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Biomedical subjects

J J Spinelli

Publications and source records attributed to J J Spinelli.

At least 19 recordsLinked to original sources
PubMed1992

Mortality patterns in female domestic workers.

To investigate mortality patterns for domestic workers, proportional mortality ratios (PMRs) were calculated for the 1,382 female domestic workers who died in British Columbia at age 20 years or over between 1950 and 1984. This group experienced fewer deaths than expected from cerebrovascular accidents (PMR = 84) and hypertension (PMR = 39). The proportion of deaths from cirrhosis was higher than expected (PMR = 152). An excess of observed deaths was also noted for all accidents (PMR = 126), accidents due to environmental factors (PMR = 439), and homicide (PMR = 235). Mortality from pneumonia was elevated for domestic workers aged 20 to 65 (PMR = 180). Further studies using more sophisticated epidemiologic methods are necessary to evaluate whether these deaths are a result of occupational exposures or of poor socioeconomic conditions.

Accidents, Occupational↗
PubMed1992

Ten-year outcome of patients with advanced epithelial ovarian carcinoma treated with cisplatin-based multimodality therapy.

PURPOSE: At the end of the 1970s it was thought that advanced epithelial ovarian cancer (EOC) could be cured by multimodality treatment using surgery, cisplatin-based combination chemotherapy, and radiotherapy (RT). Such multimodality treatment was used as standard therapy at our institution. Our long-term results are reviewed. PATIENTS AND METHODS: One hundred ninety-five previously untreated patients with stage III or IV EOC were treated between April 1979 and December 1982. All patients were to have debulking surgery, when feasible, followed by the administration of doxorubicin and cisplatin at 50 mg/m2 every 3 weeks until a total dose of doxorubicin of 450 mg/m2 had been reached. RT was used in addition in patients with disease remaining after the chemotherapy. Maintenance chemotherapy with oral cyclophosphamide and hexamethylmelamine (altretamine) was administered to patients who did not have a documented histologic complete remission. RESULTS: The 10-year overall and failure-free survivals were 4% and 8%, respectively. The median overall survival was 2 years. The achievement of a histologic complete response (n = 32) did not equate to cure because 20 (63%) of the patients eventually relapsed. Multivariate analysis identified residual disease of greater or less than 2 cm as the only independent prognostic factor. CONCLUSIONS: Our multimodality treatment program was noncurative for the majority of the patients. Innovative therapies are needed before we can hope to cure such disease.

Adult↗
PubMed1991

High-dose cytarabine and daunorubicin induction and postremission chemotherapy for the treatment of acute myelogenous leukemia in adults.

Seventy consecutive adult patients with acute myelogenous leukemia (AML), median age 44 years, received high-dose cytarabine (3 g/m2 every 12 hours for 12 doses) followed by daunorubicin (45 mg/m2 daily for three doses) for remission induction. A single, identical course was planned for postremission therapy. Complete remission (CR) was achieved in 63 patients (90%, 95% confidence interval [CI] 83% to 97%), 60 after a single course. Eight patients were selected to undergo elective bone marrow transplantation (BMT) during first CR. Of the remaining 55 patients, 40 (73%) underwent planned post-CR therapy; 15 patients did not, owing to early relapse, excessive toxicity from the induction chemotherapy, or refusal. Nineteen patients, including 13 who received planned post-CR therapy, remain in continuous CR at a median follow-up of 5.2 years (range 3.0 to 7.1 years). The 5-year actuarial leukemia-free survival was 30% (95% Cl, 19% to 42%) for all patients achieving CR and 32% (95% Cl, 19% to 47%) for the 40 patients who received the planned post-CR chemotherapy. Analysis of various putative prognostic factors for CR and overall and leukemia-free survival showed significance for a previous history of myelodysplasia, higher initial leukocyte counts, certain French-American-British (FAB) types, and certain abnormal karyotypes. None of these factors was consistently significant regarding the above parameters, although small patient numbers in certain analyses may have obscured significant associations. Myelosuppression was occasionally prolonged after remission induction and especially post-CR therapy. Severe cerebellar toxicity was observed in 13 patients; in 11 cases, this toxicity was fully reversible. Other serious complications were infrequent. Intensive chemotherapy with high-dose cytarabine and daunorubicin has substantial antileukemic activity in adult AML, and may represent an improvement over conventional therapy. Relapses were common, however, even in patients who received planned therapy, and substantial toxicity was observed. The optimum use of this regimen in AML remains to be determined.

Adult↗
PubMed1991

Mortality and cancer incidence in aluminum reduction plant workers.

An historical cohort study was conducted among 4,213 men who worked for 5 or more years at a Soderberg aluminum reduction plant in British Columbia (BC), Canada. Standardized mortality and incidence ratios were used to compare the mortality and cancer incidence of the cohort with that of the BC population and to examine risk by cumulative exposure to coal-tar pitch volatiles (CTPV) and electromagnetic fields. Significantly elevated rates were observed for bladder cancer incidence (standardized incidence ratio [SIR] = 1.69) and brain cancer mortality (standardized mortality ratio = 2.17). The risk of bladder cancer was strongly related to cumulative exposure to CTPV (P less than .01). The risk for non-Hodgkin's lymphoma also increased with increasing exposure (P less than .05), although the overall rate was similar to that of the general population (SIR = 1.06). The lung cancer rate was as expected (SIR = 0.97), but showed a weak association with CTPV exposure that was not statistically significant. No individual cause of death or incident cancer site was related to exposure to electromagnetic fields. Analysis of the joint effect of smoking and CTPV exposure on lung and bladder cancer showed the exposure response relationships to be independent of smoking.

Adult↗
PubMed1991

Busulfan, cyclophosphamide, and melphalan conditioning for autologous bone marrow transplantation in hematologic malignancy.

Sixteen patients with poor-prognosis acute myelogenous leukemia (AML), acute lymphoblastic leukemia (ALL), and non-Hodgkin's lymphoma (NHL) underwent conditioning with busulfan (16 mg/kg) and cyclophosphamide (120 mg/kg) (BUCY-2) plus melphalan (90 or 135 mg/m2) and autologous bone marrow transplantation (AuBMT) in a phase I study. At the melphalan dose of 90 mg/m2, grade greater than or equal to 3 regimen-related toxicity (RRT) was observed in five patients (31%; 95% confidence interval [CI], 11% to 59%), with hepatic (venoocclusive disease [VOD]) and urinary (hemorrhagic cystitis) RRT being the most frequent complications. Further escalation of the melphalan dose to 135 mg/m2 was deemed excessively toxic, as three of five patients had grade greater than or equal to 3 RRT. Following this experience, 21 patients with multiple myeloma (MM) and chronic myelogenous leukemia (CML) were treated with BUCY-2 plus melphalan 90 mg/m2 and AuBMT in separate studies. Three of these patients--all with extensively pretreated MM--had grade greater than or equal to 3 RRT (14%; 95% CI, 3% to 36%); no others had grade greater than or equal to 3 RRT. Therefore, a total of eight of the 37 patients (22%; 95% CI, 10% to 38%) who received BUCY-2 plus melphalan 90 mg/m2 conditioning developed grade greater than or equal to 3 RRT; three of these patients (8%; 95% CI, 3% to 25%) died of RRT. Although limited by the relatively small number of patients, our analysis of the patients receiving this regimen showed that the presence of parameters denoting the lymphoid diagnostic group (ie, ALL, NHL, and MM), more extensive pretreatment, and/or more advanced disease status were associated with a higher incidence of grade greater than or equal to 3 RRT. Response data on the AML, ALL, and NHL patients who received BUCY-2 plus melphalan 90 mg/m2 were analyzed: three patients (all with AML in first or second remission) are leukemia-free at 3.0, 2.8, and 1.4 years after AuBMT. The actuarial 2-year event-free survival in this group is 17% (95% CI, 5% to 54%). Response data on the MM and CML patients will be reported subsequently. BUCY-2 plus melphalan at a dose of 90 mg/m2 before AuBMT produces acceptable toxicity in patients who are not heavily pretreated. A full evaluation of the antineoplastic effects of this regimen requires further study.

Actuarial Analysis↗
PubMed1991

Prognostic variables in patients with diffuse large-cell lymphoma treated with MACOP-B.

One hundred twenty-six patients with diffuse large-cell lymphoma were treated with methotrexate with leucovorin, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin (MACOP-B) between April 1981 and June 1986. Univariate and multivariate analyses were performed using overall survival as of September 1989 as the end point. Four independent negative predictors of survival were identified: presence of B symptoms; more than two involved lymph node sites; more than one extranodal site (variables related to tumor burden), and age older than 60, a variable related to the patient's ability to tolerate treatment. Each variable contributed the same relative risk of dying and, accordingly, this simple predictive formula was developed empirically: (4-N) x 30 = the approximate percentage of chance of survival at 5 years. "N" is the number of predictive variables present. The same four predictors were also found to be significant by multivariate analysis when only those patients achieving a complete response were analyzed.

Adolescent↗
PubMed1991

The relationship between the absolute granulocyte count, platelet count and total leukocyte count in cancer chemotherapy patients.

A cohort of 383 patients with a variety of malignancies receiving various chemotherapy programs was analyzed to determine the relationship between the absolute granulocyte count (AGC) and the total leukocyte count (TLC). Specific groups, who were elderly, had proven bone marrow involvement, or were receiving significant doses of prednisone, were studied. The relationship between the TLC and thrombocytopenia was also examined. Results revealed that in all groups there was a correlation between the TLC and the AGC with correlation coefficients ranging from 0.82 to 0.88. Both life-threatening thrombocytopenia and granulocytopenia were rare, providing and TLC was greater than 3.0 x 10(9)/L.

Adolescent↗
PubMed1991

Neurologic complications in allogeneic bone marrow transplant patients receiving cyclosporin.

Regimens using cyclosporin (CSP) and either methylprednisolone (MP) or methotrexate (MTX) have been useful in the prophylaxis of acute graft-versus-host disease (GVHD) after allogeneic bone marrow transplantation (BMT). However, CSP produces a number of side effects, including neurologic toxicity. A retrospective review of recipients of 239 BMTs given CSP-based prophylactic regimens revealed that 10 patients (4.2%, 95% confidence interval 0% to 10.4%) experienced a syndrome characterized by hypertension, severe visual disturbances, seizures and occipital lobe density changes on brain computed tomography (nine patients) or nuclear magnetic resonance imaging (one patient). Neurologic findings were reversible in all cases, usually after temporary discontinuation of CSP. Univariate analysis identified the following risk factors for neurotoxicity: use of unrelated or HLA-mismatched related donors, administration of etoposide (VP-16) or total body irradiation as part of conditioning, use of corticosteroids for prophylaxis or treatment of acute GVHD, or development of either acute GVHD or clinically significant microangiopathic hemolytic anemia (MAHA) post-BMT. In multivariate analysis, the most important predictors were the use of VP-16 (p = 0.008), the use of a continuous infusion CSP plus MP prophylactic regimen for GVHD (p = 0.003) and the development of MAHA after BMT (p less than 0.001). The strong association with MAHA suggests that endothelial damage is related to the development of this complication.

Adolescent↗
PubMed1991

A hierarchical coding system for occupational exposure.

A 10-digit hierarchical method for coding occupationally encountered chemicals offering significant advantages over existing chemical coding systems has been developed and tested. With this unique system, substances are categorized and coded according to their composition and physical natures. Consequently, compounds of similar structure may be distinguished, and classes of similar compounds (for example, all halogenated organic compounds, all inorganic sulfates) can be readily retrieved. This novel coding system was developed to assist primarily in the identification of potential carcinogens in occupational studies using job exposure matrices. However, the system has wider applications as it can be employed by industry to facilitate data management and monitoring programs in the workplace.

Carcinogens↗
PubMed1990

Identification of occupational cancer risks using a population-based cancer registry.

The study of Xuan Wei fuel use and lung cancer mortality and also the interim case-control study suggested an association between domestic smoky coal use and Xuan Wei lung cancer. The collaborative studies of physical characterization, chemical analysis, and toxicology further substantiated this linkage. The Xuan Wei residents who used smoky coal inhaled extremely high concentrations of mostly submicron-sized particles, which can be inhaled and deposited effectively deep in the lung. These fine particles were composed mostly of organic compounds (72%), including mutagenic and carcinogenic organic compounds, especially in the aromatic and polar fractions. These residents were exposed to polycyclic aromatic compounds, such as benzo[a]pyrene, at comparable or higher levels than those measured in coke oven plants and other occupational environments (International Agency for Research on Cancer 1984). In comparison with wood and smokeless coal combustion emissions, the organic extracts of smoky coal emission particles showed much higher activity of genotoxicity and carcinogenicity. These results all point to a strong etiological link between the complex organic mixtures from smoky coal emissions and Xuan Wei lung cancer. This study and studies reported by other investigators (de Koning et al. 1984) suggested little association between indoor open-fire wood smoke and lung cancer. The less efficient lung deposition of the larger particles from wood combustion, as well as the lower concentrations of biologically active organic compounds, may contribute to the low rate of lung cancer in the wood-burning communes. As to the smokeless coal emissions, the lower particulate concentration and the lower organic content of the particles emitted may also contribute to the low lung cancer rate in the commune using this fuel. In conclusion, the complex organic mixtures from combustion emissions are genotoxic and carcinogenic in animal and in vitro assays. The magnitude of the cancer risks from the complex organic mixtures in man depends on the degree of the exposure, the types of the compounds contained in the mixtures, and the concentrations of these biologically active compounds present in the combustion emissions.

Air Pollutants↗
PubMed1990

Anatomic distribution of acquired melanocytic nevi in white children. A comparison with melanoma: the Vancouver Mole Study.

The presence of acquired benign nevi is a risk factor for cutaneous melanoma, yet relatively little is known about the etiology of nevi. We have conducted a study of the prevalence of melanocytic nevi among 1146 white Vancouver (Canada) schoolchildren aged 6 to 18 years. Numbers of nevi per square meter of body surface area increase with age in children of both sexes. Male adolescents have more nevi than female adolescents on the head and neck as well as on the trunk, while prevalence in females is higher on the upper and lower limbs. This distribution parallels that of cutaneous melanoma in British Columbia adults. Nevi are more common in children on intermittently exposed body sites than on constantly or minimally sun-exposed sites. This suggests that exposure to strong intermittent sunlight in childhood (a risk factor for cutaneous melanoma) may also be important in the etiology of acquired benign nevi.

Adolescent↗
PubMed1990

Mortality and cancer incidence in a cohort of commercial airline pilots.

We undertook a cohort study of all male pilots employed since January 1, 1950, by CP Air, now Canadian Airlines International. A total of 913 eligible pilots--630 active and 283 no longer employed--contributing 18,060 person-years of observation, were identified through company records. As of October 31, 1988, current status was obtained on 891 (97.6%). Standardized mortality ratio (SMR) and standardized incidence ratio (SIR) were used to compare, respectively, the mortality and cancer incidence of the cohort with that of the British Columbia population. Statistical significance of the SMR and SIR by comparison with the Poisson distribution (p less than 0.05 one-sided) and 90% confidence intervals (CI) were calculated. Excess deaths were observed for aircraft accidents (No. = 23; SMR = 21.29; p less than 0.001; CI 14.60, 30.20), brain cancer (No. = 4; SMR = 4.17, p = 0.017; CI 1.40, 9.50) and rectal cancer (No. = 3; SMR = 4.35; p = 0.033; CI 1.20, 11.20). Excess cancer incidence was noted for non-melanoma skin cancer (No. = 26; SIR = 1.59; p = 0.017; CI 1.10, 2.20), brain cancer (No. = 4; SIR = 3.45; p = 0.030; CI 1.20, 7.90) and Hodgkin's Disease (No. = 3; SIR = 4.54; p = 0.030; CI 1.20, 11.70). These findings, suggesting an excess risk for certain cancers in commercial airline pilots, are based on small numbers and need to be confirmed in larger cohort studies.

Aerospace Medicine↗
PubMed1990

Suntan, sunburn, and pigmentation factors and the frequency of acquired melanocytic nevi in children. Similarities to melanoma: the Vancouver Mole Study.

The association between prevalence of benign melanocytic nevi and a number of skin cancer risk factors was examined among 913 white Vancouver (Canada) school children aged 6 to 18 years. Subjects with light skin, with a propensity to burn rather than tan in the sun, and with numerous or severe sunburns in the previous 5 years had significantly higher nevus counts than individuals without these characteristics. Subjects who acquired deeper tans tended to have fewer nevi than those who did not tan. Finally, children who freckled had higher nevus counts than those who did not freckle. These findings in children are similar to those seen in studies of malignant melanoma among adults and suggest that strategies to reduce melanoma incidence should begin with young children.

Adolescent↗
PubMed1989

Pathologic prognostic factors for cutaneous malignant melanoma: the Western Canada Melanoma Study.

An analysis of data for histopathologic factors influencing survival was conducted on 798 cases of invasive cutaneous malignant melanoma. On univariate analysis, a number of factors influenced survival; however, when these factors were examined using a proportional-hazards model, sex and log of depth of penetration were the only factors governing survival. Moreover, these factors were only important in patients with lesions up to 4 mm in depth with no evidence of other disease. For patients with solitary lesions deeper than 4 mm, or patients with regional or distant disease, none of the factors examined in our study was of predictive value for survival assessment.

Adult↗