[The treatment of cancer by anthracyclines].
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Biomedical subjects
Publications and source records attributed to J Brenner.
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Thirty-six previously treated adult patients with advanced soft tissue sarcomas received CPDD 120 mg/m2 with mannitol diuresis. There were only two (6%) partial responses and five (15%) minor responses in 34 evaluable patients. Toxicity included nausea and vomiting, myelosuppression, mild ototoxicity and mild to moderate, transient nephrotoxicity. CPDD has minimal antitumor activity in previously treated patients with soft tissue sarcomas.
One-hundred-twenty-three cases of malignant pleural mesothelioma were reviewed. Exposure to asbestos or to other industrial dusts or chemicals was an important etiologic factor with 24% of patients relating such a history. A history of prior irradiation or previous lung disease was also occasionally noted. Diagnosis was most often made by exploratory thoracotomy, with pleural biopsy or cytology rarely helpful. Except for nine patients, tumor was confined to the chest at the time of diagnosis, but in 33 of the remaining 114 patients, spread to the abdomen or distant metastasis was seen during the course of disease. Surgery and radiotherapy were ineffective in preventing local recurrence. There were only three major responses to chemotherapy in 111 trials. Median survival was 12 months, and only seven patients (5.6%) lived more than five years. Patients with epithelial mesothelioma and Stage I disease had the most favorable prognosis.
Cytoreductive surgery increases the cure rate in selected patients with advanced nonseminomatous germ cell tumor receiving chemotherapy. Complete resection of residual malignancy is a prerequisite for improving long-term disease-free survival after chemotherapy. Complete resection of residual tumor after three to four inductions with an optimal chemotherapy regimen is the current recommendation. Progression of disease on chemotherapy represents a contraindication to cytoreductive surgery. Residual malignant tissue is found in up to one third of patients with clinical evidence of residual disease after chemotherapy and currently constitutes a current indication for further chemotherapy. Incomplete resection of malignant tissue and elevated tumor markers after surgery are poor prognostic signs. Elevated serum tumor marker levels after chemotherapy and prior to surgery represent a relative contra-indication to surgery, and such patients should receive additional chemotherapy.
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Seven children with malignant mesothelioma have been seen at Memorial Hospital since 1953. In six, the origin was at the pleura and in one at the peritoneum. None of the patients related a history of exposure to asbestos. Two patients lived more than five years. The other five patients died within two years of the diagnosis. Distant metastases were seen in four of the patients, including three who had metastases to brain. Surgery or radiotherapy were not effective in controlling the disease in most of the patients. One patient had a complete response to a combination of Adriamycin, cyclophosphamide, and vincristine and has remained free of disease for 5 1/2 years. The seven cases are reviewed, as are the other 42 cases of malignant mesothelioma in children reported in the literature.
Two groups of hospitalized psychotic patients were compared to a hospitalized nonpsychotic group composed mainly of major unipolar depressives. In the main, demographic and historical dimensions did not differ. Interpersonal and social role development favored the nonpsychotic group, but only employment history and maternal function reached significance. All groups were judged to be under substantial stress in association with the index hospitalization. Loss of a supportive relationship was the most frequent stress category for all groups but was relatively more frequent in the nonpsychotic (depressive) group. Medical stress was significantly higher in the psychotic groups.
Twenty-five patients with malignant peritoneal mesothelioma have been seen in Memorial Hospital since 1950. None of them had a history of exposure to asbestos and no clear etiologic factor could be determined in any of the patients. Two patients had signs of ectopic hormone production. The tumors tended to be locally invasive but distant hematogenous metastases were not seen in any of the patients. Surgery was not effective, as most patients had extensive intra-abdominal disease at the time of laparotomy. There were four long-term survivors. All of them were treated with external radiotherapy and 32P instillation after surgery. The response to chemotherapy was poor except for one partial response to combined therapy with adriamycin and radiation. Most patients died of extensive abdominal disease with a median survival of only 12 months.
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A new pilocarpin salt was obtained by chemically linking pilocarpin to a polymere substance. By galenic processing to the respective emulsion, eye drops containing this pilocarpin salt were produced, which enable a retarded pilocarpin delivery in vitro. With respect to glaucoma therapy, clinical tests showed that frequency of application can considerably be reduced. In the present investigations on a collective of 30 normal volunteers the effect of a commercial aqueous pilocarpin solution on the IOP, pupillary diameter and accommodation was compared with that of the novel pilocarpin drops.
The angioarchitectonic regions in the medulla oblongata and the midbrain of 14 grown-up guinea pigs are discribed. According to direction and number of the supplying arteries, three sections are distinguished. The medial part is supplied worst. It contains the medial row of the nuclei of the cranial nerves. The more lateral parts have always double or treble supplies. They are distinguished by a high capillary density. Those parts are associated with the medullar nuclei of the cranial nerves.
The use of certain additional substances enables preparation of pilocarpin solutions which remainstable for at least 4 years, while the usual pilocarpin solutions were subject to a relatively early decomposition. A double-blind study with 30 patients demonstrates that there is no difference between the pharmacologic effect at the pure and the modified pilocarpin solution, which justifies the use of solutions with added substances to stablize the effective component.
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