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Biomedical subjects

D Rosner

Publications and source records attributed to D Rosner.

At least 55 records · Page 3Linked to original sources
PubMed1989

Cyclic and sequential therapy with tamoxifen and medroxyprogesterone acetate in metastatic breast cancer.

A clinical trial of sequential tamoxifen and medroxyprogesterone acetate (MPA) was carried out in 36 women with metastatic breast cancer in order to evaluate the therapeutic efficacy of this regimen and to determine if tamoxifen would increase progesterone receptor (PR) levels and thereby increase response to MPA. Fourteen patients (39%) responded to this treatment, with the duration of remission ranging from 2 to 24 + months (the mean and median were 11 months). In 22 patients, PR levels were measured both before and after 7 days of tamoxifen administration. In PR-positive patients, PR changes induced by tamoxifen did not appear to increase the response rate. In PR-negative patients, PR became positive in 3 patients following tamoxifen treatment, with 2 of 3 responding to treatment, whereas in 11 others whose PR levels remained negative, only one response was observed. Our results suggest that potentiation by tamoxifen was not observed, since in our previous study, MPA alone was equally effective. Thus, tamoxifen and MPA should be given independently for palliation of metastatic breast cancer, and MPA should be administered following therapy with tamoxifen.

Adult↗
PubMed1989

The illusion of medical certainty: silicosis and the politics of industrial disability, 1930-1960.

No firm differentiation existed between social and medical standards on silicosis, the salient industrial health problem of the 1920s and 1930s. As a result, professional groups, government and labor officials, and insurance executives negotiated about the causes and consequences of the disabling condition. Debates in the 1930s formed the basis for amending state and federal compensation systems for work-related disease. If attention to silicosis declined after World War II, disputes continued about diagnosis and functional criteria for identifying pulmonary and occupationally based impairments, and about appropriate policies for treating and compensating people disabled through the course of their work.

Disability Evaluation↗
PubMed1988

Angiosarcoma of the breast: long-term survival following adjuvant chemotherapy.

The present study represents the first attempt of treating primary angiosarcoma of the breast with adjuvant vinblastine sulfate (Velban) resulting in long-term survival with no evidence of disease in two patients. The rationale for using Velban as adjuvant therapy was based primarily on a prior study where the intratumoral administration of Velban into a large fungating recurrent angiosarcoma lesion resulted in eradication of tumor and also on the recognized responses of Kaposi's sarcoma to intralesional or systemic Velban administration. Patients received Velban at a dose of 4 mg/week for 15 and 12 months postoperatively. Both patients remain disease free at 12 and 10 years, respectively. Our data suggest that adjuvant therapy with Velban appears to alter significantly the clinical course of angiosarcoma of the breast.

Adult↗
PubMed1987

A randomized study of intensive versus moderate chemotherapy programs in metastatic breast cancer.

Two intensive chemotherapy regimens CFPMV (Cytoxan [cyclophosphamide], 5-fluorouracil, prednisone, methotrexate, vincristine) and CA (Cytoxan, Adriamycin [doxorubicin]) were tested against a moderate regimen, CFP, in a prospective three-arm, randomized study with crossover when relapse or failure occurred, in order to assess whether the response, duration of remission, and survival can be altered by using more intensive regimens as first-line or as rescue therapy. All three regimens were equally effective as initial chemotherapy: CFP 26/46 (57%); CFPMV 31/48 (65%) and CA 26/47 (55%) (P = 0.61) with the least toxicity for the CFP regimen. Median duration of remission were 9.5, 11, and 9 months, respectively. Complete responses were almost identical in all three regimens: 4/46 (9%); 6/48 (12%) and 5/47 (11%) (P = 0.94). CFPMV was an effective regimen as second-line therapy: 11/33 (33%) or third-line therapy: 7/21 (33%). The CA regimen was equally effective as second-line therapy: 8/25 (32%), suggesting that intensive regimens provide an effective rescue therapy, as well in previous responders as in nonresponders. Initial intensive regimens have not substantially altered long-term survival in the whole group of treated patients, Arm II (CFPMV----CA----CFP) 17.6 months; Arm III (CA----CFP----CFPMV) 12.3 months when compared with initial moderate regimens Arm I (CFP----CFPMV----CA) 16.6 months (P = 0.24). The same lack of difference in survival was noticed in responder patients in each arm: Arm II 19.0 months; Arm III 16.0 months versus Arm I 22.0 months (P = 0.13). Our data suggest that a moderate regimen is as effective as more intense regimens for induction therapy in metastatic breast cancer, with less toxicity, preserving the opportunity for an effective rescue therapy with intensive regimens in second or third-line chemotherapy.

Adult↗
PubMed1986

Chemotherapy induces regression of brain metastases in breast carcinoma.

This study improves treatment options and ultimately survival by using systemic chemotherapy in brain metastases from breast carcinoma, since most of these patients have disseminated disease and a dismal prognosis when treated by conventional brain irradiation alone. One hundred consecutive patients with symptomatic brain metastases documented by radionuclide and/or computerized tomography scan were treated with systemic chemotherapy. Fifty of 100 patients demonstrated an objective response of brain metastases which was similar for extracranial metastases. There were 10 complete responders (CR), 40 partial responders (PR), 9 stable, and 41 nonresponders. Median duration of remission was 10+ months for CR and 7 months for PR (range, 2-72 months). Primary chemotherapy of brain metastases yielded responses in 27 of 52 patients (52%) treated with Cytoxan (cyclophosphamide) (C), 5-fluorouracil (F) and prednisone (P); 19 of 35 (54%) receiving CFP-methotrexate (M) and vincristine (V); 3 of 7 (43%) treated with MVP, and 1 of 6 (17%) receiving Cytoxan plus Adriamycin (doxorubicin) (CA). Thirteen of 35 patients (37%) who subsequently had relapse of brain metastases were retreated successfully with secondary chemotherapy. The median survival for CR and PR was 39.5 months and 10.5 months, respectively, in contrast with nonresponder patients who had a median survival of 1.5 months. Thirty-one percent of all treated patients survived more than 12 months. These findings suggest that the chemotherapeutic agents used penetrate the blood-brain barrier inducing regression of brain metastases. This approach offers a significant benefit by simultaneously controlling extracranial disease, improving the response and prolonging survival.

Adult↗
PubMed1986

Oral contraceptive use has no adverse effect on the prognosis of breast cancer.

This study evaluates the possible effect of OC use on the prognosis of established breast cancer. Three hundred forty-seven patients with primary invasive breast carcinoma age 50 and under treated from 1971 to 1981 are included in this study. There were 112 OC Users (U) and 235 Non-Users (NU). Separate retrospective analysis were done for a group of 154 patients (59 U and 95 NU) under age 35 (Group A) and for 193 patients (53 U and 140 NU) age 35 to 50 (Group B), in order to pay particular attention to relationship of duration, recency and latency of OC usage. Both subsets of U and NU presented similar clinical characteristics regarding menstrual, reproductive, family history, histology, receptor status. Users presented with a similar extent of disease as Non-Users. No significant differences were found between U and NU in disease-free interval (Gr A p = .41; Gr B p = .81), metastatic period (Gr A p = .66; Gr B p = .41) or survival (Gr A p = .54; Gr B p = .79), either alone or when adjusted for extent of node involvement. Users of less than two years (78 patients) had a similar survival (Gr A = .54; Gr B p = .36) as those of longer duration (33 patients). Recent OC users within a year of diagnosis had a similar survival as other users who stopped the pills more than one year (Gr A p = .86; Gr B p = .14). No significant differences were noticed in survival between the patients who began the use 10 years or more before diagnosis from those beginning more recently (Gr A p = .82; Gr B p = .69). Our data suggests no adverse effect of OC on the outcome of breast cancer, regardless the duration of use, latency or recency period.

Adult↗
PubMed1986

Intraductal carcinoma. Analysis of presentation, pathologic findings, and outcome of disease.

A retrospective analysis of 52 patients with intraductal carcinoma or ductal carcinoma in situ (DCIS) and 30 patients with microinvasive DCIS was performed. All patients but one were treated by mastectomy. The average follow-up was 5 1/2 years. The clinical presentation of the patients having DCIS only included the presence of a mass in 33% (17/52), nipple discharge in 34% (18/52), or suspicious mammographic finding in 33% (17/52), whereas in those patients having DCIS with microinvasion, the initial presenting symptom was a mass in 63% (19/30) of the patients, nipple discharge in 13% (4/30), and mammographic finding in 23% (7/30). The presence of axillary lymph node metastasis was identified in one of the 52 patients with DCIS and six (20%) of the 30 patients with DCIS and microinvasion. Associated carcinomas in the mastectomy specimens of patients with DCIS were as follows: DCIS, 18% (9/51); lobular carcinoma in situ, 13% (7/51); Paget's disease, 8% (4/51); and invasive carcinoma, 2% (1/51). In the 30 patients with microinvasion, DCIS was found in other quadrants in 23% (7/51) of the patients; lobular carcinoma in situ, 7% (2/51); Paget's disease, 13% (4/51); and invasive carcinoma, 7% (2/51). There was one death due to cancer in the patients with DCIS only. Of the patients diagnosed as having DCIS with microinvasion, seven patients have developed metastasis and four have died of the disease.

Adult↗
PubMed1986

Oral medroxyprogesterone in the treatment of metastatic breast cancer.

In 47 postmenopausal women with evaluable breast cancer, oral medroxyprogesterone acetate (MPA) was given at a daily dose level of 400 mg. Patients with negative estrogen receptors, poor performance status, or nonresponse to previous endocrine therapy were excluded from this study. There were 25 (53%) responders to this agent. Periods of remission ranged from 5-26 months with a median of 10 and a mean of 12+ months. Higher rates of response were noted in women over 50 years of age, in patients with osseous metastasis, and in patients with a longer disease-free interval. Adverse effects included weight gain, Cushingoid appearance, skin rash, and vaginal discharge. In this selected group of patients, oral medroxyprogesterone at a dose level of 400 mg/day appeared to provide a significant frequency of tumor response.

Adult↗
PubMed1986

Condylar retruded contact position and intercuspal position in dentulous patients. Part II: Patients classified by anamnestic questionnaire.

General agreement was found among the 75 patients' responses to the anamnestic questionnaire compared with responses in similar epidemiologic studies. An SPO has been proposed as a method of describing condylar position in addition to the MLD and the index of intercuspal asymmetry (described in Part I). The index of asymmetry was statistically significant at the 0.01 level between the group of 38 patients without primary symptoms and the group of 37 patients with one or more primary symptoms and mandibular dysfunction. The SPO hypothesis that the symptom of noise from the TMJ was present outside the SPO and absent inside the SPO was statistically significant in the categories of primary symptoms, oral habits, and psychologic self-evaluation (p less than 0.01) but was not statistically significant in regard to questions of mandibular function and chronic pain. A composite order of symptoms, determined by the sum of their rankings in each of three condylar indexes, places noise from the TMJ, facial pain, ear pain, chewing pain, and TMJ pain symptoms at the top of the list. The right and left side least squares linear analysis of 38 dental patients without primary symptoms yielded a difference of 10 degrees whereas a greater spread of 69.2 degrees was found in the group of 37 dental patients with primary symptoms and patients with mandibular dysfunction. Patients seen because of mandibular dysfunction present condylar recordings outside the SPO with a high level of agreement and a mean index of intercuspal asymmetry of 1.29 mm (SD 0.570). The three-dimensional analysis of condylar position in RCP and intercuspal position offers an explanation of why the correlation of mandibular dysfunction and occlusion has been difficult to recognize.

Bruxism↗
PubMed1986

Condylar retruded contact position and intercuspal position correlation in dentulous patients. Part I: Three-dimensional analysis of condylar registrations.

A three-dimensional condylar analysis of the ICP relative to the RCP was completed for 75 patients by using a system of styli adapted to an arcon articulator. The recorded sagittal condylar positions were seen in three of the four quadrants, the posterior-superior quadrant was devoid of registrations. The percent of registration was approximately equal for the right and left sides; anterior-inferior quadrant, 60%; posterior-inferior quadrant, 30%; and anterior-superior quadrant, 10%. Midcondylar value of the ICP presented the smallest standard deviation but the data concerning condylar position were unreliable because symmetrical and asymmetrical movement may produce similar midcondylar values. Seventy-two percent of the anterior-posterior and 45% of the superior-inferior condylar ICP recordings of patients fell within the range of a dentally healthy sample of young men. Only 2% of recordings the patients were outside this range in a superior direction. These data were nearly equal numerically for the right and left sides and conformed to the anatomic freedom of TMJ. Slightly more than 57% of the sample had an MLD greater than 0.3 mm compared with a dentally healthy sample. There was a 42% greater incidence of skew greater than 0.7 mm and a 22% greater occurrence of tilt greater than 0.7 mm in the dental patient sample, compared with the findings of Hoffman et al. An index ICP asymmetry was proposed that indicates the relative value of skew and tilt in a single quantitative factor. Three mandibular movements were identified, skew and tilt with angular components and MLD, translation. These three movements have 3 degrees of freedom, right or left movement or no movement, resulting in 27 permutations. The combination of these elements make it difficult to determine condylar position from occlusal midline observation.

Adult↗
PubMed1986

More than economism: the politics of workers' safety and health, 1932-1947.

Even within the context of the New Deal, an agency of the Department of Labor was unusual for its innovations and activism. The Division of Labor Standards went beyond the economism of hours and wages to the advocacy of a safe and healthy work place. Unlike the Public Health Service, the division eschewed the "neutrality" of research and information gathering; it sought to intervene, directly and through the states, in the work place. The end of World War II unleashed a conservative reaction that restrained government's responsibility for several decades.

Environmental Exposure↗
PubMed1985

Influence of oral contraceptives on the prognosis of breast cancer in young women.

The possible effect of oral contraceptive (OC) use on the prognosis of established breast cancer was investigated in 154 young women aged 35 and younger. No significant differences were found between the study group of 59 OC users, and the control group of 95 nonusers in age, parity and gravidity, family history of breast cancer, benign breast disease, morphology, or surgical therapy. No appreciable differences were found between OC users and nonusers in extent of disease at presentation (P = 0.78), histologic features of tumor (P = 0.83), or axillary node involvement (P = 0.88). No significant or even suggestive differences were found between users and nonusers in disease-free interval (P = 0.41), metastatic period (P = 0.66), or survival (P = 0.54), respectively, either alone or when adjusted for extent of node involvement, duration of OC use, or other risk factors. In this study no evidence was found that the use of OC has any harmful or beneficial effect on evolution and survival of breast cancer.

Adult↗
PubMed1985

What ultrasonography can tell in breast masses that mammography and physical examination cannot.

The capability of ultrasonography to provide additional information to the physical and mammographic examination for therapeutic decision was investigated in a prospective study. Four hundred patients with palpable or radiologic breast masses requiring surgical biopsy were studied. The high resolution and accuracy of ultrasonography vs. mammography in the diagnosis of cystic masses (96%, 63/66 vs. 42%, 20/48) (p less than 0.001) and fibrocystic masses (84%, 131/156 vs. 74%, 80/108) (p less than 0.10), led to a substantial reduction of surgical biopsies in favor of aspiration or follow-up policy, particularly when physical examination and mammography were inconclusive. Breast cancers were accurately diagnosed in 73% (88/120) by sonography and 84% (98/116) by mammography (p greater than 0.10). The major limitation of ultrasonography was noticed in the diagnosis of minimal breast cancer (23%, 5/21) due to its inability to visualize microcalcifications. Our study validates the importance of ultrasonography in the diagnosis and therapeutic decision of cystic and fibrocystic masses but cannot substitute mammography in early detection of breast carcinoma.

Adenofibroma↗