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Biomedical subjects

R D Hilgers

Publications and source records attributed to R D Hilgers.

At least 73 records · Page 4Linked to original sources
PubMed1990

[Quantitative determination of 5 vitreal proteins in the normal vitreous body and proliferative retinal diseases].

While progress in vitreoretinal surgery has been very rapid in recent years, our understanding of the biochemistry of normal and pathological vitreous is still limited. Therefore, we developed non-competitive ELISA techniques for the quantification of five vitreal proteins which, together with vitreal collagen (300 mg/l), account for more than 70% of the total vitreal protein. Physiological levels of the individual proteins were determined as follows: albumin 293 +/- 18 mg/l, IgG 34 +/- 3 mg/l, transferrin 74 +/- 7 mg/l, alpha 1-antitrypsin 14 +/- 3 mg/l, alpha 1-acid glycoprotein 4 +/- 0.7 mg/l. Mean values for these proteins were also obtained in vitreous aspirates from patients with traumatic proliferative vitreoretinopathy (PVR) (n = 10), idiopathic PVR (n = 10) and proliferative diabetic retinopathy (PDR) (n = 15). Significant differences were found for total vitreal protein and alpha 1-antitrypsin between the control groups and the three vitreoretinal disorders, between the PDR and control group for transferrin, and between both types of PVR and controls for alpha 1-acid glycoprotein. Given the high plasma levels of the individual proteins quantified in this study and the uniform rise in total vitreal protein, a disturbancee of blood-retinal and blood-vitreal barriers seems to be an essential features of proliferative intraocular disorders. No disease-specific change in the protein pattern could be detected for the three disorders examined.

Blood Proteins↗
PubMed1989

Randomized phase III trial of chemoimmunotherapy in patients with previously untreated stages III and IV suboptimal disease ovarian cancer: a Southwest Oncology Group Study.

Between 1979 and 1984, 185 fully evaluable patients with stage III or IV epithelial type ovarian cancer and suboptimal surgical resections were randomly assigned to treatment with doxorubicin + cyclophosphamide + BCG (DC + BCG) vs doxorubicin + cyclophosphamide + cisplatin (DCP) vs. doxorubicin + cyclophosphamide + cisplatin + BCG (DCP + BCG). Patients with measurable disease (119) were analyzed separately from those with nonmeasurable disease (66). In measurable disease patients the overall clinical complete plus partial response rates for DC + BCG, DCP, and DCP + BCG-treated patients were 36, 57, and 59%, respectively. Although there were no significant patient characteristic differences between the DCP and DCP + BCG treatment groups, the addition of cisplatin to the DC + BCG regimen resulted in significantly prolonged response (P less than 0.03) and survival (P less than 0.002) durations. To the contrary, the addition of BCG to the DCP regimen did not improve objective response rates or response or survival durations. For patients with nonmeasurable, suboptimal disease there were no significant differences between the three treatments with respect to response or survival parameters; however, patients in this disease category fared generally better than those with clinically measurable disease. We conclude that cisplatin adds significantly to the efficacy of DC + BCG, but BCG does not add to the efficacy of DCP in patients with measurable, stage III or IV disease.

Aged↗
PubMed1989

Randomized phase III trial of chemoimmunotherapy in patients with previously untreated stage III, optimal disease ovarian cancer: a Southwest Oncology Group Study.

Between 1979 and 1984, 98 patients considered to have stage III epithelial type ovarian cancer and optimal surgical resections (i.e., less than 2 cm residual tumor masses) were randomly assigned to treatment with 2 cm residual tumor masses) were randomly assigned to treatment with doxorubicin + cyclophosphamide + BCG (DC + BCG) vs doxorubicin + cyclophosphamide + cisplatin (DCP) vs. doxorubicin + cyclophosphamide + cisplatin + BCG (DCP + BCG). Seventeen (17%) were considered ineligible on the basis of formal histopathologic review. The pathologically proven complete response rates for DC + BCG, DCP, and DCP + BCG-treated patients were 20, 23, and 41%, respectively, and the median survival durations were 36.8, 48.2, and 57.4 months, respectively. Because of the relatively small sample size, definite conclusions concerning the response or survival impact of adding cisplatin to DC + BCG or BCG to DCP can not be drawn; nevertheless, all three groups of patients experienced prolonged survival durations with approximately 40% of all eligible patients alive at 5 years.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Long-term results of highly selective vagotomy for the treatment of duodenal ulcer.

Between 1971 and 1987, highly selective vagotomy (HSV) was carried out in 984 patients suffering from duodenal ulcer disease. In 97.3% of these cases, the surgical intervention was uncomplicated, the related mortality being 0.3%. During the follow-up period the postoperative condition of the patients was checked once a year wherever possible; in 92.3%, follow-up was continued until december 1987, the maximum period of postoperative follow-up being 16 years. No prognostically reliable indication of the risk of ulcer recurrence was obtained from an analysis of gastric juice. In 79.1% of the cases who underwent surgery, the result was good to satisfactory, while 11.7% had functional complaints such as dumping or diarrhea. The probability of developing a recurrent ulcer within 16 years after the initial operation was 29.7%. This rate of recurrence is determined among other things, by the discovery of clinically quiescent ulcers during the yearly follow-up examinations, when these are performed carefully, and over a sufficiently long period.

Adult↗
PubMed1988

Serum methotrexate and human chorionic gonadotropin concentrations during five-day chemotherapy for low-risk metastatic gestational trophoblastic neoplasia.

A recent report of serum methotrexate (MTX) levels measured during treatment of gestational trophoblastic neoplasia (GTN) led us to determine MTX and human chorionic gonadotropin (beta-hCG) levels in a patient with low-risk metastatic GTN with a pulmonary metastasis. Peak MTX concentrations exceeded 10(-6) mol/l considered by many investigators to be within the therapeutic range against many human tumors. Serum beta-hCG levels did not decline during MTX administration; however, after 5 days of MTX a steep dose-response curve was observed which continued during 5 courses of chemotherapy.

Adult↗
PubMed1987

Doxorubicin-cisplatin-vinblastine combination chemotherapy of advanced endometrial carcinoma: a Southwest Oncology Group Study.

A combination of doxorubicin (30 mg/m2 iv), cisplatin (50 mg/m2 iv), and vinblastine (5 mg/m2 iv) repeated every 3-4 weeks was used to treat 55 patients with advanced stage III or IV or recurrent disease. Of the 42 fully evaluable patients, there were 3 complete responders (7%) and 10 partial responders (24%). Responses were of short duration (median of 8 months, range 3-15 months) and the median survival of all evaluable patients was only 10 months from the start of therapy. Leukopenia was the major toxicity and was at least moderate in two-thirds of patients. We conclude that the addition of cisplatin and vinblastine to doxorubicin does not improve the clinical utility of doxorubicin in patients with advanced endometrial cancer.

Adult↗
PubMed1986

Chemotherapy of drug-resistant ovarian cancer: a Southwest Oncology Group Study.

We present a final analysis, including pathology review, of a cooperative group study of drug-resistant ovarian cancer. Of 200 patients registered, 112 were eligible and evaluable, with a response rate of 26% and median survival of 7 months. Because these results are poorer than those reported in the preliminary and interim analyses of this study, we scrutinized the 88 excluded patients, most of whom failed to meet our strict pathologic criteria for a diagnosis of ovarian cancer of epithelial type, and who, as a heterogeneous group, fared better than patients who did meet the eligibility criteria. We believe this analysis provides insight into the spectrum of diseases that are frequently called ovarian cancer, but might be more properly labeled abdominal carcinomatosis.

Adult↗
PubMed1986

Aggressive angiomyxoma of the vulva.

An unusual myxoid and vascular appearing neoplasm of the vulva, termed an aggressive angiomyxoma, is described in a 36-year-old Hispanic woman. The clinical presentation and recurrence pattern were typical for previously described neoplasms of the same cellular pattern. The histopathology, difficulties in determining the surgical margins, and the treatment of this tumor are discussed.

Adult↗
PubMed1984

Cisplatin neuropathy. Clinical, electrophysiologic, morphologic, and toxicologic studies.

Ten of 11 patients with ovarian cancer receiving cisplatin developed a distal sensory neuropathy, manifested early by decreased vibratory sensibility in toes and depressed ankle jerks and later by uncomfortable paresthesias. Eleven patients receiving cisplatin, 50 mg/m2 monthly (mean total, 580 mg/m2) were studied prospectively with monthly neurologic examinations and conduction velocity determinations of median, peroneal, and sural nerves. Early signs were decreased vibratory sensibility in toes (mean dose, 417 +/- 132 mg/m2 [SD]) and loss of ankle jerks (mean dose, 455 +/- 86 mg/m2). With continued therapy, four developed paresthesias. Strength was unaffected. Sural nerve responses abruptly disappeared in six of peripheral nerves from four patients showed axonal degeneration and secondary myelin breakdown. Platinum concentrations in three patients were similar in tumor (3.3 micrograms/g), sural nerves (3.5 micrograms/g), and spinal ganglia (3.8 micrograms/g), but lower in brain (0.17 microgram/g). This may explain the cisplatin toxicity of peripheral nerves with relative sparing of the central nervous system.

Adult↗
PubMed1984

Correlation of ultrasound and pathologic findings in patients with epithelial carcinoma of the ovary.

The findings from preoperative diagnostic ultrasound were compared with operative and pathologic findings in patients with ovarian cancer. Twenty laparotomies were diagnostic second-look procedures and 21 were therapeutic procedures in patients with clinically evident disease. Ultrasound was more reliable in patients with clinically suspected disease, but a site by site analysis demonstrated it is insensitive for detecting prevertebral adenopathy less than 3 cm in size, thin, 1.5 cm omental plaques, 5 cm or smaller lesions involving the mesentery or bowel and peritoneal masses 2 cm or less in size. Ultrasound was most sensitive in the detection of ascites.

Ascites↗
PubMed1984

m-AMSA and adenocarcinoma of the endometrium. A Southwest Oncology Group study.

Twenty-eight patients with advanced or recurrent adenocarcinoma of the endometrium were treated with m-AMSA. Twenty-four patients (86%) were treated at 30 mg/M2/d X 3d q 21 d and four patients were treated at 40 mg/M2/d X 3d q 21 d intravenously. Eighty-eight courses of m-AMSA were administered with a median of 2 courses per patient. One (5%) complete response occurred in 19 patients evaluable for response. Toxicity was well tolerated and generally mild. m-AMSA may be relatively inactive in the treatment of advanced adenocarcinoma of the endometrium; further studies, however, are required to determine its effectiveness in primary previously untreated disease.

Adenocarcinoma↗
PubMed1984

Phase II and pharmacokinetic study of high-dose methotrexate in the treatment of advanced gynecologic malignancy. A Southwest Oncology Group Trial.

Fifteen patients with advanced or recurrent gynecologic malignancy were treated with high-dose methotrexate (HDMTX) (1-8 g/M2) and citrovorum factor rescue (10-100 mg/M2). One complete response (13%) and two improved responses occurred in eight patients (25%) with squamous cell carcinoma and one of seven patients (14%) with nonsquamous nontrophoblastic carcinoma had stable disease for 7 months. The median duration of survival in the squamous group was 9 months and in the nonsquamous groups 6.5 months. Mean serum MTX concentrations were proportional to the doses administered and typical two compartment plasma disappearance curves were seen. Adverse toxic reactions were not observed at serum MTX levels less than 7.8 X 10(-7) M at 24 hr and 1 X 10(-7) M at 48 hr post-MTX. Hematopoietic toxicity occurred most frequently with leukopenia observed in 19.5% of courses. Hepatic, renal, gastrointestinal, and dermatologic toxicities were observed infrequently. Drug-induced nephrotoxicity occurred in one patient and possibly related leukoencephalopathy occurred in another patient. On the basis of the relatively low response rate observed in this trial and the high expense of HDMTX therapy, the value of such therapy may be limited in advanced nontrophoblastic gynecologic cancer.

Adult↗
PubMed1984

Meningeal carcinomatosis from an ovarian primary: a clinicopathologic study.

Meningeal carcinomatosis due to primary ovarian carcinoma is an uncommon metastasis that presents difficult problems in diagnosis and management of patients known to have this disease. There is evidence that extended survival due to advances in treatment of ovarian carcinoma has improved our ability to diagnose meningeal carcinomatosis of this tumor more often. Herein the first case of meningeal metastasis of primary ovarian cancer with cytologic and postmortem examination is discussed.

Adenocarcinoma↗
PubMed1984

Trophoblastic cell sensitivity to 8-day chemotherapy in nonmetastatic gestational trophoblastic neoplasia.

Serial radioimmunoassay determinations of serum beta hCG and methotrexate were compared in two patients with nonmetastatic gestational trophoblastic neoplasia (NMGTN) treated with Goldstein's modification of Bagshawe's intermediate-dose methotrexate-citrovorum factor rescue-treatment program. Pretreatment beta hCG levels (mIU/ml) ranged within the outer limits of the 10(3) log level. Following intravenous methotrexate, sharp serum peaks between 10(-6) and 10(-5) M were observed. Plasma disappearance was rapid with a 3 log drop noted within 24 hr to levels incapable of inhibiting DNA synthesis. beta hCG levels manifested a 1 to 1.5 log drop over the 8 days of chemotherapy and complete remission was noted within 5 to 6 weeks of the first dose of methotrexate. No significant clinical or laboratory toxicity was observed. Although cell culture studies show that 100% of cell death can be achieved with serum levels of 10(-5) M in methotrexate-resistant choriocarcinoma, similar data do not exist for previously untreated trophoblastic neoplastic cells. These preliminary observations suggest that serum methotrexate levels are important for establishing sensitivity levels in a heterogeneous population of trophoblastic cells in NMGTN and that the total dose of methotrexate may be safely preselected on the basis of the pretreatment beta hCG.

Adult↗
PubMed1984

Mitoxantrone in epithelial carcinoma of the ovary. A Southwest Oncology Group study.

Thirty-nine patients with advanced heavily pretreated epithelial carcinoma of the ovary were treated with mitoxantrone (dihydroxyanthracenedione hydrochloride). Twenty-five patients were started at a dose of 12 mg/m2 q 21d and 13 patients, with compromised bone marrow, at a dose of 10 mg/m2 q 21d. Two stable responses (6%) occurred in 31 fully evaluable patients. The median duration of survival was 17 weeks. The principal toxicity, hematopoietic (primarily leukopenia), was mild and well tolerated. We conclude that mitoxantrone is a relatively inactive drug in the treatment of epithelial ovarian carcinoma.

Anthraquinones↗