Search PubMed⌕ Search

Biomedical subjects

J Aisner

Publications and source records attributed to J Aisner.

At least 235 records · Page 13Linked to original sources
PubMedDate not supplied

Potential HLA-matched platelet donor availability for alloimmunized patients.

An analysis of the computer searches for HLA-matched donors was done for 100 alloimmunized patients requiring HLA-matched platelet transfusion support. With a pool of 2470 donors, an average of only 1.3 (range 0-14) perfectly matched donors were potentially available per patient. Patients had an average of 9 donors with no mismatched antigens. Although the number of potential donors increased when cross reactive or single antigen mismatches were considered, our estimate of donor availability of this type is lower than reported previously. More donors were identified for the 39 patients with relatively common genotypes than for the remaining 61 patients. Of the latter group, 25 patients did not have any potential donors with "no mismatches" while in most of the others the only suitable donor was a family member. These data suggest that, given the limitations of platelet donor selection using current HLA typing technology, it may be difficult to provide long-term platelet transfusion support for alloimmunized patients with unusual HLA types. This fact should be considered when planning intensive therapeutic regimens for alloimmunized patients with leukemia.

Blood Grouping and Crossmatching↗
PubMedDate not supplied

Donor reaction to hydroxyethyl starch during granulocytapheresis.

Granulocyte transfusion therapy has become relatively routine in centers treating patients with hematologic malignancies. The yield of granulocytes has been improved with newer leukapheresis techniques, premedication with corticosteroids, and the use of sedimenting agents, usually hydroxyethyl starch. Despite the relative safety of these techniques, there are risks to participating donors. A case of a donor reaction related to hydroxyethyl starch is presented. This report is a reminder that leukapheresis must be performed with careful consideration of therapeutic benefit-to-risk ratios.

Anaphylaxis↗
PubMedDate not supplied

Use of the computed tomographic whole body scanner to stage and follow patients with advanced ovarian carcinoma.

Advanced ovarian carcinoma continues to be a difficult tumor to evaluate noninvasively. Recent developments in chemotherapy have enhanced response rates in this disease, thus improving the likelihood of tumor regression. Computed Tomography (CT) allows the noninvasive estimation of tumor extent in patients with ovarian carcinoma. Seventeen patients with epithelial ovarian carcinoma had 22 whole body CT scans performed either just prior to or following laparotomy. For determination of tumor involvement, when the CT was positive, a high pathologic correlation was found at liver, ascitic, peritoneal, mesenteric, and omental sites (sensitivity). When the cT was negative, high pathologic correlation was found at ascitic and mesenteric sites (specificity). Lower and negative correlation at other disease sites is attributed to difficulty of CT detection of small (1 cm) tumor nodules on visceral surfaces. Eighteen patients with advanced ovarian carcinoma were followed prospectively during treatment with repetitive CT scans. CT results were compared with physical examination, other radiologic studies, and clinical status. In 83% (15/18) of patients and 88% (59/67) of CT scans performed, CT was found to contribute useful management information. Clinical decisions were made on the basis of CT alone in 43% (29/67) of scans performed. These data suggest that CT scanning is very useful in the staging and follow-up of patients with ovarian carcinoma and can replace other radiologic procedures, but it is not completely accurate and needs to be correlated with physical examination and in cases without tumors visible with CT, with laparotomy.

Female↗
PubMedDate not supplied

Protein calorie malnutrition and cancer therapy.

Anorexia and cachexia frequently complicate the late stages of malignancy and may be a prominent feature of early disease. The resulting weight loss often becomes a major focus of concern for the patient and the family and may significantly add to the morbidity and mortality of cancer. Factors which contribute to the wasting syndrome include the effects of the tumour, effects of chemotherapy, abnormalities of carbohydrate, fat and protein metabolism and the cytokine response. Administration of total parenteral nutrition (TPN) is an important method of addressing malnutrition, particularly in patients with nonfunctioning gastrointestinal tracts. A critical review of the TPN cancer literature is provided along with a discussion of new approaches and future directions in the nutritional support of patients with malignant disease, such as anabolic agents, hydrazine sulfate and megestrol.

Anorexia↗
PubMedDate not supplied

Meningeal carcinomatosis from small cell carcinoma of the lung. Consequence of improved survival.

The cells of oat cell carcinoma of the lung can be identified in sputum because of their characteristic morphologic appearance. The cells from oat cell carcinomas can also be identified in other body fluids but are seen there less often. Spinal fluid involvement with oat cell carcinoma has been seen very infrequently, presumably because of a poor survival rate. Aggressive systemic chemotherapy has improved survival, and meningeal involvement is now being recognized as a complication. Of 62 patients treated by aggressive chemotherapy protocols, six (10%) were found to have leptomeningeal involvement by cytologic evaluation of cerebrospinal fluid (CSF). Involvement was found 6 to 13 months after the initiation of therapy. Two of the six patients had no evidence of CNS metastases by CAT brain scan. Necropsy was performed in three of the six cases and showed excellent histologic correlation with the cytologic findings. Because of most therapeutic drugs' poor penetration into the CSF, and because the spinal cord is not routinely irradiated, cytologic examination of the CSF from patients with oat cell carcinoma is necessary when there are new neurologic signs or symptoms to ensure proper, specific therapy.

Carcinoma, Small Cell↗
PubMedDate not supplied

Value of prophylactic cranial irradiation given at complete remission in small cell lung carcinoma.

The optimal use of "prophylactic" cranial irradiation (PCI) in patients with small cell lung cancer remains undetermined. This study reviews the impact of PCI, given at complete remission (CR), on neurologic relapse in 172 consecutive patients with small cell lung cancer treated in three sequential chemotherapy protocols at the University of Maryland Cancer Center. In the first study of 38 patients, none received PCI. In the second study of 109 patients, the first 28 achieving CR were randomized to 3000 rad of PCI in ten fractions (PCI+) or to observation (PCI-). Thereafter, based on interim analysis, all patients achieving CR received PCI. In the third study, to date, 25 patients achieving CR have received PCI. Overall, 169 patients were evaluable for neurologic relapse, and 30 of 90 patients achieving CR received PCI. Among all patients with CR, with adjustment for disease extent, there was a significant delay to any neurologic relapse (P = 0.01) and cerebral metastases (P = 0.02) for PCI+ compared to PCI- patients. Among PCI- patients with CR, cerebral metastases alone occurred in 28% as the sole site and in 33% as the initial site, whereas cerebral relapse occurred prior to systemic relapse in only one PCI+ patient with CR. Patient survival however, was not significantly altered by PCI. PCI at CR confers effective and worthwhile local control in the CNS, especially during periods of systemic response, and a small percentage of patients may benefit. Systemic drug resistance still determines overall survival.

Adult↗
PubMedDate not supplied

High-dose cisplatin therapy using mannitol versus furosemide diuresis: comparative pharmacokinetics and toxicity.

The dose-limiting toxic effect of high-dose (100 mg/m2) cisplatin is renal insufficiency. Hydration with furosemide- or mannitol-induced diuresis has been reported to ameliorate this toxicity. Animal studies suggest that mannitol may be superior to furosemide in this regard. Twenty-two patients with advanced neoplasms refractory to conventional therapy were treated with cisplatin at a dose of 100 mg/m2 every 21--28 days. Patients were randomized to receive 37.5 g of mannitol by 6-hour infusion with cisplatin or 40 mg of furosemide prior to cisplatin therapy. Hydration with at least 1 liter of normal saline was given prior to cisplatin. Nephrotoxicity (creatinine greater than 2 mg/100 ml, creatinine clearance greater than 50 ml/minute) occurred in 19% of courses in the furosemide-treated group and in 28% of courses in the mannitol-treated group. Peak plasma platinum concentration, terminal half-life, urinary excretion, and percent protein-bound plasma platinum were similar in both groups. The use of cisplatin at this dose schedule resulted in similar toxicity and pharmacokinetics when using hydration with either furosemide or mannitol.

Adolescent↗
PubMedDate not supplied

Physiologic response and toxicity in patients undergoing whole-body hyperthermia for the treatment of cancer.

Seven patients with advanced cancer underwent whole-body hyperthermia using a nylon and vinyl mesh, water-perfused suit. Treatments were given at 41.8 degrees C for 4 hours. Five patients received concomitant cyclophosphamide with hyperthermia. Compared to baseline (37 degrees C) conditions, there was a significant rise in pulse rate (P less than 0.001), a fall in diastolic pressure (P less than 0.02), and an increase in respiratory rate (P less than 0.001). Toxic effects included fatigue, extremity edema, diarrhea, nausea and vomiting, and respiratory depression in a patient with cerebral metastases. Compared to baseline values, there was a significant increase in serum glucose (P less than 0.02) and decreases in serum calcium (P less than 0.01) and phosphorus (P less than 0.01). Significant elevations in serum LDH and SGOT values occurred 24 hours following hyperthermia, suggesting hepatic sensitivity to heat. The methods used to induce whole-body hyperthermia, as described in this paper, are feasible, permit relatively easy access to the patient, and are potentially applicable in diverse hospital settings such as intensive care units, radiation therapy areas, and conventional rooms. The physiologic alterations that were observed and the toxic effects that were documented indicate that careful monitoring of patients is necessary.

Cyclophosphamide↗
PubMedDate not supplied

Phase I trial of dihydroxyanthracenedione.

Dihydroxanthracenedione was given to 16 patients with solid tumors in a phase I clinical trial. The dose schedule used was a single daily dose for 3 consecutive days given every 3 weeks. The amount given ranged from 2 to 5 mg/m2/day. The dose-limiting toxic effect was moderate to severe leukopenia which occurred at a dose greater than or equal to 4 mg/m2/day X 3. Thrombocytopenia was infrequent and did not require transfusion. Nonhematologic side effects were insignificant and included nausea, vomiting, and green-tinged urine. A minor tumor response was noted in a patient with fibrosarcoma. The recommended doses for solid tumor phase II studies are 4 mg/m2/day X 3 for good-risk patients and 3 mg/m2/day X 3 for poor-risk patients, given every 3 weeks.

Adult↗
PubMedDate not supplied

Evaluation of gravity leukapheresis and comparison with intermittent centrifugation leukapheresis.

Fifteen normal donors underwent gravity leukapheresis using a prototype collection and reinfusion harness after receiving dexamethasone for leukocyte stimulation. A mean of 4.6 units of blood were processed, producing a mean granulocyte yield of 10.8 X 10(9), with an average donation time of 261 minutes. Granulocyte collection efficiency was 79.9 per cent, but yield was only 2.5 X 10(9) granulocytes/hour. Granulocytes obtained by gravity leukapheresis were normal morphologically and had normal bactericidal capacity. Serial determinations showed no changes before and after donation of coagulation profile and serum chemistries in the donors. Seven donors underwent leukapheresis using intermittent centrifugation the day following gravity leukapheresis without further leukocyte stimulation. Mean granulocyte yield (16.1 X 10(9)), and yield/hour (5.37 X 10(9)) of donation were significantly greater for the mechanical method (p less than 0.0005). Gravity leukapheresis required considerable blood bag handling and bag entries, even with the prototype harness. Considering the amount of blood handling, the expense of the sedimenting agent, the probable dose response phenomenon of granulocyte transfusions, and the low yield resulting from the limited volume of blood processed, this technique should not be made widely available, especially where regional centers can provide granulocytes obtained by more productive methods.

Blood Platelets↗