How can the developing world protect itself from biotech patent-holders?
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Biotechnology↗
Biomedical subjects
J H Barton
Publications and source records attributed to J H Barton.
Weekly docetaxel in the treatment of elderly patients with advanced nonsmall cell lung carcinoma. A Minnie Pearl Cancer Research Network Phase II Trial.
BACKGROUND: Weekly administration of docetaxel was found to reduce myelosuppression and other nonhematologic toxicities when compared with administration every 3 weeks. In the current Phase II trial, the authors evaluated the feasibility, toxicity, and efficacy of weekly docetaxel in the treatment of elderly patients with newly diagnosed advanced nonsmall cell lung carcinoma. METHODS: Thirty-nine patients with advanced, previously untreated nonsmall cell lung carcinoma entered this Phase II trial between February 1998 and January 1999. Patients were required either to be age >/= 65 years or to be poor candidates for combination chemotherapy due to coexistent medical illnesses. All patients received docetaxel, 36 mg/m(2), administered weekly for 6 consecutive weeks, followed by 2 weeks without treatment. Patients were reevaluated after 8 weeks of treatment; responding patients continued weekly docetaxel for a maximum of 32 weeks or until disease progression. RESULTS: Weekly docetaxel was well tolerated by this elderly group of patients with nonsmall cell lung carcinoma. Grade 3 leukopenia was noted in only 3 patients (8%), and no patient developed Grade 4 myelosuppression. Grade 3/4 nonhematologic toxicity also was uncommon; fatigue/asthenia was reported in 4 patients (10%). Seven of 38 evaluable patients (18%) had objective responses to weekly docetaxel whereas an additional 13 patients (34%) had a minor response or stable disease at first reevaluation. The median survival in this group of elderly patients was 5 months, with a 1-year actuarial survival rate of 27%. CONCLUSIONS: The results of the current study show that weekly docetaxel is active and well tolerated in elderly patients with advanced nonsmall cell lung carcinoma and provides an additional treatment option for these patients, who often tolerate combination chemotherapy regimens poorly.
Aged↗
Policy forum: intellectual property rights. Reforming the patent system.
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Intellectual Property↗
Rational limits on genomic patents.
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Expressed Sequence Tags↗
Primary intracerebral Hodgkin's disease mimicking meningioma: case report.
OBJECTIVE AND IMPORTANCE: A rare case of dura-based primary cerebral Hodgkin's disease clinically and radiographically indistinguishable from a meningioma is described. CLINICAL PRESENTATION: A 55-year-old immunocompetent woman presented with headaches and ataxia. Magnetic resonance images demonstrated a circumscribed diffusely enhancing mass with a dural tail attached to the cerebellar tentorium. INTERVENTION: Operative inspection also suggested a meningioma, but a frozen section of the firm mass revealed an inflammatory lesion. Subsequent pathological analysis demonstrated Hodgkin's disease, nodular sclerosing type. An extensive workup revealed no systemic disease. CONCLUSION: This case illustrates the rare occurrence of primary intracranial Hodgkin's disease and its mimicry of meningioma.
Brain Neoplasms↗
Smooth muscle hyperplasia of the testicular adnexa clinically mimicking neoplasia: clinicopathologic study of sixteen cases.
Sixteen cases of a largely unrecognized benign cause for an intrascrotal mass are reported herein. These cases represent a nonneoplastic excess of native smooth muscle in the paratestis or spermatic cord growing between or around vessels or efferent ducts. The patients ranged in age from 46 to 81 years, with a mean age of 63 years. The size, available in 10 of the cases, ranged from 6 mm to 7 cm, with a mean of 2.5 cm; there was no side predilection. Microscopically, the lesions consisted of fascicles of smooth muscle, growing in a periductal, perivascular, interstitial, or mixed pattern. The cohesive, interlacing growth pattern of a leiomyoma was missing in all cases. The cause of this lesion is not apparent, although microscopic epididymal or vas deferens duct ectasia in some cases suggests a possible obstructive etiology. In any case, these are benign and without clinical significance after excision and correct diagnosis. Follow-up was available in 13 patients with no recurrences observed from 1 month to 16 years postoperatively.
Aged↗
Metanephric adenoma. Clinicopathological study of fifty patients.
We report 50 examples of an uncommon type of renal adenoma from the files of the Armed Forces Institute of Pathology. They appear to be benign tumors with no malignant potential, and their chief importance is related to the fact that they are most often misinterpreted as renal cell carcinoma or epithelial Wilms' tumor. They predominated in females by well over 2:1. The mean age of the patients was 41 years, with a range of 5 to 83 years, and the mean size was 5.5 cm, with a range of 0.3 to 15.0 cm. Presenting signs and symptoms included pain in 11, hematuria in five, and palpable mass in five. In 20 patients the tumors were found incidentally during evaluation for other problems, and in six the other problem was polycythemia. This finding establishes a higher incidence of polycythemia in renal adenoma than in other previously reported renal diseases. Also of preoperative importance is the fact that these tumors are more commonly calcified than other renal neoplasms. Microscopically, these tumors consist of very small epithelial cells that form very small acini in an acellular stroma. Less often, they form tubular, glomeruloid, or polypoid and papillary formations. Most also show evidence of regression in the form of scarring and calcification. These lesions seem histogenetically related to epithelial Wilms' tumor, and, in fact, the two may occur together. They are histologically very similar to the metanephric hamartomatous element of nephroblastomatosis.
Adenoma↗
Ethnobotany and intellectual property rights.
Contemporary intellectual property law permits only the patenting of an identified active principle from a plant, not the plant or folk information relating to medicinal properties of a plant. The most significant rights of indigenous peoples are those deriving from physical control of the plants and the knowledge pertaining to their use. This control can provide the basis for trade secret protection. Such agreements are enforceable in developed nations and should become so in developing nations. There have been recent efforts to strengthen indigenous peoples' rights over genetic resources and relevant folk knowledge but the most far-reaching of these are not yet a part of international law. Pharmaceutical patents combined with trade secrecy can allow firms to develop and market products and ensure that the nation and/or people from which the material or information was derived are properly rewarded. This does not provide protection from competition or with respect to derived knowledge nor does it act retrospectively. At present, rights under the United Nations Convention on Biodiversity are prospective only. These rights belong to the nation and there is little legal pressure for recompense to be shared with indigenous peoples. A uniform agreement that deals in a balanced way with the relative rights of indigenous peoples and of their governments should be developed by non-governmental organizations.
Drug Industry↗
The readers' NIH.
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Acquired Immunodeficiency Syndrome↗
Disseminated histoplasmosis in AIDS patients in Maryland.
These patients demonstrate the difficulty in arriving at the diagnosis of disseminated histoplasmosis. The diagnosis in two of the three patients also served as the initial AIDS case-defining opportunistic infection. In each of these patients, the clinical presentations were atypical and in only one patient was a positive exposure history elicited. Recurrent bowel obstruction was the presenting complaint in the first patient and the diagnosis was made only on pathologic exam of the resected small bowel. The second patient's diagnosis was made on biopsy of the colon via colonoscopy. The third patient's diagnosis also eluded an extensive FUO workup; he was diagnosed by bone marrow culture and silver stain of a mediastinal lymph node biopsy, despite serial negative serologic tests for histoplasmosis. The first two patients had significant gastrointestinal disease which is a relatively unusual manifestation for disseminated histoplasmosis. The third patient illustrates the limited diagnostic usefulness of serologic testing in AIDS patients and the continued usefulness of bone marrow analysis in an FUO evaluation. In conclusion, these case presentations demonstrate that disseminated histoplasmosis in patients with HIV infection can present with unusual manifestations, outside of the typical endemic arca, without a positive exposure history or positive serologic test, and may be the initial AIDS case-defining opportunistic infection in these patients. Consequently, a disseminated histoplasmosis should be considered in all AIDS patients with perplexing clinical presentations.
Acquired Immunodeficiency Syndrome↗
Non-Hodgkin's lymphoma of the tonsil. A clinicopathologic study of 65 cases.
Sixty-five patients presenting to M. D. Anderson Hospital and Tumor Institute with Stages IE and IIE primary tonsillar lymphoma between 1954 and 1981 were reviewed. All cases were non-Hodgkin's lymphomas, with the majority being diffuse large cell lymphoma (85%). Initial therapy was radiotherapy alone in 54 patients, radiotherapy combined with chemotherapy in 8 patients, and chemotherapy alone in 3 patients. Stage was the most important prognostic factor, with 86% and 41% 5-year survivals for Stages IE and IIE, respectively (P = 0.006). Lymphangiography was crucial in staging patients with clinically positive cervical lymph nodes because 94% of clinically staged IIE patients developed recurrent disease, in comparison with only 50% of lymphangiogram-staged IIE patients. The incidence of large cell lymphoma was so high as to preclude analysis of survival by histologic type. From this limited series, radiotherapy alone would appear to be sufficient initial therapy for Stage IE patients, whereas Stage IIE patients probably benefit from the addition of prophylactic chemotherapy. Relapses were most common in nonirradiated lymph-node-bearing areas, with the majority presenting in the first 2 years following initial therapy. The salvage of relapsing patients has been disappointing, with the best hope residing in combination chemotherapy.
Adolescent↗
Stages I and II non-Hodgkin's lymphomas of Waldeyer's ring and the neck.
In a previous communication we reported our results for patients with localized extranodal presentations of non-Hodgkin's lymphomas of the head and neck who were admitted between 1961-1969. This review describes our larger experience from 1947-1982 in treating 137 Stages I and II Waldeyer's ring patients whose slides were available for reclassification according to the modified Rappaport System. All of these patients were treated definitively as follows: radiotherapy only, 113 patients; radiotherapy and combination chemotherapy, 17 patients; chemotherapy only, seven patients. The overall 5-year survival was 50%. Significant differences were determined for specific subgroups. For patients staged after lymphangiography, the 5-year survival was 67% as compared with 32% for non-lymphangiogram staged patients (p = 0.002). Stage (Ann Arbor) also influenced results. The 5-year survival figure for Stage I was 70% as compared with 42% for Stage II (p = 0.002). The combination of extent of disease in Waldeyer's ring and the status of the neck had a major impact on survival. When the disease was staged according to the TNMAJCC System, the 5-year survivals were: 75% for T1-T2-TX N0; 53% for T1-T2-TX N+; 54% for T3-T4 N0; and 36% for T3-T4 N+. Also, results for tonsil (52%) and base of tongue (66%) disease were better than for disease involving the nasopharynx (39%) or multiple sites (25%). Treatment also influenced survivals and disease-free survivals. The best results were obtained in patients who were treated with radiotherapy and combination chemotherapy. The 5-year survival and disease-free survival figures were 78% and 69%, respectively.
Antineoplastic Agents↗
Endothelial cell origin of thorium oxide-induced angiosarcoma of liver.
A 72-year-old woman was found at autopsy to have hepatic angiosarcoma approximately 30 years after systemic thorium oxide (Thorotrast) injection. Intracytoplasmic localization of factor VIII-related antigen was demonstrated by an immunoperoxidase method, confirming the endothelial cell origin of the tumor.
Aged↗