Howe RB, and Lobell M
- Subjects
- Acute Disease, Adolescent, Adult, Age Factors, Aged, Bone Marrow pathology, Chromosome Inversion, Female, Humans, Karyotyping, Leukemia genetics, Male, Middle Aged, Prognosis, Translocation, Genetic, Trisomy, Chromosome Aberrations, Leukemia mortality
- Abstract
Using high-resolution chromosomes of bone-marrow specimens from 105 consecutive adult patients with de novo acute nonlymphocytic leukemia, we found an unusually high degree of complexity in this disorder, which may explain previous difficulties in identifying useful prognostic indicators. Specimens from 99 of the 105 patients were successfully analyzed, and 92 (93 per cent) had a chromosomal defect. Seventeen categories were identified, 12 representing a specific recurrent defect. Three of them have been found to have independent prognostic importance. Patients with an inversion 16 (9 per cent), diagnosed as having M2, M4, or M5b disease according to the morphologic classification of the French-American-British Acute Leukemia Cooperative Study Group, had a uniform and sustained complete remission and a median survival of 25 months. In contrast, 14 patients (14 per cent) with complex chromosomal abnormalities and a diagnosis of M1, M2, M4, M5a, or M6 disease had a very poor prognosis. In 12 of the 14 patients efforts to achieve induction of remission failed, and the group had a median survival of 2.5 months. A third group with a trisomy 8 as the single defect (11 per cent) had an intermediate prognosis and a median survival of 10 months. With the different types of treatment for acute nonlymphocytic leukemia that are now available, we suggest that high-resolution chromosome analysis will become an important tool in selecting specific types of therapy for groups of patients with differing prognoses.
- Published
- 1984
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21. Anemia in the elderly. Common causes and suggested diagnostic approach.
- Author
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Howe RB
- Subjects
- Aged, Anemia etiology, Anemia, Hypochromic diagnosis, Anemia, Hypochromic etiology, Anemia, Macrocytic diagnosis, Anemia, Macrocytic etiology, Erythrocyte Count, Folic Acid Deficiency complications, Hemoglobins analysis, Humans, Middle Aged, Reticulocytes, Vitamin B 12 Deficiency complications, Anemia diagnosis
- Abstract
Anemia is a frequent finding in the elderly. Hypochromic microcytic anemia, usually secondary to iron deficiency, is the most common type. Macrocytic anemia, usually caused by folic acid or vitamin B12 deficiency, is the next most common. Both iron and vitamin B deficiencies are easy to treat with supplements, but the clinician must make a careful search for the cause of the deficiency. Normochromic normocytic anemia can be caused by a number of conditions. The only effective treatment is arrest or cure of the underlying disorder.
- Published
- 1983
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22. Retinal surgery complicated by a spontaneously acquired factor VIII inhibitor.
- Author
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Priluck IA, Howe RB, Eifrig DE, Edson JR, and Miller K
- Subjects
- Aged, Factor VIII therapeutic use, Hemophilia A drug therapy, Hemorrhage etiology, Humans, Immunosuppression Therapy, Male, Middle Aged, Postoperative Complications drug therapy, Retinal Detachment surgery, Scleral Buckling, Uveal Diseases etiology, Choroid, Factor VIII antagonists & inhibitors, Hemophilia A complications
- Abstract
We studied a factor VIII inhibitor spontaneously occurring in an otherwise healthy patient who underwent retinal reattachment. The clotting defect first manifested itself as a delayed hemorrhagic choroidal detachment. His bleeding diathesis was successfully managed by infusion of factor VIII concentrate, prednisone, and cyclophosphamide. Surgical procedures in patients with severe bleeding disorders present a difficult therapeutic problem which can be effectively managed by the close cooperation of the surgeon, hematologist, coagulation laboratory, and blood bank.
- Published
- 1978
- Full Text
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23. Current concepts of anemia in elderly patients.
- Author
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Howe RB
- Subjects
- Aged, Aged, 80 and over, Anemia, Hypochromic diagnosis, Anemia, Macrocytic diagnosis, Female, Humans, Male, Anemia diagnosis
- Published
- 1987
24. Hypocellular acute leukemia.
- Author
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Howe RB, Bloomfield CD, and McKenna RW
- Subjects
- Adolescent, Adult, Aged, Antineoplastic Agents therapeutic use, Biopsy, Cell Count, Female, Humans, Leukemia, Myeloid, Acute drug therapy, Leukemia, Myeloid, Acute mortality, Male, Middle Aged, Bone Marrow pathology, Leukemia, Myeloid, Acute pathology
- Published
- 1982
- Full Text
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25. Are 'indexes' an index of physician performance?
- Author
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Howe RB
- Subjects
- Humans, Costs and Cost Analysis, Erythrocyte Indices, Physician's Role, Role
- Published
- 1985
26. Antithymocyte globulin treatment of severe aplastic anaemia.
- Author
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Miller WJ, Branda RF, Flynn PJ, Howe RB, Ramsay NK, Condie RM, and Jacob HS
- Subjects
- Adolescent, Adult, Aged, Antilymphocyte Serum administration & dosage, Antilymphocyte Serum adverse effects, Blood Cell Count, Female, Hemoglobins analysis, Humans, Male, Middle Aged, Neutrophils cytology, Platelet Count, Time Factors, Anemia, Aplastic therapy, Antilymphocyte Serum therapeutic use, T-Lymphocytes immunology
- Abstract
Nineteen patients with severe aplastic anaemia were treated with antithymocyte globulin. Ten patients obtained remissions (transfusion independent, at least 45000 platelets and 2000 PMN/mm3) within 2-3 months and continue in remission 5-35 months after antithymocyte globulin. Ages of responders ranged from 17 to 71. Complications of antithymocyte globulin included arthralgias, rash, serum sickness, angioedema and fever. Two patients died during, two shortly after, and one 10 months after therapy. One patient with a previous remission following antithymocyte globulin relapsed and achieved a second remission with retreatment. Previous androgen therapy did not affect outcome since two of four patients with and eight of 15 patients without previous androgen therapy achieved remission with ATG. Treatment with antithymocyte globulin is a promising alternative to bone marrow transplantation in the treatment of severe aplastic anaemia.
- Published
- 1983
- Full Text
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27. Reversible pancytopenia following OKT3. Use in the context of multidrug immunosuppression for kidney allografting.
- Author
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Burke GW 3rd, Vercellotti GM, Simmons RL, Howe RB, Canafax DM, and Najarian JS
- Subjects
- Adult, CD3 Complex, Female, Humans, Kidney Failure, Chronic therapy, Lupus Erythematosus, Systemic therapy, Middle Aged, Antibodies, Monoclonal therapeutic use, Antigens, Differentiation, T-Lymphocyte immunology, Immunosuppression Therapy methods, Kidney Transplantation, Pancytopenia etiology, Receptors, Antigen, T-Cell immunology
- Abstract
We present two instances of pancytopenia in kidney transplant patients associated with a course of OKT3 therapy. In one case, OKT3 was used prophylactically, in the other therapeutically to treat biopsy-proved rejection. They both occurred in the setting of multi-drug immunosuppression, including Minnesota anti-lymphocyte globulin, and recovered with supportive therapy. Previous antihypertensive medication, antibiotics, and azathioprine were restarted without hematologic sequelae. Evidence implicating OKT3, and resultant gamma-interferon-induced marrow suppression is discussed.
- Published
- 1989
28. Recurrent chromosomal defects are found in most patients with non-Hodgkin's-lymphoma.
- Author
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Yunis JJ, Oken MM, Theologides A, Howe RB, and Kaplan ME
- Subjects
- Adult, Aged, Female, Humans, Leukemia genetics, Lymphoma pathology, Male, Middle Aged, Recurrence, Chromosome Aberrations, Lymphoma genetics
- Abstract
Using methotrexate cell synchronization, we successfully analyzed chromosomal preparations of 40 lymph node biopsies and one bone marrow sample from 44 patients with non-Hodgkin's, non-Burkitt's lymphoma. All of the 41 patients successfully analyzed showed clonal chromosomal abnormalities. In 25 of the 41 (61%), the defects were found to be consistent with (A) a deletion 6q in five of seven patients with diffuse large cell lymphoma, (B) a t(11;14), a del 11q, or a + 12 in seven of nine patients with small cell lymphocytic lymphoma, and (C) a t(14;18) in 12 of 15 patients with follicular lymphoma (small cleaved and mixed small and large cleaved) and in a single case of diffuse large cell lymphoma. In three patients with small cell lymphocytic lymphoma whose biopsies exhibited a t(11;14), lymphocytes were cultured and chromosomes examined for the presence of fragile sites. In two, frequent breaks at band 11q13.3 were observed. Such findings suggest a possible relationship between a fragile site and a predisposition to a specific chromosomal rearrangement in human neoplasia.
- Published
- 1984
- Full Text
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29. Lymphocyte studies in familial chronic lymphatic leukemia.
- Author
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Branda RF, Ackerman SK, Handwerger BS, Howe RB, and Douglas SD
- Subjects
- Aged, Antibody-Dependent Cell Cytotoxicity, Cell Membrane immunology, Erythrocytes immunology, Female, Humans, Leukemia, Lymphoid genetics, Leukemia, Lymphoid ultrastructure, Lymphocyte Activation, Lymphocytes ultrastructure, Male, Mitogens pharmacology, Pedigree, Receptors, Antigen, B-Cell, Rosette Formation, Leukemia, Lymphoid immunology, Lymphocytes immunology
- Published
- 1978
- Full Text
- View/download PDF
30. The response of erythropoietin to dietary protein in human renal disease.
- Author
-
Rosenberg ME, Howe RB, Zanjani ED, and Hostetter TH
- Subjects
- Adult, Animals, Dietary Proteins administration & dosage, Erythrocyte Aging, Erythrocyte Count, Erythropoietin blood, Erythropoietin urine, Female, Humans, Male, Middle Aged, Radioimmunoassay, Random Allocation, Rats, Rats, Inbred Strains, Reticulocytes, Dietary Proteins metabolism, Erythropoietin biosynthesis, Kidney Diseases metabolism
- Abstract
The response of erythropoietin to dietary protein was examined in nine subjects with a variety of glomerular diseases. They were randomly assigned by using a crossover design to two 11-day periods, one on a high-protein diet (2 gm/kg/day) and the other on a low-protein diet (0.55 gm/kg/day). The high-protein diet was associated with increased urinary erythropoietin excretion (4.28 +/- 0.84 U/24 hr vs 1.28 +/- 0.16 U/24/hr; p less than 0.05), increased serum erythropoietin concentration (22 +/- 2 mU/ml vs 10 +/- 2 mU/ml; p less than 0.05), and increased reticulocyte count (3.0 +/- 0.8 vs 1.6 +/- 0.4; p less than 0.05), demonstrating that erythropoietin production by the diseased kidney was still responsive to dietary protein manipulation. To examine whether changes in erythrocyte survival could be responsible for the differences in erythropoietin production, red cell survival was measured in two groups of subtotally nephrectomized rats, one group ingesting a high-protein diet (30%) and the other a low-protein diet (6%). No difference in erythrocyte survival rate was found. Reticulocyte counts were, however, elevated on the high-protein diet. We conclude that in the diseased kidney, a high-protein diet, perhaps by increasing renal O2 consumption, directly stimulates erythropoietin production.
- Published
- 1989
31. Hepatic clearance of unconjugated bilirubin in cholestatic liver diseases.
- Author
-
Bloomer JR, Berk PD, and Howe RB
- Subjects
- Adolescent, Adult, Carbon Radioisotopes, Female, Humans, Jaundice, Chronic Idiopathic blood, Liver Cirrhosis blood, Male, Middle Aged, Time Factors, Bilirubin blood, Cholestasis blood, Liver metabolism
- Published
- 1974
- Full Text
- View/download PDF
32. Tips on diagnosing and treating anemia in the aging.
- Author
-
Howe RB
- Subjects
- Aged, Anemia, Hemolytic therapy, Anemia, Hypochromic classification, Anemia, Hypochromic therapy, Anemia, Macrocytic blood, Anemia, Macrocytic therapy, Diagnosis, Differential, Erythrocyte Count, Hematocrit, Hemoglobins analysis, Humans, Middle Aged, Reticulocytes, Anemia, Hemolytic blood, Anemia, Hypochromic blood
- Published
- 1979
33. Time-related factors in quantitative risk assessment.
- Author
-
Crump KS, Allen BC, Howe RB, and Crockett PW
- Subjects
- Actuarial Analysis, Age Factors, Asbestos adverse effects, Benzene adverse effects, Humans, Leukemia mortality, Mesothelioma mortality, Models, Biological, Occupational Diseases mortality, Risk, Time Factors, Neoplasms mortality
- Abstract
In regulatory or decision-making contexts related to carcinogenic hazards, one would like to know the extra risks associated with various levels, durations, and ages of exposure to a carcinogen. To supply that information, quantitative risk assessments are required that make extrapolations on variables related to dose levels, timing of exposure, and age. Quantitative models that express age-specific mortality rates as functions of the exposure pattern and that allow such extrapolations to be made are presented. The uncertainty inherently associated with those extrapolations is discussed and is found to be exacerbated by small data sets and inadequate data availability. Specific examples are provided that involve asbestos-induced mesothelioma and leukemia caused by benzene exposure.
- Published
- 1987
- Full Text
- View/download PDF
34. Leukemia.
- Author
-
Howe RB
- Subjects
- Acute Disease, Humans, Leukemia therapy
- Published
- 1984
35. Effect of phototherapy on serum bilirubin levels and red blood cell survival in congenitally jaundiced Gunn rats.
- Author
-
Howe RB, Hadland CR, and Engel RR
- Subjects
- Animals, Disease Models, Animal, Humans, Infant, Newborn, Jaundice blood, Jaundice therapy, Jaundice, Neonatal therapy, Rats, Bilirubin blood, Erythrocyte Aging, Jaundice congenital, Phototherapy
- Abstract
Although phototherapy with blue fluorescent light effectively lowered the serum bilirubin concentration in congenitally jaundiced Gunn rats, no effect on red blood cell surivival as determined by chromium-51 labeling of homologous red blood cells and carboxyhemoglobin concentration was observed. Furthermore, attempts to demonstrate metabolic stress to the red blood cells failed to show increased glucose consumption. No oxidant damage to red cells as reflected by methemoglobin production and Heinz body formation was observed. Thus the anticipated hemolysis secondary to oxidant damage to red blood cells from phototherapy was not found.
- Published
- 1978
36. Comparison of fecal urobilinogen excretion with bilirubin production in normal volunteers and patients with increased bilirubin production.
- Author
-
Bloomer JR, Berk PD, Howe RB, Waggoner JG, and Berlin NI
- Subjects
- Adolescent, Adult, Aged, Bilirubin metabolism, Carbon Isotopes, Chromium Isotopes, Female, Humans, Male, Middle Aged, Bilirubin biosynthesis, Feces analysis, Urobilinogen metabolism
- Published
- 1970
- Full Text
- View/download PDF
37. Studies of bilirubin kinetics in normal adults.
- Author
-
Berk PD, Howe RB, Bloomer JR, and Berlin NI
- Subjects
- Adult, Bile analysis, Bilirubin analysis, Bilirubin blood, Bilirubin urine, Carbon Isotopes, Computers, Erythrocyte Aging, Feces analysis, Female, Humans, Kinetics, Male, Metabolic Clearance Rate, Bilirubin metabolism, Liver metabolism
- Abstract
This report describes studies of bilirubin kinetics in 13 healthy young adults. The plasma content of unconjugated bilirubin-(14)C was determined at frequent intervals for 24-30 hr after the intravenous injection of a tracer dose of unconjugated isotopic bilirubin. Fecal and urinary radioactivity were measured for 7 days. During this time cumulative recovery averaged 96% of the injected dose. The plasma curves were processed by digital computer. For the 30 hr experimental period, a sum of three exponentials, with average half-times of 18, 81, and 578 min, was required to describe the data. Using the plasma curve integral method, the hepatic bilirubin clearance (47 +/-10 ml/min, mean +/-SD), the bilirubin production rate (3.8 +/-0.6 mg/kg per day), and the mean red blood cell life span (101 +/-13 days) were calculated directly from the parameters of this function. To gain further insight into the metabolism of unconjugated bilirubin, the data were also used to determine the parameters of a multicompartmental model. In the model proposed, plasma unconjugated bilirubin exchanges with two additional pools one of which is thought to represent extrahepatic extravascular, and the other intrahepatic unconjugated bilirubin. Bilirubin is eliminated from the system via the proposed intrahepatic pool. From the data and the model, pool sizes and exchange rates between compartments were calculated, and the liver: plasma concentration gradient estimated. These studies provide a detailed analysis of the kinetics of unconjugated bilirubin in a healthy normal population and are intended to serve as a reference point for studies of abnormal states.
- Published
- 1969
- Full Text
- View/download PDF
38. Inorganic sulfate and thiosulfate: transport and competition in renal tubules of the dog.
- Author
-
BERGLUND F, HELANDER CG, and HOWE RB
- Subjects
- Animals, Biological Transport, Dogs, Kidney physiology, Kidney Tubules, Sulfates metabolism, Thiosulfates metabolism
- Published
- 1960
- Full Text
- View/download PDF
39. Ether-soluble bilirubin.
- Author
-
Howe RB and Pinto SD
- Subjects
- Humans, Jaundice blood, Solubility, Bilirubin blood, Ethers, Neoplasms diagnosis
- Published
- 1966
- Full Text
- View/download PDF
40. Interpretation of plasma bilirubin levels based on studies with radioactive bilirubin.
- Author
-
Bloomer JR, Berk PD, Howe RB, and Berlin NI
- Subjects
- Bilirubin metabolism, Carbon Isotopes, Clinical Trials as Topic, Depression, Chemical, Glutethimide pharmacology, Humans, Hyperbilirubinemia, Hereditary physiopathology, Liver metabolism, Liver Diseases diagnosis, Phenobarbital pharmacology, Secobarbital pharmacology, Time Factors, Tritium, Bilirubin blood, Liver physiology
- Published
- 1971
41. Bilirubin production as a measure of red cell life span.
- Author
-
Berk PD, Bloomer JR, Howe RB, Blaschke TF, and Berlin NI
- Subjects
- Anemia, Hemolytic, Autoimmune blood, Anemia, Sideroblastic blood, Bilirubin blood, Carbon Isotopes, Chromium Isotopes, Erythrocyte Count, Erythropoiesis, Feces analysis, Female, Glycine, Half-Life, Hemoglobinuria blood, Humans, Hyperbilirubinemia blood, Iron Isotopes, Lead Poisoning blood, Male, Porphyrias blood, Porphyrins blood, Urobilin analysis, Bilirubin biosynthesis, Erythrocyte Aging, Hemoglobins metabolism
- Published
- 1972
42. Constitutional hepatic dysfunction (Gilbert's syndrome). A new definition based on kinetic studies with unconjugated radiobilirubin.
- Author
-
Berk PD, Bloomer JR, Howe RB, and Berlin NI
- Subjects
- Adolescent, Adult, Bilirubin biosynthesis, Bilirubin metabolism, Biopsy, Carbon Isotopes, Computers, Erythrocyte Aging, Female, Hematocrit, Humans, Kinetics, Liver metabolism, Liver pathology, Male, Middle Aged, Time Factors, Tritium, Bilirubin blood, Hyperbilirubinemia, Hereditary diagnosis
- Published
- 1970
- Full Text
- View/download PDF
43. Quantitative studies of the delivery of hepatic-synthesized bilirubin to plasma utilizing -aminolevulinic acid-4- 14 C and bilirubin- 3 H in man.
- Author
-
Jones EA, Shrager R, Bloomer JR, Berk PD, Howe RB, and Berlin NI
- Subjects
- Adult, Bile Pigments analysis, Bile Pigments blood, Bilirubin administration & dosage, Bilirubin biosynthesis, Bilirubin blood, Carbon Isotopes, Chromium Isotopes, Feces analysis, Hematocrit, Heme metabolism, Humans, Injections, Intravenous, Levulinic Acids administration & dosage, Mathematics, Methods, Porphobilinogen urine, Porphyrias metabolism, Porphyrins blood, Time Factors, Tritium, Bilirubin metabolism, Levulinic Acids metabolism, Liver metabolism
- Abstract
After the simultaneous intravenous administration of unconjugated bilirubin-(3)H and delta-aminolevulinic acid-4-(14)C, the plasma disappearance curves of unconjugated bilirubin-(3)H and the plasma appearance curves of biosynthesized unconjugated bilirubin-(14)C have been defined in seven patients, three of whom had acute intermittent porphyria (AIP). The incorporation of (14)C into plasma unconjugated bilirubin, derived by an analysis which involves deconvolution of the two plasma curves, varied between 13.1 and 23.5% (mean 19.3%) of the injected dose in the nonporphyric patients and between 5.4 and 13.6% (mean 8.3%) of the injected dose in the porphyric patients. In five of the patients, the stercobilin-(14)C specific activity in a pooled specimen of feces was measured, enabling the following further values to be calculated: (a) the total (14)C radioactivity incorporated into bilirubin (21.0 and 25.3% [mean 23.2%] of the injected dose in two of the nonporphyric patients and between 8.5 and 25.3% [mean 14.2%] of the injected dose in the porphyric patients), and (b) the proportion of hepatic synthesized bilirubin delivered directly to plasma in the unconjugated form (between 0.520 and 0.904; mean for nonporphyric patients 0.712; mean for porphyric patients 0.614). The results demonstrate that a large proportion of bilirubin derived from hepatic hemes passes through the plasma in the unconjugated form before conjugation and secretion into bile.
- Published
- 1972
- Full Text
- View/download PDF
44. Preparation and properties of specifically labeled radiochemically stable 3H-bilirubin.
- Author
-
Howe RB, Berk PD, Bloomer JR, and Berlin NI
- Subjects
- Animals, Bilirubin blood, Carbon Isotopes, Child, Preschool, Dogs, Drug Stability, Female, Glycine metabolism, Humans, Levulinic Acids metabolism, Methods, Radiochemistry, Bilirubin biosynthesis, Tritium
- Published
- 1970
45. Excess lipofuscin accumulation in constitutional hepatic dysfunction (Gilbert's syndrome). Light and electron microscopic observations.
- Author
-
Barth RF, Grimley PM, Berk PD, Bloomer JR, and Howe RB
- Subjects
- Adolescent, Adult, Bilirubin analysis, Biopsy, Endoplasmic Reticulum, Female, Glycoside Hydrolases metabolism, Hexosamines, Histocytochemistry, Humans, Hyperbilirubinemia, Hereditary pathology, Liver analysis, Liver pathology, Liver Glycogen analysis, Lysosomes metabolism, Male, Microscopy, Electron, Middle Aged, Mitochondria, Liver, Pigments, Biological analysis, Hyperbilirubinemia, Hereditary metabolism, Pigments, Biological metabolism
- Published
- 1971
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