Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The use of recombinant human erythropoietin (rhuEPO) has revolutionized the treatment of renal anemia, but the dose regimens have not been established. We studied the effects of subcutaneous rhuEPO given 4,000U (1 vial) every 5-10 days in 9 patients on continuous ambulatory peritoneal dialysis (CAPD). Ten stable CAPD patients (6 females and 4 males; mean age +/- SEM, 54.4 +/- 5.6 years; mean baseline hemoglobin concentration 7.3 +/- 1.2g/dL) were commenced on s.c. rhuEPO. None of the patients had a history of gastrointestinal bleeding, aluminum overload, sepsis nor receiving androgens. Seven patients were receiving 4,000 U rhuEPO weekly, one patient each was receiving 4,000 U every 5 and 10 days (range, 66.7-89.3 U/kg/week). The dose was adjusted every 4 weeks according to response by altering the dose interval. The mean hemoglobin concentration increased from 7.3 +/- 1.2 g/dL to 10.3 +/- 1.1 g/dL over 8 weeks. There was no significant changes in the serum ferritin, urea, creatinine and potassium levels. One patient required an increase in antihypertensive therapy. We feel that s.c. rhuEPO 4,000 U given on an intermittent basis is effective in the treatment of anemia in CAPD patients. The administration of a single vial each time is convenient and cost sparing. The gradual rise in hematocrit avoids complications.
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PMID:Subcutaneous recombinant human erythropoietin in patients on CAPD. 168 Apr 47

Butyrate analogues have been shown to increase fetal hemoglobin (HbF) production in vitro and in vivo. Sodium phenylbutyrate (SPB), an oral agent used to treat individuals with urea-cycle disorders, has been shown to increase HbF in nonanemic individuals and in individuals with sickle cell disease. We have treated eleven patients with homozygous beta thalassemia (three transfusion dependent) and one sickle-beta-thalassemia patient with 20 g/d (forty 500-mg tablets) of SPB for 41 to 460 days. All patients showed an increase in the percent of F reticulocytes associated with treatment, but only four patients responded by increasing their Hb levels by greater than 1 g/dL (mean increase, 2.1 g/dL; range, 1.2 to 2.8 g/dL). None of the transfusion-dependent thalassemia subjects responded. Increase in Hb was associated with an increase in red blood cell number (mean increase, 0.62 x 10(12)/L), and mean corpuscular volume (mean increase, 6 fL). Changes in percent HbF, absolute HbF levels, or alpha- to non-alpha-globin ratios as measured by levels of mRNA and globin protein in peripheral blood did not correlate with response to treatment. Response to treatment was not associated with the type of beta-globin mutation, but baseline erythropoietin levels of greater than 120 mU/mL was seen in all responders and only two of eight nonresponders to SPB. Compliance with treatment was greater than 90% as measured by pill counts. Side effects of the drug included weight gain and/or edema caused by increase salt load in 2/12, transient epigastric discomfort in 7/12, and abnormal body odor in 3/12 subjects. Two splenectomized patients who were not on prophylactic antibiotics developed sepsis while on treatment. We conclude that SPB increases Hb in some patients with thalassemia, but the precise mechanism of action is unknown.
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PMID:Oral sodium phenylbutyrate therapy in homozygous beta thalassemia: a clinical trial. 752 72

Haematopoietic growth factors help patients with intense chemotherapy and patients after transplantation of bone marrow to overcome the critical stage of leucopenia. In the submitted paper the authors present more detailed data on the results of investigations evaluating G-CSF, GM-CSF and erythropoietin in patients with anti-tumourous treatment. Both leucocytic growth factors, G-CSF and GM-CSF shorten the period of leucopenia by approximately one week which means a substantial reduction of the number of infectious complications and also a reduction of the hospitalization period. The price of the mentioned growth factors which is still high as compared with the costs of intensive treatment of septicaemia in leukopenic patients. To the authors' surprise, comparing an equal period of time, treatment of septicaemia is associated with much higher costs than administration of G-CSF which can prevent sepsis or reduce its duration.
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PMID:[Hematopoietic growth factors in antineoplastic therapy from the therapeutic and economic aspect]. 768 19

13 premature babies (gestational age 31.1 +/- 0.9 weeks and birth weight 1586 +/- 261 g) were randomly assigned to receive recombinant human erythropoietin (200 U/kg i.v. three times a week during 4 weeks) or no (13 babies) as soon as haematocrit decrease < 30% between second and seventh week (TO). The two groups had similar gestational age, birth weight, Apgar score 1' and 5', O2-therapy, IPPV and volume of packed erythrocytes transfused before TO. Treatment was started at 30 +/- 0.5 days (range 21-42). At TO all subjects had not cardiopulmonary compromission, sepsis, O2-dependence, GMH-IVH > or = 2 degree grade and received iron and Vit. E by i.m. Result were evaluated through determination of hemoglobin, haematocrit, reticulocytes and volume of packed erythrocytes before and on days 7, 14, 21 and 28 of therapy. After rHuEPO the number of reticulocytes increased on days 21 and 28 of therapy (on day 21: 92.4 +/- 34.2 x 1000/L vs. 71.8 +/- 21.0, p < 0.10; on day 28: 116.2 +/- 42.9 vs. 83.8 +/- 23.2, p < 0.05); otherwise the number of transfusion (0.2 +/- 0.4 vs. 1.0 +/- 1.2, p < 0.10) and volume of packed erythrocytes (3.0 +/- 6.3 ml/kg vs. 14.9 +/- 15.9, p < 0.05) were reduced. Serum erythropoietin levels did not change during treatment, probably because, reducing the lowering of hemoglobin, hypoxic stimulus to increase of erythropoietin was suppressed.
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PMID:[Effects of recombinant human erythropoietin in the treatment of anemia of prematurity]. 773 26

To investigate the importance of transfusion practice with packed red cells (PRCs) in premature infants and to identify risk factors significant influencing transfusion practice, we analyzed 75 preterm infants (gestational age: 31 +/- 2 weeks; birth weight: 1459 +/- 402 g) admitted to the neonatal intensive care unit of Catholic University of Rome. Fifty-three (70.7%) of the infants received one or more PRCs transfusions (in total 246 transfusions). The variables associated with an increase in number and frequency of PRCs transfusions were: a) gestational age < or = 30 weeks; b) birth weight < or = 1000 g; c) severe neonatal pathology (ie a respiratory disease requiring ventilatory support and/or a clearly documented or suspected sepsis). Repeated PRCs transfusions during the first week of life significantly (p < 0.01) influenced the need for late transfusions, after 4 weeks of age, for the treatment of the anemia of prematurity. These data indicate that preterm infants with a gestational age < or = 30 weeks, a birth weight < 1000 g and a severe respiratory or infectious disease represent natural candidates for administration of recombinant human erythropoietin to reduce the need for late PRCs transfusions.
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PMID:[Anemia of prematurity: risk factors influencing red cell transfusions]. 779 3

Nowadays, maintenance dialysis can be proposed to patients suffering from myeloma with end-stage chronic renal failure. We report here data from eight patients dialysed either by hemo- (6) or peritoneal dialysis (2), together with chemotherapy in half of them. Six patients died; the longest survival has been about 6 years. The main cause of morbidity was sepsis, especially in peritoneal dialysis patients; therefore we now favour hemodialysis in patients exposed to aggressive chemotherapy. We think dialysis justified in all cases, including those with high tumor mass, in order to expect the effect of chemotherapy; then, provided good response to drugs, further survival can be consistently improved. Once on maintenance dialysis, main drawbacks for these patients are cardiovascular complications (AL amyloidosis) and above all anemia; the latter however can be markedly improved, thanks to erythropoietin therapy which provides these patients with much better quality of life.
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PMID:[End-stage chronic renal failure in myeloma: results of dialysis]. 819 Oct 93

The recent production of recombinant human growth factors has expanded the neonatal clinician's armamentarium for treating sepsis and anemia of prematurity (AOP). Agents that may prove useful in the premature neonate include recombinant human erythropoietin (rh-EPO), granulocyte colony-stimulating factor (rhG-CSF), and CSF). Within the neonatal population, research utilizing these agents is still relatively new. Appropriate clinical trials are still needed to elucidate the optimal dosing regimen for both rhG-CSF and rh-EPO, as are studies to address the issue of long-term safety. Use of rhG-CSF in sepsis and of rh-EPO for AOP is still considered experimental, but in instances where conventional treatments are not proving beneficial, these agents may provide a therapeutic alternative. Their potential for improving care of the premature neonate must also be assessed.
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PMID:Hematopoietic growth factors: Part I. 893 67

The armistice after World War II marked the beginning of an era that was to last to the end of the present century. It was an era in which many changes in medicine and nursing combined to alter the entire philosophy of managing malignant disease. More specifically, the fluid-phase tumors, which comprise myelodysplasia and the leukemias, were singled out for special attention. First there was the ease with which blood and bone marrow could be sampled, making serial investigations simple and practical. Second, cytotoxic drugs became available ranging from nitrogen mustard through cytosine arabinoside, the anthracycline antibiotics, and the epi-podophyllotoxins. Although cytomorphology of the hematopoietic tissue had been exquisitely defined with the use of Romanowsky stains coupled with electron microscopy, the diagnosis of leukemia was, before 1945, a death sentence for want of effective therapy. This changed dramatically with the introduction of the folate antagonists, and progress was unremitting as the range of new products expanded. Suddenly responses could be obtained with single agents, and fairly rapidly combinations were developed for cumulative antitumor effect. Many agents had undesirable toxicity among different organs. Although slightly different for myeloblastic or lymphoblastic variants, this approach produced apparent disease eradication. The concept of complete remission, both clinical and hematologic, was born. Some of our early enthusiasm has had to be tempered with the somber appreciation that not all patients can improve and many others experience relapses. Where then do we stand? Leukemic cells themselves seldom kill. It is the relentless and uncontrolled expansion of a neoplastic clone that leads to bone marrow failure, albeit at different rates in the various subtypes. In the acute forms, the common presentation remains symptomatic anemia, neutropenic sepsis, and thrombocytopenic bleeding. Differentiation from marrow aplasia may not be possible at first on clinical grounds, although bone tenderness, gingival hypertrophy, and skin infiltration are among the general useful differential signs. Findings in the circulation and the marrow are of cardinal importance in diagnosis; they provide the basis for classification. Improved accuracy has followed the introduction of cytochemical stains, and a widening range of monoclonal antibodies, and greater recourse to karyotyping, have enhanced diagnostic acumen. Treatment decisions rest on many variables or prognostic factors that include age, performance status, comorbidity, and disease category, with an ever increasing regard for the part played by cellular and molecular genetics. Despite skillful utilization of this wealth of information for optimal management, outcome often leaves much to be desired. Myelodysplasia encompasses a number of different syndromes in which the refractory anemias are indolent, whereas those with excess blasts progress toward overt leukemia. Considerable judgment is necessary in selecting patients for whom supportive therapy alone is appropriate and recognizing others, up to one third of patients for whom use growth factors that include erythropoietin, granulocyte or granulocyte monocyte-colony stimulating factors, and thrombopoietin can be justified. The often unfavorable result has been a stimulus to current investigations that examine the value of intensive chemotherapy or the more innovative bone marrow transplantation and its peripheral blood equivalent. Autografting is a newer alternative that does not have proved potential. Acute leukemia, whether myeloblastic or lymphoblastic, has been managed with mixed success. Remission rates have steadily increased and, notably among children, moved toward 100% in certain groupings. The downside of nonspecific drug regimens is that some patients simply may not respond, whereas others experience remissions and then relapses. (ABSTRACT TRUNCATED)
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PMID:Myelodysplasia and the leukemias. 930 44

Irradiation is known to cause temporary to permanent marrow aplasia in cancer patients when administered as a sole therapy or in combination with chemotherapy. Until now, no studies have been carried out evaluating the haematological toxicities of involved field radiation administered post autologous stem cell transplantation (ASCT). We assessed bone marrow (BM) toxicity in 93 patients who received involved field radiation post ASCT (non-Hodgkin's lymphoma 21, Hodgkin's disease 7, breast cancer 15, and other solid tumours 50. Severe BM toxicity, with grade IV neutropenia, and/or thrombocytopenia, and/or anaemia necessitating interruption of radiotherapy for more than a week, was observed in 11 patients (malignant lymphoma-8 of which 7 were NHL, and 1 HD, breast cancer-1, Wilm's tumour-1, Ewing's sarcoma-1). Patients with malignant lymphoma were at higher risk of developing post ASCT radiation-induced cytopenias than patients with breast cancer or solid tumours, 28% vs 4.5%, respectively (P < 0.05). Of the 11 patients, 7 developed bacterial sepsis and 10 were hospitalised. The radiation-induced cytopenia patients necessitated platelets and red blood cell transfusions, interrupting the course of irradiation. Of the patients suffering from non-Hodgkin's lymphoma, 8/14 (57%) of those who received conventional courses of radiotherapy relapsed compared to 6/7 (86%) of those who received interrupted radiotherapy (P < 0.05). The most appropriate timing for radiation in malignant lymphoma patients who are scheduled for ASCT, as well as the protective role of haematopoietic growth factors like erythropoietin and Granulocyte (G) or Granulocyte-Monocyte (GM), colony stimulating factors (CSF) and others, are discussed.
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PMID:Involved field radiation post autologous stem cell transplantation in lymphoma patients is associated with major haematological toxicities. 978 19

The problems of immunologic adaptation during the transitional period from intra- to extrauterine life are responsible for the physiologic immaturity of the immune function in newborn infants. In preterm neonates the immunodeficiency is more severe and prolonged and is associated with a higher incidence of infections and sepsis. Furthermore, due to immaturity of the hematologic system, anemia, thrombocytopenia, and neutropenia are frequently observed in very low birth weight infants. The dysregulation of cytokine and hematopoietic growth factor synthesis is an important contributory factor to the complex deficiency of immunologic and hematologic function in the neonate and may explain the reduced incidence of acute graft-versus-host disease observed after cord blood transplantation in children. Human milk is a rich source of most of the cytokines that are reduced in the neonate. Granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, and erythropoietin are currently under evaluation in newborn infants with septic neutropenia or anemia of prematurity.
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PMID:Hematopoietic growth factor levels in term and preterm infants. 1022 41


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