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Biomedical subjects

J K Luce

Publications and source records attributed to J K Luce.

At least 19 recordsLinked to original sources
PubMed1990

Extravasation of doxorubicin from vascular access devices.

An assessment was made of 36 extravasations of Adriamycin (doxorubicin) in which vascular access devices had been used. Of these, 25 (69%) were sufficiently severe to warrant removal of the device. Physical manifestations were frequently of delayed onset. Edema and/or erythema often involved extensive areas around the catheter or access device and in several cases were accompanied by pain, discomfort or paresthesia. In 20 patients (59%), spontaneous resolution without ulceration occurred in spite of occasional extravasation of large amounts of doxorubicin. Most extravasations were caused by a limited number of technical errors and equipment problems. These were equally divided by site into injection port extravasations and catheter-related extravasations (18 patients each). The two most frequent causes were needle and catheter tip dislodgements. Procedures are suggested for minimizing the opportunities for extravasation of doxorubicin administered through vascular access devices.

Catheterization↗
PubMed1989

Ocular adverse reactions associated with adriamycin (doxorubicin).

To assess the ocular safety of doxorubicin, we reviewed doxorubicin-associated ocular adverse reactions reported to Adria Laboratories or published in the clinical literature. Conjunctivitis was the most frequently reported reaction. Periorbital edema was reported in two patients, and lacrimation was reported in a published study. Blepharospasm, keratitis, and decreased visual acuity were reported once each in patients treated with combination chemotherapeutic regimens containing doxorubicin. These reactions usually resolved rapidly on discontinuation of the drug. Conjunctivitis frequently followed accidental ocular exposure to doxorubicin. All but a few of these reactions cleared within 24 hours of exposure. The infrequent nature and usually rapid resolution of these ocular adverse reactions suggest that when ocular toxicities occur in patients undergoing doxorubicin-containing chemotherapy, the cautious reintroduction of doxorubicin, if further antineoplastic therapy is indicated, should be considered.

Aged↗
PubMed1989

Accidental acute exposure to doxorubicin.

Accidental ocular exposure to doxorubicin was followed by no reaction or rapidly resolving conjunctivitis in 13 of 15 cases (87%). In the two remaining cases, persistent photophobia and chronic inflammation were reported. Of 28 accidental exposures to sites other than the eyes, no reactions or rapidly resolving local reactions were reported in 24 cases (86%). Nurses are at particular risk for accidental exposure to doxorubicin and accounted for 20 of the 43 reported exposures (47%).

Conjunctivitis↗
PubMed1988

Efficacy of mesna in preventing further cyclophosphamide-induced hemorrhagic cystitis.

Mesna is a sulfhydryl compound that reacts with the metabolites of cyclophosphamide that are excreted in the urine and may produce bladder wall irritation. Mesna is converted in the blood to a biochemically inactive compound that is reduced back to mesna in the kidneys. In this way it has the potential to protect the bladder mucosa without interfering with the antineoplastic effect of cyclophosphamide. Twenty-two patients who had developed hemorrhagic cystitis from cyclophosphamide were treated again with cyclophosphamide and mesna prophylaxis. A total of 68 cycles of cyclophosphamide were given with mesna, with a median of three cycles per patient. A recurrence of cystitis was prevented in all but one patient. Thus, mesna is effective in preventing recurrent cystitis in patients receiving further cyclophosphamide.

Adolescent↗
PubMed1979

Experimental skin necrosis produced by adriamycin.

Skin ulceration caused by extravasation of Adriamycin follows a severely protracted course accompanied by considerable morbidity. To develop an animal model of Adriamycin ulceration, we compared intradermal injection of Adriamycin to injection beneath the panniculus carnosus with varying drug volumes and concentrations. Injections beneath the rat panniculus carnosus caused only irregular ulcerative lesions. Intradermal injection produced predictable, uniform skin necrosis and ulceration. Both increasing volume and increasing concentration of Adriamycin caused proportionate increases in skin ulcer size and in time required for healing. A critical concentration range for Adriamycin necrosis is 0.010--0.020 mg/ml, suggesting that the drug would have to be greatly diluted to reduce clinical skin ulceration. Adriamycin-induced skin necrosis heals at a slower rate than surgically created skin defects of similar size, indicating a reduced rate of wound contraction. Removal of the necrotic skin allows faster healing, although still slower than normal, due to removal of splinting effect. Histology shows early skin necrosis, with acute inflammation developing after 1 week. Epidermal hypertrophy is present at the edges of the necrosis. The small vessels remain patent. Multiple small vesicles of unknown etiology are seen in the necrotic dermis.

Animals↗
PubMed1977

Combination chemotherapy with bis chloroethyl nitrosourea (BCNU), vincristine and dimethyl triazeno imidazole carboxamide (DTIC) in disseminated malignant melanoma.

One hundred thirty two patients with disseminated malignant melanoma were treated using a combination of BCNU, vincristine and imidazole carboxamide. A response rate of 23% was observed, while 16% had stable disease. The patients' median survival was 42 months from diagnosis and 5.3 months from the onset of treatment. These results are not significantly different from therapy with imidazole carboxamide alone. Patients on this study were observed to have a significant reduction in the number of lymphocytes in their peripheral blood (mean 1800/mm3, median 1550/mm3). Patients with lymphopenia prior to the onset of therapy (86%) had a similar response rate but a shorter median survival (4.4 months vs. 7.8 months, P = .03) than patients with normal lymphocyte levels. These findings are compatible with recent observations on the importance of host immunocompetence in patients with malignant melanoma. Eosinophil levels were not closely correlated with response, although among patients with eosinophil counts of greater than 300/mm3 (22%), a slightly higher response rate (29%) was observed (P = .13). Eosinophilia did not influence patient survival.

Carmustine↗
PubMed1977

Bis chloroethyl nitrosourea, vincristine, dimethyl triazeno imidazole carboxamide and chlorpromazine combination chemotherapy in disseminated malignant melanoma.

One hundred twenty-one patients with disseminated malignant melanoma were treated with BCNU, vincristine, DTIC, and chlorpromazine (BVD). A response rate of 22% was observed; 28% of the patients had stable disease and 50% had increasing disease. Similar response rates were obtained with both the high dose and low dose treatment schedules. Patients who exhibited some degree of improvement during their initial course of treatment had the highest overall response rate (72%) to BVD chemotherapy. The median survival from onset of therapy was six months for all patients and 18 months for patients who responded to chemotherapy. The median duration of response was 9.9 months. Thus, the addition of chlorpromazine to BVD chemotherapy did not increase tumor response, and the overall results obtained were comparable to DTIC alone. Patients were found to be lymphopenic prior to the onset of therapy. Their median absolute lymphocyte count was 1800/mm3. Those patients with absolute lymphocyte counts above the 2710/mm3 normal mean had significantly higher response rates (35% vs. 19%, P less than .05) and longer survivals (9.8 months vs. 4.3 months, P less than .05) than patients with lower initial lymphocyte levels. Pretreatment eosinophil and monocyte counts were not closely correlated with patient response or survival.

Carmustine↗
PubMed1977

Evaluation of a hexamethylmelamine and 5-fluorouracil combination in the treatment of advanced ovarian carcinoma.

The combination of two nonalkylating agents, hexamethylmelamine (HMM) and 5-fluorouracil (5-FU), was evaluated in 14 patients with advanced ovarian carcinoma. Nine patients had been treated previously with alkylating agents. The overall response rate was 36% which is not greater than could be expected with either HMM or 5-FU alone. However, the median survival of the five responders was greater than 24 months. Treatment had to be discontinued in five of 14 patients due to excessive toxicity. Although the toxic effects were predominately gastrointestinal, unpredictable hematopoietic and neurotoxic effects were observed.

Altretamine↗
PubMed1977

Chemotherapy of non-Hodgkin's lymphoma: 10 years' experience in the Southwest Oncology Group.

The Southwest Oncology Group (SWOG) has completed five studies of high-dose intermittent combination chemotherapy for the management of advanced (stage III and IV) non-Hodgkin's lymphoma involving 1143 patients from May 1966 to September 1974. Lack of uniform histopathologic interpretation precludes precise analysis of these data. Although there has been little change in complete response duration over the years of this study, there has been an overall improvement in response rate and survival though there is no statistically significant improvement in the best overall survival when compared to the Stanford experience in stage III and IV disease (1960-71). The response rate and survival in diffuse histiocytic lymphoma have improved since the first study. There is definite evidence of a plateau in the survival curve beyond 2 years. The percentage of survival at which the plateau appears has increased over the years to 40% in the most recent studies, and the survival is suggestively better than the Stanford experience (P = 0.09). Over the years there has been a distinct improvement in response rate and survival of patients with nodular lymphocytic lymphoma, although the best SWOG survival is no different than the Stanford experience (P = 0.36).

Bleomycin↗
PubMed1976

Phase II evaluation of bleomycin. A Southwest oncology Group study.

Bleomycin given intravenously (i.v.) or intramuscularly (i.m.) in twice-weekly doses of 10 mg/m2 was evaluated for efficacy and toxicity in 382 patients. Responses were observed in 11/27 Hodgkin's diseases, 10/30 lymphomas, 9/22 squamous cell cancers of ectodermal origin, 12/26 germinal cancers, and 3/8 renal adenocarcinomas. The i.m. route is less likely to casue pulmonary toxicity or hypotension than the i.v. route. Advanced age and total doses exceeding 200 mg were associated with a higher risk of lung toxicity. All responders had shown at least improvement upon receiving 200 mg; higher total doses should be used only in responding patients.

Adenocarcinoma↗
PubMed1975

Quality of life.

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Family↗