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Biomedical subjects

J Weiner

Publications and source records attributed to J Weiner.

At least 109 records · Page 6Linked to original sources
PubMed1985

Liver involvement in sickle cell disease.

In an effort to clarify the features of hepatic dysfunction in sickle cell disease, we obtained serial tests of liver function in 100 consecutive patients with sickle cell anemia and in 30 consecutive patients with hemoglobinopathy SC during a five-year period. There were 32 patients with chronic abnormalities in tests of liver function. These abnormal tests were explained by a variety of lesions in 30 cases, and the liver disease remained unexplained in only 2 patients who declined liver biopsy. The diagnoses in these 30 patients included hepatitis, chronic passive congestion, common duct obstruction, alcoholic liver disease, pregnancy, collagen-vascular disease, and sarcoidosis. Evidence for hepatitis B infection was present in 19 of those with sickle cell anemia and in 6 of those with hemoglobinopathy SC. The bilirubin levels in sickle cell anemia appeared to have a trimodal distribution, with six patients exhibiting markedly elevated levels of indirect bilirubin suggesting a difference in bilirubin metabolism. There was no evidence of liver disease in 72 patients with sickle cell anemia, nor in 24 patients with hemoglobinopathy SC, as these patients exhibited only mild elevation of their serum indirect bilirubin levels owing to chronic hemolysis. Intrasinusoidal sickling and Kupffer cell erythrophagocytosis were nearly universal findings at liver biopsy, irrespective of the clinical disorder, and were not related to the degree of liver test abnormalities. Liver and biliary tract dysfunction in sickle cell disease have been attributed to anoxia secondary to sinusoidal obstruction by sickled erythrocytes and Kupffer cell erythrophagocytosis. However, some causes of liver disease in sickle cell patients can be explained by clinical disorders other than the hemoglobinopathy alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1985

Prognostic implications of blast cell morphology in childhood acute lymphoblastic leukemia: a report from the Childrens Cancer Study Group.

The Childrens Cancer Study Group (CCSG) has evaluated French-American-British (FAB) morphology in newly diagnosed children with acute lymphoblastic leukemia (ALL) since 1975. A modification of the FAB system was used in which individual lymphoblast cells were scored and designated as either L1 or L2 on the basis of distinctive morphologic characteristics. L1 ALL was defined as less than 10% L2 cells and greater than 90% L1 cells; L2 ALL was defined as greater than or equal to 10% L2 cells and less than 90% L1 cells. FAB morphology was an independent predictor of overall survival (P = 0.02) in CCSG-141 and a highly significant predictor of successful induction of complete remission and event-free survival in the CCSG-160 series (P = 0.00001). These studies involved nearly 3900 patients. Two concordance studies have been performed. In the first (1981) study, overall concordance between the FAB reference laboratory and member institutions was 76% using a two-category system (L1, non-L1), 86% for L1 cases, and 47% for non-L1 cases. In the second (1984) concordance study, the use of more stringent, semiquantitative definitions of L1 and L2 lymphoblasts did not improve overall (75%), L1 (89%), or non-L1 (46%) concordance. The results of reference laboratory classification more powerfully predicted event-free survival than did member institutions (P = 0.016 vs P = 0.125). Quality control factors (slide preparation, cellularity, staining quality, and discipline of the reviewer) did not influence concordance. These results justify the continued assignment of patients to protocols of the CCSG-100 series on the basis of the modified FAB classification. The biological significance of the FAB morphologic variants remains to be determined.

Child↗
PubMed1984

Use of noninvasive laboratory testing in the prediction of thrombosis in the nephrotic syndrome.

A noninvasive method for diagnosing thrombosis in the nephrotic syndrome could be useful clinically. We measured hematocrit, fibrinogen, creatinine, antithrombin III, plasminogen, and alpha-2-plasmin inhibitor levels in 20 patients with nephrotic syndrome objectively studied for the presence of thrombosis, and found that by using combinations of three or more of these variables good discrimination could be obtained between those patients with and without thrombosis. We conclude that it is possible to predict risk of thrombosis in nephrotic syndrome using relatively simple noninvasive laboratory tests.

Antithrombin III↗
PubMed1981

Systemic lupus erythematosus--survival patterns. Experience with 609 patients.

Six hundred nine private patients with systemic lupus erythematosus were followed up for a mean of ten years. Ninety percent were female; 79% were white. Three hundred sixty-nine received diagnosis before 1970, and 234 after. Three hundred seventy-nine did not have nephritis; 230 did. The overall ten-year survival was 79% (87% without nephritis, 65% with nephritis). Male patients did consistently worse than female patients. No overall white vs nonwhite difference was noted. The presence of nephrotic syndrome at the onset of nephritis was a poor prognostic sign, but its development later was not. Patients younger than 16 years without nephritis have an excellent prognosis. One hundred twenty-eight patients died (82 with nephritis, 46 without nephritis). The most common causes of death were renal disease and sepsis. Improved survival of this series may reflect closer follow-up, better nutritional status, and treatment at earlier stages of disease.

Adolescent↗
PubMed1980

Treatment of advanced colon cancer with 5-fluorouracil (NSC19893) versus cyclophosphamide (NSC26271) plus 5-fluorouracil: prognostic aspects of the differential white blood cell count.

One hundred twenty-one patients with advanced measurable adenocarcinoma of the colon were randomized for treatment with intravenous 5-fluorouracil (IV 5-FU) alone, 15 mg/kg/week vs. cytoxan, 15 mg/kg/week IV, on day 1 and 5-FU, 15 mg/kg/week IV during weeks 2--5, repeated in a six-week cycle. Age, sex, performance status, and disease free intervals, were comparable in both arms. Response frequency was 11% for treatment with 5-FU alone and 10% for treatment with combination therapy. The median survival time was significantly greater in the 5-FU-alone arm (8.4 months vs. 5.6 months, P less than 0.05). In both arms, survival was correlated with the nadir white blood count (WBC) achieved during therapy (P less than 0.02). Fourteen patients had pretreatment WBC of greater than 12,000/mm3. None of them had fever, bone marrow involvement with tumor, or recognizable infection at study entry. The 14 patients had a median survival time of 2.3 months, significantly shorter than that of patients with normal pretreatment WBC (P less than 0.05). A pretreatment lymphocyte count was available for all patients. No association between this value and either response to chemotherapy or survival time was noted. These results support the superiority of 5-FU to the combination of 5-FU and cytoxan in the treatment of colon carcinoma, and point to the prognostic significance of the pretreatment WBC in this disease.

Adenocarcinoma↗
PubMed1980

Fungal infection associated with gastroduodenal ulceration: endoscopic and pathologic appearances.

Three patients with peptic ulcers diagnosed at upper gastrointestinal endoscopy are reported. All were seriously ill (2 debilitated alcoholics) and died soon afterwards. Fungi were recognized in the antemortem specimen of one of the two ulcers biopsied at the time of endoscopy and in the postmortem specimens of all. In two, demise appears to have been precipitated by erosion of the wall of a major artery by fungal invasion. Culture of the ulcer based as well as throat swabs and stool examination for mycelial and yeast forms of fungus in susceptible patients may allow a more accurate diagnosis to be made and therapy to be instituted.

Adult↗
PubMed1979

Prophylactic antibiotics in surgery. Practices within surgical services of the Veterans Administration.

A survey of prophylactic antibiotic-prescribing habits among chiefs of surgical services of the Veterans Administration yielded a 99% response. These responses have been compared with guidelines set by an expert committee on antimicrobial use for the VA central office. Assuming that 100% concordance with the standards of the committee is a desired state, the average hospital is approximately one third away from this goal (average score, 62.4%). The majority of errors were those of overuse rather than underuse. The size of the service and the existence of a university affiliation had no influence on the results. Feedback to the chiefs of service regarding the use of antibiotics was informal and tended to be carried out on rounds rather than as a result of formal audits. Most senior surgeons indicated that they would be willing to be influenced by audit guidelines.

Anti-Bacterial Agents↗