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Biomedical subjects

A Mittelman

Publications and source records attributed to A Mittelman.

At least 181 records · Page 10Linked to original sources
PubMed1984

Screening for colorectal cancer using the Hemoccult II stool guaiac slide test.

Following a series of educational spots on colorectal cancer shown on a local television news program, stool guaiac slide kits (Hemoccult II; Smith Kline Diagnostics) were distributed in shopping malls in Erie County, New York during a 3-day period in February 1982. The tests kits were sold for $1.00 a piece. A total of 8711 persons purchased test kits and 3822 persons (44%) returned slides for testing. One or more slides were positive in 107 persons (2.8%). Ninety of the 107 positive screenees (84%) saw a physician for further evaluation after screening. Eighteen positive screenees had no evidence of pathology which could cause blood in their stool when evaluated by a physician, yielding an overall false-positive rate of less than 0.5%. Seven new cases of colorectal cancer were found through screening. Five of the seven cancers (71%) detected were localized disease (Dukes' Stage A, B1 or B2), and four cases had no symptoms of disease prior to diagnosis. The findings from this study suggest that screening for fecal occult blood using the stool guaiac slide test is effective in detecting some colorectal cancers at an early stage of disease, often before symptoms appear.

Adolescent↗
PubMed1984

Hepatic artery ligation for liver metastasis in colorectal carcinoma.

From April 1975 to January 1982, 97 patients with greater than or equal to 50% of the liver involved with metastasis from colorectal carcinoma underwent hepatic artery ligation. The purpose was to evaluate median survival times in relation to performance status, synchronous intraabdominal metastasis, pulmonary metastasis, liver function tests (alkaline phosphatase, serum glutamic oxaloacetic transaminase (SGOT), lactate dehydrogenase (LDH), total bilirubin, and Dukes' staging. Results reveal that for performance status 0 to 1 (normal or symptoms, but ambulatory), median survival time was 12.3 months; status 2 to 3 (in bed less than or greater than 50% of time), 8.3 months; status 4 (100% bedridden), 2.6 months, (P less than 0.01). Median survival time in patients with only intrahepatic metastasis was 10 months versus 7 months for synchronous intraabdominal metastasis (P less than 0.01). For 20 patients with pulmonary metastasis undergoing hepatic artery ligation, the median survival time was 8.8 months (P less than 0.05). The median survival time in patients whose alkaline phosphatase was 2 times normal was 12.4 months, whereas, if alkaline phosphatase was 2 times to 4 times or greater than 4 times normal, median survival times were 7.1 and 6.9 months, respectively (P less than 0.01). Factors that adversely affect survival for hepatic artery ligation are extrahepatic metastasis, poor performance status, and elevated liver function tests (alkaline phosphatase 2 times normal). The overall median survival time in this study is 9.5 months with certain subgroups achieving 12.4 months' survival.

Adenocarcinoma↗
PubMed1984

The use of colonoscopy in the study of synchronous colorectal neoplasms.

Over a 5-year period, 185 patients with primary colorectal carcinoma were studied by colonoscopy for synchronous neoplasms. Twenty-eight patients had incomplete examinations due to obstructing tumors, and 157 had total colonoscopy. Sixty patients (35.9%) had synchronous neoplasms, of which 43 (25.7%) were adenomatous polyps, 5 (3%) were villous polyps, and 12 (7.2%) were carcinomas. The planned surgical procedure was altered on 7 of 12 synchronous cancers (58.3%), 10 of 38 adenomatous polyps, and 17 of 157 (10.8%) patients who underwent total colonoscopy. Preoperative colonoscopy is deemed essential for the optimal management of the patient with colorectal carcinoma.

Aged↗
PubMed1984

Analysis of T-cell subsets in B-cell chronic lymphocytic leukemia: a correlation with the stage of disease.

T-cell subsets were determined by the Leu monoclonal antibodies in the peripheral blood and/or bone marrow of 52 patients with B-cell chronic lymphocytic leukemia (B-CLL) not on therapy at the time of study. The diagnosis of B-CLL required that the leukemic cells expressed surface receptors for "la-like" antigen, Fc fragment of IgG, mouse red blood cells (MRBC), C3-coated red cells (EAC), and low density of monoclonal surface immunoglobulin. The Leu-3a+/2a+ ratio was applied to define the balance between the helper/suppressor subsets in the residual T-lymphocytes. Most patients showed a decrease in the Leu-3a+/2a+ ratios at all stages of disease. The decrease in ratio was mainly related to a decrease in the Leu-3a+ T-cell subset. The more advanced stages of B-CLL were associated with lower Leu-3a+/2a+ ratio, higher total white cell and percent lymphocyte counts. There was no correlation between the proportion of EAC or MRBC rosetting cells and stages of B-CLL. This analysis further suggests that B-CLL is an immunosuppressed state that becomes more pronounced in the advanced stages and is characterized by a progressive decrease in the Leu-3a+ (helper) T-cell subset.

Antibodies, Monoclonal↗
PubMed1984

An analysis of chemotherapy for colorectal carcinoma.

Five-fluorouracil (5-FU) has become the standard chemotherapeutic agent for the treatment of advanced colorectal carcinoma. It has been used as a single agent and in combination with other chemotherapeutic agents for the treatment of advanced disease. Conflicting experiences have been reported with all these therapeutic programs and a review of these studies reveals failure to take into consideration the factors determining survival and response. These factors consist of performance status, weight loss, hepatomegaly, previous chemotherapy treatment, prior radiotherapy treatment, and resected versus unresected primaries. The purpose of this study is to examine the various claims for therapeutic efficacy of drugs used in all stages of colorectal carcinoma. This will consist of a review of single agent systemic chemotherapy for advanced colorectal carcinoma, combination chemotherapy for advanced colorectal carcinoma, regional infusion, and adjuvant chemotherapy following curative resection.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

The pathophysiology of the jejunal conduit syndrome and its exacerbation by parenteral hyperalimentation.

Supravesical urinary diversion using a jejunal conduit may be associated with hyponatremia, hypochloremic-acidosis, hyperkalemia, azotemia, and a clinical picture of nausea, vomiting, dehydration, muscular weakness, elevated temperature, and lethargy. This syndrome is secondary to the loss of sodium chloride into the urine passing through the conduit and absorption of potassium and urea from it. Treatment and prevention of this syndrome consist of adequate supplements of sodium chloride and hydration. Intravenous hyperalimentation as the precipitating factor of a severe form of this syndrome and its successful management are described. The pathophysiology of the jejunal conduit syndrome is also discussed. Great selectivity and extreme caution are recommended with respect to the use of intravenous hyperalimentation in patients with jejunal conduits.

Adenocarcinoma↗
PubMed1984

Long survival after ovarian and hepatic metastasis from carcinoma of the large bowel: report of a case.

Herein we present the case of a woman who is now 19 years post abdominoperineal resection for a Dukes' C1 rectal carcinoma, 10 years post right hemicolectomy for a Duke's C1 carcinoma of the ascending colon and removal of a solitary hepatic metastasis and now 9 years post resection of an ovarian metastasis. She had 5-fluoracil, postoperatively. This is the ninth case reported in the literature of a 5-year survivor free of disease following oophorectomy for metastatic adenocarcinoma of the large bowel. The finding of ovarian and hepatic metastases from her colorectal carcinoma would have indicated a poor prognosis. We feel that those rare patients who have an unexpected long survival should be reported for accumulation of clinical data, illustration of their clinical management, and analyses of the applied therapeutic interventions.

Colonic Neoplasms↗
PubMed1984

Cavernous hemangioma of the anus.

Vascular tumors of the large bowel can be divided into malignant and benign lesions. The benign lesions can be divided into capillary and cavernous hemangiomas. Large-bowel hemangiomas are rare lesions, with the majority of cases reported in the rectum and rectosigmoid regions. Few cases of isolated anal hemangiomas are found in the literature. A case of an asymptomatic anal cavernous hemangioma, palpable on routine rectal examination and subsequently removed at proctosigmoidoscopy, is described.

Aged↗
PubMed1984

A combination of 5-fluorouracil and thymidine in advanced colorectal carcinoma.

Concurrent administration of thymidine (TdR) has been shown to increase the antitumor activity of 5-fluorouracil (5-FU) in various experimental models. The clinical response rate, side-effects, and toxicity of 5-FU and TdR were evaluated in 27 patients with advanced colorectal carcinomas. Each 6-day treatment course consisted of an IV loading dose of TdR (405 mg/kg, over 30 min), followed by continuous IV infusions of 5-FU (7.5 mg/kg per day for 5 days), and TdR (216 mg/kg per day for 6 days); courses were repeated every 4 weeks. The overall partial response rate was 4.5%, or 16.7% in patients with no prior 5-FU chemotherapy. Short-lived stable disease was seen at an overall rate of 27.3%, half of these patients with prior 5-FU chemotherapy. Myelotoxicity occurred in 64% of the patients, but this was dose-limiting in only 20%. Gastrointestinal and neurological symptoms were mild and infrequent. There was one case of treatment-related death due to sepsis secondary to leukopenia. It is concluded that the concurrent IV administration of 5-FU and TdR does not improve the response rate over that obtained with 5-FU alone.

Adult↗
PubMed1984

A proposed classification system for liver metastasis from colorectal carcinoma.

A proposed classification system for liver metastasis from colorectal carcinoma is presented. This proposed system utilizes the prognostic factors of the extent of hepatic involvement by metastasis at the time of laparotomy, performance status, preoperative serum alkaline phosphatase level, and the presence or absence of extrahepatic intraabdominal disease at the time of laparotomy. Because of the several different modes of treatment for liver metastasis from colorectal carcinoma, it is necessary that a liver classification system be adopted so that different treatment groups will be comparable. The proposed system utilizes the extent of hepatic involvement by metastasis at laparotomy with a division into three subsets of patients described by a Roman numeral. Roman numeral I represents less than or equal to 25 per cent involvement of the liver by metastasis; Roman numeral II represents greater than 25 per cent but less than or equal to 50 per cent involvement by liver metastasis, and Roman numeral III represents greater than 50 per cent involvement by liver metastasis. An Arabic subscript number is used to describe the patients' performance status. Alkaline phosphatase levels are described by a subscript letter with a representing less than two times normal alkaline phosphatase, b representing greater than two times, but less than four times normal levels, and c representing greater than four times normal levels. At the time of laparotomy extrahepatic intra-abdominal disease is represented by the superscript letter E.

Abdominal Neoplasms↗
PubMed1984

Endobronchial metastasis from colorectal carcinoma.

A case report and review of the literature concerning endobronchial metastasis from colorectal carcinoma is discussed. Careful attention to the past history of the patient, presenting symptoms and laboratory evaluation, may lessen the diagnostic difficulty in differentiating a centrally located bronchogenic carcinoma from a metastasis to a major bronchus. In the majority of cases, the primary colorectal tumor will precede the pulmonary abnormality. The most frequently manifested symptoms are cough and hemoptysis. Radiologic findings usually consist of a collapsed lung, lobe or segment secondary to the bronchial obstruction. There appears to be equal predilection for metastatic involvement of either the right or left bronchial segments. Bronchial biopsies and comparison with the previous histology of the primary colorectal tumor are mandatory.

Adenocarcinoma↗
PubMed1984

New potential treatment modalities for disseminated prostatic cancer.

The authors consider treatments that are applicable to disseminated prostatic cancer. Several types of potential developments in systemic therapy for prostatic cancer are considered: new hormonal agents, new cytotoxic agents, modulation of the antitumor efficacy or toxicity or both of standard agents, biologic response modifiers, drug delivery systems, and systems for prediction of response.

Androgen Antagonists↗
PubMed1984

Phase I-II trial of high-dose calcium leucovorin and 5-fluorouracil in advanced colorectal cancer.

Twenty-six patients with metastatic colorectal adenocarcinoma were entered into a Phase I-II study of 5-fluorouracil (5-FUra)-high-dose leucovorin (CF). The starting dose of 5-FUra was 300 mg/sq m with escalation to 750 mg/sq m/week in 6 doses given by rapid i.v. injection midway during a 2-hr infusion of CF, 500 mg/sq m. Partial responses were seen in 9 of 23 patients (6 of 12 who had had previous 5-FUra). Complete normalization of liver enzymes was seen in two of these patients. Side effects were seen sporadically with 5-FUra doses up to 600 mg/sq m. At a 600-mg/sq m 5-FUra dose, 8 of 18 patients had diarrhea, and 2 of 18 had white blood cell counts less than 3000/microliter. At a 750-mg/sq m dose of 5-FUra, 6 of 11 patients had severe diarrhea and 6 of 11 had white blood cell counts less than 3000/microliter. Other toxicities were mild conjunctivitis and lacrimation, thinning of the nails, and alopecia. In bioavailability studies of CF p.o., no plasma CF could be detected. After CF i.v., mean plasma peak was 111.3 +/- 40.3 (S.D.) microM. 5-FUra-CF appears to be effective in patients clinically resistant to 5-FUra. This study is being extended to randomized trial of 5-FUra-CF versus 5-FUra alone.

Adult↗