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Biomedical subjects

C H Srodes

Publications and source records attributed to C H Srodes.

9 recordsLinked to original sources

Metastatic cancer in Paget's disease of bone. A case report.

A 50-year-old white male presented with concurrent Paget's disease of bone and metastatic adenocarcinoma. Our review of the literature and our clinical experience suggests that carcinoma coexisting at the site of bone involved with Paget's disease occurs more commonly than has been recognized. The paucity of reports of tumor metastatic to sites of Paget's disease of bone may be due to an artifact of data collection. The differentiation of metastatic from de novo tumors must be accomplished by biopsy, and the diagnosis is essential for appropriate treatment. Commonly a correlation of known tumor types with Paget's disease is made, and metastatic tumors are excluded.

Adenocarcinoma

Maintenance chemotherapy for high-risk patients. A preliminary report.

A prospectively designed program employing surgery, radiotherapy, and maintenance chemotherapy was initiated for patients with histologic evidence of extracapsular spread of tumor in cervical metastases. Postoperative radiotherapy consisted of 6,000 rad of cobalt 60 administered in 180- to 200-rad fractions. Chemotherapy was initiated two to four weeks following radiotherapy. Methotrexate sodium (250 mg/sq m), fluorouracil (600 mg/sq m), and leucovorin calcium were administered one day per week, two weeks of three, for a total of 18 treatments in six months. Thirty-two patients have been in the therapeutic program. Toxic reaction has been minimal and self-limiting. One patient stopped chemotherapy because of toxic reaction. One patient (3%) was noncompliant. All patients have been followed up for 18 to 33 months. Twenty-one patients remain alive and free of disease (81% determinate survival). This compares with a 36% (9/25) disease-free survival for concurrent controls and 39% survival for historic controls.

Adult

Leukemia with multiple phenotypic expressions.

A patient is described who, during a three-year illness, exhibited multiple phenotypic expressions of leukemia. She was diagnosed initially as having acute lymphoblastic leukemia (ALL) followed by chronic myelogenous leukemia (CML) one and a half years later. Subsequent blast transformations were lymphoblastic, but preterminally, a myeloblastic transformation occurred. These later leukemias probably were not chemotherapy induced, because a review of her initial work-up revealed the presence of a smaller G group chromosome in 1 of 20 metaphases examined. Her clinical course also differs from the CML that presents in lymphoid blast crisis because the Philadelphia chromosome only was emerging at that point. This case illustrates the interrelationships of the various leukemias and supports the hypothesis that a totipotent stem cell may undergo leukemic transformation resulting in variable and simultaneous expressions.

Adult

Marginal neutrophil pool size in normal subjects and neutropenic patients as measured by epinephrine infusion.

The marginal granulocyte pool (MGP) was measured by epinephrine infusion in normal and neutropenic subjects. Neutrophil response curves to doses of 0.025 to 0.3 mg. in three normal subjects indicated that maximal neutrophil response was achieved by 0.1 mg. In 21 normal subjects, absolute neutrophils increased from 700 to 3,100 per microliter. The percentage increase ranged from 18 to 107 per cent of baseline. The per cent increase tended to be greater with low-normal baseline neutrophils than with high-normal neutrophils, although this relationship was not observed when increase was determined in absolute values. In neutropenic patients mean per cent increase of neutrophils was greater than observed in normal subjects, 121 vs. 50 per cent. Although the increase expressed in absolute neutrophil numbers was less in subjects with lower baseline neutrophil concentrations, there was an inverse correlation between the baseline neutrophil concentrations, there was an inverse correlation between the baseline neutrophils and the per cent increment following epinephrine. Mean increase was 200 per cent in patients with less than 200 neutrophils per microliter, compared with 61 per cent in patients with 1,000 to 1,500 neutrophils per microliter. These results indicate that circulating granulocyte pool (CGP) size may be misleading with respect to total blood neutrophils and in a sense confirm the concept of shift neutropenia, a decreased CGP and MGP as neutropenia becomes more profound suggests that shift neutropenia may be a normal physiologic methanism rather than a distinct neutropenic syndrome.

Adult

Idiopathic pulmonary hemosiderosis. Electron microscopic, immunofluorescent, and iron kinetic studies.

The clinical course of a 37-year-old white man with idiopathic pulmonary hemosiderosis is presented. This patient is unusual in that he has had repeated exacerbations and remissions over a period of seven years and remains currently in spontaneous remission with no therapy. Routine sections of the lung biopsy revealed characteristec findings. Immunofluorescence staining of the lung was negative, and electron microscopic studies showed only nonspecific findings. While in remission, 51chromium-labelled red-blood-cell survival studies and 59iron kinetic studies were performed; the results were normal.

Adult

Autonomous erythropoiesis during erythroblastic crisis of chronic myelocytic leukemia.

Two patients with chronic myelocytic leukemia who developed an erythroblastic rather than a myeloblastic phase were studied with respect to whether or not the megaloblastic erythropoiesis was subject to normal control mechanisms. After transfusion, no significant reduction was observed in the percentage of nucleated erythroid precursors or of proerythroblasts in marrow or in blood reticulocytes. In one of the two patients, ferrokinetics and urinary erythropoietin levels were studied and were also compatible with the conclusions that erythropoiesis was autonomous in this rare syndrome. Three patients with clinical pictures compatible with Di Guglielmo's syndrome were studied as controls. As has been reported previously, erythropoiesis in this syndrome appeared to be responsive to normal control mechanisms. These data suggest that these two clinically similar syndromes, erythroblastic crisis of chronic myelocytic leukemia and Di Guglielmo's syndrome may represent qualitatively different defects in hematopoietic stem cells.

Adult