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Biomedical subjects

D Adkins

Publications and source records attributed to D Adkins.

47 records · Page 3Linked to original sources
PubMed1993

Design of preparative regimens for stem cell transplantation in breast cancer.

We have evaluated tandem cycles of a tri-drug combination, termed CVP (cyclophosphamide, etoposide [VP-16], and cisplatin [Platinol]), at four levels in more than 300 patients with various types of tumors. Tandem CVP appears to be at least therapeutically equivalent to alternatives. A second potentially non-cross-resistant combination of mitoxantrone and thiotepa (MT), with or without etoposide, has been used in sequence following CVP to improve long-term, disease-free survival in patients who have multiple metastatic sites, who relapse shortly after adjuvant therapy, or who show other unfavorable clinical features. A combination of MT and etoposide (MVT) achieved an overall response rate of 61% in 32 patients with metastatic or refractory breast cancer. The etoposide was then eliminated to decrease the major toxicities of this regimen. MT was subsequently given to 37 evaluable patients prior to bone marrow infusion. The overall response rate was 48.5% Thirty patients with metastatic breast cancer were then treated with induction therapy, a cycle of CVP, and then a cycle of MT. Given the low complete remission (CR) rate to induction therapy in these patients, the CR rate achieved with CVP-MT was encouraging. Further studies are ongoing.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Durable complete remission in a patient with refractory mediastinal non-seminomatous germ cell tumor after tandem high-dose chemotherapy and autologous bone marrow transplantation.

The prognosis of patients with relapsed or refractory mediastinal germ cell tumors is uniformly poor. There have been no reports of long-term disease-free survivors using any currently available salvage regimen. We describe a patient with primary mediastinal non-seminomatous germ cell tumor refractory to initial and salvage chemotherapy, who entered his first complete remission after surgical resection and tandem autologous bone marrow transplantation. The patient remains without evidence of disease 19 months after the first BMT.

Adult↗
PubMed1993

Dose escalation of mitoxantrone given with thiotepa and autologous bone marrow transplantation for metastatic breast cancer.

High-dose chemotherapy given with autologous bone marrow support has resulted in significant tumor responses in the majority of patients with metastatic breast cancer, a minority of which are durable. To improve on these results, we are developing high-dose preparative regimens which may be given in successive cycles, each with autologous bone marrow transplantation (ABMT), over a short duration. In this report, 44 patients with metastatic breast cancer were treated with thiotepa (total dose: 900 mg/m2) and mitoxantrone (MT), administered in a dose-escalation fashion, with ABMT. The dose-limiting non-hematologic toxicity of mitoxantrone was cardiotoxicity, with the maximum tolerated dose being 50 mg/m2 Mucositis and pneumonia were also frequent treatment-related side-effects. The overall tumor response rate was 49% in this heavily pre-treated group of patients. We are currently evaluating the toxicity and efficacy of tandem non-cross-resistant transplant regimens, using the MT combination for the second cycle of therapy, in patients with metastatic breast cancer sensitive to standard dose chemotherapy.

Adult↗
PubMed1992

Urea kinetics evaluation of hemodialysis and CAPD patients.

Urea kinetics have been used to measure adequacy of hemodialysis. The role of urea kinetics in CAPD has not been clearly established. Using urea kinetics, we studied 71 hemodialysis and 71 CAPD patients. Age was 53 +/- 12 and 45.8 +/- 12 respectively. Urea kinetics in hemodialysis were studied in the standard manner. CAPD patients collected 24 hr, dialysate fluid to measure urea, creatinine, glucose and protein. Urine was collected for 24 hr. to measure urea and creatinine. Protein catabolic rate (pcr) was calculated from the total amount of urea cleared in 24 h. Both groups of patients had similar body weight. Kt/V in CAPD (0.65 +/- 0.1) was at a level considered underdialysis for hemodialysis. In both groups, pcr increased as Kt/V increased. However, CAPD patients had levels of pcr higher than hemodialysis patients at the same level of Kt/V. BUN, serum albumin and serum potassium were significantly lower in CAPD patients. Patients who dialyze more, eat more. Differences in protein intake may be due to a more liberal diet in CAPD, patient selection, removal of middle molecules, or better control of the acidosis.

Adult↗
PubMed1991

Evaluation of CAPD prescription.

Adequacy of CAPD has not been established. The recommendation is a Kt/V (K, total urea clearance in ml/min; t. time in minutes on dialysis; and V, total body water which is the volume of distribution of urea) greater than 1.5/week and/or a creatinine clearance (residual + dialysis) greater than 40 l/week/1.73 m2. We followed 20 CAPD patients for 38.6 +/- 28 mo. We measured blood urea nitrogen, serum creatinine, body weight, residual renal function (Kr), normalized protein catabolic rate (NPCR), Kt/V/week and creatinine clearance (CC) l/w/1.73 m2. We obtained the following values: B Wt 72 +/- 16 kg, BUN 56 +/- 13 mg/dl, s. Cr. 12.6 +/- 5 mg/dl, Kr 0.6 +/- 1 ml/min, NPCR 0.84 +/- 0.3 g/kg/day, Kt/V/week 1.8 +/- 0.3 and CC 50.4 +/- 10 l/w/1.73 m2. Patients dialyzed with a wide range of prescription. There was a good correlation between Kt/V and CC. There was no correlation between the dialysis prescription changes in weight and biochemical determinations. There was a direct correlation between Kt/V and NPCR: patients who were dialyzed more eat more. Of the 20 patients, 10 had 24 hospitalizations, and of these were 12 due to peritonitis. Dialysis prescription and biochemical findings of these patients did not differ significantly from nonhospitalized patients. Larger prospective studies are necessary to determine the adequate range of CAPD prescription and its relationship to morbidity and mortality.

Adult↗
PubMed1988

Biological characterization of plaque-size variants of yellow fever virus in mosquitoes and mice.

We isolated plaque-size variants of a South American strain of yellow fever virus, and compared their ability to infect orally and be transmitted by vector Aedes aegypti mosquitoes with that of the uncloned, parental virus. We analyzed the same clonal isolates in mouse virulence experiments. No significant differences could be demonstrated in the capacities of the variants to infect and be transmitted by mosquitoes or in mouse virulence tests. The 17D vaccine virus (derived from the African Asibi strain) was, however, markedly attenuated in mosquitoes; also, a variant virus (Asibi strain) derived by continuous passage in HeLa cells (and attenuated for monkeys and mice) was markedly attenuated in mosquitoes when compared with its parent virus. The results suggest that vector competence and mouse virulence are similar in plaque-size variants of the South American strain of yellow fever virus. However, if vigorous and appropriate selection pressures are applied (as established by the derivation of the 17D vaccine and HeLa passaged viruses), attenuated variants can be discovered; their role and prevalence within a virus population in nature is unknown.

Aedes↗
PubMed1982

Development of a curriculum for the preparation of phlebotomists.

Automation and other factors have produced a sharp growth in the volume of laboratory testing. This has created the need for a new position on the laboratory team: the phlebotomist. This paper describes one medical center's experience in the creation of a curriculum for the training of phlebotomists.

Blood Specimen Collection↗
PubMed1978

A comparison of behavioral and traditional treatment for middle-income problem drinkers.

Groups of middle-income outpatient problem drinkiers were randomly assigned to one of two treatments: a multicomponent positive reinforcement procedure emphasizing moderation, or "traditional" denial-confrontation therapy emphasizing abstinence. There were no significant differences between participants assigned to the two procedures with respect to pretreatment characteristics. Participants reduced their alcohol consumption significantly in both treatments. Behavioral participants reduced alcohol consumption significantly during therapy, whereas traditional participants reduced significantly prior to therapy. Significantly more traditional participants dropped out of therapy than did behavioral. The data suggested that the effects of traditional therapy were mixed, helping those participants who were receptive, driving out those who were not; moreover, reduced consumption seemed to be more the result of compliance with initial therapist demands (made during the screening period) than the effect of denial-confrontation in subsequent therapy. Behavioral treatment was more successful in several indicators of outcome; the improvement observed seemed to be attributable to the active therapeutic techniques employed.

Adult↗
PubMedDate not supplied

Apoprotein assays: radial immunodiffusion versus an immunoturbidometric technique.

The measurement of apolipoprotein using radial immunodiffusion (RID) and Cobas-Bio immunoturbidometric assays is compared. Samples were obtained from 100 patients in a fiber-diet study. RID assays were performed using plates, standards, and diluent from Tago Inc. The immunonephelometric assays were performed on a Cobas-Bio with DENS program centrifugal analyzer. The correlation coefficient for the apolipoprotein Al was 0.90 and for apolipoprotein B was 0.91. The bias of the RID was to report higher values. The Cobas-Bio system affords the clinical laboratory with a reliable and cost-effective means for assessing these apolipoproteins.

Apolipoproteins↗