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Biomedical subjects

A Kessinger

Publications and source records attributed to A Kessinger.

At least 145 records · Page 8Linked to original sources
PubMed1989

Breast carcinoma in bronchoalveolar lavage. A cytologic and immunocytochemical study.

To evaluate the effectiveness of bronchoalveolar lavage in detecting pulmonary metastases of breast cancer, we examined lavage fluid from 20 patients with routine cytologic preparations and immunoperoxidase stains with monoclonal antibody B72.3. Bronchoscopy was performed for infection surveillance prior to autologous bone marrow transplantation (nine patients), or to assess abnormal chest roentgenogram (11 patients). Metastatic adenocarcinoma was identified on Papanicolaou-stained-membrane filters in seven patients (35%), corroborated by transbronchial biopsy in four patients. No patients with chest roentgenogram suggestive of metastatic cancer or transbronchial biopsy positive for metastatic cancer had a negative lavage. Monoclonal antibody B72.3 uniformly marked malignant cell aggregates and many single cells that were inapparent in routinely stained material. Because bronchoalveolar lavage may detect metastatic adenocarcinoma with sensitivity comparable to transbronchial biopsy but with less morbidity, it is useful in the evaluation of pulmonary infiltrates in patients with primary breast carcinoma. Staining with monoclonal antibody B72.3 can be readily performed on lavage specimens and may serve as an adjunct in diagnosing malignancy.

Adenocarcinoma↗
PubMed1988

Changes in the inpatient and outpatient cancer patient population at a teaching institution over a three-year period.

Admission and outpatient clinic records of cancer patients seen by members of the University of Nebraska Medical Center Section of Oncology/Hematology in that section's clinic and on that section's hospital service were studied over a three-year period to determine if the tumor types of patients differed importantly from year to year. Cancer patients seen in other clinics or on other clinical services in the medical center were not included in this study. Some striking variations were found. The percentage of cancer patients with lymphoma admitted to the hospital increased significantly, from 23% to 41% (p less than .00001), and the percentage of those patients seen in the outpatient area increased correspondingly. In contrast, the percentage of colorectal cancer patients fell from 11% in 1984 to 4% in 1985 and to 3% in 1986 (p less than .00001). A similar decrease was found in the outpatient clinics as well. In addition, the percentage of breast cancer patients admitted to the hospital fell from 17% in 1984 to 12% in 1985 and to 11% in 1986 (p = .003); there was also a similar decline in the outpatient clinic (p = .00001). Other tumor types were equally represented in all three years in the inpatient and outpatient setting. The patient mix can vary markedly from year to year and should be monitored, so that changes in the teaching program can be made to assure the desired emphasis of all tumor types.

Curriculum↗
PubMed1988

Autologous peripheral hematopoietic stem cell transplantation restores hematopoietic function following marrow ablative therapy.

From ten patients with advanced malignant disease involving the bone marrow, autologous hematopoietic stem cells were collected from the peripheral blood during eight four-hour pheresis procedures and cryopreserved. No manipulations to increase the number of stem cells circulating in the blood were used during the collections. Following marrow ablative chemotherapy or chemoradiotherapy, the autologous cells were thawed and infused intravenously (IV). WBCs reappeared in the circulation at a median of eight days (range seven to 11 days) after stem cell infusion. Two patients died early, whereas the other eight reached normal numbers of circulating granulocytes that have persisted for up to greater than 20 months. These eight patients became independent of RBC transfusions (hemoglobin concentration greater than 10 g/dL) at a median of 27 days (range 11 to 58 days) after transplantation. One patient received platelet transfusions for counts less than 50 x 109)/L, one patient developed a clinical picture of idiopathic thrombocytopenic purpura, and six patients maintained a platelet count greater than 20 x 10(9)/L at a median of 23 days (range 14 to 25 days) following stem cell infusion. This technique allows patients ineligible for autologous bone marrow transplantation due to unacceptable anesthetic risks, prior pelvic irradiation, or bone marrow metastases to receive marrow ablative therapy.

Bone Marrow↗
PubMed1988

Failure of karyotypic instability to predict clinical progression in patients with dysmyelopoietic syndromes.

Twenty-five patients with leukemia and dysmyelopoietic syndrome underwent serial cytogenetic analysis during the course of their disease. All 21 patients with leukemia had improvement or disappearance of karyotypic abnormalities with effective treatment of their leukemia, and karyotypic progression was observed only in instances of recurrent or progressive leukemia. All four patients with dysmyelopoietic syndrome exhibited karyotypic instability, which was independent of therapeutic interventions or disease progression. The data presented suggest that karyotypic instability in the dysmyelopoietic syndromes may be more common than currently accepted.

Adolescent↗
PubMed1987

Intracavitary bleomycin and tetracycline in the management of malignant pleural effusions: a randomized study.

Both bleomycin and tetracycline have been suggested as the sclerosing agent of choice in the management of malignant pleural effusions. To determine if one drug is superior to the other in this role, patients with malignant pleural effusions were randomly assigned to receive either bleomycin or tetracycline in the previously evacuated pleural space through a thoracostomy tube. Following instillation of the assigned agent, the tube was clamped for 8 hours and then reattached to suction. When the chest tube drainage had slowed to less than 40 ml in a 24-hour period or if 7 days had passed, the tube was removed. Pleural sclerosis was attempted 42 times in 34 patients. No statistically significant differences were found between the two treatment groups when prevention of effusion reaccumulation and time to removal of the chest tube (efficiency) were compared. Side effects including pleural pain and fever, occurred with both agents, but were manageable. Since one drug was not clearly superior to the other, and bleomycin is more costly, we suggest that tetracycline rather than bleomycin be used when pleural sclerosis is needed to manage malignant pleural effusions.

Bleomycin↗
PubMed1987

Graft versus host disease following transfusion of normal blood products to patients with malignancies.

A patient undergoing treatment with cytotoxic chemotherapy for Hodgkin's disease developed graft versus host disease (GVHD) following a transfusion of packed red cells. This is the 28th reported patient with a malignancy who did not have a bone marrow transplant and developed GVHD after transfusion of normal blood or blood products. All patients had received cytotoxic chemotherapy prior to acquiring GVHD. The underlying malignancies included lymphoma, acute leukemia, neuroblastoma, rhabdomyosarcoma, and glioblastoma. Twenty-three of the 28 patients died of GVHD. The incidence of transfusion-related GVHD in this patient population is low but the illness is often fatal as treatment is largely ineffective. Transfusion-related GVHD can be prevented by irradiating all blood products with 1500 rad prior to administration.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Detection of malignant cells in histologically normal bone marrow using culture techniques.

Cellular material retained on screens used to filter aspirated bone marrow for future autologous marrow transplantation was studied using long-term culture techniques in 20 consecutive patients. All patients had marrow aspirate and biopsy specimens that were normal histologically. Cultures from five patients grew malignant cells similar to those of the known underlying malignancy. Two types of culture methods were used in these studies. Method I consisted of a long-term bone marrow culture system which predominantly favors adherent cells, and Method II consisted of a suspension type culture system favoring expansion of mononuclear cell types. These findings suggest that tumor cells are reinfused more often at the time of autologous bone marrow transplantation than has been previously suspected. Although the clinical significance of these findings is not known, it is clear that culture techniques combined with special stains and molecular probing will allow the improved detection of occult tumor cells in bone marrow from patients undergoing autologous marrow transplantation. These observations emphasize the need for a comprehensive study of histologically normal autologous marrow using culture techniques to determine the frequency of occult involvement by viable malignant cells and the clinical implications of these findings.

Adult↗
PubMed1987

Harvesting marrow for autologous transplantation from patients with malignancies.

One hundred and sixty-six patients with malignancies had 170 consecutive bone marrow collection procedures in anticipation of autologous transplantation. The morbidity associated with these harvest procedures was increased compared to morbidity experienced by normal donors who had marrow collected for allogeneic transplantation when unexplained fever (p = 0.02) and infection (p = 0.008) were considered. No differences could be found in the characteristics of the harvested marrow including concentration of nucleated cells and nucleated cell content between the two donor groups. No deaths occurred as a result of the harvest procedure. However, a previously reported series of autologous marrow donors from a different institution did not demonstrate an increased morbidity associated with marrow harvesting when compared to the same series of normal donors. The differences found in the two autologous series might be explained by differing characteristics of the patient populations. The increased morbidity found in our patients was tolerable and reversible and not a contraindication to high-dose therapy with autologous bone marrow transplantation.

Bone Marrow↗
PubMed1987

Acute renal failure associated with autologous bone marrow transplantation.

A review of 33 consecutive autologous bone marrow transplant (BMT) cases revealed three cases of acute renal failure which developed immediately following reinfusion of cryopreserved bone marrow, and which could not be explained on the basis of hypotension or nephrotoxic drugs. Gross hemoglobinuria was noted in all 33 autologous BMT patients, and may have contributed to the acute renal failure seen in the three patients. Histologic examination of the kidneys of one patient who died 3 days after BMT showed markedly dilated renal tubules filled with hemoglobin casts. The kidneys of the other two patients, who died 8 and 20 days after BMT, showed renal tubular necrosis and regeneration with numerous hemoglobin casts. All three patients had systemic candidiasis at autopsy, and there is evidence to suggest that the infection was also present at the time of BMT. Fungal sepsis may have predisposed these patients to the development of acute renal failure. We recommend the use of procedures that minimize the hemolysate content of cryopreserved bone marrow.

Acute Kidney Injury↗
PubMed1986

High dose therapy and autologous marrow transplantation as salvage treatment for patients with diffuse large cell lymphoma.

Twenty-nine patients with diffuse large cell lymphoma who failed traditional chemotherapy were treated with high dose chemotherapy with or without total body irradiation followed by infusion of cryopreserved autologous marrow. Complete response was achieved in 11/29 patients (38%), partial response in 13/29 patients (45%) and 5/29 patients (17%) had no response. Six complete responders remain well and free of disease for 5+, 6+, 9+, 10+, 18+ and 25+ months, 3 relapsed at 2, 3 and 8 months after marrow infusion, and 2 died from infectious complications. Complete response was seen more frequently with the absence of bulky tumor (70 vs 21%, P = 0.03), a total body irradiation containing regimen (52 vs 0%, P = 0.03), a history of complete remission with initial chemotherapy (55% vs. 9%, P = 0.03), and a performance status greater than or equal to 80 (56 vs 15%, P = 0.06). High dose therapy had a high response rate (83%) in resistant diffuse large cell lymphoma and yielded durable complete responses in a minority of these patients.

Adolescent↗
PubMed1986

Reconstitution of human hematopoietic function with autologous cryopreserved circulating stem cells.

Complete hematopoietic reconstitution using nonleukemic peripheral blood mononuclear cells has been achieved in animal models but not in humans. We treated two patients who had metastatic breast carcinoma involving the bone marrow and who had failed conventional therapy with high-dose chemotherapy and total body radiation. Cryopreserved autologous peripheral blood mononuclear cells (6.3-8.4 X 10(8)/kg patient weight) obtained by leukapheresis before high-dose therapy were returned to the patients intravenously. In one patient, evidence of bone marrow engraftment was present, but the patient died before full reconstitution of the peripheral blood cells occurred. Bone marrow engraftment and return of all cell lines to the peripheral blood occurred in the second patient. These findings demonstrate that human hematopoietic reconstitution can be achieved with autologous, peripheral blood, mononuclear cell transfusions following high-dose therapy. This approach may be useful to patients who have contraindications for a bone marrow harvest but who are otherwise candidates for autologous bone marrow transplantation.

Adult↗
PubMed1985

High-dose chemotherapy with autologous marrow transplantation for malignant melanoma. Case reports and literature review.

Present-day therapy for disseminated malignant melanoma is unsatisfactory; chemotherapy offers a small fraction of patients a short-lived palliative effect. Evidence exists to suggest more responses to chemotherapy could occur if dosages of chemotherapeutic agents were increased. The dosages of many chemotherapeutic agents used for melanoma are limited by myelotoxicity of the drugs. Autologous bone marrow transplantation offers a means to escalate chemotherapeutic dosages by shortening the period of life-threatening marrow toxicity to a survivable length of time. A review of 103 cases of melanoma treated with high-dose chemotherapy and autologous marrow rescue plus two cases reported here revealed that 48% of patients responded to therapy and 34% of those were complete responses. The exact role this technic will play in management of disseminated malignant melanoma requires further study.

Adult↗
PubMed1984

High dose chemotherapy with autologous bone marrow rescue for high grade gliomas of the brain: a potential for improvement in therapeutic results.

Improvements in the therapy of high grade gliomas have not been achieved since the addition of single agent chemotherapy to operation and radiation therapy in the mid-1970s. The dosages of nitrosourea compounds commonly used as chemotherapeutic agents for malignant gliomas have been limited by the myelotoxicity of the drugs. Autologous bone marrow transplantation offers a means to escalate chemotherapeutic dosages by reversing marrow toxicity. Early studies indicated that complete responses, partial responses, and clinical responses are possible using high dose chemotherapy and autologous marrow rescue. The exact role that this technique will play in the management of malignant gliomas has not yet been determined.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

Therapeutic management of small cell lung cancer. Fewer toxic reactions with lower chemotherapeutic drug dosages.

A treatment protocol for small cell lung cancer used attenuated drug dosages in an attempt to reduce toxic reactions without compromising effectiveness. Treatment consisted of cyclophosphamide, 50 mg orally daily, methotrexate, 1.25 mg orally daily, procarbazine hydrochloride, 50 mg orally daily, and vincristine sulfate, 10 micrograms/kg intravenously weekly, and was continued until relapse or for two years. Patients with limited disease were given concurrent radiation (4,000 to 5,000 rad, using standard fractionation) to the primary lesion and draining nodes. Fifty patients were evaluable for toxic reactions and survival: 22 with limited and 28 with extensive disease. Fifty-four percent of the patients with extensive disease responded; one (4%) had a complete response. Median survival of the patients with extensive disease was 20 weeks. Ninety-five percent of the patients with limited disease responded; 57% had a complete response. Median survival of these patients was 55 weeks; one-year survival was 59%, and 18-month survival was 36%. Three patients have discontinued therapy without relapse for 48, 22, and seven months. One patient remains disease free after undergoing therapy for 84 weeks. There were no treatment-related deaths, and only 4% of patients experienced WBC count nadirs of less than 1,000/cu mm. Patients with limited disease had long-term survivals comparable with those of other more toxic protocols.

Adult↗
PubMed1983

Therapy of malignant APUD cell tumors. Effectiveness of DTIC.

Eleven patients with malignant APUD tumors, five islet cell carcinomas, five carcinoid tumors and one medullary carcinoma of the thyroid were treated with DTIC. Nine of 11 patients benefitted from treatment. A literature review revealed that other APUD tumors responded when treated with DTIC. DTIC is a useful agent for treatment of malignant APUDomas, and may be the drug of choice for islet cell carcinoma of the pancreas.

Adenoma, Islet Cell↗