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Biomedical subjects

M L Margolis

Publications and source records attributed to M L Margolis.

At least 19 recordsLinked to original sources
PubMed1998

Pulmonary nodules in patients with esophageal carcinoma.

The clinical significance of lung nodules in patients with esophageal carcinoma has received little attention. Therefore, we carried out a retrospective detailed review of 116 consecutive cases of esophageal carcinoma, including 98 squamous cell cancers, seen at the Philadelphia Veterans Affairs Medical Center between 1984 and 1997. Seventy-four percent of our patients were black; it was not surprising therefore that 84% of our patients in this series had squamous cell cancers. Initially, chest radiographs, computed tomography (CT) scans, or thoracotomy showed solitary pulmonary nodules in 22 (19%) patients. A definitive diagnosis was established in 19 patients, including 15 (68%) benign nodules and 4 (18%) new primary lung carcinomas. Three (14%) nodules were indeterminate, but in no case could a solitary lung metastasis be identified. Radiographic evidence of multiple lung metastases was present, however, in 4 (3%) of 116 patients at diagnosis. Autopsies of six patients were later performed, and three showed multiple lung metastases; two of these patients had negative chest radiographs shortly before death. Our experience suggests that for a cohort of mostly squamous cell esophageal cancers, a solitary lung metastasis is rare at diagnosis; a solitary pulmonary nodule at this time likely represents a benign abnormality or primary lung cancer. Multiple pulmonary metastases are also very unusual at diagnosis, probably become increasingly common during the terminal phases of disease, and may be radiographically occult.

Carcinoma, Squamous Cell↗
PubMed1998

Answers to 5 key questions on lung cancer.

This article reviews historical and physical exam findings suggestive of lung cancer, along with basic concepts pertaining to sputum cytology, bronchoscopy, needle biopsy, chest x-ray screening, and the management of solitary nodules.

Biopsy, Needle↗
PubMed1997

Pulmonary function tests: comparison of 95th percentile-based and conventional criteria of normality.

BACKGROUND: Although 95th percentile-based normal limits are recommended instead of conventional criteria of normality to guide pulmonary function test (PFT) readings, we have found no objective assessment of how the choice of normal limits might influence PFT interpretation. METHODS: We did a retrospective comparison of PFT readings referenced to conventional criteria of normality versus independent repeat assessments influenced by 95th percentile-based normal limits in 166 veterans. We also conducted a nationwide telephone survey of VA Hospital PFT laboratories. RESULTS: Discordant readings occurred in only 7.2% of 616 individual PFTs; however, these discrepancies could potentially influence at least one component of the PFT report of 26.5% of our subjects. The 95th percentile-based normal limits were used by only 40% of VA PFT laboratories, without relationship to geography or hospital size. CONCLUSIONS: Discrepancies between 95th percentile-based and conventional normal limits can potentially influence PFT readings, and 95th percentile-based criteria are not used in the majority of VA PFT laboratories.

Hospitals, Veterans↗
PubMed1996

Pulmonary venous aneurysm presenting as a middle mediastinal mass.

A large mediastinal mass in a 43-year-old man was proven at thoracotomy to comprise a right superior pulmonary vein aneurysm. Intraoperative transesophageal echocardiography was useful in defining the abnormality. Pulmonary venous aneurysm appears to represent an extremely rare but surgically correctable addition to the differential diagnosis of middle mediastinal masses.

Adult↗
PubMed1994

Serum tumor markers in non-small cell lung cancer. A comparative analysis.

BACKGROUND: The role of serum tumor markers in non-small cell lung cancer (NSCLC) remains undefined. New proposed markers have seldom been rigorously compared with existing standards. The authors prospectively compared the performance of three new monoclonal antibodies (MoAb) (5E8, 5C7, and 1F10) with the established serum markers carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC). METHODS: The cohort consisted of 45 consecutive out-patients with newly diagnosed NSCLC: Control subjects were 38 outpatients with non-neoplastic chronic pulmonary diseases. Blood from each patient and control subject was assayed for all five tumor markers. An enzyme-linked immunosorbent assay (ELISA) was used to determine 5E8, 5C7, and 1F10 reactivity. Commercially available kits were used to measure SCC by radioimmunoassay and CEA by ELISA: Individual and combinations of tumor markers were compared in terms of sensitivity, specificity, and accuracy for NSCLC diagnosis. RESULTS: 5E8 plus 5C7 plus 1F10 significantly surpassed SCC plus CEA in terms of sensitivity (P < 0.05) and proved the most accurate marker combination. Among single markers, 5E8 was most specific, 5C7 most sensitive, and 5C7 and 1F10 each most accurate, but differences from CEA alone were not significant. Subgroup analysis by histologic type and stage demonstrated similar findings, and marker combinations yielded little additional diagnostic benefit. CONCLUSIONS: 5E8, 5C7, and 1F10 performed marginally better than did CEA and SCC in patients with newly diagnosed NSCLC: Many limitations apply in defining a clinical niche for these tumor markers in NSCLC, although 5E8, 5C7, and 1F10 previously have demonstrated a modest prognostic value. An adjunctive role in a few specific clinical contexts remains possible.

Antibodies, Monoclonal↗
PubMed1994

Obstructive sleep apnea syndrome in acid maltase deficiency.

A patient with adult acid maltase deficiency (AMD) developed severe obstructive sleep apnea (OSA) and respiratory insufficiency. Weaning failure was followed by diffuse pneumonia and death. At autopsy, profound muscle replacement by fibrofatty tissue was noted in the tongue and diaphragm, while the accessory and nonrespiratory muscles were variably preserved. To our knowledge, this case represents the first detailed clinical description of OSA associated with adult AMD. In addition, we suggest that severe tongue weakness due to fatty metamorphosis, in concert with macroglossia, provides a unique pathophysiologic mechanism for OSA.

Glucan 1,4-alpha-Glucosidase↗
PubMed1991

Cryptococcal pleural effusion preceding cryptococcal meningitis in AIDS.

The authors report a case in which a small cryptococcal pleural effusion preceded the development of severe cryptococcal meningitis in an HIV-positive patient. The appearance of an isolated transient pleural effusion is a very unusual presentation for AIDS-related complications. The authors suggest that cryptococcal infection be considered in this setting.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Frequency and clinical implications of monoclonal antibody detection of tumor-associated antigens in serum of patients with lung cancer.

We previously showed that a panel of monoclonal antibodies (MAb) (5E8, 5C7, and 1F10) that detect serum tumor-associated antigens (TAA) could distinguish patients with lung cancer from those without to a highly significant degree. However, among patients with lung cancer, the frequency and clinical importance of serum TAA expression were not established. Therefore, we analyzed the serum and initial clinical characteristics of 52 Philadelphia VA patients with newly diagnosed lung cancer seen over a 13-month period. A modified semiquantitative ELISA was employed to determine MAb reactivity. Our cohort was characterized by a mean age of 65 +/- 9 year (SD) and mean Karnovsky score of 74 +/- 10; marked weight loss was present in 28 subjects, and 39 presented with either Stage III or IV disease. The panel detected TAAs in 38 of 52 cases (sensitivity 73%; 95% Cl, 60-83%), including 13 of 22 squamous cell, 9 of 12 adenocarcinoma, 10 of 11 undifferentiated, and 6 of 7 small cell carcinomas. No significant differences were found between the reactive and nonreactive patients in terms of age, stage at presentation, histologic subtype, performance status, or weight loss. However, 1F10 and 5C7 were each associated with a greater risk of early death by Cox proportional hazard analysis (p = 0.017 and 0.006, respectively) even when other prognostic variables are accounted for. We conclude that specific serum TAA can be detected in the majority of lung cancer patients with all major histologic subtypes in a cohort with advanced tumors and poor prognostic indices.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Monoclonal antibody-mediated detection of lung cancer antigens in serum.

We assessed the ability of three monoclonal antibodies (MAbs) (5E8, 5C7, and 1F10) to detect tumor-associated antigens (TAAs) in the sera of patients seen in consultation by the Pulmonary Disease Section at the Philadelphia Veterans Administration Medical Center from September through November 1987. Eighteen of the 61 sera were obtained from patients with histologically established lung cancer. Using a semiquantitative enzyme-linked immunoassay (ELISA), TAAs were detected by the MAb panel in the sera of 12 lung cancer patients, yielding a sensitivity of 67% with a 95% confidence interval of 44 to 84%. The frequency of TAA detection varied among cell types and stages of disease. There were eight false positives and 35 true negatives, giving a specificity of 81% with a 95% confidence interval of 67 to 90%. Two of the false positives came from patients with nonpulmonary tumors known to cross-react with the MAbs (laryngeal and gastric carcinoma). The panel was able to distinguish patients with lung cancer from those without to a highly significant degree (chi 2 = 11.2 with 1 df, p less than 0.001). This study suggests that MAb-mediated detection of serum TAAs may be useful in diagnosing and characterizing lung cancers.

Adenocarcinoma↗
PubMed1986

Acid maltase deficiency in an adult. Evidence for improvement in respiratory function with high-protein dietary therapy.

Acid maltase deficiency (AMD) in the adult is associated with progressive ventilatory muscle weakness and death from respiratory failure, but effective therapy is not available at present. Because recent evidence suggests that muscle catabolism may contribute to muscle weakness in AMD, we treated a 55-yr-old man with AMD and severe ventilatory muscle weakness with a high-protein (1.6 g/kg), weight-reducing diet for 27 months. High-protein dietary therapy was associated with striking improvement in respiratory function, including measures of ventilatory muscle strength and endurance. We suggest that high-protein dietary therapy may be useful in adults with AMD and respiratory insufficiency.

Adult↗