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Biomedical subjects

R J Kryscio

Publications and source records attributed to R J Kryscio.

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

Use of snuff, chewing tobacco, and cigarettes among adolescents in a tobacco-producing area.

This study describes the prevalence and patterns of smokeless tobacco and cigarette use among adolescents with a specific focus on those living in a high tobacco production area. The subjects were 582 male and 485 female students in grades 7 through 12, with 54% living in a rural (nonmetro) area and the remainder living in an urban (metro) area. Self-reports of tobacco usage were validated using biochemical tests. High smokeless tobacco usage rates were found among nonmetro males--90% had tried one or more smokeless tobacco products and 33% had used at least one of the products in the last 6 days. Students' tobacco usage increased dramatically as the degree of personal involvement in raising tobacco increased. Of senior high boys who had household involvement in tobacco, 100% had tried snuff and 42% had used it in the last 6 days; 80% had tried cigarettes and 53% had used them in the last 6 days. Some other results were: (1) use of snuff was more popular than chewing tobacco, (2) the average grade for initiation to tobacco was the fourth grade for nonmetro students and the fifth grade for metro students, and (3) a large number of male smokeless users also reported cigarette use. Students from tobacco-raising households are at high risk for tobacco use. Future research should focus on effective prevention methods for high-risk students.

Adolescent↗
PubMed1990

Cure of cervical cancer using 252Cf neutron brachytherapy.

252Cf neutron brachytherapy was tested in a feasibility trial for efficacy for cervix cancer therapy vs. high stage radioresistant and subsequently for all stages of disease. Actuarial survival curves were analyzed for 218 patients treated between 1976 and 1983 and followed five to 14 years to the present time. A variety of doses, schedules and methods for brachytherapy was tested during this period, and a dose-response relationship for tumor eradication studied. All treatments were combined with whole-pelvis photon radiotherapy to approximately 45 to 60 Gy. This combination was found effective, particularly if an early implant schedule was used for the Cf implant, followed by whole-pelvis photon radiotherapy. For bulky/barrel shaped low-stage disease in medically fit patients, 252Cf implants were combined with surgery, i.e., extrafascial hysterectomy and was readily usable for treatment without complications and with high cure rates (92% five-year survival). All survivals and outcomes to 13 years match the best results of conventional photon radiotherapy. For all stages better results were observed for bulky, barrel, and advanced-stage tumors, especially for local tumor control, if optimal schedules, doses and implant numbers were used. Knowledge about neutron dose, dose per implant, number of implants and combination with photon beam therapy evolved during the trials. 252Cf represents a new quick acting effective radioisotope for human cancer therapy especially for treatment of radioresistant, bulky and high stage cancers.

Actuarial Analysis↗
PubMed1989

Stage I serous papillary carcinoma of the endometrium.

From 1973 to 1987, 16 patients with International Federation of Gynecology and Obstetrics (FIGO) Stage I serous papillary endometrial carcinoma were evaluated and treated at the University of Kentucky Medical Center (Lexington, KY). All patients were 60 years of age or older, and all were postmenopausal. Patients were treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy, and paraaortic lymph node sampling, and 38% were noted to have more extensive disease than appreciated clinically. Nine patients were given adjuvant postoperative radiation. Seven patients (44%) developed recurrent cancer with liver, lung, and upper abdomen being the most common sites of spread. Prognosis was most directly related to the presence of lymph vascular space invasion and the depth of myometrial penetration. No patient with serous papillary carcinoma confined to the endometrium developed recurrent cancer. In contrast, the recurrence rate of patients having myometrial invasion was 70% (P less than 0.03). Hormonal therapy was of limited value in the treatment of recurrent disease. This data suggests the need for adjuvant systemic therapy in the treatment of patients with Stage I serous papillary carcinoma of the endometrium who have myometrial invasion.

Aged↗
PubMed1989

Adjuvant oral alkylating chemotherapy in patients with stage I epithelial ovarian cancer.

From November 1973 to May 1986, 50 patients with Stage I epithelial ovarian cancer were treated at the University of Kentucky Medical Center (Lexington, KY) with oral Alkeran (melphalan) chemotherapy after primary surgery. Twenty-two patients had Grade 1 tumors, 23 patients had Grade 2 tumors, and five patients had Grade 3 tumors. Patients with ovarian tumors of borderline malignancy were excluded from this study. Twenty-eight patients received from six to 11 courses of chemotherapy and 22 patients completed 12 courses of chemotherapy. Chemotherapy was well tolerated and no patient died of chemotherapy-related complications. Thirty-eight patients underwent second-look laparotomy died of disease 41 months after diagnosis and one patient died with no evidence of disease 6 months after treatment. The actuarial survival of the total group of patients was 98% at 2 years and 94% at 5 years. Fewer than 12 months of chemotherapy may be necessary to obtain long-term survival in these patients.

Adenocarcinoma↗
PubMed1989

On the role of variable incubation periods in simple epidemic models.

The paper formulates a simple stochastic model which can be used to describe the early spread of an epidemic in a large population. Comparison of the behaviour of the epidemic under different assumptions for the distribution of the incubation period are made using the concept of partial ordering between random variables. It is shown that the process describing the infectious contacts between individuals has a major effect on the comparison of the different models. These results have important implications for modelling the AIDS epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Comparison of chemical methods for determining postmortem interval.

Accurate determination of postmortem interval (PMI) is a problem for the forensic thanatologist, especially in unwitnessed deaths. A number of objective chemical methods for determining PMI have been developed, the most widely used being accumulation of potassium in the vitreous humor. The authors previously have reported a chemical method for determining PMI from the predictable accumulation or clearance of the dopaminergic metabolite 3-methoxytyramine (3-MT) in the putamen of the brain. They have extended their previous study to compare directly the accuracy of determining PMI from the level of 3-MT in putamen with the level of potassium in vitreous humor. The data indicate that 3-MT is at least as accurate as, if not more accurate than, potassium accumulation in vitreous humor, although 3-MT levels can be affected by the cause of death and drugs present at the time of death. Nevertheless, determination of both the 3-MT and potassium levels can afford the most accurate method of determining PMI; preliminary nomograms for determining PMI from both variables are presented.

Carbon Monoxide Poisoning↗
PubMed1988

Feasibility study of Californium-252 for the therapy of stage IV cervical cancer.

Twenty patients with Stage IVA and IVB cervic cancers were treated with Californium-252 (Cf) neutron brachytherapy (NT) in a feasibility trial between 1976 and 1986. Eleven patients had Stage IVA disease; nine patients had Stage IVB disease. Patient compliance with therapy was poor in four of nine patients with Stage IVB disease, and the 50% survival time was 6 months. In Stage IVA disease there were 18% 3-year survivals. For those that failed, the 50% survival time was 7.5 months. Because of the frequency of disseminated metastases, effective adjuvant therapy needs to be developed to use after the tumor debulking therapy, especially for Stage IVB disease. A single early Cf-NT implant followed by 6000 cGy of whole-pelvis fractionated radiation would accomplish this adequately for local tumor control and palliation.

Adult↗
PubMed1988

Saliva cotinine and thiocyanate: chemical indicators of smokeless tobacco and cigarette use in adolescents.

Recent attempts to measure smoking behavior using chemical tests may have been confounded by the use of smokeless tobacco. An objective measure of smokeless tobacco use is needed, particularly among adolescents who may not provide accurate self-reports of tobacco usage. Saliva cotinine was used to distinguish self-reported tobacco users from nonusers and a combination of saliva cotinine and thiocyanate (SCN) tests was used to distinguish smokers from smokeless tobacco users. The subjects were 471 students in grades 7 through 11 who lived in a high-tobacco production area. Approximately 89% of reported nonusers had no detectable cotinine and 99% of nonusers had levels less than 25 ng/ml. Of those who had used tobacco within the last 12 hr, 95% had detectable levels of cotinine. Samples that tested positive for cotinine were also tested for SCN. Eighty-six percent of smokers and 74% of mixed users had SCN values of greater than 1000 mumol/liter, while only 14% of smokeless users had SCN values at that level. The combination of cotinine and SCN was effective in distinguishing smokers from smokeless users but was not effective in distinguishing mixed use from the other two types of use.

Adolescent↗
PubMed1988

Prognostic factors in early vulvar cancer.

Prognostic parameters were evaluated in 22 patients with small (less than or equal to 2 cm) superficially invasive (less than 5 mm) squamous cell carcinoma of the vulva. Primary surgery included radical vulvectomy with bilateral superficial and deep inguinal lymph node dissection in 11 patients, and wide local excision with ipsilateral superficial inguinal lymph node dissection in 11 patients. Of the 22 patients studied, only 2 (9%) had lymph node metastases. Both patients had a single positive ipsilateral superficial inguinal node. Perineural invasion was strongly associated with lymph node metastases (P less than 0.01). In this group of patients, grade, depth of invasion, lymph-vascular space invasion, and lymphoplasmacytic infiltration were not predictive of lymph node metastases (P greater than 0.05). Two patients initially treated with wide local excision and ipsilateral superficial inguinal lymph node dissection developed recurrent vulvar neoplasia on the contralateral vulva, and both were successfully retreated by wide local excision. All patients are presently alive and well with no evidence of disease. None of the histomorphologic parameters studied were predictive of tumor recurrence. These data suggest that wide local excision with ipsilateral superficial inguinal lymphadenectomy is effective in the treatment of patients with small, superficially invasive carcinomas of the vulva.

Adult↗
PubMed1988

Neutron interstitial brachytherapy for malignant gliomas: a pilot study.

Fifty-six patients with malignant glioma were treated with implantation of the neutron-emitting element californium-252 (252Cf) within 2 weeks after surgical debulking of the tumor. Implantation was performed using computerized tomography-guided placement of afterloading catheters, and the 252 Cf sources were removed after approximately 300 neutron rads were delivered. Patients then received 6000 to 7000 conventional photon rads by external beam. The total photon-equivalent dose to the tumor ranged from 8100 to 9100 rads. The median survival time was 10 months, with 18-and 24-month survival rates of 28% and 19%, respectively. The results of reoperation or autopsy showed that patients had recurrence of the tumor but that radiation necrosis was restricted to the area of the original tumor. Serious complications occurred in five patients (9%) and consisted of wound infections in three, cerebral edema in one, and radiation necrosis beyond the original tumor margin in one. Previous studies using external-beam neutron radiation have shown that neutrons are capable of totally eradicating malignant gliomas; however, in most cases, unacceptable widespread radiation necrosis has resulted. Neutron implants are a logical way to increase the dose to the tumor and decrease the dose to normal brain. Interstitial neutron radiation can be given safely with 252Cf, and the survival results achieved by radiation alone using relatively low doses of interstitial neutron radiation from 252Cf implants plus conventional photon radiation were equal to the results attained with any currently available conventional therapy.

Adult↗
PubMed1987

Treatment of stage IIIB cervical cancer with Californium-252 fast-neutron brachytherapy and external photon therapy.

From January 1977 to July 1984, 32 patients with Stage IIIB cervical cancer were treated at the University of Kentucky Medical Center by a combination of outpatient neutron brachytherapy and external pelvic radiation. These patients received 4500 to 5000 rad external photon therapy and two or three outpatient Californium-252 (252Cf) implants, plus sidewall boost irradiation. Treatment results were compared retrospectively to those obtained in a historical control group of patients with Stage IIIB cervical cancer treated with external radiation and conventional photon brachytherapy from 1972 to 1976. Local or regional tumor recurrence developed in 53% of patients treated with neutron therapy and an additional 9% experienced distant metastases. Thirty-eight percent of patients remain free of disease 12 to 96 months (mean, 51 months) after therapy. The 2-year and 5-year survival rates of patients treated with neutron therapy were 53% and 36%, which were not significantly different than those obtained with photon brachytherapy (2-year survival, 61%; 5-year survival, 34%). Complications of neutron therapy were minimal and included proctitis (19%) and vaginal stenosis (9%). There were no cases of enteric fistulae. Outpatient neutron brachytherapy was cost effective and was well tolerated by patients.

Adult↗
PubMed1987

Prognostic implications of large volume residual disease in patients with advanced stage epithelial ovarian cancer.

Thirty-two patients with Stage III or IV epithelial ovarian cancer and residual tumor volumes in excess of 2 cm in diameter after initial debulking were treated with platinum and cyclophosphamide chemotherapy. Twenty-seven patients (84%) received at least six courses of chemotherapy. Six patients developed grade 3 or 4 hematologic toxicity and one patient died with granulocytopenia and sepsis. The actuarial survival of the total group of patients was 78% at 12 months, 27% at 24 months, and 11% at 36 month. Of patients with residual disease 2-4 cm in diameter, 82% were alive 12 months after diagnosis and 46% were alive at 24 months. In contrast, patients with greater than 4 cm residual disease had a 12-month survival of 73% and a 24-month survival of only 7%. The size of residual tumor after surgery remains a very important prognostic factor in patients treated with platinum-based combination chemotherapy. Reoperation with further tumor debulking should be considered in ovarian cancer patients referred for chemotherapy with large volume residual disease to maximize response to combination chemotherapy.

Adult↗
PubMed1987

Tomographic levels for intravenous urography: CT-determined guidelines.

The selection of levels for tomographic sections of the kidneys during intravenous urography has previously been based on empirical observation. Three hundred abdominal computed tomographic scans were analyzed for the anteroposterior (AP) midpoints of the kidneys and their relationship to the patient's AP abdominal diameter. A graph for selection of tomographic levels was generated and compared with existing methods. These guidelines enable a more objective approach to urographic tomography.

Female↗
PubMed1986

Phase II clinical trial using californium 252 fast neutron brachytherapy, external pelvic radiation, and extrafascial hysterectomy in the treatment of bulky, barrel-shaped stage IB cervical cancer.

From June 1977 to June 1983, 32 patients with bulky (greater than 4 cm diameter), barrel-shaped Stage IB cervical cancer were treated at the University of Kentucky Medical Center by a combination of outpatient neutron brachytherapy using californium 252 (252Cf) and external pelvic radiation followed by extrafascial hysterectomy. Nineteen patients had cervical tumors 4 to 6 cm in diameter, and 13 patients had lesions in excess of 6 cm in diameter. A dose of 4500 rad external photon therapy was given from a linear accelerator, and one or two 6-hour 252Cf implants were given during or immediately after external radiation. Extrafascial hysterectomy with bilateral salpingo-oophorectomy was performed 6 weeks after completion of radiation therapy. Complications during and after radiation were minimal and included vaginal stenosis (three) and proctitis (two). Tumor clearance in the hysterectomy specimen was complete in 23 patients (72%) and residual cervical tumor was present in 9 patients (28%). Two patients developed tumor recurrence and died of disease 15 and 27 months after therapy, respectively. Thirty patients remain free of disease 26 to 96 months (median, 52 months) after treatment, and none have been lost to follow-up. The actuarial survival of these patients is 97% at 2 years and 94% at 5 years. Intracavitary neutron therapy is well tolerated and is effective when combined with external radiation and hysterectomy in the treatment of bulky, barrel-shaped Stage IB cervical cancer.

Adult↗
PubMed1985

Failure of antiplatelet therapy with ibuprofen (Motrin) to prevent neointimal fibrous hyperplasia.

To evaluate the effect of ibuprofen (Motrin) on the development of neointimal fibrous hyperplasia (NFH), 4 cm segments of expanded polytetrafluoroethylene (ePTFE) grafts with an internal diameter of 4 mm were implanted in the femoral arteries of 28 dogs. Three dogs served as controls and these grafts were removed at 7 to 14 days. The remaining 25 dogs were medicated with either intravenous (IV) or oral (PO) ibuprofen. The medicated dogs were grouped according to whether the ibuprofen was administered prior to or after graft implantation. The orally medicated dogs were also grouped according to whether the grafts were removed from 30 to 60 days after graft implantation. The grafts were analyzed for the amount of anastomotic initimal hyperplasia, pannus extension, thrombus deposition, and patency. Analysis of the data demonstrated no statistically significant differences among any of the treatment groups or the control group for the variables analyzed. We conclude that ibuprofen neither prevents nor retards the development of NFH. There was a trend toward less thrombus deposition in the animals that received oral ibuprofen preoperatively. There was also a trend toward higher patency in the animals that received ibuprofen prior to graft implantation, which most likely resulted from decreased thrombus and fibrin deposition.

Animals↗
PubMed1984

The threshold quantity of nerve required to induce limb regeneration in the chick embryo.

Wingbuds of 4-day chick embryos were amputated at the future elbow joint and a segment of embryonic neural tube was implanted longitudinally in the stump. The cross-sectional area and number of nerve bundles were determined in limbs in which limb regeneration occurred and compared with similar measurements in control limbs without neural tube implant. The number of nerve bundles in regenerated limbs was not significantly greater than in control limbs which did not regenerate. However, the cross-sectional area of nerve bundles was significantly greater in the limbs that had undergone regeneration. The data support the view that the amount of axoplasm available at the amputation (surface) site is the essential factor in determining the success or failure of regeneration.

Animals↗
PubMed1984

Mediastinal hemorrhage: an evaluation of radiographic manifestations.

Eleven common radiographic signs of mediastinal hemorrhage were evaluated by two observers for the following three patient groups: normal subjects, patients with mediastinal hemorrhage and no arterial injury, and patients with major thoracic arterial injury. Supine chest radiographs were studied in all cases. Four major conclusions can be made based upon these findings. M/C ratio (mediastinal width to chest width), tracheal deviation, left hemothorax, paraspinal line widening, and aorto-pulmonary window opacification do not reliably separate these three groups of patients. The diagnosis of mediastinal hemorrhage may be made if the aortic contour is abnormal or if one of the following signs is positive: abnormal mediastinal width, apical cap, widening of the right paratracheal stripe, or deviation of the nasogastric tube. If either the right paratracheal stripe is widened or the nasogastric tube is deviated, the diagnosis of aortic rupture can be made with a 24% probability; if both signs are negative, there is a 98% probability that aortic rupture is absent. Due to interobserver variation, there is good agreement between observers for the following four signs only: transverse mediastinal width, tracheal deviation, nasogastric tube deviation, and right paratracheal stripe widening.

Adolescent↗