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Biomedical subjects

M B Garnick

Publications and source records attributed to M B Garnick.

At least 91 records · Page 5Linked to original sources
PubMed1984

Indwelling double-J ureteral stents for temporary and permanent urinary drainage: experience with 87 patients.

Indwelling ureteral stents are a useful addition to the urologic armamentarium. The current double-J ureteral stent offers the advantages of ease of endoscopic insertion, exceptional patient tolerance and improved resistance to incrustation. We used these stents in 87 patients: to bypass obstruction in 57, as an adjunct to complicated upper tract surgery in 15, as initial treatment of upper urinary fistulas in 10 and for miscellaneous reasons in 5. The majority of the stents were placed endoscopically (58 per cent) and under local anesthesia (54 per cent). Half of the urinary fistulas healed without an operation and none of the patients treated with stents for malignant obstruction was hospitalized for more than 4 days. The stents were changed easily on an outpatient basis under local anesthesia and patient tolerance was excellent. When used as adjuncts to open procedures the stents frequently allowed for shorter hospital stay, since postoperative urinary drainage was decreased markedly. Of the 136 stents used in our series 13 became obstructed, usually after they were indwelling for more than 8 weeks. Irritative symptoms were noted in only 6 patients and responded well to pharmacologic therapy. We have found the double-J ureteral stent useful and reliable in patients with ureteral obstruction, as adjuncts to genitourinary surgery in selected instances and as internal diversion for upper urinary tract fistulas.

Catheters, Indwelling↗
PubMed1984

Changing concepts in the treatment of nonseminomatous germ cell tumors of the testis.

The development of effective chemotherapy for advanced nonseminomatous germ cell tumors of the testis has changed dramatically the outlook for this once uniformly fatal disease. We reviewed our experience with changing modalities of therapy during a 7-year period in the treatment of 152 patients with all stages of testis tumor. Survival rates have increased from 84 per cent for patients with stage A, B1 or B2 tumors treated with sandwich irradiation therapy and retroperitoneal lymph node dissection to 100 per cent for patients with node dissection with or without chemotherapy. Survival rates continuously free of disease for patients with advanced (stage B3 or C) disease have increased from 53 per cent in 1975 to 1977 to 82 per cent by the addition of platinum-based polychemotherapy and judicious lymphadenectomy. A unified plan of management for patients with low stage and advanced stage nonseminomatous testicular tumors has evolved.

Antineoplastic Agents↗
PubMed1984

Pulmonary uptake of technetium 99m macroaggregated albumin: a predictor of gastrointestinal toxicity during hepatic artery perfusion.

Hepatic artery infusion of 5-fluoro-2-deoxyuridine (5-FUdR) provides high hepatic drug levels but little systemic toxicity, since, by this route of administration, the drug is detoxified by the hepatocytes. Slow infusion of technetium 99m- (99mTc) labeled macroaggregated albumin (MAA) through the hepatic artery is an aid in catheter placement, in predicting response of liver metastases to therapy, and in identifying extra-hepatic flow in the gastroduodenal or splenic arteries as an indicator of systemic toxicity. Marked pulmonary uptake of this tracer after slow radionuclide hepatic angiography was noted in four patients who showed major gastrointestinal (GI) toxicity. A retrospective examination of pulmonary accumulation of 99mTcMAA as a predictor of GI toxicity is the subject of this paper. Two groups of patients were evaluated. The first group consisted of 14 consecutive patients in whom continuous infusion of drug was administered by an external pump by way of a percutaneous catheter. Patients received baseline and follow-up (seven to 27 days) slow-infusion tracer studies (2 to 4 mCi 99mTcMAA at 10 to 21 mL/h). The second group included 14 consecutive patients who were receiving intraarterial chemotherapy by a totally implantable pump system. All received baseline slow-infusion studies (2 to 4 mCi 99mTcMAA at approximately 0.5 to 1.0 mL/min). The percentage of the injected dose in the lung was determined. Patients with greater than 20% of tracer in the lung after radionuclide hepatic angiography had significantly greater severe GI toxicity than patients with baseline values of less than 20%. Our findings support the existence of hepatic arteriovenous (A-V) communications in some patients and suggest that they are present pretherapy. Presence of these A-V communications, which can result in a vascular bypass of normal hepatic parenchyma and the subsequent decrease in hepatic detoxification of chemotherapeutic agents, is the likely cause of GI toxicity. Pulmonary uptake of tracer injected in the hepatic artery may be useful in quantifying the degree of shunting and facilitate the monitoring of potential systemic toxicity.

Antineoplastic Agents↗
PubMed1983

Treatment and surgical staging of testicular and primary extragonadal germ cell cancer.

Fifty-four patients with disseminated germ cell cancer (primary testicular, 39; primary extragonadal, 15) were treated with vinblastine sulfate, bleomycin sulfate, and cisplatin, followed by tumor-reductive surgery. Cyclophosphamide and doxorubicin hydrochloride were given after surgery. Thirty-five patients with primary testicular disease achieved a complete remission; two of these relapsed from complete remission, and one died in complete remission. Median follow-up was 37 months. Ten (67%) of the 15 patients with extragonadal cancer achieved a complete remission; five of these relapsed from complete remission, and only four remained in complete remission for a median of 40 months. Thirty-eight patients underwent surgery after chemotherapy. Eleven had residual cancer, 14 had teratoma, and 13 had fibrosis. The use of remission-induction chemotherapy followed by surgical removal of residual abnormalities can cure most patients with disseminated testicular cancer. These same therapeutic strategies are inadequate in the treatment of patients with primary extragonadal disease.

Adolescent↗
PubMed1983

Risk factors for thyroid abnormalities after neck irradiation for childhood cancer.

Thyroid evaluations were performed in 95 patients who received radiotherapy to the neck region for childhood cancer five to 34 years earlier. Fifty-six patients (61 percent) had at least one abnormality of serum free thyroxine index, serum thyroid-stimulating hormone (thyrotropin), or thyroid palpation. Seven had subnormal free thyroxine index and 40 had elevated thyrotropin concentrations. Thyroidal radiation doses of 3,000 or more rads and lymphangiography independently increased the risk (p less than or equal to 0.01) of an elevated serum thyrotropin concentration (present in 11 percent of patients with neither risk factor, 50 percent of those who underwent lymphangiography and received less than 3,000 rads, 46 percent of those who had 3,000 or more rads and no lymphangiography, and 76 percent of those with both), but duration of follow-up did not. Twenty-six patients had thyroid nodules and six others had diffuse thyroid enlargement. The frequency of palpable abnormalities increased with the follow-up time after radiation (30 percent of patients followed up less than 10 years had abnormalities versus 43 percent of those followed up 10 or more years, p = 0.03), but was not related to the serum thyrotropin level, radiation dose, or lymphangiography. Among 10 patients who had surgery for nodules, three had localized papillary thyroid carcinomas.

Adolescent↗
PubMed1983

Acute leukemia after radiotherapy in a patient with Turcot's syndrome. Impaired colony formation in skin fibroblast cultures after irradiation.

Colonic polyposis and carcinoma developed in a woman with Turcot's syndrome at the age of 31 years; astrocytoma developed when she was 37. Her brother and sister had died of astrocytoma at the ages of 18 and 33 years, respectively. Progressive neutropenia developed in the patient three months after radiotherapy for her brain tumor and acute myelomonocytic leukemia 19 months after treatment. Three laboratories independently evaluated cultures of her skin fibroblasts for in vitro sensitivity to cell killing (loss of colony-forming ability) by x-rays. Survival assays consistently revealed slight but significant radiosensitivity in an early-passage (six to 10 doublings) fibroblast subculture. A later subculture (21 to 29 doublings) showed no abnormality, a possible effect of selective in vitro loss of radiosensitive cells.

Adenocarcinoma↗
PubMed1983

Computerized tomography scan for diagnosis and staging of renal cell carcinoma.

A comparison of computerized tomography and arteriography for the diagnosis and staging of renal cell carcinoma was done in 45 patients during a 2-year interval. Compared to arteriography, computerized tomography was more accurate in the diagnosis of renal cell carcinoma (95 versus 85 per cent), equivalent in the determination of renal vein involvement and superior in the determination of regional nodal involvement. Because of the increased diagnostic accuracy, better delineation of the local extent of the tumor and less invasive nature we recommend computerized tomography as the preferred procedure for diagnosis and staging of renal cell carcinoma. However, in patients with questionable findings arteriography and/or inferior venacavography should be used as complementary studies.

Adenocarcinoma↗
PubMed1983

Iliopelvic radionuclide lymphoscintigraphy in patients with testicular cancer.

The utility of iliopelvic lymphoscintigraphy was assessed in 21 patients with testicular cancer (six seminoma patients, 15 nonseminoma patients). Normal lymphoscintiscans demonstrated symmetric uptake of technetium-99m-labeled radiocolloid throughout the lymphatic chain, from the internal iliac nodes to the level of the renal hilum. Signs of abnormality included decreased or no uptake of radionuclide in consecutive nodes of a lymphatic chain or in an entire lymphatic chain, and diminished uptake at the level of the renal hilum. In the 15 patients with nonseminomatous germ cell cancer, correlation of the results of scanning with pathologic specimens obtained upon dissection of retroperitoneal lymph nodes revealed a sensitivity of 0.89 and a specificity of 0.83. In the six patients with seminoma, there was good correlation between scan findings and results of other radiologic tests. This study suggests that iliopelvic lymphoscintigraphy is a sensitive means of determining whether lymph node metastases are present in patients with testicular cancer.

Abdomen↗
PubMed1983

Chemotherapy of refractory germ cell cancer with Etoposide.

Eighteen patients with advanced germ-cell cancer (12 primary gonadal, six extragonadal) that was refractory to vinblastine (V), cisplatin (P), and bleomycin (B) were treated with Etoposide (VP-16-213) and cisplatin +/- bleomycin sulfate +/- doxorubicin hydrochloride. All patients experienced nausea, vomiting, alopecia, and myelosuppression. There were no treatment-related deaths. Five (42%) of 12 patients with primary gonadal germ-cell cancer achieved a complete remission and are presently alive with no evidence of disease. None of the six patients with extragonadal germ-cell cancer achieved a complete response. Thirteen patients died 6.2 months (median) after starting Etoposide treatment. Etoposide-containing chemotherapy is useful in patients with primary gonadal germ-cell cancer. Alternative therapies are needed for patients with extragonadal germ cell cancer.

Adolescent↗
PubMed1983

Long-term hepatic arterial infusion of 5-fluorodeoxyuridine for liver metastases using an implantable infusion pump.

Twenty-one patients with liver metastases of various histologies (predominantly colorectal carcinoma) underwent Infusaid pump implantation for long-term hepatic arterial 5-fluorodeoxyuridine (5-FUdR) infusion. Patients received 5-FUdR infusion on a 2-wk cycle alternating with a 2-wk saline--heparin infusion. A dosage of 0.2-0.3 mg/kg/day (average 0.23 mg/kg/day) was infused for a cumulative 5-FUdR administration of 1940 days. Six patients (29%) responded to therapy (five colorectal, one carcinoid); median response duration was 6 mo. Median survival for the treated group was 17 mo from diagnosis of liver metastases and 13 mo from pump implantation. Median survival among the six responding patients was 15 mo from diagnosis of liver metastases and 11 mo from pump implantation. Comparison of survival from the diagnosis of liver metastases of the treated group to ten patients found ineligible for the study by virtue of extrahepatic metastases revealed no significant difference in median (18 mo for ineligible group) or overall survival. However, median survival for the treated group after pump implantation (13 mo) was significantly better than the median survival of the ineligible group after evaluation for this study (4 mo). Toxicities of therapy included fatigue, anorexia, nausea, vomiting, toxic hepatitis, epigastric pain, and diarrhea. No patients died of toxicity, but six patients required hospitalization for management of pain or vomiting. No serious technical complications developed in any patient except separation of the infusion catheter at its junction with the pump in one patient, necessitating pump replacement for continuation of therapy. These survival data suggest identification of new anticancer agents for hepatic arterial infusion.

Adult↗
PubMed1983

Idiopathic thrombocytopenia in association with extragonadal germ cell cancer.

Thrombocytopenia was associated with primary extragonadal germ cell cancer in three patients. All had embryonal cell cancer with anterior superior mediastinal masses. Severe thrombocytopenia was noted initially and persisted throughout the course of the disease. Bone marrow showed increased megakaryocytes. There was no evidence of immune destruction of platelets or sequestration by the mediastinal tumor masses. Therapy with prednisone and splenectomy did not increase platelet counts and chemotherapy was extremely difficult. Idiopathic thrombocytopenia may be an adverse prognostic feature for patients with extragonadal germ cell cancer.

Adolescent↗
PubMed1983

Phase I trial of mitoxantrone by 24-hour continuous infusion.

Mitoxantrone (DAD) is a new agent which intercalates into DNA. Preclinical studies have demonstrated activity equal to or greater than that of doxorubicin in all tumor systems tested. In this phase I clinical trial, the schedule of drug administration consisted of a 24-hour continuous iv infusion repeated at 21-day intervals. Twenty-nine patients received a total of 66 courses over a dose range of 4-15 mg/m2. The dose-limiting toxic effect was leukopenia, with a wbc count nadir on Day 12 and resolution prior to Day 21. Other toxic effects were thrombocytopenia, mild phlebitis, and blue discoloration of veins. Objective tumor responses were seen in a patient with adenocarcinoma of the breast and in another patient with clear cell carcinoma of the vagina. An additional six patients with acute leukemia were treated at a dose of 12 mg/m2; a decrease in peripheral blast count was observed in four of these six patients. The toxicity of DAD by 24-hour iv infusion was similar to that previously reported for iv bolus administration. We recommend phase II evaluation of DAD at a dose of 12 mg/m2 by single iv injection at 21-day intervals. Patients with acute leukemia should be evaluated at higher dose levels.

Adolescent↗
PubMed1983

Doxorubicin in pregnancy: possible transplacental passage.

Two pregnant women with lymphoproliferative disorders were treated with doxorubicin-containing regimens. Both patients delivered shortly after a dose of doxorubicin. One child was healthy and the other was stillborn. Measurements of anthracycline levels in placental, cord, and fetal tissues by high-performance liquid chromatography suggest that doxorubicin may be transported across the placenta.

Adult↗
PubMed1982

The spectrum of genitourinary abnormalities in patients with cryptorchidism, with emphasis on testicular carcinoma.

A spectrum of genitourinary abnormalities occur in patients with cryptorchidism; the most important is the enhanced susceptibility to developing testis cancer. While the etiologic basis for developing testis cancer in cryptorchid patients remains controversial, failure of normal testicular development--testicular dysgenesis--may underlie carcinogenesis in the cryptorchid testis. This report reviews these associations as well as the characteristics of testis cancer in the cryptorchid testis and the evidence supporting early orchiopexy.

Adolescent↗
PubMed1982

Primary cerebral venous thrombosis in patients with cancer--a rarely diagnosed paraneoplastic syndrome. Report of three cases and review of the literature.

Idiopathic thrombosis of the cerebral venous structures is a rare complication of malignancy. The clinical, radiologic, pathologic, and laboratory findings in the 15 previously reported cases are reviewed, and three additional cases are reported. The clinical syndrome that develops in such patients is similar to that seen in other patients with cerebral venous or sinus thrombosis. However, the diagnosis is often not made clinically because cerebral involvement by neoplastic disease provides a more common and readily acceptable explantation of the observed phenomena. If venous thrombosis involving the brain is suspected, angiography provides the only certain method of diagnosis. The relationship of this thrombotic process to a cancer-associated hypercoagulable state is discussed.

Adenocarcinoma↗