Effects of extracorporeal circulation upon behavior, personality, and brain function. II. Hemodynamic, metabolic, and psychometric correlations.
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Adaptation, Psychological↗
Biomedical subjects
J M Rowe
Publications and source records attributed to J M Rowe.
Prolymphocytic leukemia: histologic findings in atypical cases.
Significant enlargement of peripheral lymph nodes is not characteristic of prolymphocytic leukemia. The absence of this physical feature of the disease has been so consistent in previous reports that it has come to have considerable importance in the differential diagnosis of prolymphocytic leukemia. We describe two cases of prolymphocytic leukemia, in which, in sharp contrast to other published cases, striking lymphadenopathy was present throughout the clinical course. In one case, the disease responded dramatically, but briefly, to L-asparaginase. The immunologic characteristics of cells from lymph nodes suggested that in both cases, the leukemic process was B-cell type. The features of the prolymphocytic proliferation in lymph nodes and the utility of Wright-Giemsa stained touch preparations have been emphasized.
Aged↗
Refractory acute lymphocytic leukemia: response to aclacinomycin A and VP-16-213.
Twelve patients with acute lymphoblastic leukemia (ALL) were treated with aclacinomycin A (60 mg/m2/day for five days) and VP-16-213 (100 mg/m2/day). All were heavily pretreated and had relapsed or were refractory to primary or subsequent treatment. Eight patients were refractory to reinduction therapy given for first, second, third or fourth relapse. One patient was treated in third relapse; one in second relapse (after a short second remission) and two in first relapse-one with the Ph1 chromosome, after a four-month remission, and one patient who relapsed while receiving consolidation therapy. Four patients (33 per cent) responded, three entered complete remission (25 per cent), and one a partial remission (8 per cent). Two of the patients treated for refractoriness to reinduction therapy went into complete remission. Side effects from this treatment were similar to the conventional DAT regimen (daunorubicin, cytosine arabinoside, thioguanine), although the gastrointestinal toxicity and mucositis appeared to be more severe in this study population. One of the patients had severe ventricular arrhythmias which contributed to her death. The complete remission rate (25 per cent) in this group of very heavily pretreated ALL patients warrants further studies to evaluate these preliminary findings.
Aclarubicin↗
Preservation of fertility and ovarian function and minimizing chemotherapy-induced gonadotoxicity in young women.
BACKGROUND: After the improved long-term survival in young women with lymphoma and leukemia undergoing chemotherapy, the preservation of future fertility has been the focus of recent interest. AREAS OF REVIEW: Three major topics are reviewed. They include the following: (1) the role of chemotherapy in the treatment of malignant and nonmalignant disease in young women, the types of chemotherapy and their gonadal effects (differing between ovaries and testes) in both human and other species, and the reasons for differences in the outcomes of various studies; (2) the human experience with GnRH-agonist therapy for minimizing chemotherapy-associated gonadotoxicity; and (3) inhibin measurements in young women treated by chemotherapy and in perimenopausal patients and those with impending premature ovarian failure (POF). Whereas egg retrieval for in vitro fertilization (IVF) and embryo cryopreservation is a valid assisted reproductive technology (ART) for married couples, it may be unacceptable for the young single woman. The investigational endeavors of ovarian cryopreservation awaits the clinical experience of in vitro maturation of thawed primordial follicles, their IVF, and embryo transfer. Although promising, this experience is not yet available. Moreover, the risk of possible reimplantation of malignant stem cells with the thawed cryopreserved ovary has been raised after animal observations. Therefore, until these innovative endeavors prove successful, and in parallel with them, an attempt was made to minimize the gonadotoxic effect of chemotherapy by the cotreatment with a GnRH agonistic analogue (GnRH-a) to induce a temporary prepubertal milieu, because prepubertal ovaries were found more resistant to alkylating agents' effect than the ovaries of older women. To characterize the correlation with ovarian function after gonadotoxic chemotherapy for Hodgkin or non-Hodgkin lymphoma in young women, the immunoreactive inhibin-A concentrations in the sera of these patients were measured before, during, and after the gonadotoxic chemotherapy. CONCLUSIONS: The GnRH-a cotreatment should be considered in every woman in the reproductive age receiving chemotherapy, in addition to ART and the investigational attempts of ovarian cryopreservation for future in vitro maturation or reimplantation. If these preliminary data are confirmed in a larger group of patients, inhibin-A concentrations may serve as a prognostic factor for predicting the resumption of ovarian function in addition to the levels of FSH, LH, and estradiol.
Antineoplastic Agents↗
Life-threatening autoimmune hemolytic anemia in a patient with the acquired immune deficiency syndrome.
Increasing numbers of patients are being seen with the acquired immune deficiency syndrome (AIDS). An abnormal serology with a positive direct antiglobulin test has been observed in these patients and is usually not thought to contribute to significant clinical morbidity. We describe a patient with AIDS who presented with a severe hemolytic anemia which was not distinguishable clinically and serologically from the idiopathic form of autoimmune hemolytic anemia.
Acquired Immunodeficiency Syndrome↗
Therapeutic monitoring of busulfan in pediatric bone marrow transplantation.
The aim of this study was to describe busulfan disposition in a pediatric population who underwent bone marrow transplantation (BMT). Busulfan administered dose was 1 mg/kg every 6 h for 4 days. Plasma determinations were performed after the first dosing at 0, 15, 30, 60, 90, 120, 180, 240, 300, and 360 min. A noncompartment analysis model for extravascular absorption was used for the pharmacokinetic analysis. To obtain the area under the concentration-time curve (AUC) within the "therapeutic window" of 1,000-1,200 microM x minutes a busulfan dose adjustment Was performed at the fourth dose. Forty-five busulfan pharmacokinetic analyses were performed in 34 children. Eleven children had their dose adjusted [1.19 +/- 0.14) mg/kg] at the fourth dose and the AUC was monitored at the fifth one. The mean AUC +/- SD after the fifth dose (998.1 +/- 189.2 microM x min) was different (p = .006)from that after the first dose (1 mg/kg) (687.63 +/- 166.43 microM x min). Six children had their first AUC into the "therapeutic window," 17 children had their dose adjusted [1.2 (+/- 0.22) mg/kg], but the "adjusted" AUC was not available. These data suggest that it may be reasonable to recommend a busulfan dose of 1.2 mg/kg to achieve the accepted therapeutic target in children undergoing BMT.
Animals↗
Maintaining medical records.
In addition to being a required legal document, the medical record is a necessary tool for continuity of care and accurate billing. Its proper appearance, organization, and completeness are essential to good management. A series of steps have been set down in this nuts-and bolts article, providing the administrator with a systematic guide for efficient medical record maintenance.
Ambulatory Care Facilities↗