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Biomedical subjects

M K Tjwa

Publications and source records attributed to M K Tjwa.

8 recordsLinked to original sources
PubMed1998

Massive haemoptysis after radiotherapy in inoperable non-small cell lung carcinoma: is endobronchial brachytherapy really a risk factor?

BACKGROUND AND PURPOSE: This retrospective study was conducted to investigate whether endobronchial brachytherapy (EBB) is a risk factor for massive haemoptysis in patients primarily treated by a combination of EBB and external irradiation (XRT) for NSCLC. MATERIALS AND METHODS: The records of 938 patients with inoperable NSCLC who were treated with XRT and/or EBB were reviewed. The patients were divided into five groups as follows: group XRT, treated by XRT alone (n = 421); group XRTelig, treated by XRT but eligible for EBB (n = 419); group XRTEBB, primarily treated with EBB+XRT (n = 62); group EBBrec, treated by EBB for recurrence after XRT (n = 23); and group EBB, treated by EBB alone (n = 13). EBB was delivered using HDR. Patients with bronchoscopy-proven endobronchial tumour in the proximal airways, i.e. the trachea, the main bronchus or lobar bronchus were considered eligible for EBB. RESULTS: One hundred one out of 938 patients (10.8%) died from massive haemoptysis. The incidence was 4.3% in group XRT, 13.1% in group XRTelig and 25.4% in group XRTEBB. The differences between groups XRT and XRTelig as well as between groups XRTelig and XRTEBB were statistically significant (P<0.01). The incidence of massive haemoptysis depended significantly on the fraction size of brachytherapy. When two fractions of 7.5 Gy or a single fraction of 10 Gy were used, 11.1% of the patients died from massive haemoptysis. However, when a single dose of 15 Gy was used, 47.8% died from massive haemoptysis. In the multivariate analysis, a single dose of 15 Gy EBB was the most important prognostic factor for massive haemoptysis. CONCLUSION: XRT+EBB as primary treatment for NSCLC does not lead to a higher risk of massive haemoptysis as compared to XRT alone when fraction sizes for EBB of 7.5 or 10 Gy are used. However, the risk of massive haemoptysis increases dramatically when a fraction size of 15 Gy is used.

Adolescent↗
PubMed1995

Budesonide inhaled via Turbuhaler: a more effective treatment for asthma than beclomethasone dipropionate via Rotahaler.

BACKGROUND: Chlorofluorocarbon-propelled metered dose inhalers are facing a worldwide ban. Dry powder inhalers have been developed for the agents used in treatment of asthma. OBJECTIVE: Our objective was to compare the effects of two inhaled glucocorticosteroids in dry power inhalers: budesonide (delivered via Turbuhaler) and beclomethasone dipropionate (delivered via Rotahaler). METHODS: A randomized, crossover study with two steroid-treatment periods of 8 weeks. At the end of the study, the treatment with the inhaled steroid was stopped for 4 weeks. Sixteen adult patients with moderately severe asthma participated. Before the study all patients were treated with an inhaled steroid in a median dose of 0.60 mg/day (range 0.15-0.80); during the study they received 0.20 mg twice daily. Peak expiratory flow rate was measured twice daily at home throughout the study, lung function was assessed every fourth week and airway responsiveness was measured before and after each period. Preference concerning efficacy and inhaler type was assessed at the end of the study. RESULTS: Twelve patients completed the study. Lung function, airway responsiveness, and symptoms deteriorated significantly in the steroid-free washout period; this period had to be shortened in 5/12 patients. Mean morning peak expiratory flow was significantly higher during budesonide treatment than during beclomethasone dipropionate treatment, the difference being 17 L/min (95% C.I.: 2-32 L/min, P = .026). Airway responsiveness improved 1.1 doubling concentrations after budesonide treatment, but decreased 0.3 doubling concentrations after beclomethasone dipropionate treatment. The difference between the values after budesonide and beclomethasone dipropionate treatment was 1.4 doubling concentrations (95% C.I.: 0.4-2.4 doubling concentrations, P = .033). Forced expiratory flow in one second improved slightly more during budesonide than during beclomethasone treatment. The difference was 4.3% predicted (95% C.I.: -0.7-9.3%). Most patients reported budesonide Turbuhaler to be more effective (10 versus 0) and easier to use (11 versus 1) than beclomethasone dipropionate Rotahaler. CONCLUSIONS: As a consequence of the difference in local potency of the steroids and the fact that Turbuhaler deposits more drug particles in the lung than Rotahaler, budesonide inhaled via Turbuhaler appeared to be a more effective steroid formulation than beclomethasone dipropionate inhaled via Rotahaler.

Asthma↗
PubMed1994

Ectopic Cushing's syndrome in a patient with squamous cell carcinoma of the lung due to CRF-like production.

We present a patient with a poorly differentiated squamous cell carcinoma of the left lower lobe, who developed Cushing's syndrome. Adrenocorticotrophic hormone (ACTH) and cortisol levels in the blood were extremely elevated, but immunostaining for ACTH and corticotrophin releasing factor (CRF) of the primary tumour and metastases was negative. The ectopic Cushing's syndrome was probably caused by CRF-like production.

ACTH Syndrome, Ectopic↗
PubMed1991

Coagulation/fibrinolysis balance and lung cancer.

Forty-eight patients with freshly diagnosed carcinoma of the lung (40 males, 8 females) were evaluated for a coagulation profile including activated partial thromboplastin time (aPTT), prothrombin time (PT), fibrinogen, F VIII R:Ag, fibrin monomers (FM), thrombin-antithrombin-III complex (TAT-III), D-dimers and the platelet count. Thirty-eight patients had a normal aPTT and 37 patients a normal PT. None of the patients had clinical or laboratory indications of serious hemorrhage or thrombosis. On the other hand, high percentages of increased values were found for fibrinogen and F VIII R:Ag, which can be seen as prethrombotic factors. The very high percentages of elevated results for the FM, TAT-III and D-dimer are strongly indicative for low-grade coagulation activation with reactive fibrinolysis. Nevertheless, most lung cancer patients are able to maintain a normal or near normal hemostatic function. The results shown here are indicative of a coagulation and fibrinolysis equilibrium at an enhanced level and demonstrate why an unbalance between the two systems can result in thrombotic complications in (lung) cancer patients as earlier reported.

Adult↗
PubMed1986

Ketotifen and methacholine-induced bronchospasm.

In a double-blind investigation the aspecific bronchus threshold was estimated by administration of methacholine to 16 young atopic patients with proven airways hyperreactivity (PC20 histamine less than or equal to 2 mg/ml. The influence of prolonged oral administration (12 weeks) of ketotifen (2 mg/day) on the bronchus threshold value has been studied. No significant elevation was found. It could be concluded that administration of ketotifen, even in prolonged administration, has no anticholinergic effects.

Adolescent↗
PubMed1985

Measurement of the non-specific threshold stimulus for the bronchial tree by continuous monitoring of respiratory resistance using the oscillation method.

Bronchial hyperreactivity to various stimuli has been used as one of the diagnostic criteria of chronic obstructive lung diseases. We studied bronchial responsiveness to histamine in 30 patients with acute or chronic bronchitis, 28 patients with bronchial asthma and in 42 more patients with other lung diseases, using a new device--the Astograph--which yielded graphically a continuous dose-response curve of the respiratory resistance by the oscillation method during the inhalation of histamine diphosphate. The results of this method were compared with the results of FEV1 and FEF25-75 before and after the challenge procedure. An increase of the respiratory resistance (Ros) during the challenge test gave an indication of a decrease of FEV1. The increase of Ros and the decrease of FEV1 and FEF25-75 were most pronounced in the asthmatics. Not in all cases was there a correlation between the increase of Ros and the decrease of FEV1, possibly due to imperfections in the design of the equipment. We believe that the Ros measurement cannot be totally exchanged for the conventional method. The use of the Astograph alone cannot be recommended because of the false-negative reactions. A combination Astograph/Floop equipment is rather expensive, but it is the most rational and ideal. The test itself does not induce bronchoconstriction and is simple and time-saving. However, this procedure is not yet advised as a diagnostic tool for a challenge test with allergens in the diagnosis of bronchial asthma. A further investigation on the validity and security of such a provocation is still needed.

Adult↗