Blood plasma levels and elimination of salts of 2-PAM in man after oral administration.
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Adult↗
Biomedical subjects
A Goodman
Publications and source records attributed to A Goodman.
Assay of prenatal Rh antibodies to determine the need for amniotic fluid studies.
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Amniotic Fluid↗
Renal artery stent placement for the management of ischemic nephropathy.
PURPOSE: To evaluate the angiographic and clinical results of percutaneously implanted renal artery endoprostheses (stents) for the treatment of patients with ischemic nephropathy. MATERIALS AND METHODS: During a 52-month period, 45 patients with azotemia (serum creatinine > or = 1.5 mg/dL) and atheromatous renal artery stenosis untreatable by, or recurrent after, balloon angioplasty were treated by percutaneous placement of Palmaz stents. Stent implantation was unilateral in 32 cases and bilateral in 11 cases. Clinical results were determined by measurements of serum creatinine and follow-up angiography. Clinical benefit was defined as stabilization or improvement in serum creatinine level. Angiographic patency was defined as less than 50% diameter recurrent arterial stenosis. RESULTS: Stent placement was technically successful in 51 of 54 (94%) renal arteries. Technical failures were stent misdeployment requiring percutaneous stent retrieval (n = 2) and inadvertent placement distal to the desired position (n = 1). Complications included acute stent thrombosis (n = 1) and early initiation of hemodialysis (within 30 days; n = 1). There were two periprocedural deaths. With use of life-table analysis, clinical benefit was seen in 78% of patients at 6 months (n = 36), 72% at 1 year (n = 24), 62% at 2 years (n = 12), and 54% at 3 years (n = 3). In patients with clinical benefit, average creatinine level was reduced from 2.21 mg/dL +/- 0.91 before treatment to 2.05 mg/dL +/- 1.05 after treatment (P = .018). Lower initial serum creatinine level was associated with a better chance of clinical benefit (P = .05). No other variables affected outcome, including patient age, sex, diabetes, implanted stent diameter, unilateral versus bilateral stent placement, or ostial versus nonostial stent positioning. Conventional catheter angiography or spiral computed tomographic (CT) angiography performed in 19 patients (28 stents) at a mean interval of 12.5 months demonstrated primary patency in 75%. Maintained stent patency appeared to correlate with renal functional benefit. CONCLUSIONS: Percutaneous renal artery stent placement for angioplasty failures or restenoses provides clinical benefit in most patients with ischemic nephropathy.
Aged↗
Pediatric oncology and hematology in Birmingham, England.
The hematology and oncology service at Birmingham Children's Hospital was established in the late 1960s and now is one of the largest in the United Kingdom. It provides comprehensive care for the entire range of childhood malignancies, coagulation disorders, and hemoglobinopathies and other hematological disorders, and undertakes bone marrow transplant and megatherapy/peripheral blood stem cell procedures. Research includes clinical trials of treatments of childhood cancers; molecular biology studies on leukemia, Hodgkin's disease, neuroblastoma, and sarconas; childhood cancer epidemiology, and geographical and racial incidence; and treatment of hemophilia and molecular investigation of coagulation disorders. These activities involve collaboration with local, national, and international research groups.
Child↗
Computed tomography of rectal lymphoma.
We present two human immunodeficiency virus positive patients with rectal lymphoma who on CT both demonstrated similar appearances of the rectal tumour, consisting of concentric thickening of the rectal wall and thickening of the levator ani muscles.
Abscess↗
Management of cerebral palsy with botulinum-A toxin: preliminary investigation.
Use of intramuscular botulinum-A toxin (Botox) to produce neuromuscular blockade has been effective in treating certain ocular and facial muscular imbalances as well as spasmodic torticollis. In this preliminary open study, the effectiveness of intramuscularly injected Botox on the muscular imbalances of cerebral palsy was assessed in 27 pediatric patients. Each patient had "dynamic deformities" unresponsive to other treatment, and operation was the only other realistic alternative. The dose of Botox was calculated on a unit/body weight basis. In ambulatory patients, clinical changes in gait were assessed by a physician's rating scale. Reduction in spasticity became apparent in 12-72 h after injection; the effect of Botox after target threshold was reached lasted 3-6 months. No major side effects occurred. Botox may prove a useful adjuvant in conservative management of the spasticity of cerebral palsy. Successful management with these injections may allow delay of surgical intervention until the child is older and at less risk of possible complications, including the need for repeated surgical procedures.
Adolescent↗
Management of spasticity in cerebral palsy with botulinum-A toxin: report of a preliminary, randomized, double-blind trial.
In order to evaluate further the efficacy of local intramuscular injections of botulinum-A toxin (BAT-A) in the management of dynamic equinus deformity associated with cerebral palsy, a randomized, double-blind, placebo-controlled study was undertaken. When evaluated using our Physician Rating Scale, 83% (five of six) of patients receiving toxin showed improvement, versus 33% (two of six) receiving placebo. There were no major complications. BAT-A injections appear to be safe and effective in children, and merit further prospective study.
Botulinum Toxins↗
Aggressive locally recurrent vulvar cancer: review of cases presented to Massachusetts General Hospital 1990 to present.
Isolated recurrences of squamous cell vulvar carcinoma treated by surgical re-excision have excellent outcomes. There is a subset of these patients who develop multiple local recurrences that are difficult to manage and have a high risk of dying from their cancers. We reviewed women presenting with vulvar cancer (200 patients) to Massachusetts General Hospital from 1990 to present and identified 12 women with aggressive, locally recurrent squamous cell carcinomas of the vulva. The identified women all had successful primary radical vulvectomy and groin node dissections with negative surgical margins (except patient 2) and lymph nodes with no lympho-vascular space invasion. Seven women had underlying lichen sclerosis. Eight had a history of vulvar intraepithelial neoplasia or persistent carcinoma in situ. Ten patients had greater than three recurrences after primary surgical therapy. One died of recurrent vulvar cancer 10 months after her initial diagnosis. Two patients died after three recurrences. The only unifying clinicopathologic factor among these women was persistent lichen sclerosis and persistent carcinoma in situ. Understanding the underlying mechanisms that predisposed these premalignant lesions to transform into carcinomas will help predict in which women these are likely to re-occur and may help determine which women require more aggressive initial treatment.
Adult↗
A phase II study of fixed dose rate gemcitabine in patients with relapsed müllerian tumors.
Gemcitabine (2',2'-difluorodeoxycytidine) is a novel purine analog with clinical activity against ovarian cancer. Accumulation of gemcitabine triphosphate (dFdCTP) increases in a linear fashion with prolonged infusions of gemcitabine, and there is a strong relationship between intracellular accumulation of dFdCTP and DNA damage. Women with ovarian, fallopian tube, or primary peritoneal carcinoma and documented recurrent disease were eligible for the study. Patients could not have received more than four prior lines of chemotherapy and had to have measurable or evaluable disease. Gemcitabine 800 mg/m2 administered by intravenous infusion at 10 mg/m2/min (fixed dose rate [FDR]) on days 1 and 8 of a 21-day schedule. Twenty-eight patients with a median age 60 (range, 40-77) years were treated. Although 43% were Eastern Cooperative Oncology Group 0, 50% had liver metastases. Eighty-eight cycles of therapy were delivered (median 2 [range, 1-6]). Five of the first ten patients treated at 800 mg/m2 could not receive day 8 FDR-gemcitabine because of neutropenia, and the starting dose was reduced to 700 mg/m2. Even at this dose there was cumulative hematologic toxicity resulting in dose reductions. Vomiting, mucositis, diarrhea, allergy, rash, fever, and alopecia were mild. In 28 patients, there was only one partial response (4%, 95% CI 0-18%) and median time to progression was 1.7 (interquartile range, 1.2-3.9) months. FDR-gemcitabine 700 mg/m2 administered by intravenous infusion at an FDR of 10 mg/m2/min had minimal activity against heavily pretreated recurrent tumors of müllerian origin. The optimal dose and schedule of gemcitabine is yet to be defined in this population.
Adenocarcinoma↗
Violence prevention strategies targeted at the general population of minority youth.
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Adolescent↗
Phase II trial of elliptinium in advanced renal cell carcinoma.
Forty patients with advanced renal cell carcinoma were treated with elliptinium by a weekly infusion of 100 mg/m2. Of 38 evaluable patients, five had an objective response (13.2%). Average response duration was 8 months (range, 5-11). The major dose-limiting toxic effect was induction of antielliptinium antibodies, with the risk of intravascular hemolysis. Elliptinium has modest activity in advanced renal cell cancer and does not produce myelosuppression.
Adult↗
Management of valgus hindfoot deformity in pediatric cerebral palsy patients by medial displacement osteotomy.
To determine the clinical indications and efficacy of medial displacement osteotomy of the calcaneus in management of hindfoot valgus, we evaluated 18 feet (ten patients) prospectively. Average follow-up was 42 months; minimum follow-up was 24 months. The osteotomy was performed parallel to the subtalar joint through a lateral incision; the distal fragment was displaced > or = 50% and transfixed with two parallel pins for approximately 4 weeks. Analysis of hindfoot stability, foot position, and extremity function yielded excellent (n = 17) or fair (n = 1) results. Varus overcorrection in the "fair" foot required a closing wedge osteotomy.
Adolescent↗
En bloc pelvic peritoneal resection of the intraperitoneal pelvic viscera in patients with advanced epithelial ovarian cancer.
PURPOSE: We report the results of 30 patients who underwent en bloc resection of the pelvic peritoneum and all intraperitoneal pelvic viscera in the management of advanced epithelial ovarian cancer. MATERIALS AND METHODS: Between 1989 and 1993, 30 consecutive patients with advanced epithelial ovarian cancer underwent en bloc resection of the pelvic peritoneum and all pelvic viscera, except for the bladder, with a rectosigmoid reanastomosis below the peritoneal reflection. All 30 patients were managed with gastrostomy and hyperalimentation. All patients received six cycles of platinum-based combination chemotherapy; the first cycle was administered prior to discharge. RESULTS: All patients underwent cytoreduction to the largest residual mass less than 1 cm. No major complications were attributed to the gastrointestinal surgery itself. The median hospital stay was 11 days (range, 7-23). We found 26 recurrences (87%) and 14 deaths (47%). The median times to recurrence and death were 12.5 months (range, 8-24) and 23 months (range, 8-63), respectively. Sixteen of the 26 relapses (62%) were found in extraperitoneal locations and 10 (38%) in intraperitoneal locations. Only 3 (12%) of the 26 relapses presented with bowel obstruction. CONCLUSIONS: En bloc resection of the uterus, ovaries, pelvic peritoneum, and rectosigmoid followed by low anterior anastomosis is a safe operation that facilitates complete cytoreductive surgery in poor prognosis patients with advanced epithelial ovarian cancer.
Adult↗