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Biomedical subjects

J G Herman

Publications and source records attributed to J G Herman.

104 records · Page 6Linked to original sources
PubMed1985

Short course prophylactic cranial irradiation for small cell lung cancer.

Ninety-one patients with small cell carcinoma of the lung were given a shortened, intensive course of prophylactic cranial irradiation consisting of 2,000 rad in five fractions. The CNS relapse rate was 21%, but in only one of 91 patients was the brain the first and only site of relapse. Acute toxicities consisting of headache (16%) and nausea and vomiting (15%) were observed. Results are compared with previous results from other studies of cranial irradiation.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Combined modality induction therapy without maintenance chemotherapy for small cell carcinoma of the lung.

One hundred fifty-three patients with limited and 167 with extensive small cell carcinoma of the lung (SCCL) were evaluable for response to treatment with six courses of chemotherapy (cyclophosphamide, doxorubicin, and vincristine), irradiation to intrathoracic disease, and prophylactic cranial irradiation (PCI). No maintenance chemotherapy was given. Fifty-two percent of patients with limited disease (LD) and 10% of extensive disease patients (ED) achieved a complete response. The median survival times for LD and ED patients were 49 and 34 weeks, respectively. These results were compared to a previous experience with 147 patients who were treated with three courses of similar induction chemotherapy and thoracic irradiation, as well as one year of maintenance chemotherapy (CCNU, procarbazine, and methotrexate) but without PCI. Although the use of PCI was found to reduce the frequency of brain metastases as the site of first relapse, detailed comparisons of response rates and survival showed no significant differences between the two study populations. Prolonged maintenance chemotherapy of the type used in the first study does not favorably influence outcome after intensive induction therapy for SCCL.

Adult↗
PubMed1984

Radical external beam radiation therapy for prostate carcinoma.

Between 1970 and 1978, 202 patients with carcinoma of the prostate were treated with radical external beam radiation with curative intent. Intracapsular disease was present in 38% and the remaining 62% had disease extending through the prostatic capsule. The overall survival is 72% at five years, and despite the large number of patients with advanced disease the five-year disease-free survival is 46%. Significant prognostic factors include: i) tumor, grade, ii) extent of primary disease, iii) procedure done to determine diagnosis (TURP vs. needle biopsy) and iv) tumor dose. There was a significant improvement in survival at a minimum dose of 5000 Gy. Prostate carcinoma is radiosensitive and a dose-response relationship in treatment has been demonstrated by this review.

Acid Phosphatase↗
PubMed1983

Detection of radiation cardiomyopathy by gated radionuclide angiography.

Twenty-one asymptomatic adults underwent rest and exercise gated radionuclide angiography seven to 20 years after having received mediastinal radiation (2,000 to 7,600 rads) for Hodgkin's disease. None of these patients received cytotoxic chemotherapy. Twelve patients (57 percent) had abnormal left (less than 53 percent at rest and/or greater than 5 percent decrease at peak exercise) and/or right (less than 27 percent at rest and/or greater than 5 percent decrease at peak exercise) ventricular ejection fractions. Previous reports have described myocardial fibrosis occurring late after therapeutic mediastinal radiation; however, the incidence of this occurrence based on clinical follow-up has been low. Rest and exercise radionuclide angiography is a sensitive method for assessing systolic ventricular function and reveals a high prevalence of cardiomyopathy that can be linked to previous radiotherapy.

Adult↗
PubMed1983

Upper half body irradiation (UHBI) for extensive small cell carcinoma of the lung.

Upper half body irradiation (UHBI) was given to 41 of 121 patients with extensive small cell carcinoma of the lung. All patients were treated with 6 courses of cyclophosphamide, doxorubicin, and vincristine (CAV). Responding patients also received prophylactic cranial irradiation and local irradiation to prechemotherapy intrathoracic disease. Among the 70% (85/121) of patients who responded to chemotherapy, 41 have received UHBI, given one to two months later. The single fraction midline dose given has been increased in successive patients from 300 to 720 cGy (uncorrected for inhomogeneities). Actual lung doses were higher by 9-22%, (determined in 31 patients by CT scanning and lung density measurements). Adverse effects seen were vomiting, fever, drowsiness, myelosuppression, liver dysfunction and dry mouth. All were transient, and no pneumonitis or treatment deaths occurred. Adverse effect rates were similar at all dose levels. UHBI is well tolerated in patients who have received chemotherapy and merits further study.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1982

Seminoma of the testis: results of treatment and patterns of failure after radiation therapy.

Four hundred and forty-four patients with the histological diagnosis of pure seminoma were treated at The Princess Margaret Hospital between 1958 and 1976. Using the Walter Reed Hospital staging classification, 338 patients (76.1%) were Stage I, 86 (19.4%) were Stage II, and 20 (4.7%) were Stage III. The 5 year actuarial survival rate (5 yr Sa) for all stages was 87%, and for Stages I, II and III: 94%, 74% and 32% respectively. In Stage II the 5-year Sa was significantly worse when palpable abdominal disease was present (62%, vs 87% when it was absent, p less than .02). Prophylactic mediastinal irradiation was not used for patients with Stage II disease. None of 40 Stage II patients without palpable abdominal disease recurred in the non-irradiated mediastinum. Ten of 46 Stage II patients with palpable abdominal disease recurred in the mediastinum; 7 of the 10 were cured with mediastinal irradiation at the time of relapse. Prophylactic mediastinal irradiation appears unnecessary in Stage II patients. The Stage III category includes a subgroup of patients who were curable with radiation therapy:L 5/6 with supradiaphragmatic nodal disease without palpable abdominal or visceral disease were cured. Exploration of new treatment methods appears indicated for the salvage of patients recurring in sites other than the mediastinum or supraclavicular fossa and for patients presenting with visceral disease.

Adolescent↗
PubMedDate not supplied

From hospital to living room. Making the move into respiratory home care.

Respiratory therapists and hospitals see the home health care market as a way out of the fiscal bind the government has put them in. With department revenues slashed and RTs pushed out of the hospital by staffing cutbacks, home respiratory care is attracting a growing following. The opportunities and rewards are many, the challenges great.

Economic Competition↗
PubMedDate not supplied

Training mobile CT and MRI technologists. The mastery of change.

Technologists working in mobile diagnostic imaging must learn to adapt to multiple settings and to interface with many different personalities--those of physicians and patients alike. Learning to cope with the fast-moving industry of mobile CT, where change is constant, is surpassed only by learning mobile MRI, where protocols are still being developed and where change is a way of life.

Inservice Training↗
PubMedDate not supplied

New oxygen delivery systems. Gaining patient compliance.

The benefits of supplemental oxygen therapy are greatly enhanced if patient compliance is high. Standard nasal cannulae are unattractive by any standard, and patients may remove them to escape stigma or embarrassment. Both transtracheal systems and oxygen systems hidden in eyeglass frames attempt to solve this problem.

Humans↗
PubMedDate not supplied

Oximetry and home oxygen reimbursement.

Debate over use of invasive blood gas testing versus noninvasive oximetry to determine medical necessity for home oxygen has intensified since Health Care Financing Administration guidelines on reimbursement of home oxygen went into effect in October 1985.

Home Nursing↗
PubMedDate not supplied

Radiologists mobilize against DRGs.

Radiology departments--caught up in a frontal assault of economic pressures--are reevaluating procedures and reorganizing personnel. Offering moral and practical support is the American College of Radiology, which has drawn up a list of recommendations for coping with DRGs. Curious to know how workable these recommendations are, and to discover what novel approaches are being tried, Applied Radiology went to the front lines and talked with some of the field commanders.

Costs and Cost Analysis↗