Biomedical subjects

R V Gumbs

Publications and source records attributed to R V Gumbs.

8 recordsLinked to original sources

PubMed1992

Induction chemotherapy for advanced head and neck cancer: modification of response to chemotherapy by antiemetics.

Forty Stage IV head and neck cancer patients were entered on a multimodality trial of induction chemotherapy (cisplatin + infusional 5-fluorouracil), surgery, and radiation. During chemotherapy, the patients of Group A (the first 19 patients) were medicated with metoclopramide. The patients of Group B (the next 21 patients) were medicated with droperidol. The groups were comparable. The response rate (complete + partial) was 32% for Group A and 52% for Group B (p = 0.16). Primary site (p = 0.08) and surgical margin (p = 0.005) clearance of tumor were better in Group B. Nodal disease responded poorly to chemotherapy in both groups. Tumor necrosis (p = 0.006) and granulation tissue (p = 0.07) were reduced in surgical specimens after chemotherapy in Group B. The drugs were well tolerated with reversible toxicity; nausea/vomiting (p = 0.01) and weight loss (p = 0.07) after chemotherapy, were increased in Group B. The 2-year survival was 26% for Group A and 62% for Group B (p = 0.027). The median survival was 15 months for Group A and 33 months for Group B (p = 0.05). Progression-free survival improved in Group B (p greater than 0.17). These improvements in response and survival did not appear to reflect changes in surgical or radiotherapy management, but may have reflected an uninhibited effect of cisplatin in Group B. It is theorized that the metabisulfite formulated with metoclopramide altered the pharmacokinetics or pharmacodynamics of cisplatin. This resulted in the poor response to chemotherapy and poor survival in Group A. An analysis of a randomized trial comparing metoclopramide (formulated with metabisulfite) versus a control antiemetic can confirm the data presented in this pilot study. Overall, our patients survived as well as others in comparable multimodality studies in Europe and the United States.

Adult↗

PubMed1992

Fused pelvic kidneys: case report.

A case of fused pelvic kidneys is presented. We believe this to be the first report using ultrasound, computed tomography, and magnetic resonance imaging for presentation of a rare anatomic renal anomaly.

Female↗

PubMed1991

Rib fractures complicating median sternotomy.

The postoperative chest radiographs of 100 consecutive patients undergoing median sternotomy were reviewed for the presence of acute rib fractures. The majority of patients underwent coronary artery bypass grafting. Thirteen patients sustained 15 fractures. Eleven of these fractures were of the left first rib and 7 of the 15 fractures occurred at the costotransverse articulation. The fractures tended to be subtle on the postoperative portable chest radiographs and were initially overlooked in 4 patients. Heavier patients and those with larger body surface areas were more susceptible to the development of fractures. There was no statistical correlation to total operating time, bypass time, or global ischemic time.

Aged↗

PubMed1991

Lisfranc fracture-dislocations: report of two cases.

Lisfranc fracture-dislocation is a rare but sometimes dramatic injury, most commonly associated with motor vehicle and industrial accidents, and falls from heights. Radiographic examination is a crucial point in the work-up of these patients. The most common findings on plain radiographs are separation of the bases of the first and second metatarsals and the "fleck" sign, a bony fragment resulting from a fracture of the base of the first or second metatarsal. These fractures are demonstrated in the two cases presented. We conclude that these lesions can usually be diagnosed with plain radiographs if scrupulous attention is paid when evaluating the normal anatomic alignments. Computed tomography should be reserved for equivocal cases.

Adult↗

PubMed1988

Pneumocystis carinii pneumonia complicated by lymphadenopathy and pneumothorax.

A case of generalized Pneumocystis carinii infection presented as hilar and mediastinal lymphadenopathy and was complicated by spontaneous pneumothorax. Extrapulmonary P carinii infection in patients with acquired immunodeficiency syndrome is rare, and pneumothorax is even rarer. The purpose of this report is to call attention to these atypical features of P carinii infection in patients with the acquired immunodeficiency syndrome.

AIDS-Related Complex↗

PubMed1987

Thoracic extramedullary hematopoiesis in sickle-cell disease.

The radiographic manifestations of thoracic extramedullary hematopoiesis are unilateral or bilateral, smooth, sharply delineated, often lobulated paraspinal masses without erosion of the vertebral bodies or ribs, sometimes associated with subpleural, paracostal masses. These radiographic findings were encountered in eight adult patients with homozygous sickle-cell disease. In one patient, the masses encompassed essentially the entire thoracic paravertebral area bilaterally. In the other seven patients, the masses were unilateral and limited to the region of the eighth to the 12th thoracic vertebrae. Two of the eight patients had lateral subpleural masses that were not contiguous with the paraspinal masses and that were located medial to the lateral portions of the ribs. Follow-up in seven of the cases ranged from 2 to 15 years and demonstrated, after relatively rapid growth initially, either no change in size or slow growth. Each patient was asymptomatic with regard to the thoracic masses. Histologic verification was not available in any case because of the lack of clinical indication for invasive diagnostic or therapeutic procedures. The presence of well-defined unilateral or bilateral paraspinal masses and/or paracostal masses in patients with homozygous sickle-cell disease and without related symptoms should alert one to the possibility of the presence of extramedullary hematopoiesis. These masses tend to be slow-growing and should not be subjected to aggressive diagnostic and therapeutic measures.

Adolescent↗

PubMed1987

Intrapulmonary thymoma.

A 50-year-old man presented with a lung mass in the left upper lobe, which was shown by electron microscopy to be a thymoma. There was no evidence of a mediastinal mass. The lymphocytes of the tumor reacted with monoclonal antibody T101, a pan T-cell marker, and with OKT8. B1 and B2 surface antigens characteristic of B lymphocytes were not detected. Tumors of thymic epithelial cells completely covered by pleura without mediastinal involvement are rare.

Humans↗

PubMed1985

Tuberculous mediastinal lymphadenitis with a chest wall mass.

A 14-year-old black female was found to have massive lymphadenopathy and osteomyelitis of the sternum in association with a parasternal mass. Diagnostic studies revealed tuberculosis as the etiology of this patient's skeletal and mediastinal disease. The differential diagnosis of chest wall lesions accompanied by mediastinal disease is discussed.

Adolescent↗