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Biomedical subjects

R D Hilgers

Publications and source records attributed to R D Hilgers.

At least 55 records · Page 3Linked to original sources
PubMed1993

High-dose cisplatin carboplatin chemotherapy in primary advanced epithelial ovarian cancer.

The purpose of the study was to maximize platinum dose intensity in women with ovarian cancer by combining cisplatin and carboplatin and using Day 1 and 8 scheduling. Thirty-two consecutive patients with primary stage 3 or 4 epithelial ovarian cancer underwent radical cytoreductive surgery followed by high-dose cisplatin carboplatin chemotherapy. Twenty-eight tumors (88%) were stage 3C or 4 and 20 (62%) were grade 3. Following radical cytoreductive surgery, 21 patients (66%) had less than 5 mm of residual disease. The first 2 patients treated with 75 mg/m2 cisplatin and 150 mg/m2 carboplatin on Days 1 and 8 every 28 days for 5 cycles developed severe and prolonged thrombocytopenia. As a result, the dose was reduced to 70 mg/m2 cisplatin and 100 mg/m2 carboplatin for the remaining 30 patients, representing a monthly platinum dose of 207 mg/m2. Projected platinum dose intensity was 700 mg/m2 cisplatin and 1000 mg/m2 carboplatin delivered over 16 weeks. Eleven patients (44%) received 100% and 27 patients (84%) received > 90% projected platinum dose intensity. Median projected platinum dose intensity received was 97%. Grade 4 thrombocytopenia occurred in 43 cycles (28%) and grade 3 peripheral neuropathy occurred in 15 patients (47%). Central nervous system toxicity occurred frequently: ototoxicity, 66%; decreased taste, 50%; optic toxicity, 41%; memory loss, 34%. Twenty-seven patients (84%) had a clinical complete response and 7 patients (44%) undergoing second-look laparotomy had a pathologic complete response. The majority of clinical responses were based on CA-125. Median survival has not been reached at 2.1 years. Median progression-free survival is 1.4 years. Combining cisplatin and carboplatin using Day 1 and 8 scheduling allows maximum hematologic platinum dose intensity; however, peripheral neuropathy is prohibitive. Day 1 and 8 scheduling does not appear to prevent peripheral neuropathy when delivering dose-intense platinum chemotherapy. Central nervous system toxicity of high-dose platinum is more common than previously reported.

Aged↗
PubMed1993

[The materials properties of the stock for positioners--an in-vitro study. I. The elastic behavior].

The purpose of this study was to compare the physical and mechanical properties of materials for tooth positioners. 15 of these materials are in general use and four are experimental. Tensile strength at 20% elongation was observed and analyzed over a three-month period during which time the specimens were stored at 37 degrees +/- 1 degree C in an aqueous environment. The values of tensile strength covered a range from 24.9 MPa to 1.5 MPa depending on the particular material. Most of the materials displayed an increase in the module of elasticity over three-month period, but this increase was statistically significant in only one material (t-test, pmax < 0.00005).

Dental Materials↗
PubMed1993

[Ethyl cyanoacrylate (Cyano-Veneer) as an orthodontic bracket adhesive. A comparative in-vitro study with Cyano-Veneer and a conventional orthodontic bracket adhesive].

According to the claims of the manufacturer, aethylcyanoacrylate can be used to bond orthodontic brackets and some orthodontists have already adopted its use for this purpose. Because, however, the use of the material as thus applied has not yet been the object of research, the question of its adhesion to tensile forces immediately after bonding and after 50, 100, and 150 days of placement in a physiologic saline solution (0.9% NaCl) is the subject of this study. 40 bovine upper incisors were extracted from 20 animals for each of the four points in time. The brackets were bonded with Cyano-Veneer and Mono-Lok according to a randomized list. Mono-Lok, an adhesive from the group of common orthodontic adhesives, functioned as the reference material. The bonding strength of the brackets in relation to the tensile forces was measured by means of a "Zwickuniversalprüfmaschine" (Zwick universal testing machine). Immediately after bonding, the cyanoacrylate demonstrated significantly higher bonding strength values than Mono-Lok. At 50, 100, and 150 days in the physiologic saline solution, the bonding strength of both materials showed no significant difference. It can thus be concluded that, when wires are employed immediately after bonding, the danger of bracket loss is significantly reduced through the use of cyanoacrylate.

Adhesives↗
PubMed1993

Meta-analysis.

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Female↗
PubMed1993

In-111 CYT-103 immunoscintigraphy in the imaging of ovarian carcinoma.

Fifteen presurgical patients with a history of ovarian carcinoma were evaluated with immunoscintigraphy using the In-111-labeled monoclonal antibody conjugate CYT-103. Twelve of these patients had residual neoplasia at time of laparotomy. A single intravenous dose of the radiolabeled monoclonal antibody was given to these patients before restaging laparotomy. All patients also underwent CT scanning of the abdomen and pelvis before laparotomy. Immunoscintigraphy detected the presence of disease in 10 of 12 patients before surgery, whereas CT scanning detected disease in only 6 of these 12 women. The results of this study indicate that immunoscintigraphy using In-111 CYT-103 is more sensitive than CT and may add useful information to the preoperative evaluation of women with ovarian carcinoma.

Antibodies, Monoclonal↗
PubMed1993

Deficient testicular and adrenal steroidogenesis in mutant cream (e/e) Syrian hamsters.

Coat color genes have been shown to be developmental genes with wide pleiotropic actions. The present study was undertaken to analyze the effects of mutations at the e locus of the Syrian hamster on testicular and adrenal steroidogenesis. Although no differences in body weight were detected, cream (e/e) hamsters had larger testes and smaller adrenals than wildtype (+/+) animals. Plasma testosterone levels were lower in e/e than in +/+ hamsters. However; testicular progesterone levels were higher, and 17-OH-progesterone and testosterone levels were lower in e/e when compared to +/+ hamsters. The efficiency of testicular 17-hydroxylase appear to be reduced in e/e hamsters. Adrenal progesterone levels were higher. 17-OH-progesterone, testosterone, dehydroepiandrosterone sulphate and aldosterone levels were similar, and cortisol levels were lower in e/e when compared to +/+ hamsters. The efficiencies of adrenal 17-hydroxylase and 17-hydroxysteroid dehydrogenase appear to be reduced in e/e hamsters. The present data indicate that steroidogenic deficiencies are present in the testes and adrenals of e/e hamsters, and that the gonadal alterations are more severe than the adrenal ones. The e locus, in the hamster, could be a developmental gene, or could be coding for a component in a signaling pathway under the control of such a gene.

Adrenal Cortex↗
PubMed1992

Effect of dexamethasone 0.1% and prednisolone acetate 1.0% eye drops on the blood-aqueous barrier after cataract surgery: a controlled randomized fluorophotometric study.

Using non-invasive anterior chamber fluorophotometry, we performed a double-blind, randomized clinical trial on the effects of dexamethasone 0.1% and prednisolone acetate 1.0% eye drops on the blood-aqueous barrier after phacoemulsification and posterior chamber lens implantation. Twenty patients received one of the preparations topically to the surgically treated eye 5 times daily for a period of 5 days, beginning the day after surgery. Patients chosen for the study had no history of eye disease other than senile cataract nor of systemic diseases influencing the eyes. No other steroids or non-steroidal anti-inflammatory drugs were given before or during the investigation. The fluorometric data measured 5 days after surgery show a lower mean concentration of fluorescein in the dexamethasone alcohol 0.1% treated group compared with the prednisolone acetate 1.0% treated group. The difference is statistically not significant. The clinical assessment of postoperative ocular inflammation did correlate with the fluorophotometric measurements. The results of the study indicate that although dexamethasone is the more potent anti-inflammatory agent, with a better binding affinity to glucocorticoid receptors, we are--with the number of cases measured--unable to demonstrate any difference in the efficacy in protecting the blood-aqueous barrier after cataract extraction and posterior chamber lens implantation to prednisolone acetate.

Administration, Topical↗
PubMed1992

[Effect of 0.1% dexamethasone and 1.0% prednisolone acetate eyedrops on the blood-aqueous humor barrier].

In a randomized, double-blind clinical trial we studied the protective effect of prednisolone-acetate 1.0% and dexamethasone 0.1% on the blood-aqueous barrier after cataract-extraction and posterior chamber lens implantation. Pre- and postoperative anterior chamber fluorophotometry was performed after i.v. administration of 10% fluorescein-sodium in 20 eyes of 20 patients of whom 16 finished the study (mean age 68.7 +/- 11.0; 13 female, 3 male). The topical application of either drug 5 times daily for 5 days did show a significant difference in surgery mediated disturbance of BAB in each group before and after phacoemulsification. However, when comparing the effect of the two drugs with each other, a difference could not be detected (p = 0.35). To attain a statistical 95% probability that there is no significant difference between the two treatment groups, a number of 690 patients would have had to be investigated. The results can be interpreted as to be due to a better cornea penetration of prednisolone-acetate which compensate the higher glucocorticoid-potency and receptor-affinity of dexamethasone. The untreated fellow-eyes did not reveal a significant difference between the pre- and postoperative anterior chamber fluorescein-concentrations in either treatment group. Anterior chamber fluorophotometry is able to demonstrate the potency and influence of both prednisolone-acetate 1.0% and dexamethasone 0.1% eye-drops on the BAB following phacoemulsification and IOL-implantation. The difference of both drugs does not seem to be of clinical importance in this context.

Aged↗
PubMed1992

Meta-analysis of cisplatin, doxorubicin, and cyclophosphamide versus cisplatin and cyclophosphamide chemotherapy of ovarian carcinoma.

OBJECTIVE: To compare the survival with cisplatin, doxorubicin (Adriamycin), and cyclophosphamide versus that of cisplatin and cyclophosphamide in women with advanced epithelial ovarian cancer, to evaluate the effect of dose intensity, and to evaluate meta-analysis methodology. METHODS: Meta-analysis was done on 30 studies of 2060 women with stages III and IV epithelial ovarian cancer. All had 3-year survival data, adequate follow-up, no other chemotherapy, no radiation therapy, and had information for various prognostic variables (age, stage, grade, and residual disease). We used four different methods of meta-analysis: pooled published data and modified effect-size analyses of the entire group (30 studies), and pooled published data and effect-size analyses of the subset of five prospective randomized studies. RESULTS: Three-year survival for the entire group was 43% for cisplatin, doxorubicin, and cyclophosphamide versus 36% for cisplatin and cyclophosphamide; for the five prospective randomized studies, the rates were 46 and 35%, respectively. The survival advantage of cisplatin, doxorubicin, and cyclophosphamide was statistically significant when analyzed by the pooled published data and modified effect-size meta-analysis of the entire group and the pooled published data meta-analysis of the five prospective randomized studies. The effect-size meta-analysis of the five prospective studies did not reach statistical significance. Total dose intensity and doxorubicin dose intensity were not significantly associated with survival advantage in cisplatin, doxorubicin, and cyclophosphamide use. CONCLUSIONS: There seems to be a survival advantage to treatment with cisplatin, doxorubicin, and cyclophosphamide versus treatment with cisplatin and cyclophosphamide. We believe this to be due to the properties of multiagent chemotherapy (the addition of doxorubicin) rather than to increased dose intensity. In addition, we believe that physicians need to familiarize themselves with meta-analysis methodology.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Daunomycin and silicone oil for the treatment of proliferative vitreoretinopathy.

We describe the long-term results after treatment of 68 eyes showing advanced stages of proliferative vitreoretinopathy with vitrectomy, daunomycin perfusion, and silicone-oil injection. Six reoperations were performed. After 18 months, 73% of the eyes showed no signs of retinal detachment and 89% had a visual acuity of greater than 20/800. These results are better than those reported in previously published studies. Whether this improvement was due to the daunomycin treatment or to more aggressive surgical techniques such as retinotomies remains to be answered by a randomized trial.

Daunorubicin↗
PubMed1991

An immunochemical quantitative analysis of the protein pattern in physiologic and pathologic vitreous.

Biochemical changes in the vitreous in different vitreoretinal disorders have not yet been thoroughly studied. Using enzyme-linked immunosorbent analysis (ELISA), we established mean values and 95% confidence intervals for six proteins of physiologic human vitreous: albumin (293 +/- 18 mg/l), transferrin (73.7 +/- 6.6 mg/l), immunoglobulin G (IgG), (33.5 +/- 3 mg/l), alpha 1-antitrypsin (14.1 +/- 2.9 mg/l), alpha 1-acid glycoprotein (4 +/- 0.7 mg/l), and lactoferrin (less than 50 micrograms/l). These six proteins were also determined in vitreous aspirates from patients with idiopathic proliferative vitreoretinopathy (n = 10), traumatic proliferative vitreoretinopathy (n = 10), and proliferative diabetic retinopathy (n = 15). The pattern of protein levels varied widely within each of the disorders. An analysis of absolute protein levels showed significant differences in total protein and alpha 1-antitrypsin levels between controls and pathologic vitreous samples. We observed differences in transferrin between controls and proliferative diabetic retinopathy (PDR), and differences in alpha 1-acid glycoprotein between controls and both types of proliferative vitreoretinopathy (PVR). The single disorders themselves could not be differentiated by any of the proteins. When the relative contribution of single proteins to total vitreal protein was compared, albumin was lower in all three disorders than in controls. Transferrin was lower in traumatic PVR than in controls, in PDR, or in idiopathic PVR. Our results indicate that the three vitreoretinal disorders studied are characterized by a breakdown of blood-ocular barriers.

Albumins↗
PubMed1991

Pyramidal tract lesions in comatose patients.

In 197 comatose patients transcranial magnetic evoked potentials were registered to investigate the integrity of the pyramidal tract. Findings were compared to somatosensory, visual and auditory evoked potentials. Preservation, abnormalities and absence of evoked potentials were related to survival and non-survival. Transcranial magnetic and somatosensory evoked potentials proved to be of high prognostic value. While the accuracy of prediction of a fatal outcome based on transcranial magnetic evoked potentials was close to 90%, the prediction of survival was less dependable. Transcranial magnetic evoked potentials are concluded to be a valuable adjunct to the neurophysiological assessment of the comatose patient.

Adolescent↗
PubMed1991

Correlation of plasma methotrexate concentration with human chorionic gonadotropin and therapeutic response to low-dose methotrexate-citrovorum factor in low-medium-risk gestational trophoblastic tumors.

Seventeen patients with low- or medium-risk gestational trophoblastic tumors (GTT) and one patient with a placental-site trophoblastic tumor were treated according to an 8-day schedule of low-dose methotrexate (LDMTX) alternating with citrovorum factor (CF). Plasma concentrations of methotrexate (MTX) were correlated with serum human chorionic gonadotropin (hCG) levels and clinical response. After an intramuscular dose of 50 mg, plasma MTX levels rose rapidly, reached a peak concentration of 5.8 x 10(-6) M/liter at 1 hour and persisted above 10(-6) M/liter normally considered inhibitory for DNA synthesis, for approximately 7 1/2 hours. Rapid plasma clearance followed with plasma levels reaching 5-7 x 10(-8) M/liter at the time of CF administration. At 48 hours, plasma MTX levels continued to exceed 10(-8) M/liter--the break point for the appearance of clinical toxicity due to MTX. In six of sixteen, or 38%, an initial rise in hCG levels was observed. Five of the seventeen patients, or 29%, and the one patient with PSTT developed MTX resistance. The administered dose (approximately 30 mg/M2) and plasma pharmacokinetics did not differ significantly between the tumors that responded and became resistant to MTX. The authors conclude that MTX resistance in GTT occurs as a result of impaired cell membrane uptake, gene amplification of dihydrofolate reductase, or both.

Chorionic Gonadotropin↗
PubMed1991

[Daunomycin and silicone oil in treatment of proliferative vitreoretinopathy].

We describe the long-term results after treatment of 68 eyes in advanced stages of proliferative vitreoretinopathy with vitrectomy, daunomycin perfusion, and silicone oil injection. Six reoperations were performed. After 18 months, 73% of the eyes showed no signs of retinal detachment and 89% had a visual acuity greater than 20/800. These results are better than those reported in previously published studies. Whether this improvement is due to the daunomycin treatment or to more aggressive surgical techniques, such as retinotomies, remains to be answered by a randomized trial.

Combined Modality Therapy↗
PubMed1990

Failure of single dose methotrexate followed by citrovorum factor in nonmetastatic gestational trophoblastic neoplasia.

With increasing cost of medical care, newer methods of administering chemotherapy on an outpatient basis are being sought to reduce the need for hospitalization and protracted losses of valuable time for patients with nonmetastatic gestational trophoblastic neoplasia (NMGTN). To achieve this end, two NMGTN patients were treated with a single course of one dose of methotrexate (MTX) followed by multidose Citrovorum Factor (CF) without observing the expected response. Failure to respond appeared to be due to the schedule of administration. Although the dose and plasma concentrations of MTX were considered to be adequate for cell kill, fractionation--as established by conventional schedules of MTX administration--appeared necessary for response by exposing the maximum number of trophoblastic cells to inhibitory levels of MTX during the S-phase of the cell cycle.

Adult↗