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Biomedical subjects

C Lerner

Publications and source records attributed to C Lerner.

At least 19 recordsLinked to original sources
PubMed2000

The preoperative predictability of the short esophagus in patients with stricture or paraesophageal hernia.

BACKGROUND: Esophageal shortening is a known complication of advanced gastroesophageal reflux disease that may preclude a tension-free antireflux procedure. A retrospective analysis was performed to test the accuracy of preoperative testing. METHODS: From September 1993 to December 1998, 39 patients underwent esophageal mobilization with intraoperative length assessment. Patients were selected on the basis of irreducible hiatal hernia, stricture formation, or both. Patients in the upright position with a fixed hiatal hernia larger than 5 cm on an esophagram were considered to have a short esophagus. Manometric length two standard deviations below the mean for height was considered abnormally short. RESULTS: In 31 patients, intraoperative mobilization was sufficient to allow the gastroesophageal junction to lie 2 cm below the diaphragmatic crus, so no esophageal-lengthening procedure was required. Eight patients with a short esophagus required an esophageal-lengthening procedure after complete mobilization. Two patients subsequently underwent intrathoracic migration of the gastroesophageal junction (GEJ), with recurrence of symptoms and required gastroplasty during the second surgery. An esophagram had a sensitivity of 66% and a positive predictive value of 37%, whereas manometric length had a sensitivity of 43% and a positive predictive value of 25% for the diagnosis of short esophagus. The preoperative endoscopic finding of either a stricture or Barrett's esophagus was the most sensitive test for predicting the need for a lengthening procedure. CONCLUSIONS: Manometry and esophagraphy are not reliable predictors of the short esophagus. Additional tests and/or tests combined with other parameters are needed.

Esophageal Stenosis↗
PubMed1997

Tuberculosis among foreign-born persons in New York City, 1992-1994: implications for tuberculosis control.

OBJECTIVE: To study the pattern of transmission of tuberculosis (TB) among foreign-born persons living in New York City. DESIGN: A retrospective multicenter study comparing 158 foreign-born patients to 231 US-born patients diagnosed with TB between 1992 and 1994. The patients were stratified according to their Mycobacterium tuberculosis isolate DNA fingerprint patterns. RESULTS: Nineteen (16%) of 122 isolates from foreign-born TB patients and 75 (42%) of 180 isolates from US-born TB patients had DNA fingerprint patterns (cluster patterns) indicative of recent exogenous transmission (P < 0.001). All cluster pattern strains from foreign-born cases were identical to those found among US-born patients. The likelihood of infection with a cluster pattern strain among foreign-born persons increased with duration of residence in the US, and was significantly associated with being homeless (P < 0.05), or having multidrug-resistant TB (P = 0.00072). CONCLUSION: Although most (84%) cases of TB among foreign-born persons in New York City appear to result from reactivation of infections they acquired abroad, the ones who acquire new infections become infected with strains that are already circulating among the US-born TB patients in New York City, and they have risk factors similar to those faced by US-born tuberculosis patients.

Adult↗
PubMed1993

Assessing permanent damage to primitive hematopoietic stem cells after chemotherapy using the competitive repopulation assay.

The competitive repopulation assay was used to document the effects of six chemotherapeutic agents on primitive hematopoietic stem cells. The assay measures the relative abilities of donor cells to produce circulating erythrocytes and lymphocytes in lethally irradiated congeneic mice over a period of 6 months. Long-lasting marrow reconstitutive deficits in cells of donor origin occurred after exposure to 5-fluorouracil (5FU), bis-chloronitrosourea (BCNU), cyclophosphamide (CTX), vincristine (VCR), and actinomycin D (ACT) but not after exposure to cytosine arabinoside (ARA). Repopulating abilities were reduced after as little as a single dose of CTX or BCNU. A second dose of BCNU caused even more severe effects. A single dose of 5FU had no effect on repopulating abilities despite a temporary 10-fold reduction in marrow cell number, but multiple doses reduced the marrow stem-cell replicative ability to less than half of the normal control levels. These effects were not reliably predicted or detected by colony-forming assays or by reductions in marrow cell number. Thus, long-lasting proliferative defects in the primitive hematopoietic stem-cell (PHSC) population can result from the use of chemotherapeutic agents. Such findings may have clinical implications, especially in individuals receiving repeated or prolonged administration of these agents or in instances of marrow transplantation.

Animals↗
PubMed1992

Adjuvant hyperbaric oxygen in malignant external otitis.

Necrotizing invasive pseudomonal infection of the external auditory canal (malignant external otitis) is an uncommon but important disorder in the elderly. The high morbidity, and even mortality, of this disorder has been reduced by the early and intensive use of combination antipseudomonal antibiotics. However, in severely immunocompromised patients or in infection involving the base of the skull, multiple cranial nerves, or the meninges, conventional therapy has been prolonged, intensive, and relatively ineffective. We treated 16 patients with malignant external otitis with adjuvant hyperbaric oxygen therapy. In six patients, infection was in advanced stages, infections were recurrences after previous treatment, and repeated treatment with antipseudomonal antibiotics had failed. All 16 cases responded promptly when a 30-day course of hyperbaric oxygen was added to the antibiotic regimen, and all patients remained free of infection or neurologic deficit during 1 to 4 years of follow-up. No complications of this treatment modality were noted. Hyperbaric oxygen therapy reverses tissue hypoxia, which enhances phagocytic killing of aerobic microorganisms, and stimulates neomicroangiogenesis. In addition, hyperbaric oxygen augments the action of aminoglycoside antibiotics. Adjuvant hyperbaric oxygen therapy should be considered in advanced or recurrent cases of malignant external otitis.

Aged↗
PubMed1991

Systemic cold urticaria in a five-year-old boy.

A 5-year-old white boy had a history of generalized urticaria on total body exposure to a cold environment. Standard ice cube testing was negative. Plasma analysis revealed the presence of cryofibrinogen. Systemic cold challenge with serial plasma assays for complement, histamine, and prostaglandin D2 disclosed an elevation and peak of plasma histamine and prostaglandin D2 levels after the onset of generalized urticaria with no change in serum complement levels.

Child↗
PubMed1990

Clinical and serologic follow-up of four children and five adults with bird-fancier's lung.

We report the clinical and serologic findings in four children and five adults with chronic avian hypersensitivity pneumonitis. All subjects were treated with corticosteroids and bird exposure was reduced or eliminated. After a variable period, ranging from 6 months to 10 years, their clinical and serologic findings were reassessed. In terms of symptomatology, chest findings, and pulmonary functions, all four children improved and four adults improved, whereas one adult had a progressive clinical deterioration, ultimately resulting in her death 5 years later. In terms of serologic data, precipitating antibody tended to persist, and antibody to avian antigens, as determined by ELISA, remained positive, although the titer declined. We conclude that, while serologic positivity remains, the prognosis for children and adults with chronic avian hypersensitivity pneumonitis is very good, provided that irreversible damage has not already occurred at the time of diagnosis.

Adult↗
PubMed1990

5-Fluorouracil spares hemopoietic stem cells responsible for long-term repopulation.

The long-term immunohemopoietic reconstituting ability of bone marrow, treated with a single administration of 5-fluorouracil (5-FU), was measured to determine whether 5-FU caused any deleterious effect upon primitive stem cells (PSCs). Cells from 5-FU-treated marrow donors were mixed in four different proportions of total marrow contents with untreated competitor marrow containing genetically distinguishable hemoglobin (Hb) and glucosephosphate isomerase (GPI) transplantation markers. These cell mixtures were introduced into lethally irradiated hosts. The functional ability of the donor cell population was assessed by measuring the percentage of donor type Hb and GPI found in the host's circulating erythrocytes and lymphocytes, respectively. Bone marrow from mice treated with 5-FU 1, 5, and 8 days prior to transplantation produced circulating lymphoid and erythroid cells as well as equal fractions of untreated fresh marrow when surveyed approximately 90 days after transplantation. Normal reconstitutive ability was thus maintained despite a tenfold reduction in marrow cell numbers when donor mice had been treated with 5-FU 5 days prior to transplantation. Donor marrow treated with 5-FU 15 days prior to transplantation had slightly decreased repopulating ability in one of two experiments. A second round of repopulation was stimulated subsequent to the initial 90-day screening by giving hosts a sublethal (500 rad) dose of irradiation. After 3-4 months, Hb and GPI parameters were the same as preirradiation values. Thus, the radioresistance of 5-FU treated PSCs remains comparable to that of fresh marrow, and their relative repopulating ability was not comprised by the additional stress of sublethal irradiation. After both rounds of repopulation the myeloid and lymphoid pathways were repopulated equally well by PSCs surviving 5-FU treatment. Repopulation of both pathways to the same extent suggests a common precursor as the proliferative agent. These results indicate that the PSCs were unaffected after a single treatment with 5-FU, although they were concentrated tenfold.

Animals↗
PubMed1989

Inheritance and prevalence of von Willebrand's disease severe form in a Brazilian population.

Reviewed data suggest that the prevalence of severe von Willebrand's disease is influenced by ethnic and geographic factors. In the State of Rio Grande do Sul, Brazil, seven genealogies in which 11 individuals had a severe expression of von Willebrand's disease were localized. These affected subjects had similar laboratory results and all of them seemed to have resulted from double genetic defects, but the genealogic examination revealed that four of them probably resulted from combinations of autosomal recessive genes, while in the remaining the presence of dominant genes was likely and the involvement of genes for types I or II of von Willebrand's disease was possible. All of their examined relatives were asymptomatic but some of them presented unusual laboratory results, indicative of heterozygosis. The prevalence of severe cases in the surveyed population was higher than expected even when only the recessive forms were considered. It entered the expected values when it was presumed that these were all the cases currently living in the State. Genetic heterogeneity of the severe form was confirmed and it is suggested that the designations 'severe von Willebrand's disease' and 'type III von Willebrand's disease' should not be used as synonyms.

Brazil↗
PubMed1989

Use of thallium-201 SPECT to quantitate malignancy grade of gliomas.

A quantitative preoperative technique using thallium-201 single-photon emission computerized tomography is described which predicts whether specific gliomas are of high- or low-grade malignancy. An index, based on the ratio of thallium uptake in the tumor versus the homologous contralateral brain, was calculated and compared with tumor histology. The index in 14 patients with low-grade malignant gliomas was 1.27 +/- 0.40 in contrast to an index of 2.40 +/- 0.61 in 11 patients with high-grade malignant gliomas (p less than 0.0005). Whether gliomas were of low- or high-grade malignancy could be predicted with 89% accuracy using a threshold of 1.5. Low-grade gliomas with an index higher than 1.5 acted biologically more like high-grade tumors, and no tumor histologically classified as being of high-grade malignancy had an index lower than 1.7. This technique could help to reduce unrecognized sampling errors during needle biopsies of brain tumors, particularly of high-grade lesions classified in error as low-grade tumors due to inadequate biopsy material.

Aged↗
PubMed1989

An exaggerated response to beta-adrenergics.

Beta-adrenergics are used frequently in the management of asthma. Tremor has been found to be a limiting side effect with the oral or the inhaled forms. We describe one child who developed gross tremors necessitating an extensive neurologic evaluation to eliminate any other cause. With the results of a normal work-up and the reappearance of tremor when challenged again, the diagnosis of increased sensitivity to the tremorogenic effect of beta-adrenergics was made.

Adrenergic beta-Agonists↗
PubMed1988

Number and continuous proliferative pattern of transplanted primitive immunohematopoietic stem cells.

We estimated numbers of transplantable primitive stem cells (PSCs) and found evidence that the same PSC continuously produced circulating erythrocytes and lymphocytes. These estimations used the binomial formula on data from recipients of identical portions of marrow mixtures containing two distinguishable cell types. Analysis of variance was used to compare repeated tests within each recipient. Values of pi s or pi c, probabilities that two independently sampled cells were descended from the same PSC, were also estimated, as this does not require the unverified condition that all PSCs contribute equally to the differentiated cell population. Several months after transplantation, erythrocytes were descended from only a single PSC per 1-2 X 10(5) marrow cells injected, several times rarer than previously reported. Percentages of erythrocyte and lymphocyte types in each recipient were closely correlated, with r values ranging from 0.86 to 0.94, in groups receiving 2-8 X 10(5) marrow cells; apparently the same precursors repopulated both myeloid and lymphoid lines in each recipient, as expected of true PSCs. Our data did not fit the clonal succession model, which predicts sequential activation of new PSCs and deactivation of old. Between 76 and 154 days, differentiated erythrocyte precursors were probably exhausted, with no evidence for new precursor activation or for further change between 154 and 250 days. The percentage of newly produced erythrocytes (reticulocytes) of each donor type varied little when individual recipients were followed between 165 and 295 days after transplantation, and variances within recipients were similar at marrow doses from 8 to 200 X 10(5) cells, further contradicting models of sequential activation and deactivation of PSC clones. Thus, transplanted PSCs were continually active during much of the recipient's lifespan.

Analysis of Variance↗
PubMed1987

Large numbers of primitive stem cells are active simultaneously in aggregated embryo chimeric mice.

The possibility has been repeatedly raised that erythropoiesis results from clonal succession--the differentiation of one or a very small number of the most primitive stem cells that are sequentially activated to proliferate forming clones of differentiated cells and then eventually decline, to be replaced by new stem cell clones. We studied this possibility in chimeric mice made by combining embryos from two different strains so that they would have two distinct stem cell populations, each of which produces a different hemoglobin type (d and s). These were compared with F1 hybrids in which every stem cell produces both types. We measured the percentage of type d in seven to ten serial samples of circulating reticulocytes taken at three- to seven-day intervals and found that the variability in percent of this hemoglobin was only slightly higher in the chimeric mice than in F1 controls; SD ranged from 2.7% to 5.5% in the chimeric mice and from 3.4% to 3.9% in the controls. Using the binomial formula, the numbers of new clones formed during the reticulocyte life span, approximately three days, ranged from 33 to 118 in the individual chimeric mice. However, these numbers are underestimates because estimated numbers of clones depend inversely on variabilities, and the calculations did not exclude the contribution of experimental error to the overall variability. Total percentages of type d hemoglobin were also measured in seven to nine successive serial samples at 60- to 136-day intervals. These gave mean values similar to measures of newly synthesized hemoglobin in the same mice, but SD were larger, ranging from 5.3% to 8.4%. This reflects experimental error, both because of excess day-to-day variability found in this type of measurement and because there could not be fewer primitive stem cells activated to form clones of erythrocytes during the 45-day erythrocyte life span than during the three-day life span of reticulocytes. Since most and maybe all of the variation between successive samples in the same chimeric mouse appear to result from experimental error, many or even all of the primitive stem cells may simultaneously contribute to erythropoiesis.

Animals↗
PubMed1986

Ethylene oxide (ETO) as a possible cause of an allergic reaction during peritoneal dialysis and immunologic detection of ETO from dialysis tubing.

An infant with end-stage renal disease requiring continuous ambulatory peritoneal dialysis (CAPD) had a cutaneous eruption with eosinophilia. This reaction was not associated with any drug administration. An analysis for antibodies against ethylene oxide-human serum albumin (ETO-HSA) was conducted because IgE antibodies have been correlated with allergic reactions during hemodialysis. IgE and IgG antibodies against ETO-HSA were demonstrated in one of two serum samples available. Serologic evidence is presented that ETO may be eluted from the dialysis tubing, react with HSA in the peritoneum, and immunize the dialyzed host. This may be a possible explanation for allergic manifestations in our patient and others undergoing peritoneal dialysis.

Antibodies↗
PubMed1985

The inheritance of spontaneous amyloidosis development in mice: a model for hereditary threshold metabolic disorders.

To study the inheritance of spontaneous amyloidosis development in mice, we crossed the LLC strain (with a high incidence) with the A/J strain (with a low incidence) and with the HLC strain (with a zero incidence of amyloidosis). We produced the F1 and a backcross generation to each parental strain in each cross. Examination of the spleen, liver, and kidneys of each mouse for the presence of amyloid was made between age 15 and 18 months. The data fit neither a dominant nor a recessive single gene hypothesis for the development of amyloidosis. In consideration of amyloidosis as a hereditary threshold character, we developed an additive gene model. Subsequently, a test for fitness of the observed percentages to the expected percentages in the backcross generations was made according to this model. The observed percentages of amyloidosis in the spleens, livers, and individual mice agreed with the expected percentages in the LLC X A/J crosses but not in the LLC X HLC crosses. Therefore, we conclude that for the development of amyloidosis, a difference exists at one locus between LLC and A/J and at more than one locus between LLC and HLC. The probability of development of amyloidosis in an individual depends on the effects of the genes at these loci. For hereditary metabolic disorders that cannot be explained by either a single dominant or recessive gene hypothesis, this genetic model may be useful to test whether the development of the disease is due to additive effects of genes.

Amyloidosis↗
PubMed1984

Ultimate erythropoietic repopulating abilities of fetal, young adult, and old adult cells compared using repeated irradiation.

Erythropoietic repopulating abilities of fetal liver cells and young and old adult marrow cells were compared as follows: Equal numbers of cells from a donor of each age were mixed with a constant portion of cells pooled from genetically distinguishable competitors. These mixtures were transplanted into stem cell-depleted recipients, and the proportions of recipient hemoglobin that were donor type measured the relative effectiveness of early erythropoietic precursor cells from the various donors (Fig. 1). At intervals of 3-6 mo, recipients were sublethally irradiated, requiring a new round of competitive repopulation. When B6 mice were used as donors, with WBB6F1 competitors and recipients, the highest levels of stem cell activity were found using old donors (Tables I, III). This was true even with unirradiated, immune-competent W/Wv recipients (Table III). When donors and recipients were WBB6F1 hybrids, with B6 competitors, fetal cells initially gave higher levels of repopulating ability, and they were similar to the adult and old marrow cells after 400 d and after recovery from two sublethal irradiations (Table II). These effects were mostly insignificant and probably reflect small differences in initial stem cell concentrations that are brought out by the sensitivity of the competitive repopulation assay. Clearly, ultimate erythropoietic stem cell proliferative capacities did not decline as a result of the proliferation required between 15 d of fetal life and old age. Repopulating abilities of 12-d fetal liver cells were not detectable. We also showed that the proportions of newly synthesized hemoglobins made by the two types of stem cells in tetraparental mice remained nearly constant when tested at 3-d intervals over 30 d. Minimum numbers of stem cells producing erythrocytes over a single 3-d period were calculated as 62 and 128, but these are too low, since variances were similar in the tetraparental mice and in the F1 hybrid control. This contradicts the hypothesis that erythropoietic stem cells reserve limited proliferative capacities by proliferating one or a few at a time. We suggest that erythropoietic stem cells have essentially unlimited proliferative capacities and are found in approximately equal concentrations in the primary erythropoietic organs after 15 or 16 d of fetal life.

Aging↗
PubMed1984

Amyloidosis development in LLC mice.

Using electron microscopy and the protein A-gold labelling technique we studied amyloidosis in the LLC mice, an inbred strain developing amyloidosis spontaneously. We found that the reticular cells lining around the sinuses in the red pulp of the spleen were converted to amyloid. Evidence suggests that the amyloid originates in the cells themselves. The process of amyloid formation is discussed.

Amyloidosis↗