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Biomedical subjects

H O Klein

Publications and source records attributed to H O Klein.

At least 73 records · Page 4Linked to original sources
PubMed1984

[Definite indications for chemotherapy of solid tumors?].

Thirteen human malignant tumors can be cured in a high percentage by combined modality treatment (surgery, radiotherapy, chemotherapy) even if patients suffer from advanced disease. In other neoplasms accounting for about 40% of all tumors, intensive treatment leads to good palliation and significant prolongation of survival time. An important prerequisite for this success is a comprehensive pretherapeutic diagnostic work-up that reveals the extent of disease. Side effects after intensive therapy cannot be completely avoided, but can be alleviated. The complex interrelationship of interdisciplinary therapeutic measures in the context of combination modality treatment makes it necessary that patients with potentially curable neoplasms be treated at cancer centres.

Anti-Bacterial Agents↗
PubMed1984

Preclinical evaluation of toxicity and therapeutic efficacy of a stabilized cytostatic metabolite of cyclophosphamide (ASTA Z 7557, INN mafosfamide).

ASTA Z 7557 is a stabilized cytostatic metabolite of cyclophosphamide which forms crystals at room temperature and releases 4-OH-cyclophosphamide in aqueous solution. The LD50/30 in mice after push injection is 417 mg/kg, after fractionated administration (q 6 hours X 4) 794 mg/kg. Daily treatment times 5 gives a LD50/30 value of 200 mg/kg. Depression of nucleated bone marrow cells and of leukocytes in the peripheral blood is observed after treatment. Recovery is slow. This holds true for push and fractionated administration. ASTA Z 7557 is a powerful cytostatic drug for treatment of an Ehrlich ascites tumor, a Lewis lung and a mammary carcinoma. Of two human tumor xenografts a malignant amelanotic melanoma responded with slight growth delay, whereas a gastric cancer did not.

Animals↗
PubMed1984

[Late development of colonic neoplasms after uretero-sigmoidostomy].

A case report is given of a patient who developed adenocarcinoma of the colon 20 years after ureterosigmoidostomy, which had been done because of exstrophy of the bladder. A review of the literature is given covering 42 cases showing development of tumors after ureterosigmoidostomy. Possible causal mechanisms are discussed. A careful follow-up of patients with ureterosigmoidostomy is warranted, since malignant disease of the colon may occur as a late complication.

Adenocarcinoma↗
PubMed1983

[Modification of an Ehrlich ascites tumor growth by various standardized feedings].

Oral feeding of mice with hypercaloric diets inhibited growth of a hyperdiploid Ehrlich ascites tumor significantly and modified proliferation kinetics of tumor cells if feeding started 7 days before tumor transplantation. Furthermore, the tumor take rate was significantly reduced. The 4 hypercaloric diets contained as main energy sources carbohydrates, or unsaturated fatty acids, or saturated fatty acids, or a mixture of these substrates. Inhibition of tumor growth was not observed if hypercaloric feeding started on the same day the tumor transplantation occurred. Tumor bearing animals lived significantly longer compared to controls if they are on a hypercaloric diet with unsaturated fatty acids as main energy source. Survival was not influenced by the time feeding started. That means that partial prevention of cachexia was the main reason for longer survival. Feeding with a diet poor in proteins led in both experimental sets to a statistically not significant shortening of the median survival time compared to controls.

Animals↗
PubMed1983

A new working formulation of non-Hodgkin's lymphomas. A retrospective study of the new NCI classification proposal in comparison to the Rappaport and Kiel classifications.

Two hundred thirty cases of malignant non-Hodgkin's lymphomas were reclassified in a retrospective study according to the New Working Formulation for Clinical Usage of the NCI as compared to the Rappaport and Kiel classifications. The reproducibility for the individual schemes this study was 81% (Rappaport), 79% (Kiel), and 85% (New Working Formulation). In keeping with the results of the NCI international study, all lymphomas were subdivided into 3 prognostic groups: (1) low-grade malignancy (6.0 years median survival); (2) intermediate-grade malignancy (3.5 years median survival); and (3) high-grade malignancy (1.4 years median survival). The NCI-proposed New Working Formulation for Clinical Usage is thus recommended as practical and unprejudicing classification scheme for general application; however, its usefulness as tool for translating one classification scheme into another appears limited.

Europe↗
PubMed1983

Verapamil improves exercise capacity in chronic atrial fibrillation: double-blind crossover study.

Oral verapamil has previously been shown to reduce heart rate at rest and during mild exercise in chronic atrial fibrillation. Its efficacy in improving cardiovascular performance at higher levels of exercise and its safety were investigated in a prospective, randomized, placebo controlled double-blind study preceded by an open label titration phase in 20 digitalized patients with chronic atrial fibrillation. Maximal exercise capacity was improved (from 522 +/- 257 to 806 +/- 348 work units, p less than 0.0005) when tested by a standardized multistage ergometry exercise test. Heart rate was also reduced at rest, at the end of 3 minutes of 300 KPM exercise, and at the point of maximal exercise. Blood pressure and double product were also reduced. Its efficacy and safety may make verapamil the treatment of choice in chronic atrial fibrillation.

Adult↗
PubMed1983

The acute hemodynamic effects of intravenous verapamil in coronary artery disease. Assessment by equilibrium-gated radionuclide ventriculography.

The acute hemodynamic effects of an i.v. bolus of verapamil, 0.1 mg/kg or 0.06-0.075 mg/kg, were examined by serial radionuclide studies in 46 patients with coronary artery disease. In 20 patients with ejection fractions (EFs) greater than 35% (group 1A), verapamil, 0.1 mg/kg given over 1-11/2 minutes, had a biphasic effect: first, a transient decrease in EF accompanied by increased left ventricular (LV) volumes and cardiac output equivalents; then, an overshoot of EF to values above control, accompanied by a decrease in peripheral vascular resistance and a drastic decrease in LV volumes, while cardiac output equivalent remained slightly elevated. In eight patients with EFs less than 35% (group 1B), only the first effect on EF was noted. In 10 patients with EFs greater than 35% (group 2), verapamil, 0.06-0.075 mg/kg, exerted qualitatively similar but milder effects on hemodynamic function. Finally, verapamil, 0.1 mg/kg given more slowly, over 2-21/2 minutes, produced no significant changes in EF or LV volumes in another eight patients (group 3). The acute effects of verapamil are thus both time-related and dose-dependent. They are also related to the baseline functional reserve of the left ventricle. This study documents that verapamil exerts a depressant effect on LV function. However, the transient nature of this depression and the quick recovery to normal or above-normal values indicate that verapamil, in the doses used in this study, is safe to use intravenously in patients with coronary artery disease.

Adult↗
PubMed1983

The early recognition of right ventricular infarction: diagnostic accuracy of the electrocardiographic V4R lead.

The sensitivity and specificity of ST-segment elevation in the right precordial lead V4R as an early indicator of right ventricular infarction were examined in a consecutive series of 110 patients admitted for acute inferior myocardial infarction. The sensitivity was 82.7%, the specificity 76.9% and the positive predictive value 70% in 58 patients with right ventricular infarction documented by autopsy or a combination of radionuclide ventriculography and one or more of the following tests: echocardiography, technetium-99m pyrophosphate scintigraphy and hemodynamic monitoring. The negative predictive value was 87.7%. Because of its simplicity and its high sensitivity and specificity, recording of V4R should be an intrinsic part of the early evaluation and electrocardiographic examination of acute inferior wall infarction.

Adult↗
PubMed1983

Superiority of oral verapamil therapy to digoxin in treatment of chronic atrial fibrillation.

The efficacy and safety of oral verapamil, 240 mg, with or without digoxin were studied in 52 patients with chronic atrial fibrillation at rest, and during mild and maximal exercise. Twenty-four patients were studied during the following therapeutic modalities: no therapy; digoxin, 0.25 mg and 0.5 mg daily; digoxin, 0.25 mg and verapamil; and verapamil alone. Heart rate at rest and during all levels of exercise was decreased significantly (p less than 0.005), either by combining digoxin with verapamil or by verapamil therapy alone. In contrast, the excessive heart rate response to exercise was not prevented by digoxin even with good serum concentrations. The improved control of heart rate with verapamil was associated with a significantly improved exercise capacity. Verapamil is an important and safe modality of treatment, with or without digoxin, in the long-term control of heart rate in chronic atrial fibrillation. It is superior to digoxin in controlling the ventricular rate and in improving exercise capacity.

Administration, Oral↗
PubMed1983

High-dose MTX/5-FU and adriamycin for gastric cancer.

In a phase II trial we tried to evaluate the efficacy of a sequential combination of high-dose methotrexate (MTX) and 5-fluorouracil (5-FU) combined with Adriamycin (ADM). In a pilot study we had found high-dose MTX effective as a single agent in gastric cancer. MTX and 5-FU were combined sequentially because Cadman et al had shown synergism for this combination. The therapy protocol consisted of high-dose MTX, 1.5 g/m2 of body surface, and high-dose 5-FU, 1.5 g/m2. MTX was administered 1 hr prior to 5-FU. Both drugs were given as a bolus. Twenty-four hours after MTX administration, citrovorum factor rescue was started, 15 mg/m2, q.6h. X 12, orally. Forty-eight hours after MTX administration, serum concentration of the drug was measured by high performance liquid chromatography (HPLC). Fourteen days after MTX was given, ADM, 30 mg/m2, was injected as a bolus. This protocol was repeated every 28 days. Patients eligible for this treatment should have a creatinine clearance of greater than 60 ml/min. The study included 30 patients with metastasizing gastric cancer and performance status between 40% and 70%. The response rate was 63% (19 of 30 patients). Two of 30 patients had complete remissions, which are still maintained. The median survival for responders is not yet evaluable: 68% are living after 17+ mo. The median survival for nonresponders was only 5 mo. The difference in survival curves is significant at a level of p less than 0.05. Cytostatic treatment was well tolerated. Fifty percent of the patients could be treated on an outpatient basis. Total alopecia was observed in only 10% of the patients. Severe leukopenia, thrombocytopenia, and kidney disorders were not observed.

Adult↗
PubMed1982

[Chemotherapy schedule for the management of metastasizing gastric cancer. Methotrexate, adriamycin and 5-fluorouracil].

The possible effectiveness of methotrexate, 5-fluorouracil and adriamycin was tested in a phase I/II study of patients with metastasising gastric carcinoma. complete of partial remission occurred in 19 of 30 patients (approximately 63%). Two of 30 patients had complete remission. Median survival time of patients with remission cannot as yet be determined: about 68% are still alive after 17 months. Median survival time of patients with advanced tumour was only five months. The difference in survival curve is statistically significant (P less than 0.05). The study is continuing.

Adult↗
PubMed1982

Identification of normal and transposed great arteries by contrast M-echocardiography in the newborn: a combined suprasternal and precordial approach.

Diagnosis of complete transposition of the great arteries (TGA) by M-mode echocardiography depends on the correct identification of the aorta and the pulmonary artery at their roots. We describe a contrast M-mode echocardiographic technique which combines suprasternal and precordial views in which the two great arteries are visualized simultaneously. After venous injection of 1-3 ml 5% dextrose, the sequence and relative intensity of opacification of the great arteries are recorded in both views and then matched to each other. Because in the suprasternal view the aorta is always superior and the pulmonary artery inferior, the characteristics of opacification of these two arteries in the suprasternal view are used as markers for their proper identification in the precordial view. In four normal newborns contrast medium filled only the pulmonary artery. In six newborns with cardiovascular malformations with shunts and normally related great arteries, in which the contrast medium preferentially filled either the aorta (five patients) or the pulmonary artery (one patient), matching the record from the precordial view to that from the suprasteral view proved that the anterior vessel was indeed the pulmonary artery, and the posterior vessel the aorta. In five newborns with d-TGA the contrast medium preferentially filled the aorta, and the combined suprasternal and precordial approach proved that the aorta was anterior and the pulmonary artery posterior. This method is independent of the direction of venous drainage or site of injection.

Aorta↗
PubMed1982

Q-T prolongation and polymorphous ("torsade de pointes") ventricular arrhythmias associated with organophosphorus insecticide poisoning.

It is not generally appreciated in the Western world that organophosphorus poisoning may be associated with a serious and often fatal cardiac complication: Q-T interval prolongation with malignant ventricular arrhythmias of the "torsade de pointes" type. This insidious complication may lead to delayed, sudden death after the patients appears to be well on the way to recovery from the other, more dramatic respiratory and neurologic symptoms. In this study 15 patients with organophosphorus poisoning are described. Q-T prolongation was observed in 14 and malignant tachyarrhythmias in 6. In view of the dismal prognosis of these patients, ventricular pacing, previously used with success in other conditions associated with this syndrome, was tried in four patients and successfully shortened the Q-T interval and eliminated the arrhythmias. Isoproterenol did the same in a fifth patient. Awareness of this lethal, but preventable complication of organophosphorus poisoning is called for. Careful electrocardiographic monitoring is necessary until the Q-T interval returns to normal. Electrical pacing appears to be the treatment of choice for the tachyarrhythmias.

Adolescent↗