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Biomedical subjects

M Greenberg

Publications and source records attributed to M Greenberg.

At least 127 records · Page 7Linked to original sources
PubMed1994

Concurrent RhGM-CSF does not offset myelosuppression from intensive chemotherapy: randomized placebo-controlled study in childhood acute lymphoblastic leukemia.

To determine whether recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) can offset the myelosuppressive effects of intensive chemotherapy, we carried out a double-blind placebo-controlled trial in which 40 patients with acute lymphoblastic leukemia (ALL) were randomized into two groups of 20 each. One group received rhGM-CSF (5.5 micrograms/kg SC) coadministered with chemotherapy and the other, placebo coadministered with chemotherapy from day 5 to day 11 and from day 19 to day 25 of the 28-day intensification phase of our institutional high-risk protocol for childhood ALL. The results indicate that, at the dose and schedule used, rhGM-CSF did not prevent neutropenia or shorten the number of days required to complete this phase of therapy. In addition, the treated and placebo groups showed no significant difference in absolute neutrophil counts, number of days with neutropenia, number of days with fever, number of days spent in hospital, or number of days on antibiotics during the 28-day study period. There was also no difference between the two groups in the number, type, or severity of infectious episodes. Two of 20 patients in the treatment group have relapsed, whereas none of the patients in the placebo group has yet relapsed (follow-up: 3-37 months), but these events were not statistically significant. We conclude that treatment with rhGM-CSF at the dose and schedule employed is not clinically beneficial.

Adolescent↗
PubMed1994

A profile of symptomatic patients with silicone breast implants: a Sjögrens-like syndrome.

Exposure of breast tissue to silicone has been associated with autoimmune diseases in the medical literature since the 1960's. Japanese women injected with raw silicone had features of a collagen vascular disease but did not meet criteria for a specific diagnosis. Subsequently, we have seen women with silicone breast implants that have similar problems. We performed a prospective noncontrolled study on women with silicone breast implants. Results from the first 50 consecutive women revealed the most prominent complaints in this group were fatigue (89%), generalized stiffness (75%), poor sleep (71%), and arthralgias (78%). Other problems included Raynaud's phenomenon, alopecia, adenopathy, night sweats, and frequent sore throats. Unexpectedly, half of these women complained of dry eyes and dry mouths. Positive antinuclear antibodies and or rheumatoid factors were discovered in 38% of patients although the anti-SSA antibody was found in only one patient and anti-SSB in none. Labial salivary gland biopsies in 5 cases showed mononuclear cell infiltrates compatible with Sjögren's syndrome in 4. The infiltrating cells were predominantly CD68 positive monocyte/macrophages, which is different from what is found in Sjögren's syndrome. These findings may indicate the presence of a unique syndrome associated with silicone implants that is characterized by musculoskeletal pain and autoimmune features.

Adult↗
PubMed1994

Violence in American cities: young black males is the answer, but what was the question?

Many Americans believe that the public health problem of violence can be addressed by focusing on young black males. We hypothesize that our economic and political systems have created marginal urban areas of undesirable land uses and unwanted people which breed violence. Using three medium-sized cities (Camden, Newark, Trenton) located in an extremely affluent state (New Jersey) as illustrations, we show that violent death rates from homicides, poisoning/drug abuse, falls, fires, and suicide in these areas are high for whites and Hispanics, as well as blacks; females, as well as males; and middle-aged and elderly populations, as well as young populations. We conclude that marginalization (e.g. concentration, ghettoization, segregation) of unwanted land uses and unwanted people must be addressed to reduce urban violence.

Adolescent↗
PubMed1994

Nasopharyngeal carcinoma in the young.

This study was carried out to determine whether locoregional control of nasopharyngeal carcinoma in the young by irradiation has improved since 1975. Fifty-seven consecutive, previously untreated, patients, less than 30 years old, were diagnosed and treated at University of Toronto Hospitals between 1958 and 1990; 21 patients were treated before and 36 after 1975. Staging was as follows: M0, n = 54; M1, n = 3; T1 + T2, n = 26; T3 + T4, n = 31; N0, n = 10; N1 + N2a, n = 10; N2b + N2c, n = 24; N3, n = 13. All patients were irradiated. The primary tumour dose was 3500-7000 cGy (median 5450). Adjuvant chemotherapy was introduced in 1977. Subsequently, 10/26 (38%) M0 patients received this treatment. For all 57 patients, 10-year survival was 56%. For 52 M0 patients with complete follow-up data, 10-year survival was 63%; 10-year relapse free survival (RFS) was 61%. Age, sex, race, and histology were not significant variables. Ten-year RFS results were: T1 + T2, M0 (n = 24) 70%, T3 + T4, M0 (n = 27) 52%, (P = 0.25); N0-N2c (n = 41) 64%, N3 (n = 11) 54% (P = 0.31). Relapse occurred in 20/52 (38%) patients. Survival from the date of first relapse was 10% at 10 years. No patient with systemic relapse survived. Only 1/32 (3%) patients treated after 1975 developed an isolated locoregional relapse, giving a 10-year isolated locoregional relapse free rate (LR RFS) of 96%, compared with 5/20 (25%) prior to 1975, which gave a 10-year LR RFS of 75% (P = 0.05). Two of the five patients who relapsed before 1975 were salvaged by re-irradiation. Systemic relapse, either alone or combined with locoregional relapse, accounted for 6/11 (55%) relapses before 1975 and 8/9 (89%) after 1975. Ten-year systemic RFS was 90% for patients who received adjuvant chemotherapy (n = 10) and 72% for patients treated since 1977 by irradiation alone (n = 16) (P = 0.41). Isolated local relapse was exceptional in patients treated after 1975 (1/32).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Malignant rhabdoid tumour of the pineal region.

A 9-month-old male presented to hospital with signs and symptoms of raised intracranial pressure. A CT scan showed obstructive hydrocephalus from a large pineal region mass lesion into which an intratumoral hemorrhage had occurred. A posterior fossa craniectomy and subtotal excision of the mass lesion were performed. By histopathology, the lesion was a malignant rhabdoid tumour (MRT). Despite surgery and chemotherapy, the tumour grew inexorably, and the patient died four months after the initial diagnosis. MRT is a rare and highly invasive neoplasm which infrequently arises from the central nervous system. This is the first documented case of a MRT arising from the pineal region. The clinical, radiographic, and pathological features of the MRT in this patient are presented.

Brain Neoplasms↗
PubMed1994

Knowledge of the health hazard of asbestos prior to the Merewether and Price report of 1930.

The first realization of the burden of ill health associated with occupational exposure to asbestos dust, and the need for environmental control, is generally dated from the publication of the results of the survey by Merewether and Price in 1930. A review of the literature and of associated archival material throws a different light on history. There was a wealth of evidence available prior to 1930 that should have led to earlier effective control. The responsibility for this delay must be shared between manufacturers, workers' representatives, the Factory Inspectorate and Scientists involved in the relevant research.

Asbestos↗
PubMed1994

The efficacy and safety of granisetron in pediatric cancer patients who had failed standard antiemetic therapy during anticancer chemotherapy.

PURPOSE: This study was undertaken to evaluate the safety and efficacy of granisetron (a 5-hydroxytryptamine. antagonist) in children with malignant disease who had previously experienced unacceptable nausea and vomiting and/or adverse effects associated with standard antiemetic therapy. PATIENTS AND METHODS: Thirty children 3-18 years of age who were receiving anticancer chemotherapy were enrolled in the study. Patients received a prophylactic dose of granisetron before chemotherapy and two subsequent doses as needed. If further antiemetics were required, standard therapy was given and those patients were classified as treatment failures. Patients received granisetron during one to three cycles of chemotherapy; a total of 66 courses were given. RESULTS: Eighty-seven percent of patients had good control of nausea and vomiting with granisetron alone; 90% of patients elected to receive granisetron with subsequent chemotherapy. No loss of efficacy was noted with repeated cycles in 21 patients. No serious adverse events occurred. CONCLUSIONS: Intravenous granisetron (20 micrograms/kg/dose) appears to be a safe and effective drug for pediatric patients receiving emetogenic chemotherapy.

Adolescent↗
PubMed1994

Hazardous Waste Site Remediation, Neighborhood Change, and Neighborhood Quality.

We tested the hypothesis that neighborhoods with hazardous waste sites may no longer be undesirable places to live if they have been at least partly remediated. We collected 377 questionnaires (42% response rate) administered from within one-half mile of the number 1, 4, and 12 hazardous waste sites on the National Priority List (Superfund). These neighborhoods were rated higher quality than neighborhoods with unremediated hazardous waste sites and about the same as neighborhoods in northern New Jersey and the United States as a whole. Newer residents considered these formerly tainted areas to be opportunities to upgrade their housing and living conditions. Long-term residents retained the negative image of the blemished neighborhood.

Journal Article↗
PubMed1994

Violence: homicide and suicide in New Jersey.

Homicide and suicide data are examined for trends, patterns, and relationships to the public perception of violence. While homicide rates in poor urban-blighted areas in New Jersey are abominably high, there is no epidemic. We cannot afford to ignore the underlying factors that lead to violence.

Adolescent↗
PubMed1993

Optic glioma in children: surveillance, resection, or irradiation?

Eighty-seven consecutive children with newly diagnosed optic glioma were managed at University of Toronto hospitals 1958-1990. Overall the 10-year survival, relapse-free survival and freedom from second relapse rates were 84%, 68% and 85%. Twenty-seven patients relapsed or progressed, of whom 40% were free of a second relapse 10 years after the first relapse. Fourteen patients had a second relapse. Thirteen are dead. None survived 5 years after second relapse. Patients with anteriorly located tumors (N = 35), which involved the optic nerve, or chiasm and optic nerves, fared better than those with posteriorly located tumors (N = 52) with spread beyond the chiasm, 10-year survival 95% versus 76%, (p = .02), 10-year relapse-free survival 80% versus 59% (p = .02), respectively. For posterior tumors primary irradiation was more effective than primary subtotal resection for prevention of subsequent relapse, 10-year relapse-free survival 75% versus 41% (p = .02), but salvage therapy was, in part, successful and multivariate analysis of prognostic factors influencing survival for posterior tumors indicated that neither primary resection nor primary irradiation were significant factors. For first relapse, primary irradiation and the presence of neurofibromatosis were the significant favorable factors. Since 1977 and for posterior optic glioma subtotal resection or surveillance were used in 21/29 (72%) patients compared with 4/23 (17%) previously. Ten-year survival rates before and after 1977 were 78% and 67% and 10-year relapse-free survival 64% and 56%, respectively.

Adolescent↗
PubMed1993

Solving the cluster puzzle: clues to follow and pitfalls to avoid.

Dozens of methods have been proposed for the identification of disease clusters, although only a few are used routinely in published investigations. New methods, although designed to exploit some particular aspect of the data or use some specific statistical tool, are rarely compared thoroughly in terms of power or performance. Users, when confronted with the multitude of methods available, often select methods arbitrarily, basing choices on software availability, ease of implementation, or use experience rather than considerations of statistical power, possible alternative hypotheses (that is, cluster structure) and likely confounding. In this review, we extend our typology of disease clustering methods and apply it to many of the extant methods identifying strengths, weaknesses and unique features of the methods. We conclude with recommendations for which methods should be applied to which types of situations.

Cluster Analysis↗
PubMed1993

Subxiphoid approach for insertion of ICDs after previous median sternotomy.

To avoid the risks both of repeat median sternotomy and of thoracotomy, the modified subxiphoid approach was adopted for insertion of implantable cardioverter-defibrillators in 10 patients who had previously undergone cardiac operations via median sternotomy. Effective implantable cardioverter-defibrillator systems were implanted in all patients. There were no operative deaths and no hemorrhagic or respiratory complications. One patient underwent repositioning of a dislodged superior vena caval electrode, and an infected generator pocket developed in 1 patient. Early extubation was routine. Two patients were observed in the coronary care unit for the first postoperative night. Postoperative pain was controlled with oral analgesic agents. The subxiphoid approach is safe and effective, and it carries a substantially lower risk of complications than other techniques, even in this high-risk group of patients. By minimizing the need for admission to the intensive care unit, invasive monitoring, and prolonged ventilatory support, by reducing surgical complications, and by shortening the hospital stay, the subxiphoid approach saved an average of $3,295 per patient.

Adult↗
PubMed1993

Confirmation of transpyloric feeding tube placement by ultrasonography.

We compared ultrasonography with radiography for placement of transpyloric feeding tubes. Ultrasound study successfully determined tube tip position and gave functional information unavailable with radiography, allowing for greater accuracy of placement and the observation of transpyloric reflux of feedings.

Adolescent↗
PubMed1993

Lung cancer in the Schneeberg mines: a reappraisal of the data reported by Harting and Hesse in 1879.

The first description of occupational lung cancer, by Harting and Hesse in 1879, unfortunately is not readily accessible. Its account of the vicissitudes of the Schneeberg miners merits study and is therefore presented in summary and set in a historical and geological context. The authors attempted to discover the cause of the disease and made recommendations for improving the health of miners. In the course of their programme of investigations, they developed methods for measuring airborne dust and inhaled dust by personal monitoring. It was left to subsequent discovery for radon and its daughter products to be identified as the causal agents. Later generations were to discover the impact of radioactive spoils from mines situated in the mountain range in which Schneeberg was located.

Germany↗