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Biomedical subjects

N H Mulder

Publications and source records attributed to N H Mulder.

At least 289 records · Page 16Linked to original sources
PubMed1985

Influence of captopril on cis-diamminedichloroplatinum-induced renal toxicity.

Renal function studies were performed in 18 patients with nonseminomatous testicular cancer during four platinum-containing chemotherapy courses. The first 9 patients received chemotherapy alone, the second 9 also captopril, an angiotensin I converting enzyme inhibitor, in order to prevent cis-diamminedichloroplatinum-induced nephrotoxicity. In the first group a decrease in glomerular filtration rate, that was preceded by a fall in effective renal plasma flow, was observed. In the second group, captopril was able to prevent the initial decrease in effective renal plasma flow, but failed to prevent the ultimate decrease in glomerular filtration rate.

Adult↗
PubMed1985

The influence of verapamil on renal function in patients treated with cisplatin.

Nine patients with testicular cancer were treated with four platinum containing chemotherapy courses. In order to prevent cisplatin (CDDP)-induced nephrotoxicity, verapamil, a calcium entry blocker, was added to the chemotherapeutic regimen. Renal function studies, consisting of the measurement of the effective renal plasma flow (ERPF) and the glomerular filtration rate (GFR), were performed before, during and after the first dose of CDDP, at the end of the first course and at the end of the fourth course of chemotherapy. The results were compared with the results obtained previously in CDDP-treated patients not receiving verapamil. The initial decrease in ERPF during and after the first CDDP infusion was completely prevented by verapamil. Despite continuation of verapamil throughout all four courses, it failed to reduce the ultimate fall in GFR.

Adult↗
PubMed1985

Bone marrow separation, purification and cryopreservation: application for autologous bone marrow transplant (ABMT).

Autologous bone marrow transplantation is used in the treatment of patients suffering from malignant diseases. The intention of this study was to develop a technique for cryopreservation of bone marrow stem cells. A technique of purification described elsewhere (2), gave recoveries of 80% of nucleated blood cells and 87% of mononucleated blood cells after apheresis and centrifugation of buffy-coat, but when applied to bone marrow only 59% of NBC and 32% of CFUc have been harvested. We therefore modified the apheresis technique and replaced the centrifugation step by sedimentation with hydroxy-ethyl-starch. This change resulted in a small but significant increase in the yield of bone marrow cells and improved the asepsis of the procedure. From a second group of bone marrow handled with this modified protocol, final yields of 46% of NBC and 62% of MNC were obtained. After cryopreservation 87% of NBC were recovered as assessed by counting.

Adolescent↗
PubMed1984

Small cell lung cancer and the influence of chemotherapy on CFUcs in bone marrow.

To determine the optimal moment for the harvesting of bone marrow for autologous transplantation, the authors did serially colony forming units in culture (CFUc) counts in a group of 42 patients with small cell lung cancer (SCLC) before and after remission induction chemotherapy and subsequent maintenance chemotherapy. Disease stage did not influence the CFUc count except in patients with bone marrow metastases; this resulted in either abnormally low or abnormally high CFUc counts, probably dependent on the degree of invasion. After 2 courses of induction chemotherapy, the number of CFUcs was 3.1-fold higher than before therapy. After 4 courses, the CFUcs number was comparable to the pretreatment value. An inverse correlation was found between the degree of hematologic toxicity (expressed as leucocytes count) and the increase of CFUcs after induction chemotherapy. The number of CFUcs decreased during prolonged chemotherapy to low levels after 1 year. Harvesting of bone marrow is probably done best shortly after induction chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Acute effects of cis-diamminedichloroplatinum (CDDP) on renal function.

Ten previously untreated patients with metastatic non-seminomatous testicular carcinoma received cis-diamminedichloroplatinum (CDDP). Renal function studies were performed before and following the first CDDP infusion. A decrease in effective renal plasma flow (ERPF) and an increase in filtration fraction (FF) was found in all patients. These findings suggest primary changes in renal hemodynamics during CDDP infusion.

Adult↗
PubMed1984

No narcosis for bone marrow harvest in autologous bone marrow transplantation.

A prospective study with mild general analgesia and sedation together with local anesthesia during bone marrow harvest was performed. Thirty-one patients underwent 33 bone marrow collections. Pretreatment consisted of 100 mg meperidine i.m. and 20 mg diazepam i.m. 1 h before start of procedure. Eight patients got additional meperidine and diazepam during the procedure, all patients got lidocaine 1% locally. A mean volume of 1.321 was obtained with 42.5 punctures. Twenty-two patients had no complications, 4 vomited, 4 had easily correctable hypotension of short duration, one got oxygen for cyanosis of short duration. Acceptance was good in 23 patients, in 6 reasonably well, in two bad. Only one patient experienced pain problems, due to suction. Anxiety was no major problem due to good information before the procedure and mild sedation. This form of anesthesia for bone marrow collection is a safe procedure, it is generally well accepted by the patient and it can be performed on an out-patient basis.

Adult↗
PubMed1984

Effective high-dose chemotherapy with autologous bone marrow infusion in resistant ovarian cancer.

Two patients with persistent minimal ovarian cancer after conventional polychemotherapy were treated with high doses of cyclophosphamide and VP 16-213 followed by autologous bone marrow infusion. Ten months afterward no clinical signs of tumor were apparent. In one patient the complete response was surgically documented. Toxicity included cardiac and pulmonary arrest during marrow infusion in one patient, but was otherwise manageable. This method of late intensification of chemotherapy in patients with persisting ovarian cancer merits further investigation.

Adult↗
PubMed1984

Phase I evaluation of SOAz (1,3,3,5,5 pentakis(aziridino)-1 lambda 6, 2,4,6,3 lambda 5, 5 lambda 5 thiatriaza-diphosphorine-1-oxide) in a weekly schedule.

Eleven patients with advanced cancer were treated with SOAz, the first aziridino substituted inorganic heterocyclic compound to undergo phase I clinical trials. The agent was administered as a rapid i.v. infusion once a week in a dose of 50, 75 or 100 mg/m2. Severe myelotoxicity, which was prolonged and delayed in onset, precluded continuing treatment for more than three courses in 9 of 11 patients. In two patients thrombocytopenia showed no signs of recovery 9 and 11 weeks after the last infusion. Two minor responses were noted and there was one therapy-related death. Because of severe myelotoxicity, which is cumulative and may be irreversible, this treatment schedule seems unsuitable for phase II studies.

Adult↗
PubMed1984

Cyclophosphamide and VP 16-213 with autologous bone marrow transplantation. A dose escalation study.

In 13 patients with therapy-resistant solid tumors the feasibility of high-dose cyclophosphamide (7 g/m2) in combination with increasing doses of VP 16-213 with autologous bone marrow transplantation was studied. Dose-limiting extramedullary toxicity appeared to be mucositis and occurred after 2.5 g/m2. Two toxic deaths were observed in patients older than 55 yr. Responses were seen in eight out of nine evaluable patients. Two patients with ovarian cancer still have no signs of disease progression after 12+ months. High-dose cyclophosphamide (7 g/m2) can be combined with VP 16-213 1.5 g/m2 without important extramedullary toxicity. Age is probably a limiting factor for this kind of therapy.

Adult↗
PubMed1984

Patient motivation and informed consent in a phase I study of an anticancer agent.

In order to evaluate the quality of an informed consent procedure (I.C.P.) 48 patients with advanced cancer were offered participation in a phase I clinical trial and entered an I.C.P. consisting of three separate conversations. In the first session, the possible risks and benefits of a phase I study were informally explained by the patient's personal physician. The second session was attended by the patient, a relative, a registered nurse and a physician; the third session was held at least 5 days after the second. Forty-one patients gave their consent motivated by hope for improvement of their conditions, pressure exerted by relatives and friends, the desire to contribute to the progress of medicine or simply because they felt they had 'no choice'. Encouragement by relatives or friends seems to be a powerful incentive to participate. A period of a few days to consult relatives, friends or trusted physicians as a part of the procedure seems helpful in arriving at a well-considered decision.

Adult↗
PubMed1984

Influence of platinum-induced renal toxicity on bleomycin-induced pulmonary toxicity in patients with disseminated testicular carcinoma.

Pulmonary function tests, including T1CO, and renal function tests were performed and GFR and ERPF measured in 18 patients with disseminated testicular non-seminoma before and after remission induction according to the Einhorn regimen. We found a significant positive correlation between delta GFR and delta T1CO (p less than 0.05). No significance could be demonstrated between delta ERPF and delta T1CO. It is concluded that caution should be exercised in administrating bleomycin to patients with severely impaired renal function.

Adult↗
PubMed1984

Predictive factors for bleomycin-induced pneumonitis.

Five pulmonary function tests (transfer factor for carbon monoxide, diffusing capacity of the alveolar-capillary membrane, pulmonary capillary blood volume, alveolar volume, vital capacity) were performed, and creatinine clearance was measured in 39 patients with disseminated testicular nonseminomatous tumor treated with a combination chemotherapy containing bleomycin. Eight of these patients (20.5%) developed bleomycin-induced pneumonitis (BIP). To investigate which parameter has value in predicting BIP, a discriminant analysis was performed. The combination of a low normal creatinine clearance, a decrease in vital capacity and alveolar volume without a decrease in pulmonary capillary blood volume, pointed to an increased risk. We concluded that it is worthwhile to monitor these parameters and, if necessary, to adapt the chemotherapy of a patient at risk.

Adolescent↗
PubMed1984

Penetration of VP 16-213 into cerebrospinal fluid after high-dose intravenous administration.

VP 16-213 in standard doses is active against a number of solid tumors. Its penetration into the cerebrospinal fluid (CSF) is very limited at these dose levels. In 10 patients treated with high-dose VP 16-213 (0.9-2.5 g/m2), CSF levels of up to 0.54 microgram/mL were detected. In two patients with central nervous system (CNS) metastases of small cell lung cancer (SCLC) a response was seen after 1.0 and 1.5 g/m2 intravenously. High-dose VP 16-213 can possibly play a role in the treatment of CNS metastases of SCLC. Its application in late intensification regimens as a form of prophylaxis of CNS metastases should be investigated.

Adult↗
PubMed1984

Treatment of malignant germ cell tumors of the ovary with cisplatin, vinblastine, and bleomycin (PVB).

Seven patients with germ cell tumors of the ovary were treated with four cycles of cisplatin, vinblastine, and bleomycin. Six patients were without evidence of disease 17+ to 37+ months after completion of the remission-induction chemotherapy, and one patient relapsed after 9 months. Substantial toxicity of the cisplatin, vinblastine, and bleomycin regimen was noted. Despite the high response rate suggested in this small series, the optimal chemotherapeutic treatment for this disease has yet to be determined.

Adolescent↗