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Biomedical subjects

J B Aust

Publications and source records attributed to J B Aust.

At least 19 recordsLinked to original sources
PubMed1979

Combination chemotherapy for soft-tissue sarcomas: a phase III study.

A total of 144 patients with advanced sarcomas were entered into a randomized prospective protocol with four treatment arms utilizing different combinations of chemotherapeutic agents. Of these, 120 patients (83%) were judged acceptable. Treatment 1: actinomycin-D (Act-D), 0.01 mg/kg IV, days 1--5; phenylalanine mustard (L-PAM), 4 mg PO, days 1--10 every six weeks. Treatment 2: Act-D, 0.01 mg/kg IV, days 1--5; L-PAM, 4 mg PO, days 1--10; vincristine, 1 mg IV, days 1, 8, 15, 22, 29, 36, repeat every six weeks. Treatment 3: Act-D, 0.01 mg/kg IV, days 1--5; L-PAM, 4 mg PO, DAYS 1--10; NSC-1026, 200 mg/kg IV, days 1--6. Treatment 4: Adriamycin, 0.4 mg/kg IV, days 1, 2, 3, 8, 9, 10, then 2XWK starting day 15 (max. 1,200 mg). There was a provision that upon progression of the disease in the first three treatment regimens, patients would be crossed over to Treatment 4. Responses were as follows: 1 - Partial Response (PR) 1/25; No Change (NC) 9/25 (36%). gF2 - NC 17/26 (65%). 3 - NC 13/25 (52%). 4 - Complete Response (CR) 1/41; PR 6/41; (15%); NC 27/41 (66%). Clearly Treatment 4 was the best arm, with a 17% response rate and an initial progression rate of 17%. The only other response was a partial in 1. The difference is statistically significant (H = 17.247, P = 0.0006). If the responders to Adriamycin were analyzed without crossovers, the response rate would be 22% (6/27). (H = 14.079, P = 0.003). Median times to progression were 12.5, 8.7 weeks for 1 and 2, and 5 weeks for 3 and 4. There was no significant difference in the median survival times among the four treatment arms. It appears that Adriamycin as a single drug is superior to the drug combinations and would probably be even more effective used in combination with known active agents.

Antineoplastic Agents↗
PubMed1979

5-FU versus combination therapy with tubercidin, streptozotocin, and 5-FU in the treatment of pancreatic carcinomas: COG protocol 7230.

From May 1972 until May 1976, 105 patients were entered on Central Oncology Group protocol 7230 to compare the combination of streptozotocin, tubercidin, and 5-fluorouracil (5-FU) versus 5-FU alone in the treatment of adenocarcinoma and islet cell carcinoma of the pancreas. Twenty-nine were not evaluable. Thirty-six evaluable cases received 5-FU, and 40 received the combination, with no significant difference in time to progression or survival. Toxicity in the two regimens was somewhat different but was essentially similar in magnitude. Results indicate no benefit in the treatment of adenocarcinoma of the pancreas with the three-drug combination over 5-FU alone. All of the islet cell tumor patients benefited from the combination by response or arrest of progression of disease. Further study should be directed toward the use of this combination in the treatment of functioning and non-functioning islet cell tumors of the pancreas.

Adenocarcinoma↗
PubMed1979

Results of a prospective randomized study of hepatic artery infusion with 5-fluorouracil versus intravenous 5-fluorouracil in patients with hepatic metastases from colorectal cancer: A Central Oncology Group study.

In a controlled, prospectively randomized trial, 74 patients with hepatic metastases from colorectal cancer were randomized to either intra-arterial hepatic artery infusion with 5-fluorouracil (5-FU) or systemic chemotherapy with 5-FU. In 61 acceptable patients, there was no significant difference in terms of response rate, time to progression, duration of the response, and survival rate. Though the response rate for the intra-arterial infusion arm was slightly higher than for the systemic arm, the difference was not significant, and the intra-arterial infusion arm was associated with a greater incidence of nausea, vomiting, diarrhea, in addition to complications of femoral-arterial thrombosis, bleeding, and infection at the catheter site not seen in patients treated by systemic chemotherapy. Patients with an objective response to chemotherapy on either treatment arm survived twice as long as the nonresponders. Long-term survival in one patient, 77 months, can occasionally be achieved in patients with hepatic metastases.

Adenocarcinoma↗
PubMed1978

Bleeding vascular malformations of the intestine.

Thirty-nine patients with bleeding vascular malformations were evaluated. The age range was from 3 to 78 years, with a bimodal age distribution. The younger patients had no associated diseases, while those in the older category invariably had an associated cardiac lesion (aortic stenosis in 12 patients and severe atherosclerotic disease in 11 patients). With experience, colonoscopy has become a valuable adjunct to arteriography with the lesion visualized in 12 patients. Arteriography is the most useful study being diagnostic in 35 of 38 cases. Exploration alone was diagnostic in only one of 39 patients. The most common site of bleeding was the cecum (21 patients) followed by the proximal small intestine (eight patients), terminal ileum (seven patients), and ascending colon (five patients). The lesions in the proximal small bowel were much more common in the younger patients and were believed to be congenital. Resection controlled the bleeding in the majority of patients, although four recurrences have been noted. All have been documented angiographically to have been from a new lesion and two were controlled with reoperation. The key elements to control of these patient's bleeding include: (1) systematic work-up with a team approach emphasizing careful visceral angiography, and (2) the avoidance of a premature laparotomy prior to complete evaluation.

Adolescent↗
PubMed1977

Hepatic trauma: pitfalls in management.

We reviewed 233 traumatic injuries to the liver. The mortality was 11%. Deaths were due to either uncontrolled intraoperative hemorrhage or the postoperative complications of multiple organ injuries. The majority of liver injuries can be safely managed with manual compression, porta hepatic control, simple sutures, or drainage. Liver injuries involving the hepatic veins or retrohepatic vena cava continue to be highly lethal despite the use of vascular isolation and hepatic resection.

Adolescent↗
PubMed1977

Bowel obstruction and the long tube stent.

Fifty-eight cases of intestinal obstruction requiring operative intervention were reviewed. Enterolysis alone as the treatment for bowel obstruction as a result of adhesions appears to be as good or better than the long tube stent. Patients treated with enterolysis alone had a shorter period of postoperative ileus, a shorter hospital confinement following operation, and fewer recurrent obstructions. These patients also had a longer interval between episodes of reobstruction than did those treated with an intraluminal long tube stent.

Adolescent↗
PubMed1977

Primary intrahepatic gallstones.

Caroli's disease is characterized by congenital segmental dilation of the intrahepatic bile ducts producing a variety of symptoms and, usually, primary intrahepatic gallstones. We are reporting five new cases of Caroli's disease in addition to the 91 reported in the literature. The diagnosis is made by intrahepatic cholangiography; techniques are emphasized. The diagnoses were confirmed by the surgical specimen of the left lobe of the liver in cases 1 and 2, by autopsy in case 3, and by intrahepatic cholangiogram in cases 4 and 5. The treatment resulted in leftsided lobectomy of liver in cases 1 and 2. Cholecystectomy, removal of common duct stones, choledochoduodenostomy or, preferably Roux-en-Y choledochojejunostomy, were done in cases 3, 4, and 5. Two patients died more than five years after their original surgery, and three are alive at six months, six, and 13 years, respectively. This is a more encouraging outcome than is usually reported.

Adult↗
PubMed1977

Gastric devascularization: a useful salvage procedure for massive hemorrhagic gastritis.

Due to poor results with conventional operative therapy for diffuse hemorrhagic gastritis (DHG), a prospective evaluation of gastric devascularization was performed on 21 patients. Sepsis, alcoholism, and steroid abuse were the common etiologic factors. In spite of the fact that these were all critically ill patients, all stopped bleeding with this operation and only two rebled (9%). The average operating time was 84 minutes. There were two operative complications and gastric necrosis did not occur. The mortality was high (38%) due to the primary disease. Gastric devascularization is a useful salvage procedure for the patient with DHG because it can be accomplished rapidly, with few complications, has a low rebleed rate, and causes no permanent sequelae. Since this procedure causes severe gastric mucosal ischemia, it casts doubt only on the importance of this mechanism alone as the cause of "stress ulceration."

Alcoholism↗
PubMed1976

Treatment of advanced malignancy with CCNU (NSC 79037): a phase II cooperative study with long-term follow up.

CCNU (1-[2-chloroethyl]-3-cyclohexyl-1-nitrosourea, NSC-79037) was used to treat advanced malignancies in 329 evaluable patients. The treatment dosage was 130 mg/m2 for patients with adequate bone marrow reserve and 100 mg/m2 for those with compromised bone marrow. Oral treatment was repeated at 6-week intervals unless hematologic toxicity intervened. There were four complete responses: two in ovarian cancer, one with small cell carcinoma of the lung, and one with melanoma. Tumor response greater than 50% reduction in tumor size occurred in 39 patients (11.9%) while stable disease (no change or decrease or increase of less than 50% in tumor size) was noted in 152 patients (46.2%). Tumor progression occurred in 130 cases. Melanomas and ovarian and lung cancers had the highest response rates. Bone marrow depression was the major side effect of treatment; there was a significant positive correlation between the severity of leukopenia and thrombocytopenia and tumor response to treatment.

Humans↗
PubMed1976

The management of carcinoma of the larynx in a prominent patient, or did Morell Mackenzie really cause World War I?.

The influence of fate on history is a fascinating subject. This paper reviews the death of the Crown Prince of Prussia from carcinoma of the larynx. This was a critical turning point in history. The roles of the European physicians involved in his care are reviewed. It was not until after the death of Queen Victoria that the true character of these physicians was revealed.

Diagnostic Errors↗
PubMed1976

Gastric devascularization: an alternate approach to the surgical treatment of massive, diffuse hemorrhage from gastritis.

During a three-year period on the surgical services at the University of Texas in San Antonio, eight critically ill patients had various types of gastric devascularization to control erosive hemorrhagic gastritis. Among these patients were two women and one child. There were five chronic alcoholics, one aspirin abuser, one severely burned patient, and one patient with sepsis. Esophagogastroscopy was used in six patients but was diagnostic in only three. All of the patients were given intensive medical preoperative care, including an average of eight units of blood each. In four of the five known alcoholics, preoperative tests showed severely deranged clotting function. All of the patients received at least a four-point gastric vessel ligation. In addition, four had gastrotomies, three had vagotomies and pyloroplasties, and two had "complete" gastric vessel ligation. There was no significant rebleeding in five patients. Of the three patients with significant recurrent gastric hemorrhage, two were chronic alcoholics with poor clotting function, and neither was considered operable. One patient, the child, had massive rebleeding one week after gastric devascularization with vagotomy and pyloroplasty and required a subtotal gastrectomy. Of the four patients who ultimately died, three were chronic alcoholics and one had sepsis.

Adult↗
PubMed1975

Occult gastrointestinal bleeding. An evaluation of available diagnostic methods.

Occult gastrointestinal bleeding was defined as continued bleeding in spite of a normal series of roentgenorgrams of the upper part of the gastrointestinal tract, barium enema, and sigmoidoscopy. Twenty-six such patients were treated. A thorough systematic evaluation, including gastroscopy, colonoscopy, visceral angiography, and isotopic scanning, was done preoperatively. Using colonoscopy and arteriography, nearly 60% of the bleeding sites were identified. Seventy-six percent of the lesions identified were in the terminal part of the ileum or the ascending colon. Exploratory laparotomy should be performed for life-threatening hemorrhage or as a diagnostic test only after a thorough preoperative evaluation. If results of a complete preoperative evaluation including arteriography were normal, then the likelihood of finding a discrete cause of bleeding at laparotomy was high (80%). A systematic evaluation and diligence of both physcian and patient in localizing the site of bleeding are essential.

Abdomen↗
PubMed1975

Systemic chemotherapy of advanced head and neck malignancies.

Several Phase II chemotherapy protocols were evaluated in patients with advanced malignancies; 158 were evaluable head and neck cases. The protocols were as follows: five-drug combination (COMFP), four-drug (COMF), (CCNU, Adriamycin, DTIC, and cytosine arabinoside. Insufficient numbers and data were received to adequately evaluate Yoshi 864, 5 Azacytidine, porfiromycin, BCNU, and Azaserine. Significant responses to therapy were noted in the four and five-drug combinations in which 30-44% of the patients had 50% or greater regression, with an average duration of 2.2 months. Adriamycin and CCNU demonstrated lesser antitumor effects, while DTIC and cytosine arabinoside did not demonstrate significant antitumor activity in the head and neck areas. Usual toxicity consisted largely of nausea and vomiting, leukopenia, and thrombocytopenia. Alopecia was not pronouced in Adriamycin-treated patients. It appears that combination chemotherapy had a higher response rate compared to single agents used in the different cooperative protocols.

Adenocarcinoma↗
PubMed1975

Experience in the surgical treatment of diseases of the thyroid gland.

Over a 7-yr period from January 1967 to January 1974, 141 patients underwent thyroid surgery for various pathology at the Bexar County Hospital - University of Texas Medical School at San Antonio. Of these, 113 patients underwent subtotal thyroidectomy for benign diseases, including 28 of thyrotoxic patients who underwent subtotal thyroidectomy as definitive treatment. In this group of patients special interest and emphasis was placed in the preoperative and intraoperative management of the difficult and complicated hyperthyroid patient. Preoperative treatment was accomplished by the utilization of multiple drug combinations - including antithyroid drugs, adrenergic blocking agents, and iodine - which resulted in significant decrease in preparation time for surgery. Furthermore, this short intensive preoperative management of complicated hyperthyroid patients allowed satisfactory correction of their problems with little or no morbidity which otherwise would have been extremely difficult if not impossible to resolve. At operation, 28 patients were diagnosed to have malignant disease; 23 underwent total thyroidectomy and the other 5 had subtotal thyroidectomy. In addition to total or subtotal thyroidectomy, 23 patients had either classical or modified radical neck dissection including 9 patients who had bilateral neck dissection. The various surgical techniques utilized, the rationale for rapid preoperative preparation of complicated hyperthyroid patients, morbidity, and long-term follow-up are discussed.

Adolescent↗