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Biomedical subjects

S J Jubelirer

Publications and source records attributed to S J Jubelirer.

At least 19 recordsLinked to original sources
PubMed1999

Acute profound thrombocytopenia following C7E3 Fab (Abciximab) therapy: case reports, review of the literature and implications for therapy.

Platelets play a crucial role in the ischemic complications of percutaneous coronary procedures. The recent availability of C7E3 Fab (Abxiximab or ReoProtrade mark), a chimeric monoclonal antibody Fab fragment directed against the platelet glycoprotein IIb/IIIa receptor, has reduced abrupt closure and other adverse events and lessened the need for revascularization procedures. As the use for this drug has increased, rare cases of severe thrombocytopenia have been revealed. From August 1995 to June 1997, 452 patients at Charleston Area Medical Center who underwent percutaneous coronary revascularization procedures and were treated with abciximab were evaluated for the development of severe thrombocytopenia (i.e., platelet count less than 20,000 within 48 hr of treatment). A review of published reports of severe thrombocytopenia was also reviewed. A review of published reports of abciximab-induced severe thrombocytopenia, as well as our three cases, reveals that: 1) the incidence is less than 0.7%; 2) the nadir platelet count (range 1, 000-16,000) was noted within 2-31 hr after abciximab infusion; 3) the platelet count increases to greater than 100,000 within 12 days in all patients; 4) bleeding episodes were treated with platelet transfusion with an improvement in platelet count within 24 hr in all patients in whom they were given; and 5) in the one patient treated with gamma globulin alone, no significant rise in platelet count was noted. Acute severe thrombocytopenia can occur after ReoProtrade mark administration. Its development is not predictable and may occur within 2 hr of administration. Thrombocytopenia, therefore, requires consideration in every patient treated with this drug. It appears prudent to obtain a platelet count 2 hr after initiating ReoProtrade mark. If thrombocytopenia develops, then the drug can be stopped in a timely manner and platelet transfusion can be given.

Abciximab↗
PubMed1999

Conventional dose melphalan is inactive in metastatic melanoma: results of an Eastern Cooperative Oncology Group Study (E1687).

Despite reports that i.v. melphalan is active in the settings of conditioning regimens utilizing high-dose chemotherapy for autologous bone marrow transplantation and in isolated limb perfusion for the treatment of malignant melanoma, its activity at conventional doses has never been defined in this disease. We conducted a phase II study of conventional-dose i.v. melphalan (30 mg/m2) in 17 patients with metastatic melanoma. All patients were previously untreated with chemotherapy with performance status 0, 1 or 2. Forty-seven cycles were given with a median of two cycles. One patient was not evaluable due to early death. There were no responses in the 16 patients, resulting in a 0% response rate (95% confidence interval = 0-17%). We conclude that conventional-dose melphalan by i.v. administration has no appreciable activity in patients with metastatic malignant melanoma.

Adrenal Gland Neoplasms↗
PubMed1996

Assessment of knowledge, attitudes, and behaviors relative to cervical cancer and the Pap smear among adolescent girls in West Virginia.

BACKGROUND AND METHODS: Questionnaires assessing knowledge of, attitudes toward, and behaviors relative to cervical cancer and its prevention were administered to 279 tenth-grade girls. RESULTS: Eighty-four percent had heard of cervical cancer, and 83% had heard of the Pap smear. Sexual intercourse with multiple partners and cigarette smoking were risk factors identified by 65% and 40% of these students, respectively. Forty-eight percent reported being sexually active. This group, compared with those not sexually active, was more likely to 1) identify the Pap test as a test involving a vaginal examination, 2) use tobacco products, and 3) be exposed to tobacco smoke. The most common barriers to obtaining a Pap test reported by those sexually active were embarrassment (64%), pain/discomfort (57%), fear of cancer (27%), fear of parents discovering sexual activity (25%), and cost (13%). CONCLUSIONS: Based on the information obtained in this study, the authors recommend changes in school health programs that target adolescent girls: 1) risk factors and behavior should receive more emphasis, and 2) the pelvic examination and Pap test should be described in sufficient detail to address the issues of embarrassment, pain, and discomfort.

Adolescent↗
PubMed1995

The management of menopausal symptoms in women with breast cancer.

The symptomatic postmenopausal woman with breast cancer presents the clinician with a difficult task with respect to hormone replacement therapy (HRT). All of the published meta-analyses have been consistent in showing that there is a slightly increased risk of developing breast cancer in those patients using postmenopausal estrogens for greater than 10 years. However, there have been no published placebo-controlled clinical trials on the effects of HRT in women with a history of breast cancer. Quality of life must be balanced against the theoretical risk of tumor promotion. Assessment of osteoporotic and cardiac risk factors (i.e., smoking, hypertension, family history, hyperlipidemia) should influence the decision. Valid alternatives to estrogen replacement include low-dose progesterones such as Bellergal or vitamin E for hot flashes, and biphosphonates, calcium, anabolic steroids, and calcitonin for osteoporosis.

Breast Neoplasms↗
PubMed1994

Reading versus comprehension: implications for patient education and consent in an outpatient oncology clinic.

Written educational materials and consent forms are often given to patients with little regard for their ability to read them. Nationwide sampling and data from the 1990 census suggest that 10% of U.S. adults are functionally illiterate. In this study, 100 adult patients (64 female, 36 male) seen consecutively in an oncology clinic were tested for reading vocabulary (RD-VOCAB) and reading comprehension (RD-COMP) using the Woodcock-Johnson Psychoeducational Battery. The mean grade levels of education (last grade completed), reading vocabulary, and reading comprehension of all participants were 12.5, 11.3, and 10.5, respectively. The discrepancy between the grade level of education and RD-COMP varied by age, the largest discrepancies being found in the 30-39 (three grades) and 60-69 (2 1/2 grades) age groups. After controlling for educational level, it was found that the mean grade level of RD-COMP was statistically lower than educational level. Statistically assuming all subjects to have completed high school, the mean levels of RD-COMP ranged from ninth grade in the 30-39 age group to twelfth grade in the 40-49 age group. This study underscores the fact that the health professional cannot assume that a patient who has completed a certain grade level in school can read at the corresponding level. Consent forms and other health education materials should be written at least three grade levels lower than the average educational level of the target population.

Adolescent↗
PubMed1994

The value of prostatic specific antigen in prostate cancer screening in the community.

At a one-day screening for prostate cancer in 1991, a urologist evaluated 142 men ages 50 years-84 years (mean: 67 years) utilizing a digital rectal exam (DRE), serum prostatic specific antigen (PSA), and a detailed questionnaire. The 44 men with an abnormal DRE and/or PSA were recontacted by letter one year later to determine the outcome. By 12 months, 31 men (70%) with abnormal findings had seen a physician as recommended. Of the 13 men followed with abnormal DRE only, three were biopsied with no cancer found. Of the 11 with an elevated PSA only, six were biopsied and two had cancer. Of the men with both abnormal PSA and DRE, six were biopsied and two had cancer. Thus, after 12 months, the preliminary cancer detection rate was 2.8% for the entire study population, 22% for those with an elevated PSA, and 10% for those with an abnormal DRE. The results suggest that the use of PSA combined with DRE is a more efficient strategy for detecting prostate cancer than DRE alone.

Adenocarcinoma↗
PubMed1994

Results of cancer information assessment of high school students in West Virginia.

The "Just Say KNOW To Cancer" education program was implemented in public high schools in Kanawha County, W.Va., to assess students' knowledge of cancer risk factors and to provide an educational program about cancer prevention. An anonymous questionnaire was completed in two urban and six suburban schools by 1,235 students in their classrooms. The responses revealed that only 35% and 10% of students were able to identify two or more risk factors and one American Cancer Society warning sign, respectively. Tobacco was the most commonly identified risk factor, being listed by 64% of urban students, compared to 50% of suburban respondents (p < .001). Although 84% of all students correctly answered the question regarding the medical complications of smokeless tobacco, only 39% correctly answered the question relating second-hand smoke as a cancer risk factor. The results of this study indicate the need for cancer education in the high school health curriculum.

Adolescent↗
PubMed1993

Pilot study of ascorbic acid for the treatment of refractory immune thrombocytopenic purpura.

The treatment of corticosteroid- and/or splenectomy-refractory immune thrombocytopenic purpura (ITP) includes vinca alkaloids, immunosuppressives, Danazol, intravenous gammaglobulin, and alpha-interferon. However, these treatments have often been associated with toxic side effects. Brox et al. (Br J Haematol 70:341-344, 1988) reported the efficacy of ascorbic acid in the treatment of ITP; the platelet count normalized in seven of 11 patients studied, and tolerance was excellent. However, other investigators have reported less impressive results. These conflicting reports prompted a pilot study of ascorbic acid in 12 patients with refractory ITP. Patients were given 2 g every morning for at least 10 weeks. All have received glucocorticoids, three had undergone splenectomy, and six received other treatments. The maximal increase in platelet count above baseline (i.e., the prestudy platelet count) achieved was < 20,000 in 11 patients and 25,000 in one patient. Therapy was well tolerated, with only two patients complaining of dyspepsia. The results of this study suggest that ascorbic acid is not very effective in patients with refractory ITP.

Adrenal Cortex Hormones↗
PubMed1993

The changing pattern of early breast cancer and its primary management at CAMC.

To gauge the impact of screening mammography and the results of clinical trials on the pattern of primary surgical care of early breast cancer, tumor registry data from the Charleston Area Medical Center for 1980-81 was compared to tumor registry data at the hospital for 1990-91. Over the course of 10 years, there was a significant increase in the proportion of patients with T1 tumors (52% vs. 66%, p = .004), a significant increase of cases diagnosed by mammography alone (6% vs. 34%, p < .001), a significant decrease in the proportion of patients with positive axillary nodes (41% vs. 28%, p = .016), and a significant increase in the proportion of patients undergoing breast-sparing procedures (4% vs. 16%, p = .003). However, the percentage of breast-sparing operations at CAMC from 1990-91 was lower than the number reported in the National Cancer Data Base of 1988 (16% vs. 29%). A future study to assess reasons for patient selection of mastectomy or local excision is being planned.

Adult↗
PubMed1993

The use of modern radiologic methods in identifying incidental renal cell carcinoma.

The increased use of ultrasonography and computed tomography has made the incidental discovery of renal masses more common. With this factor in mind, the records of 109 patients with renal cell carcinoma diagnosed and treated at Charleston Area Medical Center (CAMC) between 1983 and 1990 were reviewed to determine how many cases were "incidentally diagnosed." Thirty-two (29 percent) of these patients had their renal cell carcinoma discovered incidentally; and of these tumors, 47 percent were Stage I and only 13 percent were Stage IV; for symptomatic patients, 22 percent were Stage I and 36 percent were Stage IV. This study also found that the classic triad of pain, hematuria and flank mass was present in only six of 109 patients (5.5 percent). Tumors found incidentally will usually be of lower pathological stage and may carry a better prognosis.

Carcinoma, Renal Cell↗
PubMed1993

An analysis of 38 cases of low-grade cerebral astrocytoma in adults.

We retrospectively reviewed 38 cases of low-grade non-pilocytic astrocytoma diagnosed at the Charleston Area Medical Center between 1957 and 1987. All patients underwent craniotomy (total resection in 8 and subtotal in 24) or stereotactic needle biopsy (6 patients). Twenty-eight patients (74%) received radiotherapy, 25 of whom received > or = 5,000 cGy. The median survival of all patients was 46 months and nine patients (24%) survived > or = 5 years. Patients under age 40 had a longer survival than those age 40 or older (59 months vs. 30.5 months, p < .05). There was no significant difference in mean survival between those who received and those who did not receive radiotherapy after incomplete surgical resection (49 months vs. 53 months, p = 1.00). Of the 29 deaths, 15 were due to malignant transformation to a high-grade glioma and 12 to recurrent low-grade glioma. Since the role of radiotherapy is unclear, it is important that patients with low-grade glioma participate in clinical trials.

Adult↗
PubMed1992

The Breast Cancer Prevention Trial (BCPT) in West Virginia.

Female breast cancer is a major medical problem with significant public health ramifications. During the next decade, more than 1.5 million women in the United States will be newly diagnosed with invasive breast cancer. The Breast Cancer Prevention Trial (BCPT) is an NIH-sponsored study which will determine whether long-term tamoxifen therapy is effective in: 1) Preventing invasive breast cancer, 2) Lowering the incidence of fatal and nonfatal myocardial infarction, and 3) Reducing the incidence of bone fractures. Sixteen thousand women, including at least 100 from West Virginia who are > or = 35 years of age at increased risk for breast cancer, will be randomized between placebo and tamoxifen during a two-year period. For each participant, the annual and lifetime probability of developing breast cancer will be estimated utilizing a computerized model of risk assessment. The placebo or tamoxifen will be administered for at least five years. Toxicity, compliance, monitoring of quality-of-life assessment, and lipid and lipoprotein evaluations are major components of this trial.

Adult↗
PubMed1992

Coronary artery bypass in two patients with immune thrombocytopenic purpura without preoperative splenectomy.

Two patients with severe coronary artery disease and idiopathic thrombocytopenic purpura underwent coronary artery bypass grafting without preoperative splenectomy. The patients' thrombocytopenia and bleeding were controlled with platelet transfusion alone. This report indicates that the use of cardiopulmonary bypass in patients with immune thrombocytopenia does not invariably mandate splenectomy, particularly in those in whom performance of a splenectomy may be associated with an increased risk of intraoperative cardiac morbidity.

Coronary Artery Bypass↗
PubMed1992

Multiple colonic polyps as the initial presentation of malignant melanoma.

A 72-year-old-man was admitted to the Charleston Area Medical Center with a one-month history of mild anemia and positive stools for occult blood. A prior UGI series, small bowel series, and barium enema were normal. A colonoscopy revealed 12 sessile, non-pigmented colonic polyps, two of which were removed and sent for histologic examination. The final pathology report revealed malignant melanoma. Physical examination revealed no obvious evidence of skin lesions or melanoma elsewhere. Subsequent staging, which included a chest X-ray, a CT scan of the abdomen and brain, UGI endoscopy, and bone scan revealed a metastatic disease. The colonic lesions regressed in response to combination chemotherapy, and the patient's transfusion requirement decreased. However, the patient died of brain metastases 10 months after the initial diagnosis. This case emphasizes the fact that: 1. Metastatic lesions of the gastrointestinal tract may be the initial manifestation of malignant melanoma and may occur in the absence of a clinically obvious lesion; 2. Colonic metastases may simulate simple polyps endoscopically, particularly if they are non-pigmented; 3. Biopsy and histologic examination of any colonic polyp is essential in patients with a prior history of melanoma; and 4. Regression of gastrointestinal lesions from melanoma and subsequent clinical improvement may occur in response to chemotherapy.

Aged↗
PubMed1991

Lung cancer in patients younger than 40 years of age.

The records of 52 patients younger than 40 years of age who had bronchogenic carcinoma diagnosed between 1965 and 1985 were reviewed. The preponderance of adenocarcinoma (54%), the lower male-female ratio in this age group compared with patients age 40 or older (2:1), the importance of cigarette smoking as a causative factor (80% of patients), the long mean duration of symptoms (5 months), and the high incidence of advanced stage at diagnosis (77% Stages III and IV) in these patients are findings similar to those reported in other published series. There was no significant difference in resectability (23% versus 19%), median survival length (5.3 months versus 6.9 months), median survival length of patients who had surgical resection (10.5 months versus 10.8 months), and 5-year survival rate (11.5% versus 6.3%) in these patients compared with a randomly selected group of 260 patients with lung cancer who were age 40 or older.

Adenocarcinoma↗
PubMed1991

Primary pulmonary hypertension. Its association with microangiopathic hemolytic anemia and thrombocytopenia.

Four patients with primary pulmonary hypertension, microangiopathic hemolysis, and thrombocytopenia were seen at the Charleston (WVa) Area Medical Center between 1983 and 1988. Characteristic laboratory and clinical features of these patients were the following: mild anemia, reticulocytosis, low serum haptoglobin value, microangiopathic red blood cell changes on peripheral blood smear, mild to moderate thrombocytopenia, normal clotting studies (ie, prothrombin time, partial thromboplastin time, fibrinogen), negative direct Coombs' test, negative glucose water test, normal serum urea nitrogen and creatinine levels, lack of improvement of hemolysis and thrombocytopenia in response to vasodilators or calcium channel blockers, and severe plexiform lesions in the pulmonary vasculature with fibrin deposition at autopsy. The hemolysis and thrombocytopenia probably developed as a result of flow through the fibrin deposition in the plexiform lesions in the pulmonary circulation and subsequent shearing of red blood cells and platelets.

Adult↗
PubMed1991

Hepatocellular carcinoma: a review of 30 years experience.

The clinical characteristics of 51 patients with hepatocellular carcinoma over a 30-year period were reviewed. Presenting symptoms commonly included abdominal pain (47 percent), anorexia (41 percent), and ascites (22 percent); however, the ability to make an early diagnosis was complicated by a variety of unusual symptoms accounting for 23 percent of presentations. While cirrhosis (41 percent) was a common associated finding, most patients (92 percent) had no prior diagnosis of liver disease. Histologic diagnosis was made by blind percutaneous biopsy (three performed, 100 percent positive), needle aspiration biopsy (four performed, 100 percent positive), laparotomy (26 percent, 85 percent positive), or autopsy (20). Only six of 51 patients underwent surgical resection. The overall median survival of 4.1 months and seven percent two-year survival in our series illustrates that thus far medical treatment is not helpful in prolonging life. Attempts to elucidate more effective systemic and regional therapy for established cases of hepatocellular carcinoma and attempts to reduce the incidence of the disease in high-risk populations through the use of hepatitis B vaccine are therefore advised.

Academic Medical Centers↗