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Biomedical subjects

J Rizzo

Publications and source records attributed to J Rizzo.

31 records · Page 2Linked to original sources
PubMed1993

Quality indicators: control maintains--propriety improves.

Continuous improvement of care depends upon the efforts of all nursing personnel. Supervisors facilitate quality program operations in their specific areas; head nurses document outcomes; and staff nurses identify problems and contribute to planning. All join in evaluating appropriateness of patient care and in modifying approaches for greater effectiveness.

Hospital Bed Capacity, 500 and over↗
PubMed1991

A phase I trial of taxol given by a 6-hour intravenous infusion.

Taxol is a unique mitotic inhibitor that has entered phase II investigation. Phase I studies demonstrated hypersensitivity reactions that were related to the cremophor vehicle and to the rate of drug infusion. As a result, the time span of intravenous (IV) infusion of taxol was routinely prolonged to 6 hours or beyond, and premedication with diphenhydramine, dexamethasone, and cimetidine was initiated. Early studies showed antitumor activity, especially against malignant melanoma and ovarian carcinoma. This phase I trial was performed giving taxol, as a 6-hour IV infusion every 21 days, without premedication. The purpose was to study the necessity of premedication and its impact on toxicity and pharmacokinetics. Thirty-one patients received 64 assessable courses of taxol. One patient had a hypersensitivity reaction, which was easily controlled using routine measures. Myelosuppression was dose-limiting, but sporadic, with two fatalities due to sepsis. Nonhematologic toxicity was of grade 1 and 2 except for one patient with grade 3 mucositis and two patients with grade 3 neuropathy. The neuropathy consisted of reversible painful paresthesias, requiring discontinuation of drug in two patients. Four partial responses were seen (three in patients with non-small-cell lung cancer, one in a patient with adenocarcinoma of unknown primary). Pharmacokinetic values were consistent with those previously reported. The occurrence of myelosuppression or neurotoxicity appeared to be associated with the area under the concentration x time curve (AUC) of taxol. The recommended phase II starting dose on this schedule is 225 mg/m2. Taxol merits broad investigation at the phase II level.

Alkaloids↗
PubMed1990

Extracranial optic nerve decompression for traumatic optic neuropathy.

We examined 14 patients with acute, unilateral optic nerve injury after blunt head trauma. In each patient the optic canal was decompressed through an ipsilateral external ethmoidectomy. The patients also received treatment with dexamethasone during the perioperative period. There was no morbidity or mortality. Eleven of the 14 patients improved, including 3 of the 5 who could not perceive light preoperatively. Transethmoid-sphenoid optic canal decompression is a safe and effective treatment for indirect optic nerve trauma.

Adult↗
PubMed1990

Analysis of anticancer drugs in biological fluids: determination of taxol with application to clinical pharmacokinetics.

Taxol, a novel antimitotic, antitumor agent is currently undergoing Phase 1 clinical trials for the treatment of various tumors. An isocratic HPLC method has been developed for the determination of taxol in human plasma and urine. The method was then applied to the clinical pharmacokinetics of taxol following 6-h intravenous (i.v.) infusions at doses of 175 and 225 mg m-2. A mobile phase of methanol-acetate buffer (0.02 M, pH 4.5) (65:35, v/v) was used to elute a C8 column with detection at 227 nm. The sample preparation involved extraction with t-butyl methyl ether followed by further clean-up of the sample by solid-phase extraction. The method was linear from 0.10-10 microM injected, with a chromatographic run time of 6 min. The results obtained from the clinical study indicate that the plasma pharmacokinetics of taxol are best characterized by a two compartment open body model. Additionally, the present study resulted in the detection of a previously unreported peak which may be a metabolite of taxol.

Alkaloids↗
PubMed1989

Axillary dissection for breast carcinoma. The myth of skip metastasis.

The question of what constitutes an adequate axillary dissection for breast cancer remains open for debate. Central to this controversy is whether axillary nodal metastasis occurs in a stepwise fashion or spreads sporadically, creating skip metastases. The therapeutic aim of axillary dissection also must be considered. To resolve this controversy, a prospective study involving 129 patients who underwent complete axillary dissection for breast carcinoma was performed. The tissue from the axillary dissections was divided intraoperatively and sent to the pathologist as two specimens. The first specimen contained all nodes lateral to the pectoralis minor muscle (Level I), whereas the second contained all nodes beneath and medial to the pectoralis minor (Levels II and III). The tissue was analyzed to determine the frequency of skip metastasis. Only two patients, 1.6 per cent of the total group or 3.2 per cent of the positive node group, were found to have a positive node in Level II-III with no metastasis in Level I. A thorough dissection of Level I alone is sufficient to detect more than 98 per cent of all axillary lymph node metastases from breast cancer. Thus, proper staging of the disease can be obtained. When Level I contained positive nodes, the probability of metastatic disease to higher levels was significant (45%), indicating further treatment is necessary in incomplete axillary dissections.

Breast Neoplasms↗
PubMedDate not supplied

Effect of improved disease management strategies on hospital length of stay in the treatment of congestive heart failure.

Congestive heart failure (CHF) afflicts more than 4.6 million people in the United States and increases at a rate of 400,000 newly diagnosed patients per year. With more than 1.5 million hospital admissions per year attributed to CHF, it is the number one cause of hospitalization. Hospital length of stay (LOS) is one key determinant of greater hospital costs and has been the focus in some economic studies of CHF patients. In the present study, the potential economic benefits for hospitals from the implementation of improved disease-specific management programs in the treatment of CHF have been quantified in terms of LOS. We estimated the potential effects of disease management on LOS as a residual variation across hospitals, controlling for the effects of patient-specific characteristics, including severity of disease, health status, insurance status, and comorbidities. The study entry criteria and random sample selection yielded 5242 records for analysis. The average LOS was 7.1 days. The fixed effects or disease management practices across hospitals contribute to the explanatory power of the model by 4%. The 104 hospital-specific fixed effects measuring the potential impact of the differences in disease management relative to the reference hospital had values ranging from-3.41 to 4.33 days, for a total spread of 7.74 days, even after controlling for all other factors. The analysis suggests that the potential gain in profits for hospitals reimbursed on a per-case basis may be substantial, if disease management strategies practiced by those hospitals that lie to the left of the mean LOS were used by those that lie to the right of the mean LOS.

Aged↗
PubMedDate not supplied

Analysis of antibiotic stability in a parenteral nutrition solution.

In children receiving multiple antibiotics and total parenteral nutrition (TPN), the amount of nutrition received can be less than optimal if the central venous line is used for administration of blood products, antibiotics and other medications. The purpose of this study was to evaluate the compatibility of commonly used antibiotics in our standard hyperalimentation solution to determine whether these drugs could be administered in a "piggyback" fashion with parenteral nutrition. If there were no incompatibility this could allow significantly more TPN to be delivered without need for extra fluid in patients receiving antibiotics several times daily. We found 13 antibiotics (amikacin, azlocillin, cefamandole, cephalothin, gentamicin, mezlocillin, moxalactam, nafcillin, oxacillin, penicillin, piperacillin, ticarcillin and tobramycin) to be stable for 6 hours and compatible with the TPN solution. They could be safely given in the presence of the hyperalimentation preparation (1.5% amino acid, 15% dextrose, vitamins, calcium (300 mg/liter) and standard electrolyte concentrations).

Anti-Bacterial Agents↗
PubMedDate not supplied

Discrepancy between in vitro and in vivo antifungal activity of albendazole.

Albendazole has in vitro activity against Cryptococcus neoformans and reduced in vitro activity for albendazole when compared with Candida albicans. The major metabolite of albendazole, albendazole sulphoxide showed no in vitro activity against isolates of either fungus. Immunocompetent mice infected intravenously (i.v.) with C. albicans were treated with albendazole doses of 20-600 mg kg-1 per day in noble agar or sesame oil for per oral (PO) administration, or 80 mg kg-1 per day in DMSO for intraperitoneal (i.p.) and i.v. administration for 10 days, and were observed for survival. Mice infected with C. neoformans intracranially received albendazole in daily doses of 600 mg kg-1 prepared in DMSO (i.p.) or peanut butter/rat chow (PO) for 10 days and were observed for survival. Mortality was not different between the treated and control animals in any study. Plasma samples from uninfected mice dosed with similar formulations and doses of albendazole were analysed by HPLC for albendazole and albendazole sulphoxide. No albendazole could be detected in any sample, while concentrations of albendazole sulphoxide (286-8697 ng ml-1) were observed in all samples. These data suggest that the absence of in vivo activity for albendazole is due to rapid conversion to the inactive albendazole sulphoxide metabolite.

Albendazole↗