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Biomedical subjects

R E Marcus

Publications and source records attributed to R E Marcus.

At least 109 records · Page 6Linked to original sources
PubMed1986

Megakaryoblastic transformation of myelofibrosis with expression of the c-sis oncogene.

We describe a case of primary myelofibrosis which terminated in an acute megakaryoblastic leukaemia with massive marrow fibrosis and osteosclerosis. The megakaryocyte lineage of the terminal phase was confirmed by ultrastructural and surface marker studies of the blast cells. The leukaemic phase was associated with the presence of large numbers of progressively more immature megakaryocyte progenitors in the peripheral blood. The expression of c-sis mRNA in these blast cells was significantly higher than in normal mononuclear cells. Activation of the c-sis protooncogene leading to increased production of platelet-derived growth factor could be related to the progressive fibrosis observed.

Adult↗
PubMed1986

Bone marrow transplantation for patients with chronic myeloid leukaemia: T-cell depletion with Campath-1 reduces the incidence of graft-versus-host disease but may increase the risk of leukaemic relapse.

Between December 1983 and November 1985 we treated 39 patients with chronic myeloid leukaemia by chemoradiotherapy and transplantation from HLA-identical sibling donors using bone marrow that had been depleted of T cells ex vivo with the rat monoclonal antibody Campath-1. Twenty-eight of the patients were in the chronic phase (good-risk group) and 11 patients were in more advanced phases of the disease (accelerated phase or blastic transformation; poor-risk group). Of the patients of good risk 23 (82%) survive; the median duration of follow-up is 461 (range 111-776) days; of the 11 patients of poor risk four survive; the median duration of follow-up is 280 (range 189-658) days. Acute graft-versus-host disease (GVHD) of grade II or greater occurred in three (11%) of the patients of good risk and in six (55%) of the patients of poor risk. In the patients of good risk haematological evidence of relapse was seen in four and cytogenetic evidence of persisting or relapsed leukaemia (based on the finding of Philadelphia-chromosome-positive marrow metaphases more than 6 months after transplant) was seen in three other patients. In comparison with the patients of good risk transplanted with untreated marrow between February 1981 and December 1983, the incidence of acute GVHD was reduced significantly (P less than 0.001) but the risk of leukaemic relapse (including patients with only cytogenetic evidence of relapse) was increased (P less than 0.005). We conclude that T-cell depletion used in this manner may be associated with an increased risk of leukaemic relapse.

Actuarial Analysis↗
PubMed1986

Preoperative use of povidone-iodine. A prospective, randomized study.

One hundred one adult orthopedic surgical patients were studied in a randomized, prospective clinical trial to compare the effectiveness of the standard povidone-iodine scrub and paint with povidone-iodine painting alone for presurgical skin preparation. No infections occurred in either group. The scrub-plus-paint group showed a 0.601 logarithmic reduction in bacteria counts, compared with 0.622 with painting alone. Further, 36.8% of the patients in the scrub-plus-paint group had skin counts that actually increased after preparation, compared with 13.8% of patients in the paint-only group. The preparation bacterial counts among inpatients, who received preoperative hexachlorophene showers, were significantly lower than that of outpatients, who did not receive preoperative showers. The data support the use of the preoperative hexachlorophene shower and the omission of scrubbing from the surgical skin preparation technique.

Ambulatory Care↗
PubMed1985

Atypical promyelocytic leukemia (M3) with immature primary granules and t(15;17).

An unusual case of acute myeloid leukemia with a standard t(15;17) is described. While light microscopy morphology was suggestive of acute myeloid leukemia M5a and light microscopy cytochemistry showed 80% of blasts to be strongly positive with Sudan Black B--more consistent with a diagnosis of M4--ultrastructural analysis demonstrated that the predominant cells were promyelocytes with immature primary granules hardly visible with the Romanovsky stains by light microscopy. Because typical cytologic and clinical features of M3 or M3 variant were lacking this atypical case would not have been recognized but for the presence of t(15;17) and the demonstration of promyelocytic features by electron microscopy.

Chromosome Banding↗
PubMed1985

Ceftazidime as first-line therapy for fever in acute leukaemia.

Fifty patients with acute non-lymphocytic leukaemia were treated by random allocation with either ceftazidime alone or a combination of piperacillin, netilmicin and cefotaxime for 65 febrile neutropenic episodes. Nineteen of 33 patient episodes (58%) responded to ceftazidime alone compared with 21 of 32 episodes (66%) treated with the combination. There was one infective death in a patient given the combination; rates of documented superinfection were low. The treatment groups appeared identical in terms of patient demography, underlying disease and other risk factors, though patients with a clinical site of infection responded more slowly than those without. Bacteraemia per se did not appear to influence outcome. Bactericidal serum concentrations greater than or equal to 8 X the minimum bactericidal concentration were predictive of a rapid response (within 4 days) to antibiotics. Furthermore, serum from patients treated with ceftazidime maintained adequate cidal activity against Pseudomonas aeruginosa for longer than that obtained from patients treated with the three-drug combination. Ceftazidime was shown to be a safe and effective alternative to the three-drug combination for the initial management of febrile neutropenic episodes in leukaemic patients.

Adolescent↗
PubMed1985

A prospective trial of young red cells in 48 patients with transfusion-dependent thalassaemia.

Young red cells (YRBC) prepared on a cell washer were compared to whole blood in a randomized prospective trial in 48 transfusion dependent patients with thalassaemia major. A minor but statistically significant decrease in blood consumption was observed in the group receiving YRBC. However, no difference was seen in transfusion interval, mean haemoglobin and rate of haemoglobin fall between the two groups. Filtered blood was shown to be as effective as frozen blood in eliminating non-haemolytic febrile transfusion reactions in all the trial patients. We conclude that any reduction in the rate of iron loading brought about by the use of YRBC is clinically insignificant and does not justify the expense, time and work required to produce young red cells for use in a large transfusion dependent thalassaemic population.

Adolescent↗
PubMed1985

Phenotypic conversion of TdT+ adult AML to CALLA+ ALL.

A case of acute leukaemia is described in which the blast cells showed Sudan Black and terminal deoxynucleotidyl transferase (TdT) positivity at presentation and did not react with the monoclonal antibodies (McAb) My9 (anti-myeloid) and J5 (anti-CALL antigen). The myeloid lineage of these cells was confirmed by the myeloperoxidase (MPO) reaction at electron microscopic level. The patient entered complete remission but relapsed one year later with blasts showing negative Sudan Black and MPO reactions. These cells were still TdT+ but J5 was now positive. This case points to the existence of a clonogenic leukaemic cell with potential for evolution in both myeloid and lymphoid lineages. This is also suggested by the reactivity of both types of blast cells with the McAb 3C5 which recognises an antigen present both on early myeloid and lymphoid precursors. It is possible that patients with such leukaemias may benefit from combined therapy directed against cells of both myeloid and lymphoid lineages.

Adult↗
PubMed1985

Young red cell preparation--a comparison of available methods.

Four possible methods of preparing young red cells (YRBC) which exploit the relationship between red cell ageing and density are compared. Of these, two cell separators and the IBM cell washer are shown to be capable of producing YRBC suitable for clinical use. YRBC prepared from the IBM 2991 cell washer are recommended for clinical trials because of lower cost, greater convenience and lower white cell contamination compared to cell separator-derived YRBC.

Cell Separation↗
PubMed1984

Late thoracic outlet syndrome secondary to pseudarthrosis of the clavicle.

Successful resolution of a late thoracic outlet syndrome secondary to pseudarthrosis of the clavicle was accomplished by surgical resection of the pseudoarthrosis and mid 3 cm of the clavicle, following conservative therapy which did not alleviate the symptoms. The patient was a 28-year-old woman. Arteriography demonstrated the lesion. A shoulder dislocation preceded the thoracic outlet syndrome; a congenital pseudarthrosis may have been present.

Adult↗
PubMed1984

Platelet derived malonyldialdehyde production in patients with thalassaemia major.

Malonyldialdehyde, a product of membrane lipid peroxidation, was measured in the platelets of 16 normal subjects after stimulation with a variety of aggregating and stimulating agents. Nethylmaleimide and hydrogen peroxide generated the largest amounts of malonyldialdehyde. These agents were used to stimulate platelets from 11 patients with thalassaemia major suffering from iron overload due to repeated transfusion. Mean malonyldialdehyde concentrations were the same in normal subjects as in thalassaemic patients, but high concentrations were recorded in patients with severe iron overload. There was a highly significant correlation between malonyldialdehyde and serum ferritin concentrations in all thalassaemic patients. Platelet derived malonyldialdehyde may be a useful test of continuing membrane damage in patients with iron overload.

Adolescent↗
PubMed1984

Internal fixation of fractures in children and adolescents. A comparative analysis.

A retrospective analysis of 4,411 consecutive pediatric fracture patients managed between 1979 and 1983 demonstrated that only 3.6% (170 patients) required internal fixation. Two patient groups with sufficient follow-up study were compared: Group 1-90 skeletally immature children and young adolescents, and Group 2-66 skeletally mature adolescents. Upper-extremity fractures, especially of the distal humerus, and displaced epiphyseal fractures were the major indication for internal fixation in Group 1, while lower-extremity diaphyseal and intra-articular fractures predominated in Group 2. Complication rates were higher than expected but fortunately most were minor-18% in Group 1 and 12% in Group 2. The results of this study demonstrate that internal fixation can be beneficial in selected fractures in children and adolescents in preventing major complications, such as premature epiphyseal closure and malunion, and in restoring and maintaining normal extremity growth and function.

Adolescent↗