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Biomedical subjects

M E Stein

Publications and source records attributed to M E Stein.

At least 37 records · Page 2Linked to original sources
PubMed1996

Variants of Kaposi's sarcoma in Southern Africa. A retrospective analysis (1980-1992).

All types of Kaposi's sarcoma (KS) are represented in the Southern African region. We present a retrospective analysis of patients with KS, treated and followed up at the Johannesburg General Hospital over a 12-year period (1980-1992). One hundred and nineteen patients with KS, divided into four groups according to their etiology (classical; endemic African; renal transplant recipients; epidemic AIDS-related) were analyzed. Choice of treatment (radiotherapy or chemotherapy) was individualized and based on clinical criteria, extent of disease and severity of symptoms. Kaposi's sarcoma showed a very high response rate to radiation therapy, regardless of variant, radiation modality or schedule. Chemotherapy was also effective in the more aggressive pattern of endemic African KS. Epidemic Kaposi's sarcoma showed the same poor outcome as demonstrated by its Western counterpart. We conclude that radiation therapy can provide excellent palliation with only minimal side-effects in all variants of KS seen in Southern Africa.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Spontaneous pneumothorax complicating chemotherapy for metastatic seminoma. A case report and a review of the literature.

BACKGROUND: Spontaneous pneumothorax complicating chemotherapy has been reported mainly in metastatic sarcoma, particularly of the osteogenic type. The main factor in the etiology of spontaneous pneumothorax could be related to tumor lysis and/or rapid rupture of chemosensitive peripheral or subpleural metastasis into the pleural cavity, thus leading to a bronchopleural fistula. METHODS AND RESULTS: A 49-year-old patient in whom spontaneous pneumothorax developed after successful chemotherapy for metastatic seminoma is described. On chest tube drainage, the lung reexpanded rapidly and the patient became clinically and radiographically symptom free. CONCLUSION: To the authors' knowledge, this is only the second case of spontaneous pneumothorax complicating chemotherapy-induced rapid regression of lung and mediastinal metastases in patients with seminoma. Spontaneous pneumothorax should be included in the spectrum of chemotherapy-related side effects in chemosensitive solid tumors with lung metastases.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Acute limb ischemia due to malignant arterial embolism from a metastatic germ cell tumor.

Arterial tumor embolization is a rare but serious complication of neoplastic disease. The majority of these tumors are associated with primary or secondary lung malignancies, originating from pulmonary vein metastasis or from an atrial mass. Malignant germ cell tumors primarily disseminate to the retroperitoneal lymph nodes and lung, and to the brain and liver later in the course of the disease. A germ cell tumor metastasis embolizing to the iliac-femoral arterial system has not yet been reported. We report a metastatic embolism in a patient with disseminated embryonal cell carcinoma causing acute limb ischemia, managed by surgical embolectomy. The sudden development of limb ischemia in a patient with a germ cell tumor should alert the physician to the possibility of tumor embolism.

Echocardiography↗
PubMed1995

Chemotherapy for AIDS-related and endemic African Kaposi's sarcoma in southern Africa.

BACKGROUND: Kaposi's sarcoma (KS), either in its endemic (African) form or its AIDS-related variant, is a common neoplastic disorder seen in Southern Africa. Chemotherapy has been proven to be very effective in advanced or relapsed African Kaposi's sarcoma, but much less so in AIDS-related, endemic KS. PATIENTS AND METHODS: The study consists of a retrospective analysis of the results of chemotherapy alone in 17 patients with African KS (AKS) and in 32 patients with epidemic AIDS-related KS (EKS), treated at the Johannesburg General Hospital between 1982 and 1992. Single agents included vinblastine, actinomycin D, bleomycin, and vincristine; combined regimens were largely doxorubicin/vincristine/bleomycin or etoposide/methotrexate. Outcome classifications were: complete remission (CR), partial remission (PR), and treatment failure (TF). RESULTS: Four of the 17 patients with AKS had CR, 10 a PR, and three were TF and died rapidly from their disease. The combined chemotherapeutic regimens produced marked symptomatic relief and even long-term remission in AKS. In patients with EKS, the response rate to chemotherapy was very low and of brief duration. No patient had a CR and debilitating side effects were common. CONCLUSIONS: The African type of AKS is a chemo-sensitive tumor, whereas the endemic type EKS, like its Western counterpart, has a dismal prognosis.

AIDS-Related Opportunistic Infections↗
PubMed1995

Case report: late aggressive meningioma following prophylactic cranial irradiation for acute lymphoblastic leukaemia.

The clinical, radiological and pathological findings in a 28-year-old female patient who developed aggressive meningioma 20 years after prophylatic cranial irradiation (PCI) for acute lymphoblastic leukaemia (ALL) are described here. Only four cases of late atypical/aggressive meningioma following PCI were detected in a thorough search of the literature. The high cure rate in childhood ALL, attributable to aggressive chemotherapy and PCI, is capable of inducing secondary brain tumour, including aggressive meningioma.

Child↗
PubMed1994

Radiation therapy for non-AIDS associated (classic and endemic African) and epidemic Kaposi's sarcoma.

PURPOSE: A retrospective analysis of patients with non-AIDS and AIDS-related Kaposi's sarcoma, who were treated with radiation therapy. METHODS AND MATERIALS: Between 1978 and 1992, 56 patients with one of the three major types (classical, endemic, epidemic) of Kaposi's sarcoma received radiation therapy as their sole treatment modality. Extent of fields, daily fractionation, and total dose were applied on a clinical basis. These lesions received superficial x-ray therapy, Co-60 teletherapy, or 6-8 MeV electron beams. Field sizes depended on extent of the lesion. Total dose administration ranged from 8-12 Gy in one exposure, or a total of 24-30 Gy fractionated over 2-3 weeks. RESULTS: The majority of patients responded to radiation therapy. Symptomatic relief was achieved in 80-100% of patients irrespective of the type of Kaposi's sarcoma, treatment modality, or schedule. Side effects were tolerable in all but three patients with epidemic type Kaposi's sarcoma, who developed severe mucositis. CONCLUSION: Radiotherapy is the most useful mode of palliative treatment for all forms of Kaposi's sarcoma in southern African patients.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Classical Kaposi's sarcoma in Caucasians in Africa--experience at the Johannesburg Hospital (1978-1992).

The data are scant concerning classical Kaposi's sarcoma (CKS) among the Caucasian population of Africa. A description of the clinical features of 15 such patients, treated and followed up at the Johannesburg General Hospital over a 14-year period (1978-1992) is presented. All patients were negative for the human immunodeficiency virus. After a mean follow-up of 50 months (range: 7-168 months), 2 patients are alive with absent or minimal disease; 1 patient is alive with stable disease and 1 has active disease involving his extremities. Three patients were lost to follow-up but had minimal or no disease when last seen. Five patients died of unrelated causes but also had minimal or no disease at their last visit. One patient died of sepsis related to active KS. Only two patients died of progressive KS. No alterations in humoral or cellular immunity were demonstrated in 2 patients with persistent disease. Four (27%) patients developed lymphoproliferative disorders including non-Hodgkin's lymphoma, Waldenström's macroglobulinemia, Hodgkin's disease and Castleman's disease (angiofollicular lymph node hyperplasia) preceding or following the diagnosis of CKS. These data confirm the indolent nature and good outcome of the classical form of Kaposi's sarcoma among Caucasians in the southern African region. The marked association between CKS and lymphoproliferative disorders warrants a long-term awareness and continued monitoring for these complications.

Adult↗
PubMed1994

Lymphoproliferative malignancies in association with endemic African Kaposi's sarcoma.

The association of classical Kaposi's sarcoma with lymphoproliferative disorders is well known. However, far less is known about lymphoproliferative malignancies in endemic African Kaposi's sarcoma. A review of 47 patients with the endemic type of Kapos's sarcoma treated at the Johannesburg Teaching Hospital Complex between 1980 and 1992 revealed four patients (8.5 pc) in whom Kaposi's sarcoma was associated with a malignant lymphoma. Possible pathogenetic mechanisms are suggested and the current literature is reviewed.

Adult↗
PubMed1994

Lymphoproliferative disorders in non-AIDS-associated Kaposi's sarcoma. The Johannesburg Hospital experience, 1980-1992.

The association of the non-AIDS-related, classic form of Kaposi's sarcoma (KS) with secondary malignancies, especially lymphoproliferative disorders, has frequently been noted. However, in endemic African-type KS, such an association has been reported only rarely. A review of 62 non-AIDS-related cases of KS treated and followed up at Johannesburg General Hospital between 1980 and 1992 revealed 8 patients (13%) in whom KS was associated with malignant lymphoproliferative disorders. The prevalence of secondary lymphoproliferative disorders was not significantly different among patients with classic KS (3/15; 20%) when compared with those who had African KS (4/47; 8%). In both forms of KS subtle disturbances of immunity have been described which may play a role in the pathogenesis of secondary lymphoproliferative disorders, although the factors responsible and the pathogenetic mechanisms involved in malignant lymphoid transformation in these patients have not been fully elucidated.

Adult↗
PubMed1994

Biology of disease and clinical aspects of AIDS-associated lymphoma: a review.

AIDS-related lymphoma was not apparent until 1985, when a statistically significant increase in the frequency of lymphoma had occurred. Over 50% are high-grade lymphoma, either immunoblastic or small, noncleaved cells (Burkitt's-like lymphoma), with involvement of extranodal sites such as the central nervous system (> one-third of patients), gastrointestinal tract, skin and bone marrow. Optimal therapy for AIDS-associated lymphoma has not yet been defined. Using intensive chemotherapy protocols, high response rates, albeit of brief duration, have been demonstrated. The majority of patients succumbed to intercurrent opportunistic infections. Poor prognosis has been particularly noted in debilitated patients, patients with a CD4 cell count of < 200/dl, bone marrow and brain involvement and a history of AIDS before diagnosing the lymphoma. New strategies in the management of patients with AIDS-lymphoma should include cytotoxic therapy, antiretroviral therapy, anti-pneumocystic Carini pneumonia, prophylaxis of CNS spread and marrow protective therapy (haematopoietic growth factors).

AIDS-Related Opportunistic Infections↗
PubMed1993

Radiation therapy in endemic (African) Kaposi's sarcoma.

PURPOSE: Evaluating the role of radiation therapy in the treatment of the endemic, African variant of Kaposi's sarcoma. A retrospective analysis. METHODS AND MATERIALS: Between 1978 and 1990, 28 symptomatic African patients with the African Human Immunodeficiency Virus negative type of Kaposi's sarcoma were referred to the Johannesburg General Hospital. Following staging, all patients were treated with radiation therapy. Doses ranged between 8-10 Gy (single fraction) or 14-24 Gy fractionated over 1-3 weeks. RESULTS: Complete and partial regression of cutaneous lesions was achieved in 9 (32%) and 15 (54%) patients, retrospectively. A complete/near-complete alleviation of symptoms was achieved in all patients. Response rate and duration of response was not influenced by age, radiation modality or schedule. Side effects were minimal. CONCLUSION: Our study emphasizes the high radiosensitivity of the endemic, African type of Kaposi's sarcoma, indicating its usefulness as the treatment of choice for this disease.

HIV Seronegativity↗
PubMed1993

Testicular seminoma stage I: treatment results and long-term follow-up (1968-1988).

Sixty-nine patients with stage I testicular seminoma were referred to the Northern Israel Oncology Center between 1968 and 1987. Sixty-four patients were irradiated postoperatively and five patients had surveillance alone. Complete follow-up was available for all patients, with a median follow-up of 86 months (range 9-239 months). The last follow-up was in December 1988. Actuarial survival was 94% to 5, 10, 15, and 20 years. Six patients relapsed following completion of irradiation. All the recurrences occurred outside the radiation field. Three of the relapsed patients could be salvaged with cisplatinum-based chemotherapy and are alive at 4, 7, and 10 years following second-line treatment. Acute or chronic side effects were mild and manageable. Seven patients developed second primary cancers, two within and six outside the radiation field. While surveillance policy alone in stage I testicular seminoma may be successful in terms of patient outcome, it requires prolonged observation, good compliance of patients, and intensive use of resources. Thus, until proved otherwise, infradiaphragmatic radiotherapy should further remain the optimal routine treatment in seminoma patients with stage I disease.

Actuarial Analysis↗
PubMed1993

Melanocytic schwannoma of the spinal cord: a case report.

Melanocytic schwannoma of the spinal cord is a tumour composed of Schwann cells capable of producing intracellular melanin. We present a case report of a 25-year-old male with melanocytic schwannoma of the 5th lumbar spinal cord root; the patient is alive and well 48 months after neurosurgical removal of the tumour. A review of the literature revealed 14 similar cases. These tumours have a local recurrence rate of up to 14%, and have a metastatic potential.

Adult↗
PubMed1993

Second primary cancer in irradiated stage I testicular seminoma.

The incidence of second primary cancer (SPC) was determined in 64 irradiated stage I testicular seminoma patients, treated and followed at the Northern Israel Oncology Center from 1968 to 1988. Seven (11%) patients developed a total of eight second cancers. The cumulative risk for developing second primary cancer at ten, 15 and 20 years following the diagnosis of seminoma was 2.5%, 5.1% and 8.9%, respectively. Two patients developed SPC within the radiation field (urinary bladder, sigmoid colon) and four patients outside the radiation field (bronchogenic cancer, thymoma, malignant melanoma, thyroid cancer). In two patients, who developed lung cancer and testicular seminoma, respectively, scatter dose from the main radiation field could not be excluded as one of the factors contributing to the SPC. Three patients died as a direct result of their SPC. It is concluded that there is a low, but significant risk of solid SPC among patients apparently cured of early stage seminoma. It will be important in future surveillance studies of stage I seminoma to assess the risk of SPC in the non-irradiated patients.

Actuarial Analysis↗
PubMed1989

Direct induction of Ia antigen on murine thyroid-derived epithelial cells by reovirus.

The ability of thyroid follicular epithelial cells (TFEC) to act as APC is linked to the expression of class II (Ia) molecules of the MHC. The cloned murine thyroid-derived epithelial cell line M.5 was used to demonstrate the potential effects of virus in the direct induction of Ia molecules on TFEC. Membrane binding and replication of reovirus type 1 in TFEC was demonstrated using fluorescein-labeled antireovirus antibody and fluorescence microscopy. One consequence of the interaction between reovirus and M.5 cells was the induction of Ia Ag and augmented class I molecule expression in M.5 cells. The levels of Ia expression at three days after reovirus binding were amplified 17.3-fold over controls and were 2-fold less than that seen upon treatment of M.5 cells with IFN-gamma. Supernatant transfer experiments showed that the induction of Ia expression was directly linked to the binding of virus to M.5 cells, and was not dependent upon virus replication or the presence of IFN. These results indicate that early events of reovirus binding or receptor internalization on TFEC initiate a signaling process which results in the induction of class II and augmentation of class I MHC protein levels on the cell surface.

Adhesiveness↗