Biomedical subjects

M Hersh

Publications and source records attributed to M Hersh.

11 recordsLinked to original sources

PubMed1994

Thrombotic microangiographic hemolytic anemia in systemic lupus erythematosus.

Thrombotic microangiopathic hemolytic anemia (TMHA) is characterized by thrombocytopenia, microangiopathic hemolytic anemia, fever, neurological symptoms, and kidney involvement. It presents as thrombotic thrombocytopenic purpura (TTP) or hemolytic uremic syndrome (HUS). TMHA has been considered to occur only rarely in systemic lupus erythematosus (SLE). However, there has been an increase in the reporting of this association in recent years, and autopsy studies have suggested that TMHA may be underdiagnosed in SLE because of the similarity in symptoms. We report four patients with SLE-related TMHA and describe 24 more patients from a literature review. All patients were women, 50% had active SLE, 89% presented as TTP, and 11% presented as HUS. Those patients with active SLE had low complement levels. Antiphospholipid antibodies or lupus anticoagulant were positive in 5 of 8 cases. Patients treated with plasma infusions or plasmapheresis had a lower mortality rate at 25% compared with 57% mortality in patients who were not treated with plasma infusions or plasmapheresis. It is suggested that TMHA should be considered in any SLE patient presenting with neurological symptoms or renal failure associated with fever, hemolytic anemia, and thrombocytopenia. Early recognition and appropriate therapy with plasmapheresis may improve prognosis.

Adult↗

PubMed1994

An estimate of the prevalence of asthma and wheezing among inner-city children.

OBJECTIVE: To estimate the prevalence of asthma and wheezing unassociated with a diagnosis of asthma among inner-city children. DESIGN: Cross-sectional survey of a sample of Bronx households. METHODS: Random digit dialing telephone survey using parental report. SETTING: Bronx County, NY. PARTICIPANTS: 662 self-designated heads-of-household who reported for all children 0 through 17 years of age living in their households. MEASUREMENTS: Questions from the Child Health Supplement to the 1988 National Health Interview Survey and the International Union Against Tuberculosis and Lung Disease Bronchial Symptoms Questionnaire were used to estimate the prevalence of asthma and wheezing-related illness. RESULTS: Information was gathered on 1285 children. Of this sample, 184 (14.3%) were reported to have ever had asthma (cumulative prevalence) and 111 (8.6%) were reported to have asthma in the last 12 months (period prevalence). The asthma period prevalence rate among Bronx children was twice the United States rate (4.3%). Among children 0 through 11 years of age, the prevalence rate was similar for boys and girls, although among children 12 through 17 years of age, asthma was significantly more prevalent among boys. Fifty-four children (4.2%) were reported to have had wheezing in the past 12 months unassociated with a diagnosis of asthma (wheeze only). The cumulative, but not the period, prevalence rate of asthma differed significantly by income and race/ethnicity. The cumulative prevalence was significantly higher among Hispanics and children from the lowest income families. The prevalence of wheeze only (no reported history of asthma) was higher among whites (6.4%) and blacks (5.8%) than Hispanics (2.9%) (P < .1). The reported number of wheezing attacks and the average number of nights per week that sleep was disturbed by wheezing during the past year were similar for those with asthma and those with wheeze only, although severe attacks (wheezing severe enough to limit speech) were significantly more likely among those reported to have asthma (P < .001). The total asthma prevalence (period prevalence of asthma plus wheeze only) was 12.8% and was quite consistent across subgroups. CONCLUSIONS: These data suggest that the prevalence of asthma among inner-city children may be substantially higher than the rates for this group estimated from national survey data. Some proportion of the wheeze only group may represent undiagnosed, and thereby undertreated, asthma. Public health efforts directed at reducing asthma morbidity and mortality need to address the possibility that asthma prevalence is higher within inner cities and that a large number of children with asthma may be inadequately diagnosed and treated.

Adolescent↗

PubMed1993

Language in differential diagnosis of a teenage schizophrenic girl with aspects of multiple personality.

Diagnosis of a teenage schizophrenic girl showed many features of her language and behavior mimicked the presentation of a Dissociative Personality Disorder. These aspects were secondary to the primary schizophrenic disorder and treated via a multimodal approach combining pharmacotherapy, individual, family, and milieu therapy. Implications are drawn for tailoring verbal interventions to such overdetermined conditions.

Adolescent↗

PubMed1989

Phase I trial of echinomycin (NSC 526417), a bifunctional intercalating agent, administered by 24-hour continuous infusion.

Echinomycin was administered to 43 patients with advanced cancer in escalating doses ranging from 60 to 2128 mcg/m2. The dose-limiting toxicity of echinomycin administered as a 24-h continuous infusion every 28 days was nausea and vomiting beginning at the end of the 24 h infusion and lasting from 3 to 8 days. Other toxicities included sporadic thrombocytopenia and biochemical evidence of liver dysfunction characterized by elevations in SGOT. Peripheral vein phlebitis was noted in 100% of patients, and watery diarrhea of 24-48-h duration was noted in 7% of patients. The maximally tolerated dose of echinomycin was 2128 mcg/m2. The recommended dose for phase II trials utilizing the 24-h continuous infusion schedule is 1600 mcg/m2 repeated every 28 days with pretreatment antiemetics.

Adult↗

PubMed1986

Adhesion, spreading and fragmentation of human megakaryocytes exposed to subendothelial extracellular matrix: a scanning electron microscopy study.

Platelet agonists and subendothelial extracellular matrix (ECM) induce morphological and biochemical changes in animal megakaryocytes, reminiscent of the response of platelets to the same substances. We have examined the behavior of human megakaryocytes exposed for up to 36 hours to the ECM produced by cultured bovine corneal endothelial cells. By phase contrast and scanning electron microscopy these megakaryocytes demonstrated non-reversible adherence and flattening with formation of long filopodia, thus confirming that human megakaryocytes acquire platelet functional capacities. In addition, megakaryocyte fragmentation into prospective platelets was apparently induced by the ECM. Up to 50% of the adherent megakaryocytes underwent spontaneous fragmentation into small particles which individually reacted like platelets on the ECM. The interaction of the megakaryocytes with the ECM was specific since no adherence, flattening or fragmentation occurred upon incubation of the megakaryocytes on regular tissue culture plastic or glutaraldehyde fixed ECM. Thus we have demonstrated platelet like behaviour of human megakaryocytes in response to this physiological basement membrane and a possible role of the subendothelium in platelet production which may occur in vivo as megakaryocytes cross the sinusoid walls and enter the blood stream.

Animals↗

PubMed1985

A phase I and pharmacokinetic comparison of hepatic arterial and peripheral vein infusions of bisantrene for liver cancer.

Bisantrene (NSC-337766) was administered to five patients with cancer of the liver (one case of hepatocellular carcinoma, two of metastatic carcinoma of unknown primary, two of metastatic colorectal carcinoma). Under fluoroscopic guidance, percutaneous hepatic venous catheters were placed in five patients and percutaneous hepatic arterial catheters in four. A fifth patient's hepatic arterial catheter was implanted at laparotomy. Hepatic plasma flow was estimated by the Fick principle using peripheral vein indocyanine green infusion. On the first day of treatment, patients received a 2- or 4 h hepatic arterial infusion of bisantrene (130 mg/m2); peripheral venous, hepatic arterial, and hepatic venous timed blood samples were drawn during and for 18 h after drug infusion. On the second day of treatment, 2- or 4 h peripheral vein infusion of bisantrene (130 mg/m2) was followed by the same blood sampling schedule. Patients were followed weekly for toxicity. Four patients received only one course of treatment, while a fifth received two courses. All patients experienced leukopenia (median nadir 2400/mm3; range 1400-2700/mm3). Two patients developed fever after drug infusion. No antitumor responses were observed. Plasma bisantrene concentrations were measured by HPLC. Pharmacokinetic analyses are reported for four patients. The hepatic extraction ratio ranged from 15% to 49%, hepatic plasma clearances were 0.029-0.353 1/min/m2; peripheral vein areas under the concentration-time curve during hepatic arterial infusion ranged from 35% to 50% of peripheral vein areas under the curve during peripheral vein infusion. We conclude that hepatic arterial bisantrene infusion offers only modest pharmacokinetic advantage to the target organ or to the systemic circulation over peripheral vein infusion.

Aged↗

PubMed1984

Phase I clinical investigation of 9-beta-D-arabinofuranosyl-2-fluoroadenine 5'-monophosphate (NSC 312887), a new purine antimetabolite.

9-beta-D-Arabinofuranosyl-2-fluoroadenine 5'-monophosphate (NSC 312887) is a new purine antimetabolite that has been evaluated in a Phase I clinical trial. The schedule of administration consisted of a single i.v. infusion over a period of 30 min once each day for 5 consecutive days, repeated at 4-week intervals. Thirteen patients received 30 courses of the drug in a dose range of 18 to 40 mg/sq m/day. Granulocytopenia and thrombocytopenia were dose limiting. Repeated courses produced similar degrees of granulocytopenia, but in 7 of 7 patients receiving 2 or more courses, the degree of thrombocytopenia was less severe during the first than during subsequent courses. Myelosuppression in humans was more severe than predicted from the mouse model. Lymphopenia was profound at all dose levels, but reversed within 3 weeks. Somnolence occurred during infusion in 8 of 13 patients, but quickly cleared after the infusion was completed. The infused drug was rapidly dephosphorylated in plasma and then cleared so there was no cumulation of drug in plasma when it was rapidly infused once each day in these doses. Phase II studies of 9-beta-D-arabinofuranosyl-2-fluoroadenine 5'-monophosphate are planned at a starting dose of 18 mg/ sq m/day for patients with prior chemotherapy or radiotherapy and 25 mg/sq m/day for those without prior therapy, as a single dose on each of 5 consecutive days repeated at 21- to 28-day intervals.

Adenocarcinoma↗

PubMed1984

Effects on human peripheral lymphocytes of in vivo administration of 9-beta-D-arabinofuranosyl-2-fluoroadenine-5'-monophosphate (NSC 312887), a new purine antimetabolite.

9-beta-D-Arabinofuranosyl-2-fluoroadenine-5'-monophosphate (NSC 312887) (2-F-ara-AMP) is a new purine antimetabolite with documented preclinical activity against a number of animal tumors. Data from in vitro studies and preclinical animal toxicology trials indicated that 2-F-ara-AMP might be lymphocytotoxic. We studied effects of 2-F-ara-AMP on peripheral lymphocytes of patients receiving the agent in a Phase I clinical trial. Eleven patients received 13 courses given by i.v. bolus daily for 5 days. Mononuclear cells were isolated, and lymphocyte subsets were quantitated by immunofluorescence and flow cytometry 1 day before treatment and 4 hr after the final infusion. Lymphocytopenia developed rapidly (median time to nadir, 6 days) and was reversible. Standard leukocyte counts, differential counts, and percentages of isolated mononuclear cells reactive with monoclonal antibodies were used to calculate numbers of peripheral cells in each major lymphocyte subpopulation. Total T-lymphocyte counts fell during all treatment courses, with calculated mean absolute T-cell counts decreasing by 90%. Decreases were observed in all major T-lymphocyte subsets. By contrast, calculated B-lymphocyte counts decreased an average of 50% and were noted to increase during two treatment cycles. We also compared in vitro recoveries of cells from each major lymphocyte subpopulation before and after administration of 2-F-ara-AMP. Recoveries of total mononuclear cells, total T-cells, and non-T-, non-B-cells all were reduced substantially by 2-F-ara-AMP, but B-cell recovery was not reduced. These in vivo data, the first in human subjects, are in agreement with in vitro studies of halopurine nucleotide analogues which have demonstrated that T-cells are more sensitive than are B-cells to the cytotoxic effects of these compounds.

Adult↗

PubMed1984

Lead poisoning in a West Bank Arab Village.

Eleven patients from the West Bank village of Es-Sawiyeh were admitted with lead poisoning to two Jerusalem hospitals between November 1982 and January 1983. They all belonged to several households of a single large family. Colicky abdominal pains were present in five patients, weakness in four, behavioral changes ranging from irritability to frank psychosis in four, and paralysis in one. Anemia of various degrees was seen in all patients. Basophilic stippling and reticulocytosis were encountered in all patients with moderate to severe anemia. Therapy with edetate disodium calcium and penicillamine resulted in clinical improvement in all patients. A preliminary survey of 270 subjects in the same village disclosed 84 subjects with abnormally elevated blood lead levels, 17 of whom had grade IV lead burden according to the Centers for Disease Control risk classification. Contamination of homemade flour by lead used for stabilizing the metal parts of stone mills was the source of poisoning. As the method of milling in many West Bank villages is similar, these findings may have important implications to the well being of a large section of the rural West Bank population.

Adolescent↗

PubMed1983

[Lead poisoning].

Explore the source record for details and available documents.

Adolescent↗

PubMedDate not supplied

A rare bone tumor in an unusual location: osteoblastoma of the vertebral body.

Most osteoblastomas involve the posterior elements alone, or both the posterior elements and the vertebral bodies. Osteoblastomas confined in the body of the vertebrae are very rare. Spinal osteoblastomas are associated with localized pain in about 80% of cases and neurological deficits in 25% to 50% of cases. Nearly half of lumbar and thoracic osteoblastomas demonstrate coexistent scoliosis with the convex side away from the involved side of the vertebrae.

Adult↗