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Biomedical subjects

M Mittelman

Publications and source records attributed to M Mittelman.

At least 55 records · Page 3Linked to original sources
PubMed1994

Transverse nail ridgings (Beau's lines) induced by chemotherapy.

Transverse grooves of the nails, designated as Beau's lines, were observed in a patient with malignant lymphoma given chemotherapy. Beau's lines disappeared in the treatment-free intervals. This observation supports the concept that these lines are the result of the suppressed growth of the nail matrix caused by antimitotic drugs.

Aged↗
PubMed1994

Chronic myelomonocytic leukemia associated with primary amyloidosis.

A case of chronic myelomonocytic leukemia (CMML) associated with primary amyloidosis (AL) is presented. Hepatosplenomegaly, macroglossia, and xanthelasma were the major physical findings. Laboratory tests showed macrocytic anemia, thrombocytopenia, monocytosis and a bi-clonal gammopathy. Early monocytes and monoblasts were noted in the bone marrow aspiration biopsy. Cytogenetic evaluation showed a clonal deletion of chromosome 21 long arm (21q-). Amyloid was present in the liver, tongue and xanthelasma. In addition, the patient was noted to have osteosclerosis of the lower extremities. Treatment with prednisone and colchicine resulted in a subjective response. The unusual association of CMML, and primary amyloidosis is discussed.

Adult↗
PubMed1994

Clinical application of recombinant erythropoietin in myelodysplasia.

This article attempts to summarize the current information regarding the clinical application of recombinant human erythropoietin in patients with myelodysplastic syndromes (MDS). To date, more than 300 MDS patients have been reported to be treated with recombinant human erythropoietin. The response patterns have been variable, but in general they range from 20% to 30%. The hormone has been shown to be safe and nontoxic.

Clinical Trials as Topic↗
PubMed1994

Is granulocyte-macrophage colony-stimulating factor (GM-CSF) safe in myelodysplastic syndromes?

The complication of secondary myelodysplastic syndrome (sMDS) during the course of multiple myeloma (MM) has been recognized for more than a decade. sMDS occurs years after MM diagnosis, and typically, at sMDS presentation the MM is stable or inactive. We report a 56-year-old patient, who developed sMDS 15 years following the diagnosis of IgG-lambda MM, which had been completely stable for 13 years. However, very soon after sMDS was diagnosed, the MM relapsed and required combination chemotherapy. The first cycle of vincristine, adriamycin and dexamethasone (VAD) resulted in severe neutropenia and sepsis, which was treated with antibiotics and recombinant human granulocyte-macrophage colony-stimulating factor (rHuGM-CSF). Two weeks after GM-CSF administration a transformation to acute myeloblastic leukemia was observed. The relation between GM-CSF and the leukemic transformation is discussed and the possible contribution of the cytokine to the stimulation of this complication is emphasized.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

Secondary myelodysplastic syndrome in multiple myeloma--a study of nine patients with an attempt to detect myeloma patients at risk.

Over a follow-up period of ten years, nine of our 100 patients with multiple myeloma (MM), developed myelodysplastic syndrome (MDS, preleukaemia). MDS occurred 19-156 (median 35) months from the diagnosis of MM. Six patients presented with pancytopenia and no patients had active MM at the time of MDS diagnosis. Three patients were defined as having refractory anaemia (RA) and six as refractory anaemia with excess blasts (RAEB) or RAEB in transformation (RAEBT), according to the FAB classification. The clinical course is characterized by increasing red blood cell and platelet transfusion requirements, recurrent infections and bleeding episodes. All patients, except for one, died within 3 to 8 (median 5) months from MDS diagnosis. The causes of death were sepsis or bleeding; three patients underwent leukaemic transformation. Thus, the clinical course of this small group of myeloma patients who developed secondary MDS (sMDS), was similar to other series of patients with sMDS. Serial bone marrow examinations suggest an initial hypercellular phase, followed by a rapidly evolving preterminal hypocellular marrow. In an attempt to detect MM patients at risk of developing sMDS, the epidemiological (including ethnic), clinical and laboratory data of the 9 MDS patients at the time of the MM presentation were reviewed and compared to the other MM patients. No significant differences were observed between the two groups in most parameters, except for two. All MDS patients were Ashkenazi Jews and no patients of Sepharadic origin developed MDS. Also, no IgA-myeloma patient developed MDS. If these findings are confirmed in a larger series, it may point to subgroups at risk which may require a different approach.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[Acute leukemia in the elderly--a death sentence?].

Elderly patients with acute leukemia are considered poor candidates for aggressive antileukemic combination chemotherapy, and are therefore regarded by many clinicians as hopeless. Are such cases really hopeless? Although mild chemotherapy with low-dose cytosine-arabinoside (LDAC) has been recognized as beneficial for more than a decade, it is not often used in the elderly. 2 cases of leukemia which developed after a myeloblastic syndrome in men aged 71 and 84 years, respectively, are described. Both achieved complete remission for 18 and 13 months, respectively, following a course of LDAC. The literature also reveals that some elderly leukemic patients may benefit from this relatively nontoxic therapy.

Age Factors↗
PubMed1993

[Acute lung injury as a complication of blood transfusion].

Acute lung injury as a complication of blood transfusion (transfusion related acute lung injury) may occur a few hours following transfusion and is characterized by sudden respiratory distress, severe hypoxemia, fever and hypotension. The clinical picture develops rapidly and is severe, and the radiological findings mimic the adult type of respiratory distress syndrome (ARDS). Treatment is mainly supportive and includes corticosteroids. Despite the relatively good prognosis, fatalities have been described. The pathogenesis involves antileukocytic antibodies, usually of the donor but occasionally of the recipient. We describe a patient who developed such complication. Since blood transfusion is a routine procedure it is of utmost importance to draw the attention of physicians to this not uncommon and potentially fatal complication. Awareness will help to prevent it, and promote early diagnosis and treatment.

Adrenal Cortex Hormones↗
PubMed1993

High Ia (HLA-DR) and low CD11b (Mo1) expression may predict early conversion to leukemia in myelodysplastic syndromes.

The FAB classification of myelodysplastic syndromes (MDS) has been useful in predicting prognosis; however, additional methods are required to detect patients at high risk for early conversion to acute nonlymphoblastic leukemia (ANLL). Using a panel of monoclonal antibodies to myelomonocytic surface antigens (MMSA) and flow cytometry, we studied bone marrow cells from 26 patients with MDS of all five FAB subtypes. The MMSA studied included Ia (HLA-DR), CD11b (Mo1), CD14 (Mo2, My4), CD13 (My7), and CD33 (My9). Marrows were considered "positive" for a given MMSA if the percentage of reactive cells exceeded the upper limit of the normal range. Twenty-four of twenty-six patients (92.3%) were CD13 (My7)+, suggesting that CD13 may serve as a diagnostic marker for MDS. Ten of twelve patients who developed ANLL during a median follow-up of 44 weeks were Ia(HLA-DR)+. The Kaplan-Meier estimated median time to leukemia (TTL) was 16 weeks for Ia+ patients and 88 weeks for Ia- patients (P = 0.004). All six patients who developed ANLL before 16 weeks from diagnosis were Ia+, while none of the Ia- patients converted to ANLL before 24 weeks. Nine of thirteen patients with low CD11b (Mo1) expression (< 53% reactive cells) developed ANLL, compared with only two of 11 patients with high CD11b expression (> 53% reactive cells). Kaplan-Meier estimated TTL was 29 weeks for patients with low CD11b, compared to 160 weeks for patients with high CD11b (P < 0.05). Patients who met both criteria, Ia+ and low CD11b, represented the poorest prognostic subgroup, with median TTL of 13 weeks compared with 88 weeks for the others (P = 0.017). Ia and CD11b patterns were not specific for MDS subtype, and their expression did not correlate with blast count. These data suggest that MDS patients whose bone marrow cells demonstrate high Ia (HLA-DR) and low CD11b (Mo1) expression represent a poor prognostic subgroup with short TTL. These patients may be candidates for early aggressive or investigational treatment.

Adult↗
PubMed1993

External high-frequency ventilation in severe chronic obstructive pulmonary disease.

We studied the effect of external high-frequency oscillation using an oscillator (Hayek oscillator [HO]) on 20 patients with severe chronic obstructive pulmonary disease (COPD). Of the 20 patients, 10 were eucapnic and 10 were hypercapnic. The HO generated frequencies from 60 to 140 cycles/min at an amplitude of 36 cm H2O (-26 to +10) and at an inspiratory/expiratory (I/E) ratio of 1:1. The results show that the HO is a powerful ventilator, reducing end-tidal PCO2 (PETCO2) by 6.7 to 9.1 mm Hg in eucapnic patients and by 6.1 to 7.9 mm Hg in hypercapnic patients. The oxygen saturation increased by 2 to 2.87 percent in the eucapnic patients and by 2.6 to 3.7 percent in the hypercapnic group in the various frequencies. The rate of elimination of CO2 and the levels of PETCO2 achieved within a short time were superior to those reported with other external ventilators. We conclude that the HO can be effectively used in severe COPD and respiratory failure for (1) assisting ventilation, thus replacing intubation and conventional mechanical ventilation, and (2) relieving muscle fatigue in short sessions.

Aged↗
PubMed1993

Ultrastructural observations on a variant of acute promyelocytic leukemia.

A patient with acute leukemia is presented in whom the leukemic cells, as seen by light microscopy were typical promyelocytes. The cells had normal or slightly invaginated nuclei with typical cytoplasmic granules and the diagnosis was confirmed by cytochemistry. The clinical course was rapid and the patient died of disseminated intravascular coagulation and urosepsis within a few days of diagnosis. However, electron microscopic examination showed cells with extremely convoluted and lobulated nuclei with nuclear pockets and cytoplasmic bridges as well as the complete absence of cytoplasmic granules in the majority of the cells. Furthermore, the urine lysozyme (muramidase) was elevated. These findings suggest that the leukemia in this patient may be classified as a hypogranular variant of acute promyelocytic leukemia (APL), with monocytoid ultrastructural appearances.

Biomarkers, Tumor↗
PubMed1993

The multiface morphology of acute leukemia.

Three distinct morphological phases during the course of acute leukemia in a 16 year old girl are described. The patient presented with morphology of acute lymphoblastic leukemia, relapsed with acute myeloblastic leukemia which later on evolved to monoblastic phase. This clinical, morphological and ultrastructural observation provides clinical evidence supporting the current concept of normal and leukemic haematopoiesis, as well as clonal evolution, according to which a stem cell is capable of giving rise to different haematopoietic lineages. It is conceivable that chemotherapy altered the balance between the stem cells and the bone marrow microenvironmental stromal cells, resulting in clonal evolution or release of a new subclone with the disease relapse.

Adolescent↗