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Biomedical subjects

J Pont

Publications and source records attributed to J Pont.

At least 37 records · Page 2Linked to original sources
PubMed1997

Calcium pyrophosphate dihydrate crystal deposition disease presenting as a pseudotumor of the temporomandibular joint.

We report a case of a 66-year-old white woman with calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. The patient related a 2-month history of swelling with tenderness over the left pre-auricular region. A CT scan suggested a synovial chondromatosis. Surgical removal was done and histologic study showed CPPD crystals. This disease rarely involves the temporomandibular joint (TMJ) and is not usually considered in the differential diagnosis. To our knowledge, only 14 cases have been reported in the literature.

Aged↗
PubMed1997

Fertility after chemotherapy for testicular germ cell cancer.

OBJECTIVE: To investigate the impact of cytostatic chemotherapy on long-term fertility in patients with testicular germ cell cancer. BACKGROUND: Many patients with testicular germ cell cancer show impaired spermatogenesis before undergoing cytotoxic chemotherapy. The known infertility before treatment and the reversibility of the fertility problems observed in some of them after successful anticancer treatment so far have prevented an assessment of the true impact of chemotherapy on long-term fertility. The introduction of a wait-and-see strategy (surveillance) for patients with testicular cancer and recent prospective trials comparing patients with and without cytotoxic chemotherapy now have provided the means for estimating the extent to which chemotherapy itself affects long-term fertility. RESULT(S): Whether spermatogenesis is impaired irreversibly by chemotherapy is determined by the cumulative dose of cisplatin. At cumulative doses > 400 mg/m2, irreversible impairment of gonadal function should be expected. CONCLUSION(S): At cumulative cisplatin doses < 400 mg (equivalent to 4 courses of state-of-the-art treatment), chemotherapy is unlikely to cause irreversible damage to fertility.

Antineoplastic Agents↗
PubMed1997

Interferon-alpha-2C and LD ara-C for the treatment of patients with CML: results of the Austrian multi-center phase II study.

Small pilot studies of patients with CML have reported on encouraging response rates after treatment with interferon-alpha (IFNalpha) in combination with low-dose cytosine arabinoside (LD ara-C). We therefore initiated a multi-center phase II trial in order to investigate the efficacy and tolerability of this combination in newly diagnosed patients with Ph-positive chronic myelogenous leukemia (CML). Eighty-four patients were treated with IFN-alpha-2c at daily subcutaneous doses of 3.5 MU and LD ara-C added subcutaneously for 10 days every month at a dose of 10 mg/m2, following an initial reduction of WBC to less than 20 x 10(9)/l with hydroxyurea (HU). Within a median observation period of 28 (5-59) months the patients received a median of 7 (1-35) IFNalpha and LD ara-C cycles. Treatment was stopped due to side effects in 16 cases (19%) and to primary or secondary treatment failure in 38 cases (45%). In 45 patients (54%) complete hematological response (CHR) was achieved; in 39 patients (46%) cytogenetic responses including 15 (18%) complete cytogenetic responses (CHR) were observed. Median duration of cytogenetic responses was 15 months. Relapses were seen in 8/15 patients (53%) with complete cytogenetic remission (CCR), in 3/6 patients (50%) with partial cytogenetic response and in 9/18 patients (50%) with minor cytogenetic response. In conclusion, the combination of IFNalpha and LD ara-C resulted in encouraging rates of hematological and cytogenetic responses in patients with CML with low to moderate toxicity.

Adolescent↗
PubMed1997

Chemotherapy for germ cell tumors relapsing after high-dose chemotherapy and stem cell support: a retrospective multicenter study of the Austrian Study Group on Urologic Oncology.

BACKGROUND: In most patients with advanced refractory germ cell tumors undergoing high-dose chemotherapy with stem cell support (HDCT) the disease progresses after HDCT. This study was designed to shed light on the unestablished role of post-HDCT chemotherapy. PATIENTS AND METHODS: In a retrospective multicenter study data of 47 evaluable patients from nine centers subjected to post-HDCT chemotherapy for progression of their germ cell tumors were collected in a questionnaire survey and analyzed for treatment response and survival. RESULTS: Of 191 patients pretreated by HDCT, 48 (25%) were subjected to post-HDCT chemotherapy for disease progression. Remission was achieved in 17 (36%) and marker-negative remission in eight (17%). The median survival time was 26 weeks, 65 weeks for responders and 13 weeks for non-responders. Only one of 47 evaluable patients achieved sustained complete remission. Remissions significantly correlated with the post-HDCT interval, the use of ifosfamide and the combination regimens of cisplatin + etoposide i.v. or ifosfamide and of paclitaxel + ifosfamide or cisplatin. On univariate analysis a longer post-HDCT interval, the use of cisplatin, paclitaxel and ifosfamide and the combined use of paclitaxel + ifosfamide and/or cisplatin significantly improved the chances of survival. On multivariate analysis only treatment with paclitaxel and ifosfamide retained independent prognostic significance for survival. CONCLUSIONS: One third of the patients considered to be candidates for further chemotherapy once progressive after HDCT went into remission with a gain in survival time. Sustained remissions may occur, but are rarely seen. Paclitaxel and ifosfamide appear to be the most effective drugs in these heavily pretreated patients.

Adult↗
PubMed1997

Testis-preserving surgery in bilateral testicular germ cell tumours.

OBJECTIVE: To evaluate the indications, techniques and outcome of organ-preserving tumour enucleation in patients with bilateral testicular germ cell tumours (BTGCT) rather than standard bilateral radical orchidectomy which results in loss of fertility and a lifelong requirement for androgen replacement. PATIENTS AND METHODS: In 13 patients with BTGCT of 6-30 mm in diameter, the tumours were enucleated under cold ischaemia after inguinal testicular exploration, and biopsies of the tumour bed and the peripheral parenchyma were taken. Histology of the orchidectomy specimen revealed a seminoma in four cases, an embryonal carcinoma in three, a teratocarcinoma and a mixed-germ cell tumour in two each, and a mature teratoma in one. Histology of the enucleated tumours showed a seminoma in seven cases, an embryonal carcinoma in five and a mature teratoma in one. Six of the 13 patients underwent testicular radiation (20 Gy) for carcinoma in situ (CIS) and five patients had adjuvant local therapy. Six months postoperatively a testicular biopsy was taken to determine the success of therapy. RESULTS: The median follow-up was 62 months (range 14-163) and the 13 patients are currently free of disease; one patient had local recurrence 9 months after tumour enucleation but after orchidectomy the patient is free of disease after a follow-up of 156 months. Serum concentrations of luteinizing hormone and testosterone were within the normal range in all patients and no androgen substitution was necessary. A testicular biopsy taken 6 months post-operatively revealed Sertoli cells only in all patients who had received radiation therapy. CONCLUSIONS: These results suggest that organ-sparing surgery in patients with BTGCT represents a new therapeutic approach with endocrinological and psychological advantages. In our experience, enucleation resection of testicular tumours is possible with certain prerequisites, i.e. the tumour is organ-confined with no infiltration of the rete testis, multiple biopsies of the tumour bed and peripheral parenchyma should be taken, any associated CIS treated by radiation therapy, and patients must be followed closely.

Carcinoma in Situ↗
PubMed1996

CEOP-IMVP-Dexa in the treatment of aggressive lymphomas: an Austrian multicenter trial.

PURPOSE: This trial evaluated the efficacy, toxicity, and practicability of a new intensive chemotherapy regimen in a multicenter setting of university and community hospitals. PATIENTS AND METHODS: We tested a hybrid protocol of two non-cross-resistant regimens, cyclophosphamide, epirubicin, vincristine, and prednisolone (CEOP) and ifosfamide, etoposide (VP-16), methotrexate, and dexamethasone (IMVP-Dexa) given every fourth week, three to six times according to response, in patients with untreated intermediate- and high-grade non-Hodgkin's lymphoma. Ten Austrian centers entered 81 patients onto this multicenter trial. Eleven patients were excluded. The median age was 55 years. Twenty-six of 70 patients had stage III or IV disease. The distribution among international risk categories low, intermediate-low, intermediate-high, and high was 20%, 34%, 23%, and 23%, respectively. RESULTS: Of 70 eligible patients, 56 (80%) had a complete remission and seven (10%) a partial remission. After a median observation time of 36 months, the estimated time to relapse and overall survival rates are 67% and 72%, respectively. Age and Karnofsky index were the only independent risk factors for survival. Toxicity was primarily hematologic, with a median granulocyte nadir of 0.56 x 10(9)/L. Sixty-seven percent of patients had infections; 25.7% were severe World Health Organization (WHO) grade III or IV. There were three treatment-related deaths. CONCLUSION: CEOP-IMVP-Dexa chemotherapy is safe and feasible on a groupwide basis even when used in community hospitals. Neutropenic infections are the major complications. A 72% 3-year survival rate in patients with intermediate- and high-grade non-Hodgkin's lymphoma warrants further studies. These data are the basis for a randomized trial to compare cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) with CEOP/IMVP-Dexa.

Adolescent↗
PubMed1996

Adjuvant chemotherapy for high-risk clinical stage I nonseminomatous testicular germ cell cancer: long-term results of a prospective trial.

PURPOSE: To assess the impact of short-term adjuvant chemotherapy on relapse rates, treatment-related morbidity, and long-term toxicity in patients with clinical stage I nonseminomatous testicular germ cell tumor (NSGCT I) who carry a high risk of relapse, ie, who show blood-vessel invasion (VI) by the primary tumor. PATIENTS AND METHODS: From January 1985 to January 1995, 42 NSGCT I patients with VI were treated with two courses of cisplatin, etoposide, and bleomycin (PEB) after orchidectomy. Of these, 29 patients with a follow-up time of more than 2 years are the subject of this report. NSGCT I patients without VI were assigned to a surveillance program and served as controls for the assessment of long-term toxicity. RESULTS: During a median follow-up time of 79 months (range, 27 to 119), two patients relapsed. One developed fully differentiated mature teratoma; the other was a true chemotherapy failure and again developed embryonal carcinoma. Twenty-seven patients (93%) are alive without evidence of disease; one patient (3%) died of progressive testicular cancer and another of lung cancer. The two courses of PEB did not cause any severe acute adverse reactions. The assessment of late sequels of adjuvant chemotherapy based on clinical and laboratory evidence of cardiovascular and pulmonary disease, fertility, and secondary neoplasms, as well as on a psychosocial questionnaire, did not show any significant disadvantages versus the control group. CONCLUSION: Adjuvant chemotherapy with two courses of PEB is an effective and reasonable treatment option for patients with clinical stage I NSGCT who carry a high risk of relapse. No adverse late sequelae were detected within a median follow-up time of more than 6 years.

Adolescent↗
PubMed1995

Antibodies to the nonstructural protein of parvovirus B19 in persistently infected patients: implications for pathogenesis.

Three patients with persistent parvovirus B19 infection, as documented by the prolonged presence of IgM directed to the viral capsid proteins and detection of viral DNA in serum by dot-blot hybridization or polymerase chain reaction (PCR), were investigated for the presence of antibodies to the nonstructural protein NS-1 of parvovirus B19. This was done by using an ELISA based on recombinant NS-1 protein. Whereas control sera displayed no reactivity, sera from persistently infected patients showed a strong specific antibody response to NS-1. Patients were followed for 3-18 months, during which IgM titers declined but IgG directed to the nonstructural protein remained detectable. The appearance of NS-1-specific antibodies might indicate an altered course of viral infection leading to the establishment of persistently active infection and subsequent destruction of cells of nonerythroid lineage.

Adult↗
PubMed1994

HIV epidemiology and risk behavior promoting HIV transmission in Austrian prisons.

In 1989, 1990 and 1992, 19%, 15% and 10%, respectively, of all prisoners newly admitted to prisons and penitentiary institutions in Austria underwent HIV antibody tests. Based on the HIV test outcome in prisons in which more than 80% of the newly admitted inmates were tested, annual HIV prevalences among prison inmates in Austria were determined. These were 0.5% (11/2,223), 1.3% (19/1,466) and 0.9% (14/1,509) in 1989, 1990 and 1992, respectively. The prevalence rates among prison inmates in Austria are thus 5 times higher than those in the general Austrian population. About 5% of all inmates belong to the high-risk group of intravenous drug users. Inquiries into HIV risk behavior among prison inmates showed that, in Austrian prisons just like in those of many other countries, intravenous drug use and sexual contacts are common practices. As disposable needles and condoms are not available to prison inmates, these practices carry a particularly high risk of HIV transmission. The data collected can be taken as a basis for developing strategies which are designed to reduce the risk of HIV transmission in prisons and which have a major bearing on the development of the HIV pandemic.

Austria↗
PubMed1994

Coincidence of severe aplastic anaemia with multiple sclerosis or thyroid disorders. Report of 5 cases.

Five patients with severe aplastic anaemia (SAA) who, simultaneously (n = 3) or consecutively (n = 2), presented with multiple sclerosis (MS) (n = 2) or immune hyperthyroidism (IHT) (n = 2) or subacute thyroiditis (n = 1) are described. Two female patients with MS developed SAA after a small dose of azathioprine. Another patient simultaneously presented with IHT and SAA. SAA and MS responded to cyclosporine while IHT required 131I. Relapsing SAA in 1 patient with MS was treated with antithymocyte globulin (ATG) which induced acute exacerbation of MS. Despite the low total dose of ATG (31.5 mg/kg), complete remission of SAA was obtained. Two other patients developed thyroid disorders, 42 and 106 months after successful immunosuppression with ATG/high-dose methylprednisolone. IHT and subacute thyroiditis were successfully treated with 131I or prednisolone, respectively, without recurrence of SAA in both cases. These are the first documented cases of SAA evolving in the course of MS while the coincidence with IHT was already described. Since enhanced expression of interferon-gamma plays a crucial role in SAA as well as in MS and in IHT, similar pathogenetic principles may apply for these seemingly unrelated disorders.

Adult↗
PubMed1994

Rapid achievement of PML-RAR alpha polymerase chain reaction (PCR)-negativity by combined treatment with all-trans-retinoic acid and chemotherapy in acute promyelocytic leukemia: a pilot study.

The reverse transcriptase-polymerase chain reaction (RT-PCR) for the fusion transcript of PML-RAR alpha can be used to detect minimal residual disease (MRD) in acute promyelocytic leukemia (APL). We have applied a semi-quantitative two-step PCR assay (sensitivity: step 1 = 1 in 10(3) cells; step 2 = 1 in 10(6) cells) to monitor the dynamics of MRD after combined therapy with all-trans-retinoic acid (ATRA) and chemotherapy (CT) in 5 patients in whom complete clinical remission (CR) was achieved. The patients received an induction treatment with ATRA for 47, 40, 38, 14 or 10 days. In three patients ATRA was followed by CT. Two patients with hyperleukocytosis at diagnosis or after ATRA received an overlapping CT starting from day 3 or 7. Four of the five patients became two-step PCR-negative in their bone marrow within 43 to 82 days after onset of therapy. Two-step PCR-negatively was achieved with ATRA plus one course of CT in these four patients who are still in continuous complete remission after 19, 18, 7 and 5 months. One of these patients did not even receive consolidation CT because of congestive heart failure. The fifth patient remained second-step PCR-positive and relapsed after 5 months. Our results indicate that the combined regimen can rapidly reduce MRD below a detection limit of 1 in 10(6) cells within 1-3 months and that these results can even by achieved by a short course of ATRA together with only one cycle of CT.

Aged↗
PubMed1993

Community worry about heart disease: a needs survey in the Coalfields and Newcastle areas of the Hunter region.

A needs survey was administered by mail in the Coalfields area of the Hunter region (a lower socioeconomic area around Cessnock) and in a higher socioeconomic area of Newcastle. The purpose was to assist planning for Coalfields Healthy Heartbeat--a community-action heart disease prevention program. Response rates from random samples of residents were 435/897 (49 per cent) for the Coalfields and 565/875 (65 per cent) for Newcastle. In both study areas heart attack was ranked eleventh from a list of 17 potential community worries, well below drugs, crime, road safety, the environment, cancer and 'loss of health'. Coalfields respondents were more worried about all issues on the list than were the residents in Newcastle and were less likely to have heard about recent health promotion campaigns. Coalfields respondents felt that heart disease prevention was the responsibility of the individual, the family, and the medical profession, in that order, and much less the responsibility of local community groups. Results suggest that health promotion strategies incorporating values, language and symbols that are meaningful to distinct subgroups may be more successful than disease-specific programs aimed at the general population.

Adult↗
PubMed1992

Recurrent granulocytic aplasia as clinical presentation of a persistent parvovirus B19 infection.

We report a case of persistent infection with human parvovirus B19 (PVB19), manifesting clinically as recurrent agranulocytosis and in bone marrow biopsy as recurrent pure granulocytic aplasia. Persistence of parvovirus infection was documented by the presence of PVB19 DNA and anti-PVB19-IgM antibodies in the serum for a period of 19 months. Granulocytic aplasia occurred only when anti-PVB19-IgG antibodies were not detectable in the serum and granulopoiesis showed immediate recovery with high dose intravenous immunoglobulin treatment. This case report suggests that the erythroid precursor cell may not be the only target cell of PVB19 infection. We suggest testing for active parvovirus infection in cases of aplasia of any lineage of the haematopoietic system.

Aged↗
PubMed1992

Treatment decision for stage I non-seminomatous germ cell tumours based on the risk factor "vascular invasion".

Surveillance has become an alternative treatment modality for stage I non-seminomatous germ cell tumours with reported relapse rates of up to 30% in retrospective studies. Results obtained in our retrospective study showed vascular invasion in primary tumours to be the risk factor with the highest negative predictive value. Since January 1985 patients with stage I non-seminomatous germ cell tumours have been stratified by the presence or absence of vascular invasion in the primary tumour: those without vascular invasion (n = 26; group A) were subjected to a rigorous surveillance programme, while those with vascular invasion (n = 22; group B) were given 2 chemotherapy courses of bleomycin, etoposide and platinum in the hope of preventing progression. Relapse rates were 3.8% and 9% in groups A and B, respectively. The pooled relapse rate for both groups A and B (n = 48) was 6.2% (3/48). After a mean follow-up time of 36 months 95.8% (46/48) of the patients were without evidence of disease.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

[Antibody prevalence for hepatitis C and other parenterally transmissible viral diseases in i. v. drug dependent patients].

Serum samples of 151 intravenous drug users were tested for markers of hepatitis B, hepatitis C, HIV and HTLV-I infection to estimate the prevalence of blood born virus infection in this high risk group. Anti HCV antibodies were found in 75% of sera. Seroprevalence for HIV was found 13%, for hepatitis B markers 68% and none for HTLV-I. Multiple infections have been very frequent.

Adult↗
PubMed1991

Carboplatin, methotrexate and vinblastin (Carbo-MV) for advanced urothelial cancer. A phase II trial.

Fifteen patients with advanced urothelial cancer were treated with carboplatin 300 mg/m2, methotrexate 30 mg/m2, and vinblastin 3 mg/m2 on day 1 and the same dosage of methotrexate and vinblastin on days 15 and 22. Six patients were pretreated with radiotherapy and or chemotherapy; 7 patients had impaired renal function due to obstructive uropathy. Eight patients achieved a partial remission; 4 patients achieved a minor remission or stabilization of progressive disease. Mean duration of response was 8+ month (2+ to 12+ month). Subjective tolerance of the treatment was excellent but there was considerable bone marrow toxicity in the pretreated patients. The data show that Carbo-MV (carboplatin, methotrexate, and vinblastin) is effective and subjectively well tolerated in advanced urothelial carcinoma.

Adult↗
PubMed1991

Non-radioactive detection of the rearranged BCR/ABL sequences amplified by polymerase chain reaction.

The polymerase chain reaction (PCR) is a powerful technique for the detection of the bcr/abl rearrangement in chronic myelogenous leukemia (CML). It allows the exponential amplification of the rearranged region, thus facilitating its detection. The specificity of the bcr/abl cDNA sequence amplified by PCR is most commonly verified by hybridization to a 32P-labeled probe. In this paper, an assay for the colorimetric detection of the amplified bcr/abl fragment is described, which offers several advantages over the use of radioactive probes. We adapted the PCR for synthesis and simultaneous labeling of DNA fragments with a non-radioactive steroid compound called digoxigenin. This labeling procedure was used to generate a digoxigenin-labeled internal probe for the chimeric bcr/abl mRNA. The assay described is based on the hybridization of the amplified bcr/abl sequence to the non-radioactively labeled probe and on the subsequent detection by an enzyme-linked immunoassay and enzyme-catalyzed color reaction. Using this protocol, we investigated 20 patients with CML along with six healthy individuals and two cell lines derived from patients with CML for the presence of the bcr/abl rearrangement. It is shown that the assay is both highly sensitive and specific and that it is readily applicable to the routine diagnosis of CML. In addition, the assay could be adapted to a number of clinical diagnostic uses.

Colorimetry↗