Biomedical subjects
Publications and source records attributed to N Abramson.
A patient is described with hairy cell leukemia, in whom a remission occurred spontaneously or in association with Legionnaires or subsequent HIV infection. Possible pathophysiological mechanisms are reviewed. Currently it is seventeen years since the diagnosis of hairy cell leukemia and fourteen years since the infusion of HIV infected blood. Hairy cell leukemia has yet to return and HIV infection has not progressed to AIDS.
Thrombocytopenia may be a benign, incidental finding in an asymptomatic patient or the sign of a potentially life-threatening disorder. The history, physical examination and peripheral blood smear can assist the physician in determining the diagnosis and treatment. After the initial blood count is repeated to help eliminate the possibility of laboratory error, a thorough history, complete physical examination, complete blood cell count and appropriate laboratory tests are required. The history may reveal related illnesses, risk factors such as infection or drug use, or a family history suggestive of congenital thrombocytopenia. The physical examination should concentrate on the lymphatic and hepatosplenic systems, with the physician looking for jaundice, fever or petechiae. With the review of a complete blood cell count and a peripheral smear examination, the initial work-up is completed and may prevent additional, unnecessary testing. Etiology-specific tests follow if needed. Serious spontaneous bleeding is usually a risk only in patients with platelet levels under 20,000 per mm3.
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PURPOSE: To compare sequential methotrexate (M) and fluorouracil (F) (M-->F) with surgery (National Surgical Adjuvant Breast and Bowel Project [NSABP] B-13) and cyclophosphamide (C), M, and F with M-->F (NSABP B-19), in patients with estrogen receptor (ER)-negative tumors and negative axillary nodes. PATIENTS AND METHODS: A total of 760 patients were randomized to B-13; 1,095 patients with the same eligibility requirements were randomized to B-19. Disease-free survival (DFS), distant disease-free survival (DDFS), and survival were determined using life-table estimates. RESULTS: A significant benefit in overall DFS (74% v 59%; P < .001) was demonstrated at 8 years in all B-13 patients who received M-->F (69% v 56% [P = .006] in those or= 50 years). A survival advantage was evident in older patients (89% v 80%; P = .03). In B-19, through 5 years, an overall DFS advantage (82% v 73%; P < .001) and a borderline survival advantage (88% v 85%; P = .06) were evident with CMF. The DFS (84% v 72%; P < .001) and survival (89% v 84%; P = .04) benefits from CMF were greater in women aged F or CMF after lumpectomy and breast irradiation resulted in a low probability of ipsilateral breast tumor recurrence (IBTR). In B-13, the frequency of IBTR was 2.6% following M-->F versus 13.4% in women treated by lumpectomy; it was 0.6% following CMF in B-19. Toxicity >or= grade 3 was more frequent among CMF patients in B-19. The age-related difference in CMF benefit was not related to amount of drug received. CONCLUSION: M-->F and CMF are effective for node-negative patients with ER-negative tumors. The incidence of local-regional or distant metastases and IBTR decreased after either therapy. The benefit from either therapy was evident in all patients, but the CMF advantage was greater in those F may be used in patients with medical problems that would preclude CMF administration.
Levels of brain creatine phosphokinase (CPK), glutamic oxalic transaminase, lactate dehydrogenase, and lactate in lumbar cerebrospinal fluid (CSF) were analyzed as an adjunctive study in a randomized clinical trial evaluating the effects of thiopental loading intravenously in comatose survivors of cardiac arrest. Three hospitals participated and a total of 62 cases of enzyme changes were studied. Enzyme levels but not lactate were higher at 48 hours than at 24 hours after restoration of spontaneous circulation. All enzymes were highly correlated with one another at 24 and 48 hours (P < .001). There was a significant negative correlation between cerebral recovery and increased CPK levels at 24 hours (P < .05), and a highly significant correlation with all three enzyme levels at 48 hours (P < .0001). The increase of cytosolic enzyme activity in lumbar CSF reflects permanent brain damage, and there is a relationship between activity levels and cerebral outcome.
In a community-wide screening program conducted in Jacksonville, Florida, 564 participants received free screening for prostate cancer. Frequency of positive results of prostate-specific antigen measurement and digital rectal examination was comparable to that found in similar programs in other communities. The estimated cost for each participant was $231, and the cost to discover each cancer was $7,240. If one also includes initial therapy in cost estimates, then the cost per participant was $520, and the cost to find and treat each patient was $16,300. The value of screening for prostate cancer must be judged by treatment outcome and underlying costs.
Risk monitoring for the Brain Resuscitation Clinical Trial II, a multicenter, placebo-controlled trial to evaluate the efficacy of the calcium-entry blocker lidoflazine in the amelioration of brain damage in comatose cardiac-arrest survivors, posed unexpected challenges. Concern arose when monitoring of adverse reactions showed an excess of dangerous cardiac arrhythmias, including rearrest, in the lidoflazine group. To ascertain the cause of this problem and determine whether it was ethical for the trial to continue, an in-depth review of data was conducted, outside experts were consulted, and additional data were collected. These efforts suggested possible causes for the problem. Existing drug administration protocols for blood pressure control were reinforced, resulting in lower subsequent arrhythmia rates. Thus, through an efficient monitoring system, an important problem was uncovered and resolved, allowing the trial to be completed without major changes.
Fermat's principle of least time has some well-known limitations. It does not, for example, apply to diffraction gratings and holograms, because it does not include the concept of waves. The substitution of least number of waves in flight for least time of flight and the addition of a term that is a function of the grating frequency result in a generalized principle. It is easy to remember because it is based on only the number of waves minus the number of grooves, and it would be especially useful when refraction and diffraction are combined, as, for example, in some holographic optical elements.
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The aim of the study was to develop a sensitive measuring method enabling direct evaluation of gingival swelling to be made as registered on dental casts. On two separate occasions, when different degrees of severity of gingival inflammation were present in the same subject, reversible hydrocolloid impressions were taken of the mandible. The casts obtained were located successively in identical three-dimensional relationships in a field of interference fringes generated by two intersecting beams of collimated helium-neon laser light, and were photographed. The evaluation of the moiré pattern obtained directly by superimposition of the two images of the surface studied indicated that a decrease in gingival height of 0.38 mm in the direction of the camera had occurred between the two occasions. The use of a computer-based image-processing system considerably improved the visibility of the pattern. The reproducibility of the impression technique, as well as the relocation and superimposing techniques, proved satisfactory at the moiré resolution used (0.19 mm). The method has potential application in clinical experimental research, and therefore warrants further evaluation.
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We studied a clinically realistic field-to-hospital scenario in dogs with four-minute ventricular fibrillation (VF) cardiac arrest followed by 30-minute standard external CPR basic life support (BLS). At the end of this 34-minute insult, cardiopulmonary bypass (CPB) was used for early defibrillation and assisted circulation for one hour (n = 10). Recovery was compared with that of control dogs (n = 10) in which standard CPR with advanced life support (ALS) for another 30 minutes was used for restoration of spontaneous circulation (ROSC). Both groups had hemodilution and heparinization; controlled blood pressure, blood gases, ventilation, and other parameters for 20 hours; and intensive care to 72 hours. During CPR-BLS of 30 minutes in both groups signs of cerebral viability returned. CPB achieved ROSC more successfully (ten of ten vs five of ten CPR-ALS controls) (P less than .02); and more rapidly, with less defibrillation energy (first countershock in eight of ten) and with less epinephrine (P less than .01). CPB improved 72-hour survival (seven of ten vs three of ten controls) (P less than .05). Between two and 24 hours, of those with ROSC, cardiac complications killed three of ten CPB dogs (after weaning), and two of five CPR-ALS dogs (NS). All seven CPB survivors to 72 hours were neurologically normal; of the three CPR-ALS survivors, one remained with severe neurologic deficit and two were neurologically normal (seven of ten CPB vs two of ten controls, P = .025). Starting CPR-BLS within four minutes of arrest can maintain cerebral viability.(ABSTRACT TRUNCATED AT 250 WORDS)
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Gastrointestinal complications in acute leukemia have been infrequently reported. Reported here is a review of all patients on the hematology teaching service with acute leukemia from 1974 to 1980 and those with intestinal complications. Of the 50 patients with acute leukemia, 14 (28%) developed an acute abdominal catastrophe. They presented with an acute surgical abdomen, diarrhea, gastrointestinal bleeding, and a paralytic ileus. All were granulocytopenic and thrombocytopenic. All but one episode was associated with the death of the patients; survival ranged from 4 to 26 days (median 9 days) after their last dose of chemotherapeutic drugs. Cytarabine was administered in 13 of the 14 patients. It is believed that bowel necrosis which causes death in acute leukemia occurs more frequently than previously thought. There is a close association of the clinical syndrome with chemotherapeutic drugs, especially cytarabine.
A prospective randomized trial in patients with previously untreated multiple myeloma was performed comparing carmustine (BCNU), cyclophosphamide, and prednisone (BCP) to melphalan (Alkeran) and prednisone (AP). Induction response rates, remission duration, and survival were similar with both regimens. Hematologic toxicity was greater with AP. Crossover studies in patients who relapsed did not illustrate any significant activity with either drug treatment program. Therefore, BCP can be utilized as initial therapy in myeloma because of comparable remission rates and less hematologic toxicity.
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