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Li X, Gong J, Feldman E, Seiter K, Traganos F, Darzynkiewicz Z. Apoptotic cell death during treatment of leukemias. Leuk Lymphoma 1994; 13 Suppl 1:65-70. [PMID: 8075583 DOI: 10.3109/10428199409052678] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The apoptosis-associated DNA strand breaks were detected in situ, in individual leukemic cells in peripheral blood and bone marrow of over 110 patients with different types of leukemia (ALL, AML, CML in blastic crisis, APL), prior to and during routine chemotherapy. The DNA strand breaks were labeled with digoxigenin- or biotin-conjugated dUTP in the reaction catalyzed by exogenous terminal deoxynucleotidyl transferase, and the cells, counterstained for DNA, were analyzed by bivariate flow cytometry. The proportion of cells with DNA strand breaks prior to therapy, most likely reflecting spontaneous apoptosis, varied from 0.1 to 16%, but in the large majority of cases was below 3%. Administration of drugs of different classes, which included DNA topoisomerase I (Topotecan) and II (mitoxantrone, VP-16) inhibitors, antimetabolite (ara-C) or microtubule poison (Taxol), all triggered the appearance of cells with extensive DNA breakage, typical of apoptosis, to up to 80%. The peak of the response, measured as maximal percent of cells with DNA strand breaks, which varied between individual patients by as much as factor 10, was generally seen between 8 to 24 h after the initial administration of DNA topoisomerase inhibitors, and somewhat later (48-72 h) during the response to Taxol or ara-C. Thus, the data show that the response to treatment with a variety of drugs, in terms of induction of apoptosis, can be conveniently measured by the present method. The prognostic value of the apoptotic index, before, as well as during treatment, is being estimated for each type of leukemia, in the ongoing prospective studies.
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Lubs HA, Rabin M, Feldman E, Jallad BJ, Kushch A, Gross-Glenn K, Duara R, Elston RC. Familial dyslexia: genetic and medical findings in eleven three-generation families. ANNALS OF DYSLEXIA 1993; 43:44-60. [PMID: 24233984 DOI: 10.1007/bf02928173] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In addition to providing information on the inheritance of dyslexia, the present study of eleven three-generation families has provided a unique opportunity to compare affected and unaffected family members at all ages. The data presented here are based on pedigree information, a questionnaire administered to all participating family members in relation to sex ratio, handedness, the severity of dyslexia by sex, pre- and perinatal complications, medical complications, years of education and earning ability, and a battery of standardized tests to define the presence or absence of dyslexia. The pattern of inheritance was consistent with the postulated autosomal dominant mode of inheritance and penetrance was found to be > 90 percent. Of 73 individuals determined to have a gene leading to dyslexia, seven were classified as obligate carriers and six as compensated adults who had no current symptoms or diagnostic evidence of dyslexia. The sex ratio (1.06) was not different from the expected ratio of 1.04. Left-handedness, major pre- and perinatal complications, and autoimmune disorders and allergy were not more common in dyslexics than non-dyslexics. The number of years of education and average income were similar in affected and unaffected family members. Compensated adults and obligate carriers were similar to unaffected family members in each of these parameters.
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Kushch A, Gross-Glenn K, Jallad B, Lubs H, Rabin M, Feldman E, Duara R. Temporal lobe surface area measurements on MRI in normal and dyslexic readers. Neuropsychologia 1993; 31:811-21. [PMID: 8413902 DOI: 10.1016/0028-3932(93)90130-r] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In a neuroanatomical study of dyslexia, measurements were made of the superior surface of the temporal lobe (SSTL) on MRI scans in a sample of 17 dyslexics and 21 non-dyslexic subjects. Both anterior and posterior halves of the SSTL area showed significant leftward asymmetry in non-dyslexics, but showed symmetry in dyslexics. The total SSTL area showed greater leftward asymmetry in non-dyslexics than in dyslexics. The dyslexics also revealed a significant correlation (r = 0.69, P = 0.005) between Woodcock-Johnson Passage Comprehension scores and posterior SSTL asymmetry, such that those with higher scores had more leftward asymmetry. This suggests that among dyslexics the direction of SSTL asymmetry may serve as a risk factor and/or a marker for the severity of reading comprehension problems.
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104
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Rabin M, Wen XL, Hepburn M, Lubs HA, Feldman E, Duara R. Suggestive linkage of developmental dyslexia to chromosome 1p34-p36. Lancet 1993; 342:178. [PMID: 8101276 DOI: 10.1016/0140-6736(93)91384-x] [Citation(s) in RCA: 113] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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105
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Soon-Shiong P, Feldman E, Nelson R, Heintz R, Yao Q, Yao Z, Zheng T, Merideth N, Skjak-Braek G, Espevik T. Long-term reversal of diabetes by the injection of immunoprotected islets. Proc Natl Acad Sci U S A 1993; 90:5843-7. [PMID: 8516335 PMCID: PMC46819 DOI: 10.1073/pnas.90.12.5843] [Citation(s) in RCA: 201] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The intraperitoneal injection of insulin-producing islets immunoprotected by an alginate-poly(amino acid) membrane is a potential method of reversing diabetes without the need for lifelong immunosuppression. Previous attempts to demonstrate this technology in large animals have failed, preventing application in humans. We have determined that key factors responsible for these past failures include cytokine (interleukins 1 and 6 and tumor necrosis factor) stimulation by mannuronic acid monomers from alginate capsules with weak mechanical integrity, which results in fibroblast proliferation. With this insight, we formulated mechanically stable microcapsules by using alginate high in guluronic acid content and report prolonged reversal of diabetes in the spontaneous diabetic dog model by the intraperitoneal injection of encapsulated canine islet allografts. Euglycemia, independent of any exogenous insulin requirement, was noted for up to 172 days. Graft survival, evidenced by positive C-peptide release, was noted for as long as 726 days in a recipient receiving a single injection of immunoprotected islets. Histological evidence of viable islets retrieved from the peritoneal cavity 6 months posttransplant confirmed the biocompatibility and immunoprotective nature of this capsule formulation. The finding that intraperitoneal injection of alginate-immunoprotected islets, a minimally invasive surgical procedure, is effective in prolonged (> 1 year) maintenance of glycemic control, without the need for lifelong immunosuppression, may have significant implications for the future therapy of type I diabetes in humans.
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106
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Jouet M, Feldman E, Yates J, Donnai D, Paterson J, Siggers D, Kenwrick S. Refining the genetic location of the gene for X linked hydrocephalus within Xq28. J Med Genet 1993; 30:214-7. [PMID: 8474107 PMCID: PMC1016302 DOI: 10.1136/jmg.30.3.214] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The most common inherited form of hydrocephalus, X linked hydrocephalus (HSAS), is characterised by mental retardation, adducted thumbs, and spastic paraplegia. Genetic analysis has mapped the locus for HSAS to subchromosomal band Xq28 within a region of approximately 2 megabases of DNA. In order to refine the location of the disease gene we have conducted genetic linkage analysis with Xq28 marker loci in four additional HSAS families. A lod score of 4.26 with polymorphic marker DXS52 (St14) confirms the linkage of HSAS to Xq28. Identification of a recombination event between the HSAS gene and Xq28 loci F8C and DXS605 (2-19) reduces the size of the interval likely to contain the disease locus to about 1.5 megabases, the distance between DXS605 and DXS52. The locus for neural cell adhesion molecule, L1CAM, maps within this interval and therefore represents a candidate gene for HSAS.
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107
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Feldman E, Levin BE, Lubs H, Rabin M, Lubs ML, Jallad B, Kusch A. Adult familial dyslexia: a retrospective developmental and psychosocial profile. J Neuropsychiatry Clin Neurosci 1993; 5:195-9. [PMID: 8508038 DOI: 10.1176/jnp.5.2.195] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study investigated the developmental, demographic, educational, and psychosocial outcome of 36 adults with third-generation familial dyslexia. Control subjects were 44 unaffected age-matched family members. Compared with control subjects, those with familial dyslexia 1) had similar incidences of perinatal complications, left-handedness, and right-left confusion but reported more early speech/language problems; 2) performed worse in reading and spelling but had similar educational achievement; 3) were more likely to report depression/anxiety symptoms and to have attention-deficit disorder with hyperactivity; and 4) were similar in medical history, marital stability, and mean income. Data suggest that, despite continued isolated reading deficits, carefully selected subjects with adult familial dyslexia do not show the previously described downward course of the learning-disabled population.
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Kantarjian HM, Smith T, Estey E, Polyzos A, O'Brien S, Pierce S, Beran M, Feldman E, Keating MJ. Prognostic significance of elevated serum beta 2-microglobulin levels in adult acute lymphocytic leukemia. Am J Med 1992; 93:599-604. [PMID: 1466355 DOI: 10.1016/0002-9343(92)90191-d] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Elevated serum beta-2 microglobulin (beta 2M) levels are associated with poor prognosis in several lymphoproliferative disorders including multiple myeloma and lymphoma. Their prognostic relevance in acute lymphocytic leukemia (ALL) is unknown. We analyzed the associations of serum beta 2M levels at diagnosis with pretreatment characteristics and with prognosis in adult ALL. PATIENTS AND METHODS One hundred fifty-nine adults with newly diagnosed ALL were investigated. Serum beta 2M levels were determined at diagnosis, on fresh peripheral blood samples, using a radioimmunoassay, the Pharmacia beta 2 Micro RIA (Pharmacia Diagnostics, Uppsala, Sweden). Statistical correlations were assessed by standard methods, and further independent prognostic value of serum beta 2M was determined by multivariate analysis. RESULTS Patients with beta 2M levels of 4.0 mg/L or above had a lower complete response rate (61% versus 80%; p = 0.02), a significantly worse survival (p < 0.01), and a significantly higher association with development of central nervous system (CNS) leukemia (p < 0.01). High beta 2M levels were more common among patients with older age, with elevated creatinine, bilirubin, and alkaline phosphatase levels, with low albumin levels, and with B-cell disease. Multivariate analysis for survival indicated the beta 2M level to be an independent prognostic variable (after adjusting for pretreatment creatinine level and age). The evaluation of beta 2M levels within low- and high-risk groups for CNS disease suggested an association of elevated beta 2M levels with a worse incidence of CNS disease in the high-risk patients. CONCLUSION Monitoring serum beta 2M levels may provide significant prognostic information in adults with ALL and should be included in their pretreatment evaluation. Its importance in childhood ALL requires investigation.
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Soon-Shiong P, Feldman E, Nelson R, Heintz R, Merideth N, Sandford P, Zheng T, Komtebedde J. Long-term reversal of diabetes in the large animal model by encapsulated islet transplantation. Transplant Proc 1992; 24:2946-7. [PMID: 1466008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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110
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Feldman E, Arlin Z, Ahmed T, Mittelman A, Puccio C, Chun H, Cook P, Baskind P. Homoharringtonine is safe and effective for patients with acute myelogenous leukemia. Leukemia 1992; 6:1185-8. [PMID: 1434802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Homoharringtonine (HHT) is a cephalotaxine alkaloid with reported efficacy in acute myelogenous leukemia (AML). In a phase II trial, we evaluated HHT 5 mg/m2 by continuous infusion daily for 9 days in patients with relapsed or refractory acute leukemia and blastic phase of chronic myelogenous leukemia (BLCML). Sixty-six patients were entered. There were 40 males and 26 females with a median age of 41 years (range 15-81). Of 43 patients with relapsed AML, seven achieved a complete remission (16%, 95% confidence interval 5%-27%). Although 11 patients with AML primarily resistant to an anthracycline/cytarabine combination did not respond, two of three patients primarily resistant to low-dose cytarabine achieved complete remission. No patients with acute lymphoblastic leukemia, biphenotypic leukemia, or BLCML responded. Hypotension during the administration of HHT was the most difficult toxicity encountered, requiring multiple interruptions of therapy in several patients and the administration of intravenous saline. Fluid retention and weight gain occurred in 29% of patients. Transient asymptomatic hyperglycemia was observed in 63% of patients. Other toxicity was mild and included nausea and vomiting, diarrhea, mucositis, hepatic dysfunction, and cardiac arrhythmias. As expected, severe myelosuppression occurred in all patients. HHT is well tolerated, but with unique problems associated with administration. It has demonstrable efficacy in pre-treated patients with AML, but its role in the treatment of this disease remains to be defined.
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Soon-Shiong P, Feldman E, Nelson R, Komtebedde J, Smidsrod O, Skjak-Braek G, Espevik T, Heintz R, Lee M. Successful reversal of spontaneous diabetes in dogs by intraperitoneal microencapsulated islets. Transplantation 1992; 54:769-74. [PMID: 1440841 DOI: 10.1097/00007890-199211000-00001] [Citation(s) in RCA: 166] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Long-term euglycemia by intraperitoneal transplantation of microencapsulated islets has not been described in the diabetic large animal model. In this study, we report the successful long-term reversal of diabetes by this method in spontaneous diabetic dogs. We have identified fundamental mechanism(s) associated with alginate-based microcapsule fibrosis, and have devised methods to ameliorate this problem. These include the use of purified alginate of low mannuronic acid content and cytokine suppression. Ten insulin-dependent, spontaneous diabetic dogs (insulin requirement 1-4 units/kg/day; absence of circulating C-peptide and diabetic K-values of 0.6 +/- 0.4) were entered into the study. Islets from mongrel donor pancreata were isolated and transplanted intraperitoneally either as free islet controls (n = 3) or as microencapsulated islet allografts (n = 7). In all seven encapsulated islet recipients, euglycemia was achieved within 24 hr (serum glucose failing from 304 +/- 117 to 116 +/- 72 mg/dl). IVGTT performed 14 days after islet transplant demonstrated normalization of K-values changing from a pretransplant level of 0.6 +/- 0.4 to 2.6 +/- 0.6. All animals receiving encapsulated islets remained euglycemic, free of the need for exogenous insulin, for a period of 63-172 days, with a median insulin-independence for 105 days. In contrast, recipients receiving free islets rejected their graft within seven days of implantation. In conclusion, this is the first report of long-term successful reversal of spontaneous diabetes in the large animal model by an intraperitoneal injection of encapsulated islets. The potential exists for this form of therapy to be explored in the treatment of type I diabetes in man.
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Feldman E, Arlin Z, Ahmed T, Mittelman A, Puccio C, Chun H, Cook P, Baskind P. Homoharringtonine in combination with cytarabine for patients with acute myelogenous leukemia. Leukemia 1992; 6:1189-91. [PMID: 1434803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Homoharringtonine (HHT) is one of several cephalotaxine alkaloids that has shown clinical efficacy in patients with acute myelogenous leukemia (AML). In a phase I trial we evaluated cytarabine 100 mg/m2 by continuous infusion daily for 7 days in combination with four dose levels of HHT ranging from 1.5-5 mg/m2 by continuous infusion daily for 7 days to see if an effective regimen could be developed. Twenty-two patients with relapsed and/or primary refractory AML were treated. Seventeen males and five females were treated, with a median age of 40 years (range 19-63). There were five remissions in 14 patients with relapsed AML and none of eight responders in patients with primary refractory AML. None of the three patients treated at 1.5 mg/m2 dose level of HHT responded. Of three patients treated at the 3 mg/m2 dose level, there was one complete remission. At both 4 mg/m2 and 5 mg/m2, two of eight patients achieved complete remission. Four of the five remissions occurred in patients with acute promyelocytic leukemia. Drug induced pancytopenia was universal, and hypotension and fluid retention were more common at the higher dose levels. Other toxicity was mild and included nausea, vomiting, diarrhea, and mucositis. No significant hepatic, renal, or cardiac toxicity was seen. We conclude that the dose of HHT 4 mg/m2 for 7 days by continuous infusion in combination with cytarabine is safe for patients with AML; and this combination is appropriate for a phase II evaluation.
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Dworkin B, Winzelberg N, Ahmed T, Lebovics E, Heier S, Feldman E, Stein B, Casellas A, Arlin Z. The safety and efficacy of gi endoscopy in patients with acute-leukemia - a review of 27 cases. Int J Oncol 1992; 1:439-42. [PMID: 21584564 DOI: 10.3892/ijo.1.4.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In the course of aggressive treatment for acute leukemia, the ensuing pancytopenia and intensive medical support may be accompanied by severe gastrointestinal (GI) complications. Therefore, to assess the safety and efficacy of GI endoscopy as a means of diagnosis, we analyzed the records of 16 patients undergoing 27 endoscopies a mean (+/-S.D.) of 18.4 +/- 11.9 days post chemotherapy. There were 6 procedures performed in patients with acute lymphocytic, 18 with acute myelogenous, including 3 with acute promyelocytic and 3 with blastic phase chronic myelogenous leukemia. 10/27 procedures were performed in patients with less than 1000 WBC/mm3 and 19/27 had less than 100,000 platelets. 15 patients had 25 upper endoscopies done for: bleeding (twenty-one), abdominal pain (two), and persistent vomiting (two). The principal bleeding sources were: esophagitis (eleven), Mallory Weiss tear (one), gastritis (three), gastric ulcer (one), duodenal ulcer (five). In the non-bleeding cases 2 exams were normal and the others had gastritis (one) and esophagitis (one). 15/25 procedures (64%) resulted in new diagnosis and 20/25 (80%) in additional therapies. 47% of patients undergoing upper GI endoscopy received specific new therapies as a result of that procedure. Nd: YAG laser photocoagulation was effective in stopping bleeding lesions in 4/6 cases. 10/12 bleeding patients had persistent or recurrent bleeding and 2 died from bleeding. None had surgery. Two patients underwent colonoscopy, both for colonic distention. One patient, who had been recently treated for Cl. difficile had submucosal petechiae. The other had non-specific colitis. No biopsies were done and both cases were successfully decompressed..No complications occurred from any GI endoscopy. We conclude that GI endoscopy can be safely performed in patients with acute leukemia, resulting in specific diagnoses and therapies. Esophagitis is a principal cause of GI bleeding in these patients. The role of therapeutic endoscopy in controlling bleeding is promising but requires further evaluation.
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114
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Greene D, Nakamura J, Thomas T, Lattimer-Greene S, Henry D, Feldman E, Stevens M, Killen P, Sima A. The myo-inositol (MI) depletion hypothesis of diabetic complications. Exp Eye Res 1992. [DOI: 10.1016/0014-4835(92)90778-q] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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115
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Kantarjian HM, Keating MJ, Estey EH, O'Brien S, Pierce S, Beran M, Koller C, Feldman E, Talpaz M. Treatment of advanced stages of Philadelphia chromosome-positive chronic myelogenous leukemia with interferon-alpha and low-dose cytarabine. J Clin Oncol 1992; 10:772-8. [PMID: 1569449 DOI: 10.1200/jco.1992.10.5.772] [Citation(s) in RCA: 92] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate the efficacy of interferon-alpha (IFN-A) and low-dose cytarabine (ara-C) combination chemotherapy in patients with chronic myelogenous leukemia (CML). PATIENTS AND METHODS Sixty patients with advanced phases of Philadelphia chromosome (Ph)-positive CML received combination therapy with IFN-A 5 x 10(6) U/m2 daily, and low-dose ara-C 15 mg/m2 daily for 2 weeks every 4 weeks until remission, then for 1 week every month as maintenance. Forty patients were in late chronic-phase CML, and 20 were in accelerated-phase CML (16 with clonal evolution only, four with other criteria). Their outcome was compared with 58 patients (39 late chronic-phase CML and 19 accelerated-phase CML) who had been previously treated with IFN-A alone in the same dose schedule. RESULTS In late chronic-phase CML, patients receiving IFN-A plus ara-C had a better complete hematologic response (CHR) rate compared with those treated with IFN-A alone (55% v 28%; P = .02), a trend for better Ph suppression (15% v 5%; P = .13), and a longer survival (3-year survival rate 75% v 48%; P less than .01). These differences do not seem to be caused by imbalances in prognostic factors between the two treatment groups. In accelerated-phase CML, the addition of ara-C to IFN-A did not improve the response rate of treated patients, and the difference in survival was accounted for by different patient characteristics. Suppression of clonal evolution was observed in five patients (25%). Patients with clonal evolution as the only criterion for disease acceleration had a longer survival than those with other or additional accelerated-phase criteria (3-year survival rate 67% v 22%; P less than .01). CONCLUSION The results with the combination of IFN-A plus ara-C in late chronic-phase CML are encouraging, and suggest the need for its evaluation in early chronic-phase CML.
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MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cytarabine/administration & dosage
- Drug Administration Schedule
- Humans
- Interferon-alpha/administration & dosage
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myeloid, Accelerated Phase/drug therapy
- Leukemia, Myeloid, Chronic-Phase/drug therapy
- Middle Aged
- Research Design
- Survival Analysis
- Treatment Outcome
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Zec RF, Landreth ES, Vicari SK, Belman J, Feldman E, Andrise A, Robbs R, Becker R, Kumar V. Alzheimer Disease Assessment Scale: a subtest analysis. Alzheimer Dis Assoc Disord 1992; 6:164-81. [PMID: 1485931 DOI: 10.1097/00002093-199206030-00004] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The Alzheimer Disease Assessment Scale (ADAS) was administered to 61 Alzheimer patients, 52 elderly controls, and 80 controls between age 7 and 54 years. The Alzheimer group was categorized into different severity levels of dementia based on MMSE scores: very mild (> or = 24), mild (> or = 20), moderate (10-19), and severe (0-9). All 11 ADAS Cognitive subtest scores for the mild, moderate, and severe dementia groups were statistically worse than the elderly control group. This was also the case for the very mild group, except for Naming, Commands, Constructional Praxis, and Ideational Praxis. In terms of magnitude of effect, memory and spontaneous language items were the earliest indicators on the ADAS, while praxis, commands, and naming items were only sensitive later in the course of the disorder. The best single indicators of progression throughout the severity continuum of dementia (i.e., from normal to severe) were the Orientation subtest, the ADAS Cognitive score, and the ADAS Total score. The ADAS Noncognitive subtests generally did not show the progression with increasing dementia that was evident on the ADAS Cognitive subtest. Differences in educational level had no statistically significant effects on any of the ADAS subtest scores, and age differences were few and small in magnitude. The differential rate of decline of the various ADAS subtests appears to reflect both the changing pattern of cognitive impairments as a function of severity of DAT and also to some extent the psychometric limitations of some of the subtests.
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Arlin ZA, Feldman E, Finger L, Decter J, Cook P, Ahmed T, Puccio C, Chun H, Mittelman A. Improving the "quality of remission induction" therapy: a necessary step for increasing the cure rate in acute myelogenous leukemia. Cancer Invest 1992; 10:183-4. [PMID: 1551027 DOI: 10.3109/07357909209032779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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118
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Abraham NG, Feldman E, Falck JR, Lutton JD, Schwartzman ML. Modulation of erythropoiesis by novel human bone marrow cytochrome P450-dependent metabolites of arachidonic acid. Blood 1991; 78:1461-6. [PMID: 1909194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In the hematopoietic system the adherent stromal cells produce cytokines necessary for proliferation and differentiation of hematopoietic cells. In the present study, we showed the ability of adherent stromal cells to generate novel metabolites of arachidonic acid via the NADPH-cytochrome P450-dependent monooxygenase system. These metabolites were recovered in the incubation media, suggesting their release from cells. The formation of arachidonic acid metabolites was inhibited by 7-ethoxyresorufin and SKF-525A, but not by indomethacin or BW-755C. By using two-step high-pressure liquid chromatography (HPLC), bone marrow-adherent stromal cells and incubation media showed the presence of metabolites in a peak eluted at 19 to 20 minutes. The isolated HPLC peak was used to measure its effect on colony-forming unit-erythroid (CFU-E) growth and compare it with that of synthetic cytochrome P450 arachidonate metabolites, 19- and 20-hydroxyeicosatetraenoic (HETE) acid. These bone marrow cytochrome P450 arachidonic acid metabolites at picomolar concentration potentiated erythropoietin (Epo)-induced CFU-E growth by fourfold to sixfold. Addition of 19- and 20-HETE to the bone marrow culture resulted in a potentiating effect on CFU-E number in a dose-dependent manner. 20-HETE was much more potent in stimulating CFU-E growth than 19-HETE at a similar concentration of 10(-11) mol/L. The potentiating effect of 20-HETE resulted in a shifting to the left of the dose-response curve to Epo. To substantiate the finding of an active NADPH-dependent cytochrome P450-metabolizing system, we further examined the ability of adherent cells to metabolize exogenous pharmacologic compounds such as benzo(a)pyrene, a substrate for the heme-cytochrome P450 system, aryl hydrocarbon hydroxylase. The adherent stromal cytochrome P450 metabolizes benzo(a)pyrene at comparable levels to blood vessel endothelial cells. These novel observations underscore the importance of adherent stromal cytochrome P450 to metabolize endogenous substrates, including arachidonic acid, to compounds that may interact in a paracrine manner with Epodependent hematopoietic cells.
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Feldman E. Identifying the genes for diabetes and schizophrenia. West J Med 1991. [DOI: 10.1136/bmj.303.6794.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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120
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Feldman W, Feldman E, Goodman JT, McGrath PJ, Pless RP, Corsini L, Bennett S. Is childhood sexual abuse really increasing in prevalence? An analysis of the evidence. Pediatrics 1991; 88:29-33. [PMID: 2057270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
One controversy regarding childhood sexual abuse is whether the increased rate of reported cases reflects a true increase in prevalence. In this report, data obtained in the 1970s and 1980s were compared with those of the 1940s. Using predetermined criteria for quality of information, commonality of definitions of childhood sexual abuse, and research design, the authors reviewed the Kinsey report published in 1953 and 19 prevalence studies reported in the last 10 years. Interrater reliability was .97 for each paper. In spite of differences in study designs and populations surveyed, where definitions of childhood sexual abuse were similar, the more recent studies with the strongest methodology reported prevalence figures similar to those of Kinsey in the 1940s, ie, 10% to 12% of girls younger than 14 years of age. Thus it would appear that increased reporting is due to changes in legislation and social climate rather than a true increase in prevalence. The absence of an increase in prevalence of childhood sexual abuse should not deter those interested in pursuing solid research in prevention and treatment because any childhood sexual abuse is too much.
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Grant S, Arlin Z, Gewirtz D, Feldman E. Effect of pharmacologically relevant concentrations of mitoxantrone on the in vitro growth of leukemic blast progenitors. Leukemia 1991; 5:336-9. [PMID: 2027301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The inhibitory effects of a 1 h exposure to pharmacologically relevant concentrations of the anthracenedione mitoxantrone were assessed with respect to the in vitro clonogenic growth of leukemic myeloblasts obtained from patients with acute myelogenous leukemia (AML). A steep mitoxantrone dose-response curve was observed, and increases in drug concentrations at both low and high dose ranges were associated with a significant potentiation of anti-leukemic effects. In particular, mitoxantrone concentrations of 1 microM or greater were highly inhibitory to leukemic blast progenitor cell growth, and were also effective in reducing or eliminating leukemic cell self-renewal capacity in those samples assayed. These findings suggest that mitoxantrone mediated lethal effects towards leukemic cells are dose-related within a pharmacologically achievable range, and raise the possibility that an increase in plasma levels through dose escalation might lead to enhanced leukemic cell killing in vivo.
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122
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Parks RW, Zec RF, Kuhn M, Vicari S, Feldman E, Coburn KL, Ashford JW, Crockett DJ, Moreno MA, Rashid A. Electrocortical mapping, MRI, and neuropsychological measures: evidence of Alzheimer's disease in the presence of vascular lesions. Arch Clin Neuropsychol 1991; 6:393-408. [PMID: 14589529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
We report here a case study of a 76-year-old woman with a high school education, whose presenting psychiatric symptomatology indicated dementia of unknown etiology. Neuropsychological test results were consistent with AD, but diagnosis was complicated by an MRI showing a large right hemisphere cortical infarct and scattered subcortical changes leading to a diagnosis of possible AD. Electrocortical mapping showed the right hemisphere infarct, and gave independent evidence suggestive of AD in the relatively intact left hemisphere. This case demonstrates the utility of multidimensional assessment as an aid to differential diagnosis.
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123
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Arlin Z, Feldman E, Finger L, Mittelman A, Ahmed T. Age, phenotype, and curability in acute myelogenous leukemia. Cancer Invest 1991; 9:655-7. [PMID: 1747792 DOI: 10.3109/07357909109039877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
The prevalence, nature, associations and outcome of psychiatric morbidity among four hundred and fifty severe general medical admissions are described. Affective disorder was diagnosed in 13 percent of men and 17 percent of women. It was associated with a history of previous psychiatric disorder and current social problems. Persistent affective disorder after discharge was associated with continuing medical and social problems. Alcohol problems were common in men, especially in those with social problems, and often went unrecognized by medical staff. Cognitive impairment was confined to the elderly and was associated with longer hospital stay and high mortality. Patients with emotional and cognitive disorder make considerable demands on medical, social and psychiatric services during and following admission. The implications for improved recognition and management of psychiatric morbidity in general medical patients are discussed.
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125
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Parks RW, Zec RF, Kuhn M, Vicari S, Feldman E, Coburn KL, Ashford J, Crockett DJ, Moreno MA, Rashid A. Electrocortical mapping, MRI, and neuropsychological measures: Evidence of Alzheimer's disease in the presence of vascular lesions. Arch Clin Neuropsychol 1991. [DOI: 10.1093/arclin/6.4.393] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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126
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Schwarz M, Feldman E, Susswein AJ. Variables affecting long-term memory of learning that a food is inedible in Aplysia.. Behav Neurosci 1991; 105:193-201. [PMID: 2025389 DOI: 10.1037/0735-7044.105.1.193] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Long-term memory of learning that a food is inedible was studied in Aplysia. Seven days after a single training session, animals retained significant memory, as measured by a number of parameters. A 2nd experiment demonstrated savings 3 weeks after 2 training sessions. Long-term memory was also found after training procedures were altered to resemble those more likely to occur in nature, such as training for only 10 min or training with ad-lib access to inedible food, with no experimenter intervention. The effects were determined of bilaterally sectioning the esophageal nerves that innervate the gut. Denervation of the gut blocked the ability to learn that food is inedible but did not affect memory after the task had already been learned.
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127
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Arlin ZA, Hiddemann W, Feldman E, Mittelman A, Ahmed T. Further thoughts on 'cell kill' in acute leukemia. Acta Haematol 1991; 85:1-5. [PMID: 2011923 DOI: 10.1159/000204842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
With traditional therapy of acute myelogenous leukemia, not more than 20% of patients achieve long-term survival. Efforts at intensifying postinduction chemotherapy have resulted in minor improvements only, but this limited progress has been hampered by increasing toxic-death rates. Eradication of the leukemia burden may be achieved by the introduction of more effective induction regimes and these may be rendered more effective by the application of 'enhancers'. With a lower tumor burden, and with more appropriate timing for supralethal therapy, it may be possible to achieve cure with greater frequency. Measurement of 'minimal residual disease' permits more logical selection of postinduction therapy.
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128
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Leutz WN, Greenlick M, Ervin S, Feldman E, Malone J. Adding long-term care to Medicare: The Social HMO Experience. J Aging Soc Policy 1990; 3:69-87. [PMID: 10186798 DOI: 10.1300/j031v03n04_06] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The rancor accompanying the repeal of most of the 1988 Medicare Catastrophic Act reflects both the national need to improve health and long-term care benefits for the elderly and the political obstacles to finding new sources of financing for such benefits. Neither the need nor the obstacles will go away, but policymakers are now likely to look for lower-cost, efficient, and privately funded alternatives. The authors have developed and tested one such approach: the Social Health Maintenance Organization (SHMO). Operating since 1985, the SHMO model integrates community-based, long-term care services into the managed, prepaid HMO design. The four test sites are adding long-term care to Medicare at no extra cost to the government and only modest premiums for the 17,000 current members. Although the benefits offer limited protection for long-term nursing home care, they do cover long-term care in community settings, where people tend to prefer to stay. Also, integration of the acute and long-term care systems improves the ability to respond to the medical needs of frail members, who also have high acute-care use. The SHMO's model of front-end, community-oriented, long-term care benefits integrated with Medicare appears to be a practical, affordable, and clinically appropriate way to address the rising concern with the lack of coverage and services for long-term care.
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Abolhassani M, Riley WM, Feldman E, Arlin Z, Chiao JW. Two separate differentiation inducing proteins for human myeloid leukemia cells and their isolation from normal lymphocytes. PROCEEDINGS OF THE SOCIETY FOR EXPERIMENTAL BIOLOGY AND MEDICINE. SOCIETY FOR EXPERIMENTAL BIOLOGY AND MEDICINE (NEW YORK, N.Y.) 1990; 195:288-91. [PMID: 2236110 DOI: 10.3181/00379727-217-2-rc1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Conditioned medium from mitogen stimulated normal peripheral blood lymphocytes (PBL) has been demonstrated to contain a maturation inducer activity mediating the differentiation of human myeloid leukemia cells to monocytes and macrophages. The maturation inducer activity was isolated by salt precipitation, Sepharose CL-6B ion exchange and affinity chromatographies and electrophoresis. Two separate activities with M.W. ranges of 52-56 and 32-35 kDa capable of mediating the terminal differentiation of leukemic HL-60 promyelocytes to monocytes and macrophages were detected. The higher molecular weight species was determined to be a 54 kDa single polypeptide and was found to be distinct from IL-3 and IL-6 by ELISA and differentiation blocking assay. The inducing activity of the 32-35 kDa material was largely neutralized after treatment with anti-IL-3, but not with other antibodies. Employing the immunofluorescent antibody technique, the 54 kDa protein was detected on the surface membranes of PBL. The proportions and number of maturation inducer bearing lymphocytes in patients with acute myelogenous leukemia (0.4% and 35/mm3, respectively) were significantly lower than that of healthy donors (7.9% and 178/mm3) The role of these physiological factors in leukemia cell differentiation is discussed.
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130
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Hawton K, Mayou R, Feldman E. Significance of psychiatric symptoms in general medical patients with mood disorders. Gen Hosp Psychiatry 1990; 12:296-302. [PMID: 2210346 DOI: 10.1016/0163-8343(90)90046-f] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Little difference was found between the psychiatric symptoms of medical patients and general-population subjects with affective disorder, both groups having been assessed with the same procedure (Present State Examination). Discrimination between medical patients with and without affective disorder was best achieved when patients with depressive and anxiety disorders were considered separately. Depressed mood, morning depression, and hopelessness were the key symptoms in the depressives, and nervous tension, free-floating anxiety, panic attacks, and specific phobias in the patients with anxiety disorders. Symptom profile did not distinguish patients with persistent affective disorders from those whose disorders had resolved at a 4-month follow-up.
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131
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Arlin Z, Case DC, Moore J, Wiernik P, Feldman E, Saletan S, Desai P, Sia L, Cartwright K. Randomized multicenter trial of cytosine arabinoside with mitoxantrone or daunorubicin in previously untreated adult patients with acute nonlymphocytic leukemia (ANLL). Lederle Cooperative Group. Leukemia 1990; 4:177-83. [PMID: 2179638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This phase III, randomized trial in previously untreated adults with ANLL compared mitoxantrone plus cytosine arabinoside with the CALGB "7 + 3" daunorubicin-based regimen. Two hundred evaluable patients (98 treated with the mitoxantrone-based regimen and 102 with the daunorubicin-based regimen) were included in the analysis of efficacy. The median age of the patients was 60 years. The induction regimen comprised cytosine arabinoside 100 mg/m2 by infusion daily for 7 days and mitoxantrone 12 mg/m2 or daunorubicin 45 mg/m2 daily for days 1-3. If needed, a second induction course was administered: cytosine arabinoside for 5 days and mitoxantrone or daunorubicin for 2 days. Postremission therapy consisted of two consolidation courses, identical to the second induction course. Sixty-three percent (62 of 98) of patients treated with mitoxantrone achieved complete remission (CR), compared to 53% (54 of 102) treated with daunorubicin. The median time to CR was 35 days in patients treated with mitoxantrone and 43 days for those treated with daunorubicin. Eighty-nine percent (55 of 62) of patients treated with mitoxantrone who entered complete remission achieved CR following one induction course, compared to 68% (37 of 54) of patients treated with daunorubicin who entered CR. The median duration of CR was 240 days in patients treated with mitoxantrone and 198 days in those treated with daunorubicin; the median length of survival was 328 days in patients who received mitoxantrone and 247 days in those who received daunorubicin. The toxicity profiles in patients treated with either of the two regimens were comparable in incidence and in severity. Patients treated with mitoxantrone required fewer median platelet units and were treated with fewer median days of intravenous antibiotics, compared to those who received daunorubicin. Mitoxantrone in combination with cytosine arabinoside is effective in previously untreated ANLL. complete remissions occur more frequently after a single induction course of the mitoxantrone-based regimen, compared to the standard Cancer and Acute Leukemia Group B regimen. This should be explored in further trials.
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Zec RF, Landreth E, Feldman E, Vicari S, Belman J, Andrise A, Pinto S, Engelman J, Kumar V, Becker R. A comparison of Alzheimer patients and elderly controls on the Alzheimer Disease Assessment scale. Arch Clin Neuropsychol 1990. [DOI: 10.1093/arclin/5.2.229a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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133
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Mittelman A, Savona S, Puccio C, Chun H, Ahmed T, Feldman E, Sullivan P, Arnold P, Arlin Z. Phase II trial of fludarabine phosphate (F-Ara-AMP) in patients with advanced head and neck cancer. Invest New Drugs 1990; 8 Suppl 1:S65-7. [PMID: 1696246 DOI: 10.1007/bf00171986] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Thirteen patients with advanced head and neck cancer were entered into a phase II study of fludarabine phosphate. Fludarabine phosphate was given by continuous infusion for 5 days, at a starting dose of 20 mg/m2 per day for patients previously treated with one regimen and 25 mg/m2 per day for previously untreated patients; therapy was repeated every 3-4 weeks. Of the 13 patients, 3 had undergone one prior regimen and 10 patients were previously untreated by chemotherapy. No responses were observed. Myelosuppression was the most common toxicity observed. Four patients developed mild nausea, vomiting and seven developed bleeding stomatitis that resolved in one week. In addition, four patients developed headaches which resolved spontaneously. No renal, hepatic, or neurotoxicity was observed. Our study demonstrates that in previously treated and untreated patients, fludarabine phosphate given on this schedule has little activity in patients with advanced head and neck cancer.
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Arlin Z, Feldman E, Ahmed T, Mittelman A, Puccio C, Biguzzi S. Intensive chemotherapy with interferon for induction of true remission in chronic phase of chronic myelogenous leukemia. Cancer Invest 1990; 8:303. [PMID: 2400954 DOI: 10.3109/07357909009017597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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135
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Valdini A, Steinhardt S, Feldman E. Usefulness of a standard battery of laboratory tests in investigating chronic fatigue in adults. Fam Pract 1989; 6:286-91. [PMID: 2632306 DOI: 10.1093/fampra/6.4.286] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Twenty-two adults with chronic fatigue were studied to determine the clinical usefulness of commonly applied laboratory tests. Subjects with the chief complaint of fatigue persisting for more than one year were followed for an average of seven months at a university family health centre. During this time a group of commonly recommended tests were carried out and the patients had repeated physical examinations. Physical diseases and laboratory abnormalities were few, and patients with abnormal values and active problems were followed until their fatigue resolved or their abnormalities reverted to normal following therapy. The study demonstrated that the presence of an abnormal laboratory result in a fatigued individual does not necessarily indicate the cause of fatigue. A psychiatric history was also performed and patients were tested with the symptom check list 90-R (SCL-90-R), a 90-item psychological symptom check list. Seven patients were receiving psychotherapy when they enrolled in the study. Two additional subjects entered therapy after the start of the study. Results on the symptom check list for the study group were largely abnormal, with a majority scoring in the highest quartile for depression, paranoid ideation and psychoticism. It is concluded that the investigation of patients with fatigue which has lasted for longer than one year should focus on psychological causes. In this group of patients laboratory abnormalities are not useful in guiding evaluation or treatment for their fatigue.
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136
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Roth MP, Petersen GM, McElree C, Feldman E, Rotter JI. Geographic origins of Jewish patients with inflammatory bowel disease. Gastroenterology 1989; 97:900-4. [PMID: 2777043 DOI: 10.1016/0016-5085(89)91495-9] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Ulcerative colitis and Crohn's disease are more common among Jews than among non-Jews. Despite the existence of studies on the prevalence and incidence of inflammatory bowel disease in relation to the continent of residence or origin, there are no studies on the specific countries of origin of Ashkenazi Jewish patients. We report here the first analysis of 233 U.S. Jewish patients by defined world regions and subregions. Using two different sets of controls (a self-referred Jewish population for Tay-Sachs disease carrier detection and a sample of Jewish persons ascertained through unrelated studies from the same hospital as our patients), we found a significant excess of patients of middle European origin relative to those of Polish or Russian origin. These observations suggest that the inflammatory bowel disease gene(s) are more prevalent in the Jewish population that originated in middle Europe than in those from Poland and Russia. These results further suggest that Jewish patients with inflammatory bowel disease probably represent a nonrandom genetically predisposed subset of the Jewish population. This provides further evidence for the genetic contribution to inflammatory bowel disease in general, and to its higher risk in the Jewish population.
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Ahmed T, Ciavarella D, Feldman E, Ascensao J, Hussain F, Engelking C, Gingrich S, Mittelman A, Coleman M, Arlin ZA. High-dose, potentially myeloablative chemotherapy and autologous bone marrow transplantation for patients with advanced Hodgkin's disease. Leukemia 1989; 3:19-22. [PMID: 2642573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Twenty three patients with Hodgkin's disease were treated with BCNU (carmustine), etoposide, and cyclophosphamide at doses of 450-600 mg/m2, 1500-2000 mg/m2, and 120 mg/kg respectively. Bone marrow refrigerated at 4 degrees C for 2-5 days or cryopreserved at -80 degrees C was used to reconstitute bone marrow function. The median age was 28 (range 16-48), and the median Karnofsky performance status was 70. Nineteen patients had progressive disease while on chemotherapy. The median number of prior regimens was three (1-7), and the median number of prior chemotherapy drugs was 10 (range 4-12). Ten patients had received at least two of the drugs used in this study and four had had all three. Indicator lesions included lung (10), peripheral lymph nodes (9), retroperitoneal nodes (8), liver (3), and chest wall masses (2). Ten patients achieved a complete remission (43.5%; 95% confidence limits 23-64%), and five patients had a partial remission (21.7%; 95% confidence limits 5-39%). The median duration of complete remission was 6 months (range 2-13+ months). Responses were shorter in duration for patients with primary refractory disease. Liver function abnormalities were noted in nine (39%) cases. Post transplant, the recovery time was 18 days (range 11-43) for WBC and 24 days (11-77) for platelets. Two patients died of septic episodes while neutropenic. The median number of RBC units used was seven (range 1-45). Ten patients had evidence of pulmonary dysfunction. In seven patients there was symptomatic improvement with steroid therapy, but three patients who were not treated with steroids died as a result of interstitial pneumonia. Future programs should consider bone marrow transplantation in patients with Hodgkin's disease earlier in the course of disease, at the time of minimal residual disease, and employ newer, potentially less toxic drugs.
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138
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Arlin ZA, Feldman E, Kempin S, Ahmed T, Mittelman A, Savona S, Ascensao J, Baskind P, Sullivan P, Fuhr HG, Mertelsmann R. Amsacrine with high-dose cytarabine is highly effective therapy for refractory and relapsed acute lymphoblastic leukemia in adults. Blood 1988; 72:433-5. [PMID: 3165293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Thirty-six patients with relapsed acute lymphoblastic leukemia (ALL) and four with primary refractory ALL were treated with a regimen that included amsacrine, 200 mg/m2, intravenously daily for three days with cytarabine, 3 gm/m2, by infusion over three hours daily for five days. There were 27 remissions in the 36 relapsed patients and two in the four patients with primary refractory disease. Seventeen of the 23 patients with common ALL, four of the six with T-cell ALL, one of the three with B-cell ALL, and seven of eight whose cells were not characterized responded. Toxicity of this regimen was comparable to other reinduction regimens for ALL, but the side effects characteristic of high-dose cytarabine therapy were absent. Since these results compare favorably with conventional induction regimens, its use in the primary treatment of adults and children with high-risk ALL is proposed.
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Hanley DF, Feldman E, Borel CO, Rosenbaum AE, Goldberg AL. Treatment of sagittal sinus thrombosis associated with cerebral hemorrhage and intracranial hypertension. Stroke 1988; 19:903-9. [PMID: 3388462 DOI: 10.1161/01.str.19.7.903] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Two cases of complete sagittal sinus occlusion with multiple brain hemorrhages, elevated intracranial pressure, and disseminated intravascular coagulation are described. These patients were successfully managed using pentobarbital-induced coma to ameliorate intracranial pressure elevation. This therapy was combined with monitoring of intracranial pressure and intermittent drainage of cerebrospinal fluid to further control intracranial pressure elevations. Thrombus and coagulopathy resolved with pentobarbital alone in one patient and after pentobarbital plus heparin therapy in the second patient. It is suggested that cases of severe distal sagittal sinus thrombosis with brain hemorrhage and intracranial hypertension may benefit from combined pentobarbital coma and intraventricular drainage. This allows for stabilization of bleeding tendencies before instituting heparin therapy when necessary. Management of sagittal sinus thrombosis with barbiturates or ventricular drainage is best performed in an intensive care unit environment with continuous monitoring of intracranial pressure and substantial electrophysiologic and neuroradiologic support.
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140
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Feldman W, Feldman E, Goodman JT. Culture versus biology: children's attitudes toward thinness and fatness. Pediatrics 1988; 81:190-4. [PMID: 3422404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Many of the studies regarding children's acquisition of prevailing cultural concepts of physical attractiveness are flawed by small and unrepresentative samples, measurement instruments of questionable reliability and validity, and experimental designs that do not protect against bias. Additional studies in which these methodologic flaws are overcome must be carried out if we are to understand truly when and how cultural concepts of beauty are acquired. Nevertheless, the majority of the studies already done find that children acquire prevailing cultural values of beauty before adolescence and that thinness is desirable to girls considerably before puberty. It is suggested that the etiology of eating disorders and the reasons for their increasing prevalence will not be discovered by studying only clinical cases. We propose that those interested in this important health problem study children before adolescence in an attempt to learn how preoccupation with weight begins and why thinness is believed to be attractive. Once these are understood, a greater challenge will be the development and testing of interventions--be they in the schools or using the media--which can effectively prevent this public health problem. When culture and biology clash, people may suffer.
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Abstract
Medical, psychiatric and social outcome were examined in medical in-patients previously identified as suffering from psychiatric disorder. One third of patients with an affective (emotional) disorder on admission were still psychiatrically ill four months after discharge. Persistent disorder was associated with continuing physical illness. During the year following admission those with affective disorder on admission continued to make greater demands on medical, social and psychiatric services than matched controls and had double the mortality rate (not significant). Patients with organic mental states on admission had a high mortality and morbidity, and made considerable continuing use of general hospital social and psychiatric services. Improved recognition of psychiatric disorder during hospital admission could result in better overall care of medical patients' psychiatric and social difficulties and more effective use of medical resources.
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142
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Feldman E, Dodge KA. Social information processing and sociometric status: sex, age, and situational effects. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 1987; 15:211-27. [PMID: 3611520 DOI: 10.1007/bf00916350] [Citation(s) in RCA: 92] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Theoretically based measures of social information-processing patterns in specific situations were developed and administered to popular, average, socially rejected, and socially neglected girls and boys in the first, third, and fifth grades (total n = 95). Measures included interpretations of peers' intentions, quantity and quality of responses generated to problematic stimuli, evaluations of responses, and enactments of particular responses. Three kinds of situations were generated empirically as stimuli: being teased, being provoked ambiguously, and initiating entry into a peer group. Deviant children (rejected and neglected) were found to respond deficiently compared to average and popular children, but only in the situation in which they were teased. Older children performed more competently than younger children in all three situations. Interactions among gender, sociometric status, and age also were found. Findings were interpreted as evidence of the elusiveness and complexity of social information-processing defects among low sociometric status children.
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143
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Feldman E, Mayou R, Hawton K, Ardern M, Smith EB. Psychiatric disorder in medical in-patients. THE QUARTERLY JOURNAL OF MEDICINE 1987; 63:405-12. [PMID: 3659259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Four hundred and fifty-three general medical in-patients were screened for mood disorder (anxiety and depression), organic mental states and alcohol problems. Using the Present State Examination, affective disorder was identified in 14.6 per cent, being especially common in younger women. Organic psychiatric disorder was very common in the elderly, occurring in 31 per cent of those over 70 years, and 18 per cent of men and 4 per cent of women admitted to a drink problem. Mood disorder was not related to the type or severity of physical illness, but was significantly associated with previous psychiatric history and social problems. Two-thirds of those with mood disorder on admission who were still alive four months after discharge were improved. House officers and family doctors identified approximately half the cases of depression and anxiety, but house officers were no more likely to recognise the more severe cases than the milder ones. Organic psychiatric disorder was often missed, alcohol problems less so.
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144
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Arlin Z, Mehta R, Feldman E, Sullivan P, Pucillo A. Amsacrine treatment of patients with supraventricular arrhythmias and acute leukemia. Cancer Chemother Pharmacol 1987; 19:163-4. [PMID: 3568274 DOI: 10.1007/bf00254571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Three patients with a history of supraventricular arrhythmia presented with relapse of acute leukemia. Two of the three patients were in sinus rhythm, receiving digoxin and/or verapamil daily. The third patient was in atrial fibrillation, but her heart rate was controlled with daily digoxin. All three patients received amsacrine without the occurrence of cardiac events. Although amsacrine may cause ventricular arrhythmias in the setting of hypokalemia, correction of the electrolyte abnormality permits its use in patients with a history of supraventricular arrhythmias.
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145
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146
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Arlin ZA, Ahmed T, Mittelman A, Feldman E, Mehta R, Weinstein P, Rieber E, Sullivan P, Baskind P. A new regimen of amsacrine with high-dose cytarabine is safe and effective therapy for acute leukemia. J Clin Oncol 1987; 5:371-5. [PMID: 3546613 DOI: 10.1200/jco.1987.5.3.371] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Amsacrine and high-dose cytarabine (HiDAc), when administered as single agents, are effective treatment of acute leukemia. When used in combination, a high remission rate is also possible. We treated 47 patients with acute myelogenous leukemia (AML), acute lymphoblastic leukemia (ALL), and blastic phase of chronic myelogenous leukemia (CML) with a combination of amsacrine and HiDAc. The patients received amsacrine 200 mg/m2 daily for three days and, concurrently, HiDAc 3 g/m2 over three hours once daily for five days. Of 20 evaluable patients with AML in relapse, there were 12 remissions; of seven additional patients with primary refractory AML, there were two remissions, and of 12 patients with ALL in relapse, there were eight remissions. The three patients with blastic phase CML and the three patients with biphenotypic leukemia did not respond. Nausea, vomiting, stomatitis, hepatic dysfunction, and diarrhea were common, but cutaneous, conjunctival, and significant cerebellar and cerebral side effects were absent. We conclude that this regimen is highly effective therapy for AML and ALL and is also safe, eliminating the major toxicities encountered with HiDAc.
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147
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Zimmer EZ, Goldstein I, Feldman E, Glik A. Maternal and newborn levels of glucose, sodium and osmolality after preloading with three intravenous solutions during elective cesarean sections. Eur J Obstet Gynecol Reprod Biol 1986; 23:61-5. [PMID: 3781072 DOI: 10.1016/0028-2243(86)90105-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The influence of maternal i.v. loading with 1500 ml fluid prior to epidural anesthesia and elective cesarean section was studied in 60 healthy parturients near term. Three different solutions were used. Normal saline 0.9%, Hartmann's solution and dextrose 5%. A significant rise in glucose level accompanied by a significant decrease in sodium level was found in mothers and newborns of the group hydrated with the dextrose solution.
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148
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Feldman E, Haberman S, Abisogun AO, Reich R, Levran D, Maschiach S, Zuckermann H, Rudak E, Dor J, Tsafriri A. Arachidonic acid metabolism in human granulosa cells: evidence for cyclooxygenase and lipoxygenase activity in vitro. Hum Reprod 1986; 1:353-6. [PMID: 3104399 DOI: 10.1093/oxfordjournals.humrep.a136422] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
In view of the studies demonstrating the involvement of eicosanoids (prostaglandins and hydroxyperoxides, including leukotrienes) in ovulation in several mammalian species, we have examined the activity of the two enzyme systems, lipoxygenase and cyclooxygenase in human granulosa cells obtained from women undergoing in-vitro fertilization--embryo transfer. The activity of cyclooxygenase was assessed by radioimmunoassay of prostaglandin E and of 6-keto-prostaglandin F1 alpha, the conversion product of prostacyclin, accumulated in the culture medium of granulosa cells. Lipoxygenase activity was detected by the conversion of [14C]arachidonic acid into its products (hydroxyperoxides and leukotrienes) separated by reversed phase high-performance liquid chromatography. The results confirmed the activity of cyclooxygenase in human granulosa cells, production in vitro of prostaglandin E and prostacyclin and demonstrated the presence of active lipoxygenase enzymes. These results support the possible involvement of eicosanoids in ovulation of the human.
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149
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Susswein AJ, Schwarz M, Feldman E. Learned changes of feeding behavior in Aplysia in response to edible and inedible foods. J Neurosci 1986; 6:1513-27. [PMID: 3711992 PMCID: PMC6568563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Feeding behavior in Aplysia fasciata and A. oculifera is modified by pairing the behavior with reinforcing consequences. Successful and unsuccessful attempts to transfer food from the buccal cavity to the crop act as positive and negative reinforcers, respectively. A number of changes in feeding behavior occur as a result of pairing of feeding with the negative reinforcer: feeding responses become less effective in leading to the entry of food into the buccal cavity; when food does enter the buccal cavity, it exits sooner; swallowing responses after food entry are less likely to occur; Aplysia eventually cease responding to food. Pairing successful transfer of food into the crop with feeding behavior produces opposite effects. Behavioral change is specific to pairing, as shown by lack of change when reinforcement is explicitly unpaired with feeding behavior. Behavioral change is specific to foods with a particular taste and texture; generalization to alternate foods was not observed. In spite of cessation of feeding, animals remain aroused, as shown by low response latency to alternate foods. Memory of response change persists for at least 48 hr.
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150
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Shalev E, Segev G, Ben-Ami M, Weiner E, Feldman E, Zuckerman H. [Ultrasound diagnosis of fetal malformations]. HAREFUAH 1986; 110:277-8. [PMID: 3525347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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