Search PubMed⌕ Search

Biomedical subjects

D Goldfinger

Publications and source records attributed to D Goldfinger.

At least 55 records · Page 3Linked to original sources
PubMed1982

Use of lymphoplasmapheresis or plasmapheresis in the management of acute renal allograft rejection.

Several recent reports have documented the value of intensive plasmapheresis as an adjunct to standard immunosuppressive therapy for patients suffering acute renal allograft rejection. We have treated four rejection episodes in three patients with intensive plasmapheresis and two rejection episodes in two additional patients with intensive lymphoplasmapheresis. Five of six rejection episodes were reversed, and four of the five patients treated have retained functioning grafts for follow-up periods ranging from 4 months to 3 years. Previous investigators have reported encouraging results using plasmapheresis, and we believe our experience supports the requirement for further controlled studies with this procedure. Moreover, we note that no previous work has been described with lymphoplasmapheresis and suggest that removal of lymphocytes, in addition to plasma, may further augment immunosuppression in the treatment of renal allograft rejection.

Acute Disease↗
PubMed1982

Plasmapheresis in lupus nephritis with nephrotic syndrome: a long-term followup.

Lupus nephritis with nephrotic syndrome is one of the most serious complications of systemic lupus erythematosus. Six female patients with systemic lupus and nephrotic syndrome, refractory to immunosuppressive drug therapy, received 15-20 exchange plasmaphereses. One patient, treated concurrently with high-dose steroids, showed temporary improvement, and five patients, treated concurrently with steroids and either cyclophosphamide or azathioprine, had long-term remissions. Plasmapheresis is a promising therapeutic modality in cases of refractory lupus nephritis with nephrotic syndrome.

Adolescent↗
PubMed1982

Ineffectiveness of aspirin and dipyridamole in the treatment of thrombotic thrombocytopenic purpura.

Platelet-inhibiting drugs have been used widely in the treatment of thrombotic thrombocytopenia purpura. Nineteen consecutive patients received various treatments including platelet inhibitors, glucocorticoid drugs, whole blood or plasma exchange transfusions, and splenectomy. During treatment with aspirin and dipyridamole in 14 patients, five died, and only one had neither new neurologic signs nor worsening thrombocytopenia. Prostacyclin in one patient was not beneficial. Serious bleeding complications, including massive upper gastrointestinal hemorrhage, epistaxes, or subarachnoid hemorrhage confirmed at autopsy, occurred in five of the 19 patients and only during treatment with aspirin and dipyridamole. We conclude that there is no evidence for the effectiveness of aspirin and dipyridamole in the treatment of thrombotic thrombocytopenic purpura and that these drugs may increase the risk of serious bleeding complications.

Adolescent↗
PubMed1981

Current status of therapeutic apheresis in rheumatoid arthritis.

Evidence developed over the years has suggested that lymphocyte depletion and removal of plasma factors can ameliorate rheumatoid arthritis. In our studies of 40 patients, a subset of patients that respond best to 20 therapeutic lymphoplasmapheresis over 11 weeks has emerged. These are functional Class III patients with seropositive, erosive progressive disease who have little deformity. They must be on long-acting agents or cytotoxic drugs during pheresis to prevent antibody rebound. Other studies have since confirmed our work. The major side effects of pheresis are elucidated. Technologic developments will enable selective pheresis procedures to be in widespread use within a few years.

Arthritis, Rheumatoid↗
PubMed1980

Advances in the use of therapeutic pheresis for the management of rheumatic diseases.

Twenty-two patients with rheumatoid arthritis, 3 with seronegative juvenile rheumatoid arthritis, 4 with systemic lupus erythematosus, and 4 with psoriatic arthritis have undergone therapeutic pheresis at our institution over the last 3 yr. Lymphoplasmapheresis appears to be the most effective form of pheresis in treating rheumatoid arthritis. After achieving a remission with 20 treatments performed in 11 wk, a flare may be preventable by pheresing patients 3 times a week every 6 wk provided the patient is on a concomitant, long-acting agent. Therapeutic pheresis has been disappointing in seronegative juvenile rheumatoid arthritis. Life-threatening complications of systemic lupus erythematosus may respond dramatically to pheresis. In treating less severe disease on a long-term basis, pheresis has demonstrated excellent steroid sparing properties. Nonspondylytic psoriatic arthritis responds slowly to pheresis, but arthritic remissions may be prolonged, even though skin response is variable. Experience in the use of pheresis for treating these diseases has allowed for the development of criteria for deciding whether to institute such therapy as an adjunct to more standard modes of treatment for individual patients. Also, a variety of "technical" factors can influence the outcome of therapy, and these must be managed appropriately. Therapeutic pheresis is a promising tool for investigating and treating rheumatic diseases.

Adolescent↗
PubMed1979

RBC exchange pheresis for priapism in sickle cell disease.

An intermittent-flow blood cell separator was used to perform a sub-total RBC exchange pheresis with prompt relief or priapism secondary to sickle cell disease. The blood cell separator offers an efficient, practical, safe method of performing exchange transfusion in the adult. Surgical procedures in the treatment of priapism have met with limited success and carry a 50% rate of subsequent impotence. We believe that RBC exchange pheresis offers a superior approach in the treatment of complications of sickle cell crisis, including priapism, and should be instituted in the symptomatic patient before more drastic procedures are undertaken.

Adult↗
PubMed1979

Plasmapheresis and lymphoplasmapheresis in the management of rheumatoid arthritis.

We have demonstrated the efficacy of therapeutic pheresis in a number of rheumatic diseases, especially rheumatoid arthritis (RA). Ten of 12 patients with RA went into remissions averaging 4 months. These patients were pheresed 20 times over 11 weeks in a tapering fashion on a Haemonetics Model 30 Blood Processor. Clinical remissions were sustained even though serologies, immunoglobulins, immune functions, sedimentation rates, and circulating immune complexes returned to their pre-pheresis baseline by pheresis number 20. All these patients were taking gold or D-penicillamine concurrently, but neither of the 2 patients who failed to respond was on these agents. Plasmapheresis was just as effective as lymphoplasmapheresis. It is theorized that removal of a plasma factor that modulates lymphocyte or neutrophil function produces remissions in RA and that long-acting drugs (e.g., gold or penicillamine) are able to prevent its continued production and produce a sustained remission.

Adult↗
PubMed1976

Anti-Wrb, and other autoantibodies responsible for positive direct antiglobulin tests in 150 individuals.

Eluates from the red blood cells (and sera whenever free autoantibody was present) of 150 individuals with positive direct antiglobulin tests, have been studied for antibody specificity. Of 87 patients with AIHA, 64 had autoantibodies reacting with all red cell samples including Rhnu11. Of these 64 anti-d1 autoantibodies, two were, and 32 contained, auto-anti-Wrb. Of 33 patients being treated with alphamethyldopa, who had developed positive direct antiglobulin tests, 23 had anti-d1 autoantibodies four of which contained auto-anti-Wrb. Of 30 haematologically normal donors with positive direct antiglobulin tests, 23 had anti-d1 autoantibodies, two of which were, and six of which contained, auto-anti-Wrb. The full specificities of autoantibodies, other than anti-Wrb and anti-d1, in the 150 patients are described, as are the natures of the protein red cell coatings that caused the positive direct antiglobulin tests. The presence of free serum autoantibody as a correlate of the three clinical conditions is reported. Several observations on auto-anti-Wrb are documented. The antibody can cause gross red cell destruction in vivo, but can be benign on other occasions; it occurs with approximately the same frequency in AIHA patients and "normal" donors with positive direct antiglobulin tests, but in fewer patients with alphamethydopa induced positive direct antiglobulin tests; it does not activate complement in vivo; and finally it may eventually provide a clue to the aetiology of AIHA.

Anemia, Hemolytic, Autoimmune↗
PubMedDate not supplied

An autoantibody with anti-Wrb specificity in a patient with warm autoimmune hemolytic anemia.

A patient with warm autoimmune hemolytic anemia (AIHA) has been found to possess an autoantibody with Wrb specificity. While this is the first known description of Wrb specificity in this disease, additional studies on the Wrb status of En(a-) cells indicate that autoantibodies previously thought to be anti-Ena are in reality also anti-Wrb. Autoantibodies with Wrb specificity may thus be a rather common finding in patients with AIHA who have been thought to have "panagglutinins" on their red blood cells. Since anti-Wra alloantibodies are found frequently in patients with AIHA, it seems possible that the Wright system holds some clue to the pathogenesis of this disease.

Anemia, Hemolytic, Autoimmune↗
PubMedDate not supplied

An En(a-) red cell sample that types as Wr(a-b-).

In the course of investigating a patient with autoimmune hemolytic anemia in which the causative autoantibody had anti-Wrb specificity, it was demonstrated that an En(a-) red blood cell sample typed as Wr(a-b-). The only known example of Wr(a+b-) blood typed as En(a+) so that anti-Wrb and anti-Ena do not have the same specificity.

Anemia, Hemolytic, Autoimmune↗
PubMedDate not supplied

Autologous blood transfusion in coronary artery bypass surgery.

Forty-four patients undergoing coronary artery bypass surgery participated in an autologous blood donor program. Blood was collected at weekly intervals up to three days prior to the scheduled date of surgery. Sixteen patients donated a total of two autologous units each, and 28 patients donated one autologous unit each. No donor morbidity or mortality was encountered during or following blood donation. Autologous blood accounted for more than one-third of all blood required by these patients throughout their hospital courses. Autologous transfusion appears to be a safe procedure for patients with severe coronary artery disease.

Adult↗