Biomedical subjects
F P Smith
Publications and source records attributed to F P Smith.
Archival correspondence regarding the origin of the Harvey Cushing Society: the American Association of Neurological Surgeons.
Behind the scenes in the origin of the Harvey Cushing Society, now known as the American Association of Neurological Surgeons, there were many interesting political factors occurring, which appeared in correspondence and were preserved and later forwarded by William P. Van Wagenen to the Harvey Cushing Section of the Yale Medical Library. This correspondence, circa 1931, provides an interesting account of the aspirations of young neurosurgeons who wished to gain societal status, without offending the giants of the Society of Neurological Surgeons.
A discussion of "Method comparison of EMIT II and OnLine with RIA for drug screening," (J. Forensic Sci., Vol. 38, No. 6, Nov. 1993, pp. 1326-1341)
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Drug concentrations, not absorbance units, required for comparing precisions of different immunoassays.
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A discussion of opiate concentrations in hair (Kintz, P. and Mangin, P., "Opiate concentrations in human head, axillary, and pubic hair," Journal of Forensic Sciences, Vol. 38, No. 3, May 1993, pp. 657-662.)
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Precise terminology in scientific communications.
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Isomeric amphetamines--a problem for urinalysis?
Alkyl amphetamine isomers (amphetamine, 1-phenyl-2-butylamine (PBA), methamphetamine, N-methyl-PBA, N,N-dimethylamphetamine, N-ethylamphetamine, N-ethyl-PBA and N,N-diethylamphetamine) were purchased or synthesized and tested by immunoassay and GC/MS for their detectability in urine. Some cross reactivity was observed with PBA, N-methyl-PBA N-ethylamphetamine, and N-ethyl-PBA when analyzed using a series of commercial amphetamine and methamphetamine immunoassays. Chromatographic co-elution problems were observed for the underivatized isomeric group N,N-dimethylamphetamine, N-ethylamphetamine, and N-methyl-PBA under GC/MS conditions used; and their GC/MS spectra were quite similar. Of the potential derivatives, pentafluoropropionyl (PFP) anhydride and heptafluorobutyryl (HFB) anhydride provided adequate separation and easily distinguishable spectra using the electron-impact GC/MS conditions specified.
Callosotomy for seizures.
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Benzoylecgonine (cocaine metabolite) detection in hair samples of jail detainees using radioimmunoassay (RIA) and gas chromatography/mass spectrometry (GC/MS).
Benzoylecgonine (BE) was detected in hair samples using nonproprietary extraction methodology and modifications of well-established radioimmunoassay (RIA) screening/quantitative gas chromatography/mass spectrometry (GC/MS) confirmation procedures. Samples collected anonymously from a population of 48 jail detainees weighed between 5.3 and 61.2 mg. All of the 22 hair samples which had RIA results indicating the presence of BE or immunologically similar substances above a cutoff amount of 1.25 ng/sample (50 ng/mL) were confirmed by GC/MS. Several varieties of hair color and texture were tested, although in each general category there were samples which contained BE as well as other samples which did not reveal detectable amounts of BE. The range of concentrations in 22 hair extracts that screened positive were 0.26 to 18 ng/mg hair as determined by GC/MS. In comparison with other reports of cocaine-related substances in hair, these data show consistent concentrations.
Phase I study of oral spirogermanium.
Thirty-three patients with advanced malignancy were treated with oral spirogermanium in a Phase I study to determine a maximum tolerated dose. Patients were entered in the study at doses of 100, 200, and 300 milligrams daily. The dose-limiting toxicity was gastrointestinal with moderate nausea and vomiting occurring with the 300 milligram dose. No myelosuppression or renal dysfunction was noted. Elevations of serum transaminase were seen in 41 percent of the patients at study entry. While abnormalities in hepatic function were recorded during the study, the relationship to spirogermanium could not be determined. No patient exhibited clinical hepatic dysfunction or elevation of serum bilirubin. It is recommended that future studies of oral spirogermanium incorporate careful monitoring of these parameters. Two patients with lymphoproliferative disorders had objective responses to therapy. A dose of 200 milligrams is recommended for further Phase II trials.
Psychological evaluation of head-injured patients.
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Therapy of advanced gastric carcinoma. The Georgetown-Lombardi Cancer Center experience.
Gastric carcinoma, despite a decreasing incidence in the United States over the past 40 years, is the seventh most common cause of cancer death in this country and remains a significant worldwide problem. The 5-fluorouracil, Adriamycin (doxorubicin), and mitomycin (FAM) chemotherapy regimen, which was initially reported by Georgetown in 1979, has become a standard for advanced gastric carcinoma with response rates in the 40% range. The FAM regimen as well as subsequent trials conducted at Georgetown and our current approach to management of this tumor are discussed. Despite a decade of intensive clinical research, we have not identified a modification or innovation that is superior to the original FAM.
Retrograde axoplasmic transport of adriamycin.
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Efficacy of tetrahydrocannabinol in patients refractory to standard antiemetic therapy.
Oral delta-9-tetrahydrocannabinol (THC), 15 mg/m2, was compared to prochlorperazine (PCZ), 10 mg. for the control of cancer chemotherapy-related emesis. Thirty-six patients whose vomiting was refractory to standard antiemetic therapy were entered in this randomized comparative cross-over study. THC decreased nausea and vomiting in 23 of 36 (64%) patients compared to 1 of 36 receiving PCZ. THC efficacy was not dependent on the class of antineoplastic-agent inducing the emetic symptoms, age of patients or type of sensorial change experienced. Using the 15 mg/m2 dose, all patients experienced transient sensorial changes, characterized as a pleasant "high" in 19 or a variable state of dysphoria in 17 cases. This study confirms the usefulness of THC in patients whose chemotherapy-induced nausea and vomiting is refractory to other standard antiemetics. While excellent antiemetic control was achieved at the dosage 15 mg/m2, dysphoria was encountered at this dose level and we recommend that an initial dose of 5 mg/m2 which, if necessary, can be carefully increased to achieve maximum antiemetic benefit.
Prospective study of chemotherapy in patients with metastatic gastrinoma.
Ten consecutive patients with metastatic gastrinoma that increased in size over time were studied prospectively during treatment with monthly cycles of streptozotocin (3 g/m2), 5-fluorouracil (1.2 g/m2), and adriamycin (40 mg/m2) to determine the response rate and time-courses of changes during chemotherapy and to assess various methods of evaluating the effect of chemotherapy. Forty percent of patients demonstrated an initial objective response (greater than or equal to 25% decrease in tumor size with no new lesions) and 60% failed chemotherapy (greater than or equal to 25% increase in tumor size or appearance of new lesions). The mean dose of streptozotocin was 27 g/m2 with objective responses occurring at 3.7 +/- 0.7 mo and failures at 4.5 +/- 0.7 mo. Responses lasted 9.7 +/- 2.8 cycles and no complete responses occurred. Survival was not significantly different in responders versus nonresponders (26 +/- 11 vs. 15 +/- 4.8 mo, p greater than 0.1). Changes in serum gastrin concentration, basal acid output, or sensitivity to a given dose of histamine H2-receptor antagonist did not reflect changes in tumor size. Computed tomography and angiography were the best methods to assess changes in tumor size during chemotherapy, whereas liver-spleen scan and ultrasound were relatively insensitive. All patients developed side effects with chemotherapy: 100% had vomiting, 80% alopecia, 40% transient proteinuria, and 20% leukopenia. The present results indicate that chemotherapy with streptozotocin, 5-fluorouracil, and adriamycin is much less effective in patients with extensive metastatic gastrinoma than previously reported. Computed tomography scanning is the method of choice to assess changes in tumor size. Changes in serum gastrin concentration, acid secretion, or tumor size assessed by liver-spleen scan or ultrasound are not sensitive indicators of the tumor response during chemotherapy.
FAM (5-fluorouracil, doxorubicin, and mitomycin) plus triazinate (FAM-T) in gastric carcinoma: a combined phase II trial of the Mid-Atlantic Oncology Program and the Pan American Health Organization.
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Multiple deaths from argon contamination of hospital oxygen supply.
During the course of routine hospital surgical procedures, three patients lapsed into hypoxic cyanosis. Two expired immediately, another after four days of coma. Investigation of the hospital's central liquid oxygen tank revealed that it had been refilled recently and was labelled both "oxygen" and "argon." Mass spectrometric analysis of gas sampled from the questioned tank revealed a predominance of argon. A discussion of the sampling technique, method of analysis, role of the criminalist, and causes of this accident is presented.
Treatment of cancer-associated hemolytic uremic syndrome with staphylococcal protein A immunoperfusion.
Plasma perfusion over filters containing staphylococcal protein A (SPA) was used to treat 11 patients with adenocarcinoma who developed a hemolytic uremic syndrome. Immunoperfusion resulted in complete clearance of pretreatment elevated levels of circulating immune complexes in eight of the 11 patients with normalization of complement values depressed at the start of the therapy in seven. A significant rise in platelets and erythrocyte counts was achieved in nine patients, and stabilization of progressive renal impairment was achieved in six. The response was incomplete and short lived in three patients with clinically evident tumor recurrence, whereas long-term control of the syndrome was demonstrated in seven patients in complete tumor remission (no recurrence with median follow-up of 9 months). SPA immunoperfusion appears to be an effective form of therapy for this otherwise fatal syndrome.