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Biomedical subjects

J Kaufman

Publications and source records attributed to J Kaufman.

At least 199 records · Page 11Linked to original sources

The pathophysiologic and roentgenologic effects of chest irradiation in breast carcinoma.

We studied the effects of radiation therapy on lung function in 21 patients who underwent modified radical mastectomy and radiotherapy for breast carcinoma. The patients had pulmonary function studies and chest X rays prior to radiation therapy and at six weeks, and three, six, and twelve months following radiation therapy. All pulmonary function studies showed a small but statistically significant decline within the first three months following radiation therapy. Changes in the moderate and large airways continued to occur after three months. None of the changes in pulmonary function were reversible. Radiographic changes occurred in 12 patients. These changes occurred later than the lung function changes (median time for the changes was twelve months) and were unrelated to changes in lung function.

Adult↗

Catheter-related septic central venous thrombosis--current therapeutic options.

Central venous catheter-related infection and evidence for central venous thrombosis developed in five patients. On the basis of ongoing bacteremia after catheter removal and venographic confirmation, catheter-related septic central venous thrombosis (CR-SCVT) was confirmed. These patients were treated successfully with anticoagulation and antibiotics; none required surgical exploration or drainage.CR-SCVT is a complication of modern venous access techniques and is easily confused with sepsis from other anatomic sites. Even when recognized antemortem, CR-SCVT carries an excessive morbidity and mortality. The therapy for this complication is not standardized, but catheter removal, anticoagulation and a prolonged course of antibiotics are appropriate initial therapy. Surgical vein ligation or excision are reserved for refractory sepsis or abscess formation.

Adult↗

Eastern Cooperative Oncology Group phase II studies in advanced measurable colorectal cancer. I. Razoxane, Yoshi-864, piperazinedione, and lomustine.

During a 6-month interval, Eastern Cooperative Oncology Group randomized 127 patients who had received prior chemotherapy, and who had advanced measurable, surgically incurable colorectal cancer, to receive piperazinedione (PZD), Yoshi-864, or razoxane (ICRF-159). The observed response (and median survival) rates were: PZD, one of 35 patients (17 weeks); Yoshi-864, one of 34 (19 weeks), and ICRF-159, none of 38 (23 weeks). Among 107 evaluable patients, there were five episodes of life-threatening toxicity with PZD (one death) and four with ICRF-159 (two deaths). In the same protocol, 42 evaluable patients who had not received prior chemotherapy were randomized to be treated with lomustine (CCNU) or one of the three drugs in the "previously treated" trial. One CR (41 weeks) was seen with ICRF-159 and two PRs were seen with CCNU. Life-threatening toxicity occurred in three patients, two who received CCNU (one death) and one who received PZD. No survival advantage was seen. We do not encourage further phase II trials in colorectal cancer with the agents studied.

Antibiotics, Antineoplastic↗

Serum concentrations of thyroxine, 3,5,3'-triiodothyronine, thyrotropin, and prolactin in dogs before and after thyrotropin-releasing hormone administration.

Serum concentrations of thyrotropin (TSH), prolactin, thyroxine, and 3,5,3'-triiodothyronine in 15 euthyroid dogs and 5 thyroidectomized and propylthiouracil-treated dogs after thyrotropin-releasing hormone (TRH) administration were measured. Although thyroidectomized and propylthiouracil-treated dogs had higher (P less than 0.01) base-line concentrations of TSH in serum than did euthyroid dogs, concentrations of TSH after TRH administration varied at 7.5, 15, and 30 minutes with 14 of 45 samples obtained from healthy dogs having lower TSH concentrations than before TRH challenge. Similarly, concentrations of 3,5,3'-triiodothyronine in the serum of euthyroid dogs 4 hours after TRH administration were similar (P less than 0.05) to concentrations before TRH challenge. Although the mean concentration of thyroxine in serum was elevated (P less than 0.05) 4 hours after administration of TRH to euthyroid animals, as compared with base-line levels, the individual response was variable with concentrations not changing or decreasing in 4 dogs. Therefore, the TRH challenge test as performed in the current investigation was of limited value in evaluating canine pituitary gland function. Although mean concentrations of TSH in serum were higher (P less than 0.05) in euthyroid dogs after TRH administration, the response was too variable among individual animals for accurate evaluation of pituitary gland function. Concentrations of prolactin in the sera of dogs after TRH administration, confirmed previous reports that exogenously administered TRH results in prolactin release from the canine pituitary and indicated that the TRH used was biologically potent.

Animals↗

Pancreatic beta cell tumor in a ferret.

A ferret with clinical and laboratory signs of hypoglycemia was found at surgery to have a beta cell tumor of the pancreas. There had been recurrent episodes of weakness, ataxia, dehydration, and hypothermia. A fasting blood glucose content was 43 mg/dl and the amended insulin/glucose ratio was 362.5. The tumor was removed, yet hypoglycemia persisted postoperatively. Clinical signs related to hypoglycemia did not recur following application of medical treatment and frequent feedings. The histologic appearance of the tumor closely resembles that which has been seen in other species.

Adenoma, Islet Cell↗

Diseases of the adrenal cortex of dogs and cats.

Of cases of hyperadrenocorticism in small animals 80-85% are the result of adrenocortical hyperplasia. Middle-aged or older Poodles, Dachshunds, Boston Terriers and Boxers are most commonly affected, and cats rarely. Clinical signs include polydipsia, polyuria, alopecia, abdominal distension, lethargy, weakness, hepatomegaly, calcinosis cutis, testicular atrophy and anestrus. Hematologic and biochemical changes may include neutrophilia, lymphopenia, monocytosis, eosinopenia, increased blood levels of alkaline phosphatase, SGPT, cholesterol, Na and glucose, and decreased K and T4 levels. The high-dosage dexamethasone suppression test helps differentiate pituitary-dependent hyperadrenocorticism from that caused by adrenal tumors. The low-dosage dexamethasone suppression test, determination of plasma ACTH levels, and ACTH response test are additional diagnostic aids in the diagnosis of Cushing's disease. Medical treatment involves oral use of mitotane (o,p'-DDD) at 50 mg/kg/day for 7 days and prednisone or prednisolone at 0.05 mg/kg/day. Hypophysectomy has been used with only 5% mortality in cases of pituitary-dependent hyperadrenocorticism. Adrenalectomy is indicated in cases of adrenal neoplasia.

Adrenocorticotropic Hormone↗

Diseases of the adrenal cortex of dogs and cats.

The most common cause of hypoadrenocorticism in dogs is idiopathic immune-mediated destruction of the adrenal cortex. Other causes include anterior pituitary insufficiency, pituitary or adrenal neoplasia, acute withdrawal of exogenous corticosteroids, and mitotane toxicity. Females are affected more often than males; only 1 feline case has been documented. Animals 2-5 years old are most commonly affected. Clinical signs include lethargy, weakness, weight loss, anorexia, vomiting, diarrhea and bradycardia. Hematologic and biochemical changes can include eosinophilia, lymphocytosis, anemia, hyperkalemia, hyponatremia and hypercalcemia. Diagnosis is by finding negligible resting levels of plasma cortisol and no response to ACTH administration, and a serum Na:K ratio of 20:1 or less. Treatment involves restoring fluid volume, correcting acidosis, and supplementing salt and glucocorticoids. Daily oral use of prednisone at 0.05 mg/kg can safely maintain most affected dogs. Some dogs only require glucocorticoids in stressful situations. Iatrogenic secondary adrenocortical insufficiency (iatrogenic Cushing's disease) may result from a single injection of long-acting glucocorticoids or from long-term use. Clinical signs are the same as for natural hyperadrenocorticism, but endogenous cortisol release is suppressed. Treatment is gradual withdrawal of the offending glucocorticoid and elimination of the cause that initially prompted glucocorticoid therapy.

Addison Disease↗

Inactivation of antiadherence effect of bladder surface glycosaminoglycan by a complete urinary carcinogen (N-methyl-N-nitrosourea).

The glycosaminoglycan layer at the bladder surface nonspecifically blocks the adherence of bacteria, ions and molecules to the epithelium. It may be an important element in the 1st line of defense against infection, calculi and even carcinogens for the transitional cells of the bladder. To determine whether the bladder glycosaminoglycan layer plays a role in preventing carcinogenesis, we tested the effect of a complete urinary carcinogen, N-methyl-N-nitrosourea, on the glycosaminoglycan barrier in our in vivo adherence assay. Bacterial adherence was significantly greater in carcinogen-treated bladders than in control bladders, indicating that N-methyl-N-nitrosourea inactivates the antiadherence effect of the surface glycosaminoglycan. The bladder glycosaminoglycan layer may help protect the bladder from carcinogens present in the urine. Qualitative or quantitative defects in the glycosaminoglycan(s) present may influence an individual's susceptibility to the development of bladder tumors.

Adhesiveness↗

Topical beta-aminopropionitrile in the treatment of Peyronie's disease.

We treated 9 patients with Peyronie's disease for 1 to 8 years in duration with a 4-week course of beta-aminopropionitrile free base as the pure liquid. The drug was applied topically to the plaques twice daily. Patients were followed with ultrasound imaging of the plaques and saline inflations of the corpora cavernosa with photographic documentation of the deformity. No significant adverse effect was noted. Three patients experienced a subjective response but did not demonstrate objective change on the aforementioned studies. It was concluded that topical beta-aminopropionitrile was not effective in reversing the deformity of Peyronie's disease. Further investigation into specific anti-collagen drugs for the treatment of this condition may be warranted.

Administration, Topical↗

Dynamics of propranolol dosing schedules.

Kinetic and dynamic data from 27 healthy male subjects were evaluated in a double-blind, randomized, double-crossover study to test the hypothesis that 180 mg/day propranolol twice and three times a day would provide much the same plasma levels and beta 1-blockade. The data indicate that propranolol twice rather than three times a day should be favored when beta 1-blockade is needed in therapy. The dynamic efficacy of the two schedules was the same and maximum concentration, AUC0-24, and 0-hr plasma propranolol values were higher after twice-than after three-times-daily dosing. The degree of beta 1-blockade (reduction in exercise tachycardia) was much the same on both dosing regimens at trough concentrations. These data indicate that both twice- and three-times-a-day dosing schedules provide well-sustained 24-hr beta-blockade and are probably interchangeable for therapeutic purposes.

Adult↗

Cis-diamminedichloroplatinum (DDP) induced acute renal failure (ARF): attempts at amelioration.

Nephrotoxicity is a dose limiting feature of cis-diamminedichloroplatinum (DDP) cancer chemotherapy. We have previously developed a model of DDP induced acute renal failure in the rat, which is characterized by non oliguric progressive azotemia. Protocols have been established in humans to prevent or diminish DDP associated renal alterations during the course of cancer chemotherapy. The present studies were designed to evaluate the effect of prior diuretic therapy, with furosemide, and enhanced solute diuresis, using dextrose and water as the sole source of drinking fluid, on DDP induced acute renal failure in the rat. As compared to water drinking controls neither the diuretic nor the enhancement of osmotic excretion effected DDP associated mortality. The courses of the acute renal failure observed in all three study groups were similar; however, there was a suggestion in the surviving animals that these maneuvers may have contributed to a more rapid return in renal function among rats not dying of DDP induced acute renal failure.

Acute Kidney Injury↗

Propranolol dosage, plasma concentration, and beta blockade.

One hundred sixty-nine normal men received varying propranolol dosage regimens and placebo. Dose level and frequency were compared with plasma propranolol levels and beta blockade, as assessed by reduction of exercise tachycardia. Propranolol levels above 20 ng/ml induced significant beta blockade. An average daily propranolol dose slightly in excess of 160 mg led to a minimum plasma level above 20 ng/ml. Approximately 50% of subjects achieved 20 bpm or greater decrease in exercise tachycardia with 160 mg per day. The degree of beta blockade at the daily minimum propranolol level was related to dose and not dose frequency. The relation of propranolol dose and plasma levels to beta blockade in normal subjects appears to reflect observations in large clinical trials.

Adolescent↗