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Biomedical subjects

P Stewart

Publications and source records attributed to P Stewart.

At least 163 records · Page 9Linked to original sources
PubMed1983

Transfusion requirements after HLA-identical marrow transplantation in 82 patients with aplastic anemia.

Red blood cell (RBC) and platelet (PLT) transfusion requirements during the first 13 weeks after HLA-identical marrow transplantation were studied in 82 patients with aplastic anemia. On the average, patients were given 9 units of RBCs (1-82) and 44 units of PLTS (6-468). The greatest need for support was during the first 4 weeks postgrafting. A multivariate statistical analysis of 22 variables showed that RBC and PLT requirements increased with age. In addition, RBC requirements increased if the patient had isohemagglutinins against the marrow donor's RBC, i.e., if the marrow transplant was across a major ABO barrier.

ABO Blood-Group System↗
PubMed1983

A comparative assessment of an automated blood microprocessor for fetal blood pH measurements in the labour ward.

A new fully automated, self-calibrating, blood pH analyser was compared with a standard reference instrument for the measurement of pH of fetal scalp and umbilical cord blood samples. The new instrument is reliable and simple to operate, the volume of blood needed for analysis is small and it does not require the availability of trained laboratory technicians for its use.

Blood Chemical Analysis↗
PubMed1983

Intensive chemoradiotherapy with autologous marrow transplantation for small cell carcinoma of the lung.

Ten patients with small cell carcinoma of the lung (seven with extensive and three with limited disease) underwent several courses of conventional therapy. The patients were then referred for autologous marrow transplantation, three during a complete response, six during a partial response, and one following no response. The pretransplantation regimen consisted of 120 mg/kg of cyclophosphamide followed by 800-1000 rad of total-body irradiation. In addition, six of the seven patients with extensive disease received high-dose nitrosourea. Following the infusion of cryopreserved autologous marrow, all patients achieved engraftment. Of the three patients without detectable tumor at the time of transplant, two died with tumor present and one survives without recurrence 27 months after transplantation. Of the other seven patients, two had a complete tumor response; both died of interstitial pneumonitis, one without detectable tumor and one with microscopic tumor at autopsy. One of the other five patients had a partial response, but all died of tumor progression. The median survival from initial therapy in patients with extensive disease was 9 months and with limited disease was 18.5 months.

Autopsy↗
PubMed1983

Marrow transplantation from HLA-identical siblings for treatment of aplastic anemia: is exposure to marrow donor blood products 24 hours before high-dose cyclophosphamide needed for successful engraftment?

The present study in patients with aplastic anemia was undertaken to determine whether exposure of recipients to donor blood products 24 hr before preparation with cyclophosphamide (1) enhanced the rate of sustained engraftment of marrow from HLA-identical siblings as suggested by animal experiments, (2) increased the rejection rate, in particular in transfused patients who may already have been exposed to donor antigens by blood products, or (3) was of no relevance to the outcome of transplantation of marrow from HLA-identical siblings. One-hundred fifty-five patients were studied, of whom 78 received blood products from the marrow donor 24 hr before cyclophosphamide and 77 did not. A binary logistic regression analysis was applied to the data, simultaneously considering five previously known risk factors for rejection. Results showed that preceding transfusion of donor blood products had neither a significant beneficial nor detrimental effect on the incidence of sustained engraftment.

Anemia, Aplastic↗
PubMed1983

Allogeneic marrow transplantation for acute nonlymphoblastic leukemia after first relapse.

Sixty-two patients with acute nonlymphoblastic leukemia in first relapse or second remission were treated with allogeneic marrow transplantation from HLA-matched siblings. In 17 patients (group 1), no attempt at reinduction of remission was made prior to transplantation. In 20 patients (group 2), attempts at inducing a second remission prior to transplantation were unsuccessful; and in 25 patients (group 3), a second remission was achieved. Five of 17 patients (29%) in group 1, 2 of 20 (10%) in group 2, and 5 of 25 (20%) in group 3 are surviving disease-free 2-6 yr after grafting. Early mortality from nonleukemic causes was equal in the 3 groups, but the risk of recurrent leukemia after transplantation was less in patients transplanted without attempts at reinduction (group 1). Among patients transplanted in relapse, those in early relapse (less than 30% blast cells in the marrow) appeared to do better than patients in florid relapse. The results obtained in group 1 are as good as or better than those achieved in patients transplanted in second or subsequent remission. Thus, for patients with acute nonlymphoblastic leukemia not transplanted in first remission, the optimal time for transplantation would appear to be as soon as possible after the first relapse.

Acute Disease↗
PubMed1983

Fanconi's anemia treated by allogeneic marrow transplantation.

Eight patients with Fanconi's anemia were given cyclophosphamide alone (seven patients) or combined with procarbazine and antithymocyte globulin (one patient) followed by marrow grafts from HLA-identical siblings. All patients had engraftment. Seven developed acute and three chronic graft-versus-host disease (GVHD). Three patients died with GVHD and infectious complications (days 19, 56, and 82) and one with an intracerebral hemorrhage (day 540). Four patients are surviving 647-3435 days after grafting, two are well, and two have chronic GVHD that is improving. These results show that Fanconi's anemia can be treated successfully by allogeneic marrow transplantation.

Anemia, Aplastic↗
PubMed1982

Treatment of chronic granulocytic leukaemia in chronic phase by allogeneic marrow transplantation.

Ten patients with chronic granulocytic leukaemia in the chronic phase have been treated with chemoradiotherapy followed by transplantation of bone marrow from HLA-identical siblings. Engraftment was achieved in all patients, and Philadelphia chromosome disappeared from the nine patients who had it before transplantation. Four patients have died, three with interstitial pneumonitis and one with severe graft-versus-host disease (GvHD). Six patients are alive and well in complete clinical, cytogenetic, and haematological remission, 1-3 years after transplantation, despite complications in three patients (one had interstitial pneumonitis, one had mild veno-occlusive disease of the liver, and one had severe GvHD).

Adult↗
PubMed1982

Repair of large ventricular septal defects in infants and small children.

It is possible to achieve excellent results for primary closure of ventricular septal defects regardless of the age of the patients when surgical intervention is required. Thirty-two severely symptomatic patients, age 1-24 months, with large ventricular septal defects (m Qp/Qs = 3.4, m R VSD = 4.0), had primary repair of the defects with one (3%) hospital death. Seven patients (22%) had increased pulmonary vascular resistance ranging from 5.4 to 12 units/m2. It was possible to close the ventricular septal defect through the right atrium in 26 patients (81%). Pulmonary artery banding was not performed in any patient with isolated ventricular septal defect during the period of this study. The 31 survivors have been followed an average of four years, and 30 of them are remarkably improved and remain New York Heart Association Class I or II. Only one patient, with obstructive pulmonary vascular disease (pulmonary resistance = 12 U/m2), died suddenly 16 months after operation. Follow-up catheterization was offered to all patients, and to date, 18 (60%) have been restudied. These hemodynamic data show that pulmonary vascular resistance after surgery is usually normal or only minimally elevated; except for one patient with a large residual ventricular septal defect, functionally significant left to right shunts were eliminated. These results and the analysis of results of combined series reported in the literature for primary and staged operations for the continued practice of primary repair of isolated large ventricular septal defects in infants and children who require surgery.

Age Factors↗
PubMed1982

Spontaneous labour: when should the membranes be ruptured?

Sixty-eight patients (32 multigravidae, 36 primigravidae) with intact membranes admitted in early spontaneous labour were studied. Patients were randomly allocated to two groups: group I had an immediate amniotomy and group II were allowed to retain their membranes intact until full dilatation. Early amniotomy significantly shortened the length of labour and reduced the need for augmentation and instrumental delivery. There were no differences between the two groups in fetal outcome as measured by Apgar scores, umbilical arterial and venous blood pH, neonatal jaundice or admission to the special-care baby unit. Fetal heart-rate recordings obtained in group I by applying a fetal electrode after amniotomy were of superior quality to those obtained in group II by ultrasound and were more suitable for interpretation. 'Normal' and 'suspicious' tracings occurred equally in the two groups. Our results suggest some benefits from early amniotomy and no adverse effects on the fetus.

Adult↗
PubMed1982

Induction of labour: a comparison of a single prostaglandin E2 vaginal tablet with amniotomy and intravenous oxytocin.

In a randomized controlled study of 100 women of low parity and favourable induction features, induction of labour by means of a single vaginal tablet containing 3 mg of prostaglandin E2 (PGE2) was compared with the conventional method of amniotomy and intravenous oxytocin. Four of the patients (8%) who received the prostaglandin tablet required additional intravenous oxytocin to achieve delivery. The prostaglandin group had a longer mean overall induction-delivery interval but a shorter amniotomy-delivery interval than the oxytocin group. One patient in the PGE2 group and two in the oxytocin group required caesarean section. The PGE2 treated patients expressed a higher level of satisfaction with their method of induction, they required less analgesia, had less blood loss at delivery and their babies had a lower incidence of neonatal jaundice.

Adolescent↗
PubMed1982

Multiple pregnancy and fetal abnormalities in association with oral contraceptive usage.

1,000 multiple births were examined in relation to maternal exposure to an oral contraceptive before conception. There was a significantly higher rate of monozygotic twinning among pregnancies which took place within 6 months of cessation of the contraceptive. In the monozygotic group there was a significant increase in the incidence of congenital abnormalities (P less than 0.01) when conception occurred within 3 months of cessation of the contraceptive.

Abnormalities, Drug-Induced↗
PubMed1982

Immediate and delayed neurotoxicity after mechlorethamine preparation for bone marrow transplantation.

Twenty-four patients, including two with aplastic anemia and 22 with malignancy, underwent marrow transplantation after preparation with mechlorethamine, 0.3 to 2.0 mg/kg body weight. Fourteen of the 21 neurologically evaluable recipients developed immediate neurotoxicity a median of 4 days after treatment (range, 0 to 34 days). Confusion and disorientation were observed in six patients, headache in six, hallucinations n four, lethargy in four, tremors in three, paraplegia in one, seizure in one, and vertigo in one. Whereas acute symptoms cleared in 11 patients, three remained symptomatic until death. Twelve evaluable patients survived more than 60 days; all six with previous acute toxicity subsequently developed delayed onset of new neurologic findings (personality change, confusion, seizure, diplopia, or dementia) a median of 169 days (range, 70 to 248 days) after treatment. Cerebrospinal fluid analysis was usually normal but cerebral computed tomographic scans showed ventricular enlargement and electroencephalograms showed diffuse slowing. Postmortem histologic examination of brain showed neuronal degenerative changes with increased vascularity, gliosis, and perivascular fibrosis. Neurotoxicity appeared to increase with age and mechlorethamine dose and was commoner in patients given additional procarbazine or cyclophosphamide.

Adolescent↗
PubMed1981

A comparison of oestradiol and prostaglandin E2 for ripening the cervix.

A study was conducted to compare the cervical ripening effect of extra-amniotic prostaglandin E2 with that of extra-amniotic oestradiol valerate in preparation for induction of labour. Sixty primigravidae with an unripe cervix received one or other agent suspended in a viscous gel. The degree of cervical ripening was similar in both groups but more patients treated with prostaglandins became established in labour before planned amniotomy, and poor progress in labour was less common in this group.

Adult↗