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Biomedical subjects

H M Clink

Publications and source records attributed to H M Clink.

At least 19 recordsLinked to original sources
PubMed1994

Myelopathy after intrathecal chemotherapy. A case report with unique magnetic resonance imaging changes.

BACKGROUND: Paraplegia caused by intrathecal chemotherapy has no known pathognomonic features and is a diagnosis of exclusion. METHODS: The authors reported the clinical and neuroimaging findings in one patient with this syndrome. RESULTS: The patient had severe paraplegia with urinary retention and impaired pain and touch sensation below T-10 with sparing of proprioception and vibration sense. Magnetic resonance imaging (MRI) scan showed diminished intensity throughout the central cervical spinal cord. Post-gadopentetate dimeglumine enhancement was scattered throughout the cervical spinal cord and in two areas of the dorsal spinal cord. Axial views of the cervical spinal cord showed that this enhancement was limited to the lateral columns. CONCLUSIONS: The MRI in myelopathy due to intrathecal chemotherapy may show a unique pattern of postgadopentetate dimeglumine enhancement limited to the lateral columns of the spinal cord. However, two recently encountered patients with the same syndrome did not show similar changes.

Adolescent↗
PubMed1992

Double-blind randomized study of the effect of infusion rates on toxicity of amphotericin B.

Results of a double-blind randomized non-crossover study of rapid (45 min) versus slow (4 h) infusion of amphotericin B administered to 20 patients with proven or suspected fungal infection are reported. Toxicity was higher in the rapid infusion group than it was in the slow infusion group (mean total 7-day chill score, 173 +/- 276 versus 20 +/- 30 [P less than 0.01]; mean total 7-day dosage of meperidine required to abate rigors, 180 +/- 133 versus 58 +/- 78 mg [P less than 0.05]; and mean maximum total 7-day pulse rise, 225 +/- 64 versus 135 +/- 56 beats per min [P less than 0.02], respectively). When analyzed on a daily basis, the mean chill score, meperidine dosage, and pulse rise were also higher; and in addition, nausea and vomiting (5 of 11 patients who received a rapid infusion versus 0 of 9 patients who received a slow infusion [P less than 0.01]) appeared to be more common in those who received amphotericin B rapidly. The daily analysis approach proved that tolerance to these side effects developed with each subsequent infusion day, and by day 7 the incidence and severity were the same. This development of tolerance was significant for the mean chill score in the rapid infusion group (P less than 0.05) and for the proportion of patients with chills (P less than 0.005 for the slow infusion group; P less than 0.05 for the rapid infusion group). A decrease in creatinine clearance to greater than 51% of the baseline value was seen in two patients in each group. There were five deaths (four in the rapid infusion group, 1 in the slow infusion group) within 1 month, but none was clearly related to the amphotericin B infusion. The mean time to defervescence was similar for each group (10.8 +/- 4.1 days in the slow infusion group versus 9.9 +/- 5 days in the rapid infusion group). A rapid infusion regimen for amphotericin B cannot be recommended, at least during the first 5 to 7 days of treatment.

Adolescent↗
PubMed1983

Detection of micrometastases in patients with primary breast cancer.

An immunocytochemical method was used to screen smears obtained at primary surgery from multiple bone-marrow sites in 110 patients with breast cancer; at this time other techniques did not reveal metastases. Tumour cells were detected in the bone-marrow of 31 (28%) patients. The number of cells detected ranged from 1 to greater than 500; none was detected in conventionally stained smears. Patients in whom conventional criteria indicated a very poor prognosis seemed more likely to have such micrometastases. A further follow-up period is required to determine whether patients with micrometastases relapse earlier than those in whom no tumour cells are demonstrable.

Adult↗
PubMed1983

Mismatched family donors for bone-marrow transplantation as treatment for acute leukaemia.

35 patients were treated for acute myeloid leukaemia or acute lymphoblastic leukaemia with allogeneic bone-marrow grafts from a parent, child, or sibling who was mismatched at the major histocompatibility complex (MHC). 11 of these patients are alive at least 6 months after grafting, 5 of them after more than 2 years. Of the 15 patients aged under 20 at the time of the graft, 8 are alive and well 6 months to 3 years later. Cyclosporin A was given to all patients after grafting. 1 patient died of acute graft-versus-host disease and in 2 other cases this was a major factor in their death. Graft failure caused the death of 2 patients. 4 patients died of recurrent leukaemia. A fatal complication in 12 patients was pulmonary oedema, often associated with convulsions, intravascular haemolysis, and renal failure. Some of these patients had viral or bacterial infections, but in the majority the syndrome was not associated with demonstrable infection. This syndrome, in which the essential lesion appears to be vascular, was much more common in recipients of mismatched than matched grafts. 3 others died from lung disease in which infection was a factor.

Acute Disease↗
PubMed1983

Mianserin and blood dyscrasias.

1 The haematological side-effects of mianserin have been studied. 2 There are 26 reported cases, of which 19 appear to show a definite association with the drug. A high proportion are female. 3 A reversible agranulocytosis has been most commonly observed, occurring between four and six weeks of treatment. On cessation of therapy, the counts have recovered. 4 Three patients have died, following a longer course of treatment. Two of these were septicaemic and the third, thrombocytopenic in addition. This is probably related to a failure of marrow recovery owing to the longer exposure, in the third case progressing to aplasia. 5 The number of reported dyscrasias is extremely small compared with the number of courses of mianserin prescribed. 6 It is desirable that a blood examination should be made at four weeks after starting treatment with mianserin to identify those patients at risk.

Adult↗
PubMed1982

Ratio of blood and marrow-derived cells in bone marrow transplantation.

The content of the cell suspensions used in bone marrow transplantation can vary by at least twelvefold in the ratio of bone marrow-derived to blood-derived cells. The ratio is somewhat higher in young donors but is similar for male and female donors and is not closely correlated with the incidence of graft v host reactions.

Adolescent↗
PubMed1981

Acute myeloid leukaemia: comparison of support required during initial induction of remission and marrow transplantation in first remission.

Two groups of patients with acute myeloid leukaemia (AML), treated concurrently, were compared to assess the support required during bone-marrow hypoplasia. One group of patients received drugs to induce initial remission; patients in the other group (in first remission) each received a bone-marrow transplant from a matched allogeneic sib. The patients who received marrow transplants required less time in hospital, were febrile on fewer days, received less therapeutic antibiotic treatment, and had fewer bacterial infections. They also required half as many units of platelets and blood per 100 days. The mean weight-loss per patient was the same in each group, and no patient required intravenous feeding. Transplantation for AML in first remission requires less supportive care than initial remission induction.

Adolescent↗
PubMed1981

Increased detection of mammary carcinoma cells in marrow smears using antisera to epithelial membrane antigen.

We have developed a technique for the immunocytochemical staining of marrow smears using antiserum to epithelial membrane antigen (EMA). This membrane component is confined to, but widely distributed in, epithelial tissues and tumours derived from them, and is strongly expressed by infiltrating breast carcinoma cells. Marrow aspirates from patients with both early and metastatic breast cancer have been examined, and the results of immunocytochemical staining compared with conventional cytology and histology. Staining with antiserum to EMA enabled us to detect small numbers of carcinoma cells, and increased the yield of positive samples. Furthermore, using this technique, we found malignant cells in the marrow of patients with primary breast cancer with no other evidence of metastatic disease. Thus immunocytochemical staining for EMA may be of value in the detection of micrometastases in patients with primary breast carcinoma.

Antigens, Surface↗
PubMed1980

The place of bone-marrow transplantation in acute myelogenous leukaemia.

28 patients with acute myeloid leukaemia (AML) in first remission were maintained on chemotherapy, consisting of courses of cytosine arabinoside and daunorubicin, and immunotherapy with irradiated AML cells and BCG. The relapse rate and survival rate of these patients were compared with those of a simultaneously treated group of 22 patients in first remission who received sibling bone-marrow transplants after cyclophosphamide (60 mg/kg) given for 2 days and followed by a single dose of 1000 rads total body irradiation. Substantially fewer transplanted patients (4 out of 22) than chemo-immunotherapy patients (19 out of 28) relapsed (p less than 0.005) and 14 (64%) transplanted patients remain alive, well, and disease-free. Survival curves of the two groups of patients show that the transplanted patients never fared worse than the chemo-immunotherapy patients. We suggest that when possible young AML patients in remission should be offered transplantation as an alternative form of treatment.

Adolescent↗
PubMed1980

Cyclosporin A to prevent graft-versus-host disease in man after allogeneic bone-marrow transplantation.

Cyclosporin A has been used in conjunction with allogeneic bone-marrow transplantation in the treatment of 23 patients--21 with acute leukaemia, 1 with chronic granulocytic leukaemia, and 1 with aplastic anaemia. The drug was given twice daily from the day before transplant. At the start of the study cyclosporin prophylaxis was stopped in 3 patients within 44 days of transplantation because of non-specific rashes and/or deteriorating renal function. All 3 patients had acute graft-versus-host disease (GVHD) and died. Thereafter the drug was not stopped because of possible toxic manifestations, and 20 patients have been studied (median follow-up 7 months; maximum 13 months). 2 patients have acquired GVHD; 1 patient died of acute GVHD and 1 has chronic mild disease. 3 other patients have died, 2 of recurrent leukaemia and a third of staphylococcal pneumonia with renal failure. Of the remaining patients, 1 has recurrent leukaemia and 1 has moderately severe renal failure. Several toxic effects of cyclosporin A have been observed but they are mostly reversible and no second malignant neoplasm has developed.

Adolescent↗
PubMed1980

Cytogenetic follow-up study of acute non-lymphocytic leukaemia.

A cytogenetic study was made at diagnosis in 68 patients with acute non-lymphocytic leukaemia. The median survival time of the group of patients was 47 weeks. Patients with totally abnormal karyotypes in the bone marrow had a median survival of 14 weeks, whereas for those with only chromosomally normal cells the median survival was 52 weeks, and 47 weeks for those with normal and abnormal cells. Survival was not influenced by the presence or absence of clonal abnormalities. A cytogenetic follow-up study was made on 41 of these patients. One of the three patients, still in first remission after 3 years, originally had an 8;21 translocation. In general, the abnormalities present at diagnosis disappeared during remission and there was no evidence that clones of abnormal cells were produced by treatment. The chromosomal findings in relapse were not necessarily the same as those seen at diagnosis and the abnormal karyotypes found were usually not clonal in type. A simple kinetic technique, in which the yield of mitoses after 2 and 24 h is compared, may be used as an adjunct to cytogenetic studies in predicting relapse.

Adolescent↗
PubMed1979

Parenteral acyclovir therapy for herpesvirus infections in man.

Acyclovir is a new antiviral agent which is highly active against herpesviruses in vitro and in laboratory animals. Twenty-three cancer patients with cutaneous and/or systemic herpes zoster or herpes simplex infections were treated with parenteral acyclovir. All had received previous specific treatment for their malignant disease and ten had undergone bone-marrow transplantation. The drug seemed to arrest the progress of the infections and was most effective when given early. Although two patients showed transient increases in blood-urea, possibly the result of acyclovir, the drug was remarkably non-toxic in the doses used.

Adolescent↗