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Biomedical subjects

M Auerbach

Publications and source records attributed to M Auerbach.

At least 19 recordsLinked to original sources
PubMed2001

Absence of neuropsychologic deficits in patients receiving long-term treatment with alprazolam-XR for panic disorder.

Studies to date on the effects of benzodiazepines on neuropsychologic function have yielded conflicting data with respect to the type, severity, and duration of deficits that may be induced by these agents. As part of a placebo-controlled trial of alprazolam-XR (extended release) administered in combination with cognitive-behavioral therapy in patients with panic disorder, a battery of tests was used to measure neuropsychologic function. Thirty-eight outpatients were randomly assigned to receive either alprazolam-XR or placebo. Dosages were titrated up so that the alprazolam group (N = 18) received a mean dose of 4 mg/day (reduced in two patients because of sedative side effects). Neuropsychologic function after 6 weeks of therapy at the target dosage was compared with baseline assessments in each group. Both groups showed a statistically significant improvement from baseline to repeated assessments on measures of attention, executive functioning, psychomotor speed, and visual memory (p < 0.001); these gains were attributed to a practice effect. No significant changes were noted in measures of learning, verbal memory, or reaction time, and neither group showed any deterioration from baseline to retesting in any aspect of neuropsychologic function. These findings call into question the assumption that long-term benzodiazepine therapy produces significant neuropsychologic deficit in patients with diagnosed anxiety disorders.

Adult↗
PubMed2001

A pilot program of improved methods for community-based screening for dementia.

The authors examined the effectiveness of a voluntary memory impairment-screening program for community-dwelling older persons, assessing three factors: appropriateness of screening instrument, reliability of complaints of cognitive difficulties, and adherence to screening recommendations. Two cognitive screening instruments, the Mini-Mental State Exam (MMSE) and the Seven-Minute Screen (7MS) were compared in 59 participants. Twenty-nine percent showed signs of impairment on the 7MS. Results suggested that the 7MS and the MMSE may have different sensitivities and specificities for the detection of early dementia. Failure on the 7MS was not predicted by cognitive or functional complaints. The study identified and addressed factors affecting compliance with screening recommendations.

Aged↗
PubMed1998

Value of methylprednisolone in prevention of the arthralgia-myalgia syndrome associated with the total dose infusion of iron dextran: a double blind randomized trial.

The safety and efficacy of total dose infusion (TDI) of iron dextran has been well documented. In 40% of treated patients, an arthralgia-myalgia syndrome develops. The purpose of this randomized, double-blind, prospective study was to investigate whether intravenous (i.v.) administration of methylprednisolone (MP) prevents this complication. Sixty-five patients, 34 women and 31 men, ages 36 to 80 years, received either normal saline before and after TDI (group 1), 125 mg i.v. MP before and saline after TDI (group 2), or 125 mg i.v. MP before and after TDI (group 3). Patients were observed for 72 hours and reactions were recorded and graded according to severity. Fifty-eight percent of group 1 patients, 33% of group 2, and 26% of group 3 had reactions to TDI. The severity of reactions (minimal, mild, and moderate, respectively) was as follows: group 1--6, 6, and 2; group 2--1, 5, and 0; group 3--5, 1, and 0. Data were analyzed by the two-sided Fisher's exact test using 95% confidence intervals with the approximation of Woolf. These data demonstrate that administration of MP before and after TDI reduces the frequency and severity of the arthralgia-myalgia syndrome. We conclude that 125 mg i.v. MP should be given routinely before and after TDI of iron dextran.

Adult↗
PubMed1998

A neuropsychological study of panic disorder: negative findings.

BACKGROUND: Gray (1982) proposed that the septo-hippocampal system, which plays an important role in learning and memory, may partially mediate anxiety. Thus, patients with anxiety disorders may manifest neurocognitive performance deficits. We hypothesized that patients with panic disorder would demonstrate learning and memory deficits relative to normal comparison subjects. METHOD: Comprehensive neuropsychological batteries were administered to 69 panic disorder subjects and 19 normal volunteers. RESULTS: There were no significant group differences in any neuropsychological performance domain including learning, memory, attention, visuospatial functioning, and psychomotor speed. Multiple regression conducted to evaluate the contribution of clinical symptoms to neuropsychological impairment within the panic disorder sample revealed that anxiety severity did not affect neuropsychological test performance. LIMITATIONS: Most patients had mild or moderate, rather than severe, panic disorder. CONCLUSION: Neuropsychological dysfunction was not associated with panic disorder.

Adolescent↗
PubMed1998

A randomized trial of three iron dextran infusion methods for anemia in EPO-treated dialysis patients.

Forty-three hemodialysis patients receiving recombinant erythropoietin (rHuEPO, epoietin alpha) were randomized to receive intravenous iron dextran as a total-dose infusion, 500-mg infusion to total dose, or 100-mg bolus to total dose, in each case during the dialysis procedure. The dose of iron dextran was calculated from the patient's existing hemoglobin to achieve a desired hemoglobin. Patients were eligible to receive intravenous iron dextran if they had a serum ferritin of < or = 100 ng/mL or a serum ferritin of 100 to 200 ng/mL, along with a transferrin saturation of < or = 19%. Patients were excluded if they had prior therapy with iron dextran, aluminum intoxication, or transfusion during the study. The time to the maximum hemoglobin, acute adverse reactions, and delayed adverse reactions were analyzed statistically, and no differences were seen in any of the three groups. Total-dose intravenous iron dextran infusion is safe, convenient, less expensive, and as efficacious as divided-dose infusions.

Anemia↗
PubMed1997

Treatment of advanced pancreatic carcinoma with a combination of protracted infusional 5-fluorouracil and weekly carboplatin: a Mid-Atlantic Oncology Program Study.

BACKGROUND: Advanced pancreatic cancer is a rapidly fatal disease whose course has been little influenced by chemotherapy. Earlier studies have shown some modest promise for the combination of protracted infusional 5-fluorouracil (PIF) and cisplatin. We sought to evaluate a regimen of possibly lesser toxicity, PIF plus weekly carboplatin. PATIENTS AND METHODS: Fifty-four patients with advanced adenocarcinoma of the pancreas were treated with a regimen of protracted infusional fluorouracil 300 mg/m2/day for 70 days and carboplatin 100 mg/m2/weekly on weeks 1 through 10 of a 12-week cycle. After a two-week rest, cycles were repeated until progression. RESULTS: Median duration on treatment was 82 days (range 4-490 days). Toxicity was mild. Grade 3-4 toxicities were anemia 11%, leukopenia 6%, thrombocytopenia 2%, nausea/ vomiting 7%, diarrhea 9%, mucositis 9%, and renal 2%. Response was evaluable in 47 patients. There were two complete and seven partial responses (17% overall objective response rate among all patients). Stable disease for greater than 12 weeks was seen in 19 patients (40%) and progression in 19 (40%). The median overall survival was 22 weeks (1-99), with 61 weeks median survival in responders (22-99). One-year survival was 13%. CONCLUSIONS: Response and survival results with this regimen are at least equal to the best combination regimens reported, and were obtained with a low overall rate of serious toxicity.

Adult↗
PubMed1997

Effect of maternal asthma on performance of parenting tasks and children's school attendance.

We evaluated the effects of maternal asthma on specific parameters of family function including the children's school attendance and mother's performance of basic parenting tasks. A case-controlled study of mothers with asthma (MA; n = 24) with children under the age of 13 and matched mothers without asthma (CM; n = 27) was performed. Children of mothers with asthma had a significantly impaired ability to attend school compared to children of control mothers (odds ratio = 15, 95% CI). Twenty-two percent of MA reported that their asthma caused their children to miss school at least once per month. In addition, 27% of MA reported that their children were regularly late for school because of the mother's asthma. Only 5% of the control mothers reported that their health caused their children to miss school, and none reported lateness. Asthma also impaired the ability of the MA to perform basic parenting tasks such as dressing children and preparing meals for children. These adverse effects of parental asthma on children's school attendance and parenting represent previously unappreciated indirect costs of asthma and may have immediate as well as future consequences.

Absenteeism↗
PubMed1996

Case report: severe microcytosis associated with the anemia of chronic disease.

When microcytosis is present in patients with anemia of chronic disease, the mean corpuscular volume (MCV) rarely if ever falls below 70 fL. The lowest MCV previously reported is 67 fL. We describe a patient with anemia of chronic disease with severe microcytosis and an MCV of 61 fL. After correction of the chronic disorder, complete correction of the hematologic values occurred. In patients with a low total iron binding capacity, iron therapy should not be instituted without clearly establishing the presence of iron deficiency irrespective of the degree of microcytosis.

Anemia↗
PubMed1995

Effects of modified pharmacologic stress approaches on hyperemic myocardial blood flow.

UNLABELLED: Pharmacologic stress testing with 0.56 mg/kg of intravenous dipyridamole is frequently used to noninvasively detect coronary artery disease (CAD). However, high-dose dipyridamole (0.80 mg/kg) or the combination of standard-dose dipyridamole (0.56 mg/kg) with the isometric handgrip maneuver might evoke a greater coronary hyperemic response. METHODS: To evaluate the effect of modified pharmacologic stress tests, myocardial blood flow as quantified in 11 male subjects (mean age: 27 +/- 7 yr) during standard-dose dipyridamole (0.56 mg/kg), high-dose dipyridamole (0.80 mg/kg) and standard-dose dipyridamole combined with the isometric handgrip exercise using dynamic PET and a two-compartment model for 13N-ammonia. RESULTS: Systolic blood pressure, heart rate and rate pressure product remained unchanged from standard to high-dose dipyridamole but increased with the addition of the isometric handgrip. Myocardial blood flow was unchanged from standard to high-dose dipyridamole but was lower with the addition of the isometric handgrip. CONCLUSION: The hyperemic response induced by standard-dose dipyridamole cannot be further enhanced by high-dose dipyridamole. The addition of the isometric handgrip exercise results in a modest, but significant decline in hyperemic blood flow possibly due to increased extravascular resistive forces or an increase in a mediated coronary vasoconstriction associated with exercise.

Adult↗
PubMed1995

Etoposide plus cisplatin followed by thoracic radiation for stage IIIB non-small cell lung cancer: MAOP study 2188.

Thirty-five patients with stage III B non-small cell lung cancer were treated with the combination of cisplatin (CDDP) 30 mg/M2/day and etoposide (VP16-213) 75 mg/M2/day administered as a 72-hour infusion. Twenty evaluable patients (67%) received subsequent thoracic radiation as definitive regional therapy following a clinical response or stable disease status. Complete plus partial responses to chemotherapy were observed in 15 patients (5CR and 10PR or 44%). Of the 20 patients who received radiation, six responded with five transitioning from stable disease to partial (2) or complete (3) responses. The overall response rate to the combined sequential chemotherapy plus radiation was therefore 20/35 or 59% with eight complete responders. Histopathology influenced the response rate to chemotherapy (53% versus 30% for epidermoid versus adenocarcinomas, respectively), but following radiation, the response rates were similar for the two pathologic subtypes (73% versus 71%). Median overall survival was 363 days with 20% of patients alive at 13 to 45 months. The response rate for CDDP plus VP16-213 chemotherapy administered as a 72-hour infusion was superior for stage III B non-small cell lung cancer compared with stage IV disease as previously reported by the Mid Atlantic Oncology Program (44% versus 25%). This difference between stage III B and stage IV was also reflected in median survival (363 days versus 190 days). The sequential addition of radiation therapy to this chemotherapy regimen is feasible in stage III B disease with a small proportion of patients demonstrating long-term survival.

Adenocarcinoma↗
PubMed1994

Acute myeloid leukemia in patients more than 50 years of age: special considerations in diagnosis, treatment, and prognosis.

Although most patients with acute myeloid leukemia are more than 50 years of age and age is known to be an adverse prognostic factor, relatively few studies have been conducted to determine the optimum treatment strategy for the older patient. This report suggests that, until definitive studies are conducted in this age group, intensive chemotherapy should always be considered if the older patient's overall status and desires are consistent with this approach. Other factors, specifically cytogenetic and cell-surface marker findings, provide prognostic information, independent of age, and should also be considered during patient management.

Acute Disease↗
PubMed1994

HIV-related training programs for health care professionals: findings from a collaborative assessment.

Seeking to avoid duplication of effort, evaluators from twelve separate HIV-related training programs worked together to share information, assessment tools, measurement instruments, and preliminary findings across programs. Each training program focused on preparing health care professionals to meet the growing demands of the AIDS epidemic and specifically address psychosocial issues of care. The collaborative effort of program evaluators included an examination of experiences across programs and yielded recommendations for needs assessments, process evaluation procedures, and outcome measures. This paper focuses on the findings from an analysis of needs assessments and process evaluations across twelve HIV-related training programs in eleven areas of the country.

Forecasting↗
PubMed1992

Hexamethylene bisacetamide in myelodysplastic syndrome: effect of five-day exposure to maximal therapeutic concentrations.

The efficacy of hexamethylene bisacetamide (HMBA), a potent polar-planar solvent which is capable of differentiating leukemias and solid tumors in vitro at clinically achievable concentrations, was studied in 16 patients with severe myelodysplastic syndromes (MDS). An adaptive control dosing algorithm was used to maintain HMBA steady-state concentrations (Css) within a narrow therapeutic window (1-2 mM) for five days every four weeks. Despite achieving the target HMBA Css during at least two courses in each of 15 patients, HMBA did not produce clinically relevant improvements in blood cell counts nor in other functional indices. Instead, HMBA induced cytopenias in the majority of these patients, most of whom had preexisting cytopenias and limited hematopoietic reserves. These disappointing results correlated with concurrent in vitro bone marrow studies from these patients in which both the HMBA concentrations that were optimal for differentiation in vitro (2-5 mM) and the HMBA Css that were achieved in this study (1-2 mM) substantially inhibited the growth of granulocyte-macrophage colony-forming units and erythroid burst-forming units. Although the mechanism responsible for the anti-proliferative effects of HMBA on hematopoietic progenitors (cytotoxicity versus terminal differentiation) could not be determined, the induction of cytopenias and lack of significant clinical improvements suggest that HMBA is cytotoxic and will not be useful alone as a differentiating agent on this schedule of administration in the treatment of MDS.

Acetamides↗
PubMed1988

Effects of influenza A virus on human neutrophil calcium metabolism.

Bacterial superinfection in influenza A virus-related illness may in part be explained by virus-induced neutrophil dysfunction. We here provide evidence that this effect is related to abnormal calcium metabolism of virus-infected cells. Neutrophils exposed to influenza virus for 0.5 h at 37 degrees C showed depressed O2- generation and release of radiolabeled arachidonic acid upon stimulation with FMLP. The peak cytosolic Ca2+ level achieved by virus-infected neutrophils after FMLP stimulation was significantly depressed as is efflux of 45Ca2+. This deficient Ca2+ mobilization could not be attributed to alterations of inositol phosphate production or Ca2+ influx in response to FMLP, both of which were unaffected by prior virus infection. Given these findings, the immediate effects of influenza virus on neutrophil Ca2+ metabolism were examined. The virus itself caused a rise in cytosolic Ca2+ and an efflux of 45Ca2+ without any corresponding 45Ca2+ influx. Total cell Ca2+ however was not depleted as measured by atomic absorption. Influenza virus, therefore, causes neutrophil activation leading to significant perturbations in Ca2+ metabolism and later to impaired mobilization of Ca2+ stores. This system offers a model for phagocyte deactivation and an opportunity to define control mechanisms of signal transduction.

Arachidonic Acid↗
PubMed1988

Clinical use of the total dose intravenous infusion of iron dextran.

Eighty-seven patients with anemia and absent bone marrow hemosiderin were given treatment with total dose intravenous infusions of iron dextran. The effect of rate of infusion and premedication with diphenhydramine, aspirin, and methylprednisolone on acute and delayed reactions was assessed. All patients were monitored for 72 hours after infusion. Two patients reacted to the test dose. One responded with generalized body pain that lasted approximately 5 minutes. In one an anaphylactoid reaction developed, which was promptly terminated by intravenous methylprednisolone, subcutaneous epinephrine, and intravenous diphenhydramine. Transient delayed adverse reactions easily controlled by nonsteroidal anti-inflammatory drugs occurred in 37 patients. The most common delayed reaction was a syndrome characterized by arthralgia, myalgia, and fever. Seven subjects had a chronic disease in addition to anemia with absent bone marrow iron. In all seven normal hemoglobin and hematocrit values were attained after treatment. The results of our experience with total dose intravenous iron dextran therapy suggest that it be the preferred method of replenishment in clinical situations where parenteral administration of iron is indicated. An unexpected benefit was the efficaciousness of this method of administration in patients with iron deficiency and coexisting chronic disease. A protocol for its administration is proposed.

Anaphylaxis↗
PubMed1986

Systemic babesiosis. Another cause of the hemophagocytic syndrome.

Hemophagocytosis is a pathologic finding in a variety of infectious diseases associated with peripheral pancytopenia. In addition, hemophagocytosis is a prominent finding in malignant histiocytosis, a primary disorder of the monocyte-macrophage system. Systemic babesiosis is a rare parasitic disorder associated with intraerythrocytic parasites in the peripheral blood. There has been no description of the marrow findings in this disorder. A patient is described who had systemic babesiosis and prominent hemophagocytosis that disappeared after appropriate antiparasitic therapy. Systemic babesiosis should be considered in the differential diagnosis of hemophagocytosis.

Babesiosis↗