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Biomedical subjects

J A Penner

Publications and source records attributed to J A Penner.

At least 19 recordsLinked to original sources
PubMed1979

Gold-induced thrombocytopenia responsive to cyclophosphamide.

Thrombocytopenia and nephrotic syndrome developed in a 51-year-old patient receiving gold therapy for rheumatoid arthritis. Marrrow findings and platelet infusion studies were consistent with a pattern of increased platelet destruction, known to occur in gold-induced thrombocytopenia. Improvement in the platelet count after therapy with dimercaprol was transient, and although steroids and splenectomy were not effective, a response was achieved with cyclophosphamide. The use of immunosuppressive drugs can be considered in refractory cases of gold-induced thrombocytopenia in which a significant hemorrhagic risk is present.

Aurothioglucose↗
PubMed1979

Endotoxin-induced intravascular coagulation (DIC) and its therapy.

Anticoagulants in the form of heparin, dipyridimole, steroids, prostaglandin E1, Macrodex, and antithrombin III were administered in separate experiments prior to endotoxin infusion in the dog. The pattern of disseminated intravascular coagulation (DIC) developed consistently when endotoxin alone was administered. Heparin dosages from 1 to 10 mg/kg did not influence the appearance of thrombocytopenia but effectively eliminated the decrease in fibrinogen levels ordinarily found. Antithrombin III (AT III), obtained from the National Red Cross, administered in a dose designed to provide a doubling of the circulating AT III, reduced the fibrinogen utilization to a similar degree as heparin without affecting the platelet loss. Dipyridimole, as administered, was ineffective in this model, and did not alter the development of thrombocytopenia or the hypofibrinogenemia. Steroids, Macrodex, and prostaglandin E1 had minimal effect on the coagulopathy. Our finding would suggest that the endotoxin effect on dog platelets id direct, and not mediated by thrombin, and that the role of heparin in the clinical management of DIC should be considered only in instances in which renal complications exist.

Animals↗
PubMed1977

The effect of propranolol on hemolysis in patients with an aortic prosthetic valve.

Propranolol was given to five patients with severe hemolytic anemia from arotic prostheses. Red cell survival, lactic dehydrogenase, serum hemoglobin, and 24 hour urine iron values were used to evaluate the severity of hemolysis with and without propranolol treatment. Three patients had a clear decrease in the level of hemolysis with propranolol therapy. One patient developed congestive failure after 6 months on propranolol. The decrease in hemolysis is most likely related to a slower heart rate.

Anemia, Hemolytic↗
PubMed1977

Fatal colitis in a hemophilic patient with inhibitor.

A severe colitis developed in a hemophilic patient following an antibiotic regimen which included clindamycin. A surgical procedure, total hip replacement, had been complicated by the appearance of a powerful factor VIII inhibitor and a Bacteroides fragilis infection. The resulting bleeding diathesis was successfully managed with the use of an "activated prothrombin complex"; however, the occurrence of colitis following intravenous clindamycin therapy proved to be fatal. Clindamycin, like the related antibiotic lincomycin, appears to have significant intestinal toxicity and should be restricted to the treatment of life-threatening proven Bacteroides infections.

Adult↗
PubMed1977

Prothrombin complex concentrates.

The use of the prothrombin complex products for the treatment of inhibitor patients is discussed in relation to our difficulty in identifying the effective therapeutic principle, as well as the factors responsible for thrombogenicity. It would appear that combination of factors is responsible for either or both therapeutic and thrombogenic phenomena. Possible intermediate or aggregate forms of the procoagulants are present in the products, protected from the neutralizing effects of antithrombin III.

Antithrombin III↗
PubMed1976

Antihemophilic factor inhibitors. Management with prothrombin complex concentrates.

Prothrombin complex concentrates have been evaluated in the treatment of acute bleeding episodes occurring in 11 hemophilic and two nonhemophilic patients with factor VIII inhibitors. In several of the hemophilic patients, a continued fall in inhibitor levels has been observed coincident with continued use of the concentrate Proplex, and one of these patients is now responsive to factor VIII therapy. The therapeutic effectiveness of prothrombin complex products appears to be related to the presence of small amounts of activated factors or to the continued formation of factor Xa in vivo as a result of the increased levels of prothrombin and factors VII and X. Until high-potency activated products are available, prothrombin concentrates offer an effective means of treating patients with factor VIII inhibitor.

Acute Disease↗
PubMed1976

Lymphomas of the masticator space.

Lymphomas that involved the masticatory space occurred in three patients. In one patient, the masticator space remained the sole manifestation for many years; in the other two patients, the masticator-space involvement was a local manifestation of constitutional disease. In all three patients, excisional biopsies and microscopical tissue examinations were carried out because of a mass deep to the parotid gland. The symptoms and signs are quite similar to those manifested in patients with infection. Surgical procedures other than incisional biopsy are not indicated. Irradiation and chemotherapy appear to be the treatments of choice.

Adult↗
PubMed1976

Treatment of refractory thrombocytopenic purpura with cyclophosphamine.

Cyclophosphamide, an immunosuppressive agent, was administered as an additional mode of therapy to 30 patients with idiopathic thrombocytopenic purpura (ITP) refractory to conventional management. Of 22 previously tested by splenectomy an excellent response was achieved in 12, who remained in complete hematologic remission for 14-96 months after therapy was discontinued; a fair response in 3, with definite increase in platelets, but not to normal levels; and a poor response in 7 who failed to improve. Of 8 nonsplenectomized patients who failed to respond to steroids or maintain a response after steroids were discontinued, 4 were considered excellent, 1 required continued therapy to remain in remission (good response), 2 were fair, and 1 was poor. Remission was observed in 2-10 weeks in both groups and appeared to be related to duration of disease; presence of disease for less than 1 year was associated with a much better response to treatment (11 of 15) when compared with disorders lasting over 2 years (6 of 15). Cyclophosphamide therapy offers additional means of treating patients with ITP who fail to respond to conventional therapy and may serve as an alternative to splenectomy when surgery is contraindicated.

Adolescent↗