Lithium therapy in childhood neutropenia.
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Agranulocytosis↗
Biomedical subjects
J Goldberg
Publications and source records attributed to J Goldberg.
Tuberculous sacroiliitis.
We have described an unusual case of tuberculous sacroiliitis associated with adrenal insufficiency, with details of radiologic studies and review of the literature concerning tuberculous sacroiliitis.
Female↗
Prolonged exposure to a war environment and its effects on the blood pressure of pregnant women.
The present research examined the effects of living in an area which had been a target of terrorist activities for a long period, as well as the effects of war, on blood pressure of pregnant women. For this purpose, the blood pressures of 5804 Israeli pregnant women, who gave birth between July 1973 and June 1975 and who had lived in either high, medium or low military stress environments were compared. Blood pressures that were measured immediately before delivery were taken from the delivery record of the pregnant women in the hospital. Results showed that the women in the high stress environment displayed significantly higher systolic and diastolic blood pressure, both during the relatively calm period and the period of the Yom Kippur War, than women who lived in the low stress environment. Women who lived in the medium stress area were in between these two groups. War increased the blood pressure in all three environments, but the increase in blood pressure from the calm period to the war period was greater in the high and medium stress environments than in the low stress environment. Results further showed that the younger women displayed greater increase in the systolic blood pressure than the older women. This finding was attributed to the fact that the husbands of the younger women serve in the front lines to a greater extent, which probably induces a higher level of anxiety.
Adult↗
Effect of occupational exposure to elemental mercury on short term memory.
Previous studies have indicated that exposure to elemental mercury is associated with increased short term memory scanning time. In an effort to provide converging evidence that short term memory is one locus of the neurotoxic effect of mercury, two measures of short term memory capacity were used in this study. The first measure, the Wechsler digit span forward, was too imprecise and unreliable to detect any adverse effects. The second measure, an estimate of the worker's 50% threshold for correct serial recall, was more satisfactory and provided evidence of a statistically significant decrease in short term memory capacity associated with increasing exposure to elemental mercury (based on a group of 26 workers, urinary mercury average 0.20 mg/l, range 0.0-0.51 mg/l). A replication study of another group of 60 workers was performed to confirm this apparent mercury related effect. Despite lower urinary mercury concentrations in this second group (0.11 mg/l average), a statistical association was again observed relating urine mercury to reduced short term memory capacity.
Adolescent↗
Phase II trial of combination chemotherapy of colonic cancer with 5-fluorouracil, mitomycin C, and hexamethylmelamine.
HexMF consists of hexamethylmelamine 150 mg/m2 D2-15, mitomycin C (MMC) 10 mg/m2 D2 and 5-fluorouracil (5-FU) 30 mg/kg/day as a continuous infusion D1-5 in 4-5 week cycles. It was designed as an alternative to treating patients with standard single agents in sequence, thereby preventing the testing of new drugs as part of primary therapy. Median survival was 12+ months for patients with measurable and 18+ months for patients with nonmeasurable colorectal cancer. It was 9+ months from the onset of secondary chemotherapy. Toxicity included severe thrombocytopenia (50%), severe leukopenia (25%), and moderate stomatitis (50%). Only one instance of leukopenia was life-threatening. The MMC and 5-FU infusion skeleton provides an attractive strategy for testing new drugs as primary therapy. HexMF itself has a potentially broad antitumor spectrum and excellent acceptance by patients. It is suitable for additional phase II trials.
Altretamine↗
Phase II trial of combination chemotherapy for pancreatic cancer with 5-fluorouracil, mitomycin C, and hexamethylmelamine.
A combination consisting of hexamethylmelamine 150 mg/m2 D2-15, mitomycin C 10 mg/m2 D2 and 5-fluorouracil 30 mg/kg/day as a continuous infusion for 5 days, in 4-5 week cycles, underwent phase II trial as primary therapy for 21 patients with regional and metastatic cancer of the pancreas. Median survival from the onset of therapy was 43 weeks. There were 2 complete responses, 4 minor responses and 6 stable diseases for more than 6 months. Nonambulatory patients were among the responders. There was only 1 life-threatening toxicity (thrombocytopenia) and only 33% of patients had clinically silent severe hematological toxicity. The regimen is well tolerated, active and associated with excellent survival. This regimen is suitable for further confirmatory trials.
Altretamine↗
Chronic neutropenia: diagnostic approach and prognosis.
Chronic neutropenia is a term used to describe a group of disorders characterized by a persistent neutrophil count of less than 1500 cells/microliters. We studied seven children and three sets of parents. We separated patients into a group with good prognosis and a group at higher risk of infection by using a combination of tests, including bone marrow aspiration and biopsy, steroid stimulation of bone marrow reserve, and in vitro CFU-GM and CSA assays. Children with a normal number of myeloid elements in their bone marrow and a normal bone marrow response to steroid stimulation had a benign course. CFU-GM and CSA assays helped to classify these children's neutropenia when their bone marrow had decreased numbers of myeloid elements. Family studies in three children were consistent with an inherited neutropenia, even when their parents were hematologically normal.
Adult↗
Risk factors for postoperative recurrence of Crohn's disease.
To identify potential risk factors that influence postoperative recurrence rates of Crohn's disease, the postoperative recurrence-free survival of 93 patients who underwent their first resections at The Mount Sinai Hospital between 1964 and 1973 has been examined. Features analyzed individually and jointly were age, sex, anatomic location, operative procedure, and preoperative disease duration. In patients with Crohn's colitis, recurrence rates appeared somewhat lower among 11 patients with ileostomy than among 5 patients with anastomosis. In the entire series, recurrence rates were lowest in patients with longest preoperative durations (p = 0.02). This same tendency was especially marked among the 68 patients without ileostomies (p = 0.005). Likewise, among the 38 patients with ileitis, the relative risk of recurrence was significantly lower for those with disease duration exceeding 10 yr (p = 0.01). Relative risk of recurrence in the entire series for patients with 2-yr duration was 1.5 compared with those who had 10-yr duration. This inverse association between preoperative disease duration and postoperative recurrence rate may reflect persisting differences between inherently more aggressive versus more indolent forms of Crohn's disease.
Adult↗
Mortality from traumatic injuries. A case-control study using data from the National Hospital Discharge Survey.
This study examines a large number of demographic, hospital, patient volume, and medical factors that may influence in-hospital mortality due to trauma. The authors use data from the 1977 and 1978 National Hospital Discharge Survey to assemble a case-control data set of severe injuries (n = 336). Cases are defined as "deaths from trauma," and control subjects are "injured survivors." Control subjects are frequency-matched to cases on the basis of overall severity, site of the most severe anatomic injury, and age. The analysis estimates the relative risk of mortality associated with different levels of the risk factors by the odds ratio. The unadjusted results indicate a significant impact of the following variables: sex (with males at higher risk), average severity of hospital case mix, number of severe trauma patients treated at a hospital (with high-volume hospitals at increased risk), ischemic heart disease and other forms of heart disease, malignant neoplasms, influenza and pneumonia, and emergency tracheotomy or tracheostomy. After adjustment using multiple logistic regression, the single significant risk factor is the presence of ischemic heart disease and other forms of heart disease. The implication of this finding is that hospitals exhibit little difference in mortality from severe trauma after adjustment for patient mix characteristics. Possible explanations for this result are tendered.
Adult↗
Oculomotor reflexes after semicircular canal plugging in cats.
The horizontal ocular reflexes of cats were studied before and after plugging all 6 semicircular canals (2 cats) or the horizontal canals only (2 cats). After plugging, the vestibulo-ocular reflex (VOR) was virtually absent in the cats with all canals plugged; a small phase-advanced VOR was detectable only at high velocities of rotation. There was no VOR recovery over several months. A compensatory cervico-ocular reflex (COR) appeared within a few days of plugging in all cats, and increased in gain slowly over time. The cats with horizontal canals plugged had little VOR during yaw rotation with the head pitched near 30 degrees down from the stereotaxic plane. When the head was pitched nose up from this null plane, a horizontal VOR appeared and increased as the sine of pitch angle, indicating that the cats relied on normal or increased coupling of vertical canals to horizontal eye movers for generation of compensatory eye movements. Periods of compensatory and anticompensatory eye movements were recorded during downward pitched yaw.
Animals↗
Nailfold capillary microscopy as a diagnostic tool and in followup examination.
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Capillaries↗
Dynamic properties of vestibular reflexes in the decerebrate cat.
Vestibulocollic (VCR) and vestibulo-ocular (VOR) reflexes were studied during angular rotation in the horizontal plane in precollicular decerebrate cats. Angular position was modulated by sinusoids or sums of sinusoids with frequencies ranging from 0.05 to 5 Hz. Reflex motor output was measured by recording electromyographic (EMG) activity of the lateral rectus and dorsal neck muscles and discharge of abducens motoneurons. Measured with respect to input angular acceleration VCR motor output displayed a second order lag at low frequencies, bringing mean EMG phase (-136 degrees) and gain slope (-35 dB/decade) close to those of an angular position signal at 0.2 Hz. At higher frequencies the lag was counteracted by a second order lead bringing mean phase (-52 degrees) and gain slope (-5.6 dB/decade) back close to those of an angular acceleration signal at 3 Hz. By contrast, mean phase (-113 degrees to -105 degrees) and gain slope (-21 to -28 dB/decade) of the VOR motor output remained close to those of an angular velocity signal across the entire frequency range. The data suggest that neural pathways producing the VCR receive selective input from "irregular type" horizontal semicircular canal afferents which provide one lag and one lead in the overall transfer function while the other lag and lead are produced by central pathways. Transection of the medial longitudinal fasciculus (MLF), which eliminates all of the most direct (three neuron) arcs of the horizontal VCR, did not cause any detectable change in the horizontal VCR at either low or high frequencies. Reductions in overall gain occurred in some cases but these could be attributed to damage to axons outside the MLF. Less direct pathways, probably including vestibuloreticulospinal pathways, are thus able to produce both the low-frequency, phase-lagging and high-frequency, phase-leading components of the horizontal VCR.
Afferent Pathways↗
Cognitive self-control factors in EMG biofeedback.
This study investigated the efficacy of manipulation of cognitive self-control expectancy in EMG biofeedback training. It was predicted that a treatment procedure, which includes a positive-cognitive stage that establishes and reinforces a positive self-control belief system and also includes a training stage in EMG biofeedback, will be more effective in achieving a reduction in EMG activity than a treatment procedure which includes a negative-cognitive stage and which also includes ambiguous features prior to training and a treatment approach solely concerned with training. The study consisted of four groups with 10 subjects in each. In one group, expectation for inner control ability was created prior to actual training in reducing EMG activity. In the second group, expectation for negative self-control ability was created prior to EMG training. The third group only underwent the actual training in EMG. The fourth group served as a control group. The results show that the positive-cognitive self-control group was significantly more effective in reducing muscle activity than the other groups.
Adult↗
Predictive value of the CFU-C assay in acute nonlymphocytic leukemia.
A double-layer agar culture assay for granulopoietic progenitor cell (CFU-C) was employed to study the in vitro growth pattern of bone marrow or peripheral blood cells from 37 patients at diagnosis of acute nonlymphocytic leukemia. The patients were classified as having type A growth if there were greater than 50 colonies (A1), or greater than one colony and greater than 50 clusters was observed after 14 days in culture (A2). Type B growth was defined as no growth (B1), less than 50 colonies and less than 50 clusters (B2) or cluster growth only (B3). Agar cultures containing marrow cells from 10 patients were stained in situ, and the colonies and clusters revealed abnormal cellular maturation. Treatment with cytosine arabinoside and an anthracycline resulted in a complete remission of leukemia in one of 15 patients with type A growth and 17 of 22 patients with type B growth. The subtype of growth pattern did not correlate with the mechanism (i.e., drug resistance versus kinetic resistance) for the failure to achieve a complete remission. The subtype of type B growth (B1, B2 or B#) did not correlate with the duration of complete remission. Nonetheless, the growth patterns observed in cultures of cells obtained from patients with acute nonlymphocytic leukemia appear to be excellent predictors of the success of achieving complete remission with induction therapy.
Acute Disease↗
A comparison of nine systems to diagnose schizophrenia.
The files of 283 hospitalized patients discharged with a diagnosis of schizophrenia, schizoaffective schizophrenia, or paranoid state were examined without knowledge of the patient's subsequent history. These patients, most of whom had originally been diagnosed by DSM-I criteria, were retrospectively diagnosed by New York Research Diagnostic Criteria (RDC), the New Have Schizophrenia Index (NHSI), the St. Louis criteria, Taylor-Abrams 1978 criteria, Schneider's first-rank symptoms (FRS), the Washington IPSS 12-Point Flexible System, Astrup's process/nonprocess distinction, and DSM-III. Kappa values measuring pairwise diagnostic agreement amont the nine systems were typically low except among RDC, DSM-III, and St. Louis criteria. Long-term followup status was not significantly predicted by the FRS, NHSI, or Taylor-Abrams criteria. Diagnosis by means of the other systems, especially the Astrup process/nonprocess distinction, was significantly correlated with followup. However, Astrup's "process" schizophrenia is not operationally defined and could not be expected to be used with the degree of interrater reliability desired by researchers. On the other hand, of the operationally defined systems, DSM-III schizophrenia has the highest correlation with followup and is thus suggested for use by researchers desiring a highly homogeneous, although narrowly defined, population. Investigators wishing to cast a wider net could use a less restrictive system such as the RDC, with or without schizoaffectives included.
Adult↗
The effect of stress and meditation on salivary protein and bacteria: a review and pilot study.
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Adult↗
Reduction of mortality in general medical in-patients by low-dose heparin prophylaxis.
The effect of prophylactic low-dose heparin on mortality was tested in 1358 consecutive patients admitted to the medical wards of an acute care hospital. Eligibility for treatment or exclusion was ascertained on admission by predefined contraindications. Eligible patients with even-number hospital records were assigned to treatment (5000 U twice daily), those with odd-number records served as controls. Because determination of eligibility was open to bias, evaluation of treatment was based on comparison of the total even-number group (669 patients, of which 411 were treated with heparin), and the total odd-number group (689 patients, none treated with heparin). Mortality was significantly lower in the even-number group-7.8% (52 of 669 patients) versus 10.9% (75 of 689 patients) in the odd-number group; the difference increased consistently with length of hospitalization (p = 0.025). The estimated reduction in mortality attributable to heparin was 31.1%. We believe that low-dose heparin prophylaxis is appropriate in all immobilized medical patients who are not at risk of bleeding.
Adult↗
Chemotherapy versus chemoimmunotherapy with levamisole or Corynebacterium parvum in advanced lung cancer.
A total of 109 patients with advanced lung cancer, all cell types, were randomized between MACC chemotherapy only, consisting of methotrexate, doxorubicin (Adriamycin), cyclophosphamide, and lomustine (CCNU); MACC plus levamisole (LMS) orally; and MACC plus Corynebacterium parvum (CP) sc. Of these patients, 101 were evaluable, with no differences among the three treatment groups for overall response rate and survival time. Objective response rates and median survival times were 41% and 230 days for patients given MACC only, 39% and 257 days for those given MACC plus LMS, and 44% and 223 days for those given MACC plus CP, respectively. There was a significant increase in survival for patients with large cell anaplastic carcinoma receiving CP or LMS, particularly in the good-performance-status category. Pretreatment delayed cutaneous hypersensitivity to recall antigens in 50 patients had prognostic significance, but repeat tests after 2 months of treatment in 30 patients did not show different patterns of conversion among the three groups. There was no difference in hematologic toxicity among the three groups. With the possible exception of large cell anaplastic carcinoma, immunotherapy with LMS or CP as given in this trial does not appear to be therapeutically advantageous in advanced lung cancer.
Adenocarcinoma↗