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Biomedical subjects

D L Trump

Publications and source records attributed to D L Trump.

141 records · Page 8Linked to original sources
PubMed1981

Computerized tomography and lymphangiography in staging testis tumors.

The usefulness of computerized tomography, lymphangiography and tumor markers has been examined in 20 consecutive patients with pathologic stage I or II nonseminomatous testicular tumors. Computerized tomography had a false negative rate of 40 per cent, a false positive rate of 50 per cent and an over-all accuracy of 69 per cent. Lymphangiography had a false negative rate of 42 per cent, a false positive rate of 0 and an over-all accuracy of 69 per cent. The combination of computerized tomography and lymphangiography did not significantly improve the diagnostic accuracy of either technique alone. Furthermore, because tumor markers usually were elevated in the presence of bulky metastatic disease that was detected easily by either computerized tomography or lymphangiography, they did not add measurably to the sensitivity of either computerized tomography or lymphangiography in the diagnosis of retroperitoneal lymph node metastases. Consequently, retroperitoneal lymphadenectomy remains the only reliable means for accurate staging of patients with nonseminomatous testicular tumors.

Chorionic Gonadotropin↗
PubMed1981

Cutaneous involvement in malignant histiocytosis. Case report and review of the literature.

Malignant histiocytosis (MH) is a rare, malignant neoplasm with protein manifestations, including fever, lymphadenopathy, hepatosplenomegaly, pancytopenia, and, infrequently, cutaneous lesions. A patient had initial manifestations that included fever and skin lesions. Skin lesions began on distal areas of the extremities and spread to involve proximal areas of the extremities and the abdomen. Erythematous maculopapular lesions, nodules, and plaques were present in various stages of development, which evolved into ulcerated plaques that exuded a serosanguineous discharge. Spontaneous healing of lesions occurred, leaving hyperpigmented, atrophic scars. Histologically, the deep dermis and subcutaneous tissues contained a diffuse infiltrate of histiocytes, lymphocytes, and mononuclear cells. Erythrophagocytosis by histiocytes was present in the skin biopsy material. Thirteen percent of 320 cases in the literature had skin involvement. This report and review of the literature indicate that, in selected cases, skin biopsy may contribute to the diagnosis of MH.

Biopsy↗
PubMed1979

The effects of L-dopa on in vitro and in vivo calcitonin release from medullary thyroid carcinoma.

The in vivo and in vitro effects of the dopamine precursor L-dopa on basal and stimulated calcitonin release from medullary thyroid carcinoma have been studied. In six studies of five patients, including 7- to 8-h control and test periods, oral L-dopa depressed basal calcitonin secretion by an average of 35%; the peak effects occurred within 30 min of drug administration and lasted for as long as 4 h. In seven of eight patients with medullary thyroid carcinoma (three infused with calcium and five with pentagastrin), L-dopa inhibited to varying degrees peak levels of stimulated calcitonin release and total calcitonin secretion; basal calcitonin levels, where directly tested, also again generally fell after L-dopa by an average of 50%. In a short term organ culture system using medullary thyroid carcinoma tissues, calcitonin secretion into the medium was linear with time for 2 h and could be stimulated by dibutyryl cAMP and pentagastrin. L-Dopa, in concentrations from 0.5--3.0 mM, inhibited basal calcitonin secretion (ranging from 25--55%). Addition of the L-dopa decarboxylase inhibitor, alpha-methyldopa, abolished the inhibitory effects of L-dopa. Another L-dopa decarboxylase inhibitor, carbidopa, stimulated calcitonin secretion in vitro; this effect may be independent of the L-dopa decarboxylase-inhibiting properties of this drug since alpha-methyldopa alone did not stimulate calcitonin secretion. It is concluded that the amine precursor L-dopa inhibits calcitonin release in patients with medullary thyroid carcinoma; the in vitro studies suggest that a portion of this effect may involve direct metabolism of L-dopa to dopamine in the tumor tissue itself. The importance of considering the uptake of amine precursors and the subsequent metabolism of these compounds as a modulating site for peptide hormone release from peripheral endocrine tissues is stressed.

Calcitonin↗
PubMed1979

Important clinical pharmacologic considerations in the use of methadone in cancer patients.

The manufacturer's recommended dose of methadone, which is 2.5-10 mg every 3-4 hours, is excessive. Methadone has an average primary-phase half-life of 14.3 hours and a slower secondary-phase half-life averaging 54.8 hours. Administering the recommended dose of methadone and escalating doses within 2-3 days may lead to very high plasma levels of the drug. In addition, factors such as drug-drug interaction and/or hepatic and renal dysfunction may affect the metabolism of methadone and result in its accumulation. Methadone is an effective analgesic whose pharmacokinetics must be appreciated in order for it to be used safely and effectively. Three cases of methadone overdose are presented.

Adult↗
PubMed1978

Anaerobic liver abscess and intrahepatic metastases: a case report and review of the literature.

A patient is described in whom the first recurrence of a cloacogenic carcinoma of the rectum was an intrahepatic metastasis associated with an hepatic abscess caused by the anaerobic bacterium Peptococcus prevotii. Three previously reported cases of infection associated with hepatic tumor nodules have been found in which bacteriologic data were provided, and in all three cases anaerobic bacteria were the primary or only infection organisms. Experimental data exist which document the ability of certain anaerobic bacteria to grow selectively in tumor nodules, but not in the normal tissues of a tumor-bearing host. Since 23% of patients with liver metastases have fever and offer a clinical picture compatible with infection, occult anaerobic infection associated with liver metastases may be more common than previously recognized.

Adult↗
PubMed1977

Watery diarrhea syndrome in an adult with ganglioneuroma-pheochromocytoma: identification of vasoactive intestinal peptide, calcitonin, and catecholamines and assessment of their biologic activity.

A case of adult ganglioneuroma-pheochromocytoma with an associated watery diarrhea syndrome is reported. High levels of vasoactive intestinal peptide (VIP) were found in preoperative serum and in tumor tissue. The serum VIP levels fell to normal, and the watery diarrhae syndrome completely ceased following removal of the tumor. In addition to containing VIP, the tumor was rich in catecholamines, and calcitonin. Peptide hormone-containing extracts and catecholamine extracts from the tumor both activated the adenyl cyclase system and increased lipolytic activity in a preparation of isolated rat fat cells. The findings in this patient further link VIP with neural crest tissues, and suggest the importance of determining catecholamine levels in patients with the watery diarrhea syndrome.

Acidosis↗
PubMed1977

Acute myelogenous leukemia as a late complication of the multimodality therapy for Hodgkin's disease.

Progressive thrombocytopenia developed in a patient following the completion of total lymphoid irradiation and combination chemotherapy for Hodgkin's disease. Thorough evaluation eventually yielded a diagnosis of acute myelogenous leukemia (AML). Previous workers have suggested that the development of thrombocytopenia with a hypoplastic marrow following total lymphoid irradiation indicated recurrent Hodgkin's disease. When the combination cytopenias and hypoplastic marrow is recognized these workers have recommended early combination chemotherapy. Recent data suggest a 1300-fold increase in the risk of AML following multimodality therapy for Hodgkin's disease. We feel that a careful search for AML should be conducted in patients with deteriorating hematologic parameters following therapy for Hodgkin's disease and that this search should include sampling bone marrow outside irradiated areas.

Adult↗
PubMed1976

Bromide intoxication.

Bromide intoxication is now an uncommon disease. This report reviews the experience with this disorder at the Johns Hopkins Hospital over the last 23 years and reemphasizes the variable neuropsychiatric symptoms which these patients present. Impaired sensorium, fever, skin rash, abnormal serum chloride, and a history of proprietary drug abuse are clinical features which may suggest the presence of bromide intoxication. Treatment consisting of saline administration often augmented with mercurial, thiazide or "loop" diuretics was uniformly effective. The declining incidence of this disorder is felt to be due to the decrease in physicians' use of prescription bromides and the declining availability of proprietary bromide containing compounds.

Adolescent↗
PubMedDate not supplied

Phase I study of vinblastine and verapamil given by concurrent iv infusion.

Overcoming resistance to chemotherapy is an important goal in cancer treatment. In many systems, resistance to anthracyclines and vinca alkaloids correlates with a diminished intracellular content of drug. In P388 leukemia and Ehrlich ascites tumor, an active outward transport of anthracyclines and vinca alkaloids occurs. Calcium channel blockers, such as verapamil, inhibit this active outward transport and increase intracellular content of vinblastine and anthracyclines in cells resistant to vinca alkaloids and anthracyclines, respectively. We report a phase I trial of vinblastine (1.5 mg/m2 daily as iv continuous infusion X 5 days) in 17 patients and concurrent verapamil in escalating doses. Verapamil was administered as a loading dose (0.02-0.1 mg/kg) followed by a maintenance infusion (0.036-0.18 mg/kg/hour) for 5 1/2 days with continuous cardiac monitoring. There was no apparent augmentation of vinblastine toxicity when vinblastine and verapamil were given concurrently. ECG change was the dose-limiting toxicity. At 0.12 mg/kg/hour, five of nine patients developed first-degree heart block (mean P-R interval, 0.32 seconds; range, 0.23-0.52 seconds). Junctional rhythms were noted in two of 17 patients. Reversible nonspecific T-wave changes were seen in four of 17 patients. Blood pressure and left ventricular ejection fractions (ultrasonic) were not altered. Five of 17 patients had wbc count nadirs less than 2000/mm3, and two of 17 patients had platelet count nadirs less than 100,000/mm3. Four patients experienced neurotoxicity. A mean vinblastine concentration of 2.2 ng/ml (0.55 nM) and a mean verapamil concentration of 290 ng/ml (0.45 microM) were achieved with the concurrent 5-day infusion. The tolerable levels of verapamil obtained appear to be less than those which were reported to inhibit vinblastine efflux in vitro. Additional in vitro experiments at the tolerable doses of vinblastine and verapamil are recommended.

Adult↗