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Biomedical subjects

J Aisner

Publications and source records attributed to J Aisner.

At least 217 records · Page 12Linked to original sources
PubMed1976

Torulopsis glabrata infections in patients with cancer. Increasing incidence and relationship to colonization.

Torulopsis glabrata, an opportunistic pathogen, was found to be the etiologic agent of infections in patients with cancer. This observation prompted a retrospective review to determine the incidence and underlying factors of infection with this organism. This study showed that T. glabrata had been cultured frequently and that the incidence of infection has been progressively increasing. During a 48-month period (9/70-8/74), T. glabrata was cultured from routine surveillance and diagnostic cultures in 167 patients, 27 of whom had either presumed or documented infection. Review of clinical and necropsy records implicated T. glabrata infections as a contributory factor in the death of 14 of the 27 patients. Etiologic diagnosis of infection was established antemortem in only three patients. Pulmonary isolation in pure growth occurred in 24 of the 27 patients. Seventeen of 19 infected patients who had prior routine surveillance cultures were colonized prior to infection. Infection occurred in the setting of far advanced malignancy or leukopenia and followed the use of systemic, broad spectrum antibiotics. T. glabrata is a frequently overlooked opportunistic pathogen which, in the proper setting, appears to be producing increasing numbers of infections.

Bone Neoplasms↗
PubMed1976

Clinical experience with transfusion of cryopreserved platelets.

Multiple units of platelet concentrate obtained by plateletpheresis of normal, 'random' or HL-A matched donors were pooled and frozen in polyolefin bags using 5% dimethysulphoxide (DMSO) as a cryoprotective agent and a controlled freezing rate of I degrees C/min. The platelets were stored at approximately-I20 degrees C for as long as 20I days, thawed rapidly at 37 degrees C, washed once and resuspended in ACD plasma prior to transfusion. Two different final concentrations of platelets (approximately 2.7 and 9.0 X 10(12)/1.) were studied. Twenty-three thrombocytopenic patients have received a total of 40 frozen platelet transfusions. The mean freeze-thaw loss was 2I% and was similar for both platelet concentrations. All transfusions were well tolerated and there were no side effects attributable to the small amounts of DMSO infused. Increments in platelet counts I h after transfusion ranged from 0 to 102 X 10(9)/1. with an overall mean corrected increase in evaluable patients of 12 800 (increase x surface area (m2)/number of platelets transfused x 10(11)). Corrected increases tended to be greater with the low concentration of platelets. Overall, the increase in count for the frozen platelet transfusions was 65% of the increments obtained with fresh platelet transfusions administered within 1 week of the frozen platelets. Bleeding times were partially corrected after four out of six transfusions with post-transfusion counts greater than 50 X 10(9)/1., and active haemorrhage was controlled in some patients by frozen platelet transfusions. These results indicate that pooled platelets can be frozen, thawed and transfused with reasonable efficiency. The frozen platelets can circulate and function haemostatically and may eventually play an important role in supportive care.

Blood Cell Count↗
PubMed1976

Transtracheal selective bronchial brushing for pulmonary infiltrates in patients with cancer.

Patients with cancer frequently develop pneumonitis for which no cause is documented ante mortem. Noninvasive diagnostic techniques, such as sputum induction, are generally inadequate, especially in myelosuppressed patients. To avoid pulmonary contamination with organisms colonizing the oronasopharynx and to obtain uncontaminated speciemens, 38 patients underwent bronchial brushing utilizing a transtracheal approach after sputum induction and transtracheal aspiration failed to establish the etiology. Patients with thrombocytopenia were brushed after platelet transfusion. Eleven patients were not clinically considered to be infected; seven proved to have pulmonary metastases, of which one case was diagnosed by this technique; and four patients in whom no diagnosis was obtained by brushing subsequently proved to have interstitial fibrosis (three cases) or a collapsed lobe (one case). Twenty-seven patients were clinically presumed to be infected. Ultimately, 17 of these 27 patients were proven to have pulmonary infection, and 14 of these 17 were etiologically documented by brushing. In ten of the 27 patients presumed to be infected, no etiology could be established by any method. Seven of these ten patients were receiving broad-spectrum antibiotic therapy at the time. Significant but nonfatal complications, including hemoptysis, pneumothorax, and cervical cellulitis, occurred in seven patients; however, this procedure is a relatively safe and useful method to include in the orderly evaluation of myelosuppressed cancer patients with suspected pulmonary infections.

Bronchi↗
PubMed1976

Randomized clinical comparison of daunorubicin (NSC-82151) alone with a combination of daunorubicin, cytosine arabinoside (NSC-63878), 6-thioguanine (NSC-752), and pyrimethamine (NSC-3061) for the treatment of acute nonlymphocytic leukemia.

Sixty-six newly diagnosed patients with acute nonlymphocytic leukemia received either daunorubicin alone or a combination of daunorubicin, cytosine arabinoside, 6-thioguanine, and pyrimethamine for remission-induction therapy. The two treatment groups were comparable with respect to the two major prognostic factors in this disease, which were age and presence or absence of infection on admission. The two therapies produced similar results with respect to CR rate and median survival results. Single-agent therapy was associated with less frequent utilization of hospital inpatient facilities and fewer platelet transfusions. The four-drug combination did not decrease the incidence of meningeal leukemia. Patients who achieved CR were treated with two half-dose consolidation courses of the successful remission-induction regimen. Subsequently, all patients received cyclophosphamide and guanazole monthly for maintenance therapy. Median durations of remission for both induction-treatment groups were similar (6.8 and 5.6 mos). The therapeutic results with the single agent in this study were not inferior to those obtained with the drug combination tested, as well as most other previously reported combinations of antileukemic drugs.

Acute Disease↗
PubMed1975

Clinical experience with transfusion of granulocytes obtained by continuous flow filtration leukopheresis.

Granulocytes obtained by continuous flow filtration leukopheresis (CFFL) were transfused to 21 patients on 131 occasions. An average of 28.2 times 10-9 granulocytes were administered per transfusion. These cells were more than 90 per cent viable by dye exclusion, ingested latex particles normally and had almost normal bactericidal activity. Migration to skin windows was demonstrated on four of six attempts, but 51-Cr-labeling studies failed to show localization in infected areas on six occasions. Post-transfusion granulocyte count increments averaged 225/mul and were transient. Significant transfusion reactions occurred during 35 transfusions to 13 patients. Reactions occurred in some patients without demonstrable alloimmunization and after six infusions of HL-A identical or compatible cells. Definite clinical improvement was noted in three recipients. Stabilization of infection with patient survival occurred nine times, and progression of infection with death eight times. Granulocytes obtained by CFFL are viable and functional. Their transfusion is not without risk and must still be considered an investigative procedure of suggestive but as yet unproved clinical efficacy.

Acute Disease↗
PubMed1975

Transient neutropenia induced by transfusion of blood exposed to nylon fiber filters.

During the course of granulocyte collection by continuous-flow filtration leukopheresis, an abrupt fall in neutrophil count was noted (mean decrease 77%, range 64%-95%). Neutropenia occurred within 5 min of return of blood exposed to the nylon fiber filters and lasted less than 30 min. Saline exposed to the fibers, withdrawal and reinfusion of whole blood, and heparin did not cause neutropenia. Heparinized blood passed by gravity through isolated filters and reinfused immediately also induced neutropenia (mean decrease 64% +/- 8%, range 11%-19%). Blood anticoagulated with ACD (decrease 19.5% +/- 6%, range 6%-56%), heparinized plasma (N = 10, decrease 15% +/- 3%, range 3%-29%) and platelet-rich plasma exposed to the filters failed to produce neutropenia. 91% +/- 2% of the neutrophils adhered to the fibers using heparinized blood as compared to 21% +/- 5% using ACD (p less than 0.001). All donors were asymptomatic during the infusions. These results suggest that during neutrophil adherence a substance is released which produces profound, transient neutropenia perhaps by inducing margination of cells.

Agranulocytosis↗
PubMedDate not supplied

Initial observations on the effects of delta 9-tetrahydrocannabinol on the plasma pharmacokinetics of cyclophosphamide and doxorubicin.

We studied the effect of THC upon the pharmacokinetics of cyclophosphamide (CTX) and doxorubicin (ADR). Plasma THC was determined by RIA. Plasma concentrations of CTX and ADR were measured by GLC and fluorescence, respectively. RIA confirmed plasma levels of THC greater than 20 ng/ml for patients who received THC. CTX half-life was not significantly changed with use of THC (7.7 +/- 3.6 hours without versus 5.25 +/- 2.6 hours with THC). ADR half-life with THC was greater than without THC (175 +/- 197 hours versus 92 +/- 92 hours, respectively). Total drug exposure as determined by areas under the curves were similar (12.4 +/- 6 microM . hr without versus 13.8 +/- 4 microM . hr with THC). These preliminary data suggest that RIA is reliable for assessing THC plasma concentrations. THC induces no apparent alterations of CTX or ADR pharmacokinetics.

Cyclophosphamide↗
PubMedDate not supplied

The effect of hydroxyethyl starch on in vitro platelet and granulocyte function.

The effect of hydroxyethyl starch (HES) on granulocyte and platelet functions was assessed. No alteration of granulocyte viability, morphology, phagocytic ability, or bactericidal capacity was detected after incubation with 6 per cent HES at 25 C for two hours. Platelet morphology, size distribution, aggregation, nucleotide and serotonin release, and platelet factor-3 availability were also unchanged after exposure to HES. It is concluded that HES has no adverse effect on cell function and appears to be a suitable adjuvant agent for blood cell component collection.

Blood Bactericidal Activity↗
PubMedDate not supplied

Frozen autologous platelets in the supportive care of patients with leukemia.

Multiple units of platelet concentrate obtained by intensive plateletpheresis of patients with leukemia in remission were pooled and frozen using 4 to 5 per cent dimethylsulfoxide and retransfused during periods of thrombocytopenia. Plateletpheresis was well tolerated by all donors and an average platelet yield per unit of 0.99 X 10(11) (n = 155) was obtained. The results of 107 transfusions to 36 patients are presented. An average of 32.4 per cent of the platelets were lost during the freeze-thaw process. Freezing loss was lowest at a freezing rate of one degree C per minute, at a lower final concentration of platelets, and when polyolefin bags were used. The mean corrected posttransfusion count increment was 6,400/mul (range 600-19,000 xm2/10(11) platelets transfused). In vivo results did not correlate with freezing rate but were statistically significantly better at lower platelet (approximately 0.16 X 10(11) platelets/10 ml) concentrations. Eleven patients, including some who were refractory to random donor platelets were supported entirely with autologous platelets during reinduction therapy for leukemia. When administered prophylactically the autologous platelets seemed to prevent hemorrhage during periods of thromobocytopenia although in most patients bleeding times were not corrected posttransfusion. This study demonstrates that frozen autologous platelets can be used in the supportive care of thrombocytopenic patients. Further technical improvements are necessary before platelet freezing becomes practical for widespread use.

Blood Cell Count↗
PubMedDate not supplied

A standardized technique for efficient platelet and leukocyte collection using the Model 30 Blood Processor.

The Model 30 Blood Processor is a safe and simple means of harvesting blood cell components. Presently cell collection depends on a visual assessment by the operator of the indistinct boundaries of cell fractions. To determine when each cell component could best be harvested, serial samples were taken from the output port at fixed intervals anf the results of counts and differentials were graphed and tabulated. Studies in normal donors were done using acid-citrate-dextrose (ACD), 2 per cent sodium citrate in 6 per cent hydroxyethyl starch (HES), or heparin as anticoagulants. There was considerable overlap between the latter part of the platelet band, the leukocyte band and the rising hematocrit with all three anticoagulants. Normally functional lymphocytes could be harvested efficiently (approximately 80%) using ACD or heparin. Platelets could be harvested from ACD very efficiently (approximately 90%). Granulocytes could not be harvested from ACD (less than 10%) since they were dispersed in the red blood cell (RBC) layer. Using HES, granulocytes could be harvested efficiently (approximately 70%) by extending collection into the RBC layer. Based on these data, a standard technique for cell collection has been devised. The flow rate is slowed to 20 ml/min and collection is carried 30 ml (90 seconds at a rate of 20 ml/min) for platelets. The RBC loss is approximately 6 to 8 and 2 to 3 ml/pass respectively. These studies indicate that the Model 30 is a highly efficient apparatus for blood cell separation, but the volume of blood processed is limited by the intermittent blood flow.

Blood Cell Count↗
PubMedDate not supplied

Failure of postfiltration leukapheresis plasma to increase granulocyte yields.

Autologous plasma collected either during or immediately after continuous flow filtration leukapheresis (CFFL) was infused prior to subsequent donations in an attempt to induce granulocytosis and to augment granulocyte yields. Granulocytosis did not occur in the 15 to 20 minutes following plasma administration and no increase in granulocyte yields could be demonstrated. In addition, the plasma infusion did not affect the timing or magnitude of the transient granulocytopenia which characteristically occurs during CFFL. Although infusion of postfiltration leukapheresis plasma does not appear to feasible or practical means of enhancing granulocyte collection, it may still serve as a valuable tool in the study of granulocyte kinetics.

Agranulocytosis↗
PubMedDate not supplied

A comparison of platelets prepared by the Haemonetics Model 30 and multiunit bag plateletpheresis.

Platelet concentrates were prepared using the Haemonetics Model 30 (M-30) and a multiunit bag pheresis method. Comparisons of collection efficiency using paired donor collections and posttransfusion recovery using the same donor-recipient pairs were made for the two methods. The M-30 proved consistently superior as a method of collection in terms of efficiency and yield per hour (p less than .001). When the platelets obtained were transfused to HL-A matched, clinically stable, thrombocytopenic patients with acute leukemia similar increments within the expected range were obtained at 1 hour and 18 hours posttransfusion. While the M-30 is a more efficient collection method, the bag method is still relatively efficient and may be more suitable for smaller centers and specialized uses.

ABO Blood-Group System↗