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Biomedical subjects

B Reichman

Publications and source records attributed to B Reichman.

At least 37 records · Page 2Linked to original sources
PubMed1994

Prenatal ultrasonographic diagnosis of fetal cerebral ventriculitis associated with asymptomatic maternal cytomegalovirus infection.

Cytomegalovirus is the most common cause of congenital viral infection. In utero infection is usually suspected in patients with growth-retarded fetuses or when maternal illness precipitates serological investigations. A case is presented where routine ultrasound examination at 30 weeks' gestation in an asymptomatic patient demonstrated mild fetal ventriculomegaly. Transvaginal ultrasound enabled the visualization of intraventricular adhesions and small periventricular cysts. The suspected diagnosis of in utero cytomegalovirus infection was confirmed by the presence of IgM antibodies in fetal blood and subsequently by isolation of the virus from the infant's urine. The presence of mild fetal ventriculomegaly should prompt transvaginal brain imaging.

Adult↗
PubMed1994

The association between alpha-fetoprotein and beta hCG levels prior to and following chorionic villus sampling in cases that spontaneously miscarried.

Maternal serum alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (beta hCG) measurements taken prior to chorionic villus sampling (CVS) in 21 patients who subsequently miscarried were compared with measurements in a control group of 113 patients with uneventful pregnancies. Patients with AFP levels of 10 iu/ml or more prior to the CVS had a 4.3 times greater risk of miscarriage (95 per cent confidence interval 1.3-13.6). AFP levels obtained 1 week after the CVS in the 13 patients with late miscarriages were higher than in the control group (P = 0.06). Patients miscarrying had a greater rise in AFP (P = 0.06) and a greater fall in beta hCG levels (P = 0.04) following the CVS procedure, compared with the control subjects. Each 10-unit change in the difference between AFP or beta hCG levels prior to and 1 week following the CVS was associated with a significantly increased risk for late miscarriage. Elevated maternal serum AFP levels early in pregnancy and changes in AFP and beta hCG levels following CVS may predict an increased risk for subsequent miscarriage.

Abortion, Spontaneous↗
PubMed1994

A prospective comparison of the outcome of triplet pregnancies managed expectantly or by multifetal reduction to twins.

OBJECTIVE: Our aim was to compare the outcome of triplet pregnancies managed expectantly or by multifetal reduction to twins. STUDY DESIGN: From January 1984 through January 1992, 140 triplet gestations were diagnosed before the ninth gestational week. Multifetal pregnancy reduction was performed at the patient's request in 34 women. The remaining 106 triplet pregnancies were managed expectantly. All patients were prospectively followed up and delivered in a single perinatal department. RESULTS: Loss of the entire pregnancy before 25 gestational weeks occurred in 20.7% of the triplet pregnancies managed expectantly as compared with 8.7% in the group with reduction to twins. A successful pregnancy as defined by the discharge home of at least one infant occurred in 88.2% of the group with reduction to twins and 74.5% of the triplets managed expectantly. Fetal reduction to twins was associated with a significantly lower incidence of the following: prematurity (p < 0.001), low-birth-weight infants (p < 0.001), and very-low-birth-weight infants (p < 0.001). Pregnancy complications and neonatal morbidity and mortality were less in the group with reduction to twins. CONCLUSIONS: Multifetal pregnancy reduction of triplet pregnancies to twins resulted in improved pregnancy outcome without an excess loss of the entire pregnancy as compared with the outcome of triplet gestations managed expectantly.

Abortion, Therapeutic↗
PubMed1994

Noninvasive determination of neonatal hyperbilirubinemia: standardization for variation in skin color.

The estimation of plasma bilirubin concentration in neonates, using a transcutaneous, noninvasive jaundice meter, is significantly affected by many factors, such as gestational age, birthweight, phototherapy, and skin pigmentation. In an attempt to minimize the influence of skin color and hence circumvent the need for standardization curves for different ethnic populations, we obtained noninvasive jaundice meter readings from the infant's midsternum within 4 hours of birth and subtracted this measurement from subsequent reading in infants with hyperbilirubinemia. These results were correlated with simultaneous plasma bilirubin determinations. By this method, a single standardization curve and improved sensitivity, specificity, and predictive values for the noninvasive determination of neonatal hyperbilirubinemia in a population of mixed ethnic origin was obtained.

Bilirubin↗
PubMed1994

Effect of maternal immunization with oral poliovirus vaccine on neonatal immunity.

During the summer of 1988, an outbreak of poliomyelitis caused by poliovirus 1 occurred in Israel, during which a national mass immunization campaign with oral poliovirus was undertaken. This prospective study was undertaken to assess the effect of maternal oral poliovirus immunization during the third trimester of pregnancy on neonatal immunity against poliovirus. Cord blood specimens of 88 neonates, born 2 to 7 weeks after maternal immunization, were examined for antipoliovirus antibodies and compared with 100 samples obtained from neonates 7 months before the outbreak. Blood samples were also obtained from the 62 mothers of neonates who had been immunized 2 to 5 weeks before delivery. Sera were tested for neutralizing antibodies to the 3 poliovirus types using a microneutralization technique. The geometric mean titer to poliovirus type 1 was significantly higher in neonates whose mothers were immunized during pregnancy (87.1) than in the offspring of the nonvaccinated group (53.0), P < 0.05. Two to 3 weeks after immunization, geometric mean titers against all 3 poliovirus types were higher in maternal blood than in cord blood whereas 4 to 5 weeks after vaccination a significant difference was found for type 3 only. Although oral poliovirus immunization during pregnancy resulted in higher neonatal antibody titers to poliovirus type 1, the proportion of newborns with titers of < 1:8 to the 3 poliovirus types did not change significantly.

Antibodies, Viral↗
PubMed1994

Early neonatal renal venous thrombosis: long-term outcome.

Renal venous thrombosis was diagnosed in the first week of life in 6 of 30,101 live infant births born at the Chaim Sheba Medical Center in Israel from 1984 to 1989. The thrombosis was unilateral in 5 neonates and bilateral in 1. Predisposing maternal risk factors included 2 cases of maternal diabetes and 1 case of maternal hypertension with associated intrauterine growth retardation. Perinatal risk factors included 2 cases of prematurity with severe hyaline membrane disease, 1 infant who was small for gestational age and another with asphyxia. Follow-up for 1-5 years following the acute event revealed normal growth and development in all infants. None of the patients was hypertensive and all had normal renal glomerular and tubular functions. Renal imaging and scan studies revealed loss of perfusion in 4 atrophic kidneys and diminished perfusion in the remaining 2. In conclusion, although renal venous thrombosis in neonates is associated with low mortality, long-term dysfunction in the affected kidney is common.

Causality↗
PubMed1994

Prognostic value of the immediate response to surfactant.

AIM: To evaluate the association between the immediate response to surfactant treatment and morbidity and mortality in infants with severe respiratory distress syndrome. METHODS: The response to surfactant was defined as the difference in the arterial:alveolar (delta a:A) ratio before and one hour after the first surfactant dose. Measurements were obtained from 253 Israeli infants participating in the multi-centre Curosurf 4 trial of surfactant replacement therapy. RESULTS: Delta a:A ratios ranged from -0.115 to 0.8 and were significantly related to both birth weight and gestational age. Among infants weighing 1001-1500 g mortality decreased from 40% among very bad responders to zero among good responders. The incidence of pneumothorax decreased with better response. Logistic regression analysis showed a hierarchy of predictive power for mortality: birth weight or gestational age; immediate response to surfactant; severity of initial disease. CONCLUSION: The immediate response to surfactant treatment is a significant prognostic indicator for mortality and morbidity.

Biological Products↗
PubMed1994

Fluorescence polarization of serum lipids in pregnancies complicated by hypertensive disorder.

Hypertensive disorders in pregnancy are associated with an increase in serum lipid fractions. Fluorescence Polarization (FP) of lipids in the serum of 80 hypertensive pregnant patients at full term was compared to measurements in a control group of 71 healthy pregnant volunteers. In addition, the FP values were correlated with measurements of serum lipid fraction in 34 hypertensive and 17 control patients. Both chronic hypertension and pregnancy induced hypertensive (PIH) subjects had significantly reduced serum FP values compared to the control group. This difference was however present only in the severely hypertensive patients, independent of the etiology of this disorder. Highly significant correlations were present between the FP values and serum level of Triglycerides r = -0.85, Very Low Density Lipoprotein r = -0.76, and Low Density Lipoprotein r = 0.53. Serum FP values appear to reflect the change in the lipoprotein pattern present in pregnant patients with hypertensive disorders. This change appears to reflect the severity of the condition rather than the etiology of the hypertension.

Cholesterol↗
PubMed1994

Intraperitoneal Taxol (paclitaxel) in the management of ovarian cancer.

In an effort to examine the safety and pharmacology of the intraperitoneal (i.p.) delivery of paclitaxel, 25 patients (24 with ovarian cancer) were treated in a phase I dose escalation trial. The drug was administered in normal saline every 3 to 4 weeks, starting at a dose of 25 mg/m2. The dose-limiting toxicity at doses at or above 175 mg/m2 was abdominal pain. A 3-log pharmacokinetic advantage for peritoneal cavity exposure to paclitaxel, compared with the systemic compartment, was observed. High levels of drug persisted within the cavity for longer than 48 hours following a single treatment. In addition, significant paclitaxel concentrations were found in the systemic compartment after i.p. treatment, despite the pharmacokinetic advantage demonstrated for cavity exposure. Several patients exhibited clinical and laboratory evidence of an antitumor response. On the basis of these data, further exploration of a potential role for i.p. paclitaxel in the management of ovarian cancer appears justified.

Dexamethasone↗
PubMed1993

Phase II trial of carboplatin and etoposide in metastatic breast cancer.

BACKGROUND: High-dose chemotherapy with hematopoietic support produces high rates of response in metastatic breast cancer. To facilitate new high-dose regimens there is a need to identify active agents with toxicity limited to hematopoietic suppression. Cisplatin/etoposide is a highly active regimen in metastatic breast cancer, but cisplatin dose-escalation is limited by nonhematologic toxicity. Carboplatin is active in breast cancer and has marrow-dominant toxicity. Demonstration of activity for the combination of carboplatin and etoposide would facilitate their inclusion in high-dose programs. METHODS: A single treatment arm prospective Phase II study in patients with measurable or evaluable breast cancer was done. RESULTS: Forty-six patients with metastatic breast cancer were treated with the combination of carboplatin and etoposide. Among 19 patients without prior chemotherapy, one complete and seven partial responses were observed, for an objective response rate of 42% (95% exact confidence intervals [CI], 20-67%). One partial response was seen among 12 patients with prior chemotherapy limited to the adjuvant setting. No responses were seen among 14 patients who had received prior chemotherapy for metastatic cancer. Two treatment-related deaths occurred, both attributable to sepsis. One patient returned to her community for treatment after receiving one course of protocol therapy before response assessment and could not be studied for response. CONCLUSION: The activity observed with this regimen in patients with no prior chemotherapy coupled with its potential for dose escalation suggests a possible role in high-dose programs with hematopoietic support. The inactivity of the combination in patients with prior therapy for metastatic breast cancer indicates that there is no advantage to its use in the salvage setting.

Adult↗
PubMed1993

Intraperitoneal chemotherapy in the management of ovarian cancer.

During the past decade, intraperitoneal therapy of ovarian cancer has evolved from a pharmacologic model into an established treatment technique for women with this malignancy. Approximately 40% of patients with small-volume residual ovarian cancer (microscopic disease or macroscopic tumor, < or = 0.5 cm in maximum tumor diameter), after an objective response to initial organoplatinum-based systemic chemotherapy, may have a surgically documented complete response to platinum-based intraperitoneal chemotherapy. Patients who have not responded to systemic platinum administration rarely will respond to the drug given intraperitoneally, despite the presence of only small-volume residual disease when this regional treatment strategy is used. Other agents with antineoplastic activity after intraperitoneal administration in women with ovarian cancer include mitoxantrone, taxol, alpha-interferon and gamma-interferon, and interleukin-2. Although intraperitoneal therapy currently is being examined as a component of the initial chemotherapeutic program for patients with ovarian cancer, a precise role for regional drug delivery in this clinical setting remains to be defined.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Epithelial ovarian cancer in the elderly. The Memorial Sloan-Kettering Cancer Center experience.

BACKGROUND: There is evidence of differences between older (> or = 65 years of age) and younger (< 65 years of age) women with ovarian cancer. METHODS: To evaluate differences in the care of older versus younger patients with ovarian cancer, a retrospective review was conducted of the records of 146 patients who had their initial surgery for ovarian cancer at the Memorial Sloan-Kettering Cancer Center from January 1987-January 1991. RESULTS: There was a significant difference in stage at presentation between the older (48 patients) and younger (98 patients) populations (Stage I/II: older 10%; younger 25%; P < 0.05). Although there was no statistically significant difference in the distributions of patients according to tumor grade between the two groups, 10% of the younger patients had ovarian cancer of low malignant potential, compared to only 2% of older patients (P < 0.1). Forty-six percent of the younger patients entered an intensive initial chemotherapy trial compared to only 17% of the older patients (P < 0.001), principally due to comorbid medical conditions (e.g., heart disease). Finally, whereas the relative number of younger to older patients with ovarian cancer undergoing initial surgery at this institution was 2:1, the relative number of totally new patients to the service (including referral for initial treatment or salvage programs) was 4:1 (P < 0.001), suggesting that older patients with ovarian cancer are less likely to be referred for secondary experimental programs than for initial treatment. CONCLUSIONS: These data suggest that there are major differences between the presentation and treatment strategies of older compared to younger patients with ovarian cancer.

Adult↗
PubMed1993

Evidence for persistence of mitoxantrone within the peritoneal cavity following intraperitoneal delivery.

In clinical trials examining the intraperitoneal (ip) administration of mitoxantrone as therapy of platinum-refractory small-volume residual ovarian cancer, the characteristic "blue color" of the agent has been demonstrated to stain the surface of the peritoneal cavity and to persist for > or = 1 month following the last course of therapy. To determine if this blue staining material contains potentially cytotoxic concentrations of mitoxantrone, we analyzed tissue obtained at exploratory laparotomy in six women who had last received the agent administered ip from 6-22 weeks prior to surgery. Concentrations of mitoxantrone ranged from < 0.1 to 13.8 micrograms/g of tissue examined. Since any mitoxantrone present on the peritoneal surface will be highly protein bound, any residual drug may not have cytotoxic potential. The dose-response curves of mitoxantrone in a human clonogenic cytotoxicity assay against the RPMI 2780/S human ovarian cell line were virtually identical when the cells were incubated in either 5 or 50% fetal bovine serum, suggesting that protein binding will not significantly impair mitoxantrone-induced tumor cell killing. We conclude that the ip administration of mitoxantrone may lead to prolonged exposure of surface tumor to the high local concentrations of the active cytotoxic agent. This effect may contribute significantly to the antineoplastic potential of ip mitoxantrone in patients with small-volume residual ovarian cancer.

Dose-Response Relationship, Drug↗
PubMed1993

The use of recombinant human erythropoietin to prevent carboplatin-induced anemia.

Anemia is a frequent and potentially serious toxicity associated with the use of carboplatin, particularly when this agent is administered in the salvage setting. In an effort to evaluate a possible role for human erythropoietin (rh-E) in preventing or minimizing carboplatin-induced anemia we analyzed the impact of the agent on anemia and transfusion requirements of women with ovarian cancer who were treated on one of two nonrandomized trials employing identical second-line carboplatin-based intraperitoneal regimens, with the only difference in the regimens being the addition of rh-E (Study 1, without rh-E; Study 2, with rh-E). There was a statistically significant difference in the incidence of documented nadir hemoglobin levels of < 9 g/dl (Study 1, 60%; Study 2, 13%; P < 0.005) and < 8 g/dl (Study 1, 33%; Study 3, 6%; P < 0.05). We also observed a threefold reduction in transfusion requirements with the use of rh-E (Study 1, 23%; Study 2, 6%), but this difference was not statistically significant with the limited sample size evaluated. In this nonrandomized comparison of two identical chemotherapy programs we have demonstrated that rh-E significantly reduced the incidence and severity of anemia associated with carboplatin-based chemotherapy. A randomized trial examining the potential impact of rh-E on carboplatin-induced anemia and transfusion requirements is warranted.

Adult↗
PubMed1993

Salvage intraperitoneal mitoxantrone therapy of ovarian cancer: influence of increasing the volume of treatment.

Despite the demonstrated activity of intraperitoneal mitoxantrone in patients with small volume-platinum-refractory ovarian cancer, previous reports have revealed that many patients fail to achieve adequate distribution of the cytotoxic drug throughout the peritoneal cavity when delivered in a "standard" 2-liter treatment volume. In an effort to improve the distribution and therapeutic efficacy of intraperitoneal mitoxantrone, 22 patients with platinum-refractory ovarian cancer were treated with the drug at a dose of 10 mg/m2 given in 2 liters of normal saline followed by an additional 1-2 liters every 2 weeks for eight cycles. The surgically defined complete response rate in 17 patients evaluable for response with platinum-refractory ovarian cancer was 24%, with an overall response rate of 29%. Of 18 in which the influence of treatment volume could be examined (4 patients developed catheter failure), 12 (67%) were able to tolerate a 4-liter treatment volume for > 80% of courses, with a total of 15 patients (83%) receiving treatment with a minimum of a 3-liter treatment volume. We conclude that it is possible to safely increase the intraperitoneal treatment volume to 3-4 liters in most patients undergoing this therapeutic strategy. While the impact on therapeutic efficacy of expanding the volume employed for cytotoxic drug delivery remains to be defined, in theory this approach may optimize the opportunity for agents achieving high-intraperitoneal concentrations to produce their maximal cytotoxic effect.

Adult↗
PubMed1993

Impact of age on survival of patients with ovarian cancer.

In an effort to determine if there are significant differences in outcome between elderly (> or = 65 years of age) and younger (< 65 years of age) women with epithelial ovarian cancer we examined the survival of patients with this malignancy who underwent their initial surgical evaluation at the Memorial Sloan-Kettering Cancer Center from January 1987-January 1991. The actuarial median overall survival for the 98 younger patients has not been reached but will exceed 4 years, compared to a median survival of 24 months for the 48 elderly patients (P < 0.0001). For individuals with advanced (stages 3-4) disease, excluding patients with tumors of low malignant potential, the median survival for the younger patient population has also not been reached and will exceed 4 years, compared to 21 months for the older population (P < 0.0001). Even in the limited number of patients with local/regional (stages 1-2) ovarian cancer, there was a statistically significant superior survival for the younger group of patients (P < 0.02). With a single exception, all deaths were believed to be due principally to disease progression, rather than to an unrelated comorbid medical event. We conclude that elderly patients with ovarian cancer experience a significantly inferior survival than younger individuals with this malignancy. Evaluation of larger populations will be required to confirm the results of this analysis and to probe for explanations for the striking survival differences we have observed.

Adult↗
PubMed1993

Mitomycin-C plus a 3-day continuous intravenous infusion of 5-fluorouracil: an inactive salvage regimen for platinum-resistant ovarian carcinoma.

In a Phase II trial, patients with refractory ovarian cancer were given 10 mg/m2 mitomycin-C i.v. every 8 weeks and 1000 mg/m2/day 5-fluorouracil for 3 consecutive days by continuous intravenous infusion repeated every 4 weeks. Sixteen heavily pretreated patients with platinum-resistant disease were treated and no major responses were observed. Only 2 patients required subsequent dose reduction for myelotoxicity. No sign of gastrointestinal toxicity was seen. This regimen is inactive as salvage treatment for refractory ovarian cancer.

Adult↗