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Biomedical subjects

G Rosen

Publications and source records attributed to G Rosen.

At least 163 records · Page 9Linked to original sources
PubMed1983

Quantitative scanning of soft-tissue sarcomas with nitrogen-13-labeled L-glutamate.

Nitrogen-13-L-glutamate, a labeled amino acid enzymatically synthesized from cyclotron-produced N-13 ammonia and alpha-ketoglutaric acid, was used as an imaging agent in 14 patients with soft-tissue sarcomas. Concentration of nitrogen-13 label within the sarcoma was seen in 11 of the 14 patients; in some cases, clinically inapparent metastatic tumor lesions could also be detected. In eight patients, the tumor response to chemotherapy was evaluated by serial studies with this agent. In each case, the change in uptake of N-13 label by the sarcoma after therapy paralleled the clinical response to treatment. N-13-labeled L-glutamate may thus be of value as an imaging agent in the management of patients with soft-tissue sarcomas.

Adolescent↗
PubMed1983

Preoperative chemotherapy and surgical resection in the management of posterior paraspinal tumors. Report of three cases.

Three patients with posterior paravertebral tumors are presented to illustrate the value of preoperative chemotherapy prior to surgical resection. All three had massive tumors adjacent to the spine, extending over several vertebral segments, with myelographic evidence of epidural involvement in one patient. Tissue diagnosis by incisional biopsy confirmed the diagnosis of extraosseous osteogenic sarcoma in one, extraosseous Ewing's sarcoma in the second, and embryonal rhabdomyosarcoma in the third. All patients were treated with chemotherapy preoperatively. Marked regression in tumor size was noted, and surgical excision of the tumor along with involved segments of spine was easily accomplished. Histological examination following surgery revealed completely necrotic tumor in two patients. Preoperative chemotherapy for fully malignant tumors offers the following advantages: 1) extremely bulky and otherwise unresectable tumors can be reduced in size to enable complete surgical resection; 2) systemic chemotherapy is instituted earlier in the course of disease to prevent more effectively the appearance of metastases; and 3) the information gained regarding the sensitivity of the tumor to a particular chemotherapy regimen allows postoperative adjuvant chemotherapy to be used on a more rational basis.

Adolescent↗
PubMed1983

Effect of lithium carbonate plus oxymetholone vs. lithium alone on chemotherapy-induced myelosuppression.

To evaluate the possible additive leukocyte count-enhancing properties of lithium and oxymetholone, patients (1-21 years old) were randomized to receive lithium or lithium plus oxymetholone after chemotherapy. Seventy-one trials with lithium, 63 with both drugs, and 79 in the control group, were compared. White blood cell count and neutrophil nadirs were better in both treatment groups than in the controls (p = 0.001) but an additive effect of oxymetholone above and over lithium alone was seen only in patients under 15 years old (p = 0.05). The median duration of severe neutropenia (absolute neutrophil count less than 1000/cm3) was 6.2 days/patient in the control group but only 4.5 days/patient and 3.8 days/patient in the lithium and lithium plus oxymetholone groups, respectively (p = 0.0001). Both the lithium and lithium plus oxymetholone treatments had a modest platelet-sparing effect (p = 0.03). No difference in the hemoglobin nadirs was observed in the three groups. While the majority of the patients lost weight in the control and lithium-treated group, the patients on oxymetholone gained weight (median 1.25 kg) p = 0.00001. Lithium reduces the period of neutropenia after chemotherapy during which the patients may acquire infection. The addition of oxymetholone does not substantially lessen myelosuppression in most patients but improves the patients' appetite and weight.

Adolescent↗
PubMed1983

Pelvic Ewing's sarcoma. Advances in treatment.

In a study of eighteen patients with pelvic Ewing's sarcoma who were treated with a multidisciplinary approach, chemotherapy was effective in controlling systemic spread of the tumor. Surgery coupled with improved methods of chemotherapy provided results that were statistically superior to those obtained with radiation and chemotherapy alone in control of the local pelvic lesion. A twofold increase in the survival rate was seen at a median follow-up of thirty-six months in the patients who had the resection. Our results suggest that pelvic Ewing's sarcoma is best treated by initial chemotherapy, followed by local wide marginal resection of the pelvic lesion coupled with perimeter radiation therapy and concluded with additional chemotherapy. Survival rates of patients with pelvic Ewing's sarcoma may then approach the excellent survival rates of patients with lesions in more favorable anatomical locations.

Adolescent↗
PubMed1982

[New therapeutic results in osteosarcoma].

Primary systemic chemotherapy and delayed surgery, if it is surgically feasible with preservation of the limb, has produced better results in osteogenic sarcomas than primary surgery with loss of time due to the postoperative therapy free interval. Histologic examination of the resected tumor determines the effect of preoperative chemotherapy and identifies patients at high risk. These patients not having a favorable effect on preoperative chemotherapy can be placed on an alternative postoperative regimen before relapsing clinically. These earlier changes of chemotherapeutic strategy in patients with histologically proven ineffective chemotherapy has yielded further improvement in treatment results in patients with osteogenic sarcomas with a 93% disease free survival (median 20 months) to date using an individualized taylored treatment approach at the Memorial Sloan Kettering Cancer Center/New York. Now that effective chemotherapy is available for many other malignant tumors this model of "neo-adjuvant" chemotherapy could also serve as a model for the treatment of other highly malignant tumours.

Amputation, Surgical↗
PubMed1982

Telangiectatic osteogenic sarcoma: a clinicopathologic study of 124 patients.

One hundred-twenty-four patients with this rare and special variant of osteogenic sarcoma were treated at Memorial Sloan-Kettering Cancer Center from 1921 through 1979, representing 11% of all of osteogenic sarcomas. The lesions were predominantly lytic, destructive tumors with only minimal sclerosis on roentgenograms and soft as well as cystic on gross examination. Histologically, aneurysmally dilated spaces lined or traversed by sarcoma cells producing osteoid were noted. The differential diagnosis both radiographically and histologically included several benign lesions like aneurysmal bone cyst and giant cell tumor, among many others. It was found that telangiectatic osteogenic sarcoma is relatively frequent in the femoral diaphysis and in the distal end of the femur. Twenty-nine percent of the patients present with pathologic fracture, or this develops later. Age and sex distribution, or clinical signs or symptoms were those of ordinary osteogenic sarcomas. No differences in survival rates were found in lesions that were purely lytic or those with minimal sclerosis. Similarly, no differences in survival were noted when comparing patients with telangiectatic or ordinary osteogenic sarcoma. As a matter of fact, definite increase in survival was found in patients treated since 1975 with preoperative multidrug chemotherapy employing high-dose methotrexate. Adriamycin, and the combination of bleomycin, cyclophosphamide, and dactinomycin.

Adolescent↗
PubMed1982

Preoperative chemotherapy for osteogenic sarcoma: selection of postoperative adjuvant chemotherapy based on the response of the primary tumor to preoperative chemotherapy.

Since June 1978, 57 patients with primary osteogenic sarcoma of an extremity were treated with high-dose methotrexate (HDMTX) and citrovorum factor rescue (CFR), Adriamycin, and the combination of bleomycin, cyclophosphamide and dactinomycin (BCD) given for 4-16 weeks prior to definitive surgery. Histologic examination of the resected primary tumor determined the effect of preoperative chemotherapy with many primary tumors showing greater than 90% tumor necrosis attributable to preoperative chemotherapy. All patients having this favorable effect of chemotherapy on the primary tumor were continued on the same chemotherapy regimen postoperatively (regimen B). However, in those patients not having a good effect of preoperative chemotherapy on the primary tumor, HDMTX with CFR was subsequently deleted from their postoperative chemotherapy and they were placed on a regimen containing cisplatinum at the dose of 120mg/M2 with mannitol diuresis combined with Adriamycin in addition to BCD (regimen A). In the current study, 35 of the 57 patients did not demonstrate a good effect of chemotherapy on the primary tumor and were assigned to regimen A postoperatively. Of these 35 patients, 32 (91%) have remained continuously free of recurrent or metastatic disease from 6-34 months following the start of therapy. Among the 22 remaining patients having a good histologic response and treated with regimen B postoperatively, there has been only one relapse in a patient who had a local recurrence in the area of an inadequately resected primary tumor three months after the cessation of chemotherapy. Thus, 53 of 57 patients (93%) are continuously with no evidence of recurrent or metastatic disease from 6-35 months (median, 20 months) from the start of treatment. This study demonstrates the value of thorough histologic examination in predicting survival in responding patients and in helping identify patients whose disease-free survival rate can be substantially increased if they are given alternative postoperative adjuvant chemotherapy after failing to have a good response to preoperative chemotherapy. This individualized chemotherapeutic strategy has yielded the highest disease-free survival rate reported to date for osteogenic sarcoma.

Antineoplastic Agents↗
PubMed1982

Depression and somatization: a review. Part I.

The authors describe the relationship between the major depressive disorder and somatization. A literature review documenting the incidence and prevalence of depression in primary care and the rate of misdiagnosis is presented. Evidence is collated that points to several factors in misdiagnosis. The patient often selectively complains about the somatic manifestations of depression, minimizes the affective and cognitive components and is treated symptomatically. This is due to the physician's lack of recognition that the patient may have major depressive disorder and yet not recognize and report the mood component. The authors develop a conceptual; model that elucidates the mechanism behind the selective perception and focus by the patient on the somatic manifestations of depression. In this first part, the influence of sociocultural and childhood experience on the ability of the patients to recognize and report mood changes is delineated. Understanding this model is crucial in preventing misdiagnosis and potential iatrogenic harm to the patient.

Age Factors↗
PubMed1982

Depression and somatization: a review. Part II.

In Part I, the authors described the relationship between somatization and depression and the extent and rate of misdiagnosis of the problem of depression in primary care. A conceptual model was developed to explain the patient's selective perception and focus on the somatic manifestation of depression and the resulting misdiagnosis. In the first section, the sociocultural and childhood experience were reviewed as two major factors influencing the ability of the patient to perceive affective changes. In this second part, the authors review the influence of the developmental stage of the patient's cognitive mechanisms and the effect of the environmental systems in which the patient dwells, i.e., medical care, family and social network, work/disability and the sociopolitical institutions, on the recognition of affective, cognitive and somatic symptoms.

Adolescent↗
PubMed1982

Gallium scans in Paget's sarcoma.

Bone and gallium scans were performed in twelve patients with Paget's sarcoma. Most of these patients had polyostotic Paget's disease. The lesions with sarcomatous changes were usually associated with less Tc-99m MDP uptake as compared with Pagetoid bone which was not sarcomatous. Gallium uptake in the tumor area was proportionally higher than the MDP uptake and appeared quite irregular. Follow-up scans were available in a limited number of patients. Temporary response to chemotherapy was reflected by the decreased gallium uptake in the tumor area. Gallium scans appear to be useful in confirming the diagnosis of Paget's sarcoma and may be valuable in monitoring therapeutic response.

Aged↗
PubMed1982

Replacement children: Expanding the concept.

A case report of a family that considered having a replacement child after one of their children was diagnosed as having a developmental delay is presented, and the literature dealing with replacement children is reviewed. The definition of a replacement child is expanded to include children who are conceived after a sibling has been diagnosed as having a developmental delay. Recommendations are made for the pediatrician who is responsible for the care of the child with a newly diagnosed developmental delay.

Adult↗
PubMed1982

Imaging of primary Ewing sarcoma with 13N-L-glutamate.

Eleven patients with untreated primary Ewing sarcoma were studied with intravenously administered 13N-labeled L-glutamate. Seven were repeatedly scanned during chemotherapy using this agent and 99mTc-methylene diphosphonate (99mTc-MDP). The untreated primary tumor was distinctly visualized with 13N-L-glutamate in all cases; the distribution of 13N label in the tumor sometimes differed from that of 99mTc. A kinetic study showed rapid uptake of 13N by tumor tissue. Repeat scans following therapy indicated that 13N-L-glutamate and 99mTc-MDP uptake showed changes consistent with histological findings following subsequent surgery. 13N uptake often decreased more markedly than 99mTc uptake during chemotherapy, but metastatic lesions were not visualized with 13N-L-glutamate. Tumor imaging with this labeled amino acid may be of value in assessing the response of primary Ewing sarcoma to chemotherapy.

Adolescent↗
PubMed1982

Radiographic changes in primary osteogenic sarcoma following intensive chemotherapy. Radiological-pathological correlation in 63 patients.

Sixty-three patients with osteogenic sarcoma of the long bones, all of whom were treated with chemotherapy, demonstrated striking and unusual radiographic changes. Patients with a "good" radiographic response (48%) showed the most dramatic changes, including medullary sclerosis, prominent periosteal new bone formation, and disappearance of the soft-tissue mass; and these findings correlated well with the histological grading of the surgical specimens. Radiographic evaluation of patients receiving chemotherapy for osteogenic sarcoma is a valuable method of assessing response.

Adolescent↗
PubMed1982

Excision of Zenker's diverticulum using auto-suture technique.

The one-stage transcutaneous hypopharyngeal diverticulectomy has become the accepted procedure for treating most of Zenker's diverticula. Myotomy of the crico pharyngeus is simultaneously done as a safeguard for sac recurrence. Experience of our general-surgical colleagues with stapling devices has inspired us to use auto-suture technique for the resection of Zenker's diverticulum.

Diverticulum, Esophageal↗
PubMed1982

Somatization in family practice: a biopsychosocial approach.

The family physician sees many patients who present physical symptoms that have primarily an emotional or psychosocial basis. This paper defines the concept of somatization, reviews its prevalence and consequences, and develops a conceptual model of somatization that includes cultural, childhood, psychological, and environmental factors. Physicians and the medical care system play a significant role in reinforcing somatization by patients. A biopsychosocial approach to the clinical assessment, diagnosis, and management of these patients is presented along with case examples that exemplify the utility of this approach.

Adolescent↗