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Biomedical subjects

Robert Morgan

Publications and source records attributed to Robert Morgan.

At least 19 recordsLinked to original sources
PubMed2004

Prognostic indicators and survival in patients with stage IIIB inflammatory breast carcinoma after dose-intense chemotherapy.

PURPOSE: To improve treatment outcome for patients presenting with inflammatory breast cancer (IBC), we have sequentially developed and tested single and tandem dose-intense chemotherapy regimens (DICT). Tumor- and treatment-related factors were analyzed to generate a prognostic model. PATIENTS AND METHODS: Between May 1989 and April 2002, 120 patients received conventional-dose chemotherapy, surgery, and sequentially developed single- or tandem-cycle DICT. Disease- and treatment-specific features were subjected to univariate and multivariate analysis to correlate with outcome. RESULTS: At a median follow-up of 61 months (range, 21 to 161 months), estimated 5-year relapse-free survival (RFS) and overall survival (OS) were 44% (95% CI, 34% to 53%) and 64% (95% CI, 55% to 73%), respectively. In an age-adjusted multivariate analysis, RFS was better in patients with estrogen receptor (ER)/progesterone receptor (PR)-positive tumors (P =.002), for patients with fewer than four involved axillary nodes before DICT (P =.01), and in patients treated with radiation therapy (P =.001) and tandem DICT (P =.049). OS was improved in patients with ER/PR-positive tumors (P =.002), in those with fewer than four involved axillary nodes before DICT (P =.03), and in patients treated with radiation therapy (P =.002). CONCLUSION: This retrospective analysis suggests that either single or tandem DICT can be administered safely and may benefit selected patients with stage IIIB IBC. Those with receptor-negative IBC and with four or more involved axillary nodes before DICT need improved neoadjuvant and postadjuvant intensification therapy. A prospective randomized trial of single versus tandem DICT would be required to confirm the potential benefit of tandem DICT in the setting of IBC.

Adult↗
PubMed2004

Neurophysiological study of peripheral neuropathy after high-dose Paclitaxel: lack of neuroprotective effect of amifostine.

PURPOSE: To determine if there is a beneficial effect of amifostine in preventing or reducing the neuropathy induced by high-dose paclitaxel. METHODS: Breast cancer patients receiving high-dose infusional paclitaxel (725 mg/m(2)/24 h) in combination with doxorubicin (165 mg/m(2)/96 h) and cyclophosphamide (100 mg/kg/2 h; ACT) were studied on two autologous peripheral blood stem cell transplant protocols, one with and one without amifostine (740 mg/m(2) administered over 10 min before and 12 h after initiation of the paclitaxel infusion). Patients were evaluated before ACT and 20-40 days later with neurological examination, a composite peripheral neuropathy score, peroneal and sural nerve conduction studies, and quantitative sensory testing. RESULTS: There was no significant difference in paclitaxel maximum concentration, systemic clearance, or area under the curve determinations. Narcotic requirement as well as recovery of hematopoietic counts were also similar in subjects with or without amifostine. After ACT was administered, there was a decrease in peroneal nerve compound muscle action potential amplitude and sural nerve sensory action potential amplitude, as well as an increase in vibratory and cold detection thresholds. Clinical composite peripheral neuropathy scores were similar despite amifostine treatment; and logarithm to the base 2 ratios post/pre ACT showed no significant effect of amifostine on peroneal nerve compound muscle action potential, sural nerve sensory action potential, vibratory detection thresholds, or cold detection thresholds. All subjects had acroparesthesias and lost their ankle deep-tendon reflexes after administration of ACT. CONCLUSIONS: Single high-dose paclitaxel produces predictable clinical and neurophysiological changes so that patients receiving high-dose therapy are ideal subjects to test the effectiveness of neuroprotective agents. Amifostine was ineffective in preventing or reducing the neurotoxicity of high-dose paclitaxel.

Adult↗
PubMed2004

Pre-myomectomy uterine artery embolisation minimises operative blood loss.

Women with massive fibroids (extending beyond the level of the umbilicus) are conventionally offered a hysterectomy, rather than myomectomy, which is considered too technically challenging, with risks of excessive haemorrhage. Some women desire fertility, or may simply wish to preserve their uterus. Uterine artery embolisation is a relatively new treatment for fibroids, and complication rates are thought to be high with massive fibroids. We have performed uterine artery embolisation immediately prior to myomectomy, and found a reduction in blood loss. Uterine artery embolisation may be a useful adjunct to surgery in women with massive fibroids or for whom uterine artery embolisation alone is considered inadequate primary treatment, those with previous myomectomy where surgery might be complicated by extensive adhesions, in Jehovah's Witnesses and in other women who refuse blood transfusion.

Arteries↗
PubMed2004

Challenges and strategies for proper pediatric nutrition and weight control.

Pediatric and adolescent obesity are a growing problem in New Jersey and throughout the United States. The long-term health consequences may produce a generation of children with a shorter life expectancy than their parents have. A coordinated effort by parents, teachers, physicians, public health organizations, schools, and peers is essential in encouraging children who are currently overweight to lose weight and attain a normal body mass index and to prevent other children from becoming overweight.

Adolescent↗
PubMed2004

Challenges and strategies for improving the mental health of New Jersey children and adolescents.

Mental health issues facing children and adolescents in New Jersey are an under-recognized health care issue. Insufficient data are available to fully define the scope of the problem. Current resources for early diagnosis and treatment do not meet the need. In an era in which the usual stress of adolescence is compounded by violence in schools and the threat of terrorism, more needs to be done to ensure the mental health of all of our children and adolescents.

Adolescent↗
PubMed2003

Current treatment methods for postcatheterization pseudoaneurysms.

Pseudoaneurysms are a recognized complication of arterial catheterization. Until recently, the standard method of treatment has been surgical. The past decade has seen the introduction of several minimally invasive techniques that have largely replaced surgical treatment of pseudoaneurysms. The most commonly used methods are ultrasound-guided compression and percutaneous injection of thrombin into the pseudoaneurysm. This review article describes all the methods available for the treatment of postcatheterization pseudoaneurysms, presents results from the largest published series, and discusses the relative merits of each technique.

Aneurysm, False↗
PubMed2003

Embolization of a renal artery aneurysm using ethylene vinyl alcohol copolymer (Onyx).

PURPOSE: To report the embolization of a renal artery aneurysm using Onyx, a radiopaque nonadhesive liquid embolic agent. CASE REPORT: A 28-year-old woman with hypertension and fibromuscular dysplasia presented with a 20-mm renal artery aneurysm. In order to avoid any migration of embolic material into the parent vessel, a compliant balloon was inflated to exclude the aneurysm from the blood flow while injecting the liquid embolic agent. Complete aneurysm exclusion was achieved immediately, with no angiographic or duplex evidence of distal embolization or intra-aneurysmal flow. The Doppler ultrasound at 6 months confirmed aneurysm exclusion. CONCLUSIONS: The ease of use and nature of this material makes Onyx an effective and safe option in the treatment of wide-necked renal aneurysms.

Adult↗
PubMed2002

Phase I pharmacodynamic study of time and sequence dependency of hydroxyurea in combination with gemcitabine: a California Cancer Consortium Trial.

Preclinical studies in our laboratory have demonstrated that prior exposure to hydroxyurea increases the percentage of cells in S phase, enhancing the cytotoxicity of subsequent gemcitabine treatment in human oropharyngeal KB cells. To evaluate the clinical implications of this time- and sequence-dependent potentiation, we performed a phase I trial of hydroxyurea given over 24 h followed by a 30-min infusion of gemcitabine in weeks 1 and 2 of a 3-week cycle. The dose of hydroxyurea was fixed at 500 mg orally every 6 h for four doses starting 24 h before each dose of gemcitabine. The initial dose level of gemcitabine was 250 mg/m(2) on days 2 and 9, and this was escalated stepwise to 1000 mg/m(2) on days 2 and 9. Gemcitabine pharmacokinetics were determined on days 2 and 9 of the first cycle. Of 27 patients enrolled (12 female, 15 male), 24 were evaluable for response and 23 were evaluable for toxicity. Their median age was 56 years (range 27-76 years). Tumor types included lung, head and neck, pancreas, breast, colon, prostate, stomach, ovary, esophagus, germ cell, thyroid, gallbladder, and unknown primary. A total of 80 cycles of treatment were completed. One patient (unknown primary) had an objective partial response lasting 21 months, and 12 patients had stable disease. All observed dose-limiting toxicities were related to myelosuppression. The gemcitabine maximum tolerated dose was established at 750 mg/m(2) on days 2 and 9. Hydroxyurea had no effect on the plasma pharmacokinetics of gemcitabine. These results suggest that hydroxyurea followed by gemcitabine can be safely administered and has activity on this schedule. We are presently developing a phase II trial of this regimen for patients with platinum-resistant head and neck cancer.

Adult↗
PubMed2002

Endovascular repair of contained rupture of the thoracic aorta.

PURPOSE: To assess the efficacy of stent-grafts for the treatment of acute rupture of the thoracic aorta. METHODS: Four patients with acute contained ruptures of the thoracic aorta were treated by insertion of stent-grafts. The underlying aortic lesions were aneurysm, acute aortic ulcer, acute type B dissection and giant cell aortitis. The procedures were performed under general anesthesia in three patients and local anesthesia in one patient. RESULTS: All stent-grafts were successfully deployed. All patients survived the procedure and are now alive and well at follow-up (mean 6.3 months, range 44 days-16 months). One patient underwent a second stent procedure 10 days after the first procedure because of a proximal endoleak. All hemothoraces have resolved. There were no complications. CONCLUSION: Treatment of acute contained ruptures of the thoracic aorta by the insertion of stent-grafts is feasible. The technical success rates, complication rates and patient survival compare favorably with emergency surgery.

Aged↗
PubMed2002

Autologous thrombin: a new embolization treatment for traumatic intrasplenic pseudoaneurysm.

PURPOSE: To report the use of autologous thrombin for transcatheter embolization of a traumatic parenchymal splenic pseudoaneurysm. CASE REPORT: A 15-year-old boy presented with a splenic parenchymal laceration after blunt abdominal trauma. The patient was managed conservatively but developed an intrasplenic pseudoaneurysm (grade III AAST scale) with subcapsular contrast extravasation after 3 weeks. Autologous thrombin was isolated from the patient's blood and subsequently delivered to the lesion by transcatheter superselective injection into the aneurysm neck. The patient was asymptomatic after the procedure. Nine months' follow-up demonstrated a normal spleen with completely homogenous parenchyma. CONCLUSIONS: Autologous thrombin injection to induce thrombosis of intrasplenic pseudoaneurysm represents a new treatment option for traumatic abdominal organ injuries. Intrasac thrombosis can be safely induced to successfully restore the splenic parenchymal integrity without introduction of foreign material and associated risks of adverse reactions or infection that might accompany the use of commercial thrombin preparations.

Adolescent↗
PubMed2001

Percutaneous thrombectomy: a review.

Percutaneous thrombectomy (PT) is an established technique for the removal of acute thrombus in occluded arteries, veins and vascular grafts. Percutaneous thrombectomy can be used as an adjunctive treatment to other methods of thrombus removal such as thrombolysis or as sole therapy. The two main methods are percutaneous aspiration thrombectomy in which thrombus is removed by suction with the aid of wide-bore catheters, and mechanical thrombectomy using a variety of automated devices to fragment or remove thrombus. Aspiration thrombectomy is often used as an adjunct to thrombolysis in acute arterial occlusion, or as salvage therapy to remove distal emboli following iliac or femoropopliteal angioplasty. Mechanical thrombectomy is useful for the treatment of thrombosed dialysis grafts and is being increasingly used for the treatment of massive pulmonary emboli and ileofemoral or ileocaval deep venous thromboses.

Arterial Occlusive Diseases↗