Dose intensity in the treatment of diffuse large-cell lymphoma.
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Biomedical subjects
Publications and source records attributed to B Peterson.
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The identification of recurring chromosomal translocations has provided clues to the gene regions important in lymphoma development. Among 157 patients with non-Hodgkin lymphoma studied by cytogenetic analysis, four new recurring translocations have been identified--t(8;9) (q24;p13), t(11;18)(q21;q21), t(14,15)(q32;q15), and an unbalanced translocation giving rise to der(22)t(17;22) (q11;p11). Each translocation appeared twice. The t(11;18) was the only karyotypic abnormality in the two patients with it, and the t(14;15) was the sole karyotypic abnormality in one patient. All translocations were found in B-cell malignancies and were associated with both nodal and extranodal disease. Among the regions affected, only the immunoglobulin heavy-chain gene MYC, and BCL2, have thus far been associated with lymphoma. The breakpoint sites identified by these translocations warrant further investigation at the molecular level.
The motor output to the lateral rectus eye muscle was studied in decerebrate cats with electromyographic recordings and in alert cats with multi-unit and single neuron recordings from abducens nucleus. The axis of rotation that produced maximal excitation of the lateral rectus was calculated from responses to rotations in many different stimulus orientations, and was found to lie near the axis of the horizontal semicircular canals, but pitched slightly nose down from the canal axis (4.6 degrees). The results from decerebrate and alert cats were in agreement. The dynamics of lateral rectus activation were quite similar in all planes. Responses at high frequencies were in phase with rotation velocity and responses lagged toward position phase as frequency and velocity were decreased. Differences in decerebrate cat low frequency responses to rotations with and without a sinusoidal gravitational stimulus implicated an otolith input to lateral rectus.
Four series of experiments investigated how adaptive changes in direction of the cat's vestibulo-ocular reflex (VOR) vary with position of the animal during adaptive training and postadaptive testing. In all experiments VOR was measured electrooculographically during rotations about earth-horizontal and vertical axes in the dark before and after 2 h of adaptation in which 0.25 Hz sinusoidal whole body rotation about a horizontal/vertical axis was paired with synchronous 0.25 Hz rotation of a visual pattern about a vertical/horizontal axis, respectively. In upright sagittal (US) experiments, coupling of pitch rotation with visual pattern rotation about an earth vertical axis yielded an adaptive horizontal VOR response to pitch rotation whose gain had a local maximum at 0.25-0.5 Hz plus a sustained rise for frequencies below 0.1 Hz. When post-tests were done with the animal rolled 90 degrees onto its side and rotated about the earth vertical axis (pitch relative to the cat), the low frequency rise was eliminated and the 0.25 Hz peak was reduced. In on side sagittal (SS) experiments, where training was done in the latter (on side) position, training produced only the 0.25 Hz peak without the low frequency rise, indicating that the rise is due to coupling of otolith input to horizontal VOR. Again the 0.25 Hz peak was reduced when testing was done with the cat oriented 90 degrees from the training position (in the US position). This indicates that the cross-coupled canal-ocular reflex response is modulated or gated by the position of the animal with respect to gravity.(ABSTRACT TRUNCATED AT 250 WORDS)
Alert cats were rotated sinusoidally (0.25 Hz) in their sagittal plane while viewing optokinetic motion in their horizontal plane. Vertical and horizontal vestibulo-ocular reflex (VOR) was measured in the dark before and after 2 h of these adaptation stimuli in upright or onside orientation of the cat. Onside exposure produced maximal adaptive horizontal VOR at the training frequency. Upright exposure produced highest gain at lower frequencies. A cat with inoperative vertical canals adapted only to upright exposure. We conclude that in the presence of horizontal image rotation either vertical canal or otolith stimulation can produce adaptation in VOR direction and stimulation of both produces complex adaptation dynamics.
Vestibulocollic reflex responses of several neck muscles in decerebrate cats were studied during angular rotations of the whole body in a large number of vertical and horizontal rotation planes, at frequencies from 0.07 to 1.6 Hz. Vestibulocollic responses were compared to eye muscle and forelimb muscle vestibular responses. Electromyographic activity was recorded by fine wires inserted in biventer cervicis, complexus, longus capitis, obliquus capitis inferior, occipitoscapularis, rectus capitis major, splenius, lateral rectus, and triceps brachii. At frequencies of approximately 0.5 Hz and above, neck muscle electromyographic response gains were sinusoidal functions of stimulus orientation within a set of vertical or horizontal planes, and a muscle's response phase remained constant across rotation planes, or reversed by 180 degrees. Response patterns at high frequencies were consistent with vestibulocollic reflex activation by semicircular canals through brain circuitry that modifies canal dynamics. At frequencies of approximately 0.5 Hz and above, the stimulus orientation in which a given neck muscle's response was maximal remained nearly constant across frequencies. Thus, we used responses to rotations at high frequencies to calculate axes of maximal response of each muscle in three-dimensional space. Lateral rectus, obliquus, and to a lesser extent, splenius and longus capitus were activated predominantly by horizontal rotations. Biventer was activated predominantly by pitch, triceps predominantly by roll, and complexus, occipitoscapularis, and rectus major significantly excited by rotations in all three coordinate planes. In some cases, at frequencies less than 0.5 Hz, neck muscle response phase varied depending on the vertical plane in which the cat was rotated, and the optimal response plane was poorly defined and varied with frequency. These responses indicated that, at some frequencies, neck muscle activity can result from summation of inputs with differing spatial orientation and dynamics (spatial-temporal convergence). Differences between responses to vertical and horizontal rotations suggested that low-frequency spatial-temporal convergence behavior of the vestibulocollic reflex during vertical rotations was due to convergent semicircular canal and otolith receptor inputs.(ABSTRACT TRUNCATED AT 400 WORDS)
Responses to natural stimulation were studied in electrically identified secondary vestibular neurons of awake cats. A class of neurons was identified whose response dynamics and responses to rotations in several vertical and horizontal planes indicated that they received semicircular canal input. Each canal neuron had clearly defined planes of maximal and null sensitivity to rotation. The orientation of these planes indicated that 44% of the neurons received input from one pair of canals, 40% from two, and 16% from all 3 canal pairs. Many cells also had oculomotor-related discharges and/or responded weakly to neck rotation.
Responses to rotation in many vertical and horizontal planes were studied in electrically identified secondary vestibular neurons of alert cats. This report concerns secondary neurons that gave responses which could not be explained as due to a summation of semicircular canal inputs. These cells responded to sinusoidal rotation of the cat in any vertical plane, and response phase depended on the plane of rotation. The responses were modeled as the result of summation of two inputs that differed in their spatial orientations and dynamics. Response dynamics and a comparison of responses to vertical and horizontal rotations showed that some cells were sensitive to rotation with respect to gravity. Their responses both to gravity and horizontal rotations argue that these secondary neurons received convergent otolith and canal inputs. Some cells also had oculomotor related discharges and/or responded weakly to neck rotation.
Ten infants with acquired subglottic stenosis were treated successfully using the anterior cricoid split operation. Eight had been preterm infants who required endotracheal intubation and assisted ventilation for the respiratory distress syndrome. Two had been born at term; 1 required mechanical ventilation for aspiration of meconium and the other intubation for obstructive apnea. All had been extubated successfully in less than 2 wk and were discharged home with no signs of subglottic stenosis. These infants were referred at 2 to 13 months of age for evaluation of upper airway obstruction. By bronchoscopy, we confirmed severe subglottic stenosis in each of the infants. The anterior cricoid split procedure requires a single midline vertical incision through the anterior cartilaginous ring of the cricoid cartilage and the upper 2 tracheal rings. Our postoperative management included 7 to 10 days of endotracheal intubation, mechanical ventilation, neuromuscular blockade, sedation, and total parenteral nutrition. All were extubated at the end of this period without evidence of stridor or obstructive apnea. One patient developed a subglottic granuloma at the level of the cricoid cartilage 4 months after the operation; this was successfully excised with the carbon dioxide laser. The other 9 patients remain asymptomatic 1 month to 1 yr after the surgical repair.
Serum cholesterol as risk factor for premature mortality; 0--6, mean 3 years after a screening investigation in 10,000 middle-aged men (46--48 years at screening) was studied with respect to category of death. Serum cholesterol was reciprocally correlated to cancer deaths and to alcohol-related deaths, and strongly positively correlated to deaths in coronary heart disease. The men who died of cancer did not have lower body weight, nor was there any association with serum triglycerides. The inverse correlation to serum cholesterol did not differ between the cancer deaths occurring early, and those occurring later after screening. Part of the cholesterol/cancer death relationship may be explained by the presence of an otherwise occult malignancy at screening, but it cannot be excluded that the development of some cancers may be associated with a state of low serum cholesterol.
gamma-Glutamyltransferase (gamma-GT) and a Malmö modification of the Michigan Alcoholism Screening Test (Mm-MAST) were compared in subsamples of a health screening population of urban middle aged males with characterized levels of alcohol consumption and in the total group of deaths 0-6 years after the screening investigation. The questionnaire was markedly superior to gamma-GT in identifying the alcohol consumption in the known alcoholics but not in the other study groups. gamma-GT may be indicative of alcohol related health disturbances and may be used in their early recognition and as biochemical feedback in their further treatment and control in individuals. It may therefore be of value particularly as an instrument in a programme aimed at prevention of alcohol-related health complications.
Physical and biochemical health screening variables were compared in matched, middle-aged male samples of (a) ideological teetotallers, (b) average men, (c) self-reported alcohol abstainers, (d) low gamma-glutamyltransferase (GGT) activity, and (e-f) high GGT activity with or without admitted alcohol consumption background. The alcohol non-user groups and the individuals with low GGT had significantly lower mean values of relative body weight, pulse, systolic and diastolic blood pressure, haematocrit, serum urate, triglyceride, cholesterol, and zero and 120 min blood glucose than individuals with elevated GGT and alcohol overconsumption. The average men had intermediate levels. The frequency of increased values of the same tests was notably higher in the subjects with elevated GGT and heavy alcohol consumption than in the teetotallers and the other groups; and was lowest in the teetotallers.
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The horizontal ocular reflexes of cats were studied before and after plugging all 6 semicircular canals (2 cats) or the horizontal canals only (2 cats). After plugging, the vestibulo-ocular reflex (VOR) was virtually absent in the cats with all canals plugged; a small phase-advanced VOR was detectable only at high velocities of rotation. There was no VOR recovery over several months. A compensatory cervico-ocular reflex (COR) appeared within a few days of plugging in all cats, and increased in gain slowly over time. The cats with horizontal canals plugged had little VOR during yaw rotation with the head pitched near 30 degrees down from the stereotaxic plane. When the head was pitched nose up from this null plane, a horizontal VOR appeared and increased as the sine of pitch angle, indicating that the cats relied on normal or increased coupling of vertical canals to horizontal eye movers for generation of compensatory eye movements. Periods of compensatory and anticompensatory eye movements were recorded during downward pitched yaw.
Fifty-eight evaluable patients with non-Hodgkin's lymphoma were treated with a low dose, 120-hour continuous intravenous infusion of bleomycin in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone. Pharmacokinetic data, obtained in six patients, confirm that steady-state plasma concentrations of bleomycin can be attained even with the administration of 2 units/day of the drug. Neither clinical pulmonary toxicity nor subclinical pulmonary changes, as determined by serial measurement of the single breath carbon monoxide-diffusing capacity, were observed. Compared to similar chemotherapeutic programs utilizing bolus administration of bleomycin, pulmonary toxicity may be reduced. Response frequencies among 37 previously untreated patients were similar to those obtained using the same chemotherapeutic agents but with intravenous bolus administration of bleomycin. In addition, 18 of 21 patients who had received prior chemotherapy responded. Low dose, continuous intravenous infusion of bleomycin may improve the therapeutic index of combination chemotherapy programs for non-Hodgkin's lymphoma.
All men living in Malmö who were born in 1926-1929 were invited for a health screening examination which included, among many other things, measurement of gamma-glutamyltransferase (GGT). They were followed up and within three years after the screening 963 of 4571 men had been hospitalized. They had 17158 hospital days or almost 6 days per individual each year. The impact of alcohol on the admissions was analysed both according to the International Classifications of Diseases and a new design where all the diagnoses were grouped and coded in conditions which were judged to be alcohol-related, potentially alcohol-influenced and non-alcohol-related. Of the total days in hospital, alcohol psychosis and alcoholism accounted for 13.6 per cent. Altogether 29.2% of the days were caused by alcohol-related and potentially alcohol-influenced conditions. GGT values at the screening investigation were significantly increased in 25% of the hospitalized men. Alcohol-related admissions were seven times as many in men with GGT values in the highest quintile compared with those who had values in the lowest quintile.