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Biomedical subjects

J G Armstrong

Publications and source records attributed to J G Armstrong.

At least 55 records · Page 3Linked to original sources
PubMed1992

Nasopharyngeal brachytherapy with access via a transpalatal flap.

We used a posteriorly based transpalatal flap for interstitial nasopharyngeal brachytherapy in five patients with nasopharyngeal carcinoma. All of these implants were done with iodine 125 seeds. The disease in three of five patients has been controlled locally for 27, 30, and 40 months, respectively. Two patients experienced local failure and died. There have been no palatal healing problems despite high doses of previous radiation in all of our patients. No palatal incompetence has been seen. This technique appears safe and should be considered for discrete lesions of the high posterior or superior nasopharynx that cannot be approached by less invasive methods.

Adult↗
PubMed1992

Investigation of pleural effusion: the role of bronchoscopy.

To assess the place of bronchoscopy in the investigation of pleural effusion, 245 patients presenting during a two year period were reviewed. Of the 46 patients who had bronchoscopy, a positive yield was obtained in 13, though in five of these a second pleural aspiration was also diagnostic. Bronchoscopy was more likely to be diagnostic in patients presenting with a cough (12/24) than in those with no cough (1/22) (p less than 0.001), and in those whose chest X-ray revealed significant radiological abnormalities such as hilar enlargement, lung mass or persisting consolidation (12/29), than in those without such changes (1/17) (p less than 0.01). Bronchoscopy has a limited role in the investigation of pleural effusion. The presence or absence of cough, and the appearance of the chest X-ray, are both important considerations when planning the investigation of an undiagnosed pleural effusion.

Bronchoscopy↗
PubMed1992

Corticosteroids in acute severe asthma: effectiveness of low doses.

BACKGROUND: Although the need for corticosteroids in acute severe asthma is well established the appropriate dose is not known. METHODS: The response to intravenous hydrocortisone 50 mg (low dose), 100 mg (medium dose), and 500 mg (high dose), administered every six hours for 48 hours and followed by oral prednisone, was compared in patients with acute asthma in a double blind randomised study. After initial emergency treatment with bronchodilators subjects received oral theophylline or intravenous aminophylline and nebulised salbutamol four hourly. Patients were given low, medium, or high doses of intravenous hydrocortisone and then 20, 40, or 60 mg/day respectively of oral prednisone with a reducing regimen over the following 12 days. Beclomethasone dipropionate, 400 micrograms twice daily by metered dose inhaler, was also started. Peak expiratory flow (PEF), forced expiratory volume in one second (FEV1), and visual analogue dyspnoea scores (VAS) were recorded daily in hospital and PEF and VAS twice daily after discharge for a total of 12 days. RESULTS: The 66 subjects (40 female) who completed the study had a mean (SD) age of 31(14) years. On presentation mean (SD) FEV1% predicted in the low (n = 22), medium (n = 20), and high dose (n = 24) groups was 17(13), 19(12), and 19(11) and after emergency bronchodilator treatment 32(20), 30(12), and 36(13). After 24 hours of treatment the respective post-bronchodilator FEV1% predicted values were 62(22), 62(23), and 65(28) compared with 71(24), 69(22), and 71(24) after 48 hours. No significant difference between the groups was detected. PEF and VAS improved with treatment over the 12 days but was not influenced by steroid dose. CONCLUSIONS: Hydrocortisone 50 mg intravenously four times a day for two days followed by low dose oral prednisone is as effective in resolving acute severe asthma as 200 or 500 mg of hydrocortisone followed by higher doses of prednisone.

Acute Disease↗
PubMed1992

Base-of-tongue cancer treated with external beam irradiation plus brachytherapy: oncologic and functional outcome.

Between January 1981 and June 1990, 36 previously untreated patients with squamous cancer of the base of the tongue were treated with radiation therapy. This therapy consisted of a 5,000-5,400-cGy external beam plus a 2,000-3,000-cGy boost to the base of the tongue with an iridium-192 implant. Necks with negative nodes were only irradiated, while necks with positive nodes were treated with irradiation plus neck dissection. Actuarial local control and survival at 2 years were 87.5%. Neck control was achieved in 35 of 36 patients. When implantation was performed with the nonlooping technique, the injury rate was statistically higher than in patients who underwent implantation with the looping technique (P = .02). Thirty patients participated in a function assessment involving a Performance Status Scale for patients with head and neck cancer. The authors concluded that management of base-of-tongue cancer with external beam irradiation plus brachytherapy is both oncologically and functionally successful.

Adult↗
PubMed1992

The Rorschach test for predicting suicide among depressed adolescent inpatients.

With the decreasing length of psychiatric hospitalizations, identification of test indicators of suicide risk becomes critically important. This Rorschach study was designed to model a clinical decision-making scenario concerning adolescent suicide risk. Using Psychiatric Evaluation Form (PEF) scores, we selected a sample of 25 severely depressed and suicidal adolescents; 26 severely depressed, not suicidal adolescents; and 28 not suicidal, not depressed adolescent inpatients at The Sheppard and Enoch Pratt Hospital. A Rorschach Index using the Exner (1986) Comprehensive System for scoring was developed to predict group membership. Four of six of the features on this index selected 64% of suicidal subjects. This constellation included traditional affective variables (vista responses, color-shading blends, color dominated responses, and morbid content) as well as measures of cognitive distortion (inaccurately perceived human movement responses [M-] and special scores). We discuss the implications of these findings for the diagnosis and treatment of the suicidal adolescent.

Adolescent↗
PubMed1991

Combined surgical resection and iridium 192 implantation for locally advanced and recurrent desmoid tumors.

Thirty-eight histologically confirmed desmoid tumors were treated with conservative surgical resection and interstitial iridium 192. Patients included in this series constituted a poor prognostic group. Seventy five percent (75%) had previous recurrences of their disease and 50% had tumors 8 cm or greater in size. In addition, 16% of the patients had gross residual disease after surgical excision and 79% had positive or close margins of resection. With a median follow-up of 5.5 years, the 5-year actuarial in-field local control rate was 75% and the overall local control rate was 66%. Four of the 12 local recurrences developed at the periphery of the implant volume and four patients failed at least 3 cm or more beyond the treated volume. After salvage therapy, the 5-year actuarial local control rate was 95%. Two patients required amputation for recurrent disease. Thirty of 34 patients remain free of disease with an excellent functional result achieved. The authors conclude that surgical resection and postoperative interstitial iridium 192 is effective therapy for patients with desmoid tumors. Despite the fact that most patients in this series had bulky, recurrent tumors, excellent long-term local control and limb function were achieved.

Adolescent↗
PubMed1991

Paraspinal tumors: techniques and results of brachytherapy.

Because of their proximity to nerve roots and the spinal cord, it is frequently difficult to achieve complete resection of paraspinal tumors. We have used brachytherapy in an attempt to prevent local recurrence and its associated neurological sequelae. This report analyzes our experience with 35 patients to determine the feasibility, optimal techniques, and efficacy of this approach. The tumor types were non small-cell lung cancer (18), sarcomas (9), and other tumor types (8). Temporary, single plane implants using Ir-192 (median minimum peripheral dose 3000 cGy) were used in 21 patients, and permanent I-125 implants were used in 14 cases (median matched peripheral dose 12,500 cGy). Local control was achieved in 51% (18/35). However, local control was poor when lung cancers were implanted and in cases where the dura was exposed. Radiation myelitis did not occur despite the combined effects of previous external beam radiotherapy (N = 21) and brachytherapy. Our experience demonstrates that combined surgery and paraspinal brachytherapy can be performed with acceptable toxicity and is reasonably effective in preventing local relapse and its neurologic sequelae, particularly for tumors other than lung cancers.

Brachytherapy↗
PubMed1991

Twice daily thoracic irradiation for limited small cell lung cancer.

Thoracic failure is a significant obstacle to the cure of limited stage small-cell lung cancer (LSCLC) patients treated with combined modality therapy. In 1985 we initiated a prospective trial to evaluate the impact of twice daily thoracic irradiation without concomitant chemotherapy on control of intrathoracic tumor in LSCLC. Twenty-nine patients treated in this fashion were compared with 36 patients treated from 1979-1982 with once daily thoracic irradiation and concomitant chemotherapy. Both groups received the same induction chemotherapy; cyclophosphamide, Adriamycin, and vincristine (CAV) alternating with cisplatin and etoposide. For consolidation, the twice daily patients received thoracic irradiation, 45 Gy in 1.5 Gy fractions given twice daily, and the once daily patients received thoracic irradiation, 45 Gy in 2.5 Gy fractions given once daily with concomitant cyclophosphamide and vincristine. After completion of radiotherapy both groups received maintenance chemotherapy. The complete response (CR) rate after thoracic irradiation was higher for twice daily patients (86% (25/29) compared to the once daily patients [61% (22/36), p = 0.02]. However, this advantage was offset by the shorter duration of thoracic control among CR patients treated with twice daily thoracic irradiation compared to once daily thoracic irradiation (32% vs 67% at 2 years, p less than 0.05). In view of the enhanced initial response of LSCLC to twice daily thoracic irradiation, this basic radiotherapeutic approach seems appropriate, but new strategies using higher doses of twice daily thoracic irradiation or concomitant chemotherapy appear to be necessary to enhance long-term thoracic control.

Carcinoma, Small Cell↗
PubMed1991

Concomitant chemotherapy-radiation therapy followed by hyperfractionated radiation therapy for advanced unresectable head and neck cancer.

In January 1988, we initiated a prospective study evaluating a new treatment approach with chemotherapy and radiotherapy for unresectable head and neck cancer. Weeks 1-4 were the initial debulking phase. Radiotherapy was delivered using 1.8 Gy/day to large portals including gross disease and all areas at risk. Cisplatinum, 100mg/m2, was given concomitant with radiotherapy on days 1 and 22. Weeks 5 and 6 were the boosting phase. This involved twice-a-day irradiation. The AM fraction of 1.8 Gy was given to the entire area at risk, whereas the PM dose of 1.6 Gy was limited to the gross disease alone. Thus a total of 70 Gy/6 weeks was delivered. A total of 24 patients were treated, 22 of whom have completed this protocol and are evaluable. All patients had massive disease, with 15 having gross involvement of brain, orbit, skull base, or carotid artery. Follow-up ranged from 3-22 months (median 12 months). Major responses were achieved in 96%, with 64% complete responses and 32% partial responses. Two patients with PR were able to undergo complete surgical resection, making the overall rate of complete response, including surgery, 73%. At 1 year, actuarial survival was 69%, and local progression-free survival was 56%. Distant metastases developed in 5 (23%). This approach appears both safe and effective in producing excellent regression and local control for far advanced head and neck cancer. More time is needed to see if these results are sustained. Efforts to build upon this experience appear warranted.

Adenocarcinoma↗
PubMed1991

Extrahepatic biliary system cancer: an update of a combined modality approach.

Since January 1985, 12 patients with local/regional extrahepatic biliary system cancer (2: gallbladder; 5: Klatskin; and 5: common bile duct) underwent combined modality therapy. An endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiogram, and biliary drainage were performed in 5 patients, and 7 patients underwent laparotomy and biopsy or subtotal resection. All patients initially received 5,000 cGy to the tumor bed and primary nodal area and 10 received an additional 1,500-cGy boost to the tumor bed. Chemotherapy (5-fluorouracil/mitomycin-C) was delivered at the beginning of each radiation treatment course. Four patients received an additional 1-4 cycles of maintenance chemotherapy and 7 received a boost with brachytherapy. The median survival was 17 months and the overall 4-year actuarial survival was 36%. Four patients have no evidence of disease at 16, 30, 48, and 64 months, respectively. The patterns of failure as a component of failure were local/regional progression, 50%; abdominal failure, 58%; and distant failure, 8%. Of the 8 patients who developed failure, 6 developed a component of local/regional progression. Our data continue to show that this approach is feasible and may result in an improvement in survival. Continued follow-up will be needed to determine the ultimate impact of this aggressive approach.

Adenocarcinoma↗
PubMed1991

Limited small cell lung cancer: prognostic significance of a complete response to the induction phase of chemotherapy followed by thoracic irradiation.

Limited-stage small cell lung cancer is frequently treated with induction combination chemotherapy (ICC), followed by consolidation with thoracic irradiation. It has been suggested that patients who do not have a complete response to ICC are unlikely to have control of occult distant metastasis and consequently have such a poor prognosis that thoracic irradiation is unlikely to be of benefit. To examine this hypothesis, 48 patients treated on prospective protocols who achieved a complete response to ICC or subsequently to thoracic irradiation were analyzed. Twenty-four patients had a complete response to ICC (CR-ICC), and 24 subsequently converted to complete-response status after thoracic irradiation (CR-TI). The two groups had similar prognostic factors and treatment. Comparing CR-ICC and CR-TI patients, survival was 40% versus 26% at 2 years and 35% versus 4% at 5 years, respectively (P less than .05). Freedom from distant metastasis was 41% at 5 years for the CR-ICC patients and 8% for the CR-TI patients (P less than .05). A modest number of CR-TI patients were long-term survivors, suggesting a value for thoracic irradiation as consolidation therapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Variability in preincubation embryo development in domestic fowl. 1. Effects of nest holding time and method of egg storage.

Embryos of eggs from Single Comb White Leghorn hens were analyzed to determine whether nest holding time and method of storage had a significant effect on postoviposition embryonic growth prior to incubation. Eggs were collected from 38- to 42-wk-old hens naturally inseminated and housed in floor pens. The experiment had a 2 x 2 factorial arrangement of treatments with two nest holding times and two storage methods. Eggs were collected within 1 h of oviposition, placed on cardboard egg flats, and stored unpacked (Treatment 1), or put on flats, and packed in 30-dozen egg cases (Treatment 2). Eggs in Treatments 3 and 4 were marked within 1 h of oviposition, but remained in the nest for 6 to 7 h. These eggs were separated into unpacked (Treatment 3), and packed (Treatment 4) groups. All eggs were stored at 13.8 C for 4 days. A total of 250 embryos were staged after storage for development using the Eyal-Giladi and Kochav classification. Least square means (LSM) for stage of development were: Treatment 1, 10.76; Treatment 2, 11.52; Treatment 3, 12.41; and Treatment 4, 12.36. For the main effects, nest holding time significantly affected stage of development (P = .0001), but storage method (P = .1140) and nest holding time by storage method interaction (P = .0730) did not. Comparison of LSM of Treatment 1 versus 3 (P = .0001), 2 versus 4 (P = .0152), and 1 versus 2 (P = .0214) were significant, but Treatment 3 versus 4 (P = .8595) was not.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Malignant tumors of major salivary gland origin. A matched-pair analysis of the role of combined surgery and postoperative radiotherapy.

Between 1966 and 1982, 46 patients with previously untreated malignant tumors of major salivary gland origin received combined surgery and postoperative radiotherapy. They were compared with 46 patients treated with surgery only between 1939 and 1965, who were matched according to prognostic criteria. Radiation doses ranged from 4000 to 7740 cGy (median, 5664 cGy). The 5-year determinate survival rates for patients given combined therapy with stage I and II disease vs patients given surgery only was 81.9% vs 95.8%, while for stages III and IV it was 51.2% vs 9.5%, respectively. Local control for stage III and IV disease in patients given combined therapy vs patients given surgery only at 5 years was 51.3% vs 16.8%. For patients with nodal metastases, 5-year determinate survival for the combined-therapy group vs the surgery-only group was 48.9% vs 18.7%, and the corresponding local-regional control was 69.1% vs 40.2%. The results of this analysis suggest that postoperative radiotherapy significantly improves outcome for patients with stage III and IV disease and for patients with lymph node metastases.

Combined Modality Therapy↗
PubMed1990

Observations on the natural history and treatment of recurrent major salivary gland cancer.

In an attempt to define the natural history and the indications for postoperative radiotherapy (RT) in locally recurrent major salivary gland cancers, we reviewed 78 patients treated between 1965 and 1982. All patients underwent resection of the tumor. Group 1 (N = 38) had complete resection of tumors, with low or intermediate grade histology and without lymph node spread. Group 2 consisted of the remaining 40 patients who had high-risk features (HR) (high grade histology, lymph node metastases, and close or positive margins of resection). Half of the Group 2 patients received radiation therapy. Overall survival was 63% at 5 years, and 35% at 15 years. Survival of Group 1 was 83% at 5 years and 58% at 15 years. Local control for Group 1 was 69% at 5 years, 54% at 15 years, and was size-dependent. Group 2 survival was 40% at 5 years and 29% at 10 years. Local control at 5 and 10 years was 49% and 35%. Our data indicate that surgery alone yielded good local control in patients with small tumors (less than or equal to 3 cm) and no HR features, suggesting that postoperative RT may be unnecessary for these patients. Other patients have suboptimal local control, and although there is a rationale for the use of postoperative radiotherapy, we cannot assess its impact in this retrospective study.

Adolescent↗
PubMed1990

Postoperative radiation therapy for major salivary gland malignancies.

Between 1966 and 1982 there have been 46 patients treated with surgery plus post-operative radiation therapy for malignant tumors of salivary gland origin. The indication(s) for radiotherapy included positive margins (42%), advanced local tumor (37%), positive nodes (33%), or high grade histology (48%). Overall actuarial local control at 5 years was 73%, being 100% for T1, 83% for T2, 80% for T3, and 43% for T4. Actuarial survival at 5 years was 80% for T1, 83% for T2, 60% for T3, and 48% for T4. Patients with positive nodes (N+) did worse than those with negative nodes (No), with locoregional control and survival at 5 years being 58% vs. 83%, (P = 0.025) and 38% vs. 80% (P = less than .01), respectively. We found no need for contralateral neck treatment even for those with positive nodes. Also, to date, none of eight patients with adenoid cystic histology has failed locally, as opposed to three of eight failures in patients treated with surgery alone. We believe that post-operative irradiation provides excellent locoregional control for appropriate patients with malignant tumors of major salivary glands.

Adolescent↗
PubMed1990

Long-term outcome of small cell lung cancer.

Long-term survival (greater than or equal to 3 years) is possible in a small proportion of patients with SCLC, particularly if the disease is limited in extent. The influence of thoracic irradiation on the long-term outcome of limited stage patients is controversial, although there is a suggestion of benefit. Despite the use of irradiation, thoracic recurrence is the single most important site of treatment failure. Further experience will be necessary to determine if radiotherapeutic strategies to enhance thoracic control can improve long-term survival. Prophylactic cranial irradiation (PCI) may influence long-term survival of limited stage patients who achieve a complete response to therapy and remain controlled in the chest. However, this is not clearly established and must be considered in the light of the contribution of PCI to neurotoxicity occurring in survivors. Reduction in the radiation fraction size and the omission of chemotherapeutic agents which cause neurotoxicity, either alone or by synergism with PCI, are reasonable approaches to pursue in an attempt to prevent this complication. A small proportion of NSCLC occurring after treatment of SCLC may be preventable by attempts to eradicate NSCLC components present in the original SCLC. Leukemogenic chemotherapy agents may contribute to the development of secondary ANL, and should probably not be used in view of the availability of alternative equally effective agents.

Carcinoma, Non-Small-Cell Lung↗