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Biomedical subjects

R E Marcus

Publications and source records attributed to R E Marcus.

At least 91 records · Page 5Linked to original sources
PubMed1991

An assessment of the efficacy of antimicrobial prophylaxis in bone marrow autografts.

Fifty-three patients undergoing autologous bone marrow transplantation received antimicrobial prophylaxis with ciprofloxacin with or without erythromycin and low dose intravenous amphotericin B. Eight patients remained afebrile throughout the neutropenic period. All other patients had one or more febrile episodes. The median time to fever after the onset of neutropenia was 7 days. There were no gram-negative organisms isolated from blood cultures during any of these episodes whereas gram-positive organisms were isolated in 28. There was one death in this series associated with sepsis. The use of low-dose prophylactic parenteral amphotericin did not prevent the subsequent successful use of full dose amphotericin for antibiotic-resistant fever. Ciprofloxacin effectively prevents gram-negative sepsis. The addition of erythromycin does little to prevent gram-positive sepsis. The use of regimens with agents with activity against gram-positive organisms is appropriate initial treatment of all febrile neutropenic episodes.

Adolescent↗
PubMed1990

Utilization and effectiveness of autologous blood donation for arthroplastic surgery.

Autologous blood predeposit before elective surgery is a rapidly expanding transfusion practice. The authors have conducted a 3-year analysis of an autologous blood predeposit program to assess its impact on orthopaedic joint surgery. The authors conclude: autologous blood donation has resulted in a reduction of homologous blood transfusions in patients undergoing elective hip and knee procedures from 73% to 18% and from 71% to 12%, respectively. In addition, autologous blood preoperative donation in elective orthopaedic joint surgery has increased dramatically, so that while previously this practice was considered underutilized, autologous blood as an alternative to homologous blood transfusion now represents a standard of practice for elective orthopaedic joint arthroplasty at University Hospitals of Cleveland.

Arthroplasty↗
PubMed1990

The impact of preoperative autologous blood donation on orthopaedic surgical practice.

We have conducted a retrospective 3-year analysis of our autologous blood donation program to assess its impact on orthopaedic surgery. We conclude: (1) utilization has increased from less than 5% of eligible patients in the first audit interval to nearly 50% in the last audit interval; (2) in the last audit interval, autologous blood donation resulted in a reduction of homologous blood transfusion from 41% in nonautologous blood patients to 14% in autologous blood donors; (3) increasingly conservative transfusion practice is seen for all patients undergoing elective orthopaedic surgery; (4) regional blood centers are responding to increasing requests for autologous blood with programs that are effective in attracting autologous blood donors; (5) on the basis of utilization and efficacy, preoperative autologous blood donation as an alternative to homologous blood transfusion now represents a standard of practice for elective orthopaedic surgery.

Blood Transfusion, Autologous↗
PubMed1990

Assessment of extradural degenerative disease with Gd-DTPA-enhanced MR imaging: correlation with surgical and pathologic findings.

To test whether gadolinium-DTPA-enhanced MR would increase the conspicuity of extradural degenerative disease in the previously unoperated patient, we prospectively studied a group of 30 patients with symptoms suggestive of disk disease. Surgical findings and pathologic correlations were used as an objective measure of accuracy. Gadolinium-DTPA increased the confidence of diagnosis at one of eight operated cervical levels (six patients) and changed the diagnosis from extradural degenerative disease to tumor in one patient. The mechanism of enhancement of the epidural space and peridiskal region appears to be related to accumulation of contrast material within the epidural venous plexus, as well as to epidural fibrosis associated with disk disruption and herniation. While the immediate clinical utility of gadolinium-DTPA for morphologic analysis seems limited to difficult cervical spine cases, the presence of enhancement as a marker of epidural fibrosis and attempted healing may prove to be of great importance in studying the natural history and basic pathophysiology of degenerative disk disease.

Adult↗
PubMed1990

Changes in the natural anticoagulants following bone marrow transplantation.

The natural anticoagulants, protein C, protein S and antithrombin, were measured in 21 patients following bone marrow transplantation (BMT). The patients were divided into two groups, those with normal protein C concentration post-BMT and those with significantly reduced protein C concentrations; 12 cases fell into the second group. In addition there was an associated fall in protein S in this group of patients. In spite of the presumed hypercoagulable state only one patient developed overt veno-occlusive disease (VOD) of the liver and no other thrombotic events occurred. The fall in protein C and protein S was coincident with the peak incidence of VOD and is likely to be a contributing factor to the genesis of this condition. Only protein S measured pre-BMT was of predictive value in identifying patients likely to develop reduced levels of these anticoagulants post-BMT. Age, sex, diagnosis, type of conditioning and the pre-BMT measurement of protein C and antithrombin had no predictive value.

Adolescent↗
PubMed1990

Veno-occlusive disease of the liver complicating ABMT successfully treated with recombinant tissue plasminogen activator (rt-PA).

A 45-year-old man underwent autologous bone marrow transplantation for relapsed myeloma. The procedure was complicated by the development of veno-occlusive disease (VOD) of the liver. Thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) resulted in rapid resolution of hepatic encephalopathy and ascites with improvement in liver function. The use of rt-PA in the management of VOD appears effective and should be evaluated in further patients.

Bone Marrow Transplantation↗
PubMed1989

Autografting for patients with chronic myeloid leukaemia in chronic phase: peripheral blood stem cells may have a finite capacity for maintaining haemopoiesis.

We treated 14 patients with Ph-chromosome-positive chronic myeloid leukaemia still in chronic phase by autografting with blood-derived haemopoietic stem cells. Eleven patients were autografted electively after cytoreductive treatment with busulphan (16 mg/kg) and melphalan (60 mg/m2) and three were autografted after marrow cells from HLA-identical sibling donors had failed to engraft. In 13 patients haemopoiesis recovered; one failed to engraft and died 114 d after autografting. Two other patients became pancytopenic and received further stem cell transfusions at 3 and 40 months respectively after first autografting. One patient entered lymphoid transformation and died 14 months after autografting. Twelve patients survive at a median of 41 months (range 24-53) after autografting. Nine of the survivors have required further chemotherapy after autografting and four of the nine were electively autografted on a second occasion. Three patients surviving after autografting for 28, 43 and 53 months respectively have not required further chemotherapy. In two of these patients haemopoiesis is now predominantly Ph-negative. We conclude that autografting in chronic phase might prolong survival in some cases by reducing the size of the leukaemic stem cell population. The fact that initially successful grafts failed in two patients suggests that blood-derived stem cells may have a finite potential for self-replication.

Adult↗
PubMed1989

Antibiotic resistant fever associated with herpes simplex virus infection in neutropenic patients with haematological malignancy.

The incidence of mucocutaneous herpes simplex virus infection confirmed by culture and occurring during febrile neutropenic episodes was determined in 43 patients with haematological malignancy. The outcome of 72 episodes of neutropenic fever was determined and correlated with the presence or absence of herpes simplex virus (HSV) infection. Twenty four patients had mucocutaneous HSV infection during at least one episode. In 24 episodes in which HSV was isolated only 12.5% of fevers responded to antibiotics and 75% of fevers were otherwise unexplained. Conversely, in 48 episodes of neutropenic fever in which HSV was not isolated 67% of fevers responded to antibiotics and only 8.3% were unexplained. The difference in incidence of antibiotic resistant fever in the two groups was significant. There was, therefore, a strong association between mucocutaneous HSV infection and antibiotic resistant fever in immunosuppressed neutropenic patients. As most HSV infections are the result of virus reactivation, establishing the HSV serological state of patients would identify those at risk of infection and hence those in whom the prophylactic use of acyclovir would be indicated.

Acyclovir↗
PubMed1988

Glomerulonephritis preceding late relapse of Hodgkin's disease.

We report a case of focal sclerosing glomerulonephritis which developed 11 years after successful treatment of nodular sclerosing Hodgkin's disease. Hodgkin's disease relapsed 7 months later and responded completely to combination chemotherapy with simultaneous improvement in renal function. This case shows that relapse of Hodgkin's disease may occur after a 10 year interval and furthermore it may preceded by nephrotic syndrome. Renal disease in such cases may not recover until the underlying Hodgkin's disease is treated.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Phase II study of mitoxantrone and cytarabine in acute myeloid leukemia.

Thirty-eight patients with acute myeloid leukemia (AML) were treated with mitoxantrone (Mto) combined with cytarabine (Ara-C). Five patients had received no previous treatment for acute myeloid leukemia, seven were refractory to treatment with standard first-line chemotherapy, eight had relapsed during treatment, and 18 had relapsed after treatment was stopped. Eleven of these relapses were early (within 6 months of stopping treatment). Mto was given for 5 days by iv bolus injection at a dose of 10 mg/m2 to 12 patients and at 12 mg/m2 to 26. Ara-C was given at a dose of 1 g/m2 twice daily by a 2-hour infusion for 3 days to 37 patients. One patient received Ara-C at a dose of 500 mg/m2 twice daily for 3 days. Toxicity was acceptable except for cerebellar toxicity in two patients, which was irreversible in one. Twenty-two patients (56%) achieved complete remission (CR), and four achieved partial remission (10%). Seventy-five percent of the patients who had relapsed during treatment and 58% of those who had relapsed after treatment was stopped achieved CR. Eleven patients remain in CR at a median time of 10 months (range, 3-17) after treatment. In five patients remissions have lasted greater than 1 year, one in a patient treated in second relapse and one in a patient treated in third relapse. Mto and Ara-C appear to be effective salvage therapy in acute myeloid leukemia and should be considered for incorporation into first-line induction regimens.

Adult↗
PubMed1987

Bilateral fractures of the tibia: a severe injury associated with multiple trauma.

Trauma which results in bilateral fractures of the tibia represents a serious physical insult to the victim. A review of our experience at the Harborview Medical Center in the treatment of 14 consecutive patients with this injury provides insights into the management of multiply injured patients with long bone fractures. All of the 28 tibial fractures were the result of high-energy forces, and 16 were open injuries. Thirteen of the patients had sustained severe multiple trauma and three died as a result of their injuries. All surviving patients were followed until complete healing and long-term followup examination was obtained. The severe injuries which result in bilateral tibial fractures are associated with a high morbidity and mortality. Aggressive and meticulous management of the bony and soft-tissue injuries can provide for good results, early mobilization, and full functional return in these multiply injured patients. Primary amputation should be undertaken only as a final alternative, as most open fractures are salvageable.

Adolescent↗
PubMed1986

Adult acute lymphoblastic leukaemia: a study of prognostic features and response to treatment over a ten year period.

Between 1974 and 1984 69 adults with acute lymphoblastic leukaemia (ALL) were treated with two different protocols. Fifty-four (78%) of the patients entered complete remission (CR); 27 of these then received a consolidation protocol consisting of daunorubicin, cytosine arabinoside and 6-thioguanine, followed by two courses of intravenous methotrexate 500 mg m-2 with folinic acid rescue. All patients received intrathecal methotrexate and cranial irradiation (24 Gy) followed by maintenance therapy with 6-mercaptopurine and methotrexate for at least 2 years. The median survival for all patients was 23 months from the time of presentation with an actuarial 5-year survival of 21%. The actuarial chance of surviving 5 years in CR for patients receiving the consolidation protocol was 38% compared to 19% for patients receiving no consolidation (P = NS). Only patient age and white cell count at presentation were found to influence the chance of achieving CR and the chance of overall survival. The presence or absence of c-ALL antigen did not influence prognosis. Patients younger than 35 years with low white cell counts at presentation (less than 10 X 10(9)1(-1] had a particularly good prognosis but no patient with T-ALL and no patient older than 50 years old at diagnosis survived more than 18 months.

Adolescent↗
PubMed1986

Chromosome and cell culture studies in eosinophilic leukaemia.

A cytogenetic analysis was carried out on bone marrow cells from 11 patients who presented with hypereosinophilia and the clinical features of the idiopathic hypereosinophilic syndrome. One of these patients was found to have trisomy 8 affecting the myeloid series, including eosinophils. In this patient, marrow eosinophils also showed asynchrony of nuclear-cytoplasmic maturation, and there were increased numbers of myeloid progenitor cells in the blood. Six months later, blast cell transformation occurred, and he died soon afterwards. These findings show that abnormalities in the karyotype of bone marrow cells and culture of blood progenitor cells may help to identity eosinophilic leukaemia among patients who present with features of the idiopathic hypereosinophilic syndrome.

Adolescent↗