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Biomedical subjects

J T Lowman

Publications and source records attributed to J T Lowman.

At least 19 recordsLinked to original sources
PubMed1991

Quality of life research in oncology. Past achievements and future priorities.

The status of quality of life research in oncology is assessed, and priorities for future research with regard to conceptual and theoretical developments, focus and content of research, research designs and practical strategies for research implementation, and transferring information to clinical practice and medical policy decision-making are identified. There is general agreement that quality of life is a subjective and multidimensional construct, yet comprehensive theoretical models have not been developed and applied fully. We recommend that future research be based on conceptual models that explicate the interrelationships among quality of life domains throughout the stages of cancer care. These models, and the longitudinal research that follows from them, should attend specifically to cross-class and cross-cultural issues to avoid overgeneralization from theory and research that are based largely on the views of the majority culture. We encourage the inclusion of this theory-based quality of life assessment as a standard component of clinical trials. Success in this endeavor will require additional standardization of quality of life measures for use across a range of cancer patient populations, including the development of age-specific norms and instruments designed to assess the entire family system.

Humans↗
PubMed1990

Survival of the older patient compared with the younger patient with Hodgkin's disease. Influence of histologic type, staging, and treatment.

Age as an independent risk factor for survival of Hodgkin's disease (HD) was investigated using data for the 6345 patients in the American College of Surgeons, Patterns of Care Study. Patients were divided into those 15 to 34 years of age, and those older than 50 years. Older patients had higher rates of advanced stage and B symptoms (e.g., Stage IVB, 19.7% compared with 7.7%) and significantly higher rates of poor prognosis histologic types, odds ratio (OR) = 3.7. The older population with clinical stage (CS) I and II disease was also less likely to have received any of the selected staging procedures, bone marrow biopsy, lymphogram, or laparotomy (OR = 4.48). The two populations were equivalently understaged when CS was compared with pathologic stage (PS). In each category the older patients were more likely to have received no therapy; for PS I and II disease the OR for older patients compared with the younger patient was 2.14. When stratified by PS, B symptom status, histologic type, and treatment the older patients continued to show poorer 5-year survival by the life-table method. The authors' hypothesis--that older patients equivalently staged and treated would have no significant difference in long-term survival--was not substantiated by the data. However, in the analyses in which corrections for the known risk factors were made, the difference in survival was not as great as that in the crude, unstratified data. This study, as well as other recent studies utilizing smaller numbers of patients, finds age an independent predictor of poorer survival in HD patients.

Adolescent↗
PubMed1987

Familial Hodgkin's disease. A clinical and laboratory investigation.

A three to sevenfold increased risk of Hodgkin's disease has been noted in families of patients. We report the first family in which all four of a four member sibship had Hodgkin's disease. In these four sibling cases, we were able to explore markers of infectious etiologic factors by measuring antibodies to Epstein-Barr virus (EBV) and human T-cell lymphotropic virus (HTLV), and possible genetic risk factors by human leukocyte antigen (HLA) typing and chromosome analysis. All three men were diagnosed within six months of their 30th birthday. HLA typing revealed that all four siblings share the DR5 antigen, and two siblings share HLA-B27. Chromosome analysis on peripheral lymphocytes revealed no abnormalities. A detailed, structured interview failed to elicit evidence of unusual exposures. The EBV antibody titers are probably within the normal range and none of the family had antibodies to HTLV-III. Observations on this family suggest that genetic factors play a greater role than environmental factors in the etiology of familial Hodgkin's disease.

Adolescent↗
PubMed1986

Congestive heart failure, hypertension, and hyperreninemia in bilateral Wilms' tumor: successful medical management.

Congestive heart failure is an unusual complication of the hyperreninemia of Wilms' tumors. Cases with bilateral tumors present a difficult management problem. This is a report of the successful medical management of a child with congestive heart failure secondary to hyperreninemia from bilateral Wilms' tumor. Hypertension and hyperreninemia were extensively documented. Their etiologic relation to the congestive heart failure was supported by the patient's improved cardiac function following specific renin-angiotensin blockade. With unilateral tumors, surgical excision corrects the hypertension; however, with large bilateral tumors, excision is out of the question. A unique feature of this case is the ability to control the blood pressure with saralasin. With subsequent antitumor therapy, renin concentrations decreased proportional to tumor size, and renin angiotensin blocking therapy could be discontinued.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

In vitro sensitivity of normal granulocytic and lymphoma colonies to vinca alkaloids.

Recently, a colony-forming assay was developed in our laboratory for pediatric malignant lymphoid diseases. This assay supports the growth of lymphoma colonies (ML-CFC) as well as normal granulocytic colonies (CFU-C) and thus a direct comparison between the antineoplastic and myelosuppressive effects of a drug can be determined. To test specificity of this in vitro assay to structurally similar drugs, the inhibitory effects of three vinca alkaloids (vincristine, vindesine, vinblastine) on ML-CFC (B-, T-, pre-T-cell types) and CFU-C was determined. Our results demonstrate that all three vinca alkaloids were active agents in vitro and that a direct dose response effect occurred once a threshold dose was reached. Each vinca alkaloid had a different pattern of inhibitory effect on ML-CFC and CFU-C suggesting an inherent difference in drug metabolism by these cells. Also, based on the dose inhibiting 50% of colony formation, vinblastine was 94 times more inhibitory against malignant B-cell ML-CFCs than against granulocytic CFU-C.

B-Lymphocytes↗
PubMed1981

In vitro growth of lymphoma colonies from children with non-Hodgkin's lymphoma.

Growth in vitro of malignant lymphoid cells has been previously reported, but those studies involved direct establishment of cell lines from the patients' cells. In the present study, an in vitro system for both primary growth and passage of malignant lymphoblastic colony-forming cells (ML-CFC) was established, and for the first time, colony-forming cells from non-Hodgkin's lymphoma patients were cultured, and cell lines were established from individual colonies. Malignant lymphoid colonies grew from 9 of 16 (56%) bone marrow aspirates, which were histologically involved with lymphoma and from 5 of 29 (17%) morphologically normal bone marrow samples. ML-CFCs grew concomitantly with myeloid and monocytic CFCs and were distinguishable by their morphologic characteristics on agar, cytochemical staining characteristics, and cell surface markers. Successful passage of ML-CFCs was accomplished in five patients, and ten distinct cell lines (six null cell, three B cell, and one T cell) were established. This agar assay system provides an opportunity to study malignant lymphoma cell growth both as a primary colony and a cell line established from a primary colony.

Adolescent↗
PubMed1979

A reliable method for evaluating drug compliance in children with cancer.

Poor drug compliance may cause a decreased survival of children with malignancies. Children who fail to take their medications are not receiving optimum amounts of chemotherapy and suboptimal therapy causes a shortened survival in children with cancer. This is a study of prednisone compliance in 52 children with cancer during three distinct phases of therapy. The patients were either known to be taking prednisone (on-therapy group), off prednisone (off-therapy group), or their compliance was unknown (unknown group). Evaluation of prednisone compliance was attempted by measuring hemoglobin level changes, weight changes, and random urinary 17-ketogenic steroids. The results obtained show that while hemoglobin and weight changes are not helpful, a random urine 17-ketogenic steroid assay is able to differentiate clearly those patients who are taking their prednisone. By the use of this assay it was found that 33% of patients who by protocol and instruction were supposed to be receiving prednisone were not complying. Separate analysis of adolescents revealed an even more alarming 59% noncompliance rate. This striking level of noncompliance strongly suggests that the survival of patients may be threatened by noncompliance.

17-Ketosteroids↗
PubMed1978

Colony formation in vitro by leukemic cells in acute lymphoblastic leukemia (ALL).

An assay system in vitro for the growth of malignant lymphoblastic colony-forming cells (CFC) was established. Growth of malignant myeloblastic CFC has been previously reported, but this is the first report of growth of malignant lymphoblastic CFC. Established assay systems in vitro have been very helpful in elucidating the control of growth and differentiation of both normal and malignant bone marrow cells. Lymphoblastic CFC were grown from the bone marrow aspirates of 20 children with acute lymphoblastic leukemia. Growth of these colonies was established on an agar assay system and maintained in the relative hypoxia (7% oxygen) of a Stulberg chamber. The criteria for malignancy of these colonies was based upon cellular cytochemical staining characteristics, the presence of specific cell surface markers, and the ability of these lymphoid cells to grow without the addition of a lymphoid mitogen. With this technique, specific nutritional requirements and drug sensitivities can be established in vitro, and these data may permit tailoring of individual antileukemic therapy.

Adolescent↗
PubMed1978

Childhood cancer: Parental discord and divorce.

Parents of 191 children who were treated for cancer over a seven-year period completed and returned a questionnaire concerning marital status. Contrary to the prediction of a high divorce rate among these families, the study found a person-year divorce rate of 1.19%. This is slightly lower than the 2.03% person-year divorce rate among married couples with children in the states of Kansas and Missouri. The Arnold sign indicator analysis of the Minnesota multiphasic personality inventory was used to measure marital stress in 38 intact couples whose children were treated for cancer. The study sample experienced more stress than a comparison group of 23 couples who had hemophilic children. Both of these populations had more stress than a normal standardization group but less than a standardization group of marriage counselees.

Adult↗
PubMed1976

Evaluation of dose and schedule of L-asparaginase in multidrug therapy of childhood leukemia.

Six regimens utilizing L-asparaginase in doses of 6,000 IU/M2, 2,000 IU/M2, and 500 IU/M2 in two separate schedules (consecutive and intermittent) along with vincristine and prednisone yielded remarkably similar response rates, approximating 70%, in 306 previously treated children with acute leukemia in relapse. The addition of daunorubicin to one regimen did not alter the response rate. Hypersensitivity reactions occurred in 5% and hyperglycemia in 7%. Lower doses of L-asparaginase significantly reduced the hypersensitivity rate but no such pattern was noted for hyperglycemia. A history of prior resistance to prednisone and vincristine significantly reduced the response rate.

Acute Disease↗
PubMed1975

School phobia in children with malignant neoplasms.

With the advent of improved therapy, many of the childhood malignant diseases have become chronic. This group of patients and their families demonstrate many problems usually not associated with the primary disease, but which can become incapacitating. School phobia was selected as one such problem for this study. The 11 cases reported here demonstrate the insidious and subtle nature of the onset of the disease. With aggressive management, some long-standing cases of school phobia could be reversed, but not all. In a group subjected to a prophylactic regime at the onset of their malignant neoplasm, there have been no new cases of school phobia. It is important for pediatricians caring for these children to search actively for the signs of school phobia and intervene as soon as possible.

Activities of Daily Living↗