Andrew J Aronson, MD - Academia.edu (original) (raw)
Papers by Andrew J Aronson, MD
The virtual mentor : VM, 2008
a 50-year-old man with diabetes, is on dialysis for chronic renal failure and on the waiting list... more a 50-year-old man with diabetes, is on dialysis for chronic renal failure and on the waiting list for a kidney transplant. Because he is in relatively good health, he is low on the list. His physicians advise him that he could be on the list for up to 3 years and that his health during that time would not be jeopardized, aside from the risks and inconveniences associated with long-term dialysis. Mr. Lawrence is divorced and on bad terms with his ex-wife; he has no children and has contacted his sister and her family to see if any of them could be a living donor. His sister is obese, at risk for diabetes, and is not a suitable donor candidate; no other family members or friends are willing to consider donating a kidney to Mr. Lawrence. Unable to find a living donor and dismayed at the thought of remaining on dialysis for years, Mr. Lawrence decided to use his financial resources to purchase a kidney and undergo a transplant in China. He spent 2 months in China after the surgery, where he was cared for by a local transplant team that provided postoperative care, including monitoring his renal function and managing his immunosuppressant medications. The surgery occurred without any significant complications, and Mr. Lawrence's recovery was excellent. A month after his return to the United States, Mr. Lawrence ran out of the medications that his doctors in China had prescribed, including his immunosuppressants. He knew that failing to take the medication could cause graft rejection, so he made an appointment with Dr. Roberts, a nephrologist at a local academic center who specialized in care of renal transplant patients. Dr. Roberts was aware that many of the organs secured in China came from executed prisoners who did not always consent to organ donation. Further, Dr. Roberts was wary because purchasing organs was illegal in the U.S. Having worked in the transplant field for several decades and witnessed numerous changes in the regulations about and care of transplant patients, Dr. Roberts understood how difficult it was to secure an organ, but didn't want to be perceived as condoning Mr. Lawrence's actions. Commentary 1 by Sally Satel, MD Is it ethical for Dr. Roberts to treat Mr. Lawrence? Yes. Qualms about the circumstances surrounding a patient's activities are not a reliable ethical guide for physician behavior; if that were the case, the American Medical Association would
American journal of kidney diseases : the official journal of the National Kidney Foundation, 1982
We have previously described (Medicine 56:493, 1977) 12 patients with diffuse lupus glomeruloneph... more We have previously described (Medicine 56:493, 1977) 12 patients with diffuse lupus glomerulonephritis who had no clinical or laboratory evidence of renal involvement at the time of the initial biopsy. In this article we report the course of 10 of these patients followed for 5-11 yr (mean 83 mo). One patient died in renal failure and two others of related causes (septicemia and subarachnoid hemorrhage). Seven patients (Group I) had a benign course from a renal standpoint, with stable renal function and mild or no urinary abnormalities. Repeat biopsy in four patients in this group revealed near complete resolution of the original lesion in two and considerable improvement in two others, who now have primarily mesangial hypercellularity and a focal lesion, respectively. Renal function deteriorated in three patients (Group II), resulting in loss of congruent to 50% of GFR in two and renal death in the third. Repeat biopsy in one of these patients showed a more severe, albeit focal, glo...
Journal of Clinical Ultrasound, 1978
We have described a case of acute post-streptococcal glomerulonephritis in which the ultrasound f... more We have described a case of acute post-streptococcal glomerulonephritis in which the ultrasound findings resemble multiple solid renal masses. The diagnosis of this inflammatory lesion should be considered in the proper clinical setting.
Archives of Pediatrics & Adolescent Medicine, 1975
Sir .—I am writing concerning the case report and review by Dr. Siegler, which appeared in the De... more Sir .—I am writing concerning the case report and review by Dr. Siegler, which appeared in the December issue of theJournal(128:853, 1974). He described the unsuccessful treatment of malignant hyperreninemic hypertension in an 11-year-old girl who subsequently underwent bilateral nephrectomy and allograft transplantation. It is an excellent summary of the subject but leaves unsaid several important points concerning this fortunately rarely encountered problem in pediatric practice. Bilateral nephrectomy for hypertension is a procedure of last resort when all other means for control of high-renin hypertension have failed. Nephrectomy is irrevocable and imposes the need for dialysis and transplantation with their many problems and less-than-ideal survival rates. We have at our disposal an alternative. Contrary to Dr. Siegler's statement, there have been positive, though not widely reported, results with minoxidil therapy in children. 1-3 This potent, orally administered vasodilator is now available (though it probably was not when Dr. Siegler's
Archives of Internal Medicine, 1979
A patient with systemic lupus erythematosus (SLE) and lupus retinopathy showed resolution of subr... more A patient with systemic lupus erythematosus (SLE) and lupus retinopathy showed resolution of subretinal edema documented with fluorescein angiography. Subsequently at autopsy, immunofluorescence studies disclosed ocular deposition of immunoglobulins in the vascular layer of choroid capillaries and basement membranes of ciliary processes and bulbar conjunctivas. To our knowledge, these findings represent the first reported documentation of probable immune-complex ocular vasculitis in lupus retinopathy using immunofluorescent techniques, and they support the hypothesis that lupus retinopathy is caused by immune complex deposition as are other manifestations of SLE.
Archives of Dermatology, 1979
There is increasing evidence that, as in systemic lupus erythematosus (SLE), deposition of immune... more There is increasing evidence that, as in systemic lupus erythematosus (SLE), deposition of immune complexes plays a role in the pathogenesis of dermatitis herpetiformis (DH). Dermatitis herpetiformis and SLE were diagnosed in a 15-year-old girl with Marfan's syndrome who died of cardiac tamponade secondary to cystic medial necrosis of the ascending aorta. The concurrence of these diseases suggests that predisposition to immune-mediated disorders may be associated with the expression of multiple clinical entities.
General Hospital Psychiatry, 1987
Psychiatry Research, Nov 29, 1995
There is evidence that some schizophrenic patients have deficits on tests of cognitive function, ... more There is evidence that some schizophrenic patients have deficits on tests of cognitive function, particularly tests of executive function, including the Wisconsin Card Sorting Test (WCST) and the Trail-making Test, Part B. This study was conducted to determine the generalizability of these findings across the schizophrenia spectrum to schizotypal personality disorder (SPD). Forty DSM-III SPD patients, 56 nonschizophrenia-related other personality disorder (OPD) patients, and 32 normal volunteers from two medical centers performed tests of executive function such as the WCST, Trail-making Part B, Stroop Word-Color Test, and Verbal Fluency, as well as tests of more general intellectual functioning such as the Wechsler Intelligence Scale-Revised Vocabulary and Block Design subtests, and Trail-making Part A. SPD patients performed more poorly on the WCST and on Trail-making Part B than did OPD patients or normal subjects; the groups did not differ on tests of general intellectual functioning. SPD patients may share some of the cognitive deficits observed in schizophrenia.
Pediatric Clinics of North America, Apr 1, 1999
In the general population, an estimated 70% or more of premature morbidity can be attributed to t... more In the general population, an estimated 70% or more of premature morbidity can be attributed to tobacco use, undertreatment of hypertension, and obesity. From a public health perspective, health-related behaviors that reduce the risk for cardiovascular disease should be encouraged for all children and their families. Pediatricians are obligated to accurately and frequently monitor patients' blood pressures. When discovered, elevated blood pressure should be appropriately investigated, with the evaluation being tailored to the age of the child and to the severity of the blood pressure elevation. Investigation should focus on not only a search for a cause but also target organ effects. Timely recognition of abnormal blood pressure and appropriate interventions are necessary to affect the future development of cardiovascular and renal morbidity and mortality.
American Journal of Psychiatry, Jun 1, 1996
Journal of the American Society of Nephrology, Aug 1, 1999
The relationship of borderline infiltrates to acute rejection by Banff criteria in renal allograf... more The relationship of borderline infiltrates to acute rejection by Banff criteria in renal allografts of patients receiving only maintenance immunosuppression is not clear. Renal allograft biopsies with borderline lesions that were not treated with additional anti-rejection therapy were retrospectively studied. Sixty-five such biopsies were identified from 50 patients, and their outcome was determined by serum creatinine and/or histologic findings in subsequent biopsies, up to 40 d after the initial biopsy. In addition to the borderline infiltrates, there was evidence of acute cyclosporine or tacrolimus toxicity (58%), acute tubular necrosis (12%), and urinary obstruction (12%). Forty-day follow-up after 30 (46%) biopsies revealed serum creatinine Ͻ110% of baseline, and repeat biopsies were not indicated. In 17 (26%), the serum creatinine initially decreased, then increased, and follow-up biopsies showed acute
American Journal of Psychiatry, Nov 9, 2014
This report contains preliminary data from an open trial of brief psychodynamic psychotherapy for... more This report contains preliminary data from an open trial of brief psychodynamic psychotherapy for panic disorder. Fourteen patients with primary DSM-IV panic disorder completed a 24-session, twice-weekly course of psychodynamic psychotherapy. Other psychiatric treatment was not permitted throughout the 12-week treatment period and the 6-month follow-up. Symptoms were assessed at baseline, treatment termination, and 6-month posttermination follow-up (40 weeks). Statistically significant, clinically meaningful improvements appeared in panic, depression, anxiety, and functional impairment both at treatment termination and at 6-month follow-up. Psychodynamic monotherapy can be used successfully to retain and treat patients with panic disorder. Psychodynamic interventions warrant further study for patients with panic disorder.
Virchows Archiv. B: Cell pathology, Jan 21, 1977
Specimens of kidney, heart, lung, eye, skin, conjunctiva, choroid plexus and brain were obtained ... more Specimens of kidney, heart, lung, eye, skin, conjunctiva, choroid plexus and brain were obtained from a patient with systemic lupus erythematosus (SLE) post-mortem. The tissues were examined for immune-complex deposition by direct immunofluorescence utilizing antisera specific for IgG, IgA, IgE, IgM and the complement components Clq and C3. Tissues were also examined for C-type viral antigen by indirect immunofluorescence with an antisera raised to HEL-12 virus. Immune complexes were detected along basement membranes and/or in vessel walls of kidney, heart, lung, skin, conjunctiva and eye. HEL-12 viral antigen was detected in the same distribution as immunoglobulins and complement in all tissues. Preimmune serum did not mediate immunofluorescence and the reaction mediated by the anti-HEL-12 virus serum could be blocked by absorption with purified viral antigens. Two renal biopsies were obtained from a second SLE patient during clinical exacerbation and remission. Immunofluorescence analysis of the biopsy obtained during exacerbation showed 3 + deposition of immunoglobulin, complement and HEL-12 viral antigen. In contrast, the biopsy obtained 6 months later during remission showed trace-1 + immunofluorescence for HEL-12 viral antigen, immunoglobulin and complement. We conclude that HEL-12 viral antigen is a component of widely disseminated immune complexes in SLE, and that the disappearance of HEL-12 viral antigen occurs concomitantly with the loss of immune deposits.
Human pathology, 2001
Plasmacytic infiltrates in renal allograft biopsies are uncommon and morphologically distinctive ... more Plasmacytic infiltrates in renal allograft biopsies are uncommon and morphologically distinctive lesions that may represent variants of acute rejection. This study sought significant clinical and pathologic determinants that might have influenced development of these lesions and assessed their prognostic significance. Renal allograft biopsies (n = 19), from 19 patients, with tubulointerstitial inflammatory infiltrates containing abundant plasma cells, composing 32 +/- 8% of the infiltrating mononuclear cells, were classified using Banff '97 criteria. Clonality of the infiltrates was determined by immunoperoxidase staining for kappa and lambda light chains and polymerase chain reaction for immunoglobulin heavy-chain gene rearrangements, using V(H) gene framework 3 and JH consensus primers. In situ hybridization for Epstein-Barr virus encoded RNA (EBER) was performed in 17 cases. The clinical features, histology, and outcome of these cases were compared with kidney allograft biops...
Journal of the American Society of Nephrology : JASN, 1999
The relationship of borderline infiltrates to acute rejection by Banff criteria in renal allograf... more The relationship of borderline infiltrates to acute rejection by Banff criteria in renal allografts of patients receiving only maintenance immunosuppression is not clear. Renal allograft biopsies with borderline lesions that were not treated with additional anti-rejection therapy were retrospectively studied. Sixty-five such biopsies were identified from 50 patients, and their outcome was determined by serum creatinine and/or histologic findings in subsequent biopsies, up to 40 d after the initial biopsy. In addition to the borderline infiltrates, there was evidence of acute cyclosporine or tacrolimus toxicity (58%), acute tubular necrosis (12%), and urinary obstruction (12%). Forty-day follow-up after 30 (46%) biopsies revealed serum creatinine < 110% of baseline, and repeat biopsies were not indicated. In 17 (26%), the serum creatinine initially decreased, then increased, and follow-up biopsies showed acute rejection in nine. In 18 (28%), the creatinine remained elevated and fo...
Human Pathology, 1982
IgA nephropathy has a variable course and leads to renal failure in a substantial number of cases... more IgA nephropathy has a variable course and leads to renal failure in a substantial number of cases. In an attempt to identify prognostic indicators in this disease, we evaluated the clinical and pathologic findings of 20 unselected patients with IgA nephropathy, 13 of whom were followed for 1.5 to 5 years (mean 2.8 years). Biopsy specimens were obtained from all patients and were examined by light and electron microscopy and by immunofluorescence. The activity and severity of the lesions were graded according to a modified classification used by Meadow et al. for the nephropathy associated with tlenoch-Sch6nlein purpura. The results reveal a correlation between the histopathologic grading in the initial biopsy and the clinical outcome: Patients with mild (grade II) or moderate (grade lII) lesions had a benign course or showed evidence of active disease without deterioration of renal function, whereas all patients with grade IV or V lesions who were followed for more than one year developed end-stage renal failure. These observations suggest that histologic grading at initial renal biopsy may be a useful prognostic indicator of the clinical outcome of IgA nephropathy. IIum Pathol 13:314-322, 1982.
American journal of kidney diseases : the official journal of the National Kidney Foundation, 1989
Unlike primary idiopathic childhood hemolytic uremic syndrome (HUS), certain cases of HUS are cle... more Unlike primary idiopathic childhood hemolytic uremic syndrome (HUS), certain cases of HUS are clearly secondary. This article describes a child who represents the 11th reported case of secondary HUS following bone marrow transplantation, and notably, the fourth such case without exposure to cyclosporine A. The renal biopsy was diagnostic in this case. Therefore, the pathognomonic features of the biopsy, as well as its prognostic implications are described and clarified. This patient was treated with plasma exchange, and is the second reported surviving case of secondary HUS following bone marrow transplantation.
Pediatric Clinics of North America, 1999
Since the publication of the 1993 issue of Pediatric Clinics of North America that was devoted en... more Since the publication of the 1993 issue of Pediatric Clinics of North America that was devoted entirely to childhood hypertension, much has been published relating to the development, investigation, and treatment of elevated blood pressure in children and adolescents. The incorporation of blood pressure measurement into the routine pediatric examination has enabled both the discovery of significant asymptomatic hypertension secondary to a previously undetected disorder and the confirmation that mild elevations in blood pressure during childhood are more common than previously recognized, particularly in adolescents. Although hypertension may be a sign of underlying cardiac; endocrine; or, more commonly, renovascular or renal parenchymal disease, elevated blood pressure may also represent an early onset of essential hypertension. This article provides pediatricians with an overview and update of the poignant literature published since the 1993 Clinics, with selected earlier references. The organization of the article relies heavily on the structure of the 1993 Clinics, and the reader is referred to that publication for more extensive background references.
International Journal of Dermatology, 1983
The class of immunoglohulin Itg) deposited at the dermal-epidermal junction iDEI) of the skin in ... more The class of immunoglohulin Itg) deposited at the dermal-epidermal junction iDEI) of the skin in patients with systemic lupus erythematosus (SLEi has been proposed to have prognostic implications. The authors studied disease activity in 51 SLE patients with a positive lupus band. Patients with cutaneous IgM deposits had significantly more severe disease than those with only IgC or with mixed immunoglohulin deposits. White their data suggest an association between IgM depostis, severe disease and a poor prognosis, they urge caution in utilizing Ig deposits as a prognostic indicator.
The virtual mentor : VM, 2008
a 50-year-old man with diabetes, is on dialysis for chronic renal failure and on the waiting list... more a 50-year-old man with diabetes, is on dialysis for chronic renal failure and on the waiting list for a kidney transplant. Because he is in relatively good health, he is low on the list. His physicians advise him that he could be on the list for up to 3 years and that his health during that time would not be jeopardized, aside from the risks and inconveniences associated with long-term dialysis. Mr. Lawrence is divorced and on bad terms with his ex-wife; he has no children and has contacted his sister and her family to see if any of them could be a living donor. His sister is obese, at risk for diabetes, and is not a suitable donor candidate; no other family members or friends are willing to consider donating a kidney to Mr. Lawrence. Unable to find a living donor and dismayed at the thought of remaining on dialysis for years, Mr. Lawrence decided to use his financial resources to purchase a kidney and undergo a transplant in China. He spent 2 months in China after the surgery, where he was cared for by a local transplant team that provided postoperative care, including monitoring his renal function and managing his immunosuppressant medications. The surgery occurred without any significant complications, and Mr. Lawrence's recovery was excellent. A month after his return to the United States, Mr. Lawrence ran out of the medications that his doctors in China had prescribed, including his immunosuppressants. He knew that failing to take the medication could cause graft rejection, so he made an appointment with Dr. Roberts, a nephrologist at a local academic center who specialized in care of renal transplant patients. Dr. Roberts was aware that many of the organs secured in China came from executed prisoners who did not always consent to organ donation. Further, Dr. Roberts was wary because purchasing organs was illegal in the U.S. Having worked in the transplant field for several decades and witnessed numerous changes in the regulations about and care of transplant patients, Dr. Roberts understood how difficult it was to secure an organ, but didn't want to be perceived as condoning Mr. Lawrence's actions. Commentary 1 by Sally Satel, MD Is it ethical for Dr. Roberts to treat Mr. Lawrence? Yes. Qualms about the circumstances surrounding a patient's activities are not a reliable ethical guide for physician behavior; if that were the case, the American Medical Association would
American journal of kidney diseases : the official journal of the National Kidney Foundation, 1982
We have previously described (Medicine 56:493, 1977) 12 patients with diffuse lupus glomeruloneph... more We have previously described (Medicine 56:493, 1977) 12 patients with diffuse lupus glomerulonephritis who had no clinical or laboratory evidence of renal involvement at the time of the initial biopsy. In this article we report the course of 10 of these patients followed for 5-11 yr (mean 83 mo). One patient died in renal failure and two others of related causes (septicemia and subarachnoid hemorrhage). Seven patients (Group I) had a benign course from a renal standpoint, with stable renal function and mild or no urinary abnormalities. Repeat biopsy in four patients in this group revealed near complete resolution of the original lesion in two and considerable improvement in two others, who now have primarily mesangial hypercellularity and a focal lesion, respectively. Renal function deteriorated in three patients (Group II), resulting in loss of congruent to 50% of GFR in two and renal death in the third. Repeat biopsy in one of these patients showed a more severe, albeit focal, glo...
Journal of Clinical Ultrasound, 1978
We have described a case of acute post-streptococcal glomerulonephritis in which the ultrasound f... more We have described a case of acute post-streptococcal glomerulonephritis in which the ultrasound findings resemble multiple solid renal masses. The diagnosis of this inflammatory lesion should be considered in the proper clinical setting.
Archives of Pediatrics & Adolescent Medicine, 1975
Sir .—I am writing concerning the case report and review by Dr. Siegler, which appeared in the De... more Sir .—I am writing concerning the case report and review by Dr. Siegler, which appeared in the December issue of theJournal(128:853, 1974). He described the unsuccessful treatment of malignant hyperreninemic hypertension in an 11-year-old girl who subsequently underwent bilateral nephrectomy and allograft transplantation. It is an excellent summary of the subject but leaves unsaid several important points concerning this fortunately rarely encountered problem in pediatric practice. Bilateral nephrectomy for hypertension is a procedure of last resort when all other means for control of high-renin hypertension have failed. Nephrectomy is irrevocable and imposes the need for dialysis and transplantation with their many problems and less-than-ideal survival rates. We have at our disposal an alternative. Contrary to Dr. Siegler's statement, there have been positive, though not widely reported, results with minoxidil therapy in children. 1-3 This potent, orally administered vasodilator is now available (though it probably was not when Dr. Siegler's
Archives of Internal Medicine, 1979
A patient with systemic lupus erythematosus (SLE) and lupus retinopathy showed resolution of subr... more A patient with systemic lupus erythematosus (SLE) and lupus retinopathy showed resolution of subretinal edema documented with fluorescein angiography. Subsequently at autopsy, immunofluorescence studies disclosed ocular deposition of immunoglobulins in the vascular layer of choroid capillaries and basement membranes of ciliary processes and bulbar conjunctivas. To our knowledge, these findings represent the first reported documentation of probable immune-complex ocular vasculitis in lupus retinopathy using immunofluorescent techniques, and they support the hypothesis that lupus retinopathy is caused by immune complex deposition as are other manifestations of SLE.
Archives of Dermatology, 1979
There is increasing evidence that, as in systemic lupus erythematosus (SLE), deposition of immune... more There is increasing evidence that, as in systemic lupus erythematosus (SLE), deposition of immune complexes plays a role in the pathogenesis of dermatitis herpetiformis (DH). Dermatitis herpetiformis and SLE were diagnosed in a 15-year-old girl with Marfan's syndrome who died of cardiac tamponade secondary to cystic medial necrosis of the ascending aorta. The concurrence of these diseases suggests that predisposition to immune-mediated disorders may be associated with the expression of multiple clinical entities.
General Hospital Psychiatry, 1987
Psychiatry Research, Nov 29, 1995
There is evidence that some schizophrenic patients have deficits on tests of cognitive function, ... more There is evidence that some schizophrenic patients have deficits on tests of cognitive function, particularly tests of executive function, including the Wisconsin Card Sorting Test (WCST) and the Trail-making Test, Part B. This study was conducted to determine the generalizability of these findings across the schizophrenia spectrum to schizotypal personality disorder (SPD). Forty DSM-III SPD patients, 56 nonschizophrenia-related other personality disorder (OPD) patients, and 32 normal volunteers from two medical centers performed tests of executive function such as the WCST, Trail-making Part B, Stroop Word-Color Test, and Verbal Fluency, as well as tests of more general intellectual functioning such as the Wechsler Intelligence Scale-Revised Vocabulary and Block Design subtests, and Trail-making Part A. SPD patients performed more poorly on the WCST and on Trail-making Part B than did OPD patients or normal subjects; the groups did not differ on tests of general intellectual functioning. SPD patients may share some of the cognitive deficits observed in schizophrenia.
Pediatric Clinics of North America, Apr 1, 1999
In the general population, an estimated 70% or more of premature morbidity can be attributed to t... more In the general population, an estimated 70% or more of premature morbidity can be attributed to tobacco use, undertreatment of hypertension, and obesity. From a public health perspective, health-related behaviors that reduce the risk for cardiovascular disease should be encouraged for all children and their families. Pediatricians are obligated to accurately and frequently monitor patients' blood pressures. When discovered, elevated blood pressure should be appropriately investigated, with the evaluation being tailored to the age of the child and to the severity of the blood pressure elevation. Investigation should focus on not only a search for a cause but also target organ effects. Timely recognition of abnormal blood pressure and appropriate interventions are necessary to affect the future development of cardiovascular and renal morbidity and mortality.
American Journal of Psychiatry, Jun 1, 1996
Journal of the American Society of Nephrology, Aug 1, 1999
The relationship of borderline infiltrates to acute rejection by Banff criteria in renal allograf... more The relationship of borderline infiltrates to acute rejection by Banff criteria in renal allografts of patients receiving only maintenance immunosuppression is not clear. Renal allograft biopsies with borderline lesions that were not treated with additional anti-rejection therapy were retrospectively studied. Sixty-five such biopsies were identified from 50 patients, and their outcome was determined by serum creatinine and/or histologic findings in subsequent biopsies, up to 40 d after the initial biopsy. In addition to the borderline infiltrates, there was evidence of acute cyclosporine or tacrolimus toxicity (58%), acute tubular necrosis (12%), and urinary obstruction (12%). Forty-day follow-up after 30 (46%) biopsies revealed serum creatinine Ͻ110% of baseline, and repeat biopsies were not indicated. In 17 (26%), the serum creatinine initially decreased, then increased, and follow-up biopsies showed acute
American Journal of Psychiatry, Nov 9, 2014
This report contains preliminary data from an open trial of brief psychodynamic psychotherapy for... more This report contains preliminary data from an open trial of brief psychodynamic psychotherapy for panic disorder. Fourteen patients with primary DSM-IV panic disorder completed a 24-session, twice-weekly course of psychodynamic psychotherapy. Other psychiatric treatment was not permitted throughout the 12-week treatment period and the 6-month follow-up. Symptoms were assessed at baseline, treatment termination, and 6-month posttermination follow-up (40 weeks). Statistically significant, clinically meaningful improvements appeared in panic, depression, anxiety, and functional impairment both at treatment termination and at 6-month follow-up. Psychodynamic monotherapy can be used successfully to retain and treat patients with panic disorder. Psychodynamic interventions warrant further study for patients with panic disorder.
Virchows Archiv. B: Cell pathology, Jan 21, 1977
Specimens of kidney, heart, lung, eye, skin, conjunctiva, choroid plexus and brain were obtained ... more Specimens of kidney, heart, lung, eye, skin, conjunctiva, choroid plexus and brain were obtained from a patient with systemic lupus erythematosus (SLE) post-mortem. The tissues were examined for immune-complex deposition by direct immunofluorescence utilizing antisera specific for IgG, IgA, IgE, IgM and the complement components Clq and C3. Tissues were also examined for C-type viral antigen by indirect immunofluorescence with an antisera raised to HEL-12 virus. Immune complexes were detected along basement membranes and/or in vessel walls of kidney, heart, lung, skin, conjunctiva and eye. HEL-12 viral antigen was detected in the same distribution as immunoglobulins and complement in all tissues. Preimmune serum did not mediate immunofluorescence and the reaction mediated by the anti-HEL-12 virus serum could be blocked by absorption with purified viral antigens. Two renal biopsies were obtained from a second SLE patient during clinical exacerbation and remission. Immunofluorescence analysis of the biopsy obtained during exacerbation showed 3 + deposition of immunoglobulin, complement and HEL-12 viral antigen. In contrast, the biopsy obtained 6 months later during remission showed trace-1 + immunofluorescence for HEL-12 viral antigen, immunoglobulin and complement. We conclude that HEL-12 viral antigen is a component of widely disseminated immune complexes in SLE, and that the disappearance of HEL-12 viral antigen occurs concomitantly with the loss of immune deposits.
Human pathology, 2001
Plasmacytic infiltrates in renal allograft biopsies are uncommon and morphologically distinctive ... more Plasmacytic infiltrates in renal allograft biopsies are uncommon and morphologically distinctive lesions that may represent variants of acute rejection. This study sought significant clinical and pathologic determinants that might have influenced development of these lesions and assessed their prognostic significance. Renal allograft biopsies (n = 19), from 19 patients, with tubulointerstitial inflammatory infiltrates containing abundant plasma cells, composing 32 +/- 8% of the infiltrating mononuclear cells, were classified using Banff '97 criteria. Clonality of the infiltrates was determined by immunoperoxidase staining for kappa and lambda light chains and polymerase chain reaction for immunoglobulin heavy-chain gene rearrangements, using V(H) gene framework 3 and JH consensus primers. In situ hybridization for Epstein-Barr virus encoded RNA (EBER) was performed in 17 cases. The clinical features, histology, and outcome of these cases were compared with kidney allograft biops...
Journal of the American Society of Nephrology : JASN, 1999
The relationship of borderline infiltrates to acute rejection by Banff criteria in renal allograf... more The relationship of borderline infiltrates to acute rejection by Banff criteria in renal allografts of patients receiving only maintenance immunosuppression is not clear. Renal allograft biopsies with borderline lesions that were not treated with additional anti-rejection therapy were retrospectively studied. Sixty-five such biopsies were identified from 50 patients, and their outcome was determined by serum creatinine and/or histologic findings in subsequent biopsies, up to 40 d after the initial biopsy. In addition to the borderline infiltrates, there was evidence of acute cyclosporine or tacrolimus toxicity (58%), acute tubular necrosis (12%), and urinary obstruction (12%). Forty-day follow-up after 30 (46%) biopsies revealed serum creatinine < 110% of baseline, and repeat biopsies were not indicated. In 17 (26%), the serum creatinine initially decreased, then increased, and follow-up biopsies showed acute rejection in nine. In 18 (28%), the creatinine remained elevated and fo...
Human Pathology, 1982
IgA nephropathy has a variable course and leads to renal failure in a substantial number of cases... more IgA nephropathy has a variable course and leads to renal failure in a substantial number of cases. In an attempt to identify prognostic indicators in this disease, we evaluated the clinical and pathologic findings of 20 unselected patients with IgA nephropathy, 13 of whom were followed for 1.5 to 5 years (mean 2.8 years). Biopsy specimens were obtained from all patients and were examined by light and electron microscopy and by immunofluorescence. The activity and severity of the lesions were graded according to a modified classification used by Meadow et al. for the nephropathy associated with tlenoch-Sch6nlein purpura. The results reveal a correlation between the histopathologic grading in the initial biopsy and the clinical outcome: Patients with mild (grade II) or moderate (grade lII) lesions had a benign course or showed evidence of active disease without deterioration of renal function, whereas all patients with grade IV or V lesions who were followed for more than one year developed end-stage renal failure. These observations suggest that histologic grading at initial renal biopsy may be a useful prognostic indicator of the clinical outcome of IgA nephropathy. IIum Pathol 13:314-322, 1982.
American journal of kidney diseases : the official journal of the National Kidney Foundation, 1989
Unlike primary idiopathic childhood hemolytic uremic syndrome (HUS), certain cases of HUS are cle... more Unlike primary idiopathic childhood hemolytic uremic syndrome (HUS), certain cases of HUS are clearly secondary. This article describes a child who represents the 11th reported case of secondary HUS following bone marrow transplantation, and notably, the fourth such case without exposure to cyclosporine A. The renal biopsy was diagnostic in this case. Therefore, the pathognomonic features of the biopsy, as well as its prognostic implications are described and clarified. This patient was treated with plasma exchange, and is the second reported surviving case of secondary HUS following bone marrow transplantation.
Pediatric Clinics of North America, 1999
Since the publication of the 1993 issue of Pediatric Clinics of North America that was devoted en... more Since the publication of the 1993 issue of Pediatric Clinics of North America that was devoted entirely to childhood hypertension, much has been published relating to the development, investigation, and treatment of elevated blood pressure in children and adolescents. The incorporation of blood pressure measurement into the routine pediatric examination has enabled both the discovery of significant asymptomatic hypertension secondary to a previously undetected disorder and the confirmation that mild elevations in blood pressure during childhood are more common than previously recognized, particularly in adolescents. Although hypertension may be a sign of underlying cardiac; endocrine; or, more commonly, renovascular or renal parenchymal disease, elevated blood pressure may also represent an early onset of essential hypertension. This article provides pediatricians with an overview and update of the poignant literature published since the 1993 Clinics, with selected earlier references. The organization of the article relies heavily on the structure of the 1993 Clinics, and the reader is referred to that publication for more extensive background references.
International Journal of Dermatology, 1983
The class of immunoglohulin Itg) deposited at the dermal-epidermal junction iDEI) of the skin in ... more The class of immunoglohulin Itg) deposited at the dermal-epidermal junction iDEI) of the skin in patients with systemic lupus erythematosus (SLEi has been proposed to have prognostic implications. The authors studied disease activity in 51 SLE patients with a positive lupus band. Patients with cutaneous IgM deposits had significantly more severe disease than those with only IgC or with mixed immunoglohulin deposits. White their data suggest an association between IgM depostis, severe disease and a poor prognosis, they urge caution in utilizing Ig deposits as a prognostic indicator.