Search PubMed⌕ Search

Biomedical subjects

M Baum

Publications and source records attributed to M Baum.

602 records · Page 34Linked to original sources
PubMedDate not supplied

Biological considerations in the treatment of breast cancer: the "fall out" from clinical trials.

The evolution of the treatment for early breast cancer has now reached a critical period. At long last the conflicting claims of the anatomical and biological approaches towards treatment of this disease are being resolved by the application of prospective randomised clinical trials. The recognition that host factors exist which may place a constraint on the spread of cancer, and that haematogenous dissemination may occur long before the tumour has reached clinical proportions, has shaken the whole basis upon which "radical" cancer therapy is based. Furthermore, experimental work has suggested that lymphadenectomy or regional radiotherapy may produce sufficient disturbance to the immune competence of the host to allow the outgrowth of occult distant tumour foci. Prospective randomised clinical trials designed to determine the most effective local treatment have incidentally produced biological "fall out" which has thrown additional light on the behaviour and nature of breast cancer. It transpires that untreated mediastinal or axillary lymph nodes appear to have little growth potential of their own, or is it likely that they act as a reservoir for further metastatic dissemination. It is at last becoming accepted that irrespective of the extent of local therapy, the outcome for "early" breast cancer is predetermined by the extent of subclinical distant metastases at the time of presentation. In order to improve the results therefore, some form of adjuvant systemic therapy is essential. A number of clinical trials are at present underway designed to explore the most effective means of controlling minimal residual cancer following local ablation of the tumour.

Aged↗
PubMedDate not supplied

Severe pneumonia after heart transplantation as a result of human parvovirus B19.

The diverse manifestations of human parvovirus B19 infection have been well established. Erythema infectiosum, fetal hydrops, adult arthropathy, and aplastic anemia in patients with hemoglobinopathies or underlying immunocompromise have been described. Recently we successfully treated a patient who, after heart transplantation, had fever, rash, and pneumonia with respiratory failure caused by human parovirus B19. Human parovirus B19 has not been reported previously as a pathogen causing pulmonary disease after pediatric heart transplantation, and we wish to report it at this time.

Antibodies, Viral↗
PubMedDate not supplied

Inadequate dietary intake and altered nutrition status in early HIV-1 infection.

Recent studies indicate that multiple nutritional abnormalities occur relatively early in the course of human immunodeficiency virus (HIV-1) infection. Decreased plasma levels of vitamins B6, B12, A, and E and zinc have been correlated with dietary intake and associated with significant alterations in immune response and cognitive function. To determine the level of intake consistent with normal plasma nutrient levels, we examined nutrition status in relation to food consumption and nutrient supplementation in HIV-1-seropositive (HIV+) and -seronegative (HIV-) homosexual men. The mean level of total intake (diet plus supplements) for all nutrients was significantly higher in HIV+ men. To achieve normal plasma nutrient values, the HIV+ men appeared to require intake in multiples of the recommended dietary allowance (RDA) for vitamins A, E, B6, and B12 and zinc. For the HIV+ men, a relatively high proportion of biochemical deficiency was associated with consumption of vitamin B6 and zinc at the RDA level. Because little evidence of deficiency was observed with elevated intake in both groups, an effective program of nutritional supplementation may be beneficial in maintaining adequate plasma nutrient levels.

Adult↗
PubMedDate not supplied

Infectious complications in infant heart transplantation.

Previously we reported that the rate of mild to moderate infections and upper respiratory infections in infants who undergo transplantation under 1 year of age was the same as that of the general population. Despite this, serious infections continue to be one of the major complications in the first 3 to 4 months after heart transplantation. Among newborns and infants at Loma Linda University Medical Center, there have been 35 deaths from various causes: six (17%) were the result of infectious causes, three were in the early perioperative period, and three were late complications. There were no deaths caused directly by cytomegalovirus. From 1989 to 1992, 128 under 1 year of age underwent transplantation. Of these, 65 had at least one episode of serious infection ranging from bacterial meningitis to viral pneumonia. Of these infants, 19 had cytomegalovirus infections, with the vast majority having symptoms in the first 2 to 3 months after transplantation. Eight infants had Pneumocystis pneumonia and were treated successfully. The risk of cytomegalovirus is highest in the first 4 to 8 weeks after transplantation and in a seronegative recipient who has received an organ from a seropositive donor. Currently, our protocol to reduce the likelihood of active disease includes the use of intravenous immunoglobulin immediately after transplantation and during rejection episodes that are treated with aggressive immunosuppression and the use of oral acyclovir for the first 3 months after transplantation. If active disease develops, ganciclovir is initiated.(ABSTRACT TRUNCATED AT 250 WORDS)

Heart Transplantation↗
PubMedDate not supplied

Growth and neurodevelopmental outcome of infants undergoing heart transplantation.

The purpose of this study was to examine the long-term growth and developmental outcome of infants undergoing heart transplantation. We studied weight, length, and head circumference from birth to 12 months after surgery in 110 infant recipients less than 6 months of age. Forty-eight early transplant recipients (0 to 30 days) were compared with 62 late transplant recipients (31 to 180 days). Late transplant recipients showed less growth in all parameters at the time of transplant. However, by 6 months after transplantation, there were no differences between the two groups. Growth in 20 infants, now 3 to 7 years old, appears normal. Neurodevelopmental outcome was evaluated prospectively in 57 infants. Four months after transplantation, 11 infants (19%) had abnormal neurologic examinations, with generalized hypotonia (64%) being the most common finding. The Bayley Scale of Infant Development was administered to 48 of 57 infants. The Mental Developmental Index averaged 87 (+/- 21) and the Psychomotor Developmental Index averaged 90 (+/- 21). Of 140 infants who have undergone heart transplantation, transient postoperative seizures occurred in 23 survivors (21%) and 10 nonsurvivors (33%). Our findings suggest that growth, neurologic outcome, and development are normal in the majority of infants who undergo transplantation before 6 months of age.

Child↗
PubMedDate not supplied

Using an interactive video disk in breast cancer patient support.

A randomised-controlled trial compared outcomes for women recently diagnosed with breast cancer who either received support and information from a multidisciplinary team or used a shared decision-making programme on an interactive video disk (IVD) system. Using the IVD did not have a significant effect on the decisions women made about treatment, yet it was evaluated positively by those who used it. The results suggest that the role of clinical staff is more significant than the form of information provided. Potential benefits for the IVD were apparent such as standardising the information received by patients, promoting evidence-based practice and providing a measure for quality assurance.

Adult↗