PubMed Health⌕ Search

Biomedical subjects

H Silberman

Publications and source records attributed to H Silberman.

At least 19 recordsLinked to original sources
PubMed1996

Thymidylate synthase mRNA level in adenocarcinoma of the stomach: a predictor for primary tumor response and overall survival.

PURPOSE: We tested the hypothesis that polymerase chain reaction (PCR) quantitation of the enzyme thymidylate synthase (TS) within a primary adenocarcinoma of the stomach, has an inverse relationship to response and survival for patients who receive fluorouracil (5FU)-based chemotherapy. PATIENTS AND METHODS: Before systemic chemotherapy, the genetic expression of TS (TSmRNA level) was determined using a PCR method. Gene expression was calculated by determining the ratio between the amount of radiolabeled PCR product with the linear amplification range of the TS gene and the beta-actin gene. Chemotherapy consisted of two cycles of protracted infusion (PI) 5FU 200 mg/m2/d administered for 3 weeks with leucovorin 20 mg/m2/w. Cisplatin 100 mg/m2 was administered on day 1. RESULTS: Sixty-five patients with primary gastric cancer had a median TS mRNA level of 4.6 x 10(-3) (range, 0.9 to 20.1 x 10(-3)). Thirty-five percent of patients had measurable responses in their primary tumors. The mean gastric cancer TSmRNA level in responding and resistant patients is statistically significant (P < .001). The median survival time was 43+ months for treated patients with TSmRNA levels less than the median and 6 months for those with TS m-RNA levels greater than the median (P = .003). CONCLUSION: The genetic expression of TS (TSmRNA level) influences response to 5FU-based chemotherapy and survival for a cohort of patients with primary gastric cancer. Confirmation of these data could lead to therapeutic decisions based on specific molecular properties within a tumor.

Adenocarcinoma↗
PubMed1995

Bowel obstruction in cancer patients.

OBJECTIVE: To examine the efficacy of various interventions on bowel obstruction occurring in patients with a history of cancer. DESIGN: Retrospective case series. SETTING: A university comprehensive cancer center. PATIENTS: Sixty-one patients presenting with 81 episodes of intestinal obstruction. RESULTS: Sixty-nine episodes of obstruction affected the small bowel, including 24 complete obstructions. There were 12 episodes of large-bowel obstruction, eight of which were complete. Five patients (8.2%) had concurrent small- and large-bowel obstruction. In 59 cases, the cause was established: 36 (61%) were due to metastatic tumor and 23 (39%) were due to benign conditions. Of the 49 episodes of partial bowel obstruction, 42 (86%) initially were treated medically. Nineteen (45%) of these 42 cases of obstruction resolved after 8.7 +/- 11.1 days (mean +/- SD) of conservative management. Twenty-two patients with partial obstruction were treated surgically, with relief of obstruction in 15 cases (68%). Of the 32 episodes of complete obstruction, 26 (81%) were initially managed conservatively; in only one case (3.8%) did obstruction resolve. Surgery successfully relieved the obstruction in 16 (76%) of 21 patients. Twenty-six patients received parenteral nutrition at home as the major treatment for obstruction; 22 (85%) experienced relief of nausea and vomiting. Patients with malignant obstructions survived 0 to 24 months (median, 4.7 months); the median survival for those treated surgically was 5.0 months. CONCLUSIONS: In patients with a history of cancer, partial obstruction (but not complete obstruction) frequently resolves with medical management. Surgical intervention relieves most cases of partial or complete obstruction regardless of benign or malignant cause, but survival often is limited in the latter group. The entire intestinal tract should be evaluated in all patients, since 8.2% of patients in this series had concurrent small- and large-bowel obstructions. Home parenteral nutrition often provides symptomatic palliation in patients not amenable to surgical relief.

Activities of Daily Living↗
PubMed1994

Comparative study of infectious complications of different types of chronic central venous access devices.

BACKGROUND: Various devices for central venous access are widely used in patients with cancer. The authors studied the incidence of infectious complications affecting these different devices. METHODS: A retrospective study of 111 central venous access devices (VAD) placed in 1992 was conducted. RESULTS: Subcutaneous ports were placed in 42 patients, single lumen Groshong catheters in 45, single lumen Hickman catheters in 15, double lumen Hickman catheters in 5, and double lumen Groshong catheters in 4. Prognostic factors analysis was performed with the log rank test and Cox's multivariate analysis. Different VAD types were compared with the likelihood ratio test. There was no significant difference in the risk of VAD-related infection between Hickman and Groshong catheters. Double lumen catheters were slightly more likely to cause infectious complications than single lumen catheters, although the difference was not statistically significant (P = 0.072 and 0.083 for bacteremia and site infection, respectively). No significant difference was observed in the risk of infection between subcutaneous ports and external catheters. Multivariate analysis using Cox's proportional hazards model demonstrated age younger than 50 years as the only significant risk factor, thus younger patients should be monitored more closely. CONCLUSIONS: No significant difference was observed in the risk of infection between subcutaneous ports and external catheters. There was a slightly higher risk of infection in double lumen catheters than single lumen catheters, although the difference did not reach statistical significance. Considering the small sample size, the results should be confirmed in larger prospective studies.

Adult↗
PubMed1993

Chronic venous access in patients with cancer. Selective use of the saphenous vein.

BACKGROUND: Dependable chronic venous access is an important aspect of supportive care for patients requiring chemotherapy or other long-term therapy because it enables such patients to be treated on an outpatient basis. METHODS: The authors studied 56 patients with cancer requiring chronic venous access who had an infusion catheter placed into the inferior vena cava (IVC) through open saphenous venotomy, most commonly because superior vena cava (SVC) occlusion, severe chest wall infection, or chest wall malignancy precluded standard subclavian or jugular cannulation. RESULTS: The 56 catheters were in place for 12-550 days. The overall complication rate was 0.30 complications per 100 catheter-days. Thirty-six patients (64%) had no complications. Among the remaining 20 patients, 8 (14.3%) had a local infection, 2 (3.6%) had systemic bacteremia, and 10 had lower extremity edema, including 9 patients (16.1%) in whom the IVC was thrombosed. Twelve of the 20 complications were treated successfully without catheter removal. Thus, in 86% (48 of 56) of patients, the catheter was effective for as long as infusion therapy was required. CONCLUSION: Venous cannulation through the saphenous vein is a useful method of achieving and maintaining chronic venous access in patients in whom the subclavian or jugular veins are unavailable.

Adult↗
PubMed1992

Preoperative systemic chemotherapy followed by adjuvant postoperative intraperitoneal therapy for gastric cancer: a University of Southern California pilot program.

PURPOSE: A clinical trial for patients with gastric cancer amenable to curative resection was undertaken to determine feasibility and response to preoperative systemic chemotherapy followed by postoperative intraperitoneal (IP) chemotherapy. METHODS AND MATERIALS: Thirty-eight patients with resectable gastric tumor received two cycles of protracted intravenous (IV)-infusion fluorouracil (5FU), 200 mg/m2/d, for 3 weeks with weekly IV leucovorin 20 mg/m2 and IV cisplatin 100 mg/m2 days 1 and 29. Resection of the gastric tumor followed within 3 weeks of completion of systemic chemotherapy. Those who had all visible tumor removed with clear margins received two cycles of IP floxuridine 3,000 mg (total dose) per day for 3 days and IP cisplatin 200 mg/m2 with IV sodium thiosulfate on the fourth day of IP therapy. RESULTS: Thirty-seven of 38 patients (97%) received two cycles of systemic chemotherapy. Thirty-five of 38 patients (92%) underwent laparotomy for gastric tumor resection. Thirty-three patients (87%) had gastric resections performed; 29 (76%) had all visible tumor removed with microscopically negative margins. No operative mortality was encountered. Twenty-six patients (68%) received IP treatment. IV neoadjuvant treatment was well tolerated and resulted in 68% of the patients reporting improvement in abdominal pain, 45% objective remissions by computed tomography (CT), 38% objective remissions by gastroscopy and biopsy, and 8% had complete surgical pathologic response. Neutropenic sepsis during the IP treatment phase contributed to the only treatment-related death. Four of 29 completely resected patients (14%) have had tumor recurrence. The median follow-up time of patients remaining alive is now 19 months. The median survival for 38 patients entered onto this protocol has not been reached at 17+ months. CONCLUSION: This novel approach to the treatment of adenocarcinoma of the stomach is feasible. The neoadjuvant systemic therapy results in significant primary tumor regression. The determination of whether systemic or IP components of the program contribute to decreased recurrence or increased survival awaits a prospectively randomized clinical trial.

Adenocarcinoma↗
PubMed1992

Prospective evaluation of a double-lumen subclavian dialysis catheter for acute vascular access.

The safety and efficacy of a parallel, double-lumen hemodialysis catheter used to achieve acute, temporary vascular access were evaluated prospectively in 134 hospitalized adult patients in whom 162 catheters were placed. The arterial flow rates and venous resistance were such that 84 per cent of the catheters provided satisfactory access for dialysis. Minor manipulations of the catheter were frequently required to maximize function. Three serious complications occurred, including one instance each of pneumothorax, hemorrhage, and nonfatal pericardial tamponade.

Adult↗
PubMed1989

Absorbable versus permanent mesh in abdominal operations.

Because previous studies evaluating prosthetic mesh have yielded conflicting results, we compared two permanent (polypropylene and polytetrafluoroethylene) and two absorbable (polyglactin and polyglycolic acid) meshes with respect to histologic appearance, development of adhesions, tensile strength and occurrence of hernias in rabbits in which defects of the abdominal wall measuring 2 by 3 centimeters were repaired with one of the meshes. Twenty experiments were performed with each material, and observations were made at two, five, seven and ten weeks. The inflammatory response was minimal with all products. Adhesions were more marked with polypropylene (Marlex) than with polytetrafluoroethylene (Gore-tex); there was no difference between the absorbable meshes. In vitro tensile strength measurements at ten weeks indicated that Marlex was superior to the other materials, and between the absorbable products, polyglactin (Vicryl) was superior to polyglycolic acid (Dexon). No hernias were observed with the nonabsorbable meshes, but all of the rabbits repaired with absorbable meshes had ventral hernias by the tenth week. Thus, absorbable meshes are not indicated when prolonged tensile strength is required, but they may be useful for other purposes, including the temporary repair of fascial defects, since evisceration was not observed.

Abdominal Muscles↗
PubMed1988

Reevaluation of the maximum tolerated dose of continuous venous infusion of 5-fluorouracil with pharmacokinetics.

5-Fluorouracil (5-FU) was administered as a continuous ambulatory venous infusion to 25 patients in a Phase I trial. The principal dose limiting toxic effect observed was mucositis. Skin rash and diarrhea occurred less frequently. Hematological toxicity was modest, and no hepatic toxicity was seen. One partial remission of 138 days duration was seen in a patient with metastatic breast carcinoma who was previously refractory to a 5-FU combination regimen. Patient tolerance of 5-FU delivered in this manner appeared highly variable. On the basis of this trial, we recommend that future studies evaluating the efficacy of long-term venous infusion of 5-FU should utilize a dosage of 450 mg/m2/day.

Diarrhea↗
PubMed1988

A randomized phase I and II study of short-term infusion of high-dose fluorouracil with or without N-(phosphonacetyl)-L-aspartic acid in patients with advanced pancreatic and colorectal cancers.

Fifty-two patients with advanced gastrointestinal (GI) malignancies who had not received previous chemotherapy or radiation therapy were randomized to be treated either with 24-hour infusion of weekly fluorouracil (5-FU) or the same plus N-(phosphonacetyl)-L-aspartic acid (PALA). Forty-seven patients were evaluable for the assessment of toxicity and antitumor activity. PALA was administered as an intravenous (IV) bolus over 15 minutes at a fixed dose, 250 mg/m2. The latter agent was administered 24 hours before the start of 5-FU infusion. 5-FU was initially administered at 750 mg/m2 and was incrementally increased to 3,400 mg/m2. In both arms of the randomized study, the courses were repeated every week. In both arms of the study, ataxia and myelosuppression were the dose-limiting toxic effects. At 5-FU dose of 3,400 mg/m2, one patient in each arm developed grade 3 hematologic toxicity. Other reversible side effects included grade 2 skin changes, nausea, and vomiting. During the administration of 2,600 mg/m2 of 5-FU over 24 hours, the steady state plasma 5-FU concentration was approximately 20 mumol/L. The maximum tolerated dose (MTD) for 5-FU for protracted treatment is 2,600 mg/m2 in either arm of the study. Therapeutic response was predominantly seen in the combination arm: there were two patients with complete response (CR) and 11 patients with partial response (PR) of 28 patients in the study. In the 5-FU alone arm there were four PR and 19 patients in the study.

Adult↗
PubMed1988

The relation of thyroid indices in the critically ill patient to prognosis and nutritional factors.

Thyroid indices and nutritional assessment values were measured in 73 critically ill euthyroid patients within 48 hours of admission to the medical or surgical intensive care unit. Significantly increased rates of mortality were observed among patients with decreased T3 or T4 levels or elevated T3UR or rT3 values. Alterations in thyroid function tests were associated with changes in certain putative nutritional indices, including serum albumin and transferrin concentrations, triceps skin fold and skin test reactivity. The data indicated that thyroid parameters measured early in the critical phase of illness are predictive of subsequent outcome. The pathogenesis of altered thyroid hormone metabolism is unknown, but nutritional deprivation may be an important contributing factor.

Adolescent↗
PubMed1987

Aggressive management of cholecystitis during pregnancy.

Nonoperative management of symptomatic cholelithiasis has generally been recommended for pregnant patients. However, a review of our experience with 44 patients at the Los Angeles County-University of Southern California Medical Center indicates that conservative management is associated with recurrent episodes of biliary tract symptoms, often requiring multiple hospitalizations, as well as a significant rate of fetal loss; whereas operation performed during the second trimester was associated with little maternal morbidity, no fetal loss, and a substantial reduction in total hospital days.

Adult↗
PubMed1987

The influence of hepatitis B infection on the outcome of renal allotransplantation.

Renal allograft and patient survival and liver function abnormalities were studied in a group of HBsAg-negative and -positive recipients. Thirty-five patients were positive, and 20 patients became antigenemic prior to transplantation. Two hundred twenty-four patients were HBsAg-negative. No difference in patient or graft survival was found between patients with hepatitis B antigenemia and antigen-negative cadaver allograft recipients. The incidence of significant hepatic disease was low in comparison with several recently published reports. It is concluded that hepatitis B antigenemia is not an absolute contraindication to transplantation.

Adult↗