High-tech transference: overcoming obstacles in the application of knowledge.
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Biomedical subjects
Publications and source records attributed to S Penchas.
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Peripheral blood mononuclear cells (PBM) isolated from 23 patients with acute lymphoblastic leukemia (ALL) and 24 with acute non-lymphoblastic leukemia (ANLL) were studied for binding and mobility of Concanavalin A (Con A) receptors, using fluorescent Con A (F-Con-A). The cap forming ability of PBM from all patients was 18.7 (+/- 9.3%) and 18.9 (+/- 9.9%) for ANLL patients at the time of diagnosis or during relapse. During clinical complete remission the cap forming ability of the PBM did not change significantly. No correlation was observed between the percentage of blasts present in the peripheral blood at the time of examination and the extent of cap formation, for both types of leukemia. The pattern of F-Con-A binding to PBM in ANLL patients was different compared to that seen in ALL. In ANLL, the fluorescent stain was concentrated in a round body on the cell ("button form") after binding to the membrane, while the rest of the cell showed almost no fluorescence. The present results indicate that PBM cells from patients with acute leukemia are characterized by a high degree of Con-A receptor mobility.
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The ability to diagnose severe chronic fetal distress-impending death utilizing the six different definitions of decreased fetal movement (DFM) currently in use, was evaluated retrospectively in 616 high-risk pregnant women. The study reveals the superiority of two definitions as prognostic tools: The "movements alarm signal" (MAS), i.e. no fetal movements (FM) for at least 12 hours with audible fetal heart beats, and "ten and less FM" (less than or equal to 10 FM), i.e. ten or fewer FM in 12 hours. The application of these definitions distinguished two groups of patients which included significantly more poor outcomes than were contained by the groups of patients based on the other definitions. MAS was the definition also selecting the group with fewest false-positive cases. The monitoring of FM while utilizing one of the above two definitions of DFM as cut-off points for suspected impending fetal death is a useful adjunct in high-risk pregnancy management.
The Coulter counter, model S Plus, Provides a platelet count and a mean platelet volume in all routine specimens of blood for cell count. The value of mean platelet volume in the prediction of the haemostatic potential of thrombocytopenic patients was investigated in 175 patients with haematological disorders who underwent 1473 blood counts over five months. Eighty-four haemorrhagic episodes were detected, most in thrombocytopenic patients. The mean platelet volume of patients with haemorrhagic tendency was significantly lower (5.52 +/- SD 0.7 fl) than that of patients without these tendencies (7.87 +/- SD 1.75 fl) (p less than 0.001). In cases of severe thrombocytopenia (less than 20 x 10(9)/1 platelets) haemorrhagic episodes were frequent; however, the frequency of bleeding was considerably lower in cases in which the mean platelet volume was higher than a suggested cut-off point of 6.4 fl. Discriminant analysis selected mean platelet volume as more important than platelet count for prediction of haemorrhagic state in severe thrombocytopenia. In view of the useful discrimination that mean platelet volume provides between thrombocytopenic patients who bleed and those who do not bleed, it may serve as a guide to predict the danger of haemorrhage and the need for prophylactic platelet transfusion.
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During the years 1971-1974, ambulatory ECG monitoring (AEM) during everyday activities was done in 888 consecutive subjects. Half of them were patients who suffered from chronic ischemic heart disease (IHD), while in the others no symptoms or signs of this disease were found. Ventricular arrhythmias (VA) were detected in 196 subjects of the former and in 190 of the latter group. The Bureau of Statistics provided information concerning the individuals who died before December 31, 1976, the cause of their death and whether or not the death occurred in hospital or was 'sudden'. We found that during the follow-up period, the rate of sudden cardiac death among the patients with IHD in whom AEM detected VA was higher than in subjects without VA. In the former group, there were 12 sudden cardiac deaths among 196 patients, while in the latter there were only 4 out of 248, a statistically significant difference. Sudden cardiac death was more frequent in individuals without IHD if AEM disclosed VA (4 sudden cardiac deaths among 190 subjects), as compared to individuals without VA (no sudden cardiac deaths among 254 subjects).
The data available for 338 cases of splenectomy in agnogenic myeloid metaplasia published since 1940 were retrieved from the literature and analyzed. The median survival of cases operated upon at an early stage of the disease (as judged by their hemoglobin level, platelet number, and splenic size) was compared with the survival reported in conservatively treated patients diagnosed at an early stage of agnogenic myeloid metaplasia. Survival time since diagnosis of patients with early splenectomy was similar to, or shorter than, that reported in conservatively treated patients with early agnogenic myeloid metaplasia.
The immune system of 69 asymptomatic HBsAg carriers with normal liver function tests was evaluated. B cell function, as documented by serum immunoglobulin levels, number of mouse rosette-forming lymphocytes and lymphocyte reactivity to staphylococcal protein A, was intact. On the other hand, T cell function was markedly impaired. This was manifested by a significant decrease in E rosette-forming lymphocytes, an increase in stable rosette-forming cells and decreased reactivity to phytohaemagglutinin and concanavalin A. These data rule out the possibility that the immunological aberrations associated with hepatitis B infection are secondary to liver injury. The abnormal immune state either precedes the viral infection, thus predisposing to the acquisition of a carrier state or, alternatively, is a direct result of the infection.
A study of 90 asymptomatic hepatitis B surface antigen (HBsAg) carriers in Jerusalem showed a predominance of males over females (4:1) and of North African Jews over Jews of European or American Origin. The predominance of males remained apparent, but was not significant, when origin was controlled. Possible sources of infection were contact with jaundiced patients (29%), dental treatment (58%) and drug addiction (8%). Fifty-one percent had hepatitis B core antibody (anti-HBc) of the IgM class, 2% had hepatitis B e-antigen (HBeAg), 94% hepatitis B e-antibody (anti-HBe) and 93% had hepatitis A antibody (anti-HAV). Fourty-two percent had donated blood at least once prior to the detection of the carrier state. Fifty-five percent of 128 asymptomatic family contacts had evidence of hepatitis B virus infection. Minor abnormalities in liver function tests were found in 22% of the carriers and splenomegaly in 11%. Of ten liver biopsies performed in these cases, one had chronic active hepatitis, five had minimal histological changes, and four were normal.
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The available data of 338 cases of splenectomy in agnogenic myeloid metaplasia (AMM) published since 1940 were retrieved from the literature and analysed. There were no marked differences between male and female patients as to their survival since splenectomy, since the time of diagnosis or since the onset of the manifestations of AMM. Cardiac and thromboembolic complications caused death in 26% of the male patients, but only in 16% of the females, while hemorrhage and infections were more common causes of death among women. Leukemia developed in 11% of the males and in 6% of the female patients.
The appearance and gradual progression of atrioventricular (A-V) block in the presence of the Wolff-Parkinson-White (WPW) syndrome is an intriguing phenomenon. The vast majority of the reports up to date describe persistence of preexcitation in the face of partial or complete heart block. We describe a patient with severe coronary artery disease, in whom WPW disappeared suddenly, transiently at first, during coronary bypass surgery, and then permanently, probably as a result of an acute myocardial infarction, and in whom all the sinus beats during relentlessly progressive heart block were conducted through the normal A-V conduction system only.
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The available data on 321 published cases of splenectomy in agnogenic myeloid metaplasia were reviewed. Anaemia and thrombopenia were the most common indications for this operation. Patients reported after 1940 had a median postoperative survival of 13 months. Their postoperative mortality was 7.5% after 2 d and 25.7% after 3 months. The postoperative mortality was significantly higher when the weight of the spleen exceeded 2000 g, or in patients with platelet count less than 70 X 10(9)/l. The most common causes of death were infections (34.4%), cardiac or thromboembolic events (26.4%) and haemorrhage (17.6%). Leukaemic transformation was reported in 11.2% of the cases.