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Biomedical subjects

Christopher D Jahraus

Publications and source records attributed to Christopher D Jahraus.

8 recordsLinked to original sources
PubMed2006

Optic pathway gliomas.

Optic pathway gliomas represent approximately 5% of all pediatric intracranial tumors. While these tumors are most frequently low grade astrocytomas, they follow a highly variable clinical course, and accordingly, there is much debate regarding their optimal management. Their propensity to occur in very young children and infants further complicates selection of therapy. Historically, surgery and radiotherapy have played a primary role in management, however, in the last 15 years, chemotherapy has evolved into the first-line treatment of choice. Nonetheless, chemotherapy frequently fails, but serves to delay implementation of radiotherapy or surgery until the child has progressed neuropsychologically. An overall favorable prognosis for this tumor emphasizes the need for careful selection of therapy. Herein, we review the major features of optic pathway glioma, including epidemiology, pathology, therapeutic interventions, outcome, and treatment sequelae.

Combined Modality Therapy↗
PubMed2005

Prevention of acute radiation-induced proctosigmoiditis by balsalazide: a randomized, double-blind, placebo controlled trial in prostate cancer patients.

PURPOSE: A common complication of pelvic radiotherapy (RT) is acute radiation-induced proctosigmoiditis (RIPS), for which a multitude of therapies have been tried. The 5-aminosalicylates (5-ASA), which are traditionally used to treat inflammatory bowel disease, have been tested; however, all but one prior randomized attempt to limit or prevent RIPS with 5-ASA-type agents have failed. We sought to evaluate balsalazide, a new 5-ASA drug, for its potential to prevent or limit RIPS in patients undergoing RT for carcinoma of the prostate, as a representative sample of pelvic RT patients. Balsalazide has a unique delivery system in that 99% of ingested drug is delivered to and activated in the colon, a higher yield than all other oral agents currently available in this class. Furthermore, it lacks the antigenic sulfa moiety present in sulfasalazine, the only other 5-ASA with demonstrated benefit in this setting. Thus, it was deemed an ideal candidate for preventing or limiting RIPS. METHODS AND MATERIALS: Eligible patients included prostate cancer patients, American Joint Committee on Cancer Stage T1-3, M0 being treated with external beam radiotherapy in the University of Kentucky Department of Radiation Medicine. Between January 1, 2003 and July 1, 2004, 27 eligible patients were enrolled in the study. Patients were administered 2250 mg of balsalazide or an identical-appearing placebo twice daily beginning 5 days before RT and continuing for 2 weeks after completion. Toxicities were graded weekly according to National Cancer Institute Common Toxicity Criteria v. 2.0 for each of the following: proctitis, diarrhea, dysuria, weight loss, fatigue, nausea, and vomiting. A symptom index was formulated for each toxicity consisting of the toxicity's numeric grade multiplied by the number of days it was experienced, and summed for each grade experienced throughout the course of RT. RESULTS: With the exception of nausea or vomiting, seen in 3 patients on balsalazide and 2 on placebo, all toxicities were appreciably lower in patients taking balsalazide. Proctitis was prevented most significantly with a mean proctitis index of 35.3 in balsalazide patients and 74.1 in placebo patients (p = 0.04). Placebo patients lost an average of 2.7 pounds, whereas balsalazide patients on average gained weight. Unexpectedly, dysuria was also lower in balsalazide-treated patients. CONCLUSIONS: Balsalazide is a new-generation 5-ASA drug that yields a high concentration of active drug to the distal colon. Results of this pilot study suggest that it is able to prevent or reduce symptoms of RIPS in patients undergoing RT for prostate cancer. We feel that these results justify the formation of a cooperative group trial to assess its efficacy in a multi-institutional setting.

Acute Disease↗
PubMed2004

Vascular brachytherapy: a new approach to renal artery in-stent restenosis.

Renovascular hypertension is frequently the result of atherosclerosis and has been successfully treated with percutaneous angioplasty. Stenting of vessels has helped to significantly lower the rate of restenosis after angioplasty; however, neointimal hyperplasia frequently results in growth of tissue through the stent, causing in-stent restenosis. Similar problems are seen in coronary stenting, and vascular brachytherapy has been shown to effectively prevent repeat in-stent restenosis. While coronary and renal restenoses occur by a common physiologic mechanism, their anatomic differences have prevented widespread adaptation of vascular brachytherapy to renal in-stent restenoses. A number of recent reports have demonstrated efficacy of renal vascular brachytherapy, but thus far, no large-scale, randomized data is available. Herein is reviewed the subject of renal vascular brachytherapy and the studies that are presently used in its justification.

Angioplasty, Balloon↗
PubMed2003

Atypical presentation and progression of glioblastoma multiforme in a 6-year-old girl: multidisciplinary case report.

Glioblastoma multiforme is the most common adult malignant brain tumor but is notably less common in children. The authors describe the case of a child who presented for evaluation and treatment of neurologic signs caused by a brain stem glioma. Response to radiotherapy and chemotherapy with temozolomide was initially positive, but later extensive leptomeningeal metastasis developed. Biopsy proved the lesion to be glioblastoma multiforme. During salvage irradiation to the spine and unirradiated brain, the patient complained of hip and femur pain. Subsequent radiographs demonstrated multiple bony metastases. This pattern of spread is uncharacteristic and emphasizes the importance of adequate metastatic evaluation.

Bone Neoplasms↗
PubMed2003

Endovascular brachytherapy for the treatment of renal artery in-stent restenosis using a beta-emitting source: a report of five patients.

We report five cases of renal artery in-stent restenosis treated with endovascular brachytherapy. This procedure has been previously used extensively for the treatment of coronary artery in-stent restenosis with successful results. Therefore, it follows logically that noncoronary in-stent restenoses would also be successfully treated in this manner. Though our experience is limited, we feel that this report provides adequate data to justify the formation of a prospective trial for a more adequate evaluation of the potential utility of this intriguing approach.

Aged↗
PubMedDate not supplied

Treatment of desmoplastic small round cell tumor with image-guided intensity modulated radiation therapy as a component of multimodality treatment.

AIMS AND BACKGROUND: The authors report the case of a 31-year-old black male diagnosed with a pelvic desmoplastic small round-cell tumor who was treated with a unique radiotherapy approach incorporating intensity-modulated radiotherapy and daily ultrasound localization to ensure accurate tumor targeting. Desmoplastic small round-cell tumor is a very rare tumor, most commonly presenting in the abdominopelvic regions of adolescents and young adults. It has generally been associated with a very poor prognosis. METHODS: The patient initially underwent biopsy of the mass and omentectomy for mesenteric implants followed by chemotherapy. Chemotherapy resulted in tumor shrinkage and was followed by a second-look laparotomy. Additional omental nodules were resected, but the primary tumor was adherent to the rectum and seminal vesicles. A radiation oncology consult was obtained, and a course of image-guided intensity-modulated radiotherapy ensued with daily ultrasound localization. This resulted in shrinkage of local disease, but a new lesion was identified. The patient was subsequently started on further chemotherapy, which has maintained the disease in a stable state for several months. CONCLUSIONS: Image-guided intensity-modulated radiotherapy is a feasible option in the treatment of pelvic desmoplastic small round-cell tumor. Such therapy may permit escalation of conventional radiotherapy doses and could have a favorable impact on local control of disease. Confirmation of this belief will require additional data in the form of case reports like this. Pending such confirmation, we continue to be of the impression that desmoplastic small round-cell tumor has an overall unfavorable prognosis, regardless of treatment modalities employed.

Abdominal Neoplasms↗