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Biomedical subjects

I Shulman

Publications and source records attributed to I Shulman.

17 recordsLinked to original sources
PubMed1996

Electronic claims.

Explore the source record for details and available documents.

Electronic Data Processing↗
PubMed1993

Impact of autologous blood transfusions on patients undergoing radical prostatectomy using hypotensive anesthesia.

We report on a retrospective study consisting of 71 consecutive patients who underwent radical retropublic prostatectomy under controlled hypotensive anesthesia, examining the impact of a preoperative autologous blood collection program on perioperative blood requirements. The population consisted of 34 patients who elected not to use autologous blood (group 1) and 37 patients who underwent radical prostatectomy after storing 1 to 3 units of their own blood (group 2). Median operative time and estimated blood loss were not statistically different. In group 1, 20 homologous blood units were used by 7 patients (21%). In group 2, 37 of 41 units transfused were autologous units and only 3 patients (8%) received homologous blood. However, for every unit of autologous blood deposited preoperatively there was a corresponding decrease in admission blood concentrations and 21 of 37 patients were anemic at hospitalization. In addition, the study suggests that in many patients the anemia produced by preoperative phlebotomy does not resolve preoperatively. In response, the effectiveness of preoperative autologous blood collection is decreased by this preoperative anemia. Although inefficient, we nevertheless conclude that an autologous blood collection program decreases homologous transfusion exposure and efforts should be directed to increase the erythropoietin response to the anemia produced by preoperative phlebotomy. Presently, it is an expensive program that offers only a modest benefit for patients undergoing radical retropubic prostatectomy.

Adenocarcinoma↗
PubMed1991

Sex steroids at birth: genetic and environmental variation and covariation.

Three sex-steroids (estradiol, progesterone, & testosterone) were assayed from the umbilical cord blood of 58 same-sex twin pairs in an investigation of the effects of sex, as well as genetic and environmental factors, on neonatal hormone levels. Although significant mean differences were found between boys and girls for both testosterone and progesterone, sex appeared to account for very little of the total variation for any of the hormones. Results showed that genetic influences significantly affected within-sex variation in both estradiol and progesterone levels, while variations in the intrauterine (shared twin) environment accounted primarily for differences in levels of testosterone. Moderate correlations were also found among the three hormones. Multivariate biometrical analyses revealed these relationships to be explained by an underlying general factor of nonshared environmental influences affecting all three hormones. Genetic factors appeared to be specific to each hormone rather than correlated across hormones. These results suggest not only that genes are operating at this early age, but also that maternal and other prenatal factors (e.g., placental effects, uterine position) have a significant role in variations of sex-steroids and possibly on later behaviors.

Animals↗
PubMed1991

Chronic pain in panic disorder.

Studies indicate that panic disorder is often associated with high levels of somatic preoccupation, but the nature of these somatic complaints have not been investigated in detail. One hundred and forty-one consecutive panic disorder patients were administered a pain questionnaire and pain location diagram. Almost 40% of the patients reported chronic pain and 7.8% reported using analgesics daily. The most common locations of pain were the head, shoulders, and lower back. When compared with panic disorder patients with no reports of pain, these patients scored significantly higher on several measures of psychopathology. Panic patients with chronic pain may have more functional illness behaviors that require specific treatment considerations and may represent a subset of panic disorder that is particularly at risk for somatization, hypochondriasis, and excessive health care utilization.

Adult↗
PubMed1988

Immunochemical specificity of autoanti-Gerbich from two patients with autoimmune haemolytic anaemia and concomitant alteration in the red cell membrane sialoglycoprotein beta.

Blood samples from two patients with autoimmune haemolytic anaemia, whose autoantibodies failed to agglutinate certain examples of red cells that lack Gerbich blood group antigens, were studied using immunochemical analyses. One of these autoantibodies differed from all other anti-Ge in that it showed a unique beta sialoglycoprotein (SGP) specificity. It reacted with normal beta but not with the abnormal beta-related SGPs associated with Gerbich-negative red cells of the Gerbich and Yus types. Red cells from this patient had an alteration of beta SGP, while the alpha, gamma and delta SGPs appeared to be normal. The autoantibody from the other patient did not show this unique characteristic. Its immunochemical specificity was similar to alloanti-Ge3 in that it reacted with both beta and gamma SGPs from normal red cell membranes and with the abnormal beta-related SGPs found in red cell membranes from individuals with Gerbich-negative red cells of the Yus type. Red cells from this patient could not be analysed because she had recently received a massive transfusion of red cells.

Adolescent↗
PubMed1988

High-titer, high-thermal-amplitude cold autoagglutinin not associated with hemolytic anemia.

An example of an unusual cold autoagglutinin is reported. The antibody was monoclonal IgMKappa able to fix complement, and, in the presence of albumin, had both a high titer (greater than 4,096 at 4 degrees C) and a wide thermal range (4-37 degrees C). The patient was closely followed over a 3-year period with no evidence of hemolysis ever documented, despite a persistently positive direct antiglobulin test and the presence of the cold autoagglutinin. In contrast to previous reports regarding cold-agglutinin disease, this case demonstrates that in vivo hemolysis is not always associated with cold autoagglutinins that in vitro show a high thermal range in the presence of albumin.

Agglutinins↗
PubMed1988

Protein A immunoadsorption therapy in HIV-related immune thrombocytopenia: a preliminary report.

Nine homosexual patients with immune thrombocytopenia were treated with autologous plasma that had been perfused over silica-immobilized Staphylococcus aureus protein A (SpA). Pretreatment platelet counts ranged from 10,000 to 98,000 cells/mm3 (mean: 54,000 cells/mm3). Six patients responded to therapy. Platelets increased by a mean of 95,000 cells/mm3 (p less than 0.007) and reached normal levels (greater than 150,000 cells/mm3) in four patients. Increased platelet counts are presently sustained in these four individuals after 5 months of follow-up. Increases in platelet counts significantly correlated with decreases in platelet-associated IgG (PAIgG), platelet-directed IgG (PDIgG), and immune complexes (CIC). PAIgG and PDIgG declined by a mean of 67% (p less than 0.003) and 58% (p less than 0.007), respectively. CIC decreased by a mean of 37% (p = 0.02). Complement was concomitantly activated in all four examined patients. C3a and C5a increased 23-fold and 2.6-fold, respectively, while total hemolytic complement decreased by 50%. Activated complement components and removal of CIC and IgG thus may contribute to the platelet-enhancing activity of SpA immunoadsorption therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Production of a positive direct antiglobulin test due to suramin.

Drugs and chemicals containing multiple reactive carbonyl groups have been postulated to produce nonimmunologic positive direct antiglobulin tests (DATs) both in vitro and in vivo. Suramin sodium, a reverse transcriptase inhibitor that was under investigation as a potential treatment for human immunodeficiency virus infection, has six reactive carbonyl groups. Because of suramin's chemical structure, it was hypothesized that the drug might cause a positive DAT in vitro and possibly in vivo. Suramin was found to produce a positive DAT in vitro at concentrations of 2100 mg/L or greater but did not cause a positive DAT in five patients with acquired immunodeficiency syndrome who were treated with suramin, probably because the serum levels of suramin were too low in these patients (peak therapeutic blood levels ranged from 171 to 443 mg/L).

Acquired Immunodeficiency Syndrome↗
PubMed1986

An explanation for nonimmunologic adsorption of proteins onto red blood cells: Schiff's base reactions.

During a phase I evaluation of diglycoaldehyde (INOX), an intravenous chemotherapeutic agent used to treat children with malignancies, all of eight patients tested developed a positive direct antiglobulin test (DAT) in vivo. The DAT became positive within one to seven days after the first administration of the drug and remained positive for up to 12 days following the last dose. The indirect antiglobulin tests were negative. None of the patients showed clinical or laboratory evidence of hemolysis at the time the DAT became positive or during follow-up. Eluates made from the red cells of two of the eight patients were both negative by indirect antihuman globulin testing. In vitro studies with INOX and glutaraldehyde, both dialdehyde compounds, showed nonimmunologic adsorption of protein onto red cells, probably by the condensation of aldehyde groups of these compounds to form Schiff's bases with amino acids of serum proteins and red cell membrane proteins. This reaction provides an explanation for the globulin detected on the red cells of patients treated with INOX.

Adolescent↗
PubMed1985

Staphylococcal Protein A column: correlation of mitogenicity of perfused plasma with clinical response.

Eleven patients with advanced breast cancer and four with astrocytoma were treated with plasma perfused over columns containing staphylococcal Protein A (SPA). Doses of 5 to 20 mg of SPA were bound to collodion charcoal particles, and this treatment resulted in partial remissions in one patient with astrocytoma and in two patients with breast cancer. Remission duration was 6 wk to 6 mo. Resolution of lymphadenopathy and a decrease in carcinoembryonic antigen were noted in an additional two breast cancer patients. Systemic reactions to infused plasma consisted of fever, chills, and rigors. In brain cancer patients, increased intracranial pressure was also noted. A mitogenic substance was generated in plasma of 11 patients after it was perfused over the SPA charcoal matrix. The mitogenic material induced lymphoproliferation comparable to concanavalin A and required the presence of SPA on the collodion charcoal but was not due to leakage of SPA from the column during plasma perfusion. Of considerable significance was that only patients whose column perfused plasma contained this mitogenic activity exhibited systemic reactions, and five of these patients obtained antitumor responses. This striking correlation implies that the mitogenic factor is an active component of SPA therapy. The ability to demonstrate mitogenicity in column perfused plasma might also be useful for selecting patients amenable to SPA therapy. These findings attest to the therapeutic value of this mode of treatment and provide an initial definition of a mediator of SPA antitumor activity.

Adult↗
PubMed1981

Demyelination with hemophagocytic lymphohistiocytosis of the CNS.

A case of hemophagocytic lymphohistiocytosis with central nervous system involvement in an infant is presented. Marked demyelination of cerebral and cerebellar white matter is associated with an intense histiocytic infiltrations and astrogliosis. Histiocytes phagocytic of erythrocytes and lymphocytes are noted in a meningeal, subependymal, and perivascular distribution. Severe depletion of lymphoid tissue, associated with histiocytic infiltration, is also seen in multiple organs. While the etiology of this disease is unknown, alterations in the immune response and possible viral relationships are explored.

Brain↗
PubMedDate not supplied

Renal cell carcinoma presenting as a skeletal muscle mass: a case report.

A 62-year-old man presented with a 17-month history of a slowly enlarging biceps muscle mass. A diagnosis of metastatic renal cell carcinoma was made in the outpatient department using a soft tissue biopsy needle. Despite the rarity of muscular metastases in renal cell carcinoma, early definitive diagnosis of soft tissue masses is recommended.

Adenocarcinoma↗