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Biomedical subjects

B Lund

Publications and source records attributed to B Lund.

At least 73 records · Page 4Linked to original sources
PubMed1996

Gemcitabine: once-weekly schedule active and better tolerated than twice-weekly schedule.

This paper reviews the toxicity profile of gemcitabine, a novel anticancer drug. Gemcitabine has been administered using two different treatment schedules: once weekly or twice weekly for 3 weeks followed by a week of rest (one cycle). It was well tolerated and alopecia was not a problem. Toxicity was greater in the twice-weekly schedule. Comparing the once-weekly with the twice-weekly schedule, WHO grade 3 or 4 thrombocytopenia was reported in 4.7 and 25.6% of patients, respectively. Other hematological toxicity was minimal. Transient WHO grade 3 or 4 elevations of ALT and AST occurred in 9.2 and 7.2% of patients, respectively, in the once-weekly schedule. For the twice-weekly schedule the corresponding percentages were 12.2 and 13.8%. Symptomatic toxicity was greater in patients who received twice-weekly gemcitabine. Nausea and vomiting was mild and generally well controlled without 5HT3 antagonists. However, there was a greater incidence of nausea and vomiting on the twice-weekly schedule. Flu-like symptoms were documented in 19.8% of patients receiving once-weekly and 63.3% of patients receiving twice-weekly gemcitabine. Peripheral edema, not related to cardiac, hepatic or renal failure, was seen more often in patients on twice-weekly treatment. As the efficacy of gemcitabine in non-small cell lung cancer was equivalent when using both regimens, the better tolerated and more easily administered once-weekly schedule is recommended.

Antimetabolites, Antineoplastic↗
PubMed1996

Gemcitabine in cisplatin-resistant ovarian cancer.

Many new drugs have been tested in phase II studies in recent years. With a number of drugs the results vary because of differences in the patients recruited to these studies. A number of factors impact the response to second-line therapy, including the treatment-free interval between the end of previous therapy and the entry into phase II study, the bulk and stage of disease, the histology of the tumor, and hemoglobin level. The activity of the new drug tested is also important. It may be difficult to compare the results of different studies, as not all reports contain the same information. A report of a phase II study should contain information on all previous treatment, time since diagnosis, time since last treatment, tumor size at entry, hemoglobin values, performance status, histology, frequency of tests performed to evaluate toxicity, and clear definitions of response. Of the new drugs recently tested, the taxane paclitaxel has shown promising activity even in platinum-resistant patients. Gemcitabine, the novel nucleoside analog, also has shown activity in platinum-resistant patients in a phase II study. The response rate in this study was 19% (95% confidence limits, 9% to 34%). More importantly the responses were observed in a poor prognostic group of patients, characterized by primary platinum resistance, International Federation of Gynecology and Obstetrics stage IV, a treatment-free interval < or = 6 months, large bulky disease, and poorly differentiated/undifferentiated tumors. Both hematologic and nonhematologic toxicities were modest. The data suggest that gemcitabine, like paclitaxel, is non-cross-resistant to platinum.

Antineoplastic Agents↗
PubMed1996

Paclitaxel with carboplatin for the treatment of ovarian cancer.

Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) (135 mg/m2 over 24 hours) plus cisplatin (75 mg/m2 at a rate of I mg/min) every 3 weeks is widely accepted as the new standard of treatment for women with advanced epithelial ovarian cancer. A higher dose of paclitaxel over a shorter infusion period is under investigation as an alternative because it looks at least as effective and is more convenient to administer. However, in combination with cisplatin this dose-time schedule causes neurotoxicity in an important number of patients that can preclude the delivery of an adequate total dose. One way to decrease the incidence of this side effect is to substitute cisplatin with the analogue carboplatin. From the present data the conclusion is warranted that it is feasible to combine both drugs in an adequate dose and with acceptable toxicity. The combination would allow administration to outpatients and may be more tolerable, allowing prolonged treatment. The combination also looks attractive for re-treatment of women who relapse after completing their first-line paclitaxel/cisplatin-based therapy and who have chemotherapy-sensitive disease and prognostic features indicating that there is a high likelihood of achieving a second durable remission.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Changes in bone mineral density of the distal femur following uncemented total knee arthroplasty.

The aim of the study was to quantitate changes in bone mineral density (BMD) in the distal femur following uncemented porous-coated total knee arthroplasty. Eight patients with total knee arthroplasties (PCA Primary, Howmedica, Rutherford, NJ) (female:male ratio, 6:2; mean age, 70 years; range, 51-77 years) were scanned by dual-photon absorptiometry within 3 months after surgery and at 2 years. An average decrease of 36% (P = .01) was found in BMD behind the anterior flange of the femoral prosthesis. Proximal to the fixation pegs, BMD increased by 22% (P = .12), but behind the posterior flange of the femoral component, BMD remained unchanged (P = .53). Stress shielding anteriorly in the distal femur occurred in all patients examined 2 years after surgery, and the increase in BMD proximal to the fixation pegs was probably a result of increased and altered mechanical loading.

Absorptiometry, Photon↗
PubMed1995

Phase II study of gemcitabine in previously platinum-treated ovarian cancer patients.

Fifty-one patients with histologically confirmed epithelial stage III or IV ovarian cancer were entered into a study in which gemcitabine 800 mg/m2 was given as a 30 min intravenous infusion in a cycle once a week for 3 weeks followed by a week of rest. Patients were aged 58 years (range 23-70 years) with WHO performance status 0-2, and had received up to two different chemotherapy regimens. Thirty-eight patients had received only one prior platinum-containing chemotherapy regimen whereas 9 had received a first-line regimen on more than one occasion. A further 3 patients had received two different regimens. Of 42 patients evaluable for response, 8 (19%; 95% CI: 9%-34%) were partial responders. Seven of the 8 responders were resistant to first-line platinum-based therapy. Median duration of response was 8.1 months (range 4.4-12.5 months). Median progression-free survival was 2.8 months (range 0.2-12.5 months). Haematological toxicity with gemcitabine was modest, with grade 3 leukopenia (11 patients) and grades 3 and 4 thrombocytopenia (6 patients). Grade 3 non-haematological toxicity included nausea/vomiting (6 patients) and elevated AST/ALT (1 patient), while dose-limiting non-haematologic toxicity consisted of flu-like symptoms (2 patients), peripheral oedema (1 patient) and lethargy (1 patient). The activity and modest haematological and non-haematological toxicity seen with gemcitabine suggest that this agent should be further evaluated in the treatment of patients with ovarian cancer and in combination chemotherapy regimens, primarily in combination with platinum.

Adult↗
PubMed1995

Changes in bone mineral density of the proximal tibia after uncemented total knee arthroplasty. A 3-year follow-up of 25 knees.

We measured bone remodeling of the proximal tibia prospectively for 3 years after uncemented total knee arthroplasty (TKA) in 25 knees with primary arthrosis. In the trabecular bone below the tibial component, bone mineral density (BMD) was measured in 6 different regions of interest (ROI), using dual photon absorptiometry (DPA). In the tibial condyles, where the change in knee alignment indicated that the load was reduced postoperatively, a fast bone loss of 7-20% was seen during the first 6 months after surgery. A small, but significant increase in BMD of 2-7% was seen in the tibial condyles, where the load was increased. On average, the density for all ROI below the tibial component showed a significant and progressive decrease in BMD, reaching 22% at 3 years follow-up.

Absorptiometry, Photon↗
PubMed1995

A longterm prospective study of the equipotency between deflazacort and prednisolone in the treatment of patients with polymyalgia rheumatica.

OBJECTIVE: The aim of the study was to establish the antiinflammatory equipotency between prednisolone and deflazacort. METHODS: Thirty patients with newly diagnosed polymyalgia rheumatica (PMR) were treated double blind with either prednisolone or deflazacort in a 12-month study. The initial daily dose was 20 mg prednisolone or 24 mg deflazacort. RESULTS: The clinical control of muscle pain was significantly inferior in the deflazacort group from 6 weeks to 3 months. Otherwise there was no difference in the clinical and biochemical variables. The ratio between antiinflammatory equipotent doses of deflazacort and prednisolone (mg:mg) stabilized at about 1.55 for the daily doses and about 1.40 for the cumulative doses. CONCLUSION: In PMR the antiinflammatory equipotency (mg to mg) between deflazacort and prednisolone was close to 1.40 (7:5 mg). Twenty mg prednisolone/day was fully sufficient to suppress symptoms in 94% of the patients.

Aged↗
PubMed1995

Patients with rheumatoid arthritis benefit from early 2nd line therapy: 5 year followup of a prospective double blind placebo controlled study.

OBJECTIVE: To compare 2 treatment strategies in a prospective 5 year study of patients with rheumatoid arthritis (RA): early treatment with slow acting antirheumatic drugs (SAARD) versus a "wait and see" attitude. METHODS: One hundred thirty-seven patients with RA of < 2 years' duration entered a double blind placebo controlled study: patients in the "early" (E) group were treated with auranofin within one year of diagnosis of RA, and SAARD treatment in the initially placebo treated group was delayed 8 months compared with the former group. [The results after 2 years clearly favored early treatment (Borg G, Allander E, Lund B, et al: J Rheumatol 1988; 15:1747-54)]. RESULTS: After a total observation period of 5 years in 75 representative patients, continued improvement in the E group was demonstrated, and differences between the 2 groups were maintained with regard to clinical variables, outcome measures, and radiographic evaluation. CONCLUSION: The results indicate the existence of a therapeutic window in RA within the first 2 years of the disease.

Adult↗
PubMed1994

[Pseudocroup. Treatment in hospital].

Although croup is the most common form of airway obstruction in small children, there is debate as to the correct medical care for the hospitalized patient. A critical review of published articles was performed. It was found that a scoring system was essential for observation. There is only little information concerning the use of humidified air. Inhaled racemic epinephrine has a well-demonstrated effect. New studies indicate that L-epinephrine is as effective and safe as racemic epinephrine. Dexamethasone in doses greater than 0.6 mg/kg is effective in decreasing the length and the severity of respiratory symptoms associated with croup. When intubation is necessary steroids reduced the duration of intubation and the need for reintubation.

Child, Preschool↗
PubMed1994

Phase II study of gemcitabine (2',2'-difluorodeoxycytidine) in previously treated ovarian cancer patients.

BACKGROUND: Platinum-containing combination chemotherapy has resulted in improved survival rates in patients with advanced ovarian carcinoma, but the majority of the patients still die of their disease. It is therefore important to develop new non-cross-resistant drugs. Gemcitabine (2',2'-difluorodeoxycytidine) has shown a broad spectrum of antineoplastic activity in tumor cell cultures in vitro and in animal tumor models. Clinical activity also has been reported in a variety of solid tumor types. PURPOSE: Our purpose was to assess the clinical activity of gemcitabine in previously treated ovarian cancer patients and to further characterize the toxicity of the compound. METHODS: Gemcitabine (800 mg/m2) was given intravenously once a week for 3 consecutive weeks, followed by 1 week of rest. A maximum of two different prior treatment regimens was allowed. Response was assessed by pelvic examination and/or ultrasound and computed tomography scans every other course. RESULTS: Fifty patients were eligible; 35 (70%) had bulky disease (tumor greater than 5 cm in diameter). All patients had received prior platinum-containing combination chemotherapy. Forty-two patients were assessable for response. Eight (19%) of the 42 patients (95% confidence interval = 9%-34%) achieved a partial response, with a median response duration of 8.1 months (range, 4.4-12.5 months). All responders started treatment with gemcitabine within 6 months of prior treatment, and seven of the eight responders were resistant to first-line platinum-containing combination chemotherapy. Overall median time to progression was 2.8 months (range, 0.2 12.5 months), and overall median survival was 6.2 months (range, 0.2-26.0 months). Forty-eight patients were assessable for toxicity. Leukocytopenia and thrombocytopenia were the main toxic effects that caused dose omissions (27% and 14%, respectively) and dose reductions (37% and 21%, respectively). A transient mild flu-like syndrome occurred in 28% of the patients, and treatment-related peripheral edema developed in 22%. Grade 1 hematuria (53% of patients), grade 1-2 proteinuria (79% of patients), and liver toxicity that was mostly grade 1-2 (59% of patients) were also observed. CONCLUSIONS: Gemcitabine is a well-tolerated new drug with activity in platinum-resistant ovarian cancer patients. IMPLICATIONS: Confirmatory trials are needed, and the activity of gemcitabine in previously untreated patients should be assessed.

Adult↗
PubMed1994

[Mycoplasma pneumonia affecting the central nervous system].

The authors describe a case of Guillain-Barré syndrome and a case of encephalitis, both with serological proven Mycoplasma pneumoniae infection. In the patient with Guillain-Barré syndrome, a 49 year old male who had neurological sequelae five months after discharge, a throat swab was PCR positive for M pneumonia. The patient with encephalitis was discharged 19 days after admission without sequelae.

Adolescent↗