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Biomedical subjects

R Marra

Publications and source records attributed to R Marra.

At least 19 recordsLinked to original sources
PubMed1994

Sequential peripheral blood progenitor cell transplantation after mobilization with salvage chemotherapy and G-CSF in patients with resistant lymphoma.

We enrolled 18 patients affected by refractory or relapsed lymphoma (HD, NHL) in a two-step protocol that included salvage chemotherapy with mitoxantrone, carboplatinum, methylprednisolone, and cytosine arabinoside (MiCMA) plus G-CSF (5 micrograms/kg/day), peripheral blood progenitor cell (PBPC) collection, and subsequent transplantation after BUCY2 regimen. After MiCMA chemotherapy, four patients (22%) achieved complete response, eight patients (44%) obtained a partial response, and six showed progression of disease (PD). Fourteen out of 18 patients (78%) were considered eligible for PBPC transplantation. Three patients with complete response refused PBPCT; they are currently in continuous complete remission (CCR) at 15, 13, and 15 months, respectively. One patient has been recently transplanted but is too early to be evaluated. Ten patients so far completed the study, eight of whom are currently alive in CR, with a median follow-up of 7.5 months (range 2-13). Hematologic reconstitution was very rapid with a median time to achieve WBC > 1 x 10(9)/L, PMN > 0.5 x 10(9)/L, platelets > 50 x 10(9)/L and > 100 x 10(9)/L of 13 (range 9-15), 12 (range 9-14), 10 (range 0-22), and 14 (range 5-49) days, respectively. Our protocol is highly effective as a salvage treatment, while permitting PBPC collection after G-CSF administration. Hemopoietic reconstitution after transplantation of PBPCs collected with this procedure is complete, rapid, and sustained.

Adolescent↗
PubMed1992

Characteristics and health service utilization patterns of ventilator-dependent patients cared for within a vertically integrated health system.

OBJECTIVE: To describe the characteristics and service utilization patterns of long-term ventilator-dependent patients. DESIGN: Using medical records, a cohort of ventilator-dependent patients was identified and followed. SETTING: A vertically integrated healthcare system in southwestern Pennsylvania. PATIENTS: Forty-nine adults requiring prolonged ventilatory assistance. MEASURES: Demographics, admission date, admission diagnosis, discharge diagnosis, reason for ventilator dependency, level of care to which the patient was admitted, dates of all transfer orders, dates of all transfers between levels of care, discharge destination and subsequent readmissions. RESULTS: The major reason for long-term ventilator dependency was progressive debilitating disease of either a pulmonary or nonpulmonary nature. The mean length of stay within the system was 72.6 days +/- 42.55 (median = 59 days, range = 24 to 267 days). Patients had an average of 3.3 transfers +/- 2.53 within the system (median = 3, range = 0 to 10). No delays in transfer to lower levels of care were found. Health utilization variables were largely unrelated to reason for ventilator dependency. Almost half of the patients (n = 24 or 49.0%) died in the system. Patients who died in the system were significantly older than patients for whom discharge home was possible. CONCLUSIONS: Additional studies are necessary to describe the prevalence, etiology, health status and functional status of ventilator patients at all levels of care; the impact of different system approaches on patient well-being and cost of care; and the process of medical decision making. Economic analyses of costs and outcomes for ventilator-dependent patients using a cost-utility approach are also needed.

Acute Disease↗
PubMed1991

Apparent isolated skin relapse in acute monocytic leukemia. A case report.

A case of acute monocytic leukemia with an apparent isolated skin relapse is reported. The cutaneous involvement was associated with a morphological bone marrow remission but a cytogenetic relapse was present. Regression of the skin lesions was obtained with a protocol including daunoblastine, aracytin and thioguanine, but the patient relapsed and died a few months later without achieving another remission. The relation between cutaneous and medullary disease is discussed.

Adult↗
PubMed1991

Social images of suicide.

Emile Durkheim's analysis of historical attitudes of societies toward suicide led him to claim that (1) the social disapproval of suicidal conduct increased constantly from ancient times to the present; (2) such increased disapproval was generated by the growing emphasis put on the dignity and sacredness of the individual; (3) the condemnation of suicidal conduct was therefore essentially moral, and it expressed the strong reaction of the collective conscience against offenses to the cult of the individual. In this study we show that Durkheim's interpretation of the historical evidence is erroneous: not increasing condemnation of suicide, but rather tolerance or mild aversion is the typical social response to suicide. Also, when confronted with the historical evidence, Durkheim's claim that increased disapproval of suicide accompanied increased consideration for the dignity of the individual is shown to be unfounded. Our argument develops in four steps. First, we survey the historical evidence on views of suicidal conduct from classical times to the nineteenth-century; second, we present the moral statistics literature on suicide which flourished during Durkheim's lifetime; third, we analyze Durkheim's own theory of anomic suicide. In the conclusion we propose an alternative interpretation of the historical evidence on attitudes on suicide, and a different framework in which to highlight their significance in contemporary society.

Attitude↗
PubMed1990

Naltrexone for heroin addiction: encouraging results from Italy.

This report provides preliminary data regarding compliance rates of naltrexone (NTX) treatment for 99 consecutive heroin addicts. NTX was administered orally after a 3-13-day drug induction period. Fifteen out of the 99 patients who underwent naloxone challenge are still being treated (having taken NTX for less than 6 months to date). Of the 52 patients who completed the drug induction period, 22 (41.31%) showed satisfactory results (in terms of treatment compliance and/or opiate-free conditions at 6-month follow-up). The 52 patients who properly started regular NTX assumption stayed with the treatment for a mean 17.04 +/- 8.2 weeks. These results would demonstrate a higher than average success with NTX treatment of randomly selected heroin addicts with respect to the literature and would seem related to particularly favorable socio-cultural conditions in northern Italy (where the study was carried out).

Adult↗
PubMed1989

Inhibition by pertussis toxin of the soporific effects induced by stimulation of dopamine D2 autoreceptors in the ventral tegmental area in rats.

The behavioural and ECoG spectrum power effects of agonists at dopamine D2 autoreceptors, both after systemic or intracerebral administration, were studied in rats. It was shown that the bilateral injection of apomorphine or (+) 3PPP (0.1, 0.5 and 1.0 nmol for each compound) into the ventral tegmental area produced behavioural and ECoG sleep, accompanied by a statistically-significant increase in ECoG total spectrum power. These effects were completely antagonized by a pretreatment (24, 48 or 72 hr before) with pertussis toxin (0.34 and 3.4 micrograms), given into the same site. Similarly, behavioural sleep and an increase in ECoG total voltage power, produced by systemic administration of apomorphine (263 nmol/kg i.p.), were abolished by pertussis toxin (3.4 micrograms) injected bilaterally into the ventral tegmental area 24, 48 or 72 hr before. In conclusion, the present results suggest that behavioural and ECoG spectrum power effects, triggered by stimulation of dopamine D2 autoreceptors in the ventral tegmental area of rats, seem to be linked to the inhibition of adenylate cyclase activity through a Gi protein and or to other biochemical events linked to Gi proteins.

Adenylate Cyclase Toxin↗
PubMed1989

OKT4/OKT8 ratio in asymptomatic heroin addicts.

The OKT4 (helper) and OKT8 (suppressor) lymphocytic subpopulations were enumerated in a sample of 60 asymptomatic drug addicts and in 17 controls. No significant differences in the ratio could be found that could not be explained by the action of HIV. It can be concluded that heroin itself was not responsible for any alteration in the T4/T8 ratio in the population considered.

AIDS-Related Complex↗
PubMed1989

OAP combination in the treatment of elderly leukaemic patients with preexisting severe internal disease.

Sixteen elderly patients affected by acute non lymphoblastic leukaemia (ANLL) with a preexisting severe internal disease were treated with a low systemic toxicity drugs combination: OAP (Vincristine, Cytarabine and Prednisone). Complete remission was achieved in 5 patients (31%) after 2 OAP courses. The mean duration of remission was 18 weeks. Six patients were resistant to the therapy. Six patients died during the treatment: 5 in induction phase and 1 in consolidation phase. Even though the duration of remission was short we retain that OAP combination may be still considered a good therapeutical approach in elderly ANLL patients with associated severe internal disease.

Aged↗