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Biomedical subjects

J Goldberg

Publications and source records attributed to J Goldberg.

At least 217 records · Page 12Linked to original sources

Relationship of [3H]Ara-C incorporation and response to therapy with high-dose Ara-C in AML patients: a Leukemia Intergroup study.

Pretherapy bone marrow (BM) aspirates of 143 patients with acute myeloid leukemia (AML) were incubated simultaneously with bromodeoxyuridine (BrdU) and tritiated cytosine arabinoside ([3H]Ara-C) to determine the labeling index (LI) and extent of [3H]Ara-C incorporation. Of 143 AML patients, 121 received high-dose Ara-C (HDAra-C) as a single agent for induction therapy (55 newly diagnosed, 66 in first relapse), whereas 22 received HDAra-C plus mAMSA. The data demonstrate that a subset of patients who will fail HDAra-C remission induction therapy because of drug-resistant disease can be prospectively identified on the basis of the low amount of Ara-C incorporated by their leukemia cells.

Acute Disease↗

The counseling of SIDS parents.

The fundamental objectives in the management of sudden infant death syndrome (SIDS), as well as a brief historical review of SIDs with a description of the socioeconomic variables, are presented. The general patterns of reactions of parents of SIDS victims to the death of their child are discussed as is the role of the physician in counseling. Current problems, especially the relationship of SIDS to child abuse is discussed. A short list of major SIDS resource centers from which information and publications may be obtained is presented.

Adaptation, Psychological↗

Propranolol for the treatment of cyclosporine-induced headaches.

We studied whether small doses of propranolol given orally have an effect on headaches that are associated with intravenous cyclosporine therapy. In seven patients who had severe cephalalgia associated with intravenous cyclosporine post-bone marrow transplant, oral propranolol promptly relieved the symptoms in four patients. Intravenous propranolol was not effective in one patient who was unable to take oral medications. Propranolol should be considered as an alternative to chronic narcotics in patients with headaches due to cyclosporine.

Administration, Oral↗

Identification and characterization of a T cell-inducing epitope of bovine ribonuclease that can be restricted by multiple class II molecules.

An immunodominant epitope of bovine RNase restricted by I-Ek molecules was identified using a T cell hybridoma recognizing RNase. This epitope was localized to the peptide RNase(90-105). Single conservative amino acid substitutions were made at each of the positions 94 through 105. It was found that only at one position, Asn-103, were conservative substitutions not allowed. This residue was shown to be the critical residue in determining T cell specificity. The ability of RNase(90-105) and the well-defined T cell epitope, HEL(46-61) to stimulate mouse strains expressing different independent H-2 haplotypes was examined using a T cell proliferation assay. The response to HEL(46-61) was completely restricted to mice expressing an I-Ak molecule. In striking contrast, 6 of 10 different mouse strains, H-2b,f,k,q,s,u, mounted vigorous T cell responses to RNase(90-105). The response was restricted to both I-A and I-E molecules, including I-Ab, I-Af, I-Ek, I-Aq, and I-As. H-2d mice were nonresponders to RNase(90-105), which was shown to be due to the failure of RNase(90-105) to bind to I-Ad molecules. A variant RNase(90-105) peptide was generated, containing an I-Ad binding motif, that could bind to I-Ad molecules. Despite its ability to bind, this variant peptide was not able to stimulate a response in H-2d mice. This result demonstrates that the ability of a peptide to bind to an Ia molecule is necessary but not always sufficient for a response to occur. Thus, in contrast to the highly restricted HEL(46-61) determinant, the RNase(90-105) determinant is permissive in its binding to Ia molecules. These results show that in the universe of T cell inducing epitopes contains both highly restricted and broadly restricted epitopes are found.

Amino Acid Sequence↗

Lipoproteins act as a reusable shuttle for lipid transport in the flying death's-head hawkmoth, Acherontia atropos.

High-density lipophorin (HDLp), the major insect plasma lipoprotein in resting insects, has been postulated to function as a 'reusable shuttle' for lipid transport between tissues, capable of accepting or depositing lipids with maintenance of the structural properties of the particle. Injection of differentially radiolabeled HDLp into resting death's-head hawkmoths revealed that disappearance of the [14C]palmitate labeled lipid component of HDLp (principally diacyglycerol) was relatively quickly (half-life approx. 3 h), whereas turnover time of the apolipoproteins (marked with [14C]protein hydrolysate) was considerably longer (half-life approx. 26 h). These results strongly support the above proposal. To fuel long-distance flight, insects transport lipid in the hemolymph in the form of diacylglycerol-rich low-density lipophorin (LDLp) resulting from a conversion of HDLp to LDLp. By injection of differentially radiolabeled LDLp into flying hawkmoths we demonstrate for the first time in vivo that this mechanism of lipoprotein conversion also functions as a 'reusable shuttle'. While half-life of the lipid moiety of LDLp labeled with [14C]palmitate or [14C]glycerol (mainly diacylglycerol) during flight was only 43 and 94 min, respectively, turnover rate of its apolipoprotein moiety was considerably lower (half-life approx. 30 h). The results demonstrate the unique role of HDLp, i.e., the reversible conversion to LDLp, in lipid delivery to insect flight muscles.

Animals↗

A co-twin control study of the effects of the Vietnam War on the self-reported physical health of veterans.

This study examines the impact of military service on 13 categories of self-reported physical health problems by using a sample of 2,260 American male-male monozygotic twin pairs who served on active duty during the Vietnam War. Data were collected in 1987 by using mail and/or telephone interviews. Twins who served in Southeast Asia reported an increased prevalence of currently having hearing problems (odds ratio (OR) = 1.9, 95% confidence interval (Cl) 1.3-2.7) and persistent skin conditions (OR = 2.1, 95% Cl 1.4-3.2). Odds ratios for these health problems increased with increasing combat exposure and could not be explained by confounding due to posttraumatic stress disorder or demographic or military service factors. Significantly increased odds ratios were also demonstrated for ever having hearing problems (OR = 1.8, 95% Cl 1.3-2.5), ever having persistent skin conditions (OR = 2.1, 95% Cl 1.5-3.0), and having been hospitalized for stomach conditions (OR = 2.6, 95% Cl 1.4-4.9). Marginally increased odds ratios were demonstrated for ever having stomach conditions (OR = 1.4, 95% Cl 1.0-1.9) and urinary conditions (OR = 1.5, 95% Cl 1.0-2.1). Service in Southeast Asia was not associated with any of the remaining categories of physical health problems. Thus, although the past health of veterans who served in Southeast Asia may have been somewhat worse than that of their siblings who did not serve in southeast Asia, no major differences in current health are detected.

Adult↗

Seasonal variation in the incidence of hip fracture among white persons aged 65 years and older in the United States, 1984-1987.

This study uses 44 consecutive months of data from the Health Care Financing Administration to assess seasonal trends in hip fracture incidence among the United States white population aged 65 years and older. The authors studied a total of 621,387 cases of hip fracture which occurred from January 1984 to September 1987. During the study period, hip fracture incidence rates display a distinctive pattern of seasonal periodicity; high rates are found in the winter and low rates in the summer among both males and females. This pattern of seasonal periodicity is consistent at ages 65-74 years, 75-84 years, and greater than or equal to 85 years. When the time series of rates are stratified into five geographic levels, each level covering 5 degrees of latitude, the distinctive pattern of seasonal periodicity is the same for all levels.

Accidental Falls↗

Reliability and validity of a combat exposure index for Vietnam era veterans.

The reliability and validity of a self-report measure of combat exposure are examined in a cohort of male-male twin pairs who served in the military during the Vietnam era. Test-retest reliability for a five-level ordinal index of combat exposure is assessed by use of 192 duplicate sets of responses. The chance-corrected proportion in agreement (as measured by the kappa coefficient) is .84. As a measure of criterion-related validity, the combat index is correlated with the award of combat-related military medals ascertained from the military records. The probability of receiving a Purple Heart, Bronze Star, Commendation Medal and Combat Infantry Badge is associated strongly with the combat exposure index. These results show that this simple index is a reliable and valid measure of combat exposure.

Adult↗

Cell cycle and clinical characteristics of patients with acute myeloid leukemia and myelodysplasia whose biopsies are reactive with anti-factor VIII antibody. A Leukemia Intergroup Study.

Presence of megakaryocytic cells in patients with myeloid disorders were investigated by staining plastic embedded biopsy sections with an anti-Factor VIII antibody (AFA). Two hundred and fifty cases were studied, 207 of whom had acute myeloid leukemia (AML) while 43 had myelodysplastic syndromes (MDS). Abnormal clusters of AFA positive cells indicating multilineage disease were identified in 17% with primary AML (30/175), 38% with secondary AML (12/32) and 42% cases of MDS (18/43). Biological characteristics of these 60 AFA positive cases were investigated. No unique differences in cell cycle characteristics following bromodeoxyuridine (BrdU) were identified. We confirm several recent reports that the incidence of multilineage involvement in AML is substantial.

Adult↗

Some reasons for the lack of progress in the treatment of acute myelogenous leukemia: a review of three consecutive trials of the treatment of poor prognosis patients.

The failure of three consecutive treatment protocols to significantly increase the complete remission rate for poor prognosis newly diagnosed patients with acute myelocytic leukemia led to a detailed investigation of the causes of treatment failure. In the majority of cases treatment failure was attributable to "clinical resistance" to therapy. Upon close examination two types of "clinical resistance" were discernible: the failure of chemotherapy to produce adequate cytotoxic effects ("classical" drug resistance), and treatment failure attributed to the rapid regrowth of leukemia cells subsequent to the substantial killing of leukemia cells by cytotoxic therapy ("biological" resistance). Each form of resistance accounted for one-half of the treatment failures.

Aged↗

The analysis of 5-fluorouracil in human plasma by gas chromatography-negative ion chemical ionization mass spectrometry (GC-NICIMS) with stable isotope dilution.

5-Fluorouracil (5-FU) was extracted from plasma and converted to its di-N-ditrifluoromethylbenzyl (DTFMBz) derivative by treatment with DTFMBzBr. Under negative ion chemical ionization (NICI) conditions the derivative yielded a mass spectrum in which most of the ion current was carried by the M(-)-DTFMBz ion (m/z 355). Selected ion monitoring enabled detection of this derivative in amounts less than 1 pg, and the practical limit of detection for 5-FU extracted from plasma was ca 400 pg ml-1. 5-FU was quantified by adding a fixed amount of [15N2]5-FU to samples of plasma before extraction, and comparing the ratio of the ions of m/z 355 and 357 against a calibration curve constructed over the concentration range under investigation. The method was used to measure the variation in the concentration of 5-FU with time during continuous infusion of the drug via three, different protocols in patients with hepatic tumour.

Fluorouracil↗

Alcohol consumption in men exposed to the military draft lottery: a natural experiment.

The randomized natural experiment provided by the military draft lotteries of 1970, 1971, and 1972 is used to compare alcohol consumption in men born in the years 1950, 1951, and 1952. Alcohol consumption data are derived from the National Health Interview Survey supplements for 1977, 1983, and 1985. The analysis follows an intention-to-draft paradigm, where draft eligibility is determined solely by randomly assigned lottery numbers. Draft eligibility status is found to be unassociated with alcohol consumption, despite the fact that eligibility for the draft significantly increased the likelihood of military service and that veterans are more likely to report increased alcohol consumption compared to nonveterans. The randomized draft lottery provides an elegant natural experiment that potentially obviates the problem of confounding by premilitary service factors found in previous studies of alcohol consumption among veterans and nonveterans. However, the indirect association between draft eligibility and any health outcome (where military service is an intervening variable), together with the failure of the draft to produce a higher percent of veterans, prohibits application in all but the largest samples.

Alcoholism↗

The treatment of patients with newly diagnosed poor prognosis acute myelogenous leukaemia: response to treatment and treatment failure.

The failure of poor prognosis patients with newly diagnosed AML to enter remission is usually due to two phenomena: a high mortality rate and resistance of the leukaemia to chemotherapy. We conducted a pilot study of a regimen designed to overcome these two types of treatment failure. Patients were carefully selected for therapy on the basis of their likelihood of surviving. Chemotherapy consisted of high dose cytosine arabinoside (HDaraC) with the doses modified on the basis of patient age so as to reduce the risk of toxicity. Finally, daunorubicin was administered only to those patients for whom HDaraC was not likely to produce sufficient antileukaemia effects to produce a remission. The median patient age was 67 years and 69/88 (78%) patients had a history of preleukaemia and/or toxic exposure. Only 11/84 (13%) patients died during remission induction therapy and 40/84 (48%) entered CR. Patients with only one risk factor had a higher CR rate than those with more than one risk factor (56% v. 30%, P = 0.02) and also had longer durations (222 d v. 113.5 d, P = 0.035). Two types of resistance to chemotherapy were observed: 'classical resistance' (the failure of chemotherapy to produce substantial killing of leukaemia cells) and the rapid regrowth of leukaemia cells subsequent to a level of cytoreduction which otherwise would have been sufficient to produce a CR.

Aged↗

Post-traumatic migraine: chronic migraine precipitated by minor head or neck trauma.

Minor trauma to the head or neck is occasionally followed by severe chronic headaches. We have evaluated 35 adults (27 women, 8 men) with no prior history of headaches, who developed recurrent episodic attacks typical of common or classic migraine following minor head or neck injuries ("post-traumatic migraine"-PTM). The median age of these patients was 38 years (range 17 to 63 years), which is older than the usual age at onset of idiopathic migraine. The trauma was relatively minor: 14 patients experienced head trauma with brief loss of consciousness, 14 patients sustained head trauma without loss of consciousness, and 7 patients had a "whiplash" neck injury with no documented head trauma. Headaches began immediately or within the first few days after the injury. PTM typically recurred several times per week and was often incapacitating. The patients had been unsuccessfully treated by other physicians, and there was a median delay of 4 months (range 1 to 30 months) before the diagnosis of PTM was suspected. The response to prophylactic anti-migraine medication (propranolol or amitriptyline used alone or in combination) was gratifying, with 21 of 30 adequately treated patients (70%) reporting dramatic reduction in the frequency and severity of their headaches. Improvement was noted in 18 of the 23 patients (78%) who were still involved in litigation at the time of treatment. The neurologic literature has placed excessive emphasis on compensation neurosis and psychological factors in the etiology of chronic headaches after minor trauma. Physicians must be aware of PTM, as it is both common and treatable.

Adolescent↗

Autograft and Leeds-Keio reconstructions of the ovine anterior cruciate ligament.

This study compared the Leeds-Keio prosthesis with grafting of autogeneic patellar tendon for the reconstruction of the ovine anterior cruciate ligament under controlled conditions. Reconstructed knees from six sheep of each group were evaluated at 12, 26, and 52 weeks postreconstruction with respect to clinical assessment, gross pathology, mechanical properties, and histology. Although no difference in clinical assessment (anteroposterior draw, range of motion, and function) was noted between the prosthesis reconstruction and the autograft reconstruction, the prosthesis provided a higher strength initially, which remained relatively constant over the one-year study. However, prosthesis wear was observed, with up to 50% of Dacron fibers ruptured in some cases. Histologic sections indicated that in the ovine model, the Leeds-Keio prosthesis should be considered an artificial device and not a scaffold or stent that supports aligned collagenous growth. The autograft had low strength at 12 weeks, which increased over the study period. Despite acceptable clinical performance and adequate mechanical properties up to one year postimplantation, neither reconstruction approached the clinical or mechanical performance of the normal anterior cruciate ligament in the ovine model.

Animals↗