Biomedical subjects

E Bloom

Publications and source records attributed to E Bloom.

At least 37 records · Page 2Linked to original sources

PubMed1997

High-dose chemotherapy and autologous stem cell support followed by posttransplantation doxorubicin as initial therapy for metastatic breast cancer.

High-dose chemotherapy is associated with a high complete response rate and possibly some survival advantage in patients with metastatic breast cancer. We designed a clinical trial consisting of a two-step high-dose chemotherapy regimen followed by posttransplantation doxorubicin as the first chemotherapy treatment for metastatic disease. Twenty-one patients with metastatic breast cancer and no previous chemotherapy for metastatic disease were treated with high-dose cyclophosphamide (Cy; 5000 mg/m2), followed by granulocyte colony-stimulating factor. Peripheral blood stem cells were collected. Subsequently, patients received Cy (6000 mg/m2), thiotepa (500 mg/m2), and carboplatin (800 mg/m2) (CTCb) with hematopoietic rescue. Upon recovery of hematopoietic and gastrointestinal toxicity, three cycles of doxorubicin (Dox; 60 mg/m2) were delivered. After Cy, nine patients (45%) developed neutropenic fevers. There were no episodes of bacteremia. Patients received CTCb 37 days after starting Cy and had a hospital stay of 19 days. After CTCb, the median number of days to an absolute neutrophil count >5 x 10(9)/liter was 8, and the median number of days to a platelet count >20 x 10(9)/liter was 9. Neutropenic fevers occurred in 12 patients. There were no hemorrhagic complications. Fifty-five of the 63 planned courses of Dox were delivered. The median time from peripheral blood stem cell infusion to the first Dox cycle was 38 days. The median time to the second Dox cycle was 28 days, and to the last cycle was 30 days. Three episodes of neutropenic fevers were observed. Two patients developed herpes zoster. This regimen is feasible, with acceptable toxicity.

Adult↗

PubMed1996

Halogen lamp phototoxicity.

BACKGROUND: The radiation from quartz halogen light bulbs has been reported to cause erythema in humans and skin tumors in experimental animals. OBJECTIVE: The objective of this study was to determine the relative risk of injury to humans due to the radiation from these lamps. METHODS: We studied a 12-volt 50-watt quartz halogen lamp. We measured its ultraviolet output spectrum and the biological toxicity of its radiation by means of its pyrimidine dimer-inducing capability. RESULTS: At a 1-cm distance, the 254-nm light output of the lamp is 3 x 10(-7) W/cm2/nm. Solar radiation at this wavelength is undetectable on the earth's surface, i.e., less than 10(-12) W/cm2/nm. At 290 nm, the lamp output is approximately 3 x 10(-6) W/cm2/nm, 5,000 times greater than the summertime sun at 1 p.m. at sea level in Kuwait. The UVB and UVA output of the lamp is roughly similar to the solar output under these conditions. We also measured the pyrimidine dimer-forming potential of the lamps relative to the sun for the purpose of estimating the DNA toxicity of the lamps. At a 7-cm distance the lamp induces approximately 3.9 pyrimidine dimers/100,000 bp/min. This is approximately 4 times more rapid than that of the noontime summer sun in Michigan. CONCLUSIONS: We conclude that direct radiation from these lamps can cause damage to human skin, due to their UVC and UVB output. We estimate that the relative risk to keratinocyte DNA in human skin, in vivo, from exposure to the 50-watt halogen lamp at a distance of 7 cm is between 27 and 400% of the noontime summer sun in Michigan.

DNA↗

PubMed1996

Effect of topical cis-urocanic acid on local lymph node activation during contact sensitization in mouse, rat and guinea-pig.

Cis-urocanic acid (cUCA) has been suggested as a mediator of impairment of contact hypersensitivity induction by ultraviolet B (UVB) irradiation. We ascertained whether topical cUCA influences local lymph node activation during induction of contact hypersensitivity. Topical cUCA or vehicle was applied during the local lymph node assay to oxazolone. Local lymph node weight and cell number were assessed in all animals. Additionally, cell proliferation rate was studied in Hartley guinea-pigs and CBA/Ca mice, whereas activation of antigen-presenting cells was quantified in NMRI mice and Wistar rats. Topical cUCA suppressed all parameters of local lymph node activation due to oxazolone application in guinea-pigs. No effect, with the exception of a suppression of antigen-presenting cell activity, was seen in mice. No effect was seen in rats. The study shows that topical cUCA may suppress local lymph node activation during contact sensitization and suggests that differences between the effect of cUCA in different animal species may exist.

Animals↗

PubMed1996

Home ascites drainage using a permanent Tenckhoff catheter.

Management of refractory ascites (RA) can be accomplished in many ways. Rapid recurrence will be a problem even with repeated paracentesis. We studied the use of a permanent Tenckhoff catheter (PTC) for drainage of RA in 10 patients. The cause of RA was cardiomyopathy in 7 patients, malignancy with liver metastasis in 2, and end-stage liver disease in 1 patient. The volume of ascites drained (AD) ranged from 0.5-7.0 L, with a mean of 2.6 L. Mean blood pressure pre-AD was 112/68 mm Hg, and post-AD was 109/66 mm Hg (p > 0.05). Heart rate pre- and post-AD was 80 bpm and 81 bpm, respectively (p > 0.05). The number of ADs ranged from two to 63 (mean: 16). There was no fluid replacement during or post-AD. There were no complications or infections from AD. The mean interval between ADs was 7.8 days. Mean duration of survival was six months. All patients eventually expired. In conclusion, PTC can be a useful and safe alternative for draining RA at home in terminally ill patients. Complications of repeated paracentesis are minimized, and the need for hospitalization is avoided. AD with PTC may be preferred to repeated paracentesis in RA.

Adult↗

PubMed1995

[Radiological and endoscopic diagnosis of sigmoid diverticulitis].

In emergency, the most commonly used examination, other than plain radiographs of the abdomen, is the water-soluble contrast enema (Gastrografin). It demonstrates three different pictures, which may be more or less associated one to the other: "peridiverticulitis", featuring serrate lesions, abnormal stiffness and fixity and, in some cases, a long narrowing or stricture of the colon; diverticula, mainly in the sigmoid colon, becoming sharp-pointed or spark-liked; spillage of contrast material out of the colic lumen or into a neighbouring organ (fistula). Ultrasonography may be a useful emergency procedure to secure a hesitating diagnosis in a patient with a febrile abdominal pain or with a abdominal-pelvic mass, especially in women. Colonoscopy and barium enema are both usually contra-indicated in the acute setting of diverticulitis because of their potential hazards. On the other hand, after resolution of the acute event, these tests may allow to rule out carcinoma or associated adenomas (which coexist in more than 15% of the patients). Endoscopic control appears more especially important as initial accurate diagnosis in sometimes impossible to assess between adenocarcinoma and diverticulitis. CT scan has found an increasing place in both diagnosis and evaluation of infectious complications of diverticular disease. It is most recommended to assess the diagnosis of severe episodes, failing to clearly improve after medical treatment, and most particularly when an abscess in suspected. CT scan may demonstrate a thickening of the colic wall, high densities of pericolic fat and a tissular mass which may enclose gas bubbles.

Colonoscopy↗

PubMed1995

A local lymph-node assay validation study of a structure-activity relationship model for contact allergens.

A structure-activity relationship model for prediction of contact allergenic potential of chemicals had previously been developed. The model had been shown to be able to classify known allergens and nonallergens using data on physicochemical and reactivity parameters of functional groups by discriminant two-value multiple regression analysis. To investigate the model, six selected chemicals which had not been previously investigated for allergenicity were studied with both the model and a murine local lymph-node assay. The same compounds were predicted to be allergens (3-bromo-2-coumaranone, 1-nitrocyclohexene and alpha-acryloyloxy-beta, beta-dimethyl-beta-butyrolactone) and nonallergens (1-carbethoxy-4-piperidone, 6,7-dimethoxy-2-tetralone and 9-acetylanthracene) by both the model and the local lymph-node assay.

Allergens↗

PubMed1994

Topical FK506: suppression of allergic and irritant contact dermatitis in the guinea pig.

Topical FK506 has recently been shown to have an anti-inflammatory effect in vivo in humans. In this study its effects in contact dermatitis were studied in the guinea pig model. Topical FK506 suppressed both irritant and allergic patch-test reactions. The most prominent suppressive effect was seen when skin sites were pretreated with FK506. Topical FK506 did not impair the induction of contact allergy as assessed by challenges, although it suppressed local lymph node cell accumulation during contact allergy induction. Topical FK506 may hold promise as a treatment for skin disorders that respond to oral FK506 or cyclosporin A.

Administration, Topical↗

PubMed1994

Increased proliferation of skin cells by sublethal doses of sodium lauryl sulfate.

Most quantitative in vitro approaches to determine irritancy have examined the potential of compounds to decrease biological functions or inhibit growth of cells. Irritants, however, are known to generally have the opposite effect in vivo, i.e. to stimulate cell division. This property has not been directly studied in vitro. We examined the ability of sublethal concentrations of sodium lauryl sulfate (SLS) to stimulate cultured keratinocyte and fibroblast proliferation in vitro. The growth of keratinocytes, without added growth factors, continuously exposed to SLS for 4 days was stimulated approximately 89% compared to control. Keratinocytes exposed to SLS for 1 or 18 h were stimulated 36 and 12%, respectively, over the next 4 days of growth. Subconfluent fibroblasts were also stimulated approximately 38%. Confluent fibroblasts were stimulated 40%. All stimulations were maximal between 10(-8) and 10(-5) M added SLS. Media conditioned by keratinocytes exposed to 10(-8) M SLS were able to increase the growth of naive keratinocytes by 117%. In all experiments doses of SLS > 10(-5) M inhibited cell growth. We conclude that sublethal doses of SLS can stimulate the growth of cultured keratinocytes and fibroblasts. The stimulation of growth seen may be related to the stimulation observed in in vivo irritation.

Cell Count↗

PubMed1994

Improved response to erythropoietin in peritoneal dialysis patients as compared to hemodialysis patients: role of iron deficiency.

Various studies have shown that peritoneal dialysis patients may require less erythropoietin (rHuEPO) than maintenance hemodialysis patients. Iron deficiency in hemodialysis patients may contribute to the difference in response. This study compares the response to rHuEPO in 24 patients on CAPD to 33 patients on hemodialysis. All the hemodialysis patients received intravenous iron to prevent iron deficiency. Peritoneal dialysis patients received rHuEPO subcutaneously twice weekly. Erythropoietin was administered intravenously thrice weekly in hemodialysis patients. In peritoneal dialysis patients, hematocrit was 23.1% and 30.1%, rHuEPO dose was 80.9 and 89.0 u/kg/wk, while in hemodialysis patients hematocrit was 22.2% and 31.2%, and rHuEPO dosage was 140.2 and 154.3 u/kg/wk at initiation, and six months after therapy (p < 0.05 for dose, hemodialysis vs CAPD). Serum iron and transferrin saturation remained normal both in peritoneal and hemodialysis patients. These findings suggest that hemodialysis patients require a higher dosage of rHuEPO than peritoneal dialysis patients for a comparable rise in hematocrit, even when iron deficiency is prevented with parenteral iron. The improved efficacy of rHuEPO in CAPD patients may be due to the better removal of the inhibitors of erythropoiesis and/or the subcutaneous route of administration.

Anemia↗

PubMed1993

Diffuse vascular ectasia of the antrum, duodenum, and jejunum in a patient with nodular regenerative hyperplasia. Lack of response to portosystemic shunt or gastrectomy.

The case is reported of a 70 year old man who presented with severe anaemia because of chronic gastrointestinal blood loss. This loss was ascribed to vascular ectasia resembling the gastric antral vascular ectasia syndrome but extended to include the antrum, the duodenum, the jejunum, and, possibly, the cardiac area. This condition was associated with portal hypertension as a result of nodular regenerative hyperplasia. Consecutive treatments including sucralfate, prostaglandin E2, propranolol, organic nitrates, pentoxyphilline, corticosteroids, endoscopic sclerotherapy, portosystemic shunt, total gastrectomy, proved ineffective.

Aged↗

PubMed1993

Comparative effects of erythropoietin with oral iron in peritoneal dialysis and hemodialysis patients.

The studies on the comparative efficacy of erythropoietin (rHuEPO) in chronic hemodialysis and peritoneal dialysis patients are scarce. We compared the use of rHuEPO in 74 stable patients on hemodialysis to 24 on chronic peritoneal dialysis. All patients were on oral iron supplement. In peritoneal dialysis patients hematocrit was 23.1% and 30.1%, rHuEPO dose 80.9 U/kg/week, while in hemodialysis patients hematocrit was 21.2% and 27.5%, and rHuEPO dose was 140.2 and 165.0 U/kg/week at commencement and after 6 months, respectively. Serum iron and transferrin saturation were unchanged in peritoneal dialysis patients, but decreased in hemodialysis patients with rHuEPO therapy. These findings suggest that rHuEPO is more effective in peritoneal dialysis patients than in hemodialysis patients receiving oral iron. The improved efficacy of rHuEPO in peritoneal dialysis may be due to decreased blood loss, subcutaneous administration, and/or better removal of inhibitors of erythropoiesis. Peritoneal dialysis may be more cost-effective and desirable than hemodialysis for rHuEPO-dependent or -resistant patients.

Administration, Oral↗

PubMed1993

[Posterior fundoplication of 270 degrees. pH results after one and 5 years].

This prospective study compared pre- and postoperative pH monitoring one and five years after a 270 degrees posterior fundoplication. Thirty-six consecutive patients with gastroesophageal reflux were included over a period of 3 years. All patients had preoperative esophagoscopy and 3 hour post-prandial pH monitoring. Thirty-three patients had esophagitis. At one year follow-up, pH monitoring was performed in 31 patients and esophagoscopy in 29. At five years, 23 patients accepted a new pH control. Appraisal of efficacy was assessed by Kaye's acid reflux score (normal < or = 90) and the percentage of time (t) below pH 5 (normal < or = 10%). Among the 23 patients who were submitted 3 times to pH monitoring, Kaye's acid reflux score evolved from 149 (+/- 68) before fundoplication to 1.1 (+/- 2) and 16 (+/- 29) after one and five years respectively. The value of t decreased from 20% (+/- 16) to 0.4% (+/- 0.8) after one year and to 2.5% (+/- 3) after five years. The 270 degrees posterior valve corrects pH recordings at one year. Its efficacy remained steady after 5 years, although there was a slight increase in acid reflux scores. The mean value of these scores was always within normal limits.

Adult↗

PubMed1993

Indications for right hemicolectomy in carcinoid tumors of the appendix. The French Associations for Surgical Research.

The records of 181 patients with carcinoid tumor of the appendix, seen during a ten year period (1977 to 1987), were analyzed retrospectively to determine the indications for right colectomy and the signification of intermediate histopathologic forms. Appendectomy was the only treatment in 146 patients; while right hemicolectomy was performed upon 35 patients--in seven patients with one postoperative death initially and in 28 patients without any death or morbidity, secondarily. Colectomy was indicated initially in seven patients for bulky tumors of the base of the appendix invading the cecum or for associated carcinoma of the right colon. The 28 secondary colectomies were indicated for tumors that were statistically larger and more invasive than those treated by simple appendectomy or for intermediate forms, or both, in five instances. There were five instances of residual tumor on secondary hemicolectomy specimens. In 11 of the 181 carcinoid tumors (6 percent), the intermediate type tumor was associated with mucinous production--seven adenocarcinoids and four carcinoids with mucocele. Of the seven instances of adenocarcinoid, there was one death at two years and one patient is alive with metastases. Other than size greater than 2 centimeters and base localization, the results of the current study suggest that the presence of mucinous production cells is a further indication for secondary right hemicolectomy.

Adolescent↗

PubMed1992

[Left pancreatectomy with preservation of the spleen without its pedicle. Apropos of 13 cases].

Overwhelming post splenectomy infections in childhood were first described by King and Shumaker in 1952. This septic risk, although a matter of controversy, also exists in adults. Thus, splenic conservation must become a surgical concern in left pancreas resections for benign or traumatic diseases. The authors report their experience with a simplified procedure in which the splenic pedicle is resected "en bloc" with the left pancreas. This technique has been employed in thirteen patients, in whom spleen could be preserved in twelve, without operative mortality and a low morbidity rate.

Adult↗

PubMed1992

[Evolution and treatment of 8 patients with Fournier's perineal-scrotal gangrene].

The authors present eight cases of Fournier's gangrene treated from 1987 to 1989 (3 years). There was no discernable cause for 5 patients (62.5%). Immediate aggressive surgical debridement of all necrotic tissue was performed. Intravenous antibiotics and resuscitation fluid and hyperbaric oxygenation were also administered to all patients. Skin grafting was performed for 4 patients (40%), 3 weeks after surgical debridement. One patient died (12.5%) and 2 subsequently developed an urethral stricture. Etiology, treatment and outcome of Fournier's gangrene are discussed and the results of the study are compared to other studies. This disease is still serious, its pathogenesis is not completely elucidated, but when immediate adequate treatment is performed, the outcome is generally favourable.

Acute Disease↗

PubMed1991

Prevention of gram-positive infections after bone marrow transplantation by systemic vancomycin: a prospective, randomized trial.

Gram-positive bacteria are the most commonly isolated organisms after bone marrow transplantation (BMT) and severe streptococcus septicemia has been reported. In order to evaluate the benefit of a gram-positive prophylaxis after BMT, we conducted a prospective, randomized trial of systemic vancomycin among 60 patients undergoing BMT for hematologic malignancies. Patients were randomized to receive (n = 30) or not receive (n = 30) prophylactic vancomycin 15 mg/kg every 12 hours from day -2 until resolution of neutropenia or until the first episode of fever. All patients were treated in laminar air-flow rooms, received sterile diet, total gut decontamination, and had central venous catheters placed surgically. Vancomycin was found to be highly effective in preventing gram-positive infections that occurred in 11 of 30 patients in the control group versus zero of 30 in the vancomycin group (P less than .002). All gram-positive infections occurring in the control group were symptomatic (nine septicemia and two local infections), and one patient with Streptococcus septicemia died with pneumonia. Thus, gram-positive prophylaxis was found to decrease infection morbidity after BMT. Moreover, the number of days with fever (P less than .001), and empiric antibiotic therapy (P less than .01) was reduced without added toxicity or cost. This study confirmed the high prevalence of gram-positive infections after BMT and emphasized the clinical benefits of an adapted prophylaxis.

Adolescent↗

PubMed1990

[Mesenterico-atrial shunt in Budd-Chiari syndrome with inferior vena cava thrombosis. Report of 2 cases].

Two new cases of Budd-Chiari syndrome associated with thrombosis of the inferior vena cava are reported. The predominant clinical sign was ascites, and the diagnosis was suggested by ultrasound and confirmed by angiography and the imaging techniques. In one case, the etiological assessment revealed an association with an oral contraceptive treatment; the etiological research remained negative in the other case. A mesenterico-atrial shunt was performed in both patients, and its patency was controlled with magnetic resonance imaging: both shunts are functional after 38 and 45 months respectively. On the basis of these two cases, the diagnostic process, the surgical indications and the choice of the techniques are discussed. The mesenterico-atrial shunt described by Cameron and Maddrey in 1978 seems to be an interesting and reliable therapeutic choice for the Budd-Chiari syndrome with thrombosis of the inferior vena cava.

Adult↗

PubMed1989

Kinetics of phagocytosis in trabecular meshwork cells. Flow cytometry and morphometry.

Confluent human trabecular meshwork (HTM) cells from three different donors and at various stages of serial passage were fed fluorescein-labeled polystyrene beads. Phagocytosis was monitored for up to 6 days using flow cytometry, fluorescence microscopy, and morphometric calculations from comprehensive electron microscopic observations at key time points. During the first 4 hr after initiation of phagocytosis, the confluent endothelial monolayer lost its cohesiveness and became segregated into separate cells. During the first 3 days the cells underwent marked and progressive changes in shape and size. After 4 days, some cells detached from the dish, as necrotic debris and degenerative changes appeared. The kinetics of phagocytosis in this stable, confluent monolayer showed that recruitment (the percentage of cells which had ingested at least one bead) proceeded semilogarithmically, with 50% of the cells recruited by 8 hr and 97% by 96 hr. The time course of phagocytosis (ie, the average number of beads phagocytosed per cell) is described by a sigmoidlike curve, reaching half-maximum at 40 hr and maximum (about 500 beads per cell) at 96 hr. The rate of uptake (ie, the first derivative of the average number of beads per cell) reached a peak (nine beads per cell per hr) at 24 hr and then decelerated slowly over the next 5 days. Cytochalasin B treatment, as a control, reduced phagocytosis by approximately 70%. Flow cytometry, when combined with electron microscopy, should provide a useful tool to examine phagocytosis in HTM cells exposed to steroids and other hormones and drugs.

Adult↗