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Biomedical subjects

H B Muss

Publications and source records attributed to H B Muss.

At least 145 records · Page 8Linked to original sources
PubMed1985

Secondary malignancies of the penis and epididymis: a case report and review of the literature.

A patient with carcinoma of the colon developed metastases to the penis and right epididymis. These two organs are rare locations for metastases and the concurrent involvement of both sites has not been previously described. Our patient and the results of a literature review are presented. Two hundred eighteen cases of penile and 37 separate cases of epididymal metastases were identified. The genitourinary and gastrointestinal tracts were the predominant sites of the primary malignancies. Presenting symptoms, the interval between diagnoses of the primary and metastatic lesions, and the therapy of the penile/epididymal deposits varied greatly. Surgical excision is the major mode of therapy; radiotherapy, chemotherapy, or hormonal therapy may be beneficial in selected cases. Survival among these patients is poor due to the presence in most patients of widespread metastases in addition to their genital lesions. However, instances of prolonged survival are noted in both groups. Patient characteristics and possible mechanisms of metastatic spread to the genitals are discussed.

Adenocarcinoma↗
PubMed1985

Single agent vincristine by infusion in refractory multiple myeloma.

A phase 2 trial of vincristine infusion was conducted in a group of 21 patients with refractory multiple myeloma. Patients were generally heavily pretreated with radiotherapy and chemotherapy. Vincristine was given intravenously (IV) as a 0.5 mg bolus and followed immediately by infusion of 0.25 to 0.50 mg/m2/d for 5 days. Courses were repeated every 3 weeks in the absence of disease progression or prohibitive toxicity. Objective responses (partial) were noted in two patients (10%), both of whom were administered 0.5 mg/m2/d infusions. Response durations were brief (2.2 and 1.2 months). Toxicity consisted of neurotoxicity and myelosuppression. In addition to the occurrence of paresthesias and myalgias, ileus (two cases) and moderately severe loss of motor function (two cases) were observed. The mean lowest WBC count following treatment was 2.67 X 10(3)/microL v 3.96 X 10(3)/microL pretreatment (P = .008). The mean lowest platelet count was 75.0 X 10(3)/microL v 106.8 X 10(3)/microL pretreatment (P = .008). Vincristine infusion appears to have limited activity in the treatment of refractory multiple myeloma. Additionally, response durations were short lived and toxicity, both neurologic and hematologic, was appreciable.

Adult↗
PubMed1985

Human T-cell leukemia/lymphoma syndrome.

This syndrome should be suspected in patients with clinical features of lymphadenopathy, hepatosplenomegaly, hypercalcemia, bone lesions and circulating lymphocytes with pleomorphic nuclei. Most biopsy material has morphologic characteristics of intermediate or high-grade non-Hodgkins lymphoma. Antibody titers to human T-lymphotropic virus type I confirm the diagnosis. Treatment with combination chemotherapy results in remission for most patients, but duration of response is usually short.

Adult↗
PubMed1985

Granulomatous pneumocystosis presenting as a solitary pulmonary nodule.

A case of pneumocytosis presented radiologically as a solitary pulmonary nodule. Of cases presenting in this unusual fashion, this may be the first in which the histology was that of a fibrous and granulomatous nodule. The only pathogen identified was Pneumocystis carinii. The expected histologic pattern in pneumocystosis (interstitial pneumonitis with foamy alveolar exudate) was completely absent. Outside the major pulmonary nodule, scattered microscopic noncaseating granulomas of sarcoid type were observed. Treatment in this case consisted only of segmental pulmonary resection, but no recurrence of pneumocytosis was observed.

Diagnosis, Differential↗
PubMed1985

Megestrol acetate v tamoxifen in advanced breast cancer: a phase III trial of the Piedmont Oncology Association (POA).

One hundred twenty-four patients with recurrent or metastatic breast cancer were randomized to receive megestrol acetate 40 mg orally, four times daily, or tamoxifen 10 mg orally twice daily. If therapy failed patients were crossed over to the alternate treatment. Eligibility required that either the estrogen or progesterone receptor be positive or that both values be unknown, and that patients be at least 2 years postspontaneous menopause or over 50 years of age. Pretreatment characteristics were similar for both groups. Three patients had had previous hormonal therapy while one third had had chemotherapy. Objective response for evaluable patients based on strict UICC criteria was 29% with megestrol acetate and 31% with tamoxifen. Responses in patients with bone and soft tissue disease were similar for both regimens; however, 7 of 19 (37%) patients with visceral disease responded to tamoxifen but none of 18 (0%) responded to megestrol acetate. Response did not correlate with amount of estrogen or progesterone receptor. Unadjusted analysis of time to progression and survival showed no significant differences between regimens. With adjustment for pretreatment characteristics, patients on tamoxifen had a statistically significant prolongation of both of these parameters. Crossover data show 3 of 24 patients responding to tamoxifen after failure on megestrol acetate and 1 of 24 responding to megestrol acetate after failure on tamoxifen. However, crossover data should be viewed cautiously, as patients who are currently responding to initial treatment are those who would be most likely to respond to crossover therapy.

Aged↗
PubMed1984

High-dose cyclophosphamide and 5-fluorouracil versus vincristine, doxorubicin, and cyclophosphamide in advanced carcinoma of the breast. A phase III study of the Piedmont Oncology Association (POA).

Forty-nine patients with advanced carcinoma of the breast who had received no prior chemotherapy were randomized to receive either high-dose cyclophosphamide (C) 1250 mg/M2 intravenously on day 1 and 5-fluorouracil (F) 600 mg/M2 intravenously on days 1 through 5 (CF), or vincristine (V) 1.5 mg/M2, doxorubicin (A) 50 mg/M2 and cyclophosphamide (C) 500 mg/M2 (VAC), all intravenously on day 1. Both regimens were repeated at 3-week intervals. Nine of 25 patients (36%) treated with CF and ten of 21 patients (48%) treated with VAC showed a complete or partial response as defined by the (UICC) guidelines. The estimated median time to progression for all patients was 3.5 months for CF and 6.0 months for VAC, with the median time to progression for responding patients being 8.5 months on CF and 6.3 months on VAC. Estimated survival is also similar for the two regimens. Ten of the patients treated with high-dose CF experienced septic episodes and four died. Toxicity on the CF arm necessitated premature closure of the study, and thus full statistical comparison of the efficacy of the two regimens cannot be made.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Treatment of advanced non-Hodgkin's lymphoma with vincristine infusion.

Twenty-five patients with a variety of histologic types of advanced non-Hodgkin's lymphoma refractory to previous chemotherapy were entered into a trial of vincristine infusion. Patients received 5-day courses of vincristine 0.25 mg/m2/day by continuous intravenous infusion after an initial 0.5 mg intravenous bolus injection. Courses were repeated every 3 weeks. Objective responses were observed in nine patients (36%), all of whom had previously received vincristine given by conventional bolus injection. A complete response occurred in a patient with diffuse mixed histiocytic lymphocytic lymphoma, and partial responses were observed in eight patients with the following histologic types: diffuse poorly differentiated lymphocytic (4); nodular poorly differentiated lymphocytic (2); diffuse mixed histiocytic lymphocytic (1); and diffuse histiocytic (1). Duration of response lasted from 1.2 to 16.2 months (mean, 4.4 months). The principal complication of therapy was mild-to-moderate neurotoxicity; this occurred in 12 patients (48%) who received a total of 54 courses of vincristine infusion. Hematologic toxicity was minimal and nausea/vomiting did not occur. Vincristine infusion may afford palliation for patients with advanced non-Hodgkin's lymphomas who have become refractory to standard chemotherapeutic regimens even if they have received prior vincristine by conventional bolus injection. These data suggest the possibility of enhancing the therapeutic efficacy of vincristine in the treatment of non-Hodgkin's lymphoma by use of an infusion technique.

Adult↗
PubMed1984

Detection of brain metastasis at diagnosis of small cell carcinoma of the lung.

As a part of the initial evaluation of previously untreated patients with small cell carcinoma of the lung, radionuclide and/or computerized tomographic (CT) scanning of the brain was performed. Evidence of metastatic brain disease was documented in 10 (9%) patients (9 by CT and 1 by radionuclide scanning). CT was abnormal in 2 patients who had no evidence of brain metastasis by radionuclide scan. The detection of brain metastasis resulted in upstaging of 6 neurologically asymptomatic patients who had no other extrathoracic disease. Evaluation of the brain with CT is recommended as part of the initial staging of patients with small cell carcinoma of the lung.

Brain Neoplasms↗
PubMed1984

Improved tolerance of vincristine by glutamic acid. A preliminary report.

In a murine model system, glutamic acid has demonstrated host protective properties during administration of vincristine (VCR). Subsequently, glutamic acid has been evaluated in patients receiving VCR during adjuvant chemotherapy for stage II carcinoma of the breast. The cumulative VCR dosage and toxicities incurred in 16 patients receiving glutamic acid have been compared to those observed in 88 patients who previously received VCR without glutamic acid in the same chemotherapy program. All patients received VCR 1.0 mg/m2 weekly for 6 weeks with dose modification for neurotoxicity. Treatment patients received glutamic acid 1.5 grams p.o. daily in three divided doses during the induction course. Of the 16 treatment patients, 9 (56%) received 100% ideal dosage of VCR during induction therapy whereas only 24 of 88 (27%) comparison patients attained this dosage level (p less than .025). Gastrointestinal and hematologic toxicities were similar in both groups. These preliminary results suggest the need for an expanded trial of this agent during administration of VCR.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Pharmacokinetics of vindesine bolus and infusion.

The pharmacokinetics of vindesine were investigated during treatment of 15 patients with progressive malignancies refractory to conventional treatment. Patients were administered one of three IV dose schedules: 3.0 mg/m2 bolus injection, 1.2 mg/m2/day infusion for 5 days, or 2.0 mg/m2/day infusion for 2 days. Concentrations of the drug in the serum and urine were determined by radioimmunoassay. Serum concentrations were highest (5 X 10(-7) M) in patients receiving a bolus injection, but fell to nondetectable levels by 48 h in four of five patients (terminal t1/2 15.0 +/- 9.4 h). Compared with bolus injection, 1.2- to 1.4-fold greater areas under the blood concentration curve were observed during infusions of 2.0 mg/m2 and 1.2 mg/m2. Whereas steady-state concentrations (approximately 1 X 10(-8) M) were maintained throughout the infusion of 1.2 mg/m2/day progressively increasing serum levels were observed during the infusion of 2.0 mg/m2/day. Serum concentrations fell rapidly following discontinuation of the 2.0-mg/m2 infusion, but were somewhat more sustained in the 1.2-mg/m2 infusion group. The average urinary excretion was similar for each dose-schedule (8%-11% of the total dose). The pharmacokinetics of vindesine are influenced by variations in dose schedule.

Adult↗
PubMed1984

Second primary bronchogenic carcinomas after small cell carcinoma. Report of two cases and review of the literature.

Second primary carcinomas of the lung are well described. However, their occurrence following initial diagnosis of small cell lung carcinoma is rare. The development and antemortem diagnosis of metachronous second primary bronchogenic carcinomas in two long-term (more than four years) survivors of small cell lung cancer is described. The histologic types of the second carcinomas were mucoepidermoid and bronchoalveolar. On the basis of a review of the literature, only eight similar cases have been reported; none of the second primaries was mucoepidermoid or bronchoalveolar. The question of whether second primaries after small cell lung cancer represent true metachronous carcinomas, different degrees of differentiation of the same tumor, or the emergence of a previously unrecognized synchronous tumor is discussed. The need for awareness of this complication and the necessity for life-long follow-up in long-term survivors of small cell lung cancer is emphasized.

Carcinoma↗
PubMed1984

Bone marrow evaluation in small cell lung cancer.

The records of 87 patients with small cell lung cancer were reviewed. Patients were clinically staged with bone marrow aspirate and biopsy as well as radionuclide scans of bone, liver, and brain. Extrathoracic spread was noted in 54% (47/87) and limited disease in 46% (40/87). The bone marrow evaluation was positive in 13/62 patients (21%) and seven of these thirteen patients had normal bone scans (54%). Of these seven patients, five had no other evidence of distant metastases and their survival was 7-10 months, considerably shorter than patients found to have limited disease. Bone marrow examination appears to complement radionuclide scanning in the initial staging of patients with small cell carcinoma of the lung and provides important prognostic information.

Bone Marrow Examination↗
PubMed1984

A phase II study of PALA (NSC 224131) in patients with advanced ovarian carcinoma. A Gynecologic Oncology Group study.

Pala, 5G /M2 i.v. every 3 weeks was given to 32 evaluable patients with ovarian carcinoma (31 previously treated). No complete or partial responses were noted. Ten patients had stable disease for a median progression-free interval of 4.7+ months, while the remainder had progression of disease from the start of therapy. The major toxicity was dermatologic, and five patients had severe skin rash with desquamation or ulceration. There was no substantial hematologic or gastrointestinal toxicity. PALA displays no useful activity in previously-treated patients with ovarian cancer.

Adult↗
PubMed1984

A phase II study of dibromodulcitol (DBD) in stage IV melanoma.

Twenty-four patients were evaluated in a non-randomized study to assess the effectiveness of dibromodulcitol (DBD) in Stage IV melanoma. Patients received 100 mg/m2 of DBD orally for 35 days. The dose was escalated to 130 mg/m2 and then to 160 mg/m2 if no significant hematologic toxicity occurred. There were no objective responses, including six patients who had had no prior chemotherapy. Five patients (21%) remained stable. Median survival was 151 days. Survival favored females, nonvisceral involvement pretherapy, and patients with a disease-free interval (DFI) of greater than 1 year. None of these advantages was statistically significant. Toxicity was predominantly hematologic, but nausea, vomiting, shortness of breath, and diarrhea were also seen. Oral DBD, using this dose and schedule, does not appear efficacious in advanced disseminated melanoma.

Drug Administration Schedule↗