Search PubMed⌕ Search

Biomedical subjects

L Horwitz

Publications and source records attributed to L Horwitz.

At least 37 records · Page 2Linked to original sources
PubMed1988

The effect of therapist interventions on the therapeutic alliance with borderline patients.

The authors draw attention to the problems of establishing and maintaining a therapeutic alliance in the psychotherapy of the borderline patient. They elaborate an extensive methodology designed to study the manner in which shifts in collaboration occur in response to therapist interventions. This report demonstrates how one particular borderline patient increased his ability to collaborate with the therapist in response to a transference focus in the psychotherapy. Methodological problems are noted as are directions for future research. Only a series of patients studied with this or with similar methodology will allow for a sophisticated and empirical rationale for choosing a particular form of psychotherapy for a particular kind of borderline patient.

Adult↗
PubMed1988

A comparison of marrow transplantation with chemotherapy for adults with acute leukemia of poor prognosis in first complete remission.

From July 1980 to November 1985, 109 patients with acute myelogenous and lymphoblastic leukemia who had reached a complete remission (CR) following induction treatment were assigned to a study comparing marrow transplantation with chemotherapy as a postremission treatment. Sixty-nine patients did not have a human leukocyte antigen (HLA)-identical donor, and therefore served as chemotherapy controls; 40 patients had HLA-identical donors, and therefore were assigned to the transplant arm. Of these, 23 were transplanted in first remission and 17 were not. Ten of these 17 were subsequently transplanted in relapse. Initially, only patients with poor prognosis determined by a predictive model were entered into the study. Subsequently, patients with moderately poor prognosis were admitted. Comparing the chemotherapy group with the patients transplanted in first CR, significant control of leukemia relapse in transplanted patients was seen in the subgroup with acute myelogenous leukemia (AML) (P less than .1), and acute lymphoblastic leukemia (ALL) (P less than .01), in the poor (P = .01) and intermediate subgroup (P = .01), and in the good-prognostic groups (P = .05). The survival was affected significantly in only the poor and intermediate subgroups. The use of predictive models might help to select patients for whom bone marrow transplantation is appropriate in first remission and those for whom bone marrow transplantation can be left as the initial treatment of relapse. Predictive models could further be helpful in comparing studies performed at different transplant centers.

Adolescent↗
PubMed1987

High dose cyclophosphamide, BCNU, and VP-16 (CBV) as a conditioning regimen for allogeneic bone marrow transplantation for patients with acute leukemia.

A high dose combination chemotherapy regimen (CBV) consisting of cyclophosphamide (1.5 gm/m2 day 1 to day 4); BCNU (300 mg/m2 day 1) and etoposide (100 mg/m2 every 12 hours for 6 doses), followed by bone marrow transplant from human leukocyte antigen (HLA) identical sibling donors, was evaluated in 29 patients in whom acute leukemia was in relapse or remission. Engraftment of donor cell type occurred in all but one of 21 patients, in whom marker differences between donor and recipient were established. Two of 11 patients transplanted during relapse of the disease, lived beyond 1 year after bone marrow transplantation. One patient died free of leukemia, 41 months after transplantation of meningitis. Two of seven patients transplanted during the second remission of the disease, are alive and free of leukemia at 42+, and 8+ months. All patients transplanted during the third or fourth remission of the disease have died from either a further relapse, or transplant related causes. The low incidence of organ toxicity with CBV allows for further dose escalation of its drug components.

Acute Disease↗
PubMed1987

Enhanced antiarrhythmic efficacy of propafenone when used in combination with procainamide or quinidine.

This study evaluated the efficacy and safety of combining propafenone with procainamide or quinidine for treating ventricular arrhythmias in patients in whom procainamide or quinidine therapy alone failed to suppress arrhythmias. In 30 patients, the addition of propafenone resulted in a significant reduction of premature ventricular contraction (PVC) frequency compared to drug-free baseline (406 PVC/hr vs 33, p less than 0.001) and to procainamide or quinidine monotherapy (211 PVC/hr vs 27, p less than 0.01). Propafenone alone was also more effective than either procainamide or quinidine and resulted in significant suppression of PVC compared to the drug-free state (406 PVC/hr vs 38, p less than 0.001). However, higher propafenone doses were necessary during monotherapy as compared to propafenone therapy combined with procainamide or quinidine (730 mg/day vs 480 mg/day, p less than 0.001). Of the 30 patients, 22 required an increase in propafenone dose during monotherapy as compared to combination therapy. Thus, propafenone is an effective antiarrhythmic agent when used in combination with type IA antiarrhythmic drugs. With these combinations, lower doses of propafenone can be utilized effectively than with propafenone alone.

Adult↗
PubMed1987

High-dose chemoradiotherapy and autologous bone marrow transplantation for resistant multiple myeloma.

Seven patients with advanced multiple myeloma, refractory to therapy with alkylating agent-VAD (vincristine-adriamycin-dexamethasone), received a regimen combining high-dose melphalan with total body irradiation supported by autologous bone marrow transplantation. Very rapid, usually greater than 90% tumor mass reduction was achieved in six patients, regardless of prior chemotherapy responsiveness and marrow plasmacytosis up to 30%. Despite signs of early relapse in three patients (median remission duration of all patients, 15 months), five remain alive and well without further cytotoxic therapy from 2 to 21 months (median, 9+ months). Two patients died, one from surgical complications after transplantation and a second due to persistent neutropenia with fatal pneumonia. This treatment provides meaningful disease control for selected patients with resistant myeloma and a poor prognosis.

Blood Cells↗
PubMed1986

High-dose melphalan and total body irradiation with bone marrow transplantation for refractory malignancies.

We investigated if high dose melphalan and total body irradiation could be administered to adult patients with acceptable toxicity. Nineteen adult patients with relapsed disease, 15 of them having hematologic malignancies, were treated with high-dose melphalan (100 mg/m2-140 mg/m2) divided over 2 consecutive days followed by a rest period of 4 days before receiving total body irradiation, 850 rad administered in five fractionated doses over 3 days. Subsequently 11 patients received autologous, seven allogeneic and one syngeneic, bone marrow transplantation. All patients had severe myelosuppression and the major extramedullary toxicity was mucositis. There were three early deaths, two related to septicemia and one to graft-versus-host disease with associated cytomegalovirus pneumonitis. All patients were heavily pretreated, and 16 were demonstrating progressive disease on alternative salvage therapies at the time of bone marrow transplantation. Two of the 16 evaluable patients (12.5%) achieved complete remissions, and 10 (63%) achieved partial remissions for a total response rate of 75%. One patient is a long-term disease-free survivor (over 1 yr). An occasional patient may be cured by this approach. The combination of melphalan, an alternative alkylating agent to cyclophosphamide and total body irradiation are associated with moderate gastrointestinal toxicity in heavily pretreated adult patients. The combination warrants further investigation in a less heavily pretreated population to determine more accurately the complete response rate.

Adult↗
PubMed1985

Development of graft-vs.-host disease-like syndrome in cyclosporine-treated rats after syngeneic bone marrow transplantation. I. Development of cytotoxic T lymphocytes with apparent polyclonal anti-Ia specificity, including autoreactivity.

Lethally irradiated rats reconstituted with syngeneic bone marrow and treated with cyclosporine (CsA) for 40 d develop a graft-vs.-host disease-like syndrome (GVHD) after CsA therapy. We attempted to assess the development of autoreactivity in these animals. Results revealed that a majority of the animals with syngeneic GVHD develop autocytotoxic T lymphocytes of the OX8 phenotype. In addition to reactivity with self, these cells were capable of lysing appropriate target cells from a variety of different rat strains. The target antigens appeared to be class II major histocompatibility antigens, because lysis could be effectively blocked by an anti-Ia monoclonal antibody. Cold target inhibition studies indicated that one effector cell was capable of lysing various target cells, and provided evidence against a polyclonal activation of multiple anti-Ia-reactive cells. These results suggested that the anti-class II autoreactive cell associated with syngeneic GVHD either recognizes a common class II determinant ("public" epitope) shared by multiple strains of rats, or was polyspecific with respect to "private" class II determinants.

Animals↗
PubMed1984

Bystander CPR in prehospital coarse ventricular fibrillation.

Prehospital bystander cardiopulmonary resuscitation (CPR) was studied to determine if it affected the outcome of defibrillation. Four hundred twenty-one consecutive witnessed cardiopulmonary arrests presenting with the initial rhythm of coarse ventricular fibrillation treated by the Milwaukee County Paramedic System from January 1980 to June 1982 were analyzed. Pediatric, trauma, and poisoning patients and those receiving intravenous or endotracheal medications before defibrillation (58) were excluded. Immediate professional bystander CPR (physician, nurse, EMT) and citizen bystander CPR were compared to a control group receiving no bystander CPR until arrival of EMS personnel. A successful defibrillation occurred if defibrillation prior to administration of medication produced an effective cardiac rhythm with pulses. Eighty-eight of the 363 remaining patients (24%) converted with initial defibrillations. While the group receiving professional bystander CPR had a higher successful defibrillation rate than did the no-CPR group (35% vs 22%, P less than .04), citizen bystander CPR and no-CPR groups had similar successful defibrillation rates (24% vs 22%, no significant difference). One hundred eighty-six of the 363 patients (51%) were transported to a hospital with a rhythm and a pulse (a successful resuscitation). Ninety-seven of the 363 patients (27%) were discharged alive from the hospital (a save). Patients who were converted successfully using initial "quick-look" defibrillations were far more likely to be successfully resuscitated (79/88 [90%] vs 107/275 [39%], P greater than .0001) and to be discharged alive from the hospital (54/88 [61%] vs 43/275 [16%], P greater than .0001) than were those who required further advanced cardiac life support techniques.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

"PALS for life!" A required trauma-oriented pediatric advanced life support course for pediatric and emergency medicine housestaff.

While advanced cardiac life support (ACLS) and advanced trauma life support (ATLS) courses have become accepted standards for physicians who care for the critically ill and injured patient, only recently have pediatric advanced life support (PALS) courses been developed. The American Academy of Pediatrics has shown renewed interest in pediatric cardiopulmonary arrest after impressive gains made in adult resuscitation. The American Heart Association filled a void by including new chapters on Pediatric and Neonatal Resuscitation in the Textbook of Advanced Cardiac Life Support, 1981. A joint committee of AHA and AAP is seeking to unify course objectives and materials for standard curriculum. Because trauma is the most common cause of death and disability in children, pediatric trauma life support measures should be incorporated into any program directed toward emergency physicians and pediatricians who function in an emergency department or rural primary care setting. The Department of Pediatrics and Surgery and its division of Emergency Medicine has developed and implemented a PALS curriculum which is different from most other programs in that emphasis has been placed on pediatric trauma in addition to traditional cardiac (ACLS) resuscitation. This 20-hour program combines a modified ACLS curriculum with specific pediatric trauma lectures and laboratory sessions. It includes a canine surgical procedure lab and modified ATLS skill stations. At the completion of the course, students are eligible for ACLS certification. In the two years in which the course was given, 39 pediatric houseofficers were enrolled in the course.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1984

The precordial thump.

The American Heart Association (AHA) currently recommends the precordial thump as the initial maneuver in treatment of ventricular tachycardia (VT) and monitored ventricular fibrillation (VF). These recommendations are based largely on anecdotal reports of successful "thump-version" of asystole, VF, and VT. The Milwaukee County Paramedic System follows the AHA guidelines in the treatment of VT and VF. The precordial thump is included in the advanced cardiac life support (ACLS) paramedic training program, and has been used in our approach to the pulseless, nonbreathing patient. During an eight-month period, 50 pulseless, nonbreathing patients received precordial thumps during ACLS resuscitative attempts. Twenty-seven patients who developed monitored VT and 23 patients with monitored VF were thumped. Three of 27 patients (11%) with VT were thumped into a supraventricular rhythm, 12 of 27 patients (44%) remained in VT, and 12 of 27 patients were thumped from VT into more malignant rhythms: three, into asystole; eight, into VF; and one, into an idioventricular/electromechanical dissociation rhythm. A total of 23 patients were thumped without effect. Subsequently, using countershock and medications, 12 of these 23 patients were successfully resuscitated. In the prehospital setting the precordial thump is usually not beneficial, and may be detrimental. Thus its use as the initial maneuver in treating the cardiac arrest patient with VT or VF in this setting cannot be supported. The presence of acidosis and hypoxia may explain why prehospital precordial thump responses differ from those seen in the hospital environment.

Adult↗
PubMed1983

Cobra envenomation: an uncommon emergency.

An unusual case involving a cobra snake envenomation is presented. The patient developed transient neurological sequelae during air evacuation to a regional trauma center and required endotracheal intubation. He developed a hypersensitivity reaction to cobra antivenin which responded to diphenhydramine. The bite wound became edematous and necrotic, but responded to conservative therapy. He was discharged on the fifth hospital day and did well.

Adult↗