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Biomedical subjects

A Steinfeld

Publications and source records attributed to A Steinfeld.

14 recordsLinked to original sources
PubMed1996

Final results of a phase II chemoradiation protocol for locally advanced cervical cancer: RTOG 85-15.

BACKGROUND: The lack of improved cure rates for advanced cervical cancer after three decades of megavoltage radiotherapy (RT) has prompted continued efforts in improved treatment delivery. Concurrent chemoradiation (CR) is one of the several avenues being explored to improve these results. METHODS: Sixty women with advanced cervical cancer (30 patients with unfavorable Stage IIB and 30 patients with Stages III and IVA) were treated with CR comprising of a combination of external and intracavitary RT delivering between 7000 to 7500 cGy total to point A and 5890 to 6015 cGy to point B along with one cycle of 5-FU and mitomycin C and a second cycle of 5-FU and cis-platinum. RESULTS: Grade 3 and 4 RT-related toxicities were 15 and 3%, respectively. Chemotherapy-related Grade 3 and 4 toxicities were 9 and 2%, respectively. The 5-year survival for unfavorable Stage IIB patients was 48%; for Stages III and IVA it was 39%. CONCLUSIONS: The toxicity of this particular CR regimen was acceptable and suggests that further qualitative and quantitative intensification of chemoradiation may be attempted. Retrospective comparisons with PCS studies and previous RTOG studies 79-20 and 80-05 suggest that this particular chemoradiation regimen may offer a modest survival advantage over RT alone for Stages III and IVA disease. A CR regimen with higher doses of radiotherapy and a greater number of active chemotherapeutic agents may yet result in acceptable toxicity and further improve cure rates in advanced and poor prognostic featured cervical cancer.

Adolescent↗
PubMed1995

Fusion of immunoscintigraphy single photon emission computed tomography (SPECT) with CT of the chest in patients with non-small cell lung cancer.

In non-small cell lung cancer (NSCLC), accurate staging is critical in deciding between potentially curative surgery and palliative treatment. Image registration, or fusion, combines the unique functional information provided by SPECT imaging with the excellent anatomic detail offered by computed tomography (CT) or magnetic resonance imaging to better characterize the information provided by each separate modality. In this study, we explored the role of fusion of immunoscintigraphy SPECT with CT in the staging of NSCLC. We fused chest CT with 99mTc-labeled IMMU-4 anti-carcinoembryonic antigen Fab' antibody fragment SPECT in 14 patients with NSCLC using a landmark-based algorithm. The algorithm's accuracy was a measure from the center-to-center distance and the percentage overlap of two regions of interest: one drawn on CT and warped onto SPECT, the other drawn directly on the SPECT. We found that the average center-to-center distance was 1.3 +/- 0.8 pixels. Average overlap was 46 +/- 20%. CT-SPECT fusion helped differentiate tumor from normal blood pool, necrotic areas within viable tumor, tumor recurrence from scar, and malignant lymphadenopathy from hyperplasia. We conclude that fusion of CT and SPECT augments the information provided by each separate modality. Future clinical applications of fusion in NSCLC staging using immunoscintigraphy appear promising.

Adult↗
PubMed1994

Demand-flow airway pressure release ventilation as a partial ventilatory support mode: comparison with synchronized intermittent mandatory ventilation and pressure support ventilation.

OBJECTIVE: To evaluate airway pressure release ventilation as a partial ventilatory support mode by comparing a demand-flow airway pressure release ventilation system with synchronized intermittent mandatory ventilation and pressure support ventilation. DESIGN: Prospective, nonrandomized, cross-over trial. SETTING: Medical intensive care unit in a university medical center. PATIENTS: Sixteen consecutive patients without chronic obstructive pulmonary disease with mechanical ventilatory support of 25% to 75% of total minute ventilation on synchronized intermittent mandatory ventilation, or 25% to 75% of maximal pressure support level on pressure support ventilation. INTERVENTIONS: Each mode of mechanical ventilation was supplied to patients with comparable levels of partial support for 30 mins. MEASUREMENTS AND MAIN RESULTS: Among three different modes, demand-flow airway pressure release ventilation achieved the lowest peak airway pressure (airway pressure release ventilation 9.1 +/- 2.6 cm H2O; pressure support ventilation 18.4 +/- 4.6 cm H2O; synchronized intermittent mandatory ventilation 34.8 +/- 7.7 cm H2O; p < .001). Hemodynamic status and oxygenation status were similar among these three modes. Five (31%) of the 16 patients felt that demand-flow airway pressure release ventilation was a less comfortable mode than synchronized intermittent mandatory ventilation or pressure support ventilation. This finding had no clear correlation with their duration of airway pressure release, preset machine deflation rate, or inspiratory/expiratory ratio of machine breath. Gross asynchrony of effort and ventilator cycling was noticed in two (13%) patients while they were receiving demand-flow airway pressure release ventilation. CONCLUSIONS: We conclude that for patients who do not have chronic obstructive pulmonary disease, demand-flow airway pressure release ventilation can provide effective partial ventilatory support with lower peak airway pressure when compared with pressure support ventilation and synchronized intermittent mandatory ventilation. However, this airway pressure release ventilation system may be less comfortable than the other two modes, and asynchrony may occur in some patients.

Analysis of Variance↗
PubMed1988

Controversies in management of stages I and II testicular seminomas.

The general success in treating seminoma (Stages I and II) of the testicle has prompted questions regarding the extent of treatment that these patients require. We reviewed 79 patients treated at NYU/Bellevue Medical Center from 1965 to 1984 to establish a data base from which the controversies surrounding this disease can be viewed. Standard treatment involved a radical inguinal orchiectomy as primary therapy. Stage I patients received adjuvant radiation to para-aortic and ipsilateral iliac nodes, with additional radiation given routinely to the mediastinum of patients with Stage II disease. No major complications were observed. All Stage I patients remain free of recurrent tumor with a median follow-up of eight years. There were 4 deaths from seminoma among the Stage II patients. The use of prophylactic mediastinal radiation for Stage II patients, and observation only for Stage I patients are reviewed in light of our results and other published series. While early evidence suggests that both approaches may be reasonable, their adoption awaits confirmation by prospective trial.

Cobalt Radioisotopes↗
PubMed1988

Carcinoid of the cervix: natural history and implications for therapy.

Carcinoid tumors rarely occur in the cervix. We present a patient with FIGO stage IB disease who developed brain metastases 4 years after initial diagnosis and treatment. The clinical course of a collected series of patients with carcinoid of the cervix is reviewed. Even patients with low stage lesions frequently die of disseminated disease. Adjuvant chemotherapy may have a role in the treatment of such patients.

Adult↗
PubMed1988

Practice patterns of palliative care for the United States 1984-1985.

This study reports the national averages for patterns of palliative radiation therapy observed in the United States for patients treated in 1984-1985 and compares those patterns to the pertinent literature. The data were collected in 1984-1985 by the Patterns of Care Study Survey of Palliative Care conducted in 49 institutions selected to provide valid national averages for the practice patterns reported. Data were collected from 784 patient records selected from five "strata" of practice. Demographic data and process data were tabulated and national averages were calculated from the data. Four metastatic sites were selected, weight bearing bones (401), non-weight bearing bones (102), brain metastasis (224), and lung-mediastinum (57). The median patient age was 63 years, equally divided by sex. In 52% of patients this was the first metastasis. Common Karnofsky performance scores ranged from 40 to 80%. Lung, breast, and prostate were the most common primaries. Two-thirds of the patients were treated by linear accelerators, one-third by cobalt. The median number of fractions was 10, median dose 3000 cGy, median fraction size 300 cGy, and median treatment duration 15 days. The goal of treatment was relief of pain (98%) and return of function (30%) for weight bearing bones, for brain metastasis it was preservation of function (68%), pain relief (33%), and relief of compression (25%). All sites showed TDF values that ranged from 33-85, and a TDF of approximately 65 was most common for weight bearing bones and brain metastasis with no consistent pattern of TDF selection for the other sites. Compliance by strata of practice with work-up criteria was excellent with isolated poor compliance seen in several strata.

Age Factors↗
PubMed1987

Brain metastases from ovarian cancer.

Brain metastasis from ovarian carcinoma is a relatively rare phenomenon. At NYU Medical Center five patients were treated for this entity from 1982 to 1985. The stage at presentation ranged from stage I to stage III, and all patients had received or were receiving chemotherapy. Two patients had active disease elsewhere at diagnosis of brain metastasis, but three patients were otherwise NED. Three patients had solitary cerebellar disease, and two patients had multiple lesions. All patients were treated with whole brain radiotherapy to 3,000 cGy, with neurological improvement in three of the five patients. The central nervous system may need special consideration for prophylactic treatment in those patients with ovarian cancer who receive adjuvant chemotherapy.

Adenocarcinoma↗
PubMed1987

Incidence of developmental handicaps among the offspring of men treated for testicular seminoma.

Although the issue of fertility in patients successfully treated for testicular seminoma seems to be resolved, it remains to be determined whether these patients can father normal, healthy children. At NYU Medical Center we have surveyed the patients treated between 1969 and 1984 who were treated with radiotherapy for testicular seminomas. The survey requested information regarding the qualitative development in offspring produced before and after radiation treatments. In the 33 patients responding we were unable to find any detrimental effect, either emotionally, physically, or developmentally in offspring sired by fathers following radiation therapy for testicular seminoma.

Developmental Disabilities↗
PubMed1986

Radiotherapeutic prophylaxis of estrogen-induced gynecomastia: a study of late sequela.

Radiation therapy is an effective means of preventing the development of hormone-induced gynecomastia in men with cancer of the prostate. The efficacy and morbidity of this type of radiation was studied in a retrospective analysis of 87 patients referred for treatment from 1972 to 1982. Patients receiving DES as treatment for prostate carcinoma were treated with irradiation to the breast tissue. Patients were treated with 4 MV, 60Co superficial X rays. Doses range from 1200 to 1500 cGy in 3 fractions. The majority of patients had satisfactory results in terms of prevention of gynecomastia and mammalgia. There were few acute reactions noted and no evidence of long term sequela.

Aged↗
PubMed1986

Renal angiosarcoma.

Renal angiosarcoma, an uncommon vascular sarcoma, is primarily treated surgically. We present a patient who, at nephrectomy, had tumor adherent to the diaphragm and renal artery. Postoperative radiation was given to the renal fossa. Despite the subsequent development of bone and liver metastases, disease in the renal fossa was apparently controlled. Symptomatic bone lesions were effectively palliated with radiotherapy. This report confirms those of others suggesting that angiosarcoma does respond to radiation.

Bone Neoplasms↗
PubMed1985

Carcinomatous meningitis from transitional cell carcinoma of bladder.

The following case report presents a patient with transitional cell carcinoma of the bladder referred to this medical center after carcinomatous meningitis developed. Previously he had undergone surgical resection of the primary lesion and had received cis-platinum chemotherapy for lung metastasis. This unusual presentation of metastatic disease (carcinomatous meningitis) seems to alert the surgical and medical communities to new complications.

Carcinoma, Transitional Cell↗
PubMed1983

Leiomyosarcoma arising in an arteriovenous fistula.

The case of a man who developed a leiomyosarcoma in association with a surgically created arteriovenous fistula is reported. This unusual complication of a dialysis fistula is the first reported case of a leiomyosarcoma occurring in a surgically created fistula.

Aged↗
PubMed1983

Design of anticandidal agents: synthesis and biological properties of analogues of polyoxin L.

Six analogues of polyoxin L were synthesized from uridine. All of these analogues inhibited chitin synthetase from Candida albicans. Derivatization of the amine terminus of the polyoxin analogues resulted in loss of activity, and analogues containing aromatic amino acid residues were the most efficient inhibitors of chitin synthetase. The concentration of tryptophanyl uracil polyoxin C, 8, which caused 50% inhibition of chitin synthetase activity, was 1.6 X 10(-6) M. This was virtually identical with the activity found for polyoxin D. None of the inhibitors effectively competed with the entry of (Met)3 into C. albicans. All of the analogues caused severe morphological distortions of the yeast in culture, and a number of analogues killed C. albicans at millimolar concentrations. The results suggest that chitin synthetase inhibitors may have potential as anticandidal drugs.

Antifungal Agents↗