Showing papers by "Rush University Medical Center published in 1982"

The palliation of symptomatic osseous metastases final results of the study by the radiation therapy oncology group

Abstract: Different dose fractionation irradiation schedules have been evaluated in a randomized Radiation Therapy Oncology Group (RTOG) study to determine their palliative effectiveness in patients with osseous metastases. The frequency, promptness and duration of pain relief were utilized as measures of response. Ninety percent of patients experienced some relief of pain and 54% achieved eventual complete pain relief. Important prognosticators included the initial pain score and the site of the primary lesions. Administration of steroid or chemotherapy during the one-month on-study period did not influence the frequency of pain relief. The low-dose, short-course schedules were as effective as the high-dose protracted programs.

P-31 nuclear magnetic resonance analysis of brain: the perchloric acid extract spectrum.

Abstract: Perchloric acid (PCA) extracts were prepared from liquid-N2-frozen guinea pig brains and their organophosphate profiles examined by P-31 nuclear magnetic resonance (NMR) spectroscopy. Thirty-two phosphorus-containing brain metabolites were characterized and quantitated. A distinctive feature of brain tissue metabolism relative to that of other tissues probed by P-31 NMR is its pronounced ribose 5-phosphate content. Comparison of brain metabolite levels following control or sublethal cyanide treatment (4 mg/kg) revealed specific cyanide-induced changes in brain metabolism. Brains from cyanidetreated animals were characterized by a reduced phosphocreatine content and elevated α-glycerolphosphate and inorganic orthophosphate contents relative to control. P-31 NMR spectra of brain PCA extracts at pH 7.2 were also obtained under conditions that approximate those used for in vivo and intact tissue in vitro P-31 spectroscopic analyses. The spectra reveal nine separate resonance bands corresponding to: sugar phosphates, principally ribose 5-phosphate (3.7δ); inorganic orthophosphate (2.2δ); glycerol 3-phosphorylethanolamine (0.3δ); glycerol 3-phosphorylcholine (−0.1δ); phosphocreatine (−3.2δ); adenosine tri-(β-ATP) and di-(β-ADP) phosphate ionized end-groups (−6.2δ); α-ATP, α-ADP, and nicotinamide adenine dinucleotides esterified end-groups (−11.1δ); uridine diphosphohexose, hexose esterified end-groups (−13.0δ); and β-ATP ionized middle group (−21.6δ). Knowledge of the phosphatic molecules that contribute resonances to the brain P-31 NMR spectrum as well as understanding their magnetic resonance properties is essential for the interpretation of in vivo brain spectroscopic data as well as brain extract data, since these same compounds contribute to the intact brain P-31 spectrum.

Fibrositis and psychologic disturbance

Abstract: Thirty patients with fibrositis and 2 control groups, one of rheumatoid arthritis patients and the other of arthritis patients with other than rheumatoid arthritis, were compared on the basis of the Minnesota Multiphasic Personality Inventory (MMPI) to assess the role of psychologic factors in fibrositis. Patients with fibrositis differed in both elevation and variability in their MMPI profiles, indicating that they were more psychologically disturbed than patients with rheumatoid or other types of arthritis. The fact that almost all of the fibrositis patients' MMPI scales were higher suggests that we might be dealing with a number of different psychologic disturbances that have stiffness and musculoskeletal pain as principal and common symptoms.

A comparison of adriamycin versus vincristine and adriamycin, and cyclophosphamide versus vincristine, actinomycin-D, and cyclophosphamide for advanced sarcoma

Abstract: This randomized study, conducted by the Eastern cooperative Oncology Group, compared Adriamycin (doxorubicin) (70 mg/m2) versus vincristine (1.4 mg/m2) and Adriamycin (50 mg/m2); and cyclophosphamide (750 mg/m2) versus vincristine (1.4 mg/m2), actinomycin-D (0.4 mg/m2), and cyclophosphamide (750 mg/m2) for treatment of metastatic mesenchymal malignancies. The respective response rate seen in 200 evaluable patients to the treatments were, 27, 19, and 11%. The response rate to Adriamycin was significant better than the response to vincristine, actinomycin-D, and cyclophosphamide (P = 0.03, two-sided). The respective median survivals on the three treatments were 37, 34, and 41 weeks and were not significantly different. Moderate or severe vomiting occurred in 60% of patients receiving vincristine-cyclophosphamide-adriamycin, a greater frequency than in Adriamycin alone (P = .09 two-sided) Severe or life-threatening hematologic toxicity (leukocytes less than 2000, platelets less than 50,000) occurred in 30% of patients receiving the Adriamycin combination, a markedly increased frequency when compared to the other two regimens (P equals 0.07, P = 0.02, two-sided). This trial establishes that Adriamycin has a better response rate than the combination of vincristine-actinomycin-D-cyclophosphamide in advanced sarcomas. The combination of vincristine, Adriamycin, and cyclophosphamide increased toxicity and did not add to the therapeutic effect achieved with Adriamycin alone.

Blood group precursor T-antigen expression in human urinary bladder carcinoma.

Abstract: Tumor deletion of the ABH blood group antigens (BGAg) heralds an unfavorable prognosis in human bladder cancer. The T antigen (Thomsen-Friedenreich antigen: TAg), a precursor of other BGAg, has previously been found in malignant but not most normal cells, in which the TAg is cryptic but can be unmasked with neuraminidase (NMD). We investigated the prognostic significance of TAg expression in bladder cancer by staining paraffin sections with a T-specific lectin (peanut agglutinin [PNA]) immunoperoxidase technic. Seventy-two cases of low grade, low stage bladder cancer, 21 cases of high grade bladder cancer, and 68 controls were studied. All normals expressed the TAg only after NMD treatment (Cryptic TAg+). The Grade HI cancers, all invasive, either expressed the TAg (TAg+) (67%) or lacked T even after NMD (Cryptic TAg–) (29%), indicating that the T structure was lost rather than masked as in normal tissue. Thirty-nine per cent of 23 Grade I and II cancers which were TAg+ or Cryptic TAg– subsequently became invasive (Stage B), compared with 10% of 49 Cryptic TAg+ cancers. For 32 Grade I and II, ABH BGAg negative cancers, 64% of TAg+ or Cryptic TAg– cancers became invasive, compared with 17% of cancers which had Cryptic TAg+. Thus, the TAg may be a prognostically useful immunohistochemical tumor marker in bladder cancer, especially for tumors negative for ABH BGAg.

Reciprocal excitation of antagonistic muscles as a differentiating feature in spasticity

Abstract: The electromyographic activity evoked by forced ankle rotation in spastic patients with cerebral palsy differs markedly from that found in normal subject or in patients with adult-onset injuries to the central nervous system. Rapid dorsiflexion can produce a strong myotatic reflex electromyogram at 30 to 50 msec in the normal adult's stretched soleus muscle, while the antagonist tibialis anterior muscle remains quiet. The same is true of spastic patients whose injury has an adult onset. In patients with cerebral palsy this early response is found in both muscle groups. The pattern of “reciprocal excitation” is in marked contrast to the reciprocal inhibition normally seen. This reflex behavior suggests a fundamental developmental error in neuronal interconnections of the spinal cord in cerebral palsy.

Comparison of induction chemotherapies for metastatic breast cancer. An Eastern Cooperative Oncology Group Trial.

Abstract: Patients with advanced breast carcinoma and no prior chemotherapy were prospectively evaluated to assess the induction capabilities of cyclophosphamide, methotrexate and 5-fluorouracil (CMF), Adriamycin and vincristine (AV), and CMF plus prednisone (CMFP). The crossover responsiveness from CMF or CMFP to AV and of AV to CMF were also assessed. A disproportionate randomization led to 166 analyzable cases on AV, 79 on CMF were also assessed. A disproportionate randomization led to 166 analyzable cases on AV, 79 on CMF and 86 on CMFP induction. One hundred and twelve patients were evaluated on crossover. Induction response rates were similar with 56% on AV, 57% on CMF and 63% on CMFP. Crossover response rates ranged from 32% to 41%. CMFP and AV were superior to CMF in terms of response duration (P = 0.05), and CMFP was superior to either in terms of time to treatment failure (P = 0.04), and survival (P = 0.03). Treatment failures occurred in only the on-study organ sites of disease in 73% of the patients and did not appear to be related to the response achieved. CMF was associated with more thrombocytopenia than either AV or CMFP (P = 0.03). AV was associated with fewer infections than CMFP (P = 0.02), less diarrhea than CMFP (P = 0.04), more emesis than CMF (P = 0.02), and more neurologic toxicity than either CMF or CMFP (P less than 0.0001). There was also more emesis with CMF than with CMFP (P = 0.006). CMFP was associated with greater delivery of CMF than was the CMF regimen despite a similar day 1 leukocyte distribution. These results strongly suggest that CMF(P) and AV are clinically noncross-resistant regimens, that AV and CMF are essentially equivalently active induction regimens, and that CMFP is superior to CMF and AV.

Digital replantation and amputation--comparison of function.

Abstract: Clearer indications regarding when to replant an amputated digit can be obtained by comparing the functional capabilities of two similar groups of patients, one of which has had amputations and one of which has had replantations. This paper reports such a comparative study. Function was assessed by asking the patient to perform 10 tests designed to cover a broad spectrum of everyday activities, and grip strength was compared to that in a normal hand. Grip strength was appreciably greater in patients with replanted thumbs and multiple digits, and less so in those with replanted single digits. Based on our findings on the small, but intensively studied, number of patients assessed in this review, it would appear that thumbs should always be replanted if possible. In contrast, the functional analysis shows little necessity for replantation of a single finger. Multiple digital replantation assumes lesser functional value if one or more fingers remain that can oppose the thumb to provide prehension.

Unipolar Sensing Abnormalities: Incidence and Clinical Significance of Skeletal Muscle Interference and Under sensing in 228 Patients

Abstract: Compared to bipolar lead configurations, unipolar pacing systems presumably enhance sensing of cardiac electrical events but are ore susceptible to electrical interference, including skeletal myopotentials. The incidence and clinical significance of oversensing and of undersensing by unipolar R-wave inhibited pacemakers in 228 patients were assessed by 24-hour Holter monitoring and/or by pectoral muscle exercises. Overall, 38% of patients exhibited oversensing and false inhibition due to skeletal myopotentials. Symptoms due to oversensing occurred in 14% of patients and 58% of these required corrective intervention. The presence of silastic coating on the pulse generator had no effect on the sensing of myopotentials. In addition, the incidence of undersensing as assessed by Holter monitoring was 17% despite adequate implantation R wave amplitudes. Thus, oversensing remains a major clinical problem when using unipolar pacemaker systems and their use has not eliminated undersensing.

Alprazolam: pharmacokinetics, clinical efficacy, and mechanism of action.

Abstract: Alprazolam, a triazolobenzodiazepine, is the first of this new class of benzodiazepine drugs to be marketed in the United States and Canada It achieves peak serum levels in 07 to 21 hours and has a serum half-life of 12 to 15 hours When given in the recommended daily dosage of 05 to 40 mg, it is as effective as diazepam and chlordiazepoxide as an anxiolytic agent Its currently approved indication is for the treatment of anxiety disorders and symptoms of anxiety, including anxiety associated with depression Although currently not approved for the treatment of depressive disorders, studies published to date have demonstrated that alprazolam compares favorably with standard tricyclic antidepressants Also undergoing investigation is the potential role of alprazolam in the treatment of panic disorders Alprazolam has been used in elderly patients with beneficial results and a low frequency of adverse reactions Its primary side effect, drowsiness, is less than that produced by diazepam at comparable doses Data on toxicity, tolerance, and withdrawal profile are limited, but alprazolam seems to be at least comparable to other benzodiazepines Drug interaction data are also limited, and care should be exercised when prescribing alprazolam for patients taking other psychotropic drugs because of potential additive depressant effects

Operational definitions of schizophrenia: what do they identify?

Abstract: Several studies have shown that different systems for diagnosing schizophrenia produce diagnoses with relatively low agreement. This, however, does not necessarily imply that the different systems are identifying conceptually different diagnostic groups. They may, in fact, identify a single entity,

Sequence and timing of ventricular wall motion in patients with bundle branch block. Assessment by radionuclide cineangiography.

Abstract: We determined the sequence and timing of inward ventricular wall motion by least-square phase analysis of radionuclide cineangiograms in 10 patients with left bundle branch block (LBBB), five patients with right bundle branch block (RBBB) and 11 patients with normal conduction. All LBBB and RBBB patients had normal coronary arteries and no segmental wall motion abnormalities. The left ventricle (LV) was divided into eight segments and the right ventricle (RV) into three; sequence and timing were scored by three observers. In normal subjects, wall motion begins in either or both ventricles and ends in the LV or both ventricles. In patients with LBBB it begins in the RV and ends in the LV; in patients with RBBB is begins in the LV and ends in the RV or both ventricles. The intraventricular wall motion is also altered in the ventricle ipsilateral to a bundle branch block. In LBBB, the mean time of onset of LV wall motion is delayed 1.9 frames (38 msec), whereas RV wall motion is normal. In RBBB, the onset of RV wall motion is delayed 1.3 frames (26 msec), whereas LV wall motion is not delayed.

The Effect of D-Penicillamine on Protein-Bound Homocyst(e)ine in Homocystinurics

Abstract: Summary: There is considerable evidence that homocystine has a direct damaging effect on vascular endothelium and other tissues. The demonstration of the existance of protein-bound homocyst(e)ine has strengthened this hypothesis. In an attempt to remove bound homocyst(e)ine, D-penicillamine was given to three patients with pyridoxine-nonresponsive homocystinuria. Before the clinical trial, it had been demonstrated that 0.1 μmole per ml concentration of D-penicillamine or cysteamine released approximately 50% of the homocyst(e)ine bound to plasma proteins in vitro. Oral D-penicillamine effectively reduced both free and plasma protein-bound homocyst(e)ine in homocystinurics from the second day of treatment. The homocystine excreted in the urine was mainly in the form of homocysteine-penicillamine disulfide. No mixed disulfide was detectable in the plasma, indicating an extremely high renal clearance. These observations suggested that oral D-penicillamine removed a considerable quantity of the bound homocyst(e)ine accumulated in the tissue proteins. Speculation: D-Penicillamine treatment may be used on an experimental basis in pyridoxine-nonresponsive homocystinuric patients when dietary treatment is not practical. It may also be used in pyridoxine-responsive patients when control with pyridoxine is unsatisfactory. In addition, determination of protein-bound homocyst(e)ine should be used for the assessment of the effectiveness of therapy.

Small Cell Carcinoma of the Nose and Paranasal Sinuses

Abstract: Primary small cell carcinoma of the nose and paranasal sinuses is rare. This tumor appears to behave differently from the pulmonary small cell tumor, with propensity for local recurrence rather than early distant spread. Two new cases will be presented.

Reciprocal excitation of muscle antagonists by the primary afferent pathway

Abstract: Measurements were made from electromyograms, evoked in human soleus and tibialis anterior muscles by tendon taps. Evidence is presented to suggest that in certain motor disorders it is possible to stimulate the stretch reflex afferents from a single muscle and elicit activity both in that muscle and its antagonist at comparable latencies and levels. Responses in both muscles occur at the short latencies of an oligosynaptic or even possibly a monosynaptic pathway. We discuss the proposition that the traditional concept of spinal reciprocal innervation as an inhibitory linking of muscle antagonists must be expanded to include both inhibitory and excitatory connections. Such reciprocal excitatory connections appear pronounced in spastic patients who have suffered perinatal injuries to the immature nervous system.

Evidence for the Presence in Arterial Walls of Intracellular-Molecular Mechanism for Action of Mineralocorticoids

Abstract: Data from clinical and experimental studies indicate that mechanism(s) for action of mineralocorticoids, other than renal, must be involved in the overall effect of mineralocorticoids on circulation - increased peripheral resistance and hypertension. We have postulated existence of such a mechanism in the arterial wall and have looked for the evidence for its presence. We have found high affinity, specific binders for mineralocorticoids, and glucocorticoids, with characteristics of steroid receptors, in the cytosol of rabbit aorta and femoral and carotid arteries. These binders possess physicochemical properties of steroid receptors and, moreover, they translocate to cell nuclei (as steroid-receptor complexes) and bind to relatively specific “acceptor-sites” on nuclear chromatin. This provides evidence for the existence of an intracellular-molecular mechanism for a direct in situ action of mineralocorticoids, and also glucocorticoids, in the arterial wall. We postulate that the demonstrated previously eff...

Suture granuloma: an unusual cause of an enhancing ring lesion in the postoperative brain.

Abstract: Ring lesions are not infrequently noted at the operative site of intracranial tumors at varying intervals of time after surgery. We present a suture granuloma as an unusual cause of such a lesion. Two guidelines that help in the diagnosis and management of these lesions are discussed with emphasis on the value of the precontrast scan.

Primitive reflexes and cognitive function in the elderly

Abstract: Primitive reflexes were studied in patients with presumed Alzheimer disease and in age-matched nondemented controls. A snout reflex occurred with equal frequency (54%) in the two groups. An abnormal glabellar reflex was elicited more often in the demented patients (23%) than the controls (8%). The presence of a snout reflex was directly correlated with increasing age; the glabellar reflex showed a similar but nonsignificant trend. Neither reflex finding correlated with the presence of apparent cerebral atrophy by CT scan or the results of psychometric tests. The finding of primitive reflexes has little clinical value in the evaluation of the elderly.

The electroencephalogram in Tourette syndrome

Abstract: The electroencephalogram (EEG) was studied in 38 patients with Tourette syndrome. Psychometric tests and neurological evaluation identified patients with signs of additional central nervous system dysfunction. Thirteen patients (34%) had some EEG abnormality. In contrast to findings by other investigators, epileptiform activity was uncommon (only 2 out of 38). Most of the patients with EEG abnormalities either had other objective signs of neurological dysfunction or were taking haloperidol, a drug known to disturb the EEG.

An early postpartum hospital discharge program: implementation and evaluation.

Abstract: An early postpartum hospital discharge program for post-delivery mothers and infants is described in three phases: antepartum planning, postpartum instruction, and home follow-up. Review of statistics after two years showed few complications, and evaluation of the program by means of a questionnaire showed consumer satisfaction.