Showing papers by "Thomas Jefferson University Hospital published in 1982"

Assessment of the long-term effects of primary radiation. Therapy for brain tumors in children

Abstract: One-hundred-twelve children with primary brain tumors received definitive radiotherapy between the years 1958--1979. Sixty-nine patients were alive at intervals of 1--21 years. Thirty-eight patients underwent neurologic and endocrine evaluation, psychologic and intelligence testing, and assessement for second malignancy post-treatment. A second intracranial malignancy developed in one child, for an incidence of 1.6%. Performance status was good to excellent in 89% of the patients studied. Seventeen percent of the group were mentally retarded. Behavioral disorders were identified in 39% of the patients, 59% of the mothers, and 43% of the fathers. Of the 23 patients with nonparasellar tumors, six were found to have growth hormone deficiency, including two patients with panhypopituitarism. Disability was related to age under 3 years at the time of treatment and tumor extension to the hypothalamus.

Preoperative embolization of retroperitoneal hemangiopericytomas as an aid in their removal

Abstract: The first reported cases of preoperatively embolized hemangiopericytomas are presented. Both lesions presented in the retroperitoneum where most lesions are now considered to be malignant. In the past, the highly vascular nature of these tumors has made resection in these areas difficult. Since the angiographic picture of hemangiopericytomas is now thought to be specific, it became feasible to add preoperative embolization to the overall management of these cases. In the first case, the diagnosis had been established 15 years previously. When first seen at Thomas Jefferson University Hospital, extensive bone destruction of the sacrum and lumbar vertebrae were present. Preoperative Gelfoam embolization aided in the palliative debulking of the tumor at operation. With this experience, preoperative embolization became part of the management in the second case and aided in the complete surgical removal of the tumor. Radiation therapy in the dosage of 5000 rad was given postoperatively in this case and should also be part of the treatment plan for these lesions.

Posterior arch defects of the cervical spine

Abstract: Spondylolysis and absence of the pedicle are congenital anomalies of the posterior cervical spine. Their roentgenographic changes may be confused with other more serious entities which may necessitate either emergent therapy or require extensive diagnostic testing and treatment. Four cases are present and the literature is reviewed. A hypothesis for the embryologic etiology of these entities is proposed.

Does preoperative irradiation increase the rate of surgical complications in carcinoma of the head and neck?: A radiation therapy oncology group report

Abstract: This is a comparison of the rate of surgical complications in a group of patients with advanced but operable carcinoma of the head and neck who underwent surgery after preoperative radiotherapy (5000 rad in five weeks, 200 rad fractions, directed to the primary tumor area and neck) versus another group operated without prior irradiation. Both groups of patients formed part of a randomized prospective multiinstitutional trial of the Radiation Therapy Oncology Group (73-03). Of 229 patients who had planned operations, 88 (38%) developed some degree of surgical complications, and in 28 (12%) the complications were rated as severe. The most frequently reported complications were delayed healing and fistula formation each occurring in approximately one-fourth of each of the two treatment groups. Carotid blow-out occurred in 5% or less of the cases. No significant statistical difference between treatment groups was noted for the overall complication rate or specific type of surgical complications. A trend was noted towards more complications in the preoperative group for patients with lesions in the oropharynx and supraglottic larynx. However, an opposite trend towards more complications in the no prior irradiation group was observed among patients with lesions in the oral cavity and hypopharynx. Surgical mortality and postoperative hospital stay were not significantly different between treatment groups. We conclude that preoperative irradiation for carcinoma of the head and neck, with the stated dose, followed by surgery in 4-6 weeks, does not substantially increase the rate of overall or specific type of surgical complications, surgical mortality or hospital stay versus those patients operated without prior irradiation.

Phase II trial of tamoxifen in metastatic carcinoma of the prostate.

Abstract: Fifty-one patients with advanced metastatic carcinoma of the prostate were treated with the antiestrogen tamoxifen. Thirty-eight of these patients were refractory to prior hormonal manipulation with estrogens and/or orchiectomy, and five (13%) achieved an objective response (partial regression or stable disease using the National Prostate Cancer Project criteria). Median survival of the responders was significantly longer than that of the nonresponders (P less than 0.05). An additional 13 patients who had not previously received hormonal manipulation were treated with tamoxifen; one partial response and three disease stabilizations were noted. Response was separately evaluated for 15 patients with objectively measurable lesions using standard Phase II response criteria. Only 1/15 (7%) partial response and 3/15 (20%) disease stabilizations were documented. Subjective benefit in terms of significant pain relief was noted in 17/50 (34%) of patients. Toxicity was mild, but two possible "tumor flares" were noted. These results do not support the continued investigation of tamoxifen in advanced carcinoma of the prostate.

Modification of Radiation-induced Division Delay by Caffeine Analogues and Dibutyryl Cyclic AMP

Abstract: The mitotic selection procedure for cell cycle analysis was utilized to investigate the concentration-dependent modification of radiation-induced division delay in Chinese hamster ovary (CHO) cells by methyl xanthines (caffeine, theophylline, and theobromine) and by dibutyryl cyclic AMP. The methyl xanthines (concentrations from 0.5 to 1000 micrograms/ml) all reduced radiation-induced division delay with the effect being linear between approximately 100 and 1000 micrograms/ml. After doses of 100-300 rad, delay was reduced by 75, 94 or 83 per cent at 1000 micrograms/ml for each drug, respectively. However, the addition of dibutyryl cyclic AMP had an opposite effect: radiation-induced delay was increased by the concentration range of 0.3 to 300 micrograms/ml. These results indicate that in mammalian cells the control of cell cycle progression and the modification of radiation-induced division delay are not simply related to intracellular levels of cyclic AMP. Rather, there appear to be at least two competing mechanisms which are differentially affected by caffeine analogues or by direct addition of dibutyryl cyclic AMP. The direct effect of caffeine and the methyl xanthines on membrane calcium permeability is considered.

Home total parenteral nutrition in cancer patients

Abstract: Home parenteral nutrition has been used in a carefully selected group of patients with recurrent, incurable cancer. The goal of this treatment was to allow the patients to live their final months at home, instead of confined to hospital. Experiences with this program have shown that a rigidly defined group of patients can lead a comfortable existence with an acceptably low complication rate before eventually succumbing to their cancer. Additionally, a significant cost savings is realized, compared to the alternative of prolonged hospitalization.

Computed tomography of stress fracture

Abstract: An athletic young female developed gradual onset of pain in the right leg. Plain radiographs demonstrated solid periosteal reaction in the tibia compatible with stress fracture. She stopped sport activites but her pain continued. Follow-up radiographs of the tibia revealed changes suspicious for osteoid osteoma. Computed tomography (CT) scan demonstrated periosteal reaction, but in addition, lucent fracture lines in the tibial cortex were evident. CT obviated the need for more invasive diagnostic procedures in this patient. In selected cases CT may be useful to confirm the diagnosis of stress fracture when plain radiographic or routine tomographic studies are not diagnostic.

Summary results from the facilities master list surveys conducted by the patterns of care study

Abstract: The Patterns of Care Study has conducted three national surveys of radiation therapy facilities in the United States. This paper presents summary results from the surveys. Data are presented on the number of patients treated by radiation therapists, the number of radiation therapy facilities, number of full-time and part-time therapists, and other aspects of the practice of radiation therapy.

Hypercementosis--an important clue to Paget disease of the maxilla.

Abstract: Paget disease of the maxilla and mandible is not rare. There appears to be a significant correlation between skull involvement in the form of osteoporosis circumscripta and maxillofacial changes. The maxillary component can be of the typical form of Paget disease or be in the form of hypercementosis. The latter change is not well recognized and we present two cases with such involvement.

Combined pre and postoperative radiation for carcinoma of the rectum

Abstract: Since 1976, anew approach to adjuvant radiation therapy in carcinoma of the rectum has been used at Thomas Jefferson University Hospital. Seventy-eight patients with biopsy-proven invasive carcinoma of the rectum have been treated with low dose preoperative radiation, 500 rad given either on the day of or the day before surgery. Following surgery, the lesions were pathologically staged according to Astler-Coller's Modification of Duke's staging. Patients with good prognostic features (Stage A or B 1 ) were followed with no further treatment while patients with poor prognostic characteristics (Stage B 2 , C 1 -and C 2 ) were treated with aggressive postoperative pelvic radiation, 4500 rad delivered in five weeks. All patients entered into this study received the preoperative dose of 500 rad. Fifty-six patients underwent an A-P resection, four patients underwent a low anterior resection and ten patients had a combined abdominal transsacral resection. Eight patients were found to have liver metastasis at laparotomy and underwent a colostomy followed by palliative therapy. Twenty-nine patients were found to have early disease, Stage A or B 1 and were given no further therapy. Of 41 patients with Stage B 2 or C, 25 patients received the full course of postoperative radiation. Sixteen patients did not receive postoperative radiation for a variety of reasons. Follow-up in these patients ranges from six months to a maximum of 48 months with a median follow-up of 18 months. Sixty-nine of the total group of 78 patients are currently alive. Two patients with early tumor (Stage A or B,) have died of metastasis. One other patient with Stage A carcinoma died of unrelated causes. Two of the 25 patients receiving postoperative radiation developed metastatic disease, but none of the patients developed local recurrence in the pelvis. Six of 16 patients who should have received postoperative radiation, but did not, recurred. Four of these six recurrences have been in the pelvis. Both the incidence of failure and the pattern of recurrence between these two groups of patients who did not receive postoperative radiation is suggestive of a better effect in the PR unrelated group. Survival of patients treated with this approach appears to be improved.

Comparison of oral melphalan, CCNU, and BCNU with and without vincristine and prednisone in the treatment of multiple myeloma. Cancer and Leukemia Group B experience

Abstract: A total of 361 evaluable patients with previously untreated multiple myeloma were randomized to receive oral melphalan (0.15 mg/kg/day for seven days, followed by 0.05 mg/kg/day after recovery from the nadir of the leukocytes), BCNU (150 mg/m2 intravenously every six weeks) or CCNU (100 mg/m2 orally every six weeks). All patients received a tapering six-weeks) or CCNU (100 mg/m2 orally every six weeks). All patients received a tapering six-week course of prednisone starting at 0.8 mg/kg for the first two weeks. At week 22, one-half of the patients were randomized to receive vincristine (1 mg/m2) and prednisone (0.6 mg/kg for seven days) every two months in addition to previous therapy. The melphalan treated patients showed a significantly higher overall objective response frequency (59%), according to Myeloma Task Force criteria, when compared to those treated with BCNU (40%) or CCNU (42%). The survivals for all patients were not statistically different for the three treatment programs. However, the good-risk patients treated with melphalan had significantly longer survival (P = 0.02) than the equivalent patients who received BCNU or CCNU. The addition of vincristine and prednisone at week 2 did not significantly increase the percentage of subsequent objective responses or prolong the subsequent survival of any treatment group. It is concluded that oral melphalan is superior to BCNU and CCNU in producing objective responses and in prolonging survival in good risk patients.

Fibrous dysplasia of the facial bones and mandible.

Abstract: Five cases of fibrous dysplasia isolated to the facial bones and mandible are presented. A review of the clinical and roentgen features of facial fibrous dysplasia are described.

Evidence for route dependent biotransformation of cyclobenzaprine hydrochloride.

Abstract: Cyclobenzaprine hydrochloride was administered to healthy volunteers as a 10 mg oral tablet, 10 mg and 20 mg intramuscular injections, and a 10 mg intravenous injection. Urinary excretion and plasma level data for cyclobenzaprine together provide evidence for route dependent biotransformation. Urinary excretion of total cyclobenzaprine (unchanged plus the glucuronide conjugate) was greater for the oral treatment than for the parenteral treatments (i.m. and i.v.). Area under the plasma concentration-time curve for unchanged cyclobenzaprine, however, was less for the oral treatment than for the parenteral treatments. Based on area calculations, the bioavailability of the 10 mg oral tablet, 10 mg i.m. and 20 mg i.m. injection was 0.33, 0.76, and 0.56, respectively, when compared to the 10 mg i.v. injection of cyclobenzaprine hydrochloride. The four treatments were well tolerated and no clinically adverse effects were observed.

Comparison Between the Methods of Indirect Immunofluorescence and Specific Red Cell Adherence in Detecting ABH ISO-Antigens in Bladder Carcinoma

Abstract: We compared the method of indirect immunofluorescence (IIF) with that of specific red blood cell adherence (SRCA) for detecting ABH blood group substance (BGS) on stage O papillary transitional cell carcinoma (TCC) of the bladder. In evaluating BGS “positivity” or “negativity” both methods gave identical results. The IIF is somewhat easier to perform and less subjective in interpretation while the SRCA method needs only a conventional light microscope and the slides themselves are permanent “records”. In cases of questionable reactivity with the SRCA, the IIF was a helpful adjunct. The IIF method is a viable option to the SRCA method when studying TCC for BGS.

Intracoronary thrombolysis for acute myocardial infarction.

Abstract: Excerpt Recent observations have prompted reexamination of our concepts concerning optimal therapy for myocardial infarction. Rentrop and associates have shown the acutely occluded coronary artery ...