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Biomedical subjects

R Caplan

Publications and source records attributed to R Caplan.

At least 19 recordsLinked to original sources
PubMed1996

A phase I/II study to evaluate the effect of fractionated hemibody irradiation in the treatment of osseous metastases--RTOG 88-22.

PURPOSE: The present study was initiated to determine the maximum tolerated total dose that can be delivered by fractionated hemibody irradiation (HBI), as defined by the acute hematological and nonhematological toxicity. Although it was designed as a dose searching trial, the influence of higher doses on occult and overt disease were considered equally important. The study was not designed to evaluate pain relief. The results were compared to Radiation Therapy Oncology Group (RTOG) 82-06, which employed single high-dose HBI, to determine if either single or fractionated HBI is more effective in controlling occult or overt disease. METHODS AND MATERIALS: A total of 144 patients were entered from September 1989 to April 1993. Only patients with a single symptomatic bone metastases from either prostate or breast cancer primaries and a KPS > or = 60 were eligible. All patients initially received 30.0 Gy in 10 fractions to the symptomatic area followed by HBI in 2.50 Gy fractions to one of five arms: I-10.0 Gy (37 patients); II-12.5 Gy (23 patients); III-15.0 Gy (18 patients); IV-17.5 Gy (40 patients), and V-20.0 Gy (26 patients). A dose limiting toxicity was defined as an observed toxicity of > or = Grade 3 lasting more than 30 days postcompletion of HBI. If three or more dose-limiting toxicities occurred at any dose level, the previous dose was considered as the maximum tolerable dose. RESULTS: Thirty-six of 142 patients experienced > or = Grade 3 hematological toxicity at some time following HBI. The distribution of dose-limiting hematological toxicity in each arm was: I-two patients; II-one patients; III-zero patients; IV-one patient; and V-three patients. The major nonhematological toxicity was gastrointestinal and occurred in 10 patients. None were dose limiting. At 12 months from the initiation of treatment, the percent of patients with new disease were: Arms I-19%; II-9%; III-17%; IV-19%; V-13%; the percent of patients requiring additional treatment in the hemibody field were: Arms I-36%; II-30%; III-33%; IV-32%; and V-19%. When compared to single high-dose HBI the estimated reduction in the failure rate was 36% after fractionated HBI which potentially represents a modest improvement. CONCLUSIONS: The maximum tolerated dose of fractionated (2.50 Gy) HBI was found to be 17.5 Gy. The major dose limiting toxicity was hematological (thromboleukopenia). There was not a significant dose response effect on occult disease (appearance of new disease) or in the requirement for additional treatment, although certain trends were noted for the higher doses. When only patients completing assigned HBI from RTOG 82-06 and 88-22 were compared, there was no difference in the time to new disease or additional treatment in the treated field. Based on the investigative parameters of this study, single high-dose HBI was as effective as fractionated HBI. The incorporation of cytokines, to ameliorate hematological toxicity, should allow for the delivery of higher doses of fractionated HBI and sequential HBI as a means of delivering systemic irradiation.

Bone Neoplasms↗
PubMed1996

Blink rate in children with attention-deficit-hyperactivity disorder.

Spontaneous blink rate, a noninvasive measure of dopamine function, was coded in 28 children with attention-deficit-hyperactivity disorder (ADHD) and in 47 normal children during a listening, a conversation, and a verbal recall task. Unlike the normal children, the children with ADHD did not increase their blink rates significantly across these three tasks. The ADHD subjects were were not on stimulants had significantly lower blink rates than the normal children during verbal recall. The ADHD subjects on stimulants, however, had significantly higher blink rates than the normal subjects during the listening task. These preliminary findings are discussed in light of their potential implications for theories on neurotransmitter dysfunction and arousal in ADHD.

Adolescent↗
PubMed1996

Pediatric Rasmussen encephalitis: social communication, language, PET and pathology before and after hemispherectomy.

This prospective case study examined social communication (i.e., formal thought disorder, cohesion), language, positron emission tomography glucose utilization, and neuropathology in four children with Rasmussen encephalitis who achieved seizure control following right hemispherectomy. Prior to hemispherectomy, all four children had illogical thinking, loose associations, cohesive deficits, and impaired performance on formal language tests. Their postoperative improvement in social communication and language appeared to be related to age of onset, duration of illness, and postsurgical reversibility of hypometabolism in the nonresected prefrontal cortex. These changes were not associated with increase in IQ scores. The variability in the type and extent of pathologic change across subjects reflected the severity and duration of the illness. The study's findings imply that early surgical intervention might have mitigated certain aspects of the social communication and linguistic deficits found in these children.

Adolescent↗
PubMed1996

Final results of a phase II chemoradiation protocol for locally advanced cervical cancer: RTOG 85-15.

BACKGROUND: The lack of improved cure rates for advanced cervical cancer after three decades of megavoltage radiotherapy (RT) has prompted continued efforts in improved treatment delivery. Concurrent chemoradiation (CR) is one of the several avenues being explored to improve these results. METHODS: Sixty women with advanced cervical cancer (30 patients with unfavorable Stage IIB and 30 patients with Stages III and IVA) were treated with CR comprising of a combination of external and intracavitary RT delivering between 7000 to 7500 cGy total to point A and 5890 to 6015 cGy to point B along with one cycle of 5-FU and mitomycin C and a second cycle of 5-FU and cis-platinum. RESULTS: Grade 3 and 4 RT-related toxicities were 15 and 3%, respectively. Chemotherapy-related Grade 3 and 4 toxicities were 9 and 2%, respectively. The 5-year survival for unfavorable Stage IIB patients was 48%; for Stages III and IVA it was 39%. CONCLUSIONS: The toxicity of this particular CR regimen was acceptable and suggests that further qualitative and quantitative intensification of chemoradiation may be attempted. Retrospective comparisons with PCS studies and previous RTOG studies 79-20 and 80-05 suggest that this particular chemoradiation regimen may offer a modest survival advantage over RT alone for Stages III and IVA disease. A CR regimen with higher doses of radiotherapy and a greater number of active chemotherapeutic agents may yet result in acceptable toxicity and further improve cure rates in advanced and poor prognostic featured cervical cancer.

Adolescent↗
PubMed1996

Conversational repair in schizophrenic and normal children.

OBJECTIVE: Children acquire the skills to monitor the adequacy of their spoken message and to self-initiate repair strategies that modify the message during early, middle, and late childhood. To characterize further the communication deficits of childhood-onset schizophrenia, this study compared self-initiated repair strategies in schizophrenic and normal children and their relationship with formal thought disorder, discourse deficits, and distractibility. METHOD: Measures of self-initiated repair, formal thought disorder, and cohesion were coded in 32 schizophrenic and 47 normal children, aged 5.6 to 12.4 years, from speech samples elicited with the Story Game. RESULTS: The schizophrenic children used some repair strategies (false starts, fillers, referential revision) more infrequently than the normal children. Within the schizophrenic group, the children who were receiving neuroleptic medication underutilized repair and had more discourse deficits than the unmedicated patients. Loose associations and distractibility were associated with increased use of false starts but not fillers. CONCLUSIONS: In addition to formal thought disorder and discourse deficits, schizophrenic children underutilize self-initiated repair when presenting their thoughts to the listener, particularly if they are being treated with neuroleptics, a potential sign of increased clinical morbidity. Impoverished communication skills might reflect negative signs in childhood-onset schizophrenia.

Attention↗
PubMed1996

Obsessive-compulsive disorder, tattooing and bizarre sexual practices.

BACKGROUND: A case is presented describing an association between obsessive-compulsive disorder, tattooing and unusual sexual practices. METHOD: A single case report. CONCLUSIONS: Tattooing and unusual sexual practices are compulsive behaviours associated with the subject's obsessive-compulsive disorder. Such associations have not previously been described in the literature.

Adult↗
PubMed1996

A controlled trial of dothiepin and placebo in treating benzodiazepine withdrawal symptoms.

BACKGROUND: The possibility that treatment with tricyclic antidepressants, in the form of dothiepin, might attenuate benzodiazepine withdrawal symptoms was investigated in a double-blind trial. METHOD: Eighty-seven non-depressed psychiatric out-patients with putative normal dose benzodiazepine dependence had their benzodiazepines reduced in stepwise amounts of 20% of the original dose for eight weeks. The patients were randomised to receive dothiepin (with dosage increasing to 150 mg/day) or placebo as an aid to withdrawal before benzodiazepine reduction and these drugs were taken for four further weeks before being stopped. RESULTS: Fewer patients entered and completed the study than expected and a Type II error was possible in the results. Although there was some evidence of withdrawal symptoms being less marked in those patients allocated to dothiepin this was independent of any antidepressant effect as depression scores were lower in the placebo group in the early phase of withdrawal (P < 0.01). Of those completing the study, greater satisfaction (P = 0.03) was recorded by those who had received dothiepin; no other differences reached statistical significance. CONCLUSIONS: Dothiepin (and by implication other tricyclic antidepressants) might have some value in reducing benzodiazepine withdrawal symptoms but does not aid drug withdrawal.

Ambulatory Care↗
PubMed1996

Neoadjuvant combined modality program with selective organ preservation for invasive bladder cancer: results of Radiation Therapy Oncology Group phase II trial 8802.

PURPOSE: This phase II study was designed to evaluate effectiveness and toxicity of a combined chemoradiotherapy program with selective bladder preservation in the management of patients with invasive bladder cancer. PATIENTS AND METHODS: Ninety-one eligible patients with invasive bladder cancer stages T2M0 to T4AM0 suitable for radical cystectomy received two courses of methotrexate, cisplatin, and vinblastine (MCV regimen) followed by radiotherapy with 39.6 Gy and concurrent cisplatin. After complete urologic evaluation, operable patients who achieved complete response were selected for bladder preservation and treated with consolidation cisplatin-radiotherapy. RESULTS: Of 91 eligible patients, 85 underwent complete urologic evaluation and 68 (75%; 95% confidence interval [CI], 59% to 84%) had documented complete responses. Fourteen operable patients with residual tumor underwent immediate cystectomy. Of 70 patients treated with consolidation cisplatin-radiotherapy, 36 subsequently developed bladder recurrences, 23 of which were invasive. Patients with invasive recurrence (n = 16), extensive noninvasive recurrence (n = 6), or severe treatment complications (n = 1) underwent salvage cystectomy. Thus, a total of 37 of 91 patients (40%) required cystectomy. The 4-year cumulative risk of invasive local failure (which includes induction failures) was 43% (95% CI, 33% to 53%). The 4-year actuarial risk of distant metastasis was 22% (95% CI, 13% to 31%). The 4-year actuarial survival rate of the entire group was 62% (95% CI, 52% to 72%). The 4-year actuarial rate of survival with bladder intact was 44% (95% CI, 34% to 54%). CONCLUSION: Initial results of this combined chemoradiotherapy program show that bladder preservation can be achieved in the majority of patients, and that overall survival is similar to that reported with aggressive surgical approaches. Long-term survival and quality-of-life assessments require longer follow-up study.

Aged↗
PubMed1995

Adults with a history of child sexual abuse: evaluation of a pilot therapy service.

OBJECTIVE: To evaluate a pilot service offering therapy specifically to adults with a history of child sexual abuse. DESIGN: Questionnaire survey. SETTING: Specialised therapy unit, Breakfree, which offers care, therapy, and support. SUBJECTS: 116 clients presenting to the service who were offered therapy. MAIN OUTCOME MEASURES: Scores from three psychological questionnaires--the social activities and distress scale, the general health questionnaire, and the delusions, symptoms, and states inventory--and from questionnaires about the clients' abuse, previous use of health services, and opinion of the Breakfree service. RESULTS: Clients had received previous help from health services and other agencies without apparent effect; they were highly distressed according to their psychological scores; and they were very frequent users of the health services. The clients showed significant improvement in their psychological scores (Wilcoxon's matched pairs signed ranks test): social activities and distress scale, z = -3.3, P = 0.001; general health questionnaire, z = -5.8, P < 0.00001; delusions, symptoms, and states inventory, z = -4.8, P < 0.00001). This was most pronounced for those who had completed therapy by the end of the study. Whereas 82/88 clients had a score for the general health questionnaire that indicated clinical distress at the start, only 28/58 did so at the end of the study (only 17/35 among those who had finished therapy). CONCLUSIONS: This group of adults with a history of child sexual abuse were highly disturbed and previous high users of the health service. The specialist service Breakfree was effective in the short term and, if the benefits are sustained, would yield a net cost saving to the health service.

Adult↗
PubMed1995

What's in a name?

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Attitude to Health↗
PubMed1995

Inflict kindness.

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Education, Medical↗
PubMed1994

Impact of a multileaf collimator on treatment morbidity in localized carcinoma of the prostate.

PURPOSE: To evaluate the effectiveness of variable multileaf collimation, three-dimensional treatment planning, and computer-controlled conformal radiation therapy of prostate cancer. METHODS AND MATERIALS: Two hundred and forty-five patients with locally advanced prostate cancer have completed treatment over a 9-year time span using a multileaf collimator and conformal treatment techniques on the University of Washington cyclotron. All patients had three-dimensional treatment planning with computed tomography scans in the treatment position, and had treatment fields individually shaped to the target volume with a continuously variable multileaf collimator. Treatment was delivered under computer control with network transfer of the multileaf collimator settings from the treatment planning computer to the cyclotron control system. RESULTS: The multileaf collimator combined with three-dimensional treatment planning results in elegant dose distributions. These neuron dose distributions resulted in a reduced local/regional tumor failure rate with no increase in complications when compared to control treatment with photons in a randomized trial. Neutron treatment delivered at other institutions without conformal beam shaping resulted in the same improvement in local-regional tumor control rates, but was associated with a significantly higher normal tissue complication rate than seen with conformal neutron beam delivery techniques (grade 3 and 4 cumulative late normal tissue toxicity rates of 39% vs. 10%, p = 0.0007). CONCLUSIONS: Conformal treatment of prostate cancer using a multileaf collimated neutron beam results in increased local/regional tumor control rates with low normal tissue toxicities. This experience is directly applicable to the conformal treatment of prostate cancer with photons.

Humans↗
PubMed1994

Blink rate in childhood schizophrenia spectrum disorder.

Spontaneous blink rate, a putative measure of dopamine function, was measured in schizophrenic, schizotypal, and normal children, aged 5.6-13.2 years during three different cognitive tasks. Unlike that of schizophrenic adults, the blink rate of the schizophrenic children who were not on neuroleptics was significantly lower than that of the normal children. There were no statistically significant differences, however, in the blink rates of the neuroleptic-treated schizophrenic children and the normal children. The schizophrenic and schizotypal children had similar spontaneous blink rates. Within each diagnostic group, the blink rate was lowest for listening, intermediate for conversation, and highest for verbal recall. These findings highlight the need to examine the relationship between age, blink rate, and dopamine function in childhood-onset schizophrenia spectrum disorder.

Adolescent↗
PubMed1994

Communication deficits in childhood schizophrenia spectrum disorders.

This article examines the effects of age, cognition, and discourse skills on the clinical manifestations of formal thought disorder in 31 children with schizophrenia, 14 with schizotypal personality disorder (SPD), and 70 who were normal. The communication deficits of the 31 children with schizophrenia have three characteristics: illogical thinking, loose associations, and impaired discourse skills. Loose associations and illogical thinking reflect different aspects of impaired attention/information processing in children with schizophrenia. Only certain aspects of the discourse deficits of the children with schizophrenia are associated with the cognitive measures used in this study. The children with SPD have similar illogical thinking and loose associations scores but a narrower range of discourse deficits than the children with schizophrenia. Implications of the interaction between the clinical, cognitive, and discourse manifestations of the communication deficits of children with schizophrenia are discussed. The possible relationship between these manifestations and positive and negative symptoms of schizophrenia are also reviewed.

Attention↗