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Biomedical subjects

M L Citron

Publications and source records attributed to M L Citron.

At least 37 records · Page 2Linked to original sources
PubMed1989

Thrombosis: the major Hickman catheter complication in patients with solid tumor.

Major complications of Hickman catheter placement (thrombosis and infection) were determined in 168 patients with solid tumor (lung, 79; head and neck, 56; esophagus, 24; and miscellaneous, 9). Catheter-related thrombosis was clinically detected in 22 individuals and was detected at autopsy in six (total 17 percent). The 17 percent figure underestimates the true incidence of thrombosis since only 25 percent of study patients had autopsies. Patients with adenocarcinoma of the lung constituted a high risk group. Nine of 20 (45 percent) of these patients had thrombosis compared to 25, 9, and 16 percent of patients with squamous cell cancers of lung, head and neck and esophagus, respectively (p less than 0.002). Three patients with thrombosis had pulmonary emboli and two died. Thrombosis occurred despite daily heparin catheter flushing. INfections occurred in 11 patients. One had suspected endocarditis, one had a subcutaneous tunnel infection, and nine had exit site infections. All responded to local or systemic antibiotics. Better methods to prevent thrombosis are needed.

Adenocarcinoma↗
PubMed1988

Lung cancer, tuberculin reactivity, and isoniazid.

We determined the incidence of tuberculosis in lung cancer patients with known tuberculin status. All patients received chemotherapy with or without radiation therapy, corticosteroid therapy, or both, and none received isoniazid prophylaxis. Positive tuberculin reactivity was found in 89 of the 257 patients; among these 89, tuberculosis developed in one patient before and in one patient after chemotherapy. Among the other 168 patients, one case of tuberculosis developed after chemotherapy. For all lung cancer patients, the incidence of tuberculosis was higher than age-specific and race-specific rates in a control population. The risk of tuberculosis was judged to be significantly higher in patients with positive than with negative tuberculin reactivity; among tuberculin reactors, however, the risk of tuberculosis was estimated to be less than the potential risk of isoniazid hepatotoxicity reported in the literature for patients in a similar age group. The median survival for tuberculin-positive lung cancer patients was 9.6 months. Because of the limited survival in these patients, and because of the high risk of isoniazid hepatotoxicity for patients in this age group, we do not recommend isoniazid prophylaxis for tuberculin-positive patients receiving chemotherapy for lung cancer.

Adult↗
PubMed1987

Clearance of continuous intravenous morphine for severe cancer pain.

Four cancer patients with intractable pain received continuous morphine infusions in doses of 15-275 mg/h for a time period ranging from 4 to 27 days. Serum morphine concentrations were determined periodically following adjustments in infusion rates. As doses were changed and continued at static hourly rates, serum morphine concentrations were relatively constant 20 hours and beyond the time of the respective change, thus suggesting morphine elimination half-lives of less than or equal to 4 hours. High doses did not influence the time required to achieve steady-state concentrations. Steady serum morphine concentrations corresponded with hourly morphine doses in a parallel manner. High interpatient variabilities in clearances and steady-state serum morphine concentrations were noted. These data suggest that at morphine infusions up to 275 mg/h elimination pathways permit handling of increasing concentrations of morphine without nonlinear blood level increases. Also, marked interpatient and intrapatient variations in patient dose requirements were noted.

Female↗
PubMed1987

Pharmacokinetic comparison of intranasal, oral, and intramuscular metoclopramide in healthy volunteers.

This was a randomized, crossover study of the bioavailability and pharmacokinetics of metoclopramide given by intranasal (IN), oral (PO), and intramuscular (IM) routes. The formulations tested were 5 and 10 mg of IN gel, 10 mg PO, and 5 mg IM. The findings showed that metoclopramide follows similar absorption and elimination characteristics when given via these three extravascular routes. There were no statistically significant differences in the area under the drug concentration versus time curve (AUC) or peak metoclopramide plasma concentration (Cmax) data following PO, IM, or 10-mg IN administration. However, the 5-mg IN doses achieved an AUC that was 39.5% the AUC of the 10-mg IN dose. These data show consistent and relatively predictable metoclopramide plasma concentrations following IN administration. Further, 10-mg doses of IN and PO metoclopramide appear to be bioequivalent.

Administration, Intranasal↗
PubMed1986

Improvement of human tumor cloning assay by suspension of fibroblasts into the bottom layer of agarose.

Twenty-nine human tumors were cultured on a soft agarose cloning assay under three conditions: (1) standard (control); (2) standard with varying numbers of mitomycin C-treated 3T3 Swiss mouse embryonic fibroblasts suspended into the bottom layer of agarose; and (3) standard with varying concentrations of conditioned medium derived from those same fibroblasts. Suspension of 1 X 10(5) fibroblasts into the bottom layer of agarose was found to significantly increase the number of colonies formed over control specimens, as did cultures with 30% conditioned medium. In addition, compared with control, both of these techniques increased the number of specimens which would allow optimal vitro chemotherapy sensitivity testing. Specifically, growth of at least 30 colonies per plate increased from 7% of specimens treated under control conditions to 36% and 52% of specimens treated with 30% conditioned medium and 1 X 10(5) fibroblast-supplemented agar, respectively. This data indicate that 3T3 Swiss mouse fibroblasts improve cloning efficiency when suspended in the bottom layer of agarose or when used to produce conditioned medium. As a consequence, these techniques may permit a better opportunity to define the role of the cloning assay for cancer chemotherapy.

Colony-Forming Units Assay↗
PubMed1986

Patient-controlled analgesia for severe cancer pain.

Concern with the suboptimal management of pain in hospitalized patients has led to the development of a patient-controlled analgesia system. In this system, a preset amount of narcotic is delivered intravenously when the patient activates the demand button. We tested the safety and efficacy of this mode of treatment in eight patients with cancer suffering from severe pain. Respiratory rates, mental status, and pain relief were recorded at baseline and during the study period. Morphine sulfate doses ranged from 1 to 5 mg, and lockout intervals from 15 to 90 minutes. Patients had a higher analgesic demand, ie, self-administered more doses, during the first four hours than during the remaining time of treatment. Respiratory rates decreased during the first four hours of treatment, but no cases of significant respiratory depression were encountered during this period or thereafter in the study. Significant pain relief was produced in all patients without causing undue sedation. Patient acceptance of this mode of therapy was excellent, and the majority of patients preferred this type of analgesia to other forms of pain treatment. In conclusion, patient-controlled analgesic is effective and safe therapy for cancer pain.

Consumer Behavior↗
PubMed1986

Secretin/vasoactive intestinal peptide-stimulated secretion of bombesin/gastrin releasing peptide from human small cell carcinoma of the lung.

Bombesin/gastrin releasing peptide-like immunoreactivity (BLI) is found in the majority of small cell carcinoma of the lung (SCCL) cell lines examined. Because BLI is present in high concentration in SCCL we studied the mechanism of BLI secretion from several SCCL cell lines and in patients with SCCL. In cell line NCI-H345 the structurally related polypeptide hormones secretin, vasoactive intestinal peptide, and peptide histidine isoleucine as well as theophylline, a phosphodiesterase inhibitor, N6,O2'-dibutyryl cyclic adenosine 3':5'-monophosphate, a cyclic nucleotide analogue, increased BLI release by 16-120% and cyclic adenosine 3':5'-monophosphate by 36-350%. Similar results were obtained in SCCL cell line NCI-H209. i.v. injection of secretin (2 units/kg) significantly increased plasma BLI in 2 patients with extrapulmonary SCCL. These data suggest that SCCL cells possess receptors for secretin/vasoactive intestinal peptide and that receptor occupation stimulates in vitro and in vivo BLI secretion.

Alprostadil↗
PubMed1985

Hickman catheter tip displacement.

In a series of 60 consecutive patients in whom Hickman catheters were placed for treatment of malignancy, four properly positioned catheter tips migrated secondarily from the superior vena cava to the ipsilateral jugular vein 2, 4, 21, and 25 days after placement. Three of the four patients had begun to have catheter dysfunction when the displacement was diagnosed. No satisfactory explanation for this rarely reported complication was evident in three of the cases. Maneuvers such as coughing, Valsalva's maneuver, and forceful heparin flushing produced no motion in three normally directed catheter tips in other patients observed under fluoroscopy. The phenomenon may be more common than previously reported. Evaluation of any new Hickman catheter dysfunction should include a chest x-ray film to ascertain the position of the catheter.

Adult↗
PubMed1985

Antiemetic efficacy of levonantradol compared to delta-9-tetrahydrocannabinol for chemotherapy-induced nausea and vomiting.

The antiemetic efficacy of im levonantradol, a synthetic cannabinoid, given at a dose of 1 mg every 4 hours, was compared to oral delta-9-tetrahydrocannabinol (THC) given at a dose of 15 mg every 4 hours in a double-blind crossover study. Twenty-six patients receiving emetogenic cancer chemotherapy were evaluated. For each drug, 28% of treated patients had no nausea. The median number of emetic episodes with levonantradol was 2.0 versus 3.0 for THC (P = 0.06). Side effects occurred in 91.7% and 97.3% of levonantradol and THC patients, respectively, with drowsiness and dizziness most commonly seen. Side effects were generally well-tolerated, with only 13.9% of levonantradol and 21.6% of THC patients discontinuing treatment because of side effects. Levonantradol appears to be at least as effective an antiemetic as THC and is the only cannabinoid available for parenteral use.

Adult↗
PubMed1985

Drug precipitation within i.v. tubing: a potential hazard of chemotherapy administration.

Because relatively undiluted concentrations of drugs are maintained for prolonged periods in the Y-side arm of rapidly flowing iv infusions, we visually determined compatibilities of ten commonly used cancer chemotherapy drugs and four adjunctive drugs including droperidol, metoclopramide, furosemide, and heparin. Droperidol was found to be incompatible with furosemide, methotrexate, leucovorin, heparin, and 5-FU. Furosemide was incompatible with metoclopramide, doxorubicin, vincristine, and vinblastine in addition to droperidol. Doxorubicin was incompatible with heparin. If these drugs were administered sequentially into the Y-side arm of an iv infusion, precipitation would be expected with drug inactivation and possible drug embolization to the pulmonary circulation. Flushing the Y-side arm with a compatible solution after drug administration will prevent this problem.

Antineoplastic Agents↗
PubMed1984

Safety and efficacy of continuous intravenous morphine for severe cancer pain.

To study the efficacy and safety of continuously administered intravenous morphine for cancer pain unrelieved by standard narcotic therapy, bolus intravenous injections of 2 to 5 mg of morphine were given every 10 minutes until pain relief was achieved. Within the next hour, continuous intravenous morphine infusion was begun with the hourly dose equal to the cumulative bolus dose. Respiratory rate, pulse, blood pressure, arterial blood gas values, mental status, and pain relief were recorded at baseline and during the study period. A reduction in arterial oxygen pressure (PaO2) and/or increase in arterial carbon dioxide pressure PaCO2 of more than 20 percent of baseline values occurred, during the first 24 hours of infusion, in a minority of patients. This did not require changes in hourly morphine dose. Despite subsequent increases in morphine dose, blood gas values tended to remain at or return toward baseline values. Severe toxicity occurred during one trial and was heralded by bradypnea and marked somnolence. Major pain relief was achieved in 11 of 15 trials. Therefore, continuous intravenous morphine is effective and safe therapy. Bradypnea associated with marked somnolence is a cause for dose reduction.

Acute Disease↗
PubMed1984

Combined therapy for stage III-IV head and neck cancer: preliminary results.

As part of a combined modality treatment program using chemotherapy, surgery, and/or radiotherapy, 25 patients with previously untreated stage III or IV head and neck cancer received initial combination chemotherapy. Pathologically confirmed complete remission was noted in nine patients (36%). The overall objective major response rate (with all patients included in analysis) was 68%. The chemotherapy regimen included bleomycin, cisplatin, vinblastine, methotrexate, and 5-fluorouracil. A novel concept of drug scheduling was used, based on chemotherapy-induced improvement in RBC deformability. The underlying concept is that improved RBC deformability results in improved capillary blood flow and thereby, increased drug delivery to tumor cells. Treatment resulted in moderate hematologic and renal toxicity with no treatment-related deaths. This exceptionally high, pathologically confirmed complete response rate will hopefully provide a mechanism by which combined modality therapy can adequately be tested for its ability to prolong survival of patients with advanced head and neck cancer.

Adult↗
PubMed1984

An active chemotherapy regimen for squamous cell lung cancer.

A new concept of chemotherapy scheduling was evaluated in 20 patients with inoperable squamous cell lung cancer. The complete plus partial response rate was 85%, with 15% complete responses. The drugs utilized included vinblastine, bleomycin, methotrexate, 5-FU, cisplatin, and leucovorin. The hypothesis leading to the chosen drug schedule was that impaired rbc deformability (RBCD) found in cancer patients may produce stasis of flow in tumor capillary beds and decrease drug delivery to cancer cells. Drug schedules were designed to take advantage of chemotherapy-induced improvement in RBCD. After an initial drug treatment, a second treatment was given when RBCD increased at least 25% over pretreatment values (usually 4-6 days after the first chemotherapy dose). Drug doses were weighted so that more drug was given when RBCD was greatest. Treatment toxicity was predominantly hematopoietic and renal. This type of chemotherapy approach opens up new avenues of investigation in squamous cell cancer and other common neoplasms.

Adult↗
PubMed1984

Tumor seeding associated with bone marrow aspiration and biopsy.

A 53-year-old man with small-cell lung carcinoma underwent bone marrow aspirations and biopsies for tumor staging and harvest for autologous bone marrow infusion. Fourteen months after bone marrow aspiration and biopsy, a subcutaneous lesion grew over the posterior iliac crest, and a biopsy specimen disclosed small-cell carcinoma. To our knowledge, this is the first case report of tumor seeding associated with bone marrow aspirate and biopsy.

Biopsy, Needle↗
PubMed1983

Superior vena cava syndrome due to non--small-cell lung cancer. Resolution with chemotherapy alone.

Three patients with superior vena cava syndrome due to non--small-cell lung cancer were treated with chemotherapy alone. Symptomatic relief began within three days of treatment and substantial resolution of the syndrome occurred in all three patients. One patient had complete remission of tumor and the other two had more than a 50% tumor reduction within the first month of therapy. These are the first case reports indicating that combination chemotherapy may be effective as initial management of the superior vena cava syndrome due to non--small-cell lung cancer.

Antineoplastic Agents↗