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Biomedical subjects

M Freund

Publications and source records attributed to M Freund.

At least 145 records · Page 8Linked to original sources
PubMed1995

High-dose cytosine arabinoside and daunorubicin postremission therapy in adults with de novo acute myeloid leukemia. Long-term follow-up of a prospective multicenter trial.

A total of 149 consecutive de novo AML patients aged 50 years or less (median age = 37 years) were enrolled in this prospective multicenter trial initiated in May 1985. All patients received the same induction and early consolidation therapy with daunorubicin (DNR), cytosine arabinoside (Ara-C), and etoposide (DAV). High-dose Ara-C/DNR therapy included Ara-C at 3 g/m2, in 12 doses (HD-Ara-C/DNR I) and eight doses (HD-Ara-C/DNR II), followed by DNR 30 mg/m2 for 3 days. A complete remission (CR) was achieved in 104 (70%) patients; 61 complete responders received at least one cycle with HD-Ara-C/DNR. If those patients who were transplanted in first CR (n = 26), were not considered, the median relapse-free-survival (MRFS) of the remaining 78 patients was 15 months, with a probability of relapse-free survival (RFS) at 116 months of 30% (95% CI, 20-40%) after a median follow-up of 95 months. The MRFS of the HD-Ara-C/DNR consolidated patients was 25 months, with a probability of RFS at 116 months of 37% (95% CI, 24-50%). If all patients who were transplanted (n = 44) were not considered, the median survival time (MST) was 18 months with a probability of being alive at 118 months of 24% (95% CI, 16-33%). MST of the HD-Ara-C/DNR consolidated patients was 58 months with a survival probability of 46% (95% CI, 31-60%) at 118 months. Prognostic factor analysis did not reveal any significant influence of age, sex, FAB subtype, white blood cell count, hemoglobin level, thrombocyte count, LDH, or response to the first induction course on RFS of the HD-Ara-C/DNR consolidated patients. In summary, HD-Ara-C/DNR consolidation can improve the long-term outcome of a subgroup of de novo AML patients. Further improvement of the outcome seems to depend on the identification of patients with an inferior outcome under that strategy who might benefit from alternative treatment strategies.

Adolescent↗
PubMed1995

Fetal lung maturation in congenital diaphragmatic hernia.

OBJECTIVE: Our purpose was to determine whether congenital diaphragmatic hernia is associated with abnormalities of fetal lung maturation. STUDY DESIGN: We measured surfactant protein A and saturated phosphatidylcholine in amniotic fluid from 19 pregnancies with a prenatal diagnosis of congenital diaphragmatic hernia (gestational age 16 to 40 weeks) and 48 control pregnancies (gestational age 16 to 39 weeks). Results were compared by analysis of covariance. RESULTS: Beyond 34 weeks of gestation there was a progressive rise in amniotic fluid surfactant protein A and saturated phosphatidylcholine in control pregnancies, whereas in most fetuses with prenatal diagnosis of congenital diaphragmatic hernia these values remained low (p < 0.01). Amniotic fluid surfactant protein A was lower in fetuses with congenital diaphragmatic hernia who died or required extracorporeal membrane oxygenation than in survivors treated with conventional management (4.9 +/- 2.9 vs 16.8 +/- 5.7 micrograms/ml surfactant protein A, respectively, p < 0.05 by Mann-Whitney U test). CONCLUSIONS: There are decreased surfactant components in amniotic fluid in many pregnancies complicated by congenital diaphragmatic hernia, which may reflect fetal lung immaturity or hypoplasia.

Amniocentesis↗
PubMed1995

Characteristic biological features of human megakaryoblastic leukaemia cell lines.

Both normal and leukaemic human megakaryocytopoiesis are stimulated by several cytokines, including stem cell factor, granulocyte-macrophage colony stimulating factor (GM-CSF), interleukin-3, GM-CSF/interleukin-3 fusion protein, interleukin-6, interleukin-11, basic fibroblast growth factor and thrombopoietin, but are inhibited by tumour necrosis factor-alpha, platelet factor 4, beta-thromboglobulin, thrombin, interleukin-4, interferon-alpha and interferon-gamma. Human megakaryoblastic leukaemia cell lines have common biological features, including high expression of the megakaryocytic specific antigen: CD41; high expression of the early myeloid antigens: CD34 and CD33; constitutive expression of interleukin-6 and platelet-derived growth factor; complex karyotype picture; expression of c-kit: the stem cell factor receptor; growth-dependency or -stimulation by stem cell factor, interleukin-3 and/or GM-CSF; megakaryoblastic differentiation by phorbol-myristate-acetate; and in vivo tumorigenicity in mice is associated with marked fibrosis. Only a few agents including phorbol-myristate-acetate; vitamin D3, interferon-alpha, interferon-beta 2, erythropoietin and thrombin have been reported to induce megakaryocytic differentiation in the human megakaryoblastic leukaemia cells.

Adult↗
PubMed1995

Magnetic resonance angiography in 140 neuropediatric patients.

Three-dimensional magnetic resonance angiography (MRA) is a noninvasive technique that images the intracranial arterial vasculature without contrast agents. The suitability of MRA was evaluated for routine use and all children were prospectively studied with conventional MR imaging and time off flight MRA (FISP3D). All MR studies were performed on a 1.5 T-MRA system using a circularly polarized head coil. The study comprised 140 children, ages 3 weeks to 18 years, with different neuropediatric diseases. Major cervical and intracranial arteries were visualized in all age groups. Smaller branches of the supratentorial arteries were identified inconstantly and the number of arteries visualized increased up to the age of 6 years. Sixty-seven children (47%) had normal intracranial vasculature. MRA demonstrated anatomic variations in 21 patients (15%). Twenty-two of 32 children with congenital malformations demonstrated abnormalities of the intracranial vasculature. The diagnostic value of MRA was confirmed in 11 of 12 patients after neonatal stroke and in 3 of 10 children after stroke at older ages. Seven of 18 children with acute hemorrhage demonstrated arteriovenous malformations or an aneurysm on MRA. The correlation with digital subtraction angiographic findings was established in 13 patients. In 9 of 13 children with brain tumor, MRA proved to be diagnostically valuable. MRA proved to be of particular value in the evaluation of the carotid artery following extracorporeal membrane oxygenation therapy. MRA can be used in children of all age groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[Double spiral CT angiography].

AIM: To evaluate the clinical value of CT angiography using double-spiral CT technique. METHOD: 7 patients with peripheral occlusive disease were examined after stent placement into iliac arteries (5/7) or prior surgery under the clinical suspicion of an occluded vascular graft (2/2). After a delay of 25 sec two spiral CT-scans, each of 32 sec duration, were started. The average interscan delay was between 12-15 sec. The total examination time was about 100 sec and the total range 36 cm using a slice thickness of 3 mm and a table feed of 6 mm/sec. 150 ml of contrast material were injected continuously with 3 ml/sec. RESULTS: All stents were exactly located and diagnosed as patent (6/6) in comparison to intraarterial angiography. Two occluded vascular grafts were diagnosed, confirmed by surgical findings (2/2). Density measurements showed enough of contrast material in the vessels to perform CT-angiography even in the second part of the examination. CONCLUSION: Double-spiral CT angiography is a clinical applicable and helpful method to examine patients with peripheral occlusive disease. It allows to double the examination range without losing the advantages of small slice thickness.

Aged↗
PubMed1995

[Spiral CT angiography after the application of an iliac artery stent].

PURPOSE: To evaluate the diagnostic and clinical value of CT-A performing MIP- and SSD-reformations after intraarterial iliac stent application. METHODS: In a prospective study 32 patients underwent CT-A after stent placement in the iliac arteries. The vascular morphology was analyzed regarding neointimal hyperplasia and calcification pattern. The results were compared with those of clinical findings (walking distance), Doppler ultrasound (ankle-brachial index) and DSA. RESULTS: All 47 stents were visible and patent (100%). One misplacement was identified. A good correlation was found between an improved ankle-brachial index and CT-A (88.5%) and extension of the walking distance and CT-A (92.3%). Concerning location, number and grade of stenoses the results between CT-A and DSA matched in 42.1%. An exact mapping of calcified plaques was possible in all cases. CONCLUSIONS: CT-A as MIP is shown to be superior than DSA with regard to calcifications. Complementary to the indirect methods of the ankle-brachial index and walking distance, CT-A is useful for therapy control after vascular stent placement.

Aged↗
PubMed1995

Cross-reactivity of human molecular markers for detection of prethrombotic states in various animal species.

The aim of the present study was to investigate the reactivity of immunoreagents developed for clinical applications in humans in different animal species (hen, mouse, rat, rabbit, guinea-pig, dog, pig, sheep, baboon). Prothrombin fragment 1 + 2, thrombin-antithrombin III complex and fibrinopeptide A were tested for coagulation, platelet factor 4 and beta-thromboglobulin for platelet activation, glycoprotein IIb-IIIa, glycoprotein Ib and P-selectin for platelet membrane glycoproteins, D-dimers for fibrinolysis, thrombomodulin for activation of endothelial cells and thrombospondin and von Willebrand factor for adhesive proteins. Prothrombin fragment 1 + 2, platelet factor 4, beta-thromboglobulin and D-dimers were revealed only in baboons. Fibrinopeptide A was well detected in baboons but weakly in mice, dogs, pigs and sheep. Whereas glycoprotein IIb-IIIa was revealed on guinea-pig, dog and sheep platelets and glycoprotein Ib on rabbit and dog platelets, P-selectin and thrombomodulin were never detected. Thrombospondin was revealed in hens, mice, rats, guinea-pigs, pigs, sheep and baboons and von Willebrand factor in mice, rats, guinea-pigs, dogs, pigs, sheep and baboons. Interestingly, thrombin-antithrombin III complex (TAT) was detected in all species tested except the hen. A time- and dose-dependent increase in TAT was observed when rats, dogs or pigs were infused with thromboplastin (4.5-450 microliters/kg/h), while administration of hirudin (1 mg/kg) abolished this TAT generation. Thus, the TAT immunoassay could provide a tool for the screening of antithrombotic drugs in a number of animal species. However, the possibility of using a wider panel of human immunoreagents would appear to be restricted to baboons which display good species cross-reactivity.

Animals↗
PubMed1995

Neonatal stroke involving the middle cerebral artery in term infants: clinical presentation, EEG and imaging studies, and outcome.

Six children with neonatal cerebral infarction of the middle cerebral artery are reported. Seizures or respiratory distress were the initial symptoms. In some cases abnormal findings appeared earlier on EEG than on ultrasound. The EEG changes were concordant with the localization of the lesion. Ultrasound examinations revealed an echodense structure within the vascular territory, after a phase of appearing to be normal, highly suggestive of cerebral infarction. The diagnosis was confirmed by CT scan. Findings on EEG, cranial ultrasound and CT suggested that the stroke represented a late intra-uterine event. At long-term follow-up, six children had failed to develop normally for age and had become obviously hemiplegic as gross motor development proceeded. Four of the patients had developed epilepsy. These data indicate that the outcome of neonatal stroke may not be as positive as previously reported.

Brain↗
PubMed1995

Effect of recombinant human interferons in inducing differentiation of acute megakaryoblastic leukaemia blast cells.

The effects of interferons (IFN)-alpha, beta 2 and -gamma in inducing megakaryocytic differentiation of blast cells from a patient with acute megakaryoblastic leukaemia (AMegL) was investigated in liquid suspension culture by the increase in CD41 and CD42b expressions using monoclonal antibodies in the APAAP technique. After six days of culture, the percentage of CD41 and CD42b positive cells increased in control cultures from 15.2% and 10.6% on day 0 to 32.0 +/- 4.3% and 22.1 +/- 2.5%, respectively. The addition of IFN-alpha significantly increased the number of CD41 and CD42b positive cells by about two to three fold compared to control cultures (p < 0.01) and by about four to six fold compared to day 0 (p < 0.001) Similarly, IFN-beta 2 induced a significant increase in CD41 and CD42b positive cells. On the other hand, IFN-gamma failed to increase the number of CD41 and CD42b positive cells in comparison to control cultures on day 6 and instead stimulated a significant increase in the number of monocytes/macrophages by about ten fold compared to control cultures in IFN-gamma-treated cultures (p < 0.001). The present results suggest that megakaryocytic differentiation of blast cells in AMegL could be induced by IFN-alpha and beta 2 and support a clinical role for them in the treatment of AMegL patients. Also, the present results showed that monocytic differentiation of blast cells in AMegL could be stimulated by IFN-gamma, supporting the multipotent stem or progenitor cell origin of the AMegL subtype of acute myelogenous leukaemia.

Aged↗
PubMed1995

17p anomalies in lymphoid malignancies: diagnostic and prognostic implications.

Eighteen patients with lymphoid malignancies and abnormalities of the short arm of chromosome 17 were evaluated, in order to analyse whether this anomaly was associated with a particular subgroup of lymphoid malignancies. The patients suffered from acute lymphoblastic leukemia, high-grade non-Hodgkin's lymphoma or plasma cell leukemia. No 17p anomaly was found in any patient with chronic lymphocytic leukemia or low-grade non-Hodgkin's lymphoma. In four cases the aberration of the short arm of chromosome 17 was the sole cytogenetic abnormality, in fourteen patients additional chromosomal aberrations were found. Five out of 18 cases were Burkitt's lymphoma/leukemia showing the typical rearrangement of 8q24. In cases with a karyotype evolution the 17p anomaly was always a late event. Concerning the clinical outcome of the patients with abnormalities of the short arm of chromosome 17 eight of nineteen patients died within 90 days after the diagnosis of the 17p anomaly only three were alive at the last follow up (26 months to 40 months after diagnosis of a 17p aberration). Rearrangements of 17p, especially as secondary cytogenetic events, seem to be associated with a poor clinical outcome in lymphoid malignancies.

Adolescent↗
PubMed1995

A new fibroblast growth stimulating activity from the human megakaryoblastic leukaemia cell line ELF-153: in vitro and in vivo findings.

Although the exact mechanism for the progression of myelofibrosis in acute megakaryoblastic leukaemia is unclear, certain humoral factors released from the proliferating megakaryoblasts that are unable to store these factors in their defective alpha-granules, including platelet derived growth factor (PDGF), fibroblast growth factors (FGF), platelet factor-4 (PF-4), transforming growth factor-beta (TGF-beta) and beta-thromboglobulin, could result in increased collagen synthesis by bone marrow fibroblasts. Recently, the human megakaryoblastic leukaemia cell line MEG-01 has been shown to produce both TGF-beta and PF-4 which have enhanced the growth of bone marrow fibroblasts. Therefore, we have examined the presence of a fibroblast growth stimulating activity and the humoral factors that might be responsible for it in the supernatant of the human megakaryoblastic leukaemia cell line ELF-153 recently established in our laboratory from a patient with acute myelofibrosis. A new fibroblast growth stimulating activity has been identified in the supernatant of the ELF-153 human megakaryoblastic leukaemia cell line that is independent of the percentage of fetal calf serum in NRK-49F fibroblast agar clonogenic assays and is not due to any of the known fibroblast growth stimulating humoral factors including PDGF, epithelial growth factor, TGF-alpha or beta, tumour necrosis factor-alpha, interleukin-1, 2, 4 or 6, FGF, fibronectin, PF-4 and factor VIII AG. Also, in vivo, subcutaneous injection of ELF-153 megakaryoblastic leukaemia cells into nude mice formed, in three out of the five mice after 6 weeks, subcutaneous tumours with a very rigid texture whose histological examination revealed dense infiltration by blast cells and pronounced reticular fibrosis. Immunohistochemistry demonstrated exclusive deposition of collagen III in the extracellular matrix whereas laminin and collagen IV were absent.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Arab population data on the PCR-based loci: HLA-DQA1, LDLR, GYPA, HBGG, D7S8, Gc, and D1S80.

Allele and genotype frequencies for seven polymerase chain reaction (PCR)-based DNA genetic markers were determined in an Arab sample population. The loci analyzed were HLA-DQA1, LDLR, GYPA, HBGG, D7S8, Gc and D1S80. Results were obtained from the first six loci using the AmpliType HLA-DQ alpha DNA and AmpliType PM PCR Amplification and Typing Kits. The VNTR locus D1S80 PCR product was analyzed by polyacrylamide electrophoresis and silver staining. All loci meet Hardy-Weinberg expectations. The frequency data can be used in forensic analyses and paternity tests to estimate the frequency of a DNA profile in the Arab population.

Alleles↗
PubMed1995

[Prenatal diagnosis of spontaneous thrombosis of the umbilical artery during the third trimester of pregnancy. Two cases with surviving infants].

Thrombosis of the umbilical artery was diagnosed in utero in two cases at the echography examination performed during the third trimester of gestation. The infants were born live and in good health. This is the first report of such antenatal diagnosis. The lack of prospective studies hinder the evaluation of fetal morbidity and mortality. Nevertheless, umbilical artery thrombosis is a high risk obstetrical situation since the potential risk of another thrombus in the second umbilical artery would lead to fetal death in utero. Careful monitoring is required with extraction of the fetus as soon as term allows or whenever the elements compromise fetal development.

Adult↗
PubMed1995

[CT angiographic imaging of atypical arterial blood supply to the liver by the superior mesenteric artery].

Variations of the celiac trunk are seen in 25-35% of all patients. In 10-12% the right hepatitic artery arises from the superior mesenteric artery, the left hepatic artery in 4-5%. An aberrant origin of the common hepatic artery is seen in about 2.5%. We report about a patient with liver cell adenoma, in whom we diagnosed preoperatively the atypical origin of the common hepatic artery by performing CT angiography in the MIP technique (MIP = Maximum Intensity Projection). Conventional angiography as well as intraoperative findings confirmed the diagnosis.

Adenoma, Liver Cell↗
PubMed1995

G-CSF in the long-term treatment of cyclic neutropenia and chronic idiopathic neutropenia in adult patients.

Eleven adult patients with chronic neutropenia have been treated with recombinant human granulocyte colony-stimulating factor (G-CSF). Seven patients had idiopathic sporadic neutropenia, 2 idiopathic congenital neutropenia and 2 cyclic neutropenia. Treatment was started with 3 micrograms/kg s.c. daily and was modified according to response. All patients had a rapid increase of neutrophils. The cycle length shortened from 21 to 14 days in patients with congenital cyclic neutropenia. Doses required for maintenance ranged from 0.1 to 8 micrograms/kg. One patient with idiopathic sporadic neutropenia recovered after 151 days with an absolute neutrophil count (ANC) of > 2000/microliters and had no need for further treatment. The overall efficacy of the treatment was good with abrogation of severe infections. Treatment has been continuously given to a maximum of 4.5 years. No loss of efficacy was observed during long-term treatment. There was no evidence for lineage drain or stem cell exhaustion with prolonged treatment. Cytogenetic analyses in seven of eleven patients did not reveal the development of abnormal cell-clones. G-CSF is safe and efficient in long-term treatment of adult patients with chronic neutropenias.

Adult↗
PubMed1994

Growth and differentiation of the human megakaryoblastic cell line (ELF-153): a model for early stages of megakaryocytopoiesis.

ELF-153 is a cell line that has been established from a patient with a poorly differentiated acute myeloid leukemia associated with an acute myelofibrosis. A majority of cells had a blast morphology with the phenotype of a myeloid hematopoietic progenitor, ie, CD34+, CD33+, CD13+, HLA-DR+, but CD38-, and the remaining cells (5% to 10%) expressed platelet restricted proteins such as CD41, CD42, CD36, CD61, and von Willebrand factor; some of them were polyploid (up to 32N) and exhibited demarcation membranes and alpha granules. No erythroid or other lineage-specific markers were detected. Proliferation of ELF-153 cells was highly stimulated by interleukin-3 (IL-3) and granulocyte-macrophage colony-stimulating factor and to a lesser extent by stem cell factor and IL-6. In contrast, the cell line did not respond to erythropoietin, leukemia inhibitory factor, IL-7, IL-11, granulocyte colony-stimulating factor, and basic fibroblast growth factor. ELF-153 cells could be separated by flow cytometry into three discrete cell populations (CD34+/CD61-, CD34+/CD61+, and CD34-/CD61+) with different proliferative and endomitotic properties corresponding to distinct stages of the mega karyocyte (MK) differentiation. This MK differentiation, which involved a minority of ELF-153, could be increased in the presence of 5-azacytidine and phorbol ester, but could not be significantly modified by growth factors. By contrast, cytochalasin B dramatically induced polyploidization without differentiation. It is noteworthy that association of 5-azacytidine to cytochalasin B dramatically induced the production of polyploid MK cells. To understand the molecular mechanisms underlying this MK differentiation, the expression of GATA-1 and GATA-2 was investigated in subpopulations of ELF-153. A high level of GATA-1 and GATA-2 mRNA was only present in the CD61+ cells. Therefore, these two transactivating factors may play an important role in the MK differentiation of ELF-153. We conclude that ELF-153 might be an important tool to investigate the mechanisms by which transcription factors control differentiation of MK progenitors.

Acute Disease↗