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Biomedical subjects

M Nesbit

Publications and source records attributed to M Nesbit.

At least 73 records · Page 4Linked to original sources
PubMed1981

Differences in prognosis for boys and girls with acute lymphoblastic leukaemia.

In the period 1968--78, 3161 children were enrolled in six studies of acute lymphoblastic leukaemia by participating institutions of the Childrens Cancer Study Group. In the first two studies, which did not include central-nervous-system (CNS) prophylaxis in the treatment programme, the outcome for male and female patients was very similar. In the following four studies, which included radiation prophylaxis to the CNS, a difference in outcome favouring females appeared consistently. This difference began about 6--12 months after initial remission and was further accentuated by withdrawal of therapy. Some of these studies also included a randomised trial of duration of therapy, studying 3 versus 5 years of maintenance treatment. Analysis of these studies suggests that sex group has implications both for duration of treatment and for optimum central-nervous-system prophylaxis.

Adolescent↗
PubMed1981

Immune thrombocytopenia in severe neonatal infections.

Thrombocytopenia occurs frequently in newborn infants with sepsis, but the exact mechanism remains obscure in those infants who do not have evidence of disseminated intravascular coagulation. Since recent work has suggested a possible immune mechanism for thrombocytopenia observed in adults with sepsis, we have investigated the role of platelet-associated immunoglobulin in severe neonatal infections. To detect PAIgG we use a method employing protein A and peroxidase-antiperoxidase as a labeled antibody. PAIgG was quantitated by phase contrast microscopy and expressed as a reactive index. Our control group included 16 normal newborn infants whose mean RI was 0.65 +/- 0.01 SE. In addition to the control group, five infants with nonimmune thrombocytopenia were included; their mean RI was 0.66 +/- 0.01 SE. Seventeen newborn infants with severe infections were assayed for PAIgG. Eight of nine infants with bacterial infections had increased RI, with a mean of 1.16 +/- 0.03 SE (P less than 0.01). Six of the eight infants with viral infections had elevated RI, with a mean of 1.23 +/- 0.03 SE (P less than 0.01). These findings suggest that an immune mechanism may be involved in the thrombocytopenia of severe neonatal infection.

Bacterial Infections↗
PubMed1980

Intergroup Ewing's Sarcoma Study: local control related to radiation dose, volume, and site of primary lesion in Ewing's sarcoma.

One hundred ninety-three patients with localized Ewing's sarcoma treated at participating instutitions of the Intergroup Ewing's Sarcoma Study form the basis for this report. All patients received radiation therapy to the primary lesion and were randomized to receive vincristine, actinomycin-D, and cyclophosphamide (VAC) plus adriamycin (Regimen I); VAC alone (Regimen II); or VAC and bilateral pulmonary irradiation (Regimen III). Local control was achieved in 96% of the patients in Regimen I, and 86% of the patients in both Regimens II and III. The median duration of follow up was 83 weeks and median survival time was 172 weeks. Incremental doses of irradiation did not result in significant changes in the rate of local control of primary lesions. The local control rate was the same (92%) for tumors treated by means of whole-bone irradiation or with at least 5 cm of free margin around the lesion. The local control rate decreased to 79% for lesions treated with less than 5-cm margin. Excellent control was obtained for lesions involving the skull or spine (100%), and distal bones (fibula, 96% and tibia, 91%). Less favorable control rates were noted for pelvic and humeral lesions (84% and 79%, respectively). Bilateral pulmonary irradiation for subclinical disease played a role in lowering the incidence of lung metastases from 38% to 20% for patients treated with VAC. Lung metastases were similarly decreased (10%) when adriamycin was added to VAC chemotherapy.

Bone Neoplasms↗
PubMed1980

Dural venous sinus thrombosis in acute lymphoblastic leukemia.

Three children with acute lymphoblastic leukemia developed sagittal sinus thrombosis. One patient was in peripheral remission. One patient survived. In neither patient who died were the walls of the dural sinuses infiltrated with leukemic cells. Attention is drawn to this potentially treatable cause of central nervous system symptoms in childhood leukemia. Angiography is the diagnostic test of choice and can also demonstrate intracerebral hematoma and subdural hematoma, if present. Sinus thrombosis can occur either during exacerbation or remission of the basic leukemic process. The possibility that chemotherapeutic techniques predispose toward this complication is raised.

Adolescent↗
PubMed1979

L-asparaginase-induced hypocomplementemia in acute lymphocytic leukemia (ALL) of childhood.

Serum complement studies were carried out in five children with acute lymphocytic leukemia. During therapy with L-asparaginase, prednisone and vincristine, hypocomplementemia developed in all patients, and disappeared within 2 weeks after the discontinuation of L-asparaginase. Complement breakdown products were not present in plasma. The changes of serum complement levels paralleled those of plasma fibrinogen. These findings suggest that the hypocomplementemia observed in these patients may be related to impaired protein synthesis induced by L-asparaginase.

Adolescent↗
PubMed1979

Evaluation of intramuscular versus intravenous administration of L-asparaginase in childhood leukemia.

A study was done to evaluate intramuscular versus intravenous administration of L-asparaginase in childhood leukemia. The results of this study demonstrate that the intramuscular method of administering L-asparaginase is as effective, but less toxic, than the intravenous method for children with advanced leukemia. The utilization of L-asparaginase in the initial induction of children with lymphoblastic and undifferentiated leukemia should be investigated. Its addition to the standard inducing agents may increase the percentage and ease of remission without significantly increasing toxicity.

Asparaginase↗
PubMed1978

Second neoplasms following megavoltage radiation in a pediatric population.

Previous reports of radiation-related neoplasia have relied primarily upon patients treated by orthovoltage to low doses for benign disease. This survey is believed to be the first to assess the incidence of second neoplasms following megavoltage therapy. The source was the records of all long-term pediatric survivors (88 patients) who were treated with megavoltage radiation (cobalt 60) at the University of Minnesota. There was an average follow-up period of 14 years during which 7 second neoplasms were discovered (8%). Five were not associated with prior radiation. Both radiation-related neoplasms were associated with low doses and one was without significant morbidity. Two of the seven neoplasms were malignant; one was not associated with radiation while the other was associated with prolonged chemotherapy and low dose radiation (1%). The only fatal second neoplasm was not associated with radiation but developed 5 years after prolonged chlorambucil treatment. This review reveals the tendency of childhood cancer victims to develop other neoplasms regardless of radiation. The finding of neoplasia induction only at low radiation doses supports the Gray hypothesis of decreased tumor induction at high doses through increased cell killing.

Adolescent↗
PubMed1978

Increased survival in childhood acute nonlymphocytic leukemia after treatment with prednisone, cytosine arabinoside, 6-thioguanine, cyclophosphamide, and oncovin (PATCO) combination chemotherapy.

One hundred-sixty-three children with acute nonlymphocytic leukemia (ANLL) were treated with a multiple-drug induction program (PATCO) consisting of prednisone (PDN), cytosine arabinoside ((Ara-C), 6-thioguanine (6-TG), cyclophosphamide (CPM), and Oncovin (VCR). Ninety-six, 59%, obtained a remission. Remission was maintained with daily 6-TG and four-day pulses of Ara-C and CPM with a single dose of VCR every 28 days. The median duration of remission was 11.5 months. Certain prognostic factors affected induction rate and remission duration. Initial white blood count (WBC) was a significant factor in achieving a remission, whereas age, sex, and type of ANLL had no effect. Initial WBC, age, and sex had a significant effect on remission duration, but type of ANLL had no effect. Relapsing patients were treated with daunomycin and 5-azacytidine. The reinduction rate was 53% with a median second remission duration of 190 days. Overall survival for the 163 patients is 55.4% at 12 months, 31.5% at 24 months, 21.4% at 36 months, and 19% at 48 months.

Acute Disease↗
PubMed1976

Acute and chronic effects of methotrexate on hepatic, pulmonary, and skeletal systems.

With the progressive improvement in the survival of children with acute lymphocytic leukemia, the question of late effects of therapy on normal tissue becomes a more significant problem. In a review of a large number of children who have received long-term treatment with chemotherapy, especially methotrexate, a significant increase in the serious effects on hepatic, pulmonary, and skeletal tissue was noted. A review of the methotrexate-induced acute and chronic changes seen in these tissues is the basis for this report.

Bone and Bones↗
PubMed1975

Lymphocyte transformation in leukemic serum.

Cultures of normal lymphocytes were induced to transform by pokeweed mitogen (PWM). Inhibition of transformation was observed when these cultures contained sera isolated from children with acute lymphoblastic leukemia (ALL). The inhibition of transformation of normal lymphocytes was best demonstrated when the concentration of the leukemic serum in the culture medium was relatively high (60 percent); however, the inhibition was also observed with a more standard serum concentration (20 percent). Not all leukemic sera were inhibitory. Pretreatment sera from newly diagnosed patients with leukocyte counts greater than 50,000/mm3 were significantly inhibitory. Pretreatment sera from newly diagnosed patients with leukocyte counts less than 50,000/mm3, and sera from patients in remission or relapse had no significant effect. The inhibition observed with the sera of the high leukocyte count group was not believed to be related to cytotoxicity. The significance of this inhibitor in relation to clinical prognosis needs to be investigated.

Child↗
PubMed1975

Evidence for origin of certain childhood acute lymphoblastic leukemias and lymphomas in thymus-derived lymphocytes.

Lymphoblasts from children with acute lymphoblastic leukemia (ALL) or malignant lymphoblastic lymphoma were studied using surface markers characteristic of T and B lymphocytes. A B-cell marker, i.e. surface immunoglobulin, was absent in all cases studied. Fouteen of 22 children (64%) had lymphoblasts with one or both markers of T lymphocytes, i.e. receptors for sheep erythrocytes (E) and/or human T-lymphocyte antigen (HTLA) detectable using heterologous antithymocyte sera absorbed with B lymphocytes. In all instances, lymphoblasts which carried E receptors also carried HTLA. However, lymphoblasts in 6 cases carried HTLA but not E receptors. It is possible that ALL may often involve T lymphocytes which are early in differentiation (i.e. prior to development of E receptors) or, alternatively, that E receptors may be lost from T cells following malignant transformation. Thymus enlargement was found only in cases of ALL or lymphoma where T markers were present. Lymphoblasts carried the same markers when examined in various sites and at various times from the same patient.

Adolescent↗
PubMed1975

Retransplantation of human bone marrow. Two immunosuppressive drug regimens.

A 15-year-old boy with aplastic anemia was successfully retransplanted with matched sibling bone marrow after failure of a first transplant from the same donor. Cyclophosphamide was used as immunosuppression for the first transplant, and cyclophosphamide plus procarbazine plus antithymocyte globulin were used for the second transplant. Laboratory studies of peripheral blood and bone marrow karyotypes and T and B lymphocytes supported the conclusion that immunosuppression was inadequate for the first transplant, but adequate for the second transplant.

Adolescent↗