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Biomedical subjects

R Greenstreet

Publications and source records attributed to R Greenstreet.

17 recordsLinked to original sources
PubMed1983

Randomized controlled trial of transfer factor in Stage II malignant melanoma.

Thirty-six patients with Stage II malignant melanoma were randomized to no further therapy or transfer factor (TF) following surgical removal of all evident disease. Eighteen patients received TF, and 18 were in the surgery only group. Median disease-free intervals were 12.0 and 10.0 months, and survival, 40.8 and 27.0 months, respectively. Nine TF patients and four control patients remain alive. These differences were not statistically significant, and no adjuvant effect of TF could be demonstrated.

Adult↗
PubMed1983

Therapeutic trial of cryofiltration in patients with rheumatoid arthritis.

Cryofiltration, a new technique for on-line plasma separation and its treatment by cold filtration, enables the selective removal of immune complexes and eliminates the need for replacement proteins. Fifteen patients with rheumatoid arthritis were treated for nine to 10 consecutive sessions over a three- to five-week period. Circulating immune complexes decreased by an average of 78 percent and rheumatoid factor by 32 percent. This was accompanied by significant clinical improvement in morning stiffness, articular index, 50-foot walking time, grip strength, and target joint circumference. Cryofiltration might thus be beneficial for a subgroup of rheumatoid arthritis patients in whom conventional therapy has failed.

Arthritis, Rheumatoid↗
PubMed1983

A controlled randomized double-blind study of antilymphoblast globulin in cadaver renal transplantation.

Herein are presented the results of a controlled prospective randomized double-blind evaluation of antilymphoblast globulin as an immunosuppressive adjunct to azathioprine and prednisone in cadaver renal transplantation. There were 31 patients and 36 patients randomly assigned to therapeutic and control groups, respectively. ALG-treated patients experienced no major side-effects, a delayed onset of rejection following transplantation (P less than .005), a reduced total number of rejection episodes (P less than .05), fewer days in the hospital (P less than .05), a reduced cost of transplantation (P less than .02), improved graft survival (P less than .05), and patient survival equivalent to that of the control group. These data indicate that ALG is safe, cost-effective, and of immunologic benefit in cadaver renal transplantation.

Adult↗
PubMed1983

Low-dose maintenance prednisone and antilymphoblast globulin for the treatment of acute rejection. A steroid-sparing approach to immunosuppressive therapy.

The purpose of this prospective randomized trial was to evaluate an immunosuppressive protocol involving reduced maintenance and antirejection steroid dosages in cadaver renal transplantation. The study comprises 23 first cadaver graft recipients who experienced an acute rejection episode. All patients received an initial 14-day course of antilymphocyte globulin (ALG) and azathioprine 1.5 to 2.0 mg/kg/day. In 11 patients (group 1), a low maintenance dose of prednisone (30 mg/day) was administered and first rejection episodes were treated with a second 10-day course of ALG. The remaining 12 patients (group 2) received high maintenance doses of prednisone (2 mg/kg/day with tapering) and intravenous methylprednisolone (IVMP) for first rejection episodes. Subsequent rejections in both groups were treated with high doses of steroids. In group 1, all first rejection episodes were reversed with ALG alone, 6 patients experienced no subsequent rejection, and 10 patients currently have a functioning graft. In Group 2, the first rejection episode was reversed with IMVP alone in 10 patients; in two patients in whom IVMP therapy was unsuccessful, ALG was then administered, and subsequent rejection reversal was effected. In group 2, 4 patients experienced no subsequent rejection, and 9 patients currently have a functioning graft. Patients in group 1 received significantly lower (P less than .01) cumulative steroid doses in the first six months following transplantation, which resulted in a reduced number of major infections, as compared with patients in group 2. We conclude that the steroid-sparing regimen of low maintenance prednisone and ALG for first rejection is as effective immunologically as the established high steroid protocol.

Antilymphocyte Serum↗
PubMed1982

Failure of positive end-expiratory pressure to decrease postoperative bleeding after cardiac surgery.

To determine whether the application of positive end-expiratory pressure (PEEP) in the postoperative period after cardiac operation would reduce postoperative blood loss, the number of transfusions required, or the rate of reoperation for bleeding, we conducted a prospective study of 83 patients who underwent elective coronary revascularization. These patients were randomly assigned to receive either PEEP (10 cm H2O) or no PEEP (zero end-expiratory pressure). All other aspects of their care were identical. There was no statistically significant reduction in the amount of bleeding in patients treated with PEEP at 8 or 24 hours postoperatively. There was no significant difference in hematocrit between the groups preoperatively or postoperatively. There was no statistically significant difference in the number of reexplorations for bleeding. Finally, there was no significant difference between the groups in the amount of blood administered. On the basis of our results, we conclude that the application of PEEP in the postoperative period of cardiac operation did not reduce the amount of blood loss, the need for reexploration for bleeding, or the blood requirements in this group of patients.

Cardiac Surgical Procedures↗
PubMed1982

Long-term results of renal transplantation in recipients with a functioning graft for 2 years.

The late results of renal transplantation are reviewed in 214 recipients with a functioning allograft for 2 years. Graft survival was better (P less than 0.001) in living related recipients (t 1/2 = 17 years) compared with cadaver graft recipients (t 1/2 = 7.7 years). Graft survival was also significantly different (P less than 0.001) in patients with a 2-year serum creatinine level of less than or equal to 2.0 (t 1/2 = 16.4 years), 2.1 to 3.0 (t 1/2 = 6.5 years), or greater than 3.0 mg/dl (t 1/2 = 2.9 years). A greater proportion of patients with a 2-year serum creatinine level of greater than 3 mg/dl had experienced greater than two rejection episodes (P less than 0.0001). Among recipients with a 2-year serum creatinine level of less than or equal to 2.0 mg/dl, living related grafts achieved better graft survival than cadaver grafts (P less than 0.05). Major complications of transplantation were more common in patients with a cadaver graft, 2-year serum creatinine level of greater than 3 mg/dl, or age greater than 45 years. One hundred and forty-two patients are currently alive, 93% of whom have achieved complete rehabilitation.

Adolescent↗
PubMed1981

Reactions to contrast media: testing the CNS hypothesis.

Sodium iothalamate was injected intravenously into mice to test the hypothesis that reactions to contrast media are controlled by the central nervous system. Particular emphasis was placed on (a) the effect of the limbic portion of the brain on the hypothalamus and (b) the outflow through the autonomic nervous system. Diazepam and hexamethonium significantly affected the LD50; in addition, in comparison trials with control mice, they markedly decreased the death rate (p < 0.0005). High doses of methylprednisolone sodium succinate, given every 6 hours before the contrast medium, had no effect.

Animals↗
PubMed1981

Pruritus of cholestasis treated with plasma perfusion.

Patients with uncontrollable pruritus secondary to cholestatic liver disease were subjected to plasma perfusion in an attempt to remove the toxins responsible for this symptom. The improvement in the degree of pruritus was dramatic and surprisingly long-lasting in five of six patients. One patient had a response more difficult to evaluate. Serum bile acids levels fell in all patients in whom pruritus improved but not in the patient who responded less favorably.

Adult↗
PubMed1979

Prognostic factors affecting remission, remission duration, and survival in adult acute nonlymphocytic leukemia.

The medical records of 94 consecutive patients with acute nonlymphocytic leukemia (ANLL) were reviewed to identify significant prognostic factors. The data were analyzed using 1) Cox's linear hazard and linear logistic models, 2) chi-square comparison of the groups living longer than 2 years and those living less than 2 years, and 3) the Gehan-Breslow test of equal survival curves. The only statistically significant finding was that the presence of promyelocytic cell type and complete remission correlated with increased survival (p less than .05), but this was negated by the small number of patients with this cell type. There was a suggestive association between higher initial hemoglobin and survival (p = .09). The Gehan-Breslow test revealed a possible difference in survival between those patients more than 51 years of age and those less than 51 (p = .10). Thus none of the commonly accepted prognostic factors in acute nonlymphocytic leukemia was definitely shown to be useful. The findings of this study support an aggressive approach toward all patients with this disease.

Adolescent↗
PubMed1978

The effect of two different renal preservation methods on canine renal allograft survival.

Preservation of human cadaver kidneys for transplantation has been achieved primarily by two methods, hypothermic pulsatile perfusion with cryoprecipitated plasma and cold storage with an electrolyte solution. It has been suggested that pulsatile perfusion results in an increased antigenicity of the transplanted kidney. To investigate the possibility that pulsatile perfusion causes changes which may accelerate allograft rejection, machine preservation was compared with simple cold storage. The kidneys were preserved by either one of the two methods for 6 or 24 hours followed by allotransplantation in nephrectomised dogs. No immunosuppressive drugs were given. Kidneys which were allografted without undergoing any preservation (0 hrs) had a mean survival time of 10.4 +/- 1.7 days (n =5). Kidneys preserved by machine perfusion for 6 and 24 hours survival for 9.6 +/- 1.4 (n = 5) and 10.9 +/- 1.3 (n =9) days respectively. The mean survival time for simple cold storage for 6 and 24 hours was 9.3 +/- 1.3 (n =7) and 12.0 +/- 1.9 (n =6) days. Our findings suggest that in kidneys exposed to minimal warm ischaemia there is no significant difference between the two methods of preservation on renal allograft survival for the time intervals tested.

Animals↗
PubMed1975

Correlation of blood pressure with skinfold thickness and protein levels.

To plan prospective studies of obesity and hypertension, we measured skinfold thickness, weight, blood pressure, and protein fractions in 920 children who were divided according to age, sex, and race. Correlations between measurements were calculated within each of these groups. Children aged 10, 11, and 12 years had direct correlations between diastolic blood pressure and serum albumin level, but inverse correlations between diastolic blood pressure and alpha-globulin level as well as inverse correlations with alpha-globulin level. These correlations did not occur in similar children aged 8, 9, and 10. Although diastolic blood pressure correlated with skinfold thickness in all groups, there was no correlation between skinfold thickness and serum protein levels.

Adolescent↗
PubMedDate not supplied

Influence of estrogen receptor status on response to combination chemotherapy for recurrent breast cancer.

To determine the influence of cytoplasmic estrogen receptor (ER) status on response to chemotherapy among patients with recurrent breast cancer amenable to biopsy, we studied 65 patients who had ER determinations performed on metastatic lesions. The response to combination chemotherapy and duration of survival were determined in 49 of these patients who receive cytotoxic chemotherapy as their sole modality of treatment. Compared to patients with ER levels less than 3 femtomols/mg, patients with an ER concentration greater than or equal to femtomols/mg had a higher response rate (57% vs 21%, P less than 0.05) and a longer survival (35 vs 13 patients was attributable to response to subsequent hormonal manipulations. These differences between ER-positive and ER-negative patients were lessened by redefining ER-positive as greater than 10 femotomols/mg. Nevertheless, at our institution patients with ER-positive metastatic breast cancer have a higher response rate to chemotherapy and survive longer than their ER-negative counterparts.

Antineoplastic Agents↗