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Biomedical subjects

A Goldman

Publications and source records attributed to A Goldman.

At least 181 records · Page 10Linked to original sources
PubMed1985

A systemic lymphoproliferative disorder with morphologic features of Castleman's disease: clinical findings and clinicopathologic correlations in 15 patients.

Fifteen patients (11 males, four females; median age 57) manifested a disease characterized by (1) the histopathologic features of Castleman's disease, plasma cell type, in lymph node biopsies; (2) predominantly lymphadenopathic disease, involving multiple, preferentially peripheral nodal groups; (3) varied manifestations of multisystemic involvement (such as constitutional symptoms; splenomegaly and hypergammaglobulinemia; elevated ESR, anemia, and thrombocytopenia; hepatomegaly and altered liver function tests (LFTs); signs of renal disease); and (4) idiopathic nature. Two main patterns of evolution were recognized: persistent, with sustained clinical manifestations, and episodic, with recurrent exacerbations and remissions. Seventy-three percent of patients had infectious complications, and 27% developed malignancies. Complete remissions were obtained occasionally with antineoplastic agents and with splenectomy but not with glucocorticosteroids alone. The median survival time is 30 months; 60% of patients have died. Median follow-up in the six surviving patients is 97+ months. A review of 50 cases in the literature revealed similar clinical and laboratory features. Despite some similarities with autoimmune diseases, the main features of this process seem to best fit a hyperplastic-dysplastic lymphoid disorder in a setting of immunoregulatory deficit.

Adrenal Cortex Hormones↗
PubMed1985

Bone marrow transplantation for acute nonlymphocytic leukemia in first remission: analysis of prognostic factors.

Prognostic factors were reviewed retrospectively for 39 children and adults aged 1 to 40 years (median 14 years) with acute nonlymphocytic leukemia (ANLL) who attained a first remission and underwent bone marrow transplantation from November 1976 to July 1983. The preparation regimen for transplantation was cyclophosphamide (60 mg/kg/d for two days) followed by total body irradiation (either 750 cGy single dose at 26 cGy/min, n = 37, or 1,320 cGy fractionated at 10 cGy/min, n = 2). Twenty-three patients are surviving disease free with a median followup of three years. The three-year estimated disease-free survival is 55% +/- 17% (+/- 2 SE). Five patients have relapsed from 92 to 756 days after transplantation for an estimated relapse rate of 21% +/- 18%. Two factors, the white blood cell (WBC) count and the French-American-British (FAB) classification at leukemia diagnosis were found to be of prognostic importance. Patients with a WBC of less than 20,000/microL at diagnosis had a three-year estimated disease-free survival of 74% +/- 18% v 26% +/- 24% for those with a WBC of greater than or equal to 20,000 (P = .008). The estimated relapse rate was 6% +/- 12% for patients with a WBC at diagnosis less than 20,000 v 53% +/- 38% for patients with a WBC at diagnosis of greater than or equal to 20,000 (P = .01). Patients with myeloid morphology at diagnosis (FAB M1,2,3) had an estimated relapse rate of 9% +/- 12% v patients with monocytoid morphology (FAB M4,5a) whose estimated relapse rate was 58% +/- 44% (P = .05). Our data suggest that a high WBC count at poor prognostic factors for patients with ANLL who undergo bone marrow transplantation in first remission after conditioning with cyclophosphamide plus total body irradiation.

Acute Disease↗
PubMed1985

Autologous bone marrow transplantation for patients with acute lymphoblastic leukemia in second or subsequent remission: results of bone marrow treated with monoclonal antibodies BA-1, BA-2, and BA-3 plus complement.

Autologous bone marrow transplantation (BMT) was utilized as therapy for 23 patients with acute lymphoblastic leukemia (ALL) in second or greater remission. Bone marrow was treated in vitro with a combination of monoclonal antibodies, consisting of BA-1, BA-2, BA-3, and baby rabbit complement (BRC'). All patients were prepared for transplantation with cyclophosphamide and fractionated total body irradiation. Engraftment occurred in all 23 patients. Seven of 23 patients remain relapse-free from six to 32 months (median, 21.4 months) posttransplant. Failures were due to relapse with the exception of one patient who died of infection. This study demonstrates that autologous BMT using in vitro marrow treatment with BA-1, BA-2, BA-3, and BRC' is safe, allows engraftment, and results in prolonged survival for some patients with ALL in second or greater remission.

Adolescent↗
PubMed1984

Immunolocalization of neuroblastoma using radiolabeled monoclonal antibody UJ13A.

The monoclonal antibody UJ13A, raised after immunization of mice with human fetal brain, recognized an antigen expressed on human neuroblastoma cell lines and fresh tumors. Antibody was purified and radiolabeled with iodine isotopes using chloramine-T. In preclinical studies, 125I-labeled UJ13A was injected intravenously into nude mice bearing xenografts of human neuroblastoma. Radiolabeled UJ13A uptake by the tumors was four to 23 times greater than that by blood. In control animals, injected with a similar quantity of a monoclonal antibody known not to bind to neuroblastoma cells in vitro (FD44), there was no selective tumor uptake. Nine patients with histologically confirmed neuroblastoma each received 100 to 300 micrograms UJ13A radiolabeled with 1 to 2.8 mCi 123I or 131I. Sixteen positive sites were visible on gamma scans 1 to 7 days after injection: 15 were primary or secondary tumor sites, and one was a false positive; there were two false negatives. In two of the 15 positive sites, tumor had not been demonstrated by other imaging techniques; these were later confirmed as areas of malignant infiltration. No toxicity was encountered.

Adolescent↗
PubMed1984

Fourth International Workshop on Chromosomes in Leukemia 1982: Clinical significance of chromosomal abnormalities in acute nonlymphoblastic leukemia.

Seven hundred sixteen newly diagnosed patients were studied, to determine the clinical significance of chromosome analysis in ANLL. Karyotypes were classified in two ways. Cases were grouped into three categories, based on the presence of normal and abnormal metaphases. Cases were grouped into 12 categories based on more specific chromosome abnormalities (modified Chicago Classification). Both methods of classifying karyotypes, but especially the Chicago Classification, resulted in groups of patients with de novo ANLL with significantly different presenting clinical and hematologic features, including FAB type, leukocyte count, percent peripheral myeloblasts, platelet count, and DIC. Among patients with de novo ANLL, karyotypes, when classified according to the Chicago Classification, significantly correlated with frequency of initial complete remission and survival; the presence of normal and abnormal metaphases correlated with duration of first remission and survival. Among 305 intensively treated patients, the Chicago Classification also correlated with duration of first remission. Although both ways of classifying karyotype correlated with survival, even when other major risk factors in ANLL were considered, only the Chicago Classification was an independent prognostic factor among the intensively treated patients.

Acute Disease↗
PubMed1984

Allogeneic bone marrow transplantation as treatment for accelerating chronic myelogenous leukemia.

Sixteen patients with chronic myelogenous leukemia (CML) underwent allogeneic bone marrow transplantation (BMT) when they presented with or developed objective signs suggesting acceleration of disease. Patients have been followed for a median of 515 days (range 216-806 days). Seven patients are alive from 319 to 732 days (median 538 days). Four patients are in complete remission 501-732 days after BMT. Three patients have developed cytogenetic evidence of relapse after BMT; however, these patients are alive and not dependent on therapy and have normal activity levels at 319, 515, and 550 days following BMT. Three additional patients have developed cytogenetic and hematologic evidence of relapse after BMT, progressed to blast crisis, and died. Six patients have died of other causes. Allogeneic BMT can eradicate the abnormal clone and provide normal hematopoiesis when performed during the accelerated phase of CML; however, this approach is associated with relapse and with relatively high mortality. The long-term efficacy of this approach and the relative efficacy of transplant during acceleration rather than during the chronic phase of CML have yet to be established.

Adolescent↗
PubMed1983

Use of panels of monoclonal antibodies in the differential diagnosis of neuroblastoma and lymphoblastic disorders.

Panels of monoclonal antibodies offer a rapid and accurate adjunct to conventional techniques in the diagnosis of neuroblastoma, leukaemia, and lymphoblastic lymphoma. Heterogeneity of antigen expression is observed within a tumour type, and therefore a panel of reagents should be used for each malignancy investigated. Eight monoclonal antibodies which bind to neuroblastoma but not to normal bone marrow and five which bind to leukaemic and lymphoma cells but not to neuroblastoma have been selected for indirect-immunofluorescence testing of bone-marrow aspirates, frozen sections of tumours, and cells from malignant effusions. With this technique a confident diagnosis can be made within 2 h. Profiles of antibodies binding to tumour cells have been used to establish a definitive diagnosis in cases where conventional techniques have proved inadequate.

Adrenal Gland Neoplasms↗
PubMed1983

Volume and composition of hand sweat of White and Black men and women in desert walks.

Many investigators have sought, but failed to find, ethnic differences in the number and regional distribution of active sweat glands. In this study measurements have been made of sweat secreted on one hand and also on the whole body of Whites and Blacks walking in desert heat. Whites numbered 31 men and 27 women, ages 30 to 88 years; there were 21 Black men and 31 Black women, ages 16 to 61 years. Each walked on three occasions for 1 hour at a rate that required an oxygen consumption of about 40% of aerobic capacity. Ambient temperature ranged from 32 to 44 degrees C in 1979 and 1980; means were 38.4 degrees C in 1979 and 36.7 degrees C in 1980. There was no sweat in the gloves of many Blacks; this was true of only a few Whites. Volume of body sweat increased in both races with rate of walking; volume of hand sweat increased more in Whites than in Blacks. The Mann-Whitney test revealed that volumes of hand sweat were significantly greater for Whites than for Blacks. It was concluded that in desert walks most Whites and few Blacks sweat freely on their hands. In samples of hand sweat, Na+, K+, and Cl- were determined. Concentrations of each ion varied widely in both races, and were unrelated to race. Concentrations of Na+ and Cl- generally are somewhat higher in hand sweat than in body sweat; concentrations of K+ are much higher. It follows that the values for concentration of Na+ and Cl- reported in Table 3 probably are somewhat higher than would have been found in body sweat, and concentrations of K+ are probably much higher.

Adult↗
PubMed1983

A multidisciplinary approach to the evaluation and management of male sexual dysfunction.

We recently established a multidisciplinary center for the evaluation and treatment of male sexual dysfunction. The patients are seen in a single day by the endocrinologist, psychiatrist, psychologist, neurophysiologist and urologist. Laboratory studies include chemical and hormonal profiles, pudendal nerve latency testing and determination of the penile blood pressure. Nocturnal penile tumescence studies are done in selected cases. A diagnosis was made in 95 of 106 patients (90 per cent). The problem was psychogenic in 42 per cent of the patients, vascular and neurologic in 34 per cent, hormonal in 15 per cent, urologic in 7 per cent and medication-related in 2 per cent. The interdisciplinary approach to this problem allows for a more comprehensive and accurate evaluation, while providing a convenient service to the patient.

Adult↗
PubMed1983

Intensive therapy followed by bone marrow transplantation for patients with acute lymphocytic leukemia in second or subsequent remission: determination of prognostic factors (a report from the University of Minnesota Bone Marrow Transplantation Team).

Fifteen patients with acute lymphocytic leukemia (ALL) in second or subsequent remission received intensive therapy with cyclophosphamide and single dose, rapid rate (26 cGy/min) total body irradiation (TBI) followed by bone marrow transplantation (BMT) from a histocompatible sibling match. Outcome was compared to that of 23 conventionally treated control patients in second ALL remission who presented to the same institution during the same time period but had no available transplant donor. The 15 BMT patients and 23 control patients had similar characteristics, with the exception that the BMT patients were significantly older at the time of ALL diagnosis (12.6 yr versus 5.7 yr, p = 0.01). BMT patients had a significantly increased chance of remaining disease-free for 36 mo from time on study (43% actuarial versus 5%, p = 0.004) and a greater overall survival rate at 48 mo (47% actuarial versus 9%, p = 0.27) than the conventionally treated patients. In all, 5 of the bone marrow transplant patients (33%) remain alive and free of disease 24-48 + mo from transplantation. Several pre- and posttransplant characteristics were analyzed to determine predictive factors for a successful BMT outcome for patients with ALL in second or subsequent remission. Significant risk factors for predicting leukemic relapse included initial white blood count (WBC) greater than 50,000/microliters at ALL diagnosis (100% relapse rate versus 37% for patients with lower WBCs, p = 0.001) and presence of any extramedullary disease pre-BMT (100% relapse rate versus 37% for patients without extramedullary disease, p = 0.03). All 5 disease-free BMT survivors had initial WBCs less than 50,000/microliters and no evidence of extramedullary disease pretransplantation. Maintenance chemotherapy with 6-mercaptopurine (6MP) and methotrexate was given to four patients starting 100 days after bone marrow transplantation. Use of maintenance chemotherapy was associated with a significantly increased chance of remaining disease free (100% of patients surviving leukemia-free versus 17% for patients not receiving maintenance chemotherapy, p = 0.02). Presence of graft-versus-host disease (GVHD) did not influence leukemia-free survival. These results confirm that intensive therapy followed by bone marrow transplantation is the treatment of choice for patients with ALL in second or subsequent remission who have a histocompatible sibling match. Furthermore, the data suggest that a controlled trial to evaluate the efficacy of maintenance chemotherapy post-BMT for ALL patients is warranted.

Adolescent↗
PubMed1983

Total lymphoid irradiation and cyclophosphamide conditioning prior to bone marrow transplantation for patients with severe aplastic anemia.

A preparative regimen, consisting of total lymphoid irradiation and cyclophosphamide, was utilized in 40 patients with severe aplastic anemia undergoing allogeneic marrow transplantation. This regimen was successful in decreasing rejection in these previously transfused patients, as only one patient rejected the marrow graft. Twenty-nine of the 40 transplanted patients are surviving from 1.5 to 59 mo, with a median follow-up of 24 mo. The actuarial survival rate for these heavily transfused patients with aplastic anemia is 72% at 2 yr. This preparative regimen is extremely effective in decreasing rejection following transplantation for severe aplastic anemia. Future efforts in this area must be aimed at the elimination of graft-versus-host disease and control of fatal infections.

Adolescent↗
PubMed1982

Clinical usefulness of monoclonal-antibody phenotyping in childhood acute lymphoblastic leukemia.

Lymphoblasts from 59 children with non-T, non-B acute lymphoblastic leukaemia were studied with monoclonal antibodies to four cell-surface proteins. 87% of the children had lymphoblasts positive for HLA-DR, 82% for p30, 75% for p24, and 72% for CALLA. The commonest composite phenotype was HLA-DR+ p30+ CALLA+ p24+. Significant correlations were seen between expression of HLA-DR, p30, and CALLA, but not p24. p30- and CALLA phenotypes were found in patients with high white-blood-cell counts (WBC) and splenomegaly. With standard chemotherapy, disease-free survival from time of remission was shorter in p30- and CALLA- patients than in others. Splenomegaly was associated with poor disease-free survival and provided prognostic information independent of phenotype. High WBC was less significant than phenotype in predicting outcome and was not independent of phenotype.

Adolescent↗
PubMed1982

Tumor classification and size in germ-cell testicular cancer: influence on the occurrence of metastases.

The influence of local tumor spread (T-classification) and of tumor size on the occurrence of metastases was studied in 241 patients with testicular germ-cell neoplasms. All patients underwent thorough clinical or pathologic staging, or both, and were treated at the University of Minnesota Hospitals. Spread of tumor through the tunica vaginalis (T2) was associated with abdominal lymph node or distant metastases in eight of nine patients. Local tumor extension to the spermatic cord (T4a) was associated with metastatic spread in 29 of 31 men. Tumor size did not appear to correlate with metastatic rate. These findings are an important aid in designing adjuvant therapy trials and in establishing a "no treatment" approach after orchiectomy.

Adolescent↗