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Biomedical subjects

P Hermans

Publications and source records attributed to P Hermans.

At least 73 records · Page 4Linked to original sources
PubMed1995

Haematopoietic growth factors as supportive therapy in HIV-infected patients.

BACKGROUND: Neutropenia and anaemia are common problems in patients with HIV infection. Neutropenia can lead to a reduction in drug doses or to withdrawal of important myelosuppressive agents such as ganciclovir, zidovudine, cotrimoxazole and pyrimethamine, while anaemia may require the administration of blood transfusions. SUPPORTIVE THERAPY WITH HAEMATOPOIETIC GROWTH FACTORS: Haematopoietic growth factors such as granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) are effective in the treatment of AIDS-related neutropenia. G-CSF appears to be better tolerated than GM-CSF. Moreover, GM-CSF can stimulate HIV replication in the absence of antiretroviral treatment. Thus G-CSF may offer a better treatment option in some patients. Doses of up to 300 micrograms G-CSF (filgrastim) per day rapidly reverse neutropenia in most HIV-infected patients. Subsequently, normal neutrophil counts can be maintained with intermittent doses (1-7 days a week). This allows greater use of myelosuppressive agents. Recombinant human erythropoietin is well tolerated and effective in the treatment of anaemia due to zidovudine when endogenous erythropoietin levels are < or = 500 IU/l. Recombinant human erythropoietin combined with CSF also appears to be well tolerated and effective in the treatment of combined cytopenias. Other haematopoietic growth factor combinations are currently being explored. CONCLUSIONS: CSF and recombinant human erythropoietin, used alone or in combination, appear to be well tolerated and effective in the treatment of neutropenia and anaemia, respectively, in patients with HIV infection. G-CSF may be preferable to GM-CSF in some patients. However, the advantages of therapy with haematopoietic growth factors have to be balanced against the disadvantages of cost, inconvenience and discomfort associated with repeated subcutaneous injections. At present there is no clear evidence that CSF prolongs the survival of AIDS patients.

Anemia↗
PubMed1994

Syngeneic adoptive transfer of anti-human immunodeficiency virus (HIV-1)-primed lymphocytes from a vaccinated HIV-seronegative individual to his HIV-1-infected identical twin.

Immunotherapy by adoptive transfer of lymphocytes was attempted in identical twins, one who was virus-free and the other who was infected with human immunodeficiency virus-1 (HIV-1), at the stage of acquired immunodeficiency syndrome. The noninfected twin was vaccinated by priming with a recombinant vaccinia virus expressing the envelope glycoprotein of one of his brother's viruses and boosting with the same purified gp160 adsorbed on alum. Vaccination elicited major histocompatibility complex class I-restricted CD8+ cytolytic T lymphocytes specific for HIV-1, but no antibody response. The diseased brother, a 38-year-old homosexual who had developed repeated opportunistic infections since 1990 and had a CD4+ count reduced to practically zero, was treated by infusions of lymphocytes collected from the vaccinated brother by lymphopheresis. After a first transfer of the whole lymphocyte population, no changes were observed in the clinical status and biologic or virologic parameters. A second transfer was then applied with activation of the cells with purified envelope glycoprotein before infusion. The outcome of the treatment was an increase in total lymphocytes, in CD4+ and activated CD8+ DR+ cell counts, and in proliferative responses to HIV antigens. A marked but transient 3-log increase in cellular and plasmatic virus loads was also observed after the second adoptive transfer. These observations will be considered with attention to improve the future adoptive transfer protocols, especially in patients with severe CD4+ depletion.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Clinical use of haematological growth factors in patients with human immunodeficiency virus (HIV-1) infection.

HIV-infected patients commonly experience haematological disturbances including anemia, neutropenia or thrombocytopenia. Bone marrow failure may be caused by HIV itself, or by secondary involvement by opportunistic pathogens and malignancy. The need for multiple concomitant suppressive treatments may increase the risk of cytopenias. Strategy to reduce both anemia and neutropenia as well as to improve the haematological tolerance to myelotoxic agents have been developed by using haematological growth factors. So far, erythropoietin and granulocyte(macrophage) colony-stimulating factors have been successfully used in clinical trials including HIV-patients with either zidovudine-associated anemia or severe HIV or drug-induced neutropenia. However, according to the cost of these palliative approaches, there is a need for more reliable data showing that these growth factors could really have a major impact on the patient's compliance to therapy, reduction of hospitalization and infection rate and improvement of the overall survival.

AIDS-Related Complex↗
PubMed1994

Possible role of granulocyte-macrophage colony stimulating factor (GM-CSF) on the rapid progression of AIDS-related Kaposi's sarcoma lesions in vivo.

Drug-related neutropenia is a common observation in AIDS patients. Haematological growth factors are therefore increasingly used in combination with myelotoxic agents to reduce the risk of infection and to improve the haematological tolerance of these regimens. We report a case of an AIDS patient with Kaposi's sarcoma who received GM-CSF for severe neutropenia due to anti-tumour chemotherapy combining alpha-interferon 2b and zidovudine. During GM-CSF administration there was a marked increase in the size of the Kaposi's sarcoma lesions as confirmed by ultrasonographic examination. As GM-CSF in vitro has been shown to promote Kaposi's sarcoma-like cell cultures, we discuss the potential role of this growth factor in increasing Kaposi's sarcoma lesions in vivo.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Seasonal incidence and hemoparasite infection rates of Ixodid ticks (Acari: Ixodidae) detached from cattle in Costa Rica.

To determine the tick species hindering the cattle industry in Costa Rica and to assess infection rates of ticks with three important hemoparasite species, cattle were monitored during a period of six months (October 1992-March 1993). Four farms were located in the dry pacific region of the canton of Tilarán and a fifth farm on the slopes of the Poás volcano in a cool tropical cloud-forest ecosystem. On each farm 3 to 5 animals of 6 to 24 months of age were selected at random. All ticks were removed on a monthly basis from the right half side of each animal, while the site of attachment was recorded. Ticks were counted and differentiated according to species, developmental stage and sex. Moreover, engorged female ticks were assayed for the presence of Babesia bigemina, Babesia bovis and Anaplasma marginale using the polymerase chain reaction (PCR) multiplex system. Two species of ticks, Amblyomma cajennense and Boophilus microplus, were encountered on the cattle in the Tilarán region and one species, B. microplus, was detected in the Poás region. Two to ten times as many ticks were encountered in the Tilarán region than in the Poás region, which is in accordance with a stable enzootic protozoan disease situation in the former region and an unstable epizootic situation in the latter region. Nymphal and adult stages of both tick species were present in largest numbers on the ventral parts of the animals. PCR analysis of entire ticks indicated very high infection rates with hemoparasites of veterinary importance. This was in accordance with high seroprevalence rates in the hosts.

Animals↗
PubMed1994

Acute renal failure due to bilateral lymphomatous infiltrates. Primary extranodal non-Hodgkin's lymphoma (p-EN-NHL) of the kidneys: does it really exist?

Primary extranodal non-Hodgkin's lymphoma (p-EN-NHL) of the kidneys with acute renal failure as the only manifestation is very rare. The origin of neoplastic lymphoid cells in the kidneys, organs normally free of lymphoid tissue, is an unsolved problem. A literature review over the last ten years revealed only 9 adult cases, including ours that match the usual criteria: (1) renal failure as the initial presentation, (2) bilateral enlargement of the kidneys without obstruction and other organ or nodal involvement, (3) diagnosis only made by renal biopsy, (4) absence of other causes of renal failure, and (5) rapid improvement of renal function after radiotherapy or, as in our case, systemic chemotherapy. Autopsy on two patients confirmed that p-EN-NHL of the kidneys without dissemination does exist as a separate entity.

Acute Kidney Injury↗
PubMed1994

Filum terminale ependymoma revealed by acute cauda equina compression syndrome following intratumoral and spinal subarachnoid hemorrhage in a patient on oral anticoagulants.

A 65 year-old woman with a filum terminale ependymoma is reported, presenting with acute cauda equina compression syndrome due to intratumoural and subsequent spinal subarachnoid hemorrhage (SAH) following therapy with oral anticoagulants. Few cases of spinal ependymoma have been reported with an acute cauda equina compression syndrome as the initial and only symptom, and the unique feature of our patient's anticoagulant status has only been described once in this setting. Although intratumoural hemorrhage is very well known since the myxopapillary variant is unique to the cauda equina and consists of loose connective tissue and numerous small blood vessels that are prone to bleeding, spinal SAH is seldom seen and the different hypotheses about the pathophysiological mechanisms that might promote bleeding still remain unresolved and will be discussed in this paper, as well as the special clinical features of spinal SAH and some diagnostic and therapeutic implications. A review of the literature (Medline search 1983-1993) revealed only 13 cases, including ours, of spinal SAH due to cauda equina ependymoma, and the results of this review together with our findings are described in this paper.

Acute Disease↗
PubMed1993

Strain identification of Mycobacterium tuberculosis by DNA fingerprinting: recommendations for a standardized methodology.

DNA fingerprinting of Mycobacterium tuberculosis has been shown to be a powerful epidemiologic tool. We propose a standardized technique which exploits variability in both the number and genomic position of IS6110 to generate strain-specific patterns. General use of this technique will permit comparison of results between different laboratories. Such comparisons will facilitate investigations into the international transmission of tuberculosis and may identify specific strains with unique properties such as high infectivity, virulence, or drug resistance.

Base Sequence↗
PubMed1993

CT-scan diagnosis of bilateral obturator hernias in a patient with chronic chylous ascites.

Bilateral obturator hernias were diagnosed in a 61-year-old woman by CT-scan examination, permitting an elective surgical repair by preperitoneal interposition of Teflon mesh. The condition developed in a patient presenting with a 15-year history of chylous ascites, occasioned by primary hypoplasia of the lymphatic system and cirrhosis of the liver.

Chylous Ascites↗
PubMed1992

Pharmacokinetics of R 82913 in AIDS patients: a phase I dose-finding study of oral administration compared with intravenous infusion.

The pharmacokinetics of oral administration of R 82913, or tetrahydroimidazol [4,5,1-jk]-benzodiazepin-2(1H)-one or -thione (TIBO), was compared with those of intravenous administration in five AIDS patients. TIBO was administered as a single daily 1-h infusion of 100 mg for 29 days and orally as a single daily dose for 14 days with three consecutive regimens of 100, 200, and 100 mg with probenecid (1 g) daily. Each cycle was followed by a wash-out period. Oral bioavailability of TIBO appears to be low and is not improved by the adjunction of probenecid. Trough levels obtained with oral administration systematically remained far below the 90% inhibitory concentration of TIBO against human immunodeficiency virus type 1 (HIV-1). Tolerance of TIBO was excellent. No clinical efficacy could be demonstrated. p24 antigenemia decreased significantly in one patient under intravenous therapy. TIBO derivatives are promising anti-HIV-1 agents in vitro, but improvement of oral bioavailability is needed before implementation of long-term efficacy and tolerability studies. Moreover, rapid emergence of resistance, which has been recently documented, constitutes a major problem with most nonnucleoside reverse transcriptase inhibitors.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Percutaneous drainage of a pancreatic pseudocyst.

We present a patient who developed a pancreatic pseudocyst after surgery for a retroperitoneal fibrous histiocytoma invading the pancreatic tail. The diagnosis was made on the basis of CT and the tail pseudocyst resolved with percutaneous drainage only.

Adult↗
PubMed1992

Adrenal cortical carcinoma: a case report.

We present a case of adrenocortical carcinoma. Excretory urography and sonography revealed a left adrenal mass, which was confirmed by computer tomography and further delineated by arteriography. Complete surgical resection was possible. A summary of the clinical and radiological data is included.

Adrenal Cortex Neoplasms↗
PubMed1991

Assessment of the inhibitory effect of immunosuppressive agents on rat T cell interferon-gamma production using an ELISPOT assay.

The immunospot (ELISPOT) assay has proven to be an efficient and sensitive method for the enumeration of single cells secreting antibodies or cytokines. Here we show that the generation of interferon-gamma producing cells (IFN-gamma pc) in rat spleen cell cultures stimulated with concanavalin A (ConA) is dose-dependently inhibited by a wide variety of immunosuppressants such as cyclosporin A, FK506, hydrocortisone, dexamethasone, azathioprine and ART-18, a monoclonal antibody (mAb) with established immunosuppressive activity in organ transplantation and autoimmunity. The minimal inhibitory concentration (m.i.c.) correlated well with the reported m.i.c. in the mixed lymphocyte reaction (MLR) assay and the therapeutically effective plasma levels in vivo. Our data indicate that the IFN-gamma-specific immunospot assay is a powerful tool for determining the potency of immunosuppressive agents in vitro and provides a simple and accurate method for screening large numbers of agents with suspected immunosuppressive properties. The assay may additionally prove to be of value for determining the therapeutically effective doses of immunosuppressants that should be administered in vivo.

Animals↗
PubMed1991

Pancreatic disturbances and typhoid fever.

During an 8-year period, 14 adult patients were hospitalized with typhoid fever confirmed by positive blood cultures for Salmonella typhi. Among these patients, we have retrospectively (n = 7) and prospectively (n = 7) evaluated pancreatic disturbance by serum amylase and lipase measurements at the time of admission. In 7 (50%) biological signs of pancreatitis were noted: mean amylase level 81 IU (range 30-201 IU, normal value less than 40 IU), mean lipase level 949 IU (range 468-2,000 IU, normal value less than 300 IU). Clinical signs of pancreatitis were observed in 4 cases, one of whom had a concomitant salmonella biliary tract infection and gall stones demonstrated by laparotomy and the others a normal biliary ultrasonographic examination with a swelling of the pancreas. No alcohol or drug use or other infection were noted before admission. This study suggests that biological or clinical pancreatitis should be considered as a frequent complication of typhoid fever. S. typhi should therefore be added to the list of pathogens implicated in the pathogenesis of non-alcoholic or non-lithiasic pancreatitis.

Acute Disease↗