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W Blumenfeld

Publications and source records attributed to W Blumenfeld.

At least 37 records · Page 2Linked to original sources
PubMed1988

Pneumocystis carinii in sputum. Comparable efficacy of screening stains and determination of cyst density.

To determine whether accurate quantification of Pneumocystis carinii cysts in sputum is possible using currently available means and to determine the optimal stain for screening sputum for P carinii, we undertook a comparative evaluation of readily available stains: (1) Diff-Quik, a stain that provides tinctorial detail comparable with Giemsa, (2) toluidine blue, and (3) silver methenamine on simultaneously thawed sputum samples containing P carinii. We also studied the Diff-Quik stain in combination with (4) toluidine blue and (5) silver methenamine. The three stains were comparable for screening purposes. Each disclosed similar numbers of P carinii aggregates on similarly prepared slides. Cysts were difficult to recognize on Diff-Quik due to the negatively staining character of the cyst wall with this stain. The cyst-wall stains, toluidine blue and silver methenamine, clearly stained the cyst wall. The combination of a cyst-wall stain with Diff-Quik allowed visualization of cysts, highlighted by the cyst-wall stain, and aggregate area, delineated by the Diff-Quik, allowing expression of number of cysts per aggregate area, a measure termed cyst density.

Animals↗
PubMed1988

Use of a monoclonal antibody to detect Pneumocystis carinii in induced sputum and bronchoalveolar lavage fluid by immunoperoxidase staining.

We evaluated the utility of a monoclonal antibody that recognizes Pneumocystis carinii as a diagnostic tool in specimens of bronchoalveolar lavage fluid and sputum from patients in whom a diagnosis of P carinii pneumonia was being considered. In addition to routine processing for diagnosis by morphologic recognition of P carinii on a Diff-Quik-stained specimen, the specimen was reacted with a monoclonal antibody to P carinii and visualized in an avidin-biotin horseradish peroxidase technique. Of 50 specimens evaluated, there was 94% agreement between results of conventional Diff-Quik staining and immunoperoxidase staining. Two Diff-Quik-positive specimens were negative by immunoperoxidase staining, and one Diff-Quik-negative specimen was positive by immunoperoxidase staining. These discrepancies are most likely attributable to random distribution of P carinii onto smears. The monoclonal antibody used in this study can accurately detect P carinii in induced sputum and bronchoalveolar lavage fluid specimens.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Successful treatment with aerosolized pentamidine of Pneumocystis carinii pneumonia in rats.

We examined both the therapeutic efficacy and tissue distribution of aerosolized pentamidine in immunosuppressed rats with Pneumocystis carinii pneumonia. In rats immunosuppressed by 5 weeks of pretreatment with dexamethasone, a 2-week course of 5 mg of aerosolized pentamidine per kg per day, administered free or encapsulated in the drug carrier system (liposomes), eradicated P. carinii pneumonia in 75% of treated animals. At this dose, extrapulmonary drug uptake as measured by a sensitive high-pressure liquid chromatography assay was negligible. No significant differences in tissue distribution were noted between aerosolized free and liposome-encapsulated pentamidine. In rats receiving dexamethasone for 6 weeks prior to treatment with pentamidine, both lung uptake and therapeutic efficacy of aerosolized pentamidine (5 mg/kg per day) were substantially reduced. Aerosolized pentamidine appears to be an effective therapy for P. carinii pneumonia in rats and produces significantly lower extrapulmonary drug deposition than parenteral administration. The severity of P. carinii involvement at the time of treatment influences both the level of drug delivery to the lung and the response to aerosolized pentamidine therapy.

Aerosols↗
PubMed1986

Trimethoprim-sulfamethoxazole or pentamidine for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A prospective randomized trial.

Forty patients with the acquired immunodeficiency syndrome (AIDS) and their first episodes of Pneumocystis carinii pneumonia were assigned at random to receive either trimethoprim-sulfamethoxazole or pentamidine isethionate. The two groups did not differ significantly in the severity of pulmonary or systemic processes at enrollment. Five patients treated initially with trimethoprim-sulfamethoxazole and one patient treated initially with pentamidine died during the 21-day treatment period (p = 0.09, Fisher's exact test). No significant differences were seen between groups in rates of improvement, pulmonary function tests, or 67Ga uptake by the lungs in the survivors at completion of therapy. Adverse reactions necessitated changing from the initial drug in 10 patients in the trimethoprim-sulfamethoxazole group and 11 in the pentamidine group. Minor reactions occurred in all patients. In patients with AIDS, trimethoprim-sulfamethoxazole and pentamidine do not have statistically significant differences in efficacy or frequency of adverse reactions.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Bronchoalveolar lavage and transbronchial biopsy for the diagnosis of pulmonary infections in the acquired immunodeficiency syndrome.

The efficacy of bronchoalveolar lavage and transbronchial biopsy in diagnosing lung infection was determined in 276 fiberoptic bronchoscopic examinations done on 171 patients with known or suspected acquired immunodeficiency syndrome. Of 173 pathogens (Pneumocystis carinii, cytomegalovirus, Mycobacterium avium-intracellulare, Cryptococcus neoformans, M. tuberculosis, Coccidioides immitis, and Histoplasma capsulatum) identified during the initial evaluation or in the subsequent month, the initial bronchoscopic examination detected 166 (96%). Bronchoalveolar lavage and transbronchial biopsy had sensitivities of 86% and 87%, respectively. When bronchoscopy included both bronchoalveolar lavage and transbronchial biopsy, the yield for all pathogens was 98% and the sensitivity for P. carinii infections was 100%. Follow-up for at least 3 weeks after examination failed to detect any additional false-negative results. Fiberoptic bronchoscopy is extremely accurate for the detection of pathogens in patients with the acquired immunodeficiency syndrome, especially when bronchoalveolar lavage and transbronchial biopsy are combined. In patients at high risk of complications from transbronchial biopsy, bronchoalveolar lavage is sufficiently accurate to be used alone.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Differential diagnosis of Kaposi's sarcoma.

The biopsies of all lesions clinically thought to be suspicious for Kaposi's sarcoma (KS) were reviewed over a 15-month period. A diagnosis of KS was made in 40 of 106 biopsies (38%). The cases in which a diagnosis other than KS was made included dermatofibroma, hemangioma, and scar. This second group comprised 59 of 106 cases (56%). A third group included some lesions that had an atypical vascular proliferation, but in which the changes were insufficient for a definite diagnosis of KS. The presence of abnormally shaped vessels, especially those classified as irregular, was the best single criterion to diagnose KS in its early stages. In later stages, the neoplasm assumes a nodular configuration with typical, slitlike vascular channels. At the periphery of such nodules dilated, irregularly shaped vessels similar to those of the early lesions are often seen. The histologic features which help in the diagnosis of KS from other histologic entities are reviewed.

Adolescent↗
PubMed1984

Autopsy findings in the acquired immune deficiency syndrome.

The medical records, premortem biopsy specimens, and autopsy materials from 36 patients with acquired immune deficiency syndrome (AIDS) were reviewed. The majority of the patients were homosexual men. Widely metastatic Kaposi's sarcoma was seen in eight patients, while tumor was confined to the skin in an additional ten. Four patients had high-grade lymphomas. Thirty-five of the 36 patients had at least one opportunistic infection at some point in the course of their illness. Many patients had multiple infectious agents. The most consistent and striking autopsy finding was a severe depletion of lymphoid tissues. Death in the majority (83%) of the patients was attributable to opportunistic infections affecting most commonly the respiratory tract (64%) and meninges (11%). Three patients (9%) died with widely metastatic Kaposi's sarcoma and secondary hemorrhage.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Use of the transbronchial biopsy for diagnosis of opportunistic pulmonary infections in acquired immunodeficiency syndrome (AIDS).

The authors used a method that includes Giemsa-stained touch preparations of a lung biopsy and culture of the same biopsy for viruses and microorganisms. The yield of etiologic agent diagnoses by this cytologic method was compared with yield from a simultaneous biopsy processed by usual histologic methods and stained by hematoxylin and eosin, silver methenamine, and other stains as necessary. Fifty-nine transbronchial biopsies and eight open lung biopsies were processed on 38 male patients with the clinical and laboratory features of acquired immunodeficiency syndrome (AIDS) to determine the etiology of their pulmonary disease. Pneumocystis carinii pneumonia was diagnosed in 16 patients. When sufficient material was available, the Giemsa-stained touch preparation agreed with the histologic examination. The touch preparation specimens were cultured, and seven of the patients with Pneumocystis carinii also had cytomegalovirus (CMV). Six additional patients had pulmonary CMV infection without evidence of Pneumocystis carinii pneumonia. Mycobacterial and fungal infections also were identified in these six patients. Sixteen patients had no specific diagnosis. With adequate material, their method provides reliable results and diagnosis within two to three hours of Pneumocystis carinii. In addition, it conserves the amount of specimen required, since the same material can be used for culture.

Acquired Immunodeficiency Syndrome↗
PubMed1983

Angioimmunoblastic lymphadenopathy with dysproteinemia in homosexual men with acquired immune deficiency syndrome.

Angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) is a well-described clinicopathologic entity that tends to occur in older persons. A recently described syndrome, the acquired immunodeficiency syndrome (AIDS), occurring predominantly in young homosexual men, shows considerable clinical overlap with AILD. We studied two cases clinically typical of AIDS in which lymph node biopsies revealed AILD.

Acquired Immunodeficiency Syndrome↗
PubMed1979

A chemotactic inhibitor produced by blast cells and present in the serum of a patient with acute lymphoblastic leukemia.

A chemotactic factor inhibitor (CFI) was found in the serum of a patient with acute lymphoblastic leukemia. The factor was characterized as heat-labile, with activity against complement-dependent chemotactic factors and against the chemotactic factor produced by Escherichia coli. Normal sera and sera from other patients with acute leukemia also demonstrate heat-labile inhibitory activity against complement-dependent chemotactic factors but not against the E. coli-derived chemotactic factor. Supernatants from cultured lymphoblasts of the patient also possessed CFI activity similar in character to that found in his serum. It is suggested that in vivo the lymphoblasts were responsible for the chemotactic defect observed in his serum, presumably by manufacturing and releasing a chemotactic factor inactivator.

Adult↗
PubMed1974

Use of the umbilical vein to study the splanchnic and portal beds in shock and trauma: II. Metabolic studies.

Perumbilical portal vein catheters and arterial and central venous catheters were inserted in 16 patients recovering from trauma or other shock-producing events, and in 5 patients who later developed shock. This permitted serial measurement of blood gases, pH, and the levels of ammonia, lactate and certain other metabolites in all three circulatory systems simultaneously. Nine of the trauma patients were never in shock, had no liver disease or injury and consequently formed a baseline group for comparison with the shock patients. In the shock patients there was a significant degree of hypoxemia in the portal venous blood and an increase in the arterialportal oxygen saturation difference. Their portal venous blood showed a lower pH and a higher pCO(2) than did the portal blood of the patients who had never been in shock. In 3 of the 4 shock patients who died, the total blood lactate showed a greater increase in portal venous than in the arterial or central venous blood. In shock there was also an increase in portal venous blood ammonia which was later accompanied by increments in arterial and central venous blood ammonia. This suggests impairment of hepatic urea synthesis, allowing escape of ammonia through the liver. These phenomena, when added to the finding previously reported of an elevated portal venous pressure in some shock patients, lend support to the hypothesis that in certain cases of shock there is increased impedance to flow of portal blood through the liver with resultant stasis in the portal-splanchnic bed and ischemichypoxic hepatocellular injury.

Abdomen↗