PubMed Health⌕ Search

Biomedical subjects

S A Evensen

Publications and source records attributed to S A Evensen.

At least 37 records · Page 2Linked to original sources
PubMed1994

Characterization of CD34+ peripheral blood cells from healthy adults mobilized by recombinant human granulocyte colony-stimulating factor.

Primed peripheral blood hematopoietic stem cells (PBSC) generate and sustain lymphohematopoiesis in myeloablated animals, and recent reports indicate that allogeneic transplantation using PBSC grafts may be feasible in humans. A major concern with the use of PBSC transplants is that permanent engraftment may be limited because of lack of sufficient numbers of primitive progenitor cells in the graft. In the present study, in vitro colony formation and immunophenotype of CD34+ cells in PB of healthy adults during short-term granulocyte colony-stimulating factor (G-CSF) administration were compared with that of CD34+ cells in normal bone marrow (BM). The number of CD34+ cells mobilized to PB peaked at day 4 or 5 of G-CSF administration. The phenotypic profile of CD34+ PB cells showed a substantial increase in the percentage of CD34+CD13+ and CD34+CD33+ cells (myeloid progenitors) and a corresponding decrease in the percentage of CD34+CD10+ and CD34+CD19+ cells (B lymphoid progenitors) compared with CD34+ BM cells. The other subsets studied, including CD34+CD38- and CD34+HLA-DR- cells, were present in both compartments in similar proportions. Furthermore, primed CD34+ PB cells were enriched for colony-forming cells (CFC) and displayed an increased clonogenicity when compared with their counterparts in BM. A comparison between a postulated PBSC graft and an average BM graft is presented, showing that such PBSC grafts will be enriched for CD34+ cells as a whole, CD34+CD33+ cells, and colony-forming cells (CFC), factors which have been shown to correlate to acceleration of hematologic reconstitution and reduction in requirements for supportive care in autografting. Hence, we predict that allogeneic transplantation using G-CSF-primed PBSC grafts will result in a more rapid hematologic reconstitution after myeloablative conditioning than BM grafting. The question of whether PBSC allografting will result in permanent engraftment and clinical benefits as observed in autografting has to be determined in prospective clinical studies.

ADP-ribosyl Cyclase↗
PubMed1994

[Infusion of hematopoietic stem cells from the blood. Simpler and better than bone marrow transplantation?].

Infusion of haematopoietic stem cells, either autologous or allogeneic, allows treatment of malignant diseases with marrow ablative doses of cytostatics or whole body irradiation. Hospitalization and general anaesthesia is necessary for bone marrow harvesting, while the harvest of peripheral stem cells may be performed without hospitalization. Mobilization of haematopoietic stem cells from the bone marrow to peripheral blood, followed by cytapheresis and harvesting of the stem-cell containing fraction is a promising alternative to the harvest of marrow. We have tried this in one patient with advanced acute myeloid leukaemia and discuss our experience and that of others.

Blood Transfusion, Autologous↗
PubMed1994

[Progress in the treatment of hairy cell leukemia. Subcutaneous administration of 2-chloro-deoxy-adenosine for 7 days].

Hairy cell leukemia is a rare chronic B-lymphocyte malignancy characterized by pancytopenia, splenomegaly, immunological abnormalities and morphologically typical neoplastic mononuclear cells in blood and bone marrow. Until recently the disorder was treated with splenectomia and/or alpha-interferon. Intravenous infusion of 2-chloro-deoxy-adenosine (2-CdA) is a new and efficacious treatment principle making hairy cell leukemia a potentially curable disease. A Nordic cooperative study is currently examining the effects of 2-CdA given subcutaneously for seven days. 19 Norwegian patients are included so far, with encouraging results. The long-term effect of 2-CdA is not yet known. The high remission frequency, the short duration of the treatment and the few side effects make this drug a natural first choice in treating hairy cell leukemia.

Adult↗
PubMed1994

Estimated 8-year survival of more than 40% in a population-based study of 79 adult patients with acute lymphoblastic leukaemia.

We report 11 years experience with a modified version of a chemotherapy programme in use at the MRC Leukaemia Unit from 1982 to 1984, supplemented by allogeneic bone marrow transplantation in first relapse or second or later remission from 1985. 79 consecutive patients aged 15-60 years with newly diagnosed acute lymphoblastic leukaemia (ALL) were given induction chemotherapy. This included a standard DAT course (daunorubicin, cytarabine and thioguanine) applied as in acute myelogenous leukaemia approximately midway in the induction programme. A 3-year rotating maintenance programme consisted of combinations of cytotoxic drugs used in the induction therapy. CNS prophylaxis did not include CNS irradiation. Allogeneic BMT was not performed in first remission. The overall complete remission (CR) rate was 82% (65/79). 26 patients relapsed (seven first in the CNS). Seven patients underwent allogeneic BMT of whom six are alive and well with a mean observation time of 32 months (range 4-99 months) after transplantation. Three patients died in first CR. Estimated 5- and 8-year overall survival was 51% (95% confidence interval (CI) 39-63) and 47% (CI 33-61). For patients who reached CR, the corresponding figures were 63% (CI 50-76) and 57% (CI 41-73). Estimated disease-free survival in the remitters was 54% (CI 40-68) at 5 years and 44% (CI 28-60) at 8 years. Patient age below 25 years and white cell count below 15 x 10(9)/l at presentation were both found to improve the chance of overall survival.

Adolescent↗
PubMed1994

Synovectomy for haemophilic arthropathy: 6-21 years of follow-up in 16 patients.

OBJECTIVES: To assess the efficacy of synovectomy in reducing recurrent haemarthroses and joint pain in patients suffering from haemophilic arthropathy. Moreover, to study whether synovectomy could improve joint mobility or postpone progression of joint destruction. DESIGN: A retrospective study was conducted addressing joint-related symptoms and findings, and the need of orthopaedic surgery during follow-up. SETTING: Oslo Sanitetsforenings Rheumatism Hospital/The National Hospital, the National Centre for Orthopaedic Surgery for approximately 180 Norwegians suffering from severe congenital coagulation deficiencies. SUBJECTS: Twelve patients with haemophilia A, two patients with von Willebrand's disease and two patients with factor VII deficiency in which 21 synovectomies (nine knees, six ankles and six elbows) were performed. MAIN OUTCOME MEASURES: Joint pain, joint mobility, frequency of haemarthroses and radiographic joint scores at follow-up were compared to preoperative figures, and the number of joints in need of total joint replacement or arthrodesis was evaluated. RESULTS: Synovectomy proved efficacious in reducing recurrent haemarthroses and joint pain in all patients. The total range of motion was not improved, but correction of extension deficiency of the knee was accomplished. The progression of arthropathy was not arrested by synovectomy as judged by the radiographic assessment; and in four patients arthroplasty of the knee, and in two patients arthrodesis of the ankle, had been performed. A major wound haemorrhage and subsequent wound rupture was seen in one patient who developed high-titred neutralizing antibodies to factor VIII. CONCLUSIONS: Synovectomy for haemophilic arthropathy is safe and efficacious in reducing recurrent haemarthroses and joint pain. Synovectomy should not be performed to improve joint mobility. The progression of the arthropathy is not arrested, and subsequently many patients will be candidates for arthroplasty or arthrodesis.

Adolescent↗
PubMed1993

[Prioritizing in hospital departments].

A framework for decision-making is introduced in which two out of five patients will be denied treatment. Certain resource constraints are accepted in this hypothetical example. The authors' own ranking of five patients from a department of internal medicine are presented. It was not difficult to select the highest prioritized patients. However, ranking of the remaining patients revealed considerable controversy. Emphasis is therefore laid on the reasons given for each ranking. An interesting finding is that variations in awarding priority to some cases are clearly based on disagreement about facts, not values. The article concludes by suggesting a classification of selection criteria for priority setting based on a distinction between necessary, controversial and unacceptable criteria. The article is presented in an attempt to stimulate a debate about priority setting in everyday hospital work.

Decision Making↗
PubMed1993

[Allogeneic bone marrow transplantation in adult patients with serious hematological diseases 1985-1992].

We present updated results from allogeneic bone marrow transplantation in adult patients who received transplants between 1985 and 1992. Of 47 patients, 36 where disease-free survivors 8-93, mean 32 months after transplantation. Of these, seven had received marrow from unrelated donors. The present treatment capacity is insufficient to cover the demand for allogeneic bone marrow transplants for Norwegian patients.

Adolescent↗
PubMed1993

Knee arthroplasty in hemophilia. 5-12 year follow-up of 15 patients.

Between 1979 and 1987, 15 knee arthroplasties were performed in 15 Norwegians with congenital disorders of blood coagulation. 10 patients with a median follow-up of 7 (5-12) years had an almost painless joint, without hemorrhage. Flexion contractures were corrected, but total range of motion was not improved. There was a radiolucent zone at the bone-cement interphase of the tibial stem in 2 knees. The placement of the implants was correct and the alignment not changed. There were no fractures. 1 prosthesis had been removed because of a chronic infection. 4 patients had died. We conclude that arthroplasty can be safely performed with excellent relief of pain and improvement of function in patients with congenital disorders of blood coagulation.

Adult↗
PubMed1992

[Kasabach-Merritt syndrome. A differential diagnosis in thrombocytopenia].

The Kasabach-Merritt syndrome consists of hemangioma in association with thrombocytopenia and localized consumption coagulopathy. It is primarily a disease of childhood, but may be seen in adult patients too. When untreated, it involves considerable risk of mortality. Two adult patients are described. The disease can be cured by surgery. We discuss different options for treatment when surgery is not feasible.

Diagnosis, Differential↗
PubMed1992

[New therapeutic possibilities for acquired clonal blood diseases and myelodysplasia].

Examples of patients are used as a basis for discussing the treatment of severe aplastic anaemia with clonal chromosomal aberrations in haematopoietic cells, the aplastic form of paroxysmal nocturnal haemoglobinuria and myelodysplasia, with allogeneic bone marrow transplantation. Transplantation with marrow from an HLA-identical sibling donor has curative potential in selected patients with these disorders. The procedure should preferably be carried out before the patients have received massive treatment for the complications of marrow failure. The use of matched unrelated bone marrow donors is still at the investigation stage.

Adult↗