Risperidone and cytochrome P450 3A.
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Adult↗
Biomedical subjects
J Bork
Publications and source records attributed to J Bork.
Multimodal-therapy breast salvage in the urban poor with locally advanced cancer.
OBJECTIVES: To determine whether economically disadvantaged urban women with locally advanced breast cancer (American Joint Committee on Cancer stages IIB to IIIB) have rates of response to sequential neoadjuvant chemotherapy and radiation, breast salvage rates, overall survival rates, and disease-free survival rates comparable with those previously reported in other socioeconomic groups and to compare these variables in different ethnic groups within the study population. DESIGN: Prospective, nonrandomized, case series. SETTING: Urban county hospital. PATIENTS: Thirty-seven women with locally advanced breast cancer who came to the breast clinic at Cook County Hospital, Chicago, Ill, during a 3-year interval. INTERVENTION: Sequential chemoradiation followed by surgery in selected patients. MAIN OUTCOME MEASURES: Comparison of clinical response rates, disease-free survival rates, and breast salvage rates between different ethnic groups in the study population. RESULTS: In the entire group, the overall response rate to neoadjuvant chemotherapy was 73%, with a complete response rate of 32%. Twenty-five percent of patients whose tumors responded incompletely to chemotherapy had a complete response after subsequent radiation. With a mean follow-up of 18.7 months, 65% of patients had no evidence of disease, and breast salvage without evidence of recurrent disease was achieved in 38% of patients. No differences in overall response rates, breast salvage rates, or early disease-free survival rates were observed within different ethnic groups in the study population, and these results are generally comparable with previously reported results in other socioeconomic groups. CONCLUSION: These results do not show significant differences in responses to sequential chemotherapy and irradiation, in breast salvage rates, or in survival between different ethnic groups in this study population.
Black or African American↗
Pneumocystis carinii pneumonia in infants after heart transplantation.
Although the reported incidence of Pneumocystis carinii pneumonia after heart transplantation in adults ranges from 3% to 40%, data are lacking regarding the incidence in the pediatric heart transplantation population. A retrospective review was performed on 152 infants (0 to 12 months of age) undergoing transplantation from November 1985 through December 1993 who survived at least 6 months after heart transplantation. Patients did not receive postoperative Pneumocystis carinii prophylaxis. Ten episodes (7%) were diagnosed in four neonates and six infants. The mean postoperative time to Pneumocystis carinii diagnosis was 5 months (range 3 to 9 months). Features of Pneumocystis carinii included hypoxia and tachypnea (10 of 10), progressive interstitial infiltrates (8 of 10), and persistent right middle lobe consolidation (1 of 10). Pneumocystis carinii was diagnosed with the use of bronchoscopy in eight cases and by open lung biopsy in two cases. Mean CD4 count available on five patients at the time of Pneumocystis carinii diagnosis was 413/mm3 (range 158 to 1358); 5 of 37 patients receiving antithymocyte induction had Pneumocystis carinii versus 5 of 115 patients who did not receive induction (p = 0.05). Patients were at increased risk for the development of Pneumocystis carinii if they had more than two episodes of rejection during the first year after heart transplantation (p = 0.04). All cases were successfully treated with trimethoprim/sulfamethoxazole. The incidence of Pneumocystis carinii in infant heart transplantation recipients is approximately 7% and appears most frequently in the first 6 months after the operation. Increased risk for Pneumocystis carinii may be related to early antithymocyte induction and increased episodes of rejection.
Anti-Infective Agents↗
Breast cancer screening in an urban black population. A preliminary report.
Breast cancer is a major cause of death among black women. At Cook County Hospital in Chicago, a hospital serving a predominantly black population, only 31% of breast cancers were localized at the time of diagnosis in the years 1980-1983. A survey of patient records in the largest primary care clinic in the hospital revealed that only 2% of eligible patients had received mammograms in 1982. A nurse-run breast cancer detection program was begun in mid-1983. Since that time the proportion of women who have received periodic breast examinations has increased from 26% to 46% (P less than 0.001) and periodic mammograms have increased from 2% to 41% (P less than 0.001). The proportion of women having received breast self-examination teaching increased from 10% to 58% (P less than 0.001). The proportion of localized breast cancer was significantly greater for those women whose cancer was diagnosed through the screening program (44 of 72, 61%) compared to other clinical areas (71 of 213, 33%) in the years 1984 through 1986 (P less than 0.001). There has been a significant increase in the percentage of localized breast cancer at Cook County Hospital comparing 1980-1983 statistics (31%), before the Breast Cancer Detection Program was fully established, with 1984-1986 statistics (40%) (P less than 0.02).
Black or African American↗
Pelvic exenteration.
Sixty-eight patients at the University of Illinois, Cook County, and the West Side Veterans Administration hospitals underwent pelvic exenteration for advanced pelvic malignancies during the 15-year period from 1969 to 1984. Thirty-two had colorectal cancers, eleven cervical, seven bladder, and six vulvar; in twelve the cancers were in miscellaneous pelvic sites. Forty-five exenterations were done with intent to cure, and twenty-three for palliation of patients with bulky, necrotic tumors that had caused symptomatic fistulae, local sepsis, chronic bleeding, or severe localized pain. The total 30-day postoperative mortality was 4.4% (3/68). The 5-year survival rate of patients who underwent curative exenteration was 33% (median 27 months). Pelvic exenteration appears to be a feasible surgical procedure for a variety of advanced malignancies as well as for palliation of severely symptomatic patients.
Adult↗
Severe pneumonia after heart transplantation as a result of human parvovirus B19.
The diverse manifestations of human parvovirus B19 infection have been well established. Erythema infectiosum, fetal hydrops, adult arthropathy, and aplastic anemia in patients with hemoglobinopathies or underlying immunocompromise have been described. Recently we successfully treated a patient who, after heart transplantation, had fever, rash, and pneumonia with respiratory failure caused by human parovirus B19. Human parovirus B19 has not been reported previously as a pathogen causing pulmonary disease after pediatric heart transplantation, and we wish to report it at this time.
Antibodies, Viral↗
Infectious complications in infant heart transplantation.
Previously we reported that the rate of mild to moderate infections and upper respiratory infections in infants who undergo transplantation under 1 year of age was the same as that of the general population. Despite this, serious infections continue to be one of the major complications in the first 3 to 4 months after heart transplantation. Among newborns and infants at Loma Linda University Medical Center, there have been 35 deaths from various causes: six (17%) were the result of infectious causes, three were in the early perioperative period, and three were late complications. There were no deaths caused directly by cytomegalovirus. From 1989 to 1992, 128 under 1 year of age underwent transplantation. Of these, 65 had at least one episode of serious infection ranging from bacterial meningitis to viral pneumonia. Of these infants, 19 had cytomegalovirus infections, with the vast majority having symptoms in the first 2 to 3 months after transplantation. Eight infants had Pneumocystis pneumonia and were treated successfully. The risk of cytomegalovirus is highest in the first 4 to 8 weeks after transplantation and in a seronegative recipient who has received an organ from a seropositive donor. Currently, our protocol to reduce the likelihood of active disease includes the use of intravenous immunoglobulin immediately after transplantation and during rejection episodes that are treated with aggressive immunosuppression and the use of oral acyclovir for the first 3 months after transplantation. If active disease develops, ganciclovir is initiated.(ABSTRACT TRUNCATED AT 250 WORDS)
Heart Transplantation↗