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Biomedical subjects

H Kreisman

Publications and source records attributed to H Kreisman.

At least 37 records · Page 2Linked to original sources
PubMed1993

Effect of radiologic stage III substage on nonsurgical therapy of non-small cell lung cancer.

BACKGROUND: Patients with Stage III non-small cell lung cancer (NSCLC) whose cases are staged or treated surgically have different prognoses, depending on the substage (IIIa, IIIb). It is not known whether the prognostic differences apply to clinically staged nonsurgical cases. The authors wanted to determine whether radiologic Stage III substages, determined by computerized axial tomography (CT) scans, are prognostically important in these patients with NSCLC: In addition, they wanted to determine whether the observed superior survival of selected patients with Stage III NSCLC receiving chemotherapy in addition to radiation therapy (chemo-RT) (Cancer and Leukemia Group B protocol 8433: N Engl J Med 1990; 323:940-5) was influenced by an imbalance in the radiologic Stage III substage. METHODS: Review of pretreatment chest radiographs and CT scans with determination of TNM status and stage was done by the consensus of three readers, who were unaware of which treatment each patient had received (radiation therapy alone [RT] or chemo-RT). RESULTS: Patient characteristics in the two treatment arms were similar. Fifty-five percent of patients receiving RT had Stage IIIa and 33% Stage IIIb disease; in the chemo-RT treatment arm, 73% had Stage IIIa and 25% Stage IIIb disease (P = 0.11). Seven patients (12%) who received RT and one in the chemo-RT treatment arm (2%) had Stage I-II disease on CT scan. Patients with Stage IIIa disease had superior survival to those with Stage IIIb disease (median, 16.5 versus 10.5 months, respectively; P = 0.0045). Within each substage, survival was superior in the chemo-RT (versus RT) treatment arm (Stage IIIa, 17.2 versus 10.7 months, respectively; P = 0.16; Stage IIIb, 12.0 versus 6.9 months, respectively; P = 0.089). CONCLUSIONS: The survival advantage for selected patients with Stage III NSCLC treated with chemo-RT in this study did not result from a more favorable pretreatment radiologic Stage III substage. An advantage for induction chemotherapy was seen in patients with Stage IIIa and IIIb disease. Future studies in this population should prospectively assess and consider stratification for Stage III substage.

Adipose Tissue↗
PubMed1993

Interleukin-2 activity in patients with extensive small-cell lung cancer: a phase II trial of Cancer and Leukemia Group B.

BACKGROUND: Chemotherapy may induce overall (complete plus partial) response rates of more than 50% and complete response rates up to 25% in extensive small-cell lung cancer (stage IIIB or IV), but survival is generally limited to 8-12 months. Interleukin-2 (IL-2) has demonstrated activity against this disease in vitro and has produced regression in melanoma and renal cell carcinoma. PURPOSE: The purpose of this study was to determine in a prospective, nonblinded, phase II trial the activity of IL-2 in patients with extensive small-cell lung cancer who had not achieved complete remission with chemotherapy. METHODS: The 68 patients eligible for the study were initially treated with at least one dose of combination chemotherapy with cisplatin, doxorubicin, cyclophosphamide, and etoposide (PACE). Of the 50 who did not obtain complete remission with PACE, 24 who had measurable or evaluable disease and whose medical condition allowed further therapy were treated with IL-2. Beginning 3 weeks after the last dose of PACE, IL-2 was administered intravenously at 4.5 million Nutley units/m2 per day as a continuous infusion for 96 hours, followed by a 3-day rest. The planned duration of therapy was 8 weeks. RESULTS: Of the 24 patients eligible to receive IL-2, four (17%) with measurable disease or evaluable but not measurable disease obtained a complete response after IL-2 therapy; one (4%) patient had a partial response. The overall response rate was 21%. Complete responses continued for 8, 9, and more than 11 months in three patients; the remaining patient developed acute myelomonocytic leukemia while in complete remission approximately 8 months after the start of IL-2 therapy. Only five of the 24 patients were able to complete the planned 8 weeks of IL-2 therapy. Therapy was discontinued in 11 patients because of life-threatening side effects, in six because of disease progression, and in two who withdrew from the study, probably related to IL-2 toxicity. CONCLUSIONS: These results indicate that IL-2 has some activity in extensive small-cell lung cancer and suggest that IL-2 is not cross-resistant with PACE therapy. IMPLICATIONS: Further studies are needed to define the optimum timing, dose, and schedule of IL-2 and to determine whether the agent has a role in the therapy of small-cell lung cancer.

Adult↗
PubMed1993

A comparison of albuterol administered by metered dose inhaler (and holding chamber) or wet nebulizer in acute asthma.

BACKGROUND: Comparative studies of albuterol by wet nebulizer or metered dose inhaler have tested fixed doses of medications. We compared the dose-response relationship to albuterol by wet nebulization or metered dose inhaler in acute asthma. METHODS: Randomized, double-blind, placebo-controlled trial. Patients with acute asthma received either albuterol, 0.4 mg, by metered dose inhaler (and holding chamber) or albuterol, 2.5 mg, by wet nebulizer every 30 min until maximal bronchodilation. Forty patients (forced expiratory volume in 1 s [FEV1]: 1.15 +/- 0.43 L; 36 +/- 12 percent predicted) received metered dose inhaler and 40 others (FEV1: 1.08 +/- 0.52 L; 35 +/- 16 percent predicted) received wet nebulization. RESULTS: Twenty-six patients (65 percent) receiving metered dose inhaler and 30 (75 percent) receiving wet nebulization achieved maximal bronchodilation after two doses. Almost all reached maximal bronchodilation by four doses. The FEV1 improved by 0.72 +/- 0.49 L for metered dose inhaler and 0.68 +/- 0.61 L for wet nebulizer (p = 0.71). A significant linear relationship was seen in both groups (metered dose inhaler r = 0.94; wet nebulizer r = 0.98) between the log dose of albuterol and change in FEV1. About 1/6 the wet nebulizer dose of albuterol was needed to achieve similar response to the metered dose inhaler. CONCLUSIONS: Albuterol by metered dose inhaler provided similar bronchodilation to that achieved by wet nebulization in patients with acute asthma. The cumulative dose-response technique is applicable in the emergency department setting and is helpful in comparing the relative utility of various bronchodilator regimens.

Acute Disease↗
PubMed1992

Uses and misuses of oxygen in hospitalized patients.

PURPOSE: To document the use/misuse of oxygen therapy as compared with antibiotics in internal medicine inpatients. To determine whether the same care was being taken in the prescription and administration of both forms of therapy. PATIENTS: Ninety-six eligible patients at a university teaching hospital were entered into a study examining the use of oxygen. They were compared with 60 patients for whom antibiotics were prescribed. MATERIAL AND METHODS: Three hundred thirty consecutive newly admitted patients were screened for the presence of either (1) oxygen apparatus at the bedside, (2) physician orders for oxygen, or (3) oxygen orders noted in nursing kardex. Those meeting one of these three criteria were observed on up to four occasions over 48 hours following study entry. Similarly, patients were screened for medical orders or nursing medication kardex notation for antibiotics and were also observed for proper prescription and administration of medication. Procedural errors, determined by kardex audit and direct patient observation, were compared for the individuals with specific oxygen orders and those receiving antibiotics. RESULTS: Oxygen delivery apparatus was found in the room in 17 of 96 patients without it ever having been ordered by the physician or noted in the nursing kardex. In 27 of 96 patients, oxygen was noted in the nursing kardex and administered to patients without a physician order. There were no cases of antibiotic therapy without a physician order. Observations of 47 patients with specific orders for oxygen revealed the following errors: (1) physician order incorrectly transcribed to nursing kardex (16%), (2) flow meter off (34%), (3) oxygen delivery apparatus improperly worn (57%), (4) wrong fractional inspired oxygen concentration (58%). Improper transcription of antibiotic orders occurred on only one occasion (2%), and antibiotics were improperly administered in 5%. Arterial blood gas determinations preceded oxygen orders in 61%, whereas microbiologic cultures preceded antibiotic orders in 87% of the patients. CONCLUSIONS: We conclude that oxygen therapy is neither prescribed nor administered with the same attention that is given to other drugs such as antibiotics. Oxygen prescription and/or delivery is associated with significantly greater error than that seen with antibiotics. Education of medical personnel should stress more prudent prescription and use of oxygen in hospitalized patients.

Anti-Bacterial Agents↗
PubMed1992

Carboplatin in non-small cell lung cancer: an update on the Cancer and Leukemia Group B experience.

Since 1984, the Respiratory Committee of the Cancer and Leukemia Group B (CALGB) has evaluated carboplatin, either alone or in combination, in five separate phase II studies for patients with inoperable non-small cell lung cancer (NSCLC). All patients had an Eastern Cooperative Oncology Group performance status of 0 to 2 and had not received previous treatment with chemotherapy. In 70 patients with stage IIIB or IV disease, carboplatin 400 mg/m2 administered intravenously once every 4 weeks produced a 16% overall response rate and an acceptable toxicity profile. Subsequently, combinations of carboplatin/cisplatin, carboplatin/etoposide, and carboplatin/vinblastine have been evaluated in similar patient groups. Response rates of 11%, 12%, and 20%, respectively, were obtained. Myelosuppressive toxicity was substantially greater with carboplatin/etoposide and carboplatin/vinblastine than with carboplatin alone. Carboplatin/vinblastine demonstrated efficacy similar to that of the cisplatin/vinblastine combination previously evaluated by CALGB for treatment of similar patients with advanced NSCLC; ease of administration and lack of significant nephrotoxicity also compared favorably with cisplatin-based therapy. In regional NSCLC patients, carboplatin 100 mg/m2/wk can be administered intravenously concurrently with 60 Gy thoracic radiotherapy given over 6 weeks. The impact of concurrent carboplatin added to a sequential chemotherapy-radiotherapy program for patients with regional NSCLC is currently under study by the CALGB Respiratory Committee.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Pulmonary toxicity of antineoplastic therapy.

Pulmonary toxicity is often encountered in patients receiving antineoplastic therapy. It may produce a wide variety of clinicopathologic syndromes. As new agents are introduced and their adverse effects recognized, clinicians should be ever vigilant about the possibility of pulmonary toxicity.

Alkylating Agents↗
PubMed1991

Long-term postthoracotomy pain.

We used a pain questionnaire to evaluate the prevalence and functional significance of long-term postthoracotomy pain. Data on 56 patients who were at least 2 months postsurgery were analyzed. Thirty patients (54 percent) with a median follow-up of 19.5 months had persistent pain; 26 others were pain free at a median of 30.5 months postthoracotomy. Pain was reported in 24 of 44 patients (55 percent) who were more than one year after surgery, 13 of 29 patients (45 percent) more than two years, six of 16 (38 percent) more than three years, and three of ten patients (30 percent) greater than four years postthoracotomy. Pain intensity was low, but 13 patients stated that pain "slightly" or "moderately" interfered with their lives. Five of 56 patients had sufficiently severe chronic pain to require either daily analgesic use, nerve blocks, relaxation therapy, acupuncture, or referral to a pain clinic. We conclude that long-term chest wall pain is common postthoracotomy. It is generally not severe, but a small proportion of patients may experience persistent, moderately disabling pain.

Chronic Disease↗
PubMed1990

Small cell lung cancer presenting as a solitary pulmonary nodule.

Small cell lung cancer (SCLC) rarely presents radiographically as a solitary pulmonary nodule (SPN). Twenty-five patients with this feature were identified among 408 individuals with SCLC at McGill University (Montreal, Quebec) from 1979 through 1984. Of these, 15 (60%) were confirmed on pathologic review as SCLC (ten intermediate cell, four oat cell, one indeterminate). Pathologic review of a control group comprising 24 other limited-disease patients who were long-term survivors (greater than 20 months) confirmed 20 (84%) as SCLC (eight intermediate cell, 12 oat cell). Ten of the 15 patients with SPN were resected whereas five had chemotherapy and/or radiotherapy as primary treatment. Postoperative chemotherapy was administered to most of the resected patients. The median survival of the 15 patients with SPN was 24 months, a significantly longer survival than the other patients with SCLC. This improved prognosis in patients with SPN may be due to smaller initial tumor burden or to a fundamental biologic difference between SPN and other forms of SCLC.

Actuarial Analysis↗
PubMed1990

A comparison of enprofylline and theophylline in the maintenance therapy of chronic reversible obstructive airway disease.

To compare the efficacy and side effects of two xanthine derivatives in the maintenance therapy of reversible obstructive airway disease, 242 patients were assigned in randomized, double-blind fashion to receive either oral enprofylline or theophylline for 5 weeks in addition to their usual maintenance regimens. After a week of placebo xanthine therapy, enprofylline-treated patients received 150 mg of this drug twice daily (b.i.d.) for 3 days, 300 mg b.i.d. for 2 weeks, and 450 mg b.i.d. for 2 weeks. Theophylline was administered in identical doses, except that the final dosage increase was not made if plasma theophylline was 12 mg/ml or higher. At 300 mg b.i.d., both drugs significantly increased morning peak expiratory flow rate (PEFR), the mean increase above baseline being significantly higher for theophylline-treated patients (29.9 +/- 37.2 L/min) than for enprofylline-treated patients (17.4 +/- 36.9 L/min) (p = 0.023). At 450 mg b.i.d., improvement in morning PEFR was not significantly different between theophylline-treated (31.5 +/- 44.4 L/min) and enprofylline-treated groups (23.5 +/- 48.4 L/min). Evening PEFR, FEV1, and asthma symptom scores also improved significantly, demonstrating no significant difference between groups. The incidence of side effects was also similar between groups. We conclude that both enprofylline and theophylline offer useful bronchodilatation in the maintenance therapy of asthma, enprofylline, 450 mg b.i.d., being approximately equivalent to theophylline, 300 or 450 mg b.i.d.

Adolescent↗
PubMed1990

Cisplatin-carboplatin therapy in extensive non-small cell lung cancer: a Cancer and Leukemia Group B study.

The response to cisplatin in non-small cell lung cancer (NSCLC) is limited by the renal and neurological toxicities of this agent. Carboplatin has modest activity in NSCLC and when given in conventional doses has a different spectrum of toxicity. Both drugs were administered to 76 eligible patients with advanced NSCLC. No patient had been previously treated with chemotherapy. Cisplatin 50 mg/m2 and carboplatin 350 mg/m2 were administered every 28 days until disease progression occurred. There was 1 complete response and the overall response rate among the 68 evaluable for response patients was 13%. Neither histological subtype nor initial performance status was a significant factor influencing response. Median survival was 5.1 months with significant differences based on initial performance status but not on histological subtype. Severe or life-threatening leukopenia and thrombocytopenia occurred in 23% and 36% of the 76 patients, respectively. There were 2 toxic deaths, 1 each due to infection and haemorrhage. The efficacy of this combination is not different from that of carboplatin alone, and the combination may be of greater benefit in patients with more responsive tumours than NSCLC.

Adult↗
PubMed1990

Effect of caffeine on histamine bronchoprovocation in asthma.

It was recently reported that caffeine may reduce the clinical symptoms of asthma and may prevent the clinical manifestations of this disease. The effect of caffeine on histamine responsiveness is unknown. The effect of caffeine (5 mg/kg) and placebo on histamine responsiveness (the provocation concentration causing a 20% fall in FEV1, PC20) was studied in 10 subjects with mild asthma (prechallenge FEV1 84% of predicted value). The PC20 for histamine bronchoprovocation after caffeine ingestion was 2.65 (95% confidence limits 0.99, 7.10) mg/ml. After placebo the PC20 was 1.89 (0.96, 3.71) mg/ml. It is concluded that caffeine in a dose equivalent to about three cups of coffee has a very small effect, if any, on histamine bronchoprovocation in those with mild asthma. Specific instructions about not having drinks containing caffeine before histamine challenge are therefore not necessary.

Asthma↗
PubMed1990

Sensation of inspired volumes and pressures in professional wind instrument players.

Previous studies have failed to show consistent differences in pulmonary function between wind instrument musicians and normal controls. In this study, respiratory sensation was assessed in 13 professional wind instrument players and 13 age-matched controls. Psychophysical techniques were used to assess magnitude estimation and reproduction of lung volumes and inspiratory pressures. The exponent for volume magnitude estimation was not different in musicians and controls (1.17 +/- 0.11 vs. 1.16 +/- 0.11), but volume reproduction was more accurate in musicians. The mean exponent for pressure magnitude estimation was 1.34 +/- 0.14 and 1.06 +/- 0.09 (P = 0.057) in musicians and controls, respectively. There was no difference between groups for absolute or constant error for pressure reproduction. Professional wind instrument players appear to have some inherent or acquired differences in respiratory perception and ventilatory neuromuscular control compared with other normal subjects.

Adult↗
PubMed1990

Continuous nebulization of albuterol (salbutamol) in acute asthma.

We studied the safety and efficacy of albuterol (salbutamol) delivered by continuous nebulization (CN) in the initial emergency department treatment of asthma. In a randomized fashion 21 patients received 5 mg of albuterol by bolus nebulization (BN) at time 0 and again 60 minutes later. Twenty-one others received albuterol (0.2 mg/ml) by CN using a calibrated nebulizer with a known output of 25 ml/h. Thus, each patient had received 10 mg of albuterol over two hours. FEV1, blood pressure (BP), heart rate (HR), respiratory rate (RR), and hand tremor were recorded at 30-minute intervals. The FEV1 was 1.48 +/- 0.64 L prior to BN and increased to a maximum of 2.20 +/- 0.94 L (p less than 0.05) 90 minutes later. The FEV1 prior to CN was 1.13 +/- 0.51 L and improved to 2.20 +/- 1.02 L (p less than 0.05) at 120 minutes. The FEV1 did not differ significantly between regimens over the 2-hour period. Both modes of therapy were well tolerated. There was a slight but significant increase in HR at 30 and 90 minutes in the BN group when compared with CN. There was no significant difference in BP, RR, or tremor between the groups. Thus, albuterol by CN was found to be equally effective as the same medication by BN in the early treatment of asthma in patients seen in the emergency department.

Acute Disease↗
PubMed1990

Monoclonal anti-CEA antibodies in the discrimination between primary pulmonary adenocarcinoma and colon carcinoma metastatic to the lung.

Lung metastases from colon adenocarcinoma are often difficult to differentiate from primary lung adenocarcinoma. We studied the diagnostic value of a polyclonal anti-CEA antiserum and two monoclonal anti-CEA antibodies (B18, D14) which define antigens overexpressed in colon carcinoma. Autopsy material from 20 patients with colon carcinoma and lung metastases and 20 specimens from patients with primary lung adenocarcinoma were retrieved, stained, and interpreted without knowledge of the origin of the lung tumor. Colon carcinomas, lung metastases and lung primaries stained positively with polyclonal anti-CEA in 90-100% of cases. D14 stained 75% of colonic metastases and 70% of primary lung adenocarcinomas, whereas 95% of colon primaries were positive. Sixty-five percent of colon primaries and 50% of their metastases were positive with B18, whereas 45% of lung primaries were positive. The frequency of B18 positivity was significantly greater in those colon primaries that were surgically derived (7/9, 78%) compared with their autopsy-derived lung metastases (2/9, 22%) (P less than 0.05). Similarly, D14 staining in surgically derived colon primaries (9/9, 100%) was significantly greater than their autopsy-derived lung metastases (5/9, 56%) (P less than 0.05). In surgical/biopsy-derived tissues 9/9 colonic primaries were D14-positive, whereas only 1 of 6 lung primaries was positive (P = 0.002). We conclude that D14 and polyclonal anti-CEA both stain the majority of colon adenocarcinomas and that changes associated with prolonged fixation may reduce the positivity rate with both B18 and D14 monoclonal antibodies. All three antibodies stain autopsy-derived tissue from primary lung cancer to a significant degree.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1989

Coordination of eating, drinking and breathing in adults.

The coordination of breathing and swallowing was studied in seven normal males at rest, as well as during eating and drinking. Ventilation was monitored using respiratory inductive plethysmography and swallowing was recorded by submental electromyogram. Swallowing occurred almost exclusively in expiration. Two hundred and seventy-one swallows were seen and only two occurred in inspiration. The mean expiratory duration (Te) of breaths containing a swallow was significantly greater than the mean Te of all breaths during the same period. There was no change in mean tidal volume (VT), inspiratory duration (Ti), expiratory duration (Te), mean inspiratory flow (VT/Ti) or minute ventilation (VE) between the periods of normal breathing, eating and drinking. However, breathing became more irregular during eating and drinking. The mean coefficient of variation of VT, Te, and VT/Ti was significantly greater during eating and drinking than at rest. The coefficient of variation for VT was 22 + 3 percent, 36 +/- 5 percent, and 41 +/- 5 percent during the initial period of resting breathing, eating and drinking. For VT/Ti it was 24 +/- 6 percent, 43 +/- 14 percent and 44 +/- 8 percent during resting breathing, eating and drinking. We conclude that swallowing is almost exclusively an expiratory activity. This may play a protective role in preventing aspiration. Although the level of ventilation is maintained constant during eating and drinking, the pattern of breathing becomes increasingly irregular. This may contribute to dyspnea during meals in some patients with lung disease.

Adult↗
PubMed1989

The relationship between pulmonary function and dyspnea in obstructive lung disease.

Increased importance is now being placed on evaluating dyspnea in patients with obstructive lung disease (OLD). We measured breathlessness at rest, using a Borg scale dyspnea index (BSDI) before and after bronchodilator albuterol [salbutamol] 200 micrograms) in 93 patients with OLD drawn from a larger population undergoing routine spirometry. The median BSDI declined from 3 to 1 before and after bronchodilator, suggesting improvement in dyspnea. However, there was no correlation between initial or postbronchodilator spirometry and BSDI. The change in FEV1 similarly did not correlate with the change in BSDI (r = 0.05). A large bronchodilator response was usually associated with improvement in dyspnea, but the converse was not observed. Thus, of ten patients with an improvement in BSDI of more than two categories, six had a change in FEV1 of 0.1 L or less after bronchodilator. Analyzing a subgroup of 65 dyspneic patients with an initial BSDI of 2 or more revealed the following response groups: those with either a bronchodilator or dyspnea response alone, both together, or neither. Twenty-eight patients (43 percent) responded both subjectively and objectively. Eleven (17 percent) had a bronchodilator response only, 17 (26 percent) had a dyspnea response only, while nine (14 percent) had neither measurable response. We conclude that dyspnea is poorly correlated with results of routine spirometry in patients with OLD. The use of dyspnea ratings may yield information about bronchodilator responsiveness not appreciated by spirometry alone.

Aged↗
PubMed1988

Problems in radiographic estimation of response to chemotherapy and radiotherapy in small cell lung cancer.

Assessment of the response to therapy in small cell lung cancer requires serial tumor measurements with chest radiographs before and after treatment. Those lesions that are not measurable may be evaluated for response using subjective criteria. We studied interobserver variability in tumor measurement in 21 patients with small cell lung cancer. In addition, we analyzed the effect that the variability in measurement had on the estimation of response to combination chemotherapy with and without chest radiotherapy. Half the readers agreed that pretreatment radiographs were measurable. Posttreatment, they were more often unmeasurable. Starting from a base of 100%, representing all measurable pretreatment films, posttreatment measurability rates fell to 78% and 53% on the 2-month and 4-month films. After radiotherapy, changes particularly reduced the readers' ability to measure the tumors. There was also less interobserver agreement on response after radiotherapy. The intraclass correlation coefficient for partial or complete response versus no response was 0.42 where no chest radiotherapy had been administered and 0.17 after radiotherapy. A measurable lesion on the initial radiograph was important in improving the consistency of evaluation of complete versus partial response particularly in films taken after chemotherapy alone. These data indicate that there is only fair agreement as to whether tumors were measurable and whether a response had occurred. More consistent results were seen in films taken before administration of radiotherapy. A measurable pretreatment film was important in improving interobserver consistency in differentiating a complete from a partial response.

Carcinoma, Small Cell↗