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Biomedical subjects

P Jacobs

Publications and source records attributed to P Jacobs.

At least 415 records · Page 23Linked to original sources
PubMed1984

Unusual response of lymphocytic lymphoma (not hairy cell leukaemia) to splenectomy without chemotherapy.

An unusual period of prolonged disease control after splenectomy without chemotherapy was achieved in 3 cases of B-cell lymphocytic lymphoma with pancytopenia, massive splenomegaly, minimal lymphadenopathy and circulating hairy cells. The finding of distinctive histopathological features in the bone marrow, lymph nodes and splenic tissue enabled this unusual condition to be characterized and differentiated from hairy cell leukaemia, which may have similar presenting features and in which response to splenectomy is generally good.

Aged↗
PubMed1984

Hodgkin's disease in children. A ten-year experience in South Africa.

Twenty-seven children with Hodgkin's disease were treated with MVOPP (mustine, Velban [vinblastine], Oncovin [vincristine], procarbazine, prednisone) combination chemotherapy. All 11 children with Stage I or Stage II disease achieved complete remission and no relapses have occurred between 34 and 179 months of continuous follow-up. Of the 16 children with Stage III or Stage IV disease, two with partial remission and three nonresponding patients died with a median survival of 18 months. The remaining 11 (68%) achieved complete remission. Of these, 6 (55%) have relapsed with a median remission duration of 36 months; five have been retreated with MVOPP, and one with total nodal irradiation, and all achieved second complete remission. Three of the children have died of Hodgkin's disease, with a median survival of 55 months; one child died of acute myeloblastic leukemia while in remission; and one child remains disease-free off all therapy at 165 months; the sixth child treated with total nodal irradiation is disease-free at 166 months. The initial complete remission has been sustained in all 11 children with Stage I or Stage II Hodgkin's disease, suggesting that combination chemotherapy is an alternative to radiotherapy as the initial form of treatment in this group of individuals.

Adolescent↗
PubMed1984

The coloured elderly in Cape Town--a psychosocial, psychiatric and medical community survey. Part IV. Haematological values.

One hundred and fifty randomly selected individuals aged 65 years and over voluntarily participated in haematological studies which formed part of a comprehensive survey of the psychiatric and physical health of elderly Coloured persons in Cape Town. Complete haematological information was available for 139 of the respondents and showed that values for a standard profile of screening tests did not differ from those in groups of White subjects living in Cape Town or Western Europe or from those in subjects from the same ethnic group but aged between 20 and 60 years. In 16 cases (11,5%) the initial haematological studies showed some abnormality. In 7 subjects (5%) the total white cell counts were raised, in 4 they returned to normal and in 3 remained elevated with normal differential distributions of the cells; no explanation for this has been found. Three respondents (2%) had a raised mean cell volume attributable to alcoholism. Eight (6%) had hypochromic microcytic anaemia due to iron loss resulting from occult gastro-intestinal tract bleeding. In 1 case this was due to a hiatal hernia and in the remaining 7 to carcinoma. The study shows that in this population nutrition is generally satisfactory and emphasizes the importance of investigation to determine the cause of anaemia in the elderly.

Black or African American↗
PubMed1984

In adult acute nonlymphoblastic leukaemia extended maintenance chemotherapy has no benefit.

Fifty-two consecutive and previously untreated adults with nonlymphoblastic leukaemia underwent remission induction chemotherapy with a combination of the epipodophyllotoxin VP16-213, cytosine arabinoside, and doxorubicin (Adriamycin). Complete remission was achieved in 23 of the 52 patients (44%) by means of a single course of therapy in 20 individuals, two courses in two, and three courses in one; median duration of complete remission was 48 weeks. Failure to achieve remission status was due to primary drug resistance in 13 patients (25%), and adequate trial of therapy was not possible in 16 patients (31%) owing to their late referral and accounts for the low remission rate. Individuals achieving complete remission were randomly assigned to receive either 6 (n = 8) or 15 months (n = 13) of maintenance therapy; respective median survival was 95 and 78 weeks (P greater than 0.10). These data confirm previously reported results for complete remission induction with this three-drug combination and fail to show any difference between short (6 months) and long (15 months) maintenance chemotherapy.

Acute Disease↗
PubMed1984

Comparison of filtration to continuous-flow centrifugation for plasma exchange.

The Asahi Plasmaflo Hollow Nylon Fibre Filtration System (n = 13) was directly compared to the NCI-IBM 2990 Continuous-Flow Blood Fraction Separator (n = 10) for plasma exchange. The systems were equally efficient in achieving plasma separation. There were significant differences favouring filtration for clearance of fibrinogen (P less than 0.05), and the fourth component of complement (P less than 0.01). Greater loss of urea (P less than 0.05) was found after plasma exchange, using the cell separator. The flow characteristics were markedly different. In a standardised 4-L plasma exchange, filtration took place at 35 ml/minute, with a procedure time of 109 +/- 45 minutes in contrast to centrifugation at a plasma flow collection rate of 19 ml/minute, requiring 208 +/- 17 minutes. This time advantage for the former procedure was offset by 195 minutes required to regenerate the hollow nylon fibre unit and a further 90 minutes required for cleaning under strictly controlled aseptic techniques prior to reuse. Each filter was regenerated at least twice and reused without infection, but there was incremental loss of filtration efficiency demonstrated by decreasing clearance of an intravascular marker dye. In two of the 13 procedures using the Plasmaflo system, serious reactions necessitated termination of the procedure; this did not occur using the cell separator. Restriction of the number of times that the filter unit could be regenerated without loss of efficiency, the prolonged time required for regeneration and cleaning, coupled with the need for artificial vascular access to meet high blood flow rates required, limit the usefulness of this technique for plasma exchange.

Blood Chemical Analysis↗
PubMed1984

The function and structure of granulocytes collected using the IBM 2997 separator.

The effect of oral methylprednisolone and the sedimenting agent, hydroxyethyl starch, on granulocyte recovery, morphology, and function was studied in a volunteer donor programme. Using the IBM 2997, 10 litres of whole blood were processed, with an average procedure time of 2.4 hours and a collection volume of 300 ml. Donors not receiving methylprednisolone (n = 80) had a mean total granulocyte count of 3.5 X 10(9)/litre (range 1.6-5.3 X 10(9)/litre) and mean granulocyte yields were 1 X 10(10) (range 0.2-3.0 X 10(10)). Those receiving 48 mg oral methylprednisolone 6-8 hours before the procedure (n = 320) had a mean granulocyte count of 6.3 X 10(9)/litre (range 3.2-11.4 X 10(9)/litre) and significantly superior mean granulocyte yields of 2.0 X 10(10) (0.3-6.5 X 10(10)) (P less than 0.05). For both groups the mean packed cell volume of 0.08 litre/litre (range 0.02-0.17) and platelet contamination 1.9 X 10(11) (range 0.3-5.0 X 10(11)). In all these procedures, hydroxyethyl starch was added to the blood entering the centrifuge channel. In none of the procedures were any untoward symptoms experienced by the donors. Light microscopy and ultrastructural studies showed no difference between control granulocytes and those collected following the addition of hydroxyethyl starch or after oral methylprednisolone. Similarly, granulocyte function measured with a random migration, chemotaxis, phagocytosis, and intracellular killing was not significantly different between control cells and those exposed to the sedimenting agent or the adrenocorticosteroids (P greater than 0.10). It is concluded that donor premedication with methylprednisolone significantly enhances granulocyte yields in the presence of hydroxyethyl starch and neither agent has any demonstrable effect on granulocyte morphology or function.

Blood Donors↗
PubMed1984

Pricing behavior of non-profit agencies. The case of blood products.

In this study we examine the pricing behavior of a non-profit agency, the American National Red Cross blood service units. Two alternative hypotheses are presented: one in which the agency maximizes profits,, and one in which output is maximized subject to a breakeven constraint. Following a general approach developed by Eckstein and Fromm , pricing equations for separate blood products are applied to cross-sectional data from Red Cross blood centers to determine the impact of demand, cost, competition, and subsidy variables. The impact of these variables, in particular the impact of the fixed subsidy on price, is shown to be consistent with the output-maximizing model.

Blood Banks↗
PubMed1984

[Low-capillary-pressure pulmonary edema occurring in the acute phase of myocardial infarction].

A 44-year old man presented a postanoxic coma and acute pulmonary oedema after cardiopulmonary resuscitation in the acute phase of myocardial infarction. Early haemodynamic measurements revealed low right and left ventricular filling pressures and a low cardiac output. Haemodynamic and clinical improvement was obtained after volume expansion. The cause of low-pressure pulmonary oedema occasionally seen in patients with acute myocardial infarction is sometimes unclear. In the present case, a neurogenic mechanism may be involved. The early diagnosis of this oedema has important therapeutic implications.

Adult↗
PubMed1984

Dyskeratosis congenita. Haematologic, cytogenetic, and dermatologic studies.

In a family of 5 boys and 6 girls, 3 brothers have clinical dyskeratosis congenita. Teeth from 2 of the patients were taurodent , and mineral density of the enamel was significantly different from normal. The haematopoietic marrow was hypocellular and there was striking prominence of plasma cells having normal morphology; no granulomata were demonstrated. The decreased erythroid precursors in the marrow correlated with quantitatively reduced erythropoiesis demonstrated on ferrokinetic studies. Recurrent infections occurred but could not be related to neutropenia, and granulocytes and monocytes retained normal function. No abnormality was demonstrated in humoral or cellular immune mechanisms. While superficially similar, dyskeratosis congenita and Fanconi's anaemia are genetically distinct, being X-linked in the former and inherited as an autosomal recessive in the latter.

Adolescent↗
PubMed1984

Long-term follow-up of intraocular lens implants: the first 127 compared with the latest 100 of the same style in a span of 9 years.

The long-term follow up of the first 127 patients (127 eyes) treated by one surgeon with cataract extraction and Federov I lens implantation is reported. The proportion of patients achieving visual acuity of 6/12 or better had decreased since the one year follow-up. Corneal oedema was the most serious long-term complication. This group of patients is compared with the latest 100 patients (100 eyes) operated on by the same surgeon using the same type of implant. There was a reduction of some operative complications, and improvement in surgical techniques had resulted in a lower sample endothelial cell loss at one month.

Aged↗
PubMed1984

Hyperthyroidism and immune thrombocytopenia.

Hyperthyroidism and immune thrombocytopenia occurred concurrently in five patients; in a sixth, thyrotoxicosis developed after successful treatment of the thrombocytopenia. Correction of the hyperthyroidism was followed by a variable pattern of clinical response. In one case with mild asymptomatic thrombocytopenia spontaneous complete remission occurred. Two patients required adrenocorticosteroids to control severe thrombocytopenic purpura during the period of hyperthyroidism, after which complete remission occurred. Another patient with severe symptomatic thrombocytopenia remains with a partially compensated thrombocytolytic state but is without purpura and off all therapy. A fifth patient required splenectomy for drug-resistant thrombocytopenia and remains critically dependent on immunosuppressive therapy. The sixth patient had a relapse of immune thrombocytopenia with subsequent development of thyrotoxicosis but platelet count spontaneously returned to normal after correction of the hyperthyroidism. Pregnancy in two of these six patients was not associated with recurrence of either hyperthyroidism or thrombocytopenia. Management of symptomatic purpura in adults with co-existent hyperthyroidism may differ from that customarily employed since adrenocorticosteroid therapy may need to be extended until euthyroidism has been established before proceeding to splenectomy. When surgery is necessary, the risk of thyrotoxic storm should be anticipated, and the patient appropriately premedicated.

Adult↗
PubMed1984

Mild clinical course in two South African cases of sickle-cell anaemia.

Clinical, haematological and gene mapping data are presented on two South African cases of sickle-cell anaemia. Both individuals, who are siblings, have experienced a very mild clinical course. Restriction endonuclease analysis showed that 1 sibling was homozygous for alpha+-thalassaemia (genotype alpha-/alpha-), whereas the other had a full complement of alpha-globin genes. Both showed markedly elevated levels of Hb F. The maintenance of high levels of Hb F is the most probable explanation for the moderate clinical expression of the disorder in these patients.

Adult↗
PubMed1984

Hemodynamic effects of dobutamine in patients below and over 65 years, with left heart failure secondary to an acute myocardial infarction.

The cardiac response to sympathomimetic agents has been reported to be reduced in the elderly. We studied the hemodynamic effects of dobutamine in two groups of patients with acute myocardial infarction (AMI) and left heart failure: group A included 10 patients aged 65 years or less and group B 10 others older than 65. After a 1-hour infusion the increase in cardiac index was highly significant in both groups (27%, p less than 0.001 and 25%, p less than 0.001), and the decrease in pulmonary wedge pressure was greater in group A (42%, p less than 0.001 and 17%, p less than 0.02). The increase in double product was similar in both groups (14%, p less than 0.001 and 18%, p less than 0.005); nevertheless the 4 patients developing angina pectoris during dobutamine infusion were over 65 years. We conclude that dobutamine remains effective in the elderly with AMI and left heart failure but is less well tolerated.

Age Factors↗