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P Ernst

Publications and source records attributed to P Ernst.

At least 163 records · Page 9Linked to original sources
PubMed1991

Clinical value of PCR in diagnosis and follow-up of leukaemia and lymphoma: report of the third Workshop of the Molecular Biology/BMT study group.

The proceedings of the third workshop of the molecular biology/bone marrow transplantation (BMT) study group held in January 1991 in Verona, Italy. This workshop was convened to review progress in the application of molecular techniques to the diagnosis and follow-up of patients with chronic myeloid leukaemia (CML) as well as other haematologic malignancies. The results of polymerase chainreaction studies in 157 CML patients 1-90 months post BMT suggest that leukaemia is frequently detectable for the first 12 months but rarely detected thereafter except in patients known to have a high risk of relapse. In the acute leukaemias and lymphomas there is a rapidly increasing number of leukaemia-specific as well as clone-specific molecular markers now available for the detection of minimal disease. It may be possible to coordinate multi-center prospective studies to investigate the role of these markers in the diagnosis and follow-up of haematologic malignancies.

Bone Marrow Transplantation↗
PubMed1990

The relationship between respiratory impairment and asbestos-related pleural abnormality in an active work force.

With the general improvement in environmental controls in workplaces where asbestos is used, an increasing number of workers are seen who exhibit isolated pleural plaques. The question as to whether these are associated with respiratory impairment independently of parenchymal disease remains unresolved. The question was reinvestigated using quantitative gallium-67 lung scanning to take into account early parenchymal change not evident on the chest radiograph. We carried out a cross-sectional study of 110 construction insulators all currently at work. Overall, 58.2% had pleural abnormality, 52.5% pleural plaques only, and 5.5% diffuse pleural thickening as assessed from the PA chest radiograph. Compared with those without, those with any pleural abnormality had a decrease in FEV1 and FVC on average of 222 and 402 ml (p less than 0.05), and those with isolated pleural plaques, a decrease on average of 200 and 350 ml (p less than 0.05), after taking into account age, height, smoking status, and the presence of parenchymal abnormality as assessed by chest radiography and gallium uptake. The complaint of dyspnea with strenuous activities was also significantly related to the width and extent of chest wall pleural thickening (p less than 0.05), independently of parenchymal disease. This study suggests that the most common radiographic findings in asbestos-exposed, isolated pleural plaques are associated with a significant reduction in FEV1 and FVC, which cannot be attributed to the presence of radiographic and subradiographic pulmonary fibrosis.

Adult↗
PubMed1990

Allogeneic bone marrow transplantation for leukemia in Europe: regional differences. Report from the Leukemia Working party of the European Group for Bone Marrow Transplantation.

The results of 1904 allogeneic HLA identical sibling donor bone marrow transplants performed in 52 European centers between 1979 and 1986 and reported to the EBMT leukemia registry were analysed by geographical location of the transplant. Patients were grouped into six regions: United Kingdom, Nordic Group, Benelux, France, Central Europe and Southern Europe. There were significant differences between these regions with respect to patient population and outcome. The relative proportion of the three major disease categories, stage and subtype of the diseases, graft-versus-host disease prevention methods, donor recipient sex combinations, age of the patient, year of the transplant and the time intervals from diagnosis to transplant, from diagnosis to first complete remission for acute leukemia and the time from first complete remission to the transplant varied from region to region. The analysis of outcome parameters showed a significant difference in relapse incidence from region to region. This influence of region was confirmed in a multivariate analysis and was independent of the other factors known to affect outcome. Leukemia-free survival and transplant-related mortality were not different. The reasons for these differences could not be explained by the data in the registry. We conclude that regional factors must be considered when bone marrow transplant data are compared and we postulate that pretransplant factors probably affect outcome more than was previously realized.

Adolescent↗
PubMed1989

Relationship of lung geometry to the development of pleural abnormalities in insulation workers exposed to asbestos.

The relationship of respiratory airway and airspace geometry to radiographic evidence of pleural abnormality consistent with asbestos exposure was studied in 178 construction insulators. Lung geometry was assessed from tracings of radiographic shadows, and the measures taken were tracheal length and diameter, subcarinal angle, right and left lung lengths, and upper, middle, and lower lung widths. Important modifying variables--age, height, weight, exposure estimates, and smoking history--were included in a logistic regression model to test the significance of the lung geometry measurements as predictors of the presence or absence of pleural abnormality. No such relationships were found. Neither were there any differences in prevalence or severity of pleural disease between the right and left sides which might have been found if airway geometry were a significant determinant of asbestos pleural disease. These results do not support the hypothesis that lung geometry is a host risk factor for the development of asbestos-related pleural disease.

Adult↗
PubMed1989

Relation of airway responsiveness to duration of work in a dusty environment.

Health selection within a workforce has been found in several industries and appears to be more pronounced in dustier occupations. In this study of airway disease among workers exposed to asbestos and man made mineral fibres, 215 of 246 construction insulators 50 years old or less and currently working in the Montreal area were examined. Spirometry was completed successfully in 214 workers without known asbestosis and 207 underwent methacholine bronchoprovocation testing. Airway responsiveness was expressed as PC15, the concentration of methacholine causing a 15% fall in the forced expiratory volume in one second (FEV1). Exposure to asbestos and synthetic mineral fibre dust was estimated from the total hours of work in the trade since first employment. After the effect of age, height, and pack years of smoking had been taken into account, no relation was found between hours of work and any indices obtained from the forced expiratory manoeuvre (FEV1/FVC, MMF). After the effect of airway calibre (FEV1/FVC), age, and pack years of cigarette consumption had been taken into account, airway responsiveness decreased as the total hours of work in the trade increased. These findings suggest that workers with greater levels of airway responsiveness are more sensitive to exposure in a dusty workplace and in consequence are less likely to continue. In studies of workforces a survivor effect of this nature will tend to weaken the relation between lung function abnormality and occupational exposure.

Adult↗
PubMed1989

Stoplight Grid: a color-coded visual system for per diem staff assignment.

What is the best way to appropriately assign per diem nursing personnel? The author describes a systematic approach to per diem staff assignment called the Stoplight Grid. The Stoplight Grid correlates staff skills and preferences with unit needs and integrates this data into a color-coded system for staff assignment.

Costs and Cost Analysis↗
PubMed1988

Obstructive and restrictive ventilatory impairment in polyvinylchloride fabrication workers.

Responses to a standardized respiratory symptom questionnaire, spirometry, and cross-shift decreases in lung function between 70 current employees of a polyvinylchloride (PVC) fabrication plant and a control group consisting of 48 men employed in a vegetable packing plant were compared. FEV1/FVC was significantly lower in the PVC workers. Cross-shift drops in Vmax75 of 15% or more were also more prevalent in the exposed group (p = .01). When examining the association between months of work within the exposed workforce and spirometric indices of airway obstruction, no relationship could be demonstrated. However, an inverse dose-response relationship was seen between level of FVC and duration of employment, suggesting a restrictive impairment. While the specific exposures have not been identified, it appears that employment in PVC fabrication may be associated with both obstructive and restrictive ventilatory effects.

Adult↗
PubMed1988

Between- and within-reader variability in the assessment of pleural abnormality using the ILO 1980 international classification of pneumoconioses.

Although there are published data concerning reader variability in the assessment of parenchymal pneumoconiotic changes using the ILO Classification of Radiographs, nothing has been published on reader variability with regard to pleural abnormalities. Therefore, in the context of an epidemiologic study, we assessed between- and within-reader variability in the reading of chest radiographs for pleural abnormality using the ILO 1980 International Classification of Radiographs of Pneumoconioses. Chest radiographs of 182 insulation workers interspersed with 24 subjects without documented exposure to asbestos were assembled and read blindly by two readers, reading separately on two occasions, 1 week apart. The results of this study suggest that confident separation of pleural plaques and diffuse pleural thickening may be difficult to achieve using the present guidelines of the ILO 1980 classification. In the evaluation of the width of chest wall pleural abnormality, within-reader agreement improves as the width increases, while between-reader agreement was much less satisfactory. Excellent agreement is obtained in the evaluation of other sites, especially costophrenic angle obliteration and the presence of pleural calcification.

Adult↗
PubMed1988

Does seasonal employment in grain elevators increase nonspecific airways responsiveness?

Grain handling and increased airways responsiveness (AR) have been independently associated with an accelerated decline in forced expiratory volume in 1 sec. We performed methacholine inhalation bronchial challenge tests in 45 river port grain handlers during layoff and again during employment to determine whether short-term exposure increased AR. To assess bias, due to seasonal/temporal influences, AR was also measured in 56 nonexposed men of similar age and socioeconomic status. AR, slightly higher among laid-off grain handlers than the comparison group, fell more among grain handlers during employment than among the comparison group during the same time period. Our results do not support the hypothesis that seasonal exposure to grain dust increases AR.

Adult↗
PubMed1988

Bone marrow transplantation (BMT) versus immunosuppression for the treatment of severe aplastic anaemia (SAA): a report of the EBMT SAA working party.

This is an analysis of 509 patients with severe aplastic anaemia (SAA) treated in Europe between 1981 and 1986; 218 patients were treated by allogeneic bone marrow transplantation (BMT) from HLA identical sibling donors and 291 with immunosuppressive therapy (IS) with antilymphocyte globulin (ALG). The overall actuarial survival was 63% after BMT and 61% after IS therapy at 6 years. All patients fulfilled the criteria of SAA; however, most patients with a neutrophil count of less than 0.2 x 10(9)/l also had infections and haemorrhages. Therefore a further subclassification was defined by pretreatment peripheral blood neutrophil count: very severe aplastic anaemia (vSAA) (less than 0.2 x 10(9)/l neutrophils) and moderately severe aplastic anaemia (mSAA) (0.2-0.5 x 10(9)/l neutrophils). A Cox regression analysis showed that the only significant pre-treatment variables were a low neutrophil count (P = 0.001) and increasing age (P = 0.05). Thus it seemed reasonable to analyse survival data after combined stratification for neutrophils (vSAA versus mSAA) and age (cut off at 20 years). BMT was superior to IS in patients with vSAA under 20 years of age (64% v. 38%; P = 0.01). IS was superior to BMT in patients with mSAA aged 20 or more (82% v. 62%; P = 0.002). The two treatments gave comparable results in young patients with mSAA (BMT = 58%, IS = 62%; P = 0.1), and in older patients with vSAA (BMT = 44%, IS = 43%; P = 0.06). Overall 75/218 and 87/291 patients, given BMT or IS respectively, died. The major cause of failure in BMT patients was graft rejection (n = 22) or problems associated with graft-versus-host disease. For ALG patients the major problem was persistence of the aplasia with haemorrhage (n = 32) or infections (n = 46). This study indicates that over 60% of patients with SAA can be successfully treated with either BMT or IS. Overall survival does not differ in the two groups, though significant differences emerge after stratification for severity of the aplasia and age.

Adolescent↗
PubMed1988

Relapse after allogeneic bone marrow transplantation for acute leukaemia: a survey by the E.B.M.T. of 117 cases.

A multi-centre retrospective analysis on 117 patients relapsing after bone marrow transplantation (BMT) for acute leukaemia was carried out by the Leukaemia Working Party of the European Group for Bone Marrow Transplantation (E.B.M.T.). Forty-one patients had acute myeloid leukaemia (AML) and 76 had acute lymphoblastic leukaemia (ALL). Relapse occurred between 3 and 30 months after BMT and where investigated the leukaemia was found to have relapsed in recipient cells. In 10 cases the relapse was associated with new cytogenetic abnormalities. 74 patients received further treatment for leukaemia. Of these 21 out of 50 with ALL and 11 out of 24 with AML achieved a complete remission and had a median survival of 12 months compared with a median survival of 4 months for untreated patients or patients not achieving complete remission (P less than 0.001). Factors predictive for successful remission induction were a long interval between bone marrow transplant and relapse in ALL patients; and isolated extramedullary relapse. Presenting blast count, karyotype and remission status and number at the time of BMT were not predictive. Donor bone marrow was shown to be responsible for haemopoietic recovery occurring in the 21 out of 31 patients tested who achieved remission using donor karyotype or red blood cell antigens as markers. Nine patients received a second bone marrow transplant but only one became a long-term survivor. The results show that chemotherapy can usually prolong survival in selected patients with acute leukaemia relapsing after BMT but further BMT has a poor outlook.

Adolescent↗
PubMed1988

Mafosfamide (ASTA-Z-7654) in vitro treatment of bone marrow does not eradicate Philadelphia-positive cells in chronic myeloid leukaemia.

Bone marrow from 9 patients with Ph1+CML was treated in vitro with varying concentrations of Mafosfamide in order to test the hypothesis that selective pharmacological killing of Ph1-positive cells in CML is feasible. A marked difference in sensitivity to Mafosfamide of CFU-GM was observed, but at all concentrations 100% persistence of Ph1+ cells was noticed. We conclude that, in classical cases of Ph1-positive CML, Mafosfamide purging of bone marrow will not be effective.

Adult↗
PubMed1988

Environmental exposure to tobacco smoke and lung function in young adults.

The relationship between lung function and environmental exposure to tobacco smoke (passive smoking) was studied in 293 nonsmoking young men and women, 15 to 35 yr of age. A self-administered mailed questionnaire was used to assess the lifetime environmental exposure to cigarette smoke at home and at work for each subject. Lung function information used here had been gathered in the course of a previous study of the determinants of lung function in early adulthood. In men, maximal midexpiratory flow rate (FEF25-75) decreased in relation to an index of cumulative lifetime environmental exposure to tobacco smoke at home, after taking into account the effects of cumulative exposure at work as well as age, height, body size, respiratory pressures, and cooking fuels used at home. The components of this exposure index most closely related to the reduction in FEF25-75 were maternal smoking habits and exposure to second-hand smoke during childhood. In women, the diffusing capacity of the lung (DLCO) decreased in relation to cumulative exposure to tobacco smoke at work, after accounting for the effects of cumulative lifetime exposure at home and the other factors mentioned above. These findings contribute to the gathering evidence that environmental exposure to tobacco smoke is harmful to respiratory health, and suggest that the effects are not insignificant. For instance, the FEF25-75 of a young man 20 yr of age who had never smoked and always lived at home would be 800 ml less if both his parents smoked than if they did not.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Clinical prediction of airways hyperresponsiveness.

We tested the ability of chest physicians to detect increased airways responsiveness (IAR) in patients presenting with symptoms suggestive of asthma. Physicians ordering bronchial provocation tests for diagnostic purposes were asked to predict the clinical probability (based on the patient's history, examination, and spirometry) of IAR (defined by a PC20 for FEV1 less than or equal to 8 mg/ml of histamine). Presenting symptoms in the 38 subjects aged 16 to 78 years included cough, wheeze, dyspnea, chest tightness, and recurrent colds. There was no association between IAR and clinical probability dichotomized as less than or equal to 50 percent or greater than 50 percent (p = .16, Fisher test). The association was no stronger using only subjects in whom the clinical prediction was greater than 67 percent or less than 33 percent. If knowledge of the level of airway reactivity would influence subsequent patient management (eg, prescription of antiasthmatic therapy), then its clinical prediction should not be relied upon.

Adult↗