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Biomedical subjects

S A Feig

Publications and source records attributed to S A Feig.

At least 145 records · Page 8Linked to original sources
PubMed1984

Comparison between bone marrow transplantation and antithymocyte globulin in treatment of young patients with severe aplastic anemia.

Fifty-seven patients younger than 25 years with severe aplastic anemia underwent either bone marrow transplantation or antithymocyte globulin therapy (ATG) to ascertain which approach should be used in young patients. Thirty-five patients who had an HLA-identical sibling donor underwent bone marrow transplantation after conditioning with cyclophosphamide and low-dose total-body radiation. Twenty-two patients who did not have an HLA-identical donor received ATG. The 2-year actuarial survival of patients after transplant is 72% (95%, CI 64% to 80%), versus 45% (95%, CI 29% to 61%) in those given ATG therapy (P = 0.18). In those patients surviving 6 months after treatment, return of peripheral blood counts to normal values was more common in patients who received marrow transplant compared with those given ATG therapy (P less than 0.001). Furthermore, 24 of 26 transplant survivors had Karnofsky performance scores greater than 90%, compared with only five of 13 ATG survivors. These data suggest that bone marrow transplantation is the preferred therapy for severe aplastic anemia in young patients who have an HLA-identical sibling donor. ATG should be reversed for those young patients with severe aplastic anemia who do not have a histocompatible marrow donor.

Adolescent↗
PubMed1984

Lumpectomy and level I axillary dissection prior to irradiation for "operable" breast cancer.

Between July 1, 1979 and March 1, 1984, we treated 154 women by irradiation as an alternative to mastectomy. Excision of the primary tumor without the sacrifice of a large volume of contiguous normal breast (lumpectomy) was performed, and all but ten women also underwent concomitant level I axillary node dissection. The mean node count in the level I dissection was 27 nodes, indicating that this dissection offered accurate information about axillary node status, so that the extent of radiation therapy and subsequent adjuvant chemotherapy could be planned appropriately. Subdivision of the level I nodes into anatomic groups and their separate histologic analysis suggested that less than a complete level I dissection might miss involved nodes in almost one-half the patients with clinically negative axillae but histologically positive nodes. Postoperative complications occurred in 13% of patients, not an insignificant number, most of them being either infections or the persistent accumulation of lymph in the axillary wound. Later complications, such as infection or arm edema, also occurred, just as after mastectomy. The median follow-up of these 154 patients has been only 12 months, the maximum being not quite 5 years, so that any long-term speculations are not justified. We believe that the continued use of this combination therapy is warranted preceding irradiation by lumpectomy and level I axillary dissection as described, with careful follow-up to assess the long-term results of this option.

Adult↗
PubMed1984

Bone marrow transplantation from identical twins in the treatment of aplastic anaemia: implication for the pathogenesis of the disease.

Treatment of aplastic anaemia by bone marrow transplantation from a syngeneic (identical twin) donor has provided insights into the pathophysiology of the disease. We report from patients with severe anaemia who were treated by syngeneic bone marrow transplantation. None of the patients had sustained recovery of peripheral blood counts. All four received second transplants from the same twin donor after immunosuppressive conditioning treatment. Each had prompt recovery of haematopoiesis. A review of the literature indicates that failure of syngeneic bone marrow transplantation in patients with aplastic anaemia is not uncommon. These data indicate that aplastic anaemia may be caused by a mechanism other than an absence or intrinsic abnormality of haematopoietic stem cells in many patients.

Adolescent↗
PubMed1984

Radiation risk from mammography: is it clinically significant?

The observation of excess breast cancers among women exposed to high doses of radiation has led to speculation that a similar risk of smaller magnitude could result from the low doses of x-rays used in mammography. However, such risk is extremely small and seems negligible when compared with the potential benefit for mammographic screening performed according to the American Cancer Society and American College of Radiology guidelines.

Adult↗
PubMed1984

Transplantation of ABH incompatible bone marrow: gravity sedimentation of donor marrow.

A simple technique to separate erythrocytes from bone marrow by sedimentation under gravity after addition of hydroxyethyl starch is described. This method of removing red blood cells from the donor marrow was evaluated in 23 consecutive allogeneic bone marrow transplants between ABH-incompatible individuals. Infusion of the separated marrow was well tolerated, i.e. graft-rejection did not occur, and sustained engraftment was documented in all evaluable cases. This technique obviates the need for cumbersome and potentially hazardous large volume plasma exchange that is commonly utilized to deplete recipient isohaemagglutinins prior to transplantation.

ABO Blood-Group System↗
PubMed1984

Case problems in bone marrow transplantation. I. Graft failure in aplastic anemia: its biology and treatment.

An unusual case of graft failure following bone marrow transplantation for aplastic anemia is reported in which the patient had delayed and incomplete recovery of hematopoiesis despite documentation of sustained engraftment. The pathophysiology of graft failure following bone marrow transplantation is discussed and recent advances in pretransplant immunosuppressive therapy to prevent graft rejection are reviewed.

Adolescent↗
PubMed1983

Improved survival following bone marrow transplantation for aplastic anaemia.

We transplanted 46 patients with severe aplastic anaemia with a new pretransplant immunosuppressive regimen consisting of cyclophosphamide (200 mg/kg) and low-dose total body irradiation (3 Gy). This regimen (CY-TBI-2) was designed to decrease the high risk of graft rejection associated with the use of cyclophosphamide alone, without increasing the incidence of graft-versus-host disease (GHVD) or interstitial pneumonia (IPn). Two-year actuarial disease-free survival of patients conditioned with CY-TBI-2 was 62% (95% CI: 47-77%). Only one patient rejected her graft and the incidence and severity of GVHD and IPn were not increased compared to previous studies. Patients less than 25 years of age had excellent 2-year survival of 82% (95% CI: 69-95%). These data indicate that CY-TBI-2 is an effective means of preventing graft-rejection and achieving long-term disease-free survival in multiply transfused patients with severe aplastic anaemia.

Adolescent↗
PubMed1983

Reproducibility of mammographic classifications.

Wolfe's mammographic classification and a percentage classification are statistically evaluated for inter- and intraobserver bias and agreement by seven mammographers with a set of 200 xeromammograms. The results demonstrate significant bias and disagreement with both methods, raising questions about the clinical limitations of these or other mammographic classifications. However, about 90% of the percentage classifications of pairs of readers are within adjacent categories. This suggests that (1) more experience with precisely defined classifications and protocols, (2) the development and application of readily available instructional materials, and (3) studies to identify and evaluate sources of variation in such classifications may eventually lead to acceptable levels of reproducibility.

Breast Neoplasms↗
PubMed1983

Bone marrow transplantation for children with cancer.

Bone marrow transplantation is a new, effective method for producing long-term disease-free survival in some cancer patients whose disease cannot be controlled by conventional treatments. The procedure is arduous and costly. The major problems which limit the usefulness of bone marrow transplantation are the effectiveness with which malignant disease can be eradicated and the control of graft-vs-host disease. As approaches to these problems are developed, it is likely that bone marrow transplantation will be more widely employed in the treatment of children with cancer. Careful followup of patients will be necessary in order to define the long-term effects of bone marrow transplantation, particularly as they are expressed in disorders of growth, development, learning, and psychosocial adaptation.

Acute Disease↗
PubMed1983

Pneumococcal vaccination of recipients of bone marrow transplants.

A 14-valent pneumococcal vaccine was administered to 39 recipients of allogeneic bone marrow transplants, and their type-specific antibody responses were compared with normal control subjects. Preimmunization antibody levels in patients were twofold to 12-fold lower than those levels in control subjects for all serotypes. Mean postimmunization antibody levels for each serotype were also considerably lower in patients (range, 56 to 859 ng of antibody nitrogen per milliliter) than in control subjects (range, 727 to 5,626 ng/mL). Poor antibody responses were primarily associated with early vaccination after transplantation, corticosteroid therapy for graft-v-host disease and other illnesses, and the male sex. Antibody responses of patients not given corticosteroids and vaccinated more than seven months after transplantation improved with time after transplantation. Postvaccination infection occurred in five patients who were vaccinated early after transplantation. Pneumococcal vaccination has limited potential for providing protection in marrow transplant recipients except in the cases of those patients who are not receiving corticosteroids and are vaccinated more than seven months after transplantation.

Adolescent↗