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Biomedical subjects

J Stroehlein

Publications and source records attributed to J Stroehlein.

7 recordsLinked to original sources

Colonoscopy: its application and merit.

Much has been learned through the development of colonoscopy. This in turn has stimulated interest in roentgenographic studies and has provided a tool for conducting research studies that would not be possible without the ability to obtain tissue sequentially over a period of time. Despite these advances, questions still outnumber answers. As new technologies open doors for research that was not historically possible, commitment to research in endoscopy becomes increasingly important. The opportunities, importance and need for commitment to endoscopic research has recently been emphasized (Silverstein 1984). It is hoped that important research questions in endoscopy will be effectively addressed and this, in turn, will improve our knowledge about cancer of the large bowel and its precursors.

Adenoma↗

A comparative study of oral tegafur and intravenous 5-fluorouracil in patients with metastatic colorectal cancer.

A randomized study was conducted in patients who had measurable metastatic colorectal cancer to compare the relative efficacy and toxicities of oral tegafur (1 gm/m2/days 1-21) with those of 5-fluorouracil (5-Fu, 500 mg/m2/days 1-4, then 250 mg/m2 on days 6, 8, 10, 12). The treatment courses were repeated every 4 weeks. Patients not responding to 5-Fu treatment were switched to tegafur. Randomization was stratified for presence or absence of liver metastasis and performance status. Partial responses were observed with 5-Fu, 6/32 (19%), tegafur, 7/35 (20%), and in patients who had been switched to tegafur after failing on 5-Fu, 1/20 (5%) with patients evaluable for response. Neutropenia was more common with 5-Fu (32% vs. 1% of treatment courses). Nausea occurred in about half the treatment courses; vomiting occurred in only 22%. Mucositis and diarrhea were more common with 5-Fu and severe in patients with liver function impairment. Neurologic toxicities due to tegafur were mild and occurred in less than 10% of the treatment courses. Oral tegafur and I.V. 5-Fu were equally effective against colorectal cancer, but tegafur was associated with minimal myelosuppression, which makes it suitable for use in combination with myelosuppressive antitumor agents.

Administration, Oral↗

Phase II evaluation of aclacinomycin A (ACM-A, NSC208734) in patients with metastatic colorectal cancer.

Thirty-two patients with measurable metastatic colorectal cancer refractory to 5-fluorouracil-containing regimens received aclacinomycin A (ACM-A) on a single-dose I.V. schedule administered over 4 hours every 3 weeks. Good-risk patients received ACM-A at the starting daily dose of 100 mg/m2 while patients who had had therapy with radiation or myelosuppressive drugs such as mitomycin C or a nitrosourea compound received an initial daily dose of 80 mg/m2. There were no complete or partial remissions in this study. Twelve of 30 evaluable patients had disease stabilization. Nausea and vomiting were the dose-limiting toxic effects; myelosuppression was moderate, with neutropenia more severe than thrombocytopenia. Other toxic effects included diarrhea (in 53% of the treatment courses), phlebitis (36%), and mucositis (27%). Alopecia was rare and occurred in 3% of treatment courses, while none of the patients developed clinical manifestation of cardiac toxicity. Aclacinomycin-A administered by the single-dose schedule as used in this study is not effective against colorectal cancer.

Aclarubicin↗

Phase II evaluation of dihydroxyanthracenedione (DHAD, NSC 301739) in patients with upper gastrointestinal tumors. A preliminary report.

Twenty-nine patients with measurable metastatic upper gastrointestinal cancer received dihydroxyanthracenedione (DHAD, NSC 301739) on a 5-day I.V. schedule administered every 4 weeks. Good-risk patients received DHAD at the starting daily dose of 4 mg/m2, while patients who had had therapy with radiation or myelosuppressive drugs such as mitomycin C or a nitrosourea compound received an initial daily dose of 3 mg/m2. Most of the patients had disease refractory to 5-Fu-adriamycin-mitomycin-C-containing regimens. Eight of 25 patients evaluable for response had received no prior chemotherapy. There were no complete or partial remissions in this study. Stabilization of disease occurred in six of 14 patients with gastric carcinomas and five of 10 patients with pancreatic carcinomas. The dose-limiting toxic effect was myelosuppression; neutropenia was more severe than thrombocytopenia. The myelosuppression was more severe in patients who had poor bone marrow reserve and liver function impairment. These results suggest that DHAD administered by the 5-day dose schedule as used in this study is not very effective against gastric and pancreatic carcinomas.

Adult↗

Phase II evaluation of dihydroxyanthracenedione (DHAD, NSC 301739) in patients with metastatic colorectal cancer.

Thirty-one patients with measureable metastatic colorectal cancer refractory to 5-fluorouracil-containing regimens received dihydroxyanthracenedione (DHAD, NSC 301739) on a 5-day I.V. schedule administered every 4 weeks. Good-risk patients received DHAD at the starting daily dose of 4 mg/m2 while patients who had had therapy with radiation or myelosuppressive drugs such as mitomycin C or a nitrosourea compound received an initial daily dose of 3 mg/m2. There were no complete or partial remissions in this study. Eight of 30 evaluable patients had disease stabilization. The dose-limiting toxic effect was myelosuppression; neutropenia was more severe than thrombocytopenia. The myelosuppression was more severe in patients who had poor bone marrow reserves and abnormal pretreatment liver functions (serum alkaline phosphatase and serum glutamic oxaloacetic transaminase) levels greater than or equal to 1.5 times normal). DHAD administered by the 5-day dose schedule as used in this study is not effective against colorectal cancer.

Adult↗

Hepatic artery infusion chemotherapy: gastroduodenal complications.

Hepatic artery infusion chemotherapy is a recognized treatment of unresectable hepatic neoplasms. Because the arterial supply to the stomach and duodenum originates from the celiac and hepatic arteries, unavoidable infusion of the gastroduodenal and right gastric arteries may result in gastrointestinal complications. Of 174 patients (266 infusions) treated with hepatic artery infusion chemotherapy during a 12 month period, 18 developed severe dyspepsia. Ten of these 18 patients had gastrointestinal pathology documented by either endoscopy or upper gastrointestinal series; six had gastric ulcer and gastritis, two had duodenal ulcer, one pyloroduodenitis, and one pancreatitis. Endoscopically, the hepatic artery infusion chemotherapy-induced ulceration and gastritis were located in the distribution of the infused arteries. Radiographically, the gastric abnormalities ranged from typical benign ulcers to a pattern of multiple ulcerations with nodular fold mimicking malignancy. Angiographic correlation could be made on eight of the 10 patients. Vascular trauma, observed in five of these eight patients, seemed to contribute to gastrointestinal complications in hepatic artery infusion chemotherapy.

Adult↗

Age, affective distress, and illness detection in patients evaluated for gastrointestinal complaints.

A study of 260 patients was conducted in 1990 using a questionnaire that was designed to measure and assess their recall of symptom patterns, symptom distress levels, symptom interpretation, and physician-recommended treatment plans. The questionnaire was mailed 6-18 months after they had undergone a gastrointestinal workup for unexplained chest or abdominal pain. The authors found comparably high rates of both younger patients (age < 65) and older patients (age > or = 65) reporting symptom patterns sufficient to meet DSM-III criteria for panic, generalized anxiety, and depressive disorders. For younger but not older patients, the number of symptom complaints was related to their recall of a stress-related diagnosis made by the physician, which was less frequent for older patients. The older patients less often identified their symptoms as tension-related. Further research is needed concerning symptom reporting, illness attribution, and physician recognition of emotional etiology among elderly and younger patients with somatizing disorders.

Adolescent↗