Search PubMed⌕ Search

Biomedical subjects

D L Trump

Publications and source records attributed to D L Trump.

At least 127 records · Page 7Linked to original sources
PubMed1983

Painful gynecomastia following cytotoxic therapy for testis cancer: a potentially favorable prognostic sign?

Ninety-six patients who received cytotoxic chemotherapy for germ cell neoplasms of the testis were studied. Painful gynecomastia developed in eight patients (8%) between 6 and 24 weeks after the initiation of cytotoxic therapy (mean 18 wk). Serum content of the beta subunit of human chorionic gonadotropin was normal in each patient when gynecomastia developed. Gynecomastia occurred following cytotoxic therapy for advanced disease in seven patients, and one patient was receiving adjunctive drug therapy for stage I disease. Six of the seven patients with advanced disease were in complete remission when gynecomastia developed; survival was superior in patients who developed treatment-related gynecomastia compared to those patients who did not (p less than 0.05). Gynecomastia may occur in adult males after cytotoxic therapy for testis cancer; such gynecomastia does not necessarily indicate recurrent malignancy and may be a favorable prognostic sign.

Adolescent↗
PubMed1982

Diffuse large cell and undifferentiated lymphomas with prominent mediastinal involvement.

This report describes 11 adults with non-Hodgkin's lymphoma who presented with symptoms caused by large mediastinal masses. Patients with lymphoblastic lymphoma were excluded from this analysis. Most of the patients were young women with localized disease at presentation. Ten tumors were diffuse large cell ("histiocytic") lymphomas and one was a diffuse, undifferentiated lymphoma, non-Burkitt's type. According to the Lukes' and Collins' classification scheme, seven were large cleaved cell type, three were large noncleaved and one was small noncleaved cell type. Sclerosis was present in four cases. Despite aggressive therapy nine patients died within 26 months of diagnosis and only two remain disease-free. Median survival of these patients was 16 months. Patients with symptomatic mediastinal masses and non-Hodgkin's lymphomas composed predominantly of large cell appear to share certain clinico-pathologic features and to present a poor prognosis subset of patients with non-Hodgkin's lymphoma.

Adolescent↗
PubMed1982

Acquired extrinsic pulmonic stenosis caused by mediastinal tumors.

Clinically detectable pulmonic stenosis resulting from compression of the pulmonary artery or right ventricular outflow tract by mediastinal tumors is uncommon. This report describes the occurrence of pulmonic stenosis secondary to a mediastinal tumor in a patient with Hodgkin's disease and in two patients with non-Hodgkin's lymphomas. Review of 35 published reports reveals that teratomas (ten cases) and Hodgkin's disease (eight cases) are the neoplasms most frequently reported to cause extrinsic pulmonic stenosis. Chest pain and dyspnea were the symptoms most commonly reported and a pulmonic ejection murmur was the most common physical finding in patients with acquired pulmonic stenosis. The prognostic significance of acquired pulmonic stenosis. The prognostic significance of acquired pulmonic stenosis secondary to mediastinal tumors is unclear.

Adult↗
PubMed1982

Cerebrospinal fluid flow abnormalities in patients with neoplastic meningitis. An evaluation using 111indium-DTPA ventriculography.

Cerebrospinal fluid flow dynamics were evaluated by 111Indium-diethylenetriamine pentaacetic acid (111In-DTPA) ventriculography in 27 patients with neoplastic meningitis. Nineteen patients (70 percent) had evidence of cerebrospinal fluid flow disturbances. These occurred as ventricular outlet obstructions, abnormalities of flow in the spinal canal, or flow distrubances over the cortical convexities. Tumor histology, physical examination, cerebrospinal fluid analysis, myelograms, and computerized axial tomographic scans were not sufficient to predict cerebrospinal fluid flow patterns. These data indicate that cerebrospinal fluid flow abnormalities are common in patients with neoplastic meningitis and that 111In-DTPA cerebrospinal fluid flow imaging is useful in characterizing these abnormalities. This technique provides insight into the distribution of intraventricularly administered chemotherapy and may provide explanations for treatment failure and drug-induced neurotoxicity in patients with neoplastic meningitis.

Cerebral Ventriculography↗
PubMed1982

The prognostic and biological significance of cellular heterogeneity in medullary thyroid carcinoma: a study of calcitonin, L-dopa decarboxylase, and histaminase.

We evaluated the cellular distribution of calcitonin (CT), L-dopa decarboxylase (DDC), and histaminase [diamine oxidase (DAO)] in 33 patients with medullary thyroid carcinoma (MTC). CT immunostaining was uniform (greater than 90% of the cells) and intense (4+) in lesions from 7 patients with C-cell hyperplasia and 6 with microscopic MTC: conversely, patchy CT staining (less than 40% of the cells) and diminished intensity (1+) were found in metastases from 8 patients who died of virulent disease. In 17 patients who underwent thyroidectomy for macroscopic cervical MTC with no evidence distant metastases, CT staining was intense (3-4+) and homogeneous (greater than 90%) in 11 subjects who were well 0.5-16 yr postoperatively. Six patients with similar clinical presentations had heterogeneous staining for CT in primary tumor (less than 40% of the cells; 1-2+ intensity); 5 died of disseminated MTC 0.5-5 yr postoperatively (P less than 0.001). Biochemical studies of distant metastases revealed an inverse relationship between the distribution of CT and that of both relationship between the distribution of CT and that of both DDC (r = 0.71; P less than 0.01) and DAO (r = 0.81; P less than 0.001). We conclude that cellular heterogeneity in MTC tissue is associated with a distinct biochemical pattern, and its presence, whether in a primary or metastatic lesion, indicates a virulent neoplasm associated with a grave prognosis.

Adult↗
PubMed1982

Frequency of abnormalities of cortisol secretion and water metabolism in patients with small cell carcinoma of the lung and other malignancies.

Previous studies have suggested that ectopic production of adrenocorticotropic hormone (ACTH) or antidiuretic hormone (ADH) may occur commonly in patients with small cell carcinoma of the lung (SCCL) and that evidence of such production may be elicited only by provocative tests of water excretion and adrenal function. We studied 28 patients with SCCL and 29 patients with other cancers. Adrenal function, assessed by measuring the 8 am plasma cortisol, the 8 am to 4 pm diurnal variation in plasma cortisol, and the suppressibility of the 8 am plasma cortisol following administration of 1 mg of dexamethasone, was found to be abnormal in 28.5, 71, and 25 percent, respectively, of the patients with SCCL, compared with 18, 65, and 29.5 percent in patients with other types of cancer (P greater than 0.3). The possibility of ectopic ADH secretion was assessed by a standard water loading test, which showed excretion impairment in 60 percent of patients with SCCL and 68 percent of patients with other cancers (P greater than 0.9). Neither the stage of neoplastic disease, sites of metastatic deposits, nor performance status of the patients correlated with abnormalities of water and cortisol metabolism, indicating that such abnormalities are common in patients with all types of cancer. These data do not suggest that subclinical disturbances of adrenal function or water excretion are characteristic of any histologic type of cancer. The precise mechanism(s) underlying these abnormalities are unknown.

Adrenocorticotropic Hormone↗
PubMed1982

Gynecomastia in men following antineoplastic therapy.

Six men had painful gynecomastia develop during or following the administration of cytotoxic chemotherapy. Alternative causes of gynecomastia were not delineated in any patient. Sharp increases in levels of plasma follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were noted in five patients. Plasma testosterone concentrations were within or above the normal range in all five patients in whom they were determined. In three patients, plasma estradiol concentrations were modestly increased. One patient was studied prospectively: painful gynecomastia developed at a time when plasma FSH and LH levels were elevated, serum testosterone was decreasing from supranormal to low-normal concentrations, and plasma estradiol was rising to high levels. Plasma prolactin levels were increased in one of four patients in whom they were measured. The mechanisms leading to gynecomastia following cytotoxic chemotherapy were not defined. Damage to germinal epithelium and Leydig cells as well as changes in the peripheral metabolism of testosterone and estrogen may be important. Gynecomastia may occur following cytotoxic chemotherapy and does not necessarily represent current or progressive cancer.

Adult↗
PubMed1982

CSF infections complicating the management of neoplastic meningitis. Clinical features and results of therapy.

This study analyzes the clinical and bacteriologic features of CSF infections that occurred in patients with neoplastic meningitis treated with thiotepa and methotrexate administered through a subcutaneous reservoir and ventricular catheter (SRVC). Thirty-one patients were treated, and CSF infections occurred in four (13%). Staphylococcus epidermidis was the infecting organism in each case and Pseudomonas maltophilia occurred with S epidermidis in one patient. Fever, headache, lethargy, and evidence of CSF extravasation around the SRVC were the common manifestations of infection. The CSF leukocytosis was the only laboratory abnormality noted. All infections were cured with the appropriate antibiotics and removal of the SRVC. Risk of CSF infection did not seem to be related to the use of high doses of dexamethasone, cranial radiation therapy, or the presence or absence of leukopenia. The SRVCs were replaced and treatment of neoplastic meningitis was resumed in three patients; infection did not recur. A CSF infection during management of neoplastic meningitis may be treated effectively and does not preclude adequate therapy of neoplastic meningitis.

Adult↗
PubMed1982

Treatment of neoplastic meningitis with intraventricular thiotepa and methotrexate.

Twenty-five patients with involvement of the meninges by disseminated cancers were treated weekly with intraventricular thiotepa (10 mg) and methotrexate (10 mg) and with radiation therapy. Twenty-two of the 25 patients were clinically improved or stable. Malignant cells were cleared from the cerebrospinal fluid in 76% of the patients. Myelosuppression was the dose-limiting toxic effect, and neurotoxicity occurred in three patients. Combination chemotherapy employing thiotepa and methotrexate is a safe and effective treatment for neoplastic meningitis.

Adult↗
PubMed1982

Management of primary germ cell tumors of the mediastinum.

Twenty-eight patients with primary malignant germ cell tumors (GCT) of the mediastinum were treated at the University of California at Los Angeles and The Johns Hopkins Hospital in the past 30 years. Of 11 patients with pure seminomas, nine (82%) are free of disease from 6 months to 15 years following therapy. The primary treatment modality in these patients was mediastinal radiation; one patient with metastatic disease had a complete remission and prolonged survival following combination chemotherapy. Seventeen patients had GCT with nonseminomatous elements. Only three (18%) are alive and free of disease. One patient treated only surgically is alive at 15 years and two patients treated with combination chemotherapy and operation are alive and free of disease at 6 months and 3 years. When analyzed by a Kaplan-Meier actuarial survival estimate, patients with nonseminomatous GCT who were treated with cisplatin-bleomycin-based chemotherapy had a median survival of 14.0 months whereas those treated with chemotherapy regimens not employing these agents had a median survival of 4.0 months (generalized Wilcoxon test, p = 0.0495). Patients with pure seminomas are effectively treated with radiation therapy. Patients with nonseminomatous tumors have a much poorer prognosis and deserve aggressive multimodality therapy with cisplatin-bleomycin-based chemotherapy.

Adult↗
PubMed1981

Ectopic adrenocorticotrophic (ACTH) syndrome and small cell carcinoma of the lung-assessment of clinical implications in patients on combination chemotherapy.

Small cell carcinoma of the lung is the tumor most commonly associated with ectopic ACTH production and hypercortisolism. The relationship between this paraneoplastic endocrine syndrome and the clinical course of the tumor is examined in this review of patients with the ectopic ACTH syndrome and small cell carcinoma seen at The Johns Hopkins Oncology Center between 1973 and 1979. Five of 157 (3.2%) patients with small cell carcinoma were clinically diagnosed as having the ectopic ACTH syndrome. The onset of this endocrine syndrome appeared to coincide with a more aggressive phase of the course of small cell carcinoma. Further analysis of these cases suggests that the development of the ectopic ACTH syndrome may reflect changes in cell populations within the tumor and/or alterations in tumor behavior with time and perhaps with the effects of drug therapy.

ACTH Syndrome, Ectopic↗
PubMed1981

Serious hyponatremia in patients with cancer: management with demeclocycline.

Seventeen patients with cancer or aplastic anemia received demeclocycline as treatment for hyponatremia. Prior to demeclocycline therapy no patients showed clinical signs of fluid overload or saline depletion. In all patients inappropriately concentrated urine (mean urine osmolality = 548 mOSM/kg H2O) or increased urine content of sodium (mean urine sodium = 91 mEq/L) were documented prior to demeclocycline therapy. No patient had developed hyponatremia in association with antineoplastic drug therapy. The average serum sodium (NaS) at the time of initiation of therapy was 121 mEq/L. NaS increased in all patients despite the simultaneous administration of generous volumes of fluid. NaS exceeded 130 mEq/L and average of 3.5 days following institution of demeclocycline. Patients lost an average of 2.3 kg during demeclocycline. The toxicity noted following demeclocycline was azotemia and increased serum creatinine. Eight patients developed serum urea nitrogen (SUN) in excess of 25 mg/dl; average maximum creatinine in these eight patients was 1.9 mg/dl. Average peak creatinine in eight patients who did not develop azotemia was 0.87 mg/dl. Azotemia seemed to be correlated with simultaneous administration of other nephrotoxic agents and with administration of higher doses (1200 mg/day) of demeclocycline.

Creatinine↗
PubMed1981

Doxorubicin, vincristine, and cis-diamminedichloroplatinum (II) therapy in patients with advanced breast cancer.

Preliminary data suggesting synergistic activity of cisplatinum and doxorubicin and the expected poor prognosis of women with breast cancer who progress on treatment with cyclophosphamide, methotrexate and 5-fluorouracil (CMF), led to a trial of monthly doxorubicin (50 mg/M2), vincristine (1.4 mg/M2) and cisplatinum (50 mg/M2) in such patients. Overall partial response rate to this regimen was 42%; 37% progressed and 21% could not complete two cycles of therapy because of gastrointestinal (three or renal (one) toxicity. This study does not support the use of cisplatinum, 50 mg/M2, in combination with doxorubicin and vincristine in patients with breast cancer which has proven refractory to CMF therapy.

Adult↗