PubMed Health⌕ Search

Biomedical subjects

H Lerner

Publications and source records attributed to H Lerner.

At least 37 records · Page 2Linked to original sources
PubMed1984

[Effect of anesthesia on blood coagulation factor XIII].

57 patients who had undergone surgical operations because of varicosis were examined for the influence of the mode of anaesthesia on the plasma levels of factor XIII. Within a randomized study the patients were given by alternate order halothane (NA) (n = 19), neurolept-analgesia (NLA) (n = 19) or peridural anesthesia (PA) (n = 19). Pre- and postoperatively as well as at the 1st, 3rd, 5th, and 7th p.o. day the plasma levels of factor XIII, fibrinogen (factor I) and fibrinogen-degradation-products (FDP) were measured. FDP were not found. The levels of factor XIII remained within the normal range. Fibrinogen showed an identical course: the postoperative findings were lower than the initial ones. 24 h later the levels were higher. At the 7th p.o. day the most important readings were found. In comparing the three methods of anaesthesia the most obvious differences in the data on factor XIII were in the peridural anesthesia-group, especially on the 3rd p.o. day with significant lower results than in the other groups. The modes of anaesthesia used had no visible influence on the range of factor XIII.

Adult↗
PubMed1983

Hydroxyurea fails to improve the results of MBD chemotherapy in cancer of the head and neck, but reduces toxicity.

Thirty-six patients with advanced squamous cancer of the head and neck received chemotherapy with hydroxyurea, 2 g/m2 orally two of three weeks, plus methotrexate, bleomycin, and cisplatin (MBD) on a previously established schedule. Nineteen patients had objective responses, including six complete remissions. Eight of 13 patients with regional disease without prior radiation responded, as did 1 of 3 with distant metastases without prior radiation, and 10 of 20 with recurrent disease after radiotherapy. The median duration of response in those with recurrent or metastatic tumor was 6 months, and median survival was 6.5 months. These results are no better than those previously achieved without the addition of hydroxyurea. Toxicity, however, was milder than had previously been observed with MBD, suggesting that higher doses or more intensive schedules of hydroxyurea could be safely administered together with the other three drugs.

Adult↗
PubMed1983

Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer. An NSABP update.

The current findings completely affirm the validity of our original observations indicating the appropriateness of grouping primary breast cancer patients into those with negative, 1 to 3, or greater than or equal to 4 positive nodes. Results, however, reveal that there is a risk in combining all patients with greater than or equal to 4 positive nodes into a single group. Since there was a 25% greater disease-free survival and an 18% greater survival in those with 4 to 6 than in those with greater than or equal to 13 positive axillary nodes, such a unification may provide misleading information regarding patient prognosis, as well as the worth of a therapeutic regimen when compared with another from a putatively similar patient population. Of particular interest were findings relating the conditional probability, i.e., the hazard rate, of a treatment failure or death each year during the 5-year period following operation to nodal involvement with tumor. Whereas the hazard rate for those with negative, or 1 to 3 positive nodes, was relatively low and constant, in those with greater than or equal to 4 positive nodes the risk in the early years was much greater, but by the fifth year it was similar to that occurring when 1-3 nodes were involved, and not much different from negative node patients. The same pattern existed whether 4 to 6 or greater than or equal to 13 nodes were positive. When the current findings are considered relative to other factors with predictive import, it is concluded that nodal status still remains the primary prognostic discriminant.

Axilla↗
PubMed1983

Second malignancies diagnosed in patients receiving chemotherapy at the Pennsylvania Hospital.

During the past 15 years, the records of 2,020 patients who received chemotherapy on the surgical oncology, chemotherapy service at the Pennsylvania Hospital were reviewed. Thirty-five patients had pathologically confirmed second independent malignant tumors (not recurrences). The second cancers that developed were varied. The patients who developed these second malignancies ranged in age from 35 to 77 years (24 females, 11 males). The time interval involved was two to 102 months. Nine patients in this group of second malignancies received prior radiation therapy. The following is a list of the second cancers. There were 8 colons, 5 ovaries, 5 lungs, 6 acute myelogenous leukemias, 1 esophagus, 2 bladders, 2 epidermoid carcinomas of the skin, 2 melanomas, 1 chronic lymphatic leukemia, 1 breast cancer, 1 non-Hodgkin's malignant lymphoma, and 1 stomach cancer. The majority of second malignant tumors were amenable to some form of therapy, ie, surgery, radiation or chemotherapy. However, all of the acute myelogenous leukemias were totally refractory to any therapeutic modalities and rapidly expired. The majority of second cancers developed in patients receiving adjuvant chemotherapy. This is a patient population with a much longer expected survival time, particularly when compared to patients receiving chemotherapy for advanced disease. Twenty-five of the 34 second cancers developed in patients who received adjuvant chemotherapy for breast (14) or colorectal (11) cancers. The etiology of the second malignancies is very difficult to determine. However, alkylating agents appeared to be the possible etiologic agent involved in the development of acute myelogenous leukemia.

Adult↗
PubMed1983

Gastric cancer-survival at the Pennsylvania Hospital with and without adjuvant chemotherapy.

From 1964 to 1974, 122 patients were treated for gastric cancer; none of these patients received chemotherapy; 13 of this group were lost to follow-up. In 34 patients, the disease was too far advanced for surgical resection. Their survival ranged from 0.1 month to 7.5 months with a median survival of 1.1 months. Seventy-four patients were resected for cure; 60 patients underwent a subtotal gastrectomy. Survival ranged from 0 to 72 months with a median of eight months. Fourteen patients had total gastrectomies; survival ranged from 0.1 to 72 months with a median of 5.5 months. Only six of the resected patients had negative lymph nodes; their survival ranged from four to 36 months. In this series there were 11 operative deaths and only seven patients survived five years. Thirty-one patients who had resections were treated with adjuvant chemotherapy consisting of 0.5 g 5-fluorouracil (5-FU) IV on days 1, 8, 15, etc, and hydroxyurea (HU), 80 mg/kg per os (p.o.), on days 4, 11, 18, etc. This group has a range of survival from three to 164 months and a median survival of 25 months. Fifteen consecutive patients with nonresectable gastric cancer were treated with HU-FU with a survival of one to 30 months and a median survival of eight months. In patients with measurable disease, objective regression was clearly demonstrated.

Adenocarcinoma↗
PubMed1983

The prognostic significance of tumor location and bowel obstruction in Dukes B and C colorectal cancer. Findings from the NSABP clinical trials.

The present study examines the prognostic significance of tumor location and bowel obstruction in Dukes B and C colorectal cancer. Data were obtained from 1021 patients entered into two randomized prospective clinical trials of the NSABP. Tumor location proved to be a strong prognostic discriminant. Lesions located in the left colon demonstrated the most favorable prognosis. Tumors of the rectosigmoid and rectum had the worst prognosis with the relative risk of treatment failure for the latter being over three fold that of the left colon. When the relative risks associated with tumor location were adjusted for nodal imbalances, the left colon continued to demonstrate the most favorable prognosis. The presence of bowel obstruction also strongly influenced the prognostic outcome. Examination of the data without considering tumor location disclosed that patients with bowel obstruction were at greater risk for treatment failure than those without obstruction. The effect of bowel obstruction was influenced by the location of the tumor. The occurrence of bowel obstruction in the right colon was associated with a significantly diminished disease-free survival, whereas obstruction in the left colon demonstrated no such effect. This phenomenon was independent of nodal status and tumor encirclement, the latter two factors proving to be of prognostic significance independent of tumor obstruction. A multivariate analysis in which the covariate effects of sex, age, nodal status, tumor obstruction, encirclement, and tumor location were adjusted underscored the role of tumor location and obstruction as prognostic discriminants. The results indicate that the definition of prognostic factors can identify patient subsets with unique characteristics.

Carcinoma↗
PubMed1983

The psychological assessment of object representation.

In 1976, Blatt, Brenneis, Schimek, and Glick developed a comprehensive scale for assessing the organization and content of the "concept of the object" in Rorschach responses. Utilizing developmental theory, they developed procedures for assessing the representation of human figures on the Rorschach in terms of the degree of differentiation, articulation, and integration. This analysis of Rorschach responses has proven to be of considerable value in clinical research and has provided empirical data for the study of severe psychopathology. The present paper considers the clinical utility of this conceptual scheme. Five prototypic patients, each representing a particular diagnostic category, were selected for study on the basis of clinical case records. The object representations of the five cases are presented and analyzed in detail, and conclusions are drawn about possible configurations of object representations in different forms of psychopathology. The value of a systematic assessment of object representations for differential diagnosis as well as for the study of change in the psychotherapeutic process is considered. This approach to Rorschach interpretation represents an integration of object relations theory into Rorschach methodology. These new concepts of test assessment and interpretation offer the promise of providing a methodological framework and theoretical foundation for further innovative use of the Rorschach and other projective procedures.

Adolescent↗
PubMed1983

An object representation approach to psychostructural change: a clinical illustration.

This paper presents a systematic test-retest analysis of a disturbed, hospitalized adolescent in an attempt to demonstrate recent innovation in Rorschach theory and technique based upon important conceptual and empirical advances in object relations theory. These new perspectives supplement basic ego psychological concepts of test interpretation advanced by Rapaport and test-retest analysis developed by Schafer. The new concepts presented in this paper offer the promise of providing a methodological framework and theoretical foundation for further innovative use of the Rorschach and other projective procedures.

Adolescent↗
PubMed1982

Failure of effective initial chemotherapy to modify the course of stage IV (MO) squamous cancer of the head and neck.

Twenty-four patients with advanced squamous cancer of the head and neck without distant metastases were given combination chemotherapy including methotrexate, bleomycin and diamminedichloroplatinum before planned local treatment with irradiation or surgery. Of 22 evaluable patients, 17 had objective partial or complete remission to initial chemotherapy. However, only ten patients ever had complete clearing at any time of all tumor on clinical evaluation. Median survival was ten months, and only two patients remained alive 14 and 29 months, respectively, from entry. Toxicity was minimal with the three-drug treatment, but the addition of mitomycin-C at the start of chemotherapy substantially increased toxicity without improving efficacy. Subsequent surgery and radiotherapy were accomplished without unusual difficulty.

Adult↗
PubMed1982

Mitomycin-C, methotrexate, bleomycin and cis-diamminedichloroplatinum II in the chemotherapy of advanced squamous cancer of the head and neck.

Thirty-four patients with advanced squamous cancer of the head and neck were treated with an outpatient regimen combining mitomycin-C, cis-diamminedichloroplatinum (II), methotrexate and bleomycin. Five had complete remissions and 15 partial remissions, for an overall response rate of 59%. Responses were noted on 11 of 13 patients (85%) with disease above the clavicles without prior irradiation. Median duration of partial remission was four months. Response rate was independent of age, performance status, presence of distant metastases and primary site. Hematologic toxicity was substantially more severe with this program than had been observed in a prior study using the same regimen without mitomycin-C. Since neither complete nor partial response rates, nor response durations improved with the addition of mitomycin, we conclude that it adds little to the efficacy of the other three agents.

Adult↗
PubMed1982

Phase II evaluation of dibromodulcitol, ICRF-159, and maytansine for sarcomas.

Patients with objectively measurable soft tissue sarcomas, osteosarcomas, chondrosarcomas, and mesotheliomas were treated with dibromodulcitol (DBD) (180 mg/m2 p.o. days 1-10 q4 wks.). ICRF-159 (300 mg/m2 p.o. tid days 1-3 q4 wks), or maytansine (MAYT) (1.5 mg/m2 I.V. q3 wks.). Forty-five evaluable patients received DBD, 47 MAYT, and 37 ICRF-159. Only patients who had had their histopathologic diagnoses confirmed by a pathology reference panel were included in the final analysis. Two patients had objective partial responses: a patient with osteosarcoma who responded to DBD and a patient with fibrosarcoma who had a partial response of brief duration to ICRF-159. Approximately 70% of the patients treated with each drug were of ECOG performance status 0 or 1, and over half had moderate or worse toxicity. It seems unlikely that these drugs have significant therapeutic activity for common mesenchymal malignancies.

Adolescent↗
PubMed1981

Treatment of primary breast cancer with chemotherapy and tamoxifen.

We studied the possibility that the addition of tamoxifen to L-phenylalanine mustard combined with 5-fluorouracil enhances the benefit from the latter two drugs that has been observed in women with primary breast cancer and positive axillary nodes. Recurrence of disease was reduced at two years in patients given the three-drug regimen whose tumor estrogen-receptor levels were greater than or equal to 10 fmol. Among patients greater than or equal to 50 years old treatment failure was significantly reduced (P less than 0.001): by 51 per cent in those with one to three positive nodes and by 64 per cent in those with four or more. Higher receptor levels were associated with a greater probability of disease-free survival. Patients less than or equal to 49 years old were less responsive: those with one to three positive nodes received no benefit from tamoxifen at any receptor level, whereas those with four or more appeared to have reduced treatment failure associated with higher receptor levels. This adjuvant chemotherapy is not indicated in patients less than or equal to 49 years old whose tumor receptor levels are below 10 fmol; there is a suggestion of benefit in patients greater than or equal to 50 years old whose levels are low.

Age Factors↗
PubMed1981

The adjustable Harada-Ito procedure.

In four patients with superior oblique palsy, symptomatic excyclotorsion was present without a substantial vertical deviation. Surgery of anteriorizing and lateralizing the anterior fibers of the superior oblique tendon on an adjustable suture was performed (adjustable Harada-Ito procedure). the morning after surgery, adjustment of the suture was made to eliminate the torsional deviation. The suture was loosened when an overcorrection was present and was tightened when an undercorrection was present. Follow-up varied from two to 20 months. All patients remained free of torsional symptoms and no vertical deviation was induced. In addition, the eyes operated on had no limitation of elevation in adduction. The technique allows the surgeon to more exactly adjust the advanced fibers of the superior oblique tendon so as to minimize or eliminate the excyclotorsion and eliminate symptomatic complaints.

Adult↗
PubMed1981

Cystosarcoma phyllodes. Diagnosis and management.

The diagnosis and management of cystosarcoma phyllodes is analyzed by reviewing the literature and presenting cases from our institution. This rare neoplasm of the female breast represents less than 1% of all breast tumors. Most patients present in the fourth and fifth decades of life. The predominant complaint is a palpable mass in the breast. Systemic manifestations occur after metastases have developed. Treatment is surgical excision. There is some controversy, however, over which type of surgical procedure should be performed. We recommend total mastectomy. Local recurrence and metastases do occur and have been related to inadequate surgery and various histological characteristics (mitotic activity, tumor margin, and stromal cellular atypia).

Breast Neoplasms↗
PubMed1975

L-Phenylalanine mustard (L-PAM) in the management of primary breast cancer. A report of early findings.

Prolonged l-phenylalanine mustard (L-PAM) administration as an adjuvant to mastectomy in the management of patients with primary breast cancer and pathologically positive axillary nodes was evaluated by a prospective, randomized, clinical trial. Treatment failures occurred in 22 per cent of 108 patients receiving placebo and 9.7 per cent of 103 women given L-PAM (p = 0.01). A statistically significant difference (p = 0.02) existed in favor of L-PAM relative to disease-free interval. In premenopausal women, the difference with respect to disease-free interval of treated and control groups was highly significant (p = 0.008). A treatment failure occurred in 30 per cent of premenopausal patients receiving placebo and 3 per cent of those treated with L-PAM (p = 0.008). Whereas a similar trend was observed in postmenopausal patients, the difference is not statistically significant. Thus, L-PAM has been demonstrated to be effective in the treatment of women with primary breast cancer, particularly those who are premenopausal. Results were achieved with minimal undesirable side effects.

Bone Marrow↗