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Biomedical subjects

H Silberman

Publications and source records attributed to H Silberman.

At least 73 records · Page 4Linked to original sources
PubMed1979

Dilutions and specificity analysis of pretransplant sera.

Six serial dilutions of 51 sera from pretransplant patients were reacted against T and B lymphocytes at 5 degrees C and 37 degrees C. By the use of defined panels of T and B lymphocytes it could be shown that 10% of the 51 positive sera contained T-warm antibodies against HLA-A, -B, and -C specificities. There were 28% of the sera that had antibodies against non-HLA antigens reactive to B lymphocytes in the cold. Other sera contained mixtures of HLA and non-HLA antibodies. By dilution analysis of the sera, the mixtures could be detected and the HLA specificities identified. This ability to distinguish between HLA and non-HLA antibodies should be important in classifying pretransplant patients into high- and low-risk patients. Prior evidence that we have presented suggests that the non-HLA antibodies may be enhancing antibodies.

Antibody Specificity↗
PubMed1978

Antibody-dependent lymphocyte-mediated granulocyte cytotoxicity in man.

Sera from two patients with granulocytopenia associated with collagen vascular disease caused the destruction of normal human granulocytes by autologous lymphocytes in vitro. Granulocyte cytotoxicity was measured by the release of 51Cr during incubation with test sera and lymphocytes in microtiter plates. Between 8% and 46% granulocytoxicity was produced in granulocytes from 8 normal donors by the sera from these two patients. Less than 6% granulocytotoxicity was seen with the sera from 14 normal subjects and 29 patient controls. Treatment of lymphocyte preparations with carbonyl iron and magnetic separation to remove phagocytic cells or treatment with complement-coated red cells followed by repeated gradient centrifugation to remove complement receptor-bearing lymphocytes did not reduce the granulocytotoxicity. There was a dose-response relationship between the concentration of positive sera and granulocytotoxicity. When these sera were fractionated by Sephadex G-200 gel filtration and by ion-exchange chromatography with DEAE-cellulose, the active component appeared in the IgG-containing fractions. Thus, IgG antibody-dependent, lymphocyte-mediated granulocyte cytotoxicity represents a means of detecting human granulocyte antibodies and is a possible mechanism of autoimmune neutropenia in these two patients.

Antibody-Dependent Cell Cytotoxicity↗
PubMed1977

Parenteral nutrition with lipids.

Total parenteral nutrition with a peripherally administered fat emulsion as the major calorie source appears to be efficacious and safe. Such a regimen complements rather than replaces the glucose system an an important adjunct in patient therapy. The lipid system obviates the necessity for central venous administration, the major disadvantage of the glucose system, while the latter provides a greater caloric density.

Amino Acids↗
PubMed1977

The effect of hepatitis B antigenemia on long-term success and hepatic disease in renal transplant recipients.

The records of 192 cadaver renal allotransplants were reviewed in order to evaluate the role of the hepatitis B antigen (HBsAg) carrier state on graft function, patient survival, and the incidence of severe hepatic dysfunction. Twenty-one allografts were placed into patients with hepatitis B antigenemia. After follow-up ranging from 1.5 to 8 years (mean 4.7), graft and patient survivals were not statistically different from antigen-negative patients. In addition, the acquisition of HBsAg after grafting did not seem to affect the rate of graft failuue or death. Neither cirrhosis not fatal hepatic failure developed in the HBsAg carrier group, whereas five HBsAg-negative recipients died of hepatic disease. Among HBsAg-positive recipients, nine with functioning renal allografts and five with graft failures, there was a low incidence of e antigen, suggesting low infectivity. This may explain the lack of correlation of the surface antigen with serious liver disease. Severe hepatic disease developing in renal graft recipients is most likely attributable to causes other than hepatitis B infection. The presence of hepatitis B antigenemia alone should not be a deterrent to renal transplantation.

Cadaver↗
PubMed1977

Phase II study of oral methyl-CCNU and prednisone in previously treated alkylating agent-resistant multiple myeloma.

Thirteen patients with multiple myeloma (MM) who either failed to respond to or who were relapsing from standard agents and who received four or more courses of methyl-CCNU + prednisone (adequate drug trial) are reported in this paper. Methyl-CCNU was given orally before breakfast at 6-week intervals at a starting dose of 50 mg/m2 with the intention of increasing the dose to 100, 150, and 200 mg/m2 with each subsequent course. The dose of prednisone was 75 mg/day x 7 with each course. The response rate was 46% (six of 13 patients). No patient had better than a fair response. Drug toxicity, severe enough to prevent further dose escalation, was observed in every case. Prior BCNU therapy or the lack of response to previous alkylating agents did not prevent a response to methyl-CCNU + prednisone. The response rate of methyl-CCNU + prednisone in MM is comparable to the results achieved with other agents in similar groups of patients.

Administration, Oral↗
PubMed1977

Renal failure and the surgeon.

Surgical procedures can be accomplished successfully in patients with uremia provided certain principles of perioperative management are observed. Preoperative dialysis minimizes the biochemical derangements and improves fluid balance, hypertension and hemostasis. Drug schedules are adjusted in consideration of abnormal metabolism in renal disease. Anesthetic management is modified in recognition of potentially adverse or altered activity of anesthetic agents and neuromuscular relaxants. The lightest plane of anesthesia consistent with expeditious operative technique is maintained, since adequate tissue oxygenation is dependent upon increased cardiac output in these invariably anemic patients. Intraoperative hyperventilation sustains the usual compensatory mechanism for uremic metabolic acidosis in the conscious patient, thereby averting increments in serum potassium levels associated with increasing acidosis. Postoperative morbidity may include shunt thrombosis, infection, impaired wound healing, bleeding, pericarditis, pleuritis and pancreatitis. Hypervolemia and hyperkalemia are best managed by early postoperative dialysis. A period of nutritional support using intravenous essential L-amino acids and hypertonic glucose appears promising, especially when gastrointestinal dysfunction exists.

Anemia↗
PubMed1975

Gastric aneurysms: unusual lesions with lethal potential.

Extravisceral gastric aneurysms are rare lesions infrequently producing symptoms prior to life-threatening intraperitoneal rupture. Elective resection is indicated in those unusual cases diagnosed preoperatively. Ruptured visceral aneurysms should be included in the differential diagnosis of obscure intraperitoneal hemorrhage. In contrast, intramural gastric aneurysms produce massive hematemesis managed successfully in two cases by subtotal gastrectomy. Acknowledgment: I wish to thank Doctors Stephen A. Ockner and John Cacciamani for the kind referral of their patient and Doctor Edito Cabal, St. Louis Veterans Administration Hospital, who performed the arteriography.

Aneurysm↗
PubMed1974

Neoplasms of the small bowel.

Small bowel tumors are unusual lesions exhibiting nonspecific clinical features often diagnosed at an advanced stage. In the cases studied at the Hospital of the University of Pennsylvania nearly all the 32 patients with malignancies were symptomatic whereas in the 34 patients with benign lesions the condition was discovered as an incidental finding in about half of the patients. Weight loss, palpable mass or anemia usually indicated malignancy. Small bowel radiography was the most useful diagnostic aid in the present series. While the etiology of these lesions is unknown, villous adenomas probably bear a relationship to carcinoma. The association between chronic regional enteritis and small bowel tumors is unestablished but suggestive. An analysis of reported series reveals a disproportionate incidence of additional primary tumors in patients with small bowel neoplasms. Surgical extirpation is indicated for curative treatment. In the present series, resection in hope of cure was carried out in 25 of 32 malignant tumors resulting in eight five-year survivals. One of these latter lived nine years with disseminated malignant carcinoid reflecting the occasional indolent course of this tumor.

Adenocarcinoma↗