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Biomedical subjects

B Wilbur

Publications and source records attributed to B Wilbur.

6 recordsLinked to original sources
PubMed2001

Two cases of cutaneous Leishmaniasis presenting to the emergency department as chronic ulcers.

With the increasing numbers of travelers and immigrants coming to the United States from tropical areas where Leishmaniasis is endemic, it is important to be familiar with its common cutaneous manifestations. Leishmaniasis is a parasitic infection caused by the obligate intracellular protozoa Leishmania and is transmitted by the bite of the sandfly. It can appear as a nonhealing lesion on exposed skin in patients and is often misdiagnosed, delaying treatment. We present two cases of patients who presented to the Emergency Department with chronic, nonhealing ulcers that were ultimately found to have Leishmaniasis.

Adult↗
PubMed1987

Chemoendocrine therapy with prolonged estrogen priming in advanced breast cancer: endocrine pharmacokinetics and toxicity.

Recent efforts to improve response rates in advanced breast cancer have used short, alternating courses of antiestrogen therapy followed by estrogen priming to cytokinetically enhance tumor cell sensitivity to antimetabolites. Based on recent in vitro and in vivo studies, we have introduced a chemoendocrine regimen that uses prolonged courses of estrogen priming. The present protocol consists of alternating monthly cycles of tamoxifen (TAM) and estradiol during which sequential (24-hr) methotrexate, 5-fluorouracil, and leucovorin are administered at 2-week intervals. Twenty-five patients with metastatic breast cancer received greater than 80 endocrine cycles and greater than 300 courses of chemotherapy by this protocol; two-thirds of these patients had previously failed other endocrine or chemotherapy regimens. Most patients experienced grade 1 or 2 myelosuppression or gastrointestinal symptoms during at least one treatment cycle; however, overall toxicity was considered to be mild and therapy was very well tolerated. Serum levels of estradiol, estrone, TAM, and TAM metabolites were measured during all phases of the endocrine cycle in five patients on chronic therapy. Concentrations of TAM and its more abundant metabolite, N-desmethyltamoxifen (N-desTAM), rose twofold during antiestrogen therapy and fell during estrogen priming, with mean levels persisting greater than 100 ng/ml throughout the priming interval. Mean estradiol (E2) and estrone (E1) levels rose during priming and were sustained fivefold and tenfold above the basal postmenopausal levels measured during antiestrogen treatment. Calculating the serum molar ratios of [TAM + N-desTAM]/[E2 + E1] during each phase of the treatment cycle confirmed that estrogen priming was achieved pharmacologically by this endocrine schedule. Clinical remissions were observed in this small patient sample with seven of 18 patients achieving either complete (28%) or partial (11%) responses, and an additional 39% obtaining disease stabilization. Further clinical study is necessary to evaluate the optimal response rate of this regimen and to determine whether cyclic estrogen priming by this schedule results in enhanced tumor cell proliferation in vivo.

Adult↗
PubMed1986

Peak cerebrospinal fluid platinum levels in a patient with ependymoma: evaluation of two different methods of cisplatin administration.

Peak CSF and serum platinum levels were examined in a patient with ependymoma after each of four consecutive cisplatin doses of 100 mg/m2 administered by either 30-minute or 3-hour infusion. Both infusion lengths produced similar peak CSF platinum levels within 2 hours after the completion. Ultrafiltrate serum platinum levels correlated with the CSF platinum levels, whereas total plasma platinum did not. No differences in clinical toxicity or response were seen between the two methods of administration. Based on these preliminary results, similar peak CSF platinum concentrations are achieved by 30-minute or 3-hour infusions, and ultrafiltrate serum platinum concentrations can be used to predict these levels.

Brain Neoplasms↗
PubMed1979

Thoracic outlet syndrome.

Eleven patients with vascular sequelae of thoracic outlet syndrome were operated on at the University of California, SanFrancisco, during the past 17 years. Five patients presented with episodes of ischemia of the arm and hand secondary to microemboli released from subclavian arterial lesions produced by chronic compression at the thoracic outlet. Treatment consisted of arterial reconstruction, removal of the compressive structure, and cervical sympathectomy to relieve or lessen distal ischemia. Four of the five patients had good or excellent results; one patient required amputation of the forearm. The results were inversely proportional to the extent of distal arterial embolic occlusions present at the time of surgical treatment. Six patients presented with symptoms of chronic venous hypertension. Four of the six had subclavian venous thrombosis and were treated by transaxillary resection of the first rib to decompress the collateral veins within the costoclavicular space. All four were symptomatically improved. Two patients had venous hypertension due to extrinsic compression of the subclavian vein. One patient became asymptomatic and the other was markedly improved after resection for external compression. In this small series transaxillary resection of the first rib has resulted in symptomatic improvement in chronic venous hypertension of the arm.

Adolescent↗