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Biomedical subjects

O Shpilberg

Publications and source records attributed to O Shpilberg.

At least 55 records · Page 3Linked to original sources
PubMed1996

Low molecular weight heparin for the prevention of veno-occlusive disease of the liver in bone marrow transplantation patients.

Hepatic veno-occlusive disease (VOD), a common complication of bone marrow transplantation (BMT), is a result of intensive conditioning by chemo-radiotherapy. Endometrial injury causes fibrin deposition in the affected hepatic venules, leading to abnormal laboratory parameters followed by lethal full-blown disease. Previous studies have shown that unfractionated heparin can prevent VOD in BMT patients. Since low molecular weight heparin (LMWH) preserves the antithrombotic, but not the anticoagulant, activity of unfractionated heparin, we initiated a pilot study to determine the safety of LMWH for the prevention of VOD. Sixty-one patients undergoing BMT (allogeneic, n=24; autologous, n=37) were randomized to receive subcutaneous injection of enoxaparin (40 mg/day x 1) or a placebo prior to BMT conditioning and until day 40 after transplantation or discharge from the hospital. LMWH administration did not influence marrow engraftment, nor was it associated with bleeding tendency. Hemorrhagic events occurred significantly less frequently (P=0.025) were shorter duration (P=0.006) in the LMWH group than in the placebo group. Time to platelet recovery was significantly shorter (16.5 vs 29.6 days, (P=0.0075), and platelet transfusion requirements were lower (p=0.05) in the LMWH patients. VOD parameters occurred less frequently in the experimental group, including duration of elevated bilirubin levels (P=0.01) and incidence of hepatomegaly (P=0.04). LMWH, which seems to enhance platelet recovery, may be safely administrated to BMT patients in an attempt to prevent VOD of the liver.

Adult↗
PubMed1996

Low molecular weight heparin stimulates megakaryocytopoiesis in bone-marrow transplantation patients.

The use of low molecular weight heparin (LMWH) as prophylaxis for veno-occlusive disease of the liver has been studied in patients undergoing bone marrow transplantation (BMT). The present study analyzes the effect of LMWH on the time course of platelet recovery after BMT. Significantly accelerated platelet recovery in conjunction with lessened requirements of platelet transfusions was observed in the LMWH-treated patients.

Anticoagulants↗
PubMed1996

Transient normal platelet counts and decreased requirement for interferon during pregnancy in essential thrombocythaemia.

We report on the remarkable decrease in the platelet counts during pregnancy in two women with essential thrombocythaemia following treatment with recombinant interferon-alpha (r-IFN-alpha). Prior to pregnancy, the first patient was treated for 10 months with r-IFN-alpha 3 x 10(6) units/d six times per week, and the platelet count ranged between 750 and 800 x 10(9)/l. Starting from the sixth week of gestation, the platelet count decreased to normal levels and remained so, resulting in a lower r-IFN-alpha requirement. Following successful delivery of a healthy newborn an abrupt rise of the platelet count to pre-gestation values was observed, necessitating increased r-IFN-alpha dosage before pregnancy. The second patient when she became pregnant had been treated with r-IFN-alpha 3 x 10(6) units/d six times per week for 10 weeks. Starting from the 24th week of gestation the platelet count decreased, and despite reduction in the dose of r-IFN-alpha reached normal values at the time of delivery. The exact mechanism for the platelet count normalization during pregnancy is unclear, and several possibilities are discussed.

Female↗
PubMed1996

Hypertension in the Jerusalem 70 year olds study population: prevalence, awareness, treatment and control.

As part of the Jerusalem 70 year olds study, we evaluated the prevalence, awareness, treatment and control of hypertension (blood pressure > or = 160 mm Hg systolic and/or > or = 95 mm Hg diastolic, or current treatment with prescribed antihypertensive medications). The study cohort consisted of 448 participants, 224 of whom had hypertension. Relative to other populations, awareness was high (87%). Although the treatment rate was also relatively high (86%), the control rate was only 43%. Untreated isolated systolic hypertension was uncommon (5%), as was orthostatic hypotension (6.9%). Thus, despite a remarkable degree of awareness and treatment rate of hypertension, control levels were disappointingly low. This finding, if confirmed, requires further elucidation.

Aged↗
PubMed1996

Energy expenditure variations in soldiers performing military activities under cold and hot climate conditions.

This study assessed the energetic status of soldiers exposed to intense physical activities in cold and warm weather. Thirty subjects participated in a two-phase study group A (n = 18) in the winter phase and group B (n = 12) in the summer phase. Energy expenditure (EE) was measured by the doubly labeled water technique; after a single, oral dosing of 2H(2)18O, daily urine samples were collected for 12 successive days. Energy intake (EI) was assessed from detailed food records analyzed by computerized food charts. Energy balance was calculated as the difference between EI and EE for each subject. Mean (+/- SE) daily EE was 4,281 +/- 170 and 3,937 +/- 159 kcal/day for the winter and summer groups, respectively. Daily EI was 2,792 +/- 124 kcal/day in group A and almost identical in group B. A negative energy balance of 1,422 +/- 163 kcal/day and 924 +/- 232 kcal/day (not significant) was calculated for groups A and B, respectively. Energy expenditure is primarily determined by the level of activity rather than by climate conditions; EI is insufficient to offset the high energy requirements under these conditions.

Adult↗
PubMed1995

The need for liver transplantation: a nationwide estimate based on consensus review.

Orthotopic liver transplantation (OLT) is widely practised in developed countries. The procedure is costly, the supply of donor organs limited, and it is not known how many patients need transplantation. A community-wide estimate of the needs for OLT was performed over two years in all general hospitals in Israel. Records of 1851 patients with liver disease were screened to identify those who might eventually need OLT. The annual estimate of transplantation needs in the country was 10-15.5 per million population, with equal numbers of males and females. The addition of patients with nonreformed alcoholism and end-stage liver disease, originally set as an exclusion criteria, would have added 20% to this estimate. 37% of potential candidates were under 40 years of age at diagnosis, and about 50% were 55-64 years old. Almost 80% of patients had cirrhosis of the liver and 13.6% had fulminant hepatitis. These findings provide a basis for a national plan of OLT in Israel, and similar studies might be useful in other countries.

Adolescent↗
PubMed1995

[Long-term follow-up in polycythemia vera].

67 patients with polycythemia vera, diagnosed and treated between 1963-1990, were analyzed retrospectively. The mean follow-up was 7.4 +/- 5.1 years and median actuarial overall survival 23.6 years. 50% were treated with a single chemotherapeutic agent, and 46% with combinations of agents. In only 4% was phlebotomy the sole treatment. There were hematological complications in 18%, thromboses in 18%, and bleeding in 21%.

Combined Modality Therapy↗
PubMed1995

One of the two common mutations causing factor XI deficiency in Ashkenazi Jews (type II) is also prevalent in Iraqi Jews, who represent the ancient gene pool of Jews.

In recent years four mutations causing factor XI deficiency have been identified in Jews of Ashkenazi (European) origin. Two of them, type II (a nonsense mutation) and type III (a missense mutation), were found to prevail among 125 unrelated Ashkenazi Jews with severe factor XI deficiency. A finding of type II mutation in four unrelated Iraqi-Jewish families raised the possibility that this mutation is also common in Iraqi Jews, who represent the ancient gene pool of the Jews. A molecular-based analysis performed in 1,040 consecutively hospitalized patients disclosed the following results: Among 531 Ashkenazi-Jewish patients, the type II allele frequency was 0.0217 and among 509 Iraqi-Jewish patients, 0.0167 (P = .50). The type III allele frequency in the Ashkenazi-Jewish patients was 0.0254, whereas none of 502 Iraqi-Jewish patients examined had this mutation. These data suggest that the type II mutation was present in Jews already 2.5 millenia ago. The data also indicate that the estimated risk for severe factor XI deficiency in Ashkenazi Jews (due to either genotype) is 0.22% and in Iraqi Jews, 0.03%, and that the estimated risk of heterozygosity in Ashkenazi Jews is 9.0% and in Iraqi Jews, 3.3%. As patients with severe factor XI deficiency are prone to bleeding after injury and patients with partial deficiency may have similar bleeding complications when an additional hemostatic derangement is present, the observed high frequencies should be borne in mind when surgery is planned for individuals belonging to these populations.

Aged↗
PubMed1995

The insulin-like growth factor system in regulation of normal and malignant hematopoiesis.

The published data available on the insulin-like growth factor (IGF) family of peptides, its receptors and binding proteins in connection with normal and neoplastic hematopoietic processes are reviewed. It is found that nearly all the different hematopoietic cells, either normal or neoplastic, express IGF receptors. The IGFs are involved in normal erythropoiesis, granulopoiesis and lymphopoiesis. IGFs, especially IGF-1, are mitogenic for cell lines of myeloid and lymphoid leukemias and Burkitt's lymphoma. Differentiation of certain immature malignant cell lines is associated with a decrease in the number and affinity of IGF receptors. It might be concluded that the IGFs have an important role in the physiologic and neoplastic processes of the hematopoietic system, and the expanding knowledge of this issue will contribute to the understanding of proliferation and differentiation processes in specific hematologic disorders.

Animals↗
PubMed1995

Postremission therapy with two different dose regimens of cytarabine in adults with acute myelogenous leukemia.

Sixty-seven out of 105 (64%) adults with de novo acute myelogenous leukemia (AML), achieving complete remission after induction chemotherapy, entered two successive postremission treatment protocols. Between 1987 and 1989, 35 patients received an intermediate dose of cytarabine (IDAC) along with other drugs. Between 1990 and 1993, 32 patients received high dose cytarabine (HIDAC) with similar other drugs. Patients treated with IDAC had a median survival of 13.8 months (95% CI 11.2-23.1 months) and a 2 year survival of 34.3 +/- 8.0%. Patients receiving HIDAC had a median survival of 35.5 months (95% CI, lower limit 29.8 months) and a 2 year survival of 71.6 +/- 9.4% (P < 0.002). The 2 year actuarial leukemia-free survival (LFS) was 17.8 +/- 6.6% in the IDAC group and 67.3 +/- 10.0% months in the HIDAC group (P = 0.004). The HIDAC group had a significant 2 year survival advantage over the IDAC group only in patients younger than 45 years. The 2 year survival in the first group was 83.3 +/- 10.8% versus 23.5 +/- 10.3% in the IDAC group (P = 0.0001). In patients older than 45 years, no significant differences in 2 year survival was noticed (52.9 +/- 15.78 versus 44.4 +/- 11.7, P = 0.8). Censoring the 21 patients who underwent bone marrow transplantation (BMT) at BMT did not change significantly the survival analysis of the patients in each group. This study is consistent with previous reports favoring HIDAC intensification in the postremission treatment of young patients with AML.

Actuarial Analysis↗
PubMed1995

A controlled trial of tranexamic acid therapy for the reduction of bleeding during treatment of acute myeloid leukemia.

In order to determine the efficacy of the antifibrinolytic agent tranexamic acid (TA) in reducing bleeding and platelet transfusions during the treatment of acute myeloid leukemia (AML), we conducted a randomized placebo-controlled double-blind study. Patients with AML undergoing induction or postremission consolidation chemotherapy were randomized into TA or placebo groups. Patients were not given platelet transfusions prophylactically but only when bleeding occurred. The severity of any bleeding event was scored. Thirty eight patients were randomized during induction. There were no significant differences between the two groups in the number of bleeding events and their severity or in the number of platelet transfusions given. Eighteen patients were studied during consolidation. In contrast, to the induction period, during consolidation there was a significantly less severe bleeding tendency in the TA group resulting in a lower platelet transfusion requirement [3.7 +/- 4.1 vs. 9.3 +/- 3.3 platelet units (p < .05)]. TA was well tolerated and no side effects were seen and no specific thromboembolic events were noticed. We conclude that giving TA during the thrombocytopenic period of AML patients undergoing consolidation chemotherapy is beneficial and safely reduces platelet transfusions.

Acute Disease↗
PubMed1994

The cyclophosphamide, vincristine, prednisone, bleomycin, doxorubicin, and procarbazine (COPBLAM-I) regimen for intermediate-grade non-Hodgkin's lymphoma. Long term follow-up in 51 patients.

BACKGROUND: Cyclophosphamide, vincristine, prednisone, bleomycin, doxorubicin, and procarbazine (COPBLAM-I) is a second generation combination chemotherapy for intermediate-grade non-Hodgkin's lymphoma (NHL). Since the first report by Laurence et al. in 1982, only a few series were reported on the long term results of this regimen. METHODS: In this prospective study, the clinical courses of 51 patients with intermediate-grade NHL (F, G, or H according to the International Working Formulation grading criteria) with a median age of 65 years (range, 55-81), who were diagnosed between 1983 and 1992, are reported. Eligibility criteria included at least one full cycle of the regimen and no previous chemotherapy. RESULTS: A mean of seven cycles (range, two to nine) with two escalations (range, zero to six) was administered. In a median follow-up of 2.4 years (range, 0.5-10), 33 patients (65%) experienced complete remission. The projected 3-year overall survival (OS) and progression free survival rates (PFS) were 58% and 77%, respectively, and the projected 5-year OS and PFS were 52% and 72%, respectively. In only 2 patients (4%) were treatment-related deaths observed, whereas nonfatal complications were more common. Patients in the low risk group, according to the international NHL prognostic index, had the best outcome. The mean percentage of projected dose intensity (DI) was 95% (range, 77-109), whereas no difference in DI was found between patients younger or older than 65 years. CONCLUSIONS: In a single center, COPBLAM-I combination chemotherapy was safe and effective for patients older than 55 years with intermediate-grade NHL.

Aged↗