PubMed Health⌕ Search

Biomedical subjects

R D Siegel

Publications and source records attributed to R D Siegel.

15 recordsLinked to original sources
PubMed2001

Survival and patterns of relapse following treatment of small-cell lung cancer at a community cancer center.

BACKGROUND: Although data from previously published trials have suggested an incremental improvement in response rate and survival in patients with small-cell lung cancer, few of these trials originate from private practice/community cancer center settings. The outcomes of patients with small-cell lung cancer treated in such a practice setting are reviewed and compared to prior studies with particular attention to the potential role of prophylactic cranial irradiation (PCI). METHODS: One hundred eighty patients treated between 1988 and 1998 comprise the basis of this analysis. In each individual, the specifics of therapy were recorded as well as the best response, sites of relapse, and survival. RESULTS: The disease was limited in extent (LD) in 99 patients (55%) and extensive (ED) in 81 (45%). The overall/complete response rates for LD patients and ED patients respectively were 90.9%/72.7% and 61.7%/18.5%. Median survivals for LD and ED patients were 20.2 and 9.59 months respectively. The one-year, two-year, and five-year actual survival rates for the entire group were 59.1%, 22.2%, and 8.7%. Central nervous system relapses occurred in 42.9% of this largely nonprophylactic cranial irradiation treated patient population. The central nervous system was the only site of relapse in 13.6%. CONCLUSIONS: The outcomes of patients treated in this private practice/community cancer center setting are similar to those previously published from single university and multi-institutional studies. Although these data support the use of cranial irradiation in patients who achieve a complete response, the impact of such an intervention will remain relatively insignificant until there is an improvement in systemic therapy.

Aged↗
PubMed1998

Toxic nodular goiter. Toxic adenoma and toxic multinodular goiter.

Solitary toxic adenoma and toxic multinodular goiter are very common forms of thyrotoxicosis around the world. Advances in molecular biology and genetics have led to new insights into the pathogenesis of these disorders. Current theories on autonomy in the thyroid are discussed in this article. The therapeutic roles of surgery, radioiodine ablation, and percutaneous ethanol administration also are reviewed.

Adenoma↗
PubMed1996

Lipoproteins, apolipoproteins, and low-density lipoprotein size among diabetics in the Framingham offspring study.

Diabetes mellitus has been shown to be associated with lipid abnormalities. Prior studies have indicated that women with diabetes have a risk of coronary heart disease similar to that of men. We compared lipid parameters in diabetic and nondiabetic participants in cycle 3 of the Framingham Offspring Study. Values for plasma total cholesterol (TC), triglyceride, lipoprotein, cholesterol, apolipoprotein (apo) A1, B, apo and lipoprotein(a) [Lp(a)] and low-density lipoprotein (LDL) particle size were analyzed in 174 diabetic and 3,757 nondiabetic subjects. Data from a total of 2,025 men and 2,042 women participating in the third examination (1983 to 1987) of the Framingham Offspring Study were subjected to statistical analysis. Male and female diabetics showed lower high-density lipoprotein (HDL) cholesterol, higher triglycerides, higher very-low-density lipoprotein (VLDL) cholesterol, lower apo A1, and higher LDL particle scores, indicating smaller size, than nondiabetics. Female diabetics also showed significantly higher TC and apo B values than nondiabetics. The results remained statistically significant after controlling for obesity and menopausal status. The presence of small dense LDL particles (pattern B) was highly associated with diabetes and hypertriglyceridemia in both sexes, and the relative odds for pattern B remained significant in women but not in men after adjustment for age and hypertriglyceridemia. No differences in apo E isoform distribution were found for diabetics and nondiabetics. Diabetes was not associated with elevated LDL cholesterol levels. In conclusion, diabetics have lower HDL cholesterol and higher triglyceride levels and are more likely to have small dense LDL particles. Diabetes is not a secondary cause of elevated LDL cholesterol. Lipid screening of diabetics should include full quantification of lipids for proper assessment of potential atherosclerotic risk.

Adult↗
PubMed1994

Fatigue: the role of adrenal insufficiency.

The case described confirms the status of chronic fatigue among the most common--and most frustrating--of all the symptoms physicians are called on to evaluate. New theories regarding the causes of the complaint implicate not only neuroendocrine interactions but the immune system and its cytokines as well.

Adrenal Insufficiency↗
PubMed1992

Risk assessment in cancer patients with fever and neutropenia: a prospective, two-center validation of a prediction rule.

PURPOSE: The study was undertaken to validate a clinical model for predicting the medical risk of cancer patients with fever and neutropenia. PATIENTS AND METHODS: A consecutive sample of 444 cancer patients with fever and neutropenia (granulocyte count less than 500/microL) at two hospitals, a specialized cancer referral center and a university-affiliated general medical hospital, was studied to identify clinical characteristics in the first 24 hours that predict subsequent serious medical complications during the hospital stay. To control for bias, major risk factors and complications were subject to blinded review. RESULTS: Serious medical complications occurred in 34% of patients with risk factors identified in a prior study, including prior inpatient status (group I), outpatients with a serious independent comorbidity (group II), or uncontrolled cancer (group III), compared with 5% of the remaining patients (group IV) (P less than .000001). Two of the complications in group IV patients were transient asymptomatic hypotension, and the remaining three complications occurred after at least 1 week of progressive medical deterioration. These risk groups were independently significant in stepwise logistic regression analysis. Multiple complications (17%) and death (10%) were common among patients in groups I through III but did not occur in group IV patients. CONCLUSIONS: This risk assessment model accurately stratified the medical risk of these patients using only clinical information available on the first day of their course. Low-risk patients are an appropriate population in which to study less intensive treatment strategies.

Adolescent↗
PubMed1990

Systemic toxicity following intracavitary administration of bleomycin.

Bleomycin administered intrapleurally has been demonstrated to be an effective sclerosing agent. The lack of morbidity associated with its use has made it an attractive alternative to other available agents. Pharmacologic data indicate that (1) intracavitary bleomycin is systemically absorbed, and (2) the plasma half-life of bleomycin increases exponentially with renal failure. We report the findings in a patient with renal failure who experienced alopecia and significant mucositis following sclerotherapy. We suspect this systemic toxicity resulted from intrapleural bleomycin and suggest that this treatment be used with caution in patients with renal dysfunction.

Adult↗
PubMed1989

Osteosarcoma in adults. One institution's experience.

Twenty-six patients were referred to the adult sarcoma clinic of the authors' institution between 1979 and 1986. The diagnosis was not confirmed in four patients. The median age of the 22 confirmed patients was 37. Twelve patients had central skeletal primaries; of these 12, seven had metastatic or unresectable disease. Six patients were treated with complete resection of tumor followed by adjuvant chemotherapy; of these six, four remained continuously disease-free at 25+, 29+, 72+, and 75+ months. Eight patients received no adjuvant chemotherapy following complete resection. Four have remained disease-free for more than two years (31, 33, 44, 44+ months); however, only one remains continuously disease-free. Adults tolerated chemotherapy well and should be considered appropriate candidates for adjuvant trials. Many, however, will have advanced-stage, poor-prognosis lesions and require alternative approaches for treatment.

Adolescent↗
PubMed1988

Adults with Ewing's sarcoma. An analysis of 16 patients at the Dana-Farber Cancer Institute.

Between 1975 and 1985, 16 patients with Ewing's sarcoma were treated in the Adult Sarcoma Clinic at the Dana-Farber Cancer Institute. Of 10 patients with extraskeletal or pelvic primaries, 2 (1 pelvic, 1 extraskeletal) are surviving disease-free at 77 and 103 months from diagnosis. Of the six remaining patients, 5 are alive from 38 to 125 months from diagnosis. No relapses were documented after 18 months of disease-free survival. Adults with localized skeletal Ewing's sarcoma outside the pelvis respond well to multimodality therapy. However, pelvic and extraskeletal disease occur in a disproportionately large segment of this older population and are associated with a poor prognosis.

Adolescent↗
PubMed1986

Relapse with nodular lymphoma following combination chemotherapy for diffuse non-Hodgkin's lymphoma.

Histologic conversion within the non-Hodgkin's lymphomas is a well-described phenomenon. Conversion from an indolent to that of a more aggressive histologic pattern is the most frequently noted form of this variability. We describe two patients in whom relapse with an indolent nodular lymphoma was noted after combination chemotherapy for diffuse disease. Implications for diagnostic evaluation and therapy as well as the pathogenesis of this unique form of conversion are discussed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1976

Control of particulate emissions from stationary fuel burning sources in the core area of the Metropolitan Boston air quality control region.

Strategies to control emissions were investigated to develop a plan to meet secondary ambient particulate standards in Metropolitan Boston. Each strategy was evaluated for emission reduction potential, cost, and feasibility. The strategy selected by the State, a periodic inspection and maintenance plan for combustion sources, meets the goal of clean air at minimum cost.

Air Pollutants↗