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Biomedical subjects

J Abrams

Publications and source records attributed to J Abrams.

At least 181 records · Page 10Linked to original sources
PubMed1986

Doxorubicin, cyclophosphamide, etoposide and platinum, doxorubicin, cyclophosphamide and etoposide for small-cell carcinoma of the lung.

Small-cell lung cancer (SCLC) is a disseminated disease regardless of our ability to document all sites. Chemotherapy is thus the cornerstone of treatment. There are multiple active single agents, resulting in many combination chemotherapy regimens. Optimal combinations are probably derived from the use of synergistic drug interactions. A three drug combination of doxorubicin (Adriamycin), cyclophosphamide, and etoposide (ACE) has been used at the University of Maryland Cancer Center (UMCC) for more than a decade in sequential studies. Two hundred four patients, 143 men and 61 women, were treated on these studies. Eighty-five had limited disease (LD) and 119 had extensive disease (ED). The complete response (CR) frequencies were 65% and 43% for LD and ED, respectively, and the median survivals were 15 and 9.5 months, respectively. Twenty-two percent of the LD patients were alive at 2 years. To improve upon response or survival, and because of synergy, cisplatin was added to ACE (PACE). PACE chemotherapy was administered in two studies--study 1 at UMCC for both LD and ED, and study 2 by Cancer and Acute Leukemia Group B (CALGB) for ED only. Preliminary review suggests that CR frequencies for LD (53%, study 1) and ED (44%, study 1; 37%, study 2) were similar to prior studies, but median survivals (LD, 18+ months, study 1; ED, 15 months, study 1, 10.5 months, study 2) appears superior to previous studies. However, PACE is more toxic than ACE. Further studies of PACE are needed to assess if the additional toxicities are warranted.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Pharmacology of nitroglycerin and long-acting nitrates.

Organic nitrates are available in a remarkably diverse variety of formulations, including sublingual, buccal and oral tablets, capsules, topical creams, ointments, patches, tapes, inhalable sprays and intravenous solutions. Although not all of these formulations are available in the United States, the array of drugs and dosages approved for use is extensive. It is only by weighing the pharmacologic properties of these agents against the patient's clinical status and needs that a concise and appropriate treatment regimen may be derived. Numerous recent studies have confirmed the protracted efficacy of the organic nitrates in the treatment of patients with angina pectoris and congestive heart failure (CHF) as evidenced by improvements in cardiac hemodynamics and desired clinical parameters. It is appropriate that the patient's dosage of nitrates be administered with a formulation most likely to be both clinically effective and well tolerated. The use of nitroglycerin and isosorbide dinitrate in the acute and chronic treatment of CHF will be discussed in the context of their unique pharmacologic and pharmacokinetic properties. A rationale for the most efficacious use of these agents will be presented. Tolerance phenomena and adverse effects (i.e., headache) will also be discussed from the perspective of their significance in chronic nitrate therapy.

Absorption↗
PubMed1985

Efficacy and safety of esmolol vs propranolol in the treatment of supraventricular tachyarrhythmias: a multicenter double-blind clinical trial.

The efficacy and safety of intravenous esmolol infusion was compared to that of intravenous propranolol injection in patients with supraventricular tachyarrhythmias (SVT) in a multicenter double-blind parallel study. A total of 127 patients were randomized to either the esmolol (n = 64) or propranolol (n = 63) group. Therapeutic response was achieved in 72% of esmolol and 69% of propranolol patients (p = NS). The average dose of esmolol in responders was 115 +/- 11 micrograms/kg/min. Therapeutic response was sustained in the 4-hour maintenance period in 67% of esmolol and 58% of propranolol patients (p = NS). Rate of conversion to normal sinus rhythm was similar in the two treatment groups. After discontinuation, rapid recovery from beta blockade (decrease in heart rate reduction) was observed in esmolol patients (within 10 minutes) compared to propranolol patients (no change in heart rate up to 4.3 hours). The principal adverse effect was hypotension, reported in 23 esmolol (asymptomatic in 19) and four propranolol (asymptomatic in three) patients. In the majority of esmolol patients, hypotension resolved quickly (within 30 minutes) after esmolol was discontinued. It was concluded that esmolol was comparable in efficacy and safety to propranolol in the treatment of patients with SVT. Unlike propranolol, because of the short half-life of esmolol, rapid control of beta blockade is possible with esmolol in clinical conditions when required.

Acute Disease↗
PubMed1985

Hemodynamic effects of nitroglycerin and long-acting nitrates.

Nitroglycerin (NTG) and isosorbide dinitrate (ISDN) are potent dilators of vascular smooth muscle. The organic nitrates produce venodilation at very low doses, with little additional vasodilation of the venous circulation with increasing dosage. Nitrates increase arterial diameter and improve arterial conductance at low to moderate doses, and at high doses these agents produce dilation of the arteriolar or resistance vessels of the body. The overall hemodynamic response to nitrate administration will be modulated by the degree of sympathetic reflex discharge, the presence or absence of congestive heart failure, the dosage of administered nitrate, and the presence or absence of nitrate tolerance. Regional circulatory effects of the organic nitrates include a decrease in vascular resistance and an increase in arterial blood flow to the arms and legs. Venodilation also occurs in the extremities. In the splanchnic and mesenteric circulations, nitrates induce an initial vasodilative response followed by reflex vasoconstriction. Hepatic blood flow changes little in the normal state. Pulmonary blood flow decreases and pulmonary artery and venous pressures fall after nitrate administration. Renal blood flow remains essentially unchanged or decreases slightly after NTG administration, although reflex sympathetic activity may cause secondary vasoconstriction. The antianginal effects of nitrates have long been thought to be related to their systemic or peripheral actions, which reduce myocardial oxygen requirements through decreases in left ventricular preload and afterload. There is, however, considerable evidence that nitrates have important direct effects on the coronary circulation in both the normal and the ischemic heart. Such actions include coronary artery dilation, increased collateral blood flow, and enhanced oxygenation and nutrient perfusion to zones of ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1984

Nitrate delivery systems in perspective. A decade of progress.

In recent years the use of nitroglycerin and long-acting nitrate compounds in clinical practice has been increasing. Only 10 to 15 years ago these drugs, at least in oral formulation, were felt to have no clinical utility because of concern that potent hepatic enzyme activity would degrade sufficient amounts of the nitrate compounds from reaching the systemic circulation. However, it is now recognized that oral nitrate administration when given in sufficient amounts achieves therapeutic plasma concentrations and desired clinical effects. Nitrates are routinely used for the treatment of stable and unstable angina and also play a role in therapy for complications of myocardial infarction. Nitrates are very effective agents for preload reduction in vasodilator therapy of congestive heart failure. A wide variety of nitrate delivery systems, including the standard oral and sublingual formulations, and as well as the new transdermal nitroglycerin discs and buccal nitroglycerin, are now available. Sublingual nitroglycerin, isosorbide dinitrate, and buccal nitroglycerin are used for acute treatment of attacks of ischemic chest pain. For ambulatory patients, long-acting therapy can be administered by oral, topical ointment, transdermal disc, and buccal nitroglycerin formulations. Each compound has a slightly different onset and duration of action, which is in part dose-dependent. The relative merits and problems with each of the formulations are reviewed. Intravenous nitroglycerin is now commercially available and plays an increasing role in the intensive care units. It is an ideal drug for acute chest pain syndromes, including acute myocardial infarction. Specialized tubing does not need to be employed. The wide variety of nitrate delivery systems available to physicians makes use of this tried and true therapy practical and easy to carry out for clinicians.

Administration, Intranasal↗
PubMed1984

Phase-II study of cis-diammine-dichloro platinum (cis-platinum), bleomycin and methotrexate for advanced squamous cell carcinoma of head and neck.

Twenty-one patients with head and neck carcinomas relapsing after radiotherapy were treated with a combination of cis-platinum, bleomycin, and methotrexate. Four patients (19%) achieved a partial response. Toxicity was significant in selected cases; three patients developed WBC counts less than 1,000/mm3 and one of these patients died with sepsis. Severe mucositis was present in three of the twenty-one patients. Considering the toxicity of this combination and the limited therapeutic activity with the dose and schedule used in this study, this regimen is not recommended for the treatment of squamous head and neck carcinomas relapsing after radiotherapy.

Adolescent↗
PubMed1984

Directional variability in the R wave response during serial exercise testing in patients with coronary artery disease.

The reproducibility of the direction of R wave amplitude response to exercise was analyzed in patients with coronary artery disease. Forty-three serial exercise tests were performed by 10 patients with exertional angina pectoris and documented coronary artery disease (CAD). Seventeen tests (37%) resulted in no change or an increase in R wave amplitude (abnormal response). Twenty-six tests (63%) resulted in a decrease in R wave amplitude. The direction of the R wave amplitude response was variable in at least one exercise test in 7 of 10 patients with CAD, all of whom had reproducible ischemic ST segment responses during serial testing. The inconsistent R wave response in these patients was unrelated to heart rate, workload, or duration of exercise. Because of the variability in the directional R wave response during serial exercise testing in CAD patients, we conclude that the R wave response during exercise is unreliable for the detection of CAD or ischemia-related myocardial dysfunction.

Adult↗
PubMed1984

Rational medical therapy for stable angina pectoris.

Important advances in understanding of the pathophysiology and medical treatment of angina pectoris have taken place in the past few years. Angina may occur from increased oxygen demands that cannot be met by a diseased coronary circulation and/or primary decrease in oxygen supply to the heart. Three major categories of pharmacologic agents are used in treating angina. Nitrates remain the first-line approach; they are inexpensive and available in many delivery forms. Beta blockers are also effective in the treatment of angina pectoris, and despite their side effects, are particularly useful in effort angina. The newest agents, the calcium channel blockers, are efficacious in all types of anginal syndromes. Each group of drugs acts differently on the various pathophysiologic mechanisms that contribute to the production of angina. This commentary critically reviews the major groups of anti-anginal drugs and places them in a clinical perspective. Guidelines for choosing an appropriate agent for the treatment of angina are proposed. Special situations, such as angina and hypertension, congestive heart failure, or post-myocardial infarction angina, are discussed with respect to selection of anti-anginal therapy. The proper utilization of nitrates, calcium channel blockers, and beta blockers, alone or in combination, provides a bright future for patients with ischemic heart disease.

Adrenergic beta-Antagonists↗
PubMed1984

Duodenal duplication presenting as relapsing pancreatitis in an adult.

The first case of relapsing acute pancreatitis due to a tubular duodenal duplication is reported. The duplication is believed to have filled with secretions and intermittently impinged on and obstructed the pancreatic ductular system producing a clinical picture of relapsing acute pancreatitis. The increased pressure within the duplication also produced pressure necrosis of the mucosa lining the duplication with resultant hemorrhage and iron-deficiency anaemia. The diagnosis was made preoperatively with the aid of ERCP.

Acute Disease↗