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Biomedical subjects

R Franklin

Publications and source records attributed to R Franklin.

At least 55 records · Page 3Linked to original sources
PubMed1984

Safety and efficacy of continuous intravenous morphine for severe cancer pain.

To study the efficacy and safety of continuously administered intravenous morphine for cancer pain unrelieved by standard narcotic therapy, bolus intravenous injections of 2 to 5 mg of morphine were given every 10 minutes until pain relief was achieved. Within the next hour, continuous intravenous morphine infusion was begun with the hourly dose equal to the cumulative bolus dose. Respiratory rate, pulse, blood pressure, arterial blood gas values, mental status, and pain relief were recorded at baseline and during the study period. A reduction in arterial oxygen pressure (PaO2) and/or increase in arterial carbon dioxide pressure PaCO2 of more than 20 percent of baseline values occurred, during the first 24 hours of infusion, in a minority of patients. This did not require changes in hourly morphine dose. Despite subsequent increases in morphine dose, blood gas values tended to remain at or return toward baseline values. Severe toxicity occurred during one trial and was heralded by bradypnea and marked somnolence. Major pain relief was achieved in 11 of 15 trials. Therefore, continuous intravenous morphine is effective and safe therapy. Bradypnea associated with marked somnolence is a cause for dose reduction.

Acute Disease↗
PubMed1984

Continuous wave Doppler velocimetry as an adjunct to cross sectional echocardiography in the diagnosis of critical left heart obstruction in neonates.

If cross sectional echocardiography in isolation is used to diagnose critical left ventricular outflow obstruction in neonates, false positive and false negative diagnoses may result. Continuous wave Doppler velocimetry was used to measure blood flow velocity in the ascending and descending thoracic aorta in six neonates (aged less than 6 weeks) presenting with reduced or absent peripheral pulses in order to determine the important sites of obstruction. This technique demonstrated abnormal high velocity blood flow jets (three times higher than normal) in the ascending aorta in three patients with normal descending aortic flow velocity, suggesting aortic stenosis. In the other three patients velocity in the ascending aorta was normal but high in the descending aorta, suggesting coarctation. The Doppler diagnosis was confirmed in the five patients who required surgery. Two patients had residual high velocity jets after aortic valvotomy. Both had significant pressure gradients across the aortic valve at cardiac catheterisation with good agreement between actual gradients and those predicted by the Doppler technique. Thus a combined anatomical and physiological approach using cross sectional echocardiography and continuous wave Doppler velocimetry enables accurate non-invasive definition of the site of left ventricular outflow obstruction and may obviate the need for invasive investigation in these sick neonates.

Aortic Coarctation↗
PubMed1983

True histiocytic lymphoma. A report of four cases.

Clinical, morphologic, cytochemical, immunologic, and ultrastructural features of four cases of true histiocytic lymphoma are described. The neoplastic cells were large, ranging from 20 to 45 mu in diameter with round, folded, or convoluted nuclei, and abundant eosinophilic cytoplasm. They exhibited diffuse nonspecific esterase activity. Diffuse acid phosphatase activity was present in two cases so tested. Muramidase activity was present in half of the cases. Finely granular PAS-positive material was seen in the cytoplasm. Methyl green-pyronin positivity was variable. An occasional neoplastic cell showed erythropagocytosis in one case. Malignant cells either contained no cytoplasmic immunoglobulins (three cases) or had immunoglobulins of multiple classes (one case). Surface markers were studied in two cases; they were absent in one case, and were of multiple classes in another case. Ultrastructurally the neoplastic cells had lysosomal granules in three cases so examined, and phagolysosomes, phagocytized material and residual bodies in one of three cases so studied. Patients ranged in age from 28 to 60 years. Two patients had extralymphatic tumors. Survival of more than 5 years was seen in one patient.

Adult↗
PubMed1983

Combined modality therapy for esophageal squamous cell carcinoma.

Of 55 patients with esophageal squamous cell carcinoma, 30 with localized disease were treated with a combined modality for curative intent. Treatment consisted of mitomycin C (10 mg/m2 day 1) and continuous infusion 5-FU (1000 mg/m2 day, days 1-4, 29-32) (CT), radiation (XRT) (3000 rad, days 1-21) with nutritional support, and surgery (days 49-64). Surgery consisted of celiotomy, esophagectomy and esophagogastrostomy +/- postoperative ventilatory support. Postoperative CT plus an additional 2000 rad XRT was restricted to patients with histologic positive tumor. Since five resected patients with subclinical metastatic tumor had an inferior survival equal to 25 patients treated essentially for palliation, pretreatment celiotomy seems warranted to identify patients with an inferior prognosis. Of 18 resected patients without disseminated tumor evaluable for this combined modality: six were tumor free, three had intramural and nine transmural tumor; the median survival is 76 weeks and five of six living patients are disease free at 95-190 weeks; and local recurrence occurred in two and in two of seven unresected patients. Since toxicity was minimal except for postoperative pneumonitis (13%) and local recurrence low (13%), two courses of chemotherapy and 5000 rad XRT perhaps obviates the need for resection.

Abdomen↗
PubMed1983

Management of malignant bronchoesophageal fistulas.

Twenty-four patients with a bronchoesophageal fistula due to a malignant lesion were seen during the eight years from 1974 to 1981. Twenty of the patients had carcinoma of the esophagus, and four patients had carcinoma of the lung. All three patients who had a Celestin tube inserted had gastric reflux, and in two, the fistula was not completely occluded. Four patients who had a cervical esophagostomy, feeding jejunostomy and ligation of the gastroesophageal junction died in the immediate postoperative period. The best palliative result was achieved in 17 patients who had a bypass of the fistula with the stomach. Fourteen had a substernal gastric bypass to the cervical portion of the esophagus, and three patients had a gastric bypass to the upper thoracic portion of the esophagus by way of a right thoracotomy. Although the operative deaths occurred in six of 17 patients, the surviving patients resumed oral feeding within ten to 14 days after operation, and the pneumonias cleared. These patients had, by far, the best palliative result. We, therefore, advocate substernal or intrathoracic bypass of the bronchoesophageal fistula as soon as the general condition of the patient permits.

Adult↗
PubMed1982

Pharmacokinetics of meptazinol in man following repeated intramuscular administration.

A study was performed in 6 healthy volunteers to determine whether 50 mg intramuscular doses of meptazinol repeated four hourly for 24 h would lead to accumulation of the drug. The first dose of meptazinol was rapidly absorbed with a subsequent mean (+/- SD) elimination half-life of 1.6 +/- 0.33 h. This value was unaffected by the administration of intermediate doses. There was no significant accumulation of the drug; 95% of the steady-state plasma concentration was achieved after a mean (+/- SD) of 1.9 +/- 0.39 and 99% after a mean (+/- SD) of 2.9 +/- 0.63 doses. These findings are consistent with the theoretical prediction for a rapidly absorbed drug with a plasma elimination half-life of 1.6 h. No clinically relevant changes were seen in pulse blood pressure, haematological or biochemical screens. Reported side effects were of a subjective and minor nature.

Adult↗
PubMed1982

Simple linear filtering of time series data on a programmable calculator.

A program is presented for the Texas Instruments SR-52 programmable calculator which computes simple moving averages of time series data. Design and programming emphasis was placed on ease of use and time savings. The output from this program is useful in determining the shape of time-ordered sequences of data. The technique used for internally reordering the data after each individual calculation is explained is some detail as it may be useful in any program of an algorithm involving a moving window on a sequence of data.

Animals↗
PubMed1982

Increased numbers of lymphocytes with single class surface immunoglobulins in reactive hyperplasia of lymphoid tissue.

Forty-seven lymph nodes and one stomach exhibiting reactive hyperplasia from 40 patients were examined by morphologic and immunologic methods. Twelve lymph nodes and one stomach from ten patients had a significantly increased number (greater than 25%) of lymphocytes, with single class surface immunoglobulins or plasma cells, and plasmacytoid lymphocytes secreting single class immunoglobulins. In three cases, a diagnosis of malignancy was subsequently made on the basis of morphological and immunological evidence of tumor in other tissue. Five patients had collagen disorders, two had a persistent unexplained hypergammaglobulinemia, and two had no recognized associated disease. The significance of an increase of B lymphocytes with single class surface immunoglobulins in these cases is presently not clear, but patients with similar findings should have extensive investigation and persistent follow-up.

Adult↗
PubMed1981

Complete eradication of squamous cell carcinoma of the esophagus with combined chemotherapy and radiotherapy.

Chemotherapy (with 5-fluorouracil and either mitomycin-C or cis-platinum) combined with radiotherapy was used either for palliation or as preoperative therapy in 67 patients with squamous cell carcinoma of the esophagus. In 25 patients having chemotherapy and 5000-6000 rads, good local palliation was obtained in 11 (49%) without surgery. In the remaining 25 patients, swallowing was restored with a variety of procedures (primarily Celestine tube or gastric bypass). The average survival time was seven months and two patients are still alive at 9 and 12.5 months. Of 42 patients receiving preoperative chemotherapy and radiotherapy, 35 had surgery. Of these, 13 (37%) had complete eradication of their tumors with no histologic evidence of carcinoma in the resected esophagus or associated lymph nodes. In another six (17%), the only evidence of tumor was small microscopic foci of cancer cells in the wall of the esophagus. The 6-, 12-, and 24-month survival rates for patients having surgery after the combined preoperative chemotherapy and radiotherapy were 83 per cent, 52 per cent, and 30 per cent, respectively. These results are far superior to those previously obtained.

Adult↗
PubMed1981

Eradication and palliation of squamous cell carcinoma of the esophagus with chemotherapy, radiotherapy, and surgical therapy.

Between April, 1977, and March, 1981, 86 unselected patients with proved squamous cell carcinoma of the esophagus were treated with a combination of chemotherapy and radiotherapy followed by operation whenever feasible. The preoperative chemotherapeutic agents used initially were 5-fluorouracil, and mitomycin C. After December, 1979, cis-platinum was used instead of mitomycin C. Radiotherapy (3,000 rads) of the tumor was begun at the same time as the chemotherapy. An esophagectomy was performed on suitable candidates 3 to 4 weeks after the chemotherapy and radiotherapy were completed. The mucosal lesion disappeared in 69 of the 86 patients, and dysphagia was relieved at least temporarily in 57 of 62 patients. Recurrent dysphagia resulting from fibrosis at the tumor site caused a secondary stenosis in 11 patients. Excellent palliation was obtained in five patients with bronchoesophageal fistulas who had an initial substernal gastric bypass followed by chemotherapy and radiotherapy. Of the 48 patients who had an esophagectomy, 15 (31%) had no tumor in the resected specimen. Eleven of these 15 patients are still alive with no evidence of disease. All patients with a lesion less than 5.0 cm in length had complete regression of the tumor. We believe that this combination of chemotherapy, radiotherapy, and surgical therapy provides excellent palliation, increases resectability, and has a potential for cure.

Adult↗
PubMed1980

A phase I-II study of maytansine utilizing a weekly schedule.

Maytansine, a new ansa macrolide antitumor antibiotic, was administered to a total of 107 patients in a Phase I-II study. Dose-limiting toxic reactions which occurred at 0.75-1.0 mg/M2 in both Phase I and II were neurologic and consisted primarily of lethargy/weakness (a debilitation syndrome) and paresthesias. Gastrointestinal and neurologic toxic reactions increased in frequency and severity as a function of dose. Myelosuppression, while infrequent, occurred only in previously treated patients. Changes in liver function tests were subclinical. Two partial remissions were observed at a dose-level of 0.5 mg/M2 in Phase I:1 patient with squamous cell carcinoma of the lung responded for five weeks, while the other patient with adenocarcinoma of the lung responded for four weeks. One partial remission, lasting 14 weeks was seen in Phase II in a patient with malignant melanoma treated at dose-level of 1.0 mg/M2. All responses were in heavily pretreated patients. pairs of small bowel biopsy specimen used to define the mitotic index demonstrated peak mitotic arrest at 24 hours in contrast to vinca alkaloids which appear to have a peak mitotic arrest at 12-24 hours.

Adult↗
PubMed1978

Seven-day clotrimazole therapy for vulvovaginal candidiasis.

There were 150 patients with mycologically proven vulvovaginal candidiasis in a randomized, non-cross-over study which compared seven-and 14-day treatment courses of clotrimazole vaginal tablets (Gyne-Lotrimin) with a 14-day treatment course of miconazole nitrate 2% vaginal cream (Monistat). Adequate data for analyses were obtained for 117 patients. When patients were reexamined four or more weeks after completion of therapy, success rates, based on clinical and mycologic criteria, were: 88% for patients treated with clotrimazole for seven days, 84% for clotrimazole 14-day treatment, and 78% for miconazole nitrate 14-day treatment. There were no drug-related adverse reactions. Thus a seven-day course of therapy with clotrimazole is effective as is a 14-day course of either clotrimazole or miconazole nitrate 2% for the treatment of Candida vaginitis. Statistical analysis revealed no significant differences among the clotrimazole seven-and 14-day treatment groups and the miconazole nitrate 14-day treatment group. The shorter period of administration required for this new antifungal agent should result in better patient compliance and an improved success rate in the rate in the treatment of this frequently encountered infection.

Adolescent↗
PubMed1978

Citrate and isocitrate utilization by rat ventral prostate mitochondria.

Isolated rat ventral prostate mitochondria preparations were capable of utilizing exogenous isocitrate with some resulting production of citrate. The prostate preparation did not utilize citrate or alphaKG. Citrate utilization via isocitrate seems to be limited by a unique aconitase activity which permits isocitrate to citrate but not citrate to isocitrate conversion. In contrast, kidney cortex mitochondria (under these same conditions) were capable of utilizing citrate, isocitrate, and alphaKG, and also converting isocitrate to citrate. The results support the view that citrate oxidation by prostate may be limited at the aconitase step, and thus may be a key step in accounting for the uniquely high citrate content of prostate.

Animals↗
PubMed1976

Mitochondrial isocitrate dehydrogenase and isocitrate oxidation of rat ventral prostate.

Mitochondrial preparations isolated from rat ventral prostate were capable of oxidizing isocitrate by way of NADP isocitrate dehydrogenase (NADP-IDH) and NAD-IDH. NAD-IDH activity required ADP for activation. The pH responses for NAD-IDH and NADP-IDH were quite different. The results indicated that two different enzymes were involved in the NAD- and NADP-IDH activities. Indirect evidence indicated that NADPH-NAD transhydrogenase activity might also be involved in the mitochondrial pathway for isocitrate oxidation. NADP-IDH activity was significantly greater than NAD-IDH activity. The oxidation of isocitrate through IDH activity was coupled to the cytochrome system by NADPH- and NADH-cytochrome c reductase activities. Citrate, via isocitrate, oxidation proceeded at a much slower rate suggesting that aconitase activity could be limiting in the oxidation of citrate. In comparison to other tissues, the prostate oxidative enzyme activities are considerably lower. The results suggest that the accumulation of high prostate citrate levels is not due to a limitation imposed by a lack of IDH activity in prostate mitochondria.

Animals↗