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Biomedical subjects

J Horton

Publications and source records attributed to J Horton.

At least 145 records · Page 8Linked to original sources
PubMed1983

Clearance of pneumococcal organisms after repair of injured spleens.

Although the safety of splenic preservation has been demonstrated in a small number of cases, the follow-up in these cases has been too short to determine whether the patients are adequately protected from sepsis. The purpose of this study was to test the ability of the spleen to clear pneumococcal organisms after repairing lacerations with a surface hemostatic agent. Three groups of 20 New Zealand white rabbits were studied. Group I animals received sham operations, group II animals were given total splenectomies, and group III animals had splenic lacerations repaired with Collastat (American Medical Products Corp., Freehold, New Jersey), a local hemostatic agent. Three months later, when challenged with intracardiac Streptococcus pneumoni type III, the animals without spleens failed to clear pneumococcal organisms. This spleen-intact and spleen-repaired animals, however, both cleared pneumococcal organisms in a normal fashion.

Animals↗
PubMed1983

Effect of cimetidine treatment in the prevention of gastric ulcer relapse: a one year double blind multicentre study.

One hundred and forty six gastric ulcer patients were given open treatment using 1 g cimetidine daily to heal their ulcers. Of 130 who completed the acute treatment period of eight weeks, 112 (86%) had healed ulcers. Of these 112 patients with healed ulcers, 108 entered a one year double blind study to compare the effect of cimetidine maintenance therapy (400 mg at night) with placebo. Of the 84 patients available for assessment at the end of one year, 86% in the cimetidine treated group were in remission compared with 45% in the placebo treated group (chi 2 = 15.03; p less than 0.001). There were similar losses from non-compliance and drop out in both groups. The incidence of untoward effects and significant drug related laboratory abnormalities was low. The results indicate that cimetidine heals nearly 90% of acute gastric ulcers within eight weeks and that subsequent low dose maintenance treatment at night offers a considerable benefit over placebo therapy.

Adult↗
PubMed1982

A comparison of adriamycin versus vincristine and adriamycin, and cyclophosphamide versus vincristine, actinomycin-D, and cyclophosphamide for advanced sarcoma.

This randomized study, conducted by the Eastern cooperative Oncology Group, compared Adriamycin (doxorubicin) (70 mg/m2) versus vincristine (1.4 mg/m2) and Adriamycin (50 mg/m2); and cyclophosphamide (750 mg/m2) versus vincristine (1.4 mg/m2), actinomycin-D (0.4 mg/m2), and cyclophosphamide (750 mg/m2) for treatment of metastatic mesenchymal malignancies. The respective response rate seen in 200 evaluable patients to the treatments were, 27, 19, and 11%. The response rate to Adriamycin was significant better than the response to vincristine, actinomycin-D, and cyclophosphamide (P = 0.03, two-sided). The respective median survivals on the three treatments were 37, 34, and 41 weeks and were not significantly different. Moderate or severe vomiting occurred in 60% of patients receiving vincristine-cyclophosphamide-adriamycin, a greater frequency than in Adriamycin alone (P = .09 two-sided) Severe or life-threatening hematologic toxicity (leukocytes less than 2000, platelets less than 50,000) occurred in 30% of patients receiving the Adriamycin combination, a markedly increased frequency when compared to the other two regimens (P equals 0.07, P = 0.02, two-sided). This trial establishes that Adriamycin has a better response rate than the combination of vincristine-actinomycin-D-cyclophosphamide in advanced sarcomas. The combination of vincristine, Adriamycin, and cyclophosphamide increased toxicity and did not add to the therapeutic effect achieved with Adriamycin alone.

Adult↗
PubMed1982

Methotrexate alone or with regional subcutaneous Corynebacterium parvum in the treatment of recurrent and metastatic squamous cancer of the head and neck.

Patients with advanced, incurable squamous cancer of the head and neck were randomly assigned to treatment with weekly methotrexate alone or methotrexate with Corynebacterium parvum given subcutaneously in weekly bilateral doses in sites around the neck. The addition of C. parvum did not alter the response rate, response duration, survival (either median or long-term) or severity of toxic effects compared to treatment with methotrexate alone. Response rates were higher for patients without distant metastases, ambulatory patients, and those younger than age 65 years. Median survival was improved for responders to chemotherapy and for those initially ambulatory. C. parvum given subcutaneously has no place in the treatment of far advanced cancer of the head and neck.

Adult↗
PubMed1982

Attitudes toward cancer. II: A comparative analysis of cancer patients, medical students, medical residents, physicians and cancer educators.

The current investigation was designed to determine how cancer patients, medical students, medical residents, nononcologically oriented physicians, and cancer educators differ with respect to attitudes towards cancer. A total of 372 individuals completed the Cancer Attitude Survey. Cancer educators displayed more confidence in the patient's ability to cope with diagnostic and prognostic information than students, other physicians, and patients themselves. Patients and cancer educators favored aggressive therapy to greater extent than other physicians, students, and alumni. Among nononcologic physicians and students there were significant effects of respondent's sex and prior personal experience with cancer on the attitudes expressed. Cancer educators differed significantly by specialty with surgical oncologists most likely to favor aggressive therapy. When compared to physician groups studied in the 1960s, our overall physician group (residents, cancer educators, and other physicians) was more likely to exhibit: (1) confidence in the patient's coping ability; (2) skepticism about the efficacy of early diagnosis and the value of aggressive treatment; and (3) stronger beliefs in the patient's ability to prepare for and accept death. Comparisons of our medical student group with students studied by Haley and his colleagues revealed a similar picture. Implications of these findings for the education of medical students are discussed.

Attitude of Health Personnel↗
PubMed1982

Combination chemotherapy for advanced endometrial cancer. An evaluation of three regimens.

In patients with advanced uterine corpus carcinoma treated with the combination chemotherapy of megestrol, cyclophosphamide, and doxorubicin (MCA) or with this combination and 5-fluorouracil (MCAF), the overall response rate was 22%. There was no significant difference in response rates between the two regimens. There is some indication that survival was longer in ambulatory patients who were treated with MCA, but this combination produced more hematologic toxicity than MCAF. Patients unsuitable for treatment with doxorubicin received megestrol, 1-phenylalanine mustard, and 5-fluorouracil (MLF), which produced objective responses in 2 of 12 patients.

Antineoplastic Agents↗
PubMed1982

Comparison of four-combination chemotherapy programs in metastatic breast cancer: comparison of multiple drug therapy with cytoxan, 5-FU and prednisone versus cytoxan and adriamycin, versus cytoxan, 5-FU and adriamycin, versus cytoxan, 5-FU and prednisone alternating with cytoxan and adriamycin.

In 126 postmenopausal women with metastatic breast cancer, four chemotherapeutic combination programs were tested. Patients were stratified and randomized to one of the four programs: (1) fluorouracil, cytoxan and prednisone (CFP): (2) fluorouracil, cytoxan and Adriamycin (CAF); (3) cytoxan and Adriamycin (CA); or (4) alternating combinations of CFP-CA. Objective response rates were 17% for 18 patients on CFP, 25% for 40 patients on CAF, 42% for 41 patients on CA and 63% for 19 patients on CFP-CA. CFP-CA provided a significantly higher response rate than either CFP or CAF. The response rate of CA was intermediate. The duration of remission and survival were similar for all four groups. When progression or relapse following remission was demonstrated, patients were rerandomized to either adrenalectomy or tamoxifen. There were no responders either in the 15 patients undergoing adrenalectomy or the 11 patients receiving tamoxifen. In a crossover study, nine adrenalectomized patients received tamoxifen and four tamoxifen-treated patients underwent adrenalectomy. None responded. It appears that response rates to hormonal modalities are reduced in patients previously treated by combination chemotherapy.

Adrenalectomy↗
PubMed1982

Content bias in the neoplastic-related items of the National Board of Medical Examiners Part II Examination.

The Education Evaluation Committee of the American Association for Cancer Education (AACE) attempted to employ the neoplastic-related items from the National Board of Medical Examiners (NBME) Part II examination in a study correlating program characteristics at various medical schools with performance on the neoplastic-related items. All questions on the September, 1977 and April, 1978 NBME Part II examinations were reviewed by board certified medical oncologists who found an approximate 20% discordance between the AACE and NBME classifications. Content analysis of the neoplastic-related items disclosed a preponderance of questions related to gynecologic cancer with few questions concerning the major solid tumors: lung, breast and colorectal cancer. In addition, virtually no questions related to the psychologic impact of cancer or to the therapy of cancer were asked. We conclude that the use of item by item performance scores from the neoplastic-related items is inadequate for program analysis due to disagreements over what constitutes such an item and to content bias in the agreed upon items. We propose a coding system that may allow the results from current NBME examinations to be used in program evaluation.

Curriculum↗
PubMed1982

The importance of splenic blood flow in clearing pneumococcal organisms.

Overwhelming infection from encapsulated bacteria occurs after splenectomy. Decreases in IgM, tufsin, and serum opsonin are known to occur in animals and humans after splenectomy. A substantial immunologic advantage exists if some splenic tissue remains, but this may not offer sufficient protection from encapsulated bacteria if splenic arterial blood flow is reduced. This experiment was designed to examine the rate of pneumococcal clearance by the spleen and to determine the relationship between splenic blood flow and splenic tissue mass in bacterial clearance from the blood. Pneumococcal clearance, splenic blood flow, and residual splenic weight were measured in 171 rabbits with normal spleens, ligated splenic arteries, splenic autotransplants, hemisplenectomies, and splenectomies. Interruption of the splenic artery results in delayed pneumococcal clearance that is due to reduced blood flow and not to a decrease in splenic tissue mass. Splenic artery ligation to preserve an injured spleen cannot be assumed to give protection from sepsis.

Animals↗
PubMed1982

CEA monitoring among patients in multi-institutional adjuvant G.I. therapy protocols.

The Gastrointestinal Tumor Study Group (GITSG) has since 1975 included protocols for monitoring carcinoembryonic antigen (CEA) levels in its colorectal cancer adjuvant trials. Among the 563 patients on the colon cancer study (GI 6175) and the 207 patients on the rectal cancer study (GI 7175), one third had preoperative CEA determinations and more than 90% had some postoperative CEA monitoring. Colon cancer patients whose preoperative CEA was greater than 5 ng/ml had a greater probability of recurring than those whose values were lower (33% versus 18% recurrence with 21 months minimum follow-up; p < 0.05). The prognostic value of preoperative CEA was apparent only in patients with Dukes' C1 colon tumors. Preoperative CEA values were not of prognostic significance among the rectal adenocarcinoma patients. Although elevated levels of CEA after resection of either colon or rectum cancers were strongly associated with subsequent tumor recurrence, no single CEA value, arbitrarily defined as "elevated", provided an adequate screening test with both high sensitivity and high specificity. Postoperative CEA elevations were more strongly predictive of recurrence when part of a steadily rising trend. In the colon cancer study, the median monthly increase in CEA for disease-free patients was estimated to be zero, and for the relapsed patients 5.8%. The corresponding estimates for patients on the rectal cancer protocol were zero and 7.8%. Only 36 of the 344 disease-free patients on the colon protocol and 14 of the 94 disease-free patients on the rectal protocol (15%) exhibited a rate of increase of CEA as high as 3% per month over the entire period of observation. Two thirds of the relapsed patients on both studies showed a rate of increase this high or higher. The patterns of CEA rise in individual patients were quite varied, however, and monthly rates of increase as established in our study are not to be used as guidelines in patient management.

Carcinoembryonic Antigen↗
PubMed1982

Systemic artery-to-pulmonary artery fistula. A new therapeutic approach.

A patient with systemic artery-to-pulmonary artery fistulae is described. Historically, all therapy of this type of lesion has been surgical. We describe a new mode of treatment, therapeutic embolization, which obviates surgical intervention and its attendant risks. Embolization is an alternative to surgery that should be considered in selected cases.

Adult↗
PubMed1982

Phase III study of intermittent carmustine (BCNU), cyclophosphamide, and prednisone versus intermittent melphalan and prednisone in myeloma.

A prospective randomized trial in patients with previously untreated multiple myeloma was performed comparing carmustine (BCNU), cyclophosphamide, and prednisone (BCP) to melphalan (Alkeran) and prednisone (AP). Induction response rates, remission duration, and survival were similar with both regimens. Hematologic toxicity was greater with AP. Crossover studies in patients who relapsed did not illustrate any significant activity with either drug treatment program. Therefore, BCP can be utilized as initial therapy in myeloma because of comparable remission rates and less hematologic toxicity.

Aged↗