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Biomedical subjects

J M Rowe

Publications and source records attributed to J M Rowe.

At least 127 records · Page 7Linked to original sources
PubMed1991

Intravenous gammaglobulin treatment for immune thrombocytopenia associated with infectious mononucleosis.

Severe thrombocytopenia is an uncommon (incidence less than 1%) but serious complication of infectious mononucleosis. Corticosteroids have been used for therapy with variable responses reported. Five consecutive patients with infectious mononucleosis-related severe thrombocytopenia were treated with intravenous gammaglobulin (IVIG) at a dose of 400 mg/kg/day for 2-5 days. All patients appear to have had an immunologic or consumptive etiology for their thrombocytopenia as determined by increased marrow megakaryocytes. All patients were initially treated with oral prednisone 1 mg/kg/day. Due to the relatively slow response to prednisone (platelet count less than 20,000/microliters on the 8th to 13th hospital day) or increased bleeding symptoms, IVIG was initiated. Four of the five patients rapidly developed significant increases in their platelet counts (range 44,000/microliters to 97,000/microliters). Two of these responses were sustained and two relapses occurred (while on continued steroid therapy) which again responded to booster doses of IVIG at similar doses. IVIG has been previously shown to be effective in treating patients with idiopathic thrombocytopenia purpura. Historically, patients with infectious mononucleosis-related severe thrombocytopenia often are refractory to corticosteroid therapy and our limited experience suggests that IVIG may also be effective in infectious mononucleosis-related severe thrombocytopenia.

Adolescent↗
PubMed1991

Treatment of advanced refractory lymphomas with a combination of carmustine, bleomycin, teniposide, dexamethasone, and cisplatin (the BBVDD regimen). An ECOG pilot study.

Forty-four patients with relapsed, refractory malignant lymphomas (12 Hodgkin's disease, 32 non-Hodgkin's lymphoma) were treated with a combination of carmustine, bleomycin, teniposide, dexamethasone, and cisplatin (BBVDD regimen). Patients had failed at least one, and frequently two, chemotherapy regimens before admission to the study. Of the patients with Hodgkin's disease, 2 (17%) achieved complete response (CR), and 3 (25%) attained a partial response (PR) for an overall response rate (CR + PR) of 42%. Among the patients with non-Hodgkin's lymphoma there were 6 CR (19%) and 12 PR (37%), for an overall response rate of 56%. Median durations of response ranged from 2.5 months for nodular non-Hodgkin's lymphoma in PR to 28.5 + months for Hodgkin's disease in CR. In these heavily pretreated patients, the incidence of toxic effects was grade 3 (48%), grade 4 (23%), grade 5 (2%). The one death (grade 5 toxicity) was attributed to pulmonary impairment due to bleomycin. BBVDD is a moderately effective regimen for the palliation of patients with refractory lymphomas and merits further study.

Ambulatory Care↗
PubMed1991

Orthotopic liver transplantation for life-threatening veno-occlusive disease of the liver after allogeneic bone marrow transplant.

Veno-occlusive disease (VOD) of the liver is a serious and often lethal sequela to bone marrow transplantation. Although a history of prior hepatitis moderately increases the risk of VOD, reliable screening methods for identifying high risk patients are not available. New approaches to managing patients who develop serious VOD are needed. One approach may be the use of orthotopic liver transplantation in selected patients who are likely to die of the disease. In this report we describe a patient who underwent liver transplantation for life-threatening VOD following allogeneic transplantation for CML. Although this patient died early from interstitial pneumonitis, the orthotopic liver functioned well up to her death. Other reports describing successful liver transplants in patients with advanced VOD or graft-versus-host disease of the liver are discussed and the possible indications for liver transplantation for VOD after marrow transplantation are considered. Taken together, these reports suggest that orthotopic liver transplantation may be a feasible and potentially effective approach to managing select patients with life-threatening liver dysfunction after marrow transplantation.

Adult↗
PubMed1991

Cardiac arrest after autologous marrow infusion.

A 27-year-old woman undergoing autologous bone marrow transplantation for relapsed, refractory Hodgkin's disease developed acute non-cardiogenic pulmonary edema immediately after transfusion of autologous bone marrow. A few similar cases in the literature are identified. Although the precise mechanisms for these rare reactions are not clear, several possibilities including anaphylaxis due to dimethylsulfoxide, leukoagglutination, complement activation, and transient left ventricular dysfunction are proposed and discussed. Features which might allow patients at risk for similar events to be identified include the presence of active pulmonary tumor, and a history of dyspnea and pulmonary infiltrates following transfusion of homologous blood products.

Adult↗
PubMed1989

Renal loss following extracorporeal shock wave lithotripsy.

A patient with life-threatening retroperitoneal hemorrhage after extracorporeal shock wave lithotripsy is presented. Despite angioinfarction of the involved renal unit, nephrectomy ultimately was required to control bleeding. The urological and hematological aspects of the management are discussed.

Aged↗
PubMed1989

Studies on sound and carious enamel with the quantitative acoustic microscope.

The scanning acoustic microscope gives strong contrast from small caries lesions in sections of human enamel. The uniqueness of the acoustic microscope lies in its ability to image elastic properties. In addition to revealing the extent and the shape of lesions, the microscope may also be used to measure the elastic properties point by point across an area of interest. Since enamel is anisotropic, measurements of the Rayleigh velocity and attenuation were made as a function of direction on a section of sound enamel. The velocity was greatest parallel to the prism axis, and the attenuation was least in this direction. Measurements of V(z) across a section through a lesion are presented. The variation of attenuation can be interpreted in terms of the development of demineralization, initially along prism boundaries and then along cross-striations. The variation of velocity indicates a substantial reduction of elastic stiffness in the lesion.

Dental Caries↗
PubMed1988

Prolonged remission after life-threatening gastrointestinal hemorrhage from coexistent angiodysplasia and acquired bleeding diathesis.

A patient with angiodysplasia of the stomach and duodenum developed exceptionally severe and protracted gastrointestinal hemorrhage. Bleeding was intensified by a coexistent acquired hemostatic disorder characterized by decreased platelet aggregation with adenosine diphosphate, collagen, epinephrine and ristocetin, and a decrease in both plasma ristocetin cofactor activity and high-molecular-weight von Willebrand factor multimers. Cryoprecipitate infusion corrected the von Willebrand factor defect but did not improve platelet aggregation. Bleeding stopped after prolonged aggressive combined medical and surgical therapy, and the patient had no recurrence of bleeding while followed for 27 months. Hemorrhage from the vascular lesions themselves dominated the clinical picture of this patient and other reported patients with coexistent angiodysplasia and congenital or acquired hemostatic abnormalities.

Aged↗
PubMed1988

Effect of hydrocortisone and interleukins 1 and 2 on eosinophil progenitors in hypereosinophilic states.

The growth of eosinophil progenitors (CFU-Eo) and its modulation by hydrocortisone (HC), mononuclear cells, interleukin 1 (IL-1), and interleukin 2 (IL-2) in three cases of eosinophilia are reported in this paper. One microM HC decreased the proportion of CFU-Eo in each of these three patients, and in each case, the addition of autologous mononuclear cells at a 1:1 ratio abrogated the effect of HC on CFU-Eo. As studied in two of the three cases, IL-1 and IL-2 were able to prevent the effect of HC. Further studies showed no effect of HC when monocyte T cell-depleted marrow cells were used as the target population. These results suggest that CFU-Eo production in eosinophilic states is subject to modulation by HC and T lymphocytes.

Adult↗
PubMed1988

A translocation t(9;11)(p11;q23) in T-cell acute lymphoblastic leukemia (FAB-l2).

We here report a t(9;11)(p11;q23) as the only abnormality in the affected cells of a 20-year-old male with acute lymphoblastic leukemia (L2) of T-cell origin. One hundred six patients with acute leukemia and involvement of band 11q23 were reviewed. Young age, hyperleukocytosis, and poor prognosis characterized almost all the cases in the acute leukemias with the 11q23 translocation, despite involvement of different recipient chromosomes and different morphologic and immunologic phenotypes.

Adult↗
PubMed1988

Aclacinomycin A and etoposide (VP-16-213): an effective regimen in previously treated patients with refractory acute myelogenous leukemia.

Thirty-five patients with acute myelogenous leukemia were treated with aclacinomycin A (60 mg/m2/day for 5 days) and VP-16-213 (100 mg/m2/day for 5 days). All were previously treated and had relapsed or were refractory to primary treatment. Most patients (28) had received prior DAT (daunorubicin, cytosine arabinoside, and 6-thioguanine) induction therapy followed by one or more courses of high-dose cytosine arabinoside (HD-Ara C) as consolidation therapy or as treatment for relapse. One patient was in her fourth relapse, one had relapsed acute megakaryoblastic leukemia (following remission with DAT and HD-Ara-C), one had a treatment-induced leukemia, and four patients were treated for primary treatment failures following two induction courses with DAT or a similar regimen. Fourteen patients had infections at start of therapy. Ten patients died within 14 days of treatment, all from sepsis or bleeding, before their marrow could be evaluated for leukemic response. Fourteen patients (40%) responded; 12 (34%) entered complete remission and two (6%) a partial remission (PR). Two of the four patients who were treated for primary treatment failures went into CR. The median CR duration was 99 days (range 30 to 455 days). Side effects from this treatment were similar to the conventional DAT regimen, although the gastrointestinal toxicity and mucositis appeared to be more severe. In addition, two of the patients had severe but reversible ventricular arrhythmias. The overall response (40%) and CR rate (34%) in this group of previously treated AML patients is encouraging, and further studies are needed to evaluate these preliminary findings.

Aclarubicin↗
PubMed1987

Spontaneous hemoperitoneum in two patients with myeloproliferative disorders.

Spontaneous hemoperitoneum developed in two patients with hitherto undiagnosed myeloproliferative disorders. No other known etiology could be attributed to the two patients described. The report of these two patients suggests that the diagnosis of a myeloproliferative disorder should be considered in the evaluation of patients with spontaneous hemoperitoneum.

Aged↗