PubMed Health⌕ Search

Biomedical subjects

O Merimsky

Publications and source records attributed to O Merimsky.

At least 91 records · Page 5Linked to original sources
PubMed1992

Cortical blindness--a catastrophic side effect of vincristine.

The term 'cortical blindness' indicates loss of sight due to bilateral lesions of the occipital lobes. It is a rare, but severe, side effect of chemotherapeutic agents. Cortical blindness was diagnosed in a 67 year old woman with leiomyosarcoma of the large bowel, treated by vincristine-containing chemotherapy. Cortical blindness without focal neurological signs and with two repeated normal brain computed tomography scans, in which there was no structural damage to the occipital lobes, suggests a metabolic or toxic reaction as a cause in our patients. The temporal relationship between vincristine treatment and cortical blindness implicates vincristine as the possible causative agent for this catastrophic phenomenon.

Acute Disease↗
PubMed1992

Cisplatin-related Lhermitte's sign.

The sensation of a sudden electrical impulse travelling along the spine to the legs and feet on flexion of the neck has been known as Lhermitte's sign. Lhermitte's sign, as part of cisplatin-related neurotoxicity, was observed in four patients, with ovarian or lung cancer, simultaneously with peripheral neuropathy, after a dose of 375-700 mg/m2. The dose intensity (DI) of cisplatin in our patients ranged from 12.5 to 26.9 mg/m2/week. No direct relationship was found between DI and the timing of Lhermitte's sign. Other relevant causes for this sign were ruled out. The mechanism responsible for the development of Lhermitte's sign is unclear. Interruption of treatment with cisplatin may not prevent the appearance of Lhermitte's sign. In most of the reported cases in the literature this sign developed after the end of cisplatin courses.

Adult↗
PubMed1992

Salvage cisplatin and adriamycin for advanced or recurrent basal or squamous cell carcinoma of the face.

Is it justified to treat a small, localized and relatively indolent malignancy by systemic combined chemotherapy? Five patients with locally advanced skin tumors were treated by salvage cisplatin and adriamycin for three to five courses. Three achieved complete response, one achieved partial response and one succumbed to an unrelated cause. The rapid induction of response, high response rate, unmaintained complete remissions of long duration and relatively low rate of toxicity may justify the use of this combination for the treatment of small skin tumors when other treatment options are of no avail.

Aged↗
PubMed1992

Neurotoxicity of interferon-alpha.

Interferon (IFN) related neurotoxicity includes somnolence and confusion, fatigue, lethargy, psychiatric symptoms, conceptual disorganization, neurological deficits, cortical blindness, coma and, rarely, death. The neurologic syndromes seem to be more common in elderly patients, following intramuscular or intravenous administration, at higher doses of frequent injections of IFN-alpha and in primary renal cell carcinoma. The duration of the treatment was not strongly related to neurotoxicity. Computed tomography findings were non-specific and included atrophy or periventricular lucencies. Electroencephalograph studies demonstrated a generalized increase in slow wave activity which returned to normal after cessation of treatment. Behavioral and mental changes in patients treated with IFN are warning signs, and indicate the need to withdraw treatment.

Animals↗
PubMed1992

Fotemustine--an advance in the treatment of metastatic malignant melanoma.

Although chemotherapy has been generally of limited clinical benefit in the treatment of metastatic malignant melanoma (MMM), fotemustine (FM) is a newly developed drug which is active against this disease. Twenty-four patients with histologically proven MMM were treated with fotemustine, with or without dacarbazine (DITC) according to different phase II trials. In the first schedule, three patients received FM alone on days 1, 8, 15 followed by a 5-week rest period. The second schedule consisted of FM administered on days 1 and 8 alternating with DTIC on days 15 and 16, followed by a 5-week rest period (19 patients). The third schedule, given to two patients, consisted of DTIC followed 4 h later by FM. The overall response rate was 8.3%. Response in those who were treated with alternating drugs, included one partial response (PR) in the brain which lasted 4 months, and one PR in brain metastases with complete response (CR) in lymph nodes for 4 months. Clinical and radiological evidence of regression was observed mainly in brain metastases (22.2%), reflecting the intracerebral activity of the drug. It seems that fotemustine is superior to any other drug currently available in the treatment of these metastases.

Adult↗
PubMed1992

Encephalopathy in ifosfamide-treated patients.

Acute encephalopathy following treatment with ifosfamide and mesna was observed in 5 (4 women and 1 men) of 28 patients (17.8%), with advanced sarcoma, lymphoma or ovarian carcinoma. This appeared within 2 to 7 days following the first dose of ifosfamide treatment, and included mental status changes, urinary incontinence, weakness, seizure activity, altered consciousness and psychiatric manifestations. Three cases were fatal, while two patients recovered completely. Brain CT and morphometric studies were normal in all the patients. Associated findings were myelosuppression, renal failure and electrolyte alterations.

Aged↗
PubMed1992

Cerebral metastatic melanoma: correlation between clinical and CT findings.

Thirty patients with malignant melanoma and cerebral metastases confirmed by CT were studied. Metastases were classified according to their size: < or = 1 cm (group A), 1.1-4 cm (group B), and > 4 cm (group C), in order to assess the clinical course of the disease and predict the response to treatment with fotemustine. Group B lesions were the most common, independent of the site of the primary tumour, except for patients with rectal melanoma. Group C metastases were least common and were usually solitary. Asymptomatic patients usually had group A metastases, whereas those with non-specific complaints, hemisyndrome or neurobehavioural changes usually had group B metastases. The time from diagnosis of the primary tumour to discovery of disease in the CNS was significantly longer for those who had group A lesions, compared with those who had groups B or C lesions (P < 0.0001). Solitary lesions usually belonged to groups B or C, whereas multiple lesions belonged mainly to groups A or B. All the responders to fotemustine has mainly cortical, group A or group B lesions. Patients with group C lesions or leptomeningeal spread did not respond to fotemustine. Our findings suggest an association between the size of the cerebral metastatic lesion from malignant melanoma and clinical parameters characteristic of tumour behaviour.

Adult↗
PubMed1992

Our experience with interferon alpha: renal cell carcinoma.

Our 3-year clinical experience using recombinant interferon (rIFN) alpha-C in patients with metastatic renal cell carcinoma (RCC) is summarized. This type of IFN is a new subspecies of the IFN-alpha protein family. Its specific activity is 1-2 x 10(9) U/mg protein, the highest among IFN-alpha species presently available. Pharmacokinetic study indicated good bioavailability of the preparation from the intramuscular injection. A phase II study was performed to assess the response rate related to rIFN-alpha C at a low dosage. A dose of 3 x 10(6) U daily was administered, followed by 3 x 10(6) U/m2 every other day to avoid severe toxicity. Among 33 treated patients, a partial remission rate of 9.7% and stable disease rate of 25.8% were achieved. Side effects were usually mild and the treatment was well tolerated by the patients. However, mental deterioration and behavioral changes were observed in five patients with RCC treated by rIFN-alpha C and were related to neurotoxicity of IFN. The role of vinblastine in addition to IFN in the treatment of RCC was assessed in nine patients who had failed on IFN alone. No response was observed. It appeared that vinblastine had little if any effect in being added to IFN as second-line therapy. We conclude that rIFN-alpha C has moderate activity in the treatment of RCC. Familiarity with the possible toxicity of this agent will lead to more careful management of patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Our experience with interferon alpha: metastatic malignant melanoma.

Interferon-alpha and dacarbazine combination is a milestone in the treatment of metastatic malignant melanoma. Objective response rate ranged from 3% to 25%. Our phase II study included 34 patients; the overall response was 29.4%. Median time of survival of the responders was significantly longer than that of the nonresponders. Nine of the 34 patients had previously progressed on interleukin-2 (IL-2) and dacarbazine treatment, or had been withdrawn because of unacceptable toxicity. Two patients (22.2%) achieved partial responses. There seemed to be no cross-resistance between the two biologic response modifiers. Successful treatment of melanoma patients by interferon resulted in complete disappearance of all extracerebral lesions, but left the brain vulnerable to involvement by metastases, and was frequently a site of relapse. Brain irradiation is suggested by several investigators to prevent cerebral involvement. Ongoing protocols are an adjuvant treatment for high-risk patients and combination of interferon-alpha, IL-2, dacarbazine and cisplatinum for metastatic melanoma after failure of interferon-dacarbazine regimen.

Adolescent↗
PubMed1992

Metastases to skeletal muscles and interferon treatment.

Blood-borne metastases to a skeletal muscle are rare and may originate in various primary tumors. Recurrent solitary metastasis of renal cell carcinoma, and metastatic lesion as part of disseminated malignant melanoma in skeletal muscles are reported in two patients. In both cases interferon treatment with or without chemotherapy failed in arresting the disease.

Aged↗
PubMed1991

Interferon-related leukoencephalopathy in a patient with renal cell carcinoma.

A 75-year-old patient with metastatic renal cell carcinoma was treated with recombinant interferon alpha-C and thereafter developed a neurologic syndrome of dementia, ataxia, confusional state, loss of concentration ability and cortical blindness. CT scan findings were compatible with leukoencephalopathy, which is reported as being a toxic effect of interferon.

Aged↗
PubMed1991

Skin metastasis of ovarian cancer: report of three cases.

Three cases of skin metastases in patients with ovarian cancer are reported. The late onset of skin metastases in the course of the disease represents an advanced stage accompanied by intraperitoneal spread and has a poor prognosis. Diagnosis and differentiation from herpes zoster and other skin tumors were based on histologic examination. Palliation of symptoms and partial local response were achieved by electron beam irradiation.

Aged↗
PubMed1991

Pharmacokinetics of recombinant interferon alpha-C.

Recombinant interferon alpha-C (rIFN alpha-C, Interpharm), is a new type of alpha-interferon that has a specific activity of 1-2 x 10(9) units/mg protein. The pharmacokinetics of rIFN alpha-C were studied in 11 patients with metastatic renal-cell carcinoma. A total of 10 million units IFN alpha-C were injected intramuscularly and the serum level of IFN was evaluated up to 72 h post-administration. Measurable IFN concentrations appeared in the serum as early as 0.5 h, and levels peaked at 4-6 h (Cmax = 53.2 +/- 4.6 units/ml). Relatively high levels persisted for 24 h and declined thereafter with an apparent half-life of 3-4 h. The mean area under the serum-concentration curve (AUC) was 1,259 +/- 145 units h ml-1, indicating good bioavailability of the preparation from the intramuscular injection.

Aged↗
PubMed1991

Serial serum MCA measurements in the follow-up of breast cancer patients.

Mucin-like carcinoma-associated antigen (MCA) was serially assayed in 58 women with histologically proven breast cancer after their treatment for primary disease. MCA sensitivity and specificity were 87.5% and 76.9%, respectively, and the positive predictive value 82.4%. 10 patients had elevated MCA and no evidence of disease (NED) during their follow-up, of whom 4 finally developed overt metastases. The 4 had a mean (S.D.) MCA value of 46.48 (18.26) U/ml during the lead time, versus 18.76 (2.69) U/ml in the other 6, who are still at high risk for developing overt metastases. Raised levels of MCA in patients with NED create a dilemma of "treat" versus "wait and see". Early treatment of patients with serially uprising MCA levels should be evaluated in a prospective randomised study to assess its ability to prevent or delay the development of overt metastatic disease and influence survival.

Adult↗
PubMed1991

Treatment of advanced colorectal cancer by 5-fluorouracil-leucovorin combination with or without allopurinol: a prospective randomized study.

5-Fluorouracil (5-FU) remains the most effective chemotherapeutic agent in the management of patients with metastatic colorectal cancer. Leucovorin enhances its efficacy, but also its toxicity. Cited data suggest modulation of 5-FU toxicity by high dose allopurinol. In a prospective randomized trial we assessed the ability of allopurinol in a conventional dose to modulate the toxicity of 5-FU-leucovorin combination without compromising its efficacy in 50 patients with advanced colorectal cancer. Twenty-seven patients were randomized for allopurinol but had no benefit in terms of response or reduced toxicity over the other 23. Survival of responders with colon cancer was longer than that of non-responders (p = 0.013). Although allopurinol failed to reduce 5-FU-leucovorin toxicity, it did not lower its expected efficacy.

Adult↗