High-dose etoposide as single-agent chemotherapy for small cell carcinoma of the lung.
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Adult↗
Biomedical subjects
D H Johnson
Publications and source records attributed to D H Johnson.
Etoposide-induced hepatic injury: a potential complication of high-dose therapy.
Two cases of toxic hepatitis developing in patients receiving high-dose etoposide (VP-16-213) for refractory germinal neoplasms are described. Each patient received a total cumulative dose of at least 6800 mg/m2. Liver function abnormalities, including hyperbilirubinemia, elevated transaminases, and elevated alkaline phosphatase, became clinically apparent approximately 3 weeks following the last dose of VP-16-213. These abnormalities resolved spontaneously without sequelae over 12 weeks. High-dose VP-16-213 may be associated with hepatic injury.
Adult↗
Advanced minimal residual ovarian carcinoma: abdominopelvic irradiation following combination chemotherapy.
Seventeen patients with advanced ovarian carcinoma who had minimal residual intraabdominal disease after six months of combination chemotherapy were treated with abdominopelvic irradiation. All 17 patients had residual intraabdominal tumor nodules with a cross-sectional diameter of less than 2 cm. Eleven had only microscopic residual disease at the time of irradiation. Fourteen have relapsed at a median of eight months after the completion of radiotherapy. All but two had intraabdominal recurrences. Myelosuppression was common and severe, causing marked delays or discontinuation of radiotherapy in ten of 17 patients. Patients receiving the entire planned dose of radiotherapy had longer disease-free survival (14 months median) than did patients receiving only partial doses (seven months median). However, six of seven patients receiving full dose irradiation have relapsed. Abdominopelvic irradiation in the schedule employed here is poorly tolerated and is not an effective salvage treatment in patients with limited or microscopic residual tumor following initial combination chemotherapy.
Adenocarcinoma↗
The ultrastructure of Descemet's membrane. I. Changes with age in normal corneas.
The ultrastructure of Descemet's membrane was studied in 24 eyes, at least two eyes from patients in each of the first nine decades of life. Both the anterior banded layer and the posterior nonbanded layer were regular, predictable structures, with no extra layers or significant substructures present. The anterior banded layer was present in the eye of a fetus of five months' gestation. The thickness of the anterior layer was approximately 2 micrometers and similar in specimens from patients of all ages. The thickness of the posterior nonbanded layer of Descemet's membrane increased significantly with age, averaging approximately 2 micrometers at age 10 years and 10 micrometers at age 80 years.
Adolescent↗
The ultrastructure of Descemet's membrane. II. Aphakic bullous keratopathy.
The ultrastructure of Descemet's membrane was studied by transmission electron microscopy in nine corneal buttons from aphakic eyes with bullous keratopathy. All nine corneas had abnormal collagenous material in the posterior portion of Descemet's membrane. Five of the buttons had abnormalities in layers of Descemet's membrane secreted at an early age. These abnormalities are evidence of endothelial dysfunction long before cataract extraction. In the remaining four corneas, the Descemet's membrane secreted prior to cataract extraction remained relatively normal, despite corneal endothelial decompensation for up to five years. Thus, the layers of Descemet's membrane remain relatively unchanged after their formation and serve as a historic record of one aspect of endothelial function.
Aged↗
The ultrastructure of Descemet's membrane. III. Fuchs' dystrophy.
The ultrastructure of Descemet's membrane was studied by transmission electron microscopy in corneal buttons removed from 11 phakic eyes with Fuchs' dystrophy. Abnormalities in Descemet's membrane consistent with abnormal endothelial function early in life (prior to age 20 years) were present in all corneas. Thus, despite the relatively late clinical onset of Fuch's dystrophy, endothelial abnormalities are present quite early in life in this disease. An abnormal fibrillar layer was thicker in those corneas with greater stromal and epithelial edema, possibly indicating that this layer is formed mainly during periods of endothelial decompensation.
Aged↗
Dynamics of aqueous humor in the syndrome of exfoliation with glaucoma.
We compared the aqueous humor dynamics of the affected and unaffected eyes of ten subjects with unilateral exfoliation and glaucoma and normal fellow eyes. The affected eyes had a greater mean intraocular pressure (31.9 +/- 11 mm Hg) than the unaffected control eyes (17.7 +/- 4.7 mm Hg) and a higher apparent resistance to the outflow of aqueous humor (15.2 +/- 7.3 min mm Hg/microliter vs 6.5 +/- 2.1 min mm Hg/microliter). The affected eyes accumulated systemically administered fluorescein at an abnormal rate. The rate of aqueous flow through the anterior chamber was lower in the affected eyes than in the control eyes (2.02 +/- 0.63 min-1 X 10(2) vs 2.38 +/- 0.71 min-1 X 10(2), as was the anterior chamber volume (126 +/- 23 microliter vs 136 +/- 25 microliter). The cornea-to-anterior chamber transfer coefficient for fluorescein was within the normal range in the affected eyes (mean, 2.51 +/- 1.2 min-1 X 10(3).
Aged↗
Discontinuous counterimmunoelectrophoresis in the diagnosis of antibiotic-associated colitis.
Discontinuous counterimmunoelectrophoresis (DCIE) was employed to detect the toxin of Clostridium difficile, etiologic antibiotic-associated colitis (AAC), in bacteria-free stool filtrates from 51 patients with diarrhea. Stool samples from 31 patients contained C. difficile toxin as determined by tissue-culture assay. A positive result was obtained by DCIE in 20 of the 31 patients (65%) and was influenced by the titer of toxin present. When toxin was present by tissue-culture assay in a dilution of less than or equal to 10(-2) (11 samples), DCIE was positive in only 2 (18%). However, DCIE yielded positive results in 18 of the 20 samples (90%) containing toxin titers greater than or equal to 10(-3). The combination of DCIE and sigmoidoscopy of colonoscopy was superior to either alone in the diagnosis of AAC irrespective of the toxin titer. Nine of 11 patients (82%) whose stool samples contained C. difficile toxin in a dilution of less than or equal to 10(-2) were recognized by DCIE, endoscopy, or both. In stool samples containing toxin in titers greater than or equal to 10(-3), no false-negative results were encountered (sensitivity equals 100%). Thus, 29 of 31 patients whose stool samples contained C. difficile toxin were identified when the results of DCIE and endoscopical examination were combined (sensitivity 93.5%). Neither endoscopical examination nor DCIE yielded positive results in the 20 patients whose stool samples lacked C. difficile toxin (specificity equals 100%). DCIE is a rapid, moderately sensitive, and specific method for detecting C. difficile toxin. When DCIE is combined with endoscopy, the vast majority of patients requiring specific therapy for AAC can be identified.
Anti-Bacterial Agents↗
Pancoast's syndrome and small cell lung cancer.
Four patients with small cell lung cancer (SCC) presenting with Pancoast's syndrome are described. Superior sulcus tumors are usually caused by epidermoid carcinoma or adenocarcinoma of the lung, and are routinely treated with radiotherapy followed by radical surgery. SCC, on the other hand, is widely disseminated at diagnosis and is best treated with chemotherapy. Although not previously reported as a cause of Pancoast's tumor, these four cases of SCC presenting as such clearly indicate the need for pretreatment histologic diagnosis to avoid unnecessary surgical intervention. Transcutaneous needle aspiration biopsy is a means by which the diagnosis can be safely made in patients presenting with apical lung tumors.
Biopsy↗
Oncology Grand Rounds. Bone metastases: diagnosis and management.
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Bone Marrow Examination↗
Amyloidosis masquerading as inflammatory bowel disease with a mass lesion simulating a malignancy.
Our patient, who was known to have multiple myeloma, presented with weight loss, rectal bleeding, and a barium enema study suggestive of a colitis with a mass lesion. Colonoscopy with biopsy revealed the mass to be large mucosal folds infiltrated with amyloidosis. Amyloidosis has been reported to mimick malignancy, mainly by tumorous deposits in the stomach and less commonly in the small and large bowels. Gastrointestinal surgery in patients with amyloidosis potentially may have undesirable consequences due to failure of anastomotic suture lines and subsequent sepsis (6, 11, 17, 18). The knowledge that amyloidosis may be associated with multiple myeloma and an appreciation of the wide range of gastrointestinal roentgenographic findings in patients with amyloidosis should prompt the clinician to obtain endoscopic and biopsy evaluation of these patients.
Adult↗
Bacterial endocarditis with flail mitral valve leaflet.
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Echocardiography↗
Respiratory survey findings as predictors of disability from respiratory diseases.
Male employees of 2 East Coast telephone companies who participated in standardized respiratory surveys from 1961 to 1969 were followed to ascertain days of disability resulting from respiratory illnesses that lasted for more than a week. Subjects for this study were 1,386 white males between the ages of 40 and 65 yr who had had no disabling chest illnesses in the 3-yr period prior to examination. Several survey findings were predictive of subsequent days lost from work. Listed in order of importance, these were diminished forced expiratory volume, a history of ever having had asthma, marked shortness of breath, chronic cough and phlegm, and chronic wheeze. A history of ever having had hay fever was associated with a diminished risk of lost time because of respiratory illness.
Absenteeism↗
Prospectives on the risks of alternative fuel cycles.
A commentary is provided on the uncertainties in the data and in qualifying the phenomena relating to the risks imposed by the various steps involved in the use of coal, oil, natural gas, hydropower, and nuclear fuels for the generation of electricity. Uncertainties appear to be extremely large for hydropower which exhibits both large scale ecological impacts and the potential for high consequence, moderate frequency events at specific sites. Major risk-related uncertainties with the use of nuclear fuels include those surrounding nuclear weapons proliferation and reactor accident frequencies and consequences. Uncertainties for coal and oil include specification of the damage function of air transported sulfates and the effects of atmospheric CO2 buildup, acid rain, and groundwater contamination from mine water runoff. Compounding these problems is the potential impact of the growing global competition for a diminishing supply of oil. In the studies reviewed herein, the assessed risks of the nuclear fuel cycle are no greater than those of the primary alternatives. Prudence suggests that we do not totally reject any particular option at this time on the basis of health effects alone; similarly, no option is an undisputed choice.
Conservation of Energy Resources↗
Tricuspid atresia with dextrotransposition, dextrocardia, and mitral insufficiency: successful circulatory correction.
A 13-year-old patient with visceral and atrial situs solitus, dextrocardia, dextro (D) transposition of the great vessels with subaortic conus, tricuspid atresia, massive mitral valve insufficiency, and previously performed pulmonary artery banding was seen at our hospital. A right atrial to pulmonary artery conduit procedure and mitral valve replacement successfully repaired this child's circulation.
Adolescent↗
Applicability of white-noise nonlinear system analysis to the peripheral auditory system.
A functional series is capable of describing the input-output relationship of a general class of systems, linear or nonlinear. Wiener and his associates demonstrated methods by which these functionals could be measured from the response of the system to white noise. This paper is a critique of the application of this functional series approach to the measurement of the input-output relationship of the peripheral auditory system. The Wiener functionals are shown to be dependent on the parameters of the white noise used to measure them. The approximation of the output of a system by a truncated Wiener series is shown to have unpredictable error properties when inputs other than white Gaussian noise are used. Estimates of the Wiener functionals using the white-noise approach do not converge when the system has a point process output (e.g., spike train output).
Humans↗
The relationship between spike rate and synchrony in responses of auditory-nerve fibers to single tones.
Dischargae patterns of single auditory-nerve fibers in the cat responding to single tones were recorded and analyzed. Synchronization of the discharges to the stimulus tone was measured for frequencies below 6-kHz. The synchronized response and the average discharge rate each varied with stimulus level over 20--30-dB ranges. However, these ranges overlapped only a 10-dB range. Under certain conditions the average rate of response varied without accompanying variation in the synchronized response. The physiological implications of these observations are discussed.
Acoustic Stimulation↗
Tooth staining effects of an alexidine mouthwash.
The primary purpose of this study was to determine the amount of tooth staining produced by an alexidine mouthrinse. One hundred and eighty subjects rinsed twice daily for 1 month with either 15 ml of alexidine (0.035%) or a placebo solution. Prior to the study, the subjects were classified according to their smoking, coffee and tea drinking habits and these factors were subsequently considered in the analysis of the stain scores. Additionally, the effects on staining of a prior prophylaxis and the use of a fluoridated toothpaste during the study were determined. Upon termination of the study, subjects utilizing the active mouthrinse manifested a greater degree of staining than placebo users. The amount and intensity of the stain due to alexidine were not influenced (increased) by smoking, tea or coffee drinking habits. A prior prophylaxis did not reduce the staining propensity of alexidine users. The method of scoring developed can be used to assess the degree of tooth staining induced by antiplaque agents.
Adolescent↗