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Biomedical subjects

A Schattner

Publications and source records attributed to A Schattner.

At least 19 recordsLinked to original sources
PubMed2006

Parvovirus B19 reactivation presenting as neutropenia after rituximab treatment.

A patient with primary biliary cirrhosis and associated refractory immune thrombocytopenic purpura was treated with 4 weekly courses of rituximab, a monoclonal antibody targeting B-cell surface antigen CD20. Her thrombocyte count and even cholestatic liver function tests improved. However, 17 weeks after rituximab treatment, she developed severe neutropenia (absolute neutrophil count 0.23x10(3)/mul) and recurrent thrombocytopenia with abnormal bone marrow of all three lineages. Although delayed-onset neutropenia has been reported after rituximab, reactivated viral infections have also been encountered. Parvovirus B19 was suspected and confirmed as the cause of neutropenia in our patient. The patient was supported by GCSF treatment and recovered uneventfully after several weeks. Neutropenia after rituximab can also be the predominant manifestation of reactivated parvovirus B19 infection and have a favorable prognosis.

Journal Article↗
PubMed2005

TNF-{alpha}, chronic hepatitis C and diabetes: a novel triad.

Patients with chronic hepatitis C virus (HCV) infection have a significantly increased prevalence of type 2 DM compared to controls or HBV-infected patients, independent of the presence of cirrhosis. Moreover, antecedent HCV infection markedly increases the risk of developing DM in susceptible subjects. Even non-diabetic HCV patients have insulin resistance and specific defects in the insulin-signalling pathway. Activation of the tumour necrosis factor (TNF)-alpha system has a pivotal role in the inflammatory process of chronic hepatitis C, and TNF-alpha levels correlate with the degree of inflammation. TNF-alpha is known to cause insulin resistance, with similar defects in the insulin signalling pathway to those described in HCV infection. A model of mice transgenic for the HCV core protein demonstrated insulin resistance, glucose intolerance, and elevated intrahepatic TNF-alpha mRNA; all of which were ameliorated by anti-TNF-alpha antibodies. In addition, diabetic HCV patients have significantly higher levels of soluble TNF-alpha receptors, compared to non-diabetic HCV patients and controls. TNF-alpha may be the link between HCV infection and diabetes, suggesting an additional mechanism of diabetes with important implications for prognosis and therapy.

Diabetes Mellitus, Type 2↗
PubMed2004

Can creatinine clearance be accurately predicted by formulae in octogenarian in-patients?

BACKGROUND: As serum creatinine is relatively inaccurate for estimating renal function, prediction formulae are commonly used for more precise renal function estimation. However, these equations have not been studied in acutely hospitalized octogenarian patients. AIM: To compare three commonly used formulae for estimating GFR to measured creatinine clearance (CCR) in patients aged >/=80 years admitted to an acute geriatric department. DESIGN: Prospective, observational study. METHODS: Consecutive patients aged >/=80 years with urinary catheters, admitted over a 12-month period to the acute geriatric ward of a 600-bed university hospital, were enrolled in the study. All had an accurate 24-h urinary collection, as well as serum and urinary urea and creatinine determinations. CCR was calculated and compared with GFRs derived from the three formulae. RESULTS: Of the 154 patients enrolled in the study, 107 (69.5%) had normal serum creatinine (</=1.4 mg/dl), but 77/107 (50.0%) of these had measured CCR </=60 ml/min/1.73 m(2). Mean CCR was 45.1 ml/min/1.73 m(2) declining at the rate of 1.1 ml/min/1.73 m(2) each year. Only 9% of patients according to the Cockcroft and Jelliffe formulae, and 17% by the MDRD formula, fell within -10% and +10% of the measured CCR, which were the limits of agreement decided prior to the initiation of the study. DISCUSSION: Many elderly in-patients with moderate renal dysfunction will remain misidentified by relying on serum creatinine or commonly used prediction equations. The best practical approach in these patients is to avoid potentially nephrotoxic drugs and drugs excreted mainly through the kidneys.

Acute Disease↗
PubMed2003

Accelerated usual interstitial pneumonitis, anti-DNA antibodies and hypocomplementemia.

A healthy 60-year-old patient presented with progressive dyspnoea. Clinical, radiographic and pathological features of interstitial lung disease were found and an open lung biopsy established the diagnosis of usual interstitial pneumonitis (UIP) (idiopathic pulmonary fibrosis). Despite treatment, the patient died 4 months later in respiratory failure. Although the patient had no extra-thoracic involvement at autopsy, his illness was associated with a very high titre of anti-double-stranded DNA antibodies, hypocomplementemia, hypergammaglobulinaemia and lymphoid hyperplasia. These features and a literature review, suggest immune-mediated lung damage in a subset of patients with UIP.

Antibodies, Antinuclear↗
PubMed2003

Successful treatment of aggressive HIV-associated non-Hodgkin's lymphoma with combination chemotherapy, biotherapy with rituximab and HAART: presentation of a therapeutic option.

The incidence of non-Hodgkin's lymphoma (NHL) in individuals infected with human immunodeficiency virus (HIV) is more than 60 times higher than in matched controls. In the vast majority of cases aggressive pathological subtypes and advanced stages prevail, extranodal sites are involved and systemic symptoms are present. The prognosis of HIV-NHL remains poor and the optimal therapeutic approach has yet to be defined. We report a 48-year-old Ethiopian woman with advanced-stage HIV infection, who developed diffuse large cell, immunoblastic type B-cell NHL and was treated with a modified CHOP-like chemotherapy combined with Rituximab and supported with growth factor. Highly active antiretroviral therapy (HAART) and opportunistic infections prophylaxis were administered concomitantly. The patient completed 6 cycles of therapy and currently, 76 weeks after diagnosis, is in complete clinical remission. Despite the fact that there was a transient decrease in the CD4-positive cell number and a 1.5 log increase in plasma viral load there were no opportunistic infections, nor was life-threatening toxicity seen. Rituximab seems a well-tolerable and advantageous adjunct to chemotherapy and HAART in the treatment of aggressive HIV-associated NHL andshould be investigated in large trials in the future.

Antibodies, Monoclonal↗
PubMed2002

Thrombotic thrombocytopenic purpura as an initial presentation of primary Sjögren's syndrome.

A healthy woman presented with ecchymoses due to thrombocytopenia, with numerous bone marrow megakaryocytes, microangiopathic haemolytic anaemia, disorientation, irritability, and normal renal function. Thrombotic thrombocytopenic purpura (TTP) was diagnosed and treated successfully by plasma exchange therapy, both on presentation and during a further three relapses. The TTP was considered idiopathic until, 4 months later, definite primary Sjogren's syndrome (1 degree SS) was diagnosed following the appearance of sicca symptoms. Only four similar cases have been cited in the literature. TTP should be added to the varied haematological manifestations that may occur in patients with 1 degree SS. The possible presentation of 1 degree SS not with classic sicca symptoms but rather with haematological abnormalities, including TTP, should be recognised.

Female↗
PubMed2002

Agranulocytosis in Sjögren's syndrome: two case reports and analysis of 11 additional reported cases.

OBJECTIVES: To report 2 patients who presented with agranulocytosis that was found to be immune-mediated and associated with occult primary Sjögren's syndrome (primary SS) and to identify and study similar cases reported in the literature. METHODS: Two patients encountered in 2 large medical centers over a period of 5 years were studied in detail. All reported cases of agranulocytosis in primary SS identified through a MEDLINE search were reviewed. RESULTS: Two patients presented with marked systemic symptoms alone or associated with recurrent infections. Agranulocytosis with either a pattern of maturation arrest or a hypercellular reactive bone marrow was found and was associated with "acute phase" markers, hypergammaglobulinemia, a small paraprotein peak, and high rheumatoid factor titers. A diagnosis of immune-mediated agranulocytosis associated with an occult primary SS was established and was successfully treated with intravenous immunoglobulins or prednisone. Both patients subsequently developed skin vasculitis. This rare association of agranulocytosis and Sjögren's syndrome was identified in 11 other cases and was the presenting manifestation of primary SS in 10 of 13 (77%) patients. CONCLUSIONS: Agranulocytosis should be recognized as a rare but well-established association of primary SS. Bone marrow neutrophil production may be affected, or neutrophils may be destroyed in the circulation, by both humoral and cellular immune-mediated mechanisms. Agranulocytosis or neutropenia should be added to the varied hematologic manifestations of primary SS and may be its presenting feature and an important clue to diagnosis.

Aged↗
PubMed2001

Unexplained systemic symptoms and Gallium-67--guided decisions.

Over 3 months, a healthy man developed prominent systemic symptoms that defied investigation. Physical examination was noncontributory, and extensive studies revealed only a marked acute-phase response associated with increased serum IL-6 levels. A whole body Gallium-67 scan was crucial in diagnosis, directing attention to high uptake in the left paraspinal and psoas muscles. Open surgical excision biopsy was performed, guided by intraoperative use of a gamma-probe. Removed tissue was diagnosed as diffuse, large B-cell non-Hodgkin lymphoma of muscle (stage IE), a rare extranodal lymphoma. Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) therapy was given, and the patient became asymptomatic with normal blood tests and was thought to be in remission. However, a repeat Gallium-67 scan revealed recurrent multifocal disease and salvage chemotherapy was instituted. A 47,XXY karyotype (Klinefelter syndrome) was later identified, possibly associated with the lymphoma.

Agriculture↗