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Biomedical subjects

G Deppe

Publications and source records attributed to G Deppe.

At least 55 records · Page 3Linked to original sources
PubMed1990

Prochlorperazine and transdermal scopolamine added to a metoclopramide antiemetic regimen. A controlled comparison.

Cisplatin-induced nausea and vomiting occurs both acutely and over a prolonged period of time. These symptoms may be incapacitating and are frequently given as a reason to discontinue therapy. We compared prochlorperazine and transdermal scopolamine when added to a standardized metoclopramide antiemetic regimen. Twenty-seven patients receiving cisplatin at 100 mg/m2 were randomly assigned to one of the two treatment arms. Patients were observed during chemotherapy and answered a standard questionnaire 24-26 hours later. Among similar treatment groups no differences were seen regarding the number of emetic events, level of nausea, degree of sedation or overall acceptability of one treatment arm or another. While not superior to prochlorperazine, transdermal scopolamine is a useful antiemetic agent and can be combined with metoclopramide in an attempt to reduce cisplatin-induced nausea and vomiting. Further evaluation of this approach is needed.

Administration, Cutaneous↗
PubMed1989

Radiation therapy in stage II carcinoma of the endometrium.

A retrospective analysis of 61 patients with Stage II carcinoma of the endometrium was carried out. Our results suggest that when given carefully and adequately, radiation therapy alone is as effective as a combination of surgery and irradiation and is well tolerated. Five-year actuarial survival was 74.5% in patients treated with radiation therapy alone (16 patients) as compared to those patients who received either preoperative radiation (35 patients) or postoperation radiation (ten patients) where the survival was 70.8% and 78.3%, respectively (P greater than or equal to 0.05). Tumor was controlled in the pelvis in 93.4% of patients. Complications of treatment were seen in 8.2%. With the exception of one patient with bowel obstruction requiring surgery, the rest of the complications were minor. From these results, it appears that a planned radiotherapy is a good alternative to combination of surgery and irradiation.

Combined Modality Therapy↗
PubMed1989

Actinomycosis mimicking pelvic malignancy.

Pelvic actinomyces, usually a complication of an intrauterine device (IUD), is uncommon and may present a diagnostic dilemma because of an atypical clinical presentation. We present a patient with a cervical tumor, extensive parametrial induration with involvement of the posterior bladder wall, and regional lymph nodes which mimicked advanced cervical cancer and presented a significant diagnostic problem.

Actinomycosis↗
PubMed1989

Retroorbital metastases in ovarian cancer.

We report a patient with unilateral metastasis to the posterior orbit from poorly differentiated ovarian carcinoma with neuroendocrine features. Ocular metastases from pelvic neoplasms have been reported infrequently; however, we report the first case of an ovarian cancer with orbital metastasis as the initial presenting symptom.

Aged↗
PubMed1989

Chemotherapy in a pregnant rat model. 1. Mitomycin-C: pregnancy-specific kinetics and placental transfer.

Although cancer complicates pregnancy infrequently, its occurrence jeopardizes maternal and fetal well-being. Treatment with chemotherapeutic agents may adversely affect rapidly dividing fetal tissue, while physiologic changes in pregnancy may alter maternal drug disposition. Previous work on placental transfer and pregnancy-specific kinetics of antineoplastic agents is limited, making the establishment of treatment guidelines for the pregnant cancer patient difficult. Using a pregnant rat model and sensitive HPLC methodology we quantitated the placental transfer and resulting fetal exposure of mitomycin-C (MMC), an alkylating agent. Following maternal dosing, the relative fetal exposure was 6.4%, indicating that MMC does cross the placenta, although to a limited degree. Significant pregnancy-specific alterations in drug disposition, including higher plasma concentrations and decreased clearances in pregnant animals, highlight the need for drug-level monitoring and possible dosage modification when these agents are used in pregnancy.

Amniotic Fluid↗
PubMed1989

Chemotherapy in a pregnant rat model. 2.5-fluorouracil: nonlinear kinetics and placental transfer.

As more women postpone childbearing into their later reproductive years (M. A. Adams, G. P. Oakley, and J. S. Marks, J. Amer. Med. Assoc. 247, 493, 1982), the incidence of cancer in pregnancy is likely to increase. Information regarding the placental transfer and pharmacokinetics of antineoplastic agents is limited. The purpose of this study was to determine the kinetics of 5-fluorouracil, a fluorinated pyrimidine with known nonlinear kinetics (J. M. Collins, R. L. Dedrick, F. G. King, et al., Clin. Pharmacol. Ther. 28, 235, 1980) in a pregnant rat model and compare maternal and fetal disposition. A significant amount of 5-fluorouracil crosses the placenta and the relative fetal exposure increases in a dose-dependent fashion. In the pregnant rat model, 5-FU exhibited nonlinear pharmacokinetics as reflected by an increasing half-life, and a greater than proportional increase in the area under the concentration-time curve (AUC) with increasing dose. Fetal saturation of elimination occurred at a lower dose than in the maternal compartment. The significance of these findings to observed embryotoxicity is discussed in a pharmacodynamic model relating the pharmacokinetic behavior of a drug to its embryotoxic effects.

Animals↗
PubMed1989

Reliability of frozen section examination in identifying poor prognostic indicators in stage I endometrial adenocarcinoma.

Management of Stage I adenocarcinoma of the uterus includes hysterectomy, bilateral salpingo-oophorectomy, and selective paraaortic and pelvic lymphadenectomy. Postoperative radiation therapy (RT) is selectively employed in patients with histologically defined poor prognostic indicators. We attempted to identify these poor prognostic indicators by frozen section (FS) at primary surgery in 55 patients with Stage I endometrial adenocarcinoma; we found an excellent correlation between the results obtained on gross examination of the uterus with selected FS and the results after extensive sampling and microscopic examination of permanent section (PS). The depth of myometrial invasion was accurately predicted in 96.5%, and histologic grade in 94.5% of these patients. Sixty-six percent of patients with occult invasion of the cervix on PS were identified on FS. Using the above criteria, we identified by FS all patients (15/55) who required adjuvant RT obviating the need for pelvic lymph node dissection. On the basis of our preliminary data, we recommend the use of careful gross examination and selective FS to identify patients requiring selective pelvic and paraaortic lymphadenectomy and adjuvant therapy, thereby eliminating the need for staging lymph node dissection with its associated morbidity and complications.

Adenocarcinoma↗
PubMed1989

Vascular access in gynecologic cancer using the Groshong right atrial catheter.

From December 1986 through July 1987, forty-one Groshong catheters were inserted in 38 patients with invasive gynecologic cancer for a cumulative total of 4170 days of patient use. (mean catheter indwelling time: 93 days; range: 3-300 days). A supraclavicular approach was used to cannulate the brachiocephalic vein in 31 patients. In 6 patients, the subclavian vein was cannulated via an infraclavicular approach, while 4 patients had the catheters placed via external jugular venous cutdown. Thirty-seven catheters were inserted at the bedside without fluoroscopy using the Seldinger technique and a peel-away catheter introducer sheath. A chest x-ray was used to confirm the right atrial position of the catheter. Major complications included two pneumothoraces, and three catheter-related cases of sepsis. A unique feature of the Groshong catheter is a pressure-sensitive two-way valve at the intravascular end, minimizing the potential for air embolism and back-bleeding. This eliminates the need for a heparin flush or external clamping, but permits blood sampling. Catheter insertion and maintenance procedures at bedside are simple, time saving, and cost effective. With the increasing use of continuous chemotherapy infusion protocols, use of vesicant drugs, hyperalimentation, and the need for outpatient therapy, we recommend early placement of the Groshong catheter in the oncology patient.

Adolescent↗
PubMed1989

Concurrent radiation therapy, cis-platinum, and mitomycin C in patients with poor prognosis cancer of the cervix: a pilot study.

Nineteen patients with poor prognosis squamous cell cancer of the cervix were treated with concurrent radiation therapy (RT) and chemotherapy between February 1986 and July 1988. Treatment consisted of intravenous Mitomycin C 10 mg/m2 on days 1 and 43 and cis-platinum 50 mg/m2 on days 1, 22, and 43. All patients received external RT (5,000 cGy in 28 fractions) and brachytherapy (6,000 cGy to point A.) Additionally, patients with paraaortic lymph node involvement received 4,000 cGy paraaortic RT. The toxicity of this regimen was assessed using Southwest Oncology Group criteria. Toxicity was acceptable and did not significantly delay RT. In addition, complete pelvic response was noted in 18 of 19 (95%) patients within month of completion of therapy and maintained despite distant metastases. At the time of this report, 14 of the 19 patients are alive 9-22 months after initiation of treatment. Chemotherapy with cis-platinum and Mitomycin C concurrently with RT is feasible in patients with locally advanced cervical cancer. Further follow-up of our patients is required to determine whether this regimen will have a favorable impact on survival.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Treatment of recurrent cervical cancer with cis-platinum and mitomycin C: a phase II study.

Twenty-three patients with nonresectable, recurrent cancer of the cervix were treated with a combination of cis-platinum and Mitomycin C. The overall response rate was 35% in 20 evaluable patients. Four patients (20%) achieved a complete response with a median duration of 9 months. Three patients (15%) achieved a partial response with a median duration of 11 months. The objective response rate was 33.4% for tumors within previously irradiated sites and 45% for distant metastases. The overall median survival was 10.3 months, and median progression-free interval was 6.7 months. Toxicity with this regimen was acceptable and consisted of nausea, vomiting, marrow suppression, and peripheral neuropathy. We conclude that this regimen is well tolerated with a low incidence of toxicity and can be safely administered on an out-patient basis. However, the superiority of this combination over cis-platinum alone remains to be determined.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Control of intraoperative hemorrhage in gynecology with the use of fibrin glue.

Fibrin glue, a biodegradable tissue adhesive, is a valuable topical hemostatic agent and an effective tissue sealant. We describe the use of fibrin glue in controlling life-threatening hemorrhage in three gynecology patients. Simultaneous injection of equal amounts of cryoprecipitate and bovine thrombin at bleeding sites results in formation of the glue, which effectively controls the bleeding. When used in conjunction with good surgical technique, fibrin glue may decrease the need for blood transfusions and may shorten operating room time.

Adult↗
PubMed1989

Stage III carcinoma of the endometrium. Results of treatment.

The impact of treatment on survival was analysed in 45 patients with stage III carcinoma of the endometrium. Our results indicate that patients treated with a combination of surgery and radiation therapy did significantly better than those treated with radiation alone. The five-years survival was 57.3% and 17.5%, respectively (p = 0.01). Patients with clinical stage III (CS III) whose tumor could not be resected surgically did poorly than patients with pathological stage III (PS III). This difference, however, was not statistically significant (p = greater than 0.05). Treatment related complications were minimal. Overall survival of patients of 33.8% was directly attributable to increased pelvic and/or extra pelvic recurrences.

Adult↗
PubMed1989

Advanced ovarian cancer: urinary tract resection as a part of cytoreductive surgery.

Maximum surgical effort to minimize residual tumor following primary surgery has been shown to increase mean survival in patients with epithelial ovarian cancer. From September, 1983 to November, 1987, 22 patients underwent resection of the urinary tract as a part of cytoreductive surgery. Seven patients underwent partial cystectomy, four underwent partial cystectomy with ureteroneocystotomy, five patients underwent ureteroneocystotomy while an additional four patients underwent ureteroureteral anastomosis. One patient underwent primary transverse colon conduit while another underwent a similar procedure after developing urinary leakage. All anastomoses were protected with indwelling stents while the urinary bladder was drained with an indwelling Foley catheter for ten days. Both patients requiring conduits had undergone prior radiation therapy in addition to chemotherapy. Nine major and two minor complications occurred in seven patients. One patient died six weeks postoperatively after concurrent hepatic resection. Optimal cytoreduction was possible in 59% of the patients, and was associated with a mean survival of 15.2 months. Optimal cytoreduction including resection of the urinary tract was associated with longer survival and acceptable morbidity and it appears to be justified in patients with ovarian cancer.

Adenocarcinoma↗
PubMed1989

Adenocarcinoma in a mature cystic teratoma. A case report.

A mucin-producing adenocarcinoma arose in a well-differentiated, mature, cystic teratoma. The patient underwent a total abdominal hysterectomy, left salpingo-oophorectomy, omentectomy and paraaortic lymph node biopsy. The prognosis is unfavorable when the tumor extends through the cyst wall and involves intraperitoneal structures.

Adenocarcinoma↗