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Biomedical subjects

J Klastersky

Publications and source records attributed to J Klastersky.

At least 235 records · Page 13Linked to original sources
PubMed1983

[Late intensive chemotherapy with bone marrow autograft. Pilot study in small cell bronchial cancer].

Following three courses of induction chemotherapy, 23 patients with small cell carcinoma of the lung were treated with a late intensive regimen including autologous bone marrow infusion. Thirteen patients received high doses (2 or 3 times the induction chemotherapy dosage) of cisplatin, adriamycin and etoposide. One patient was probably cured, but renal and mucosal toxicity was observed. Three patients treated with adriamycin, etoposide and cyclophosphamide also developed severe mucositis. The seven remaining patients received high doses of cyclophosphamide (100 to 200 mg/kg) and etoposide (750 to 1000 mg/m2); responses were obtained with moderate toxicity. The long-term survival is not yet known. The usefulness of bone marrow infusion cannot be determined without further studies.

Adult↗
PubMed1983

The bactericidal activity in serum and its prognostic clinical value.

The determination of the bactericidal activity in serum also gives valuable information on the bacteria, the host and the antibiotics. Clinical studies have proven its value, especially in predicting the outcome of septicemia and other infections. Thus, the bactericidal activity in serum is a useful tool for monitoring therapy. It can also be used as an investigational means for comparing the respective efficacy of antibiotics administered alone or in combination.

Anti-Bacterial Agents↗
PubMed1983

Therapy with antibiotics in leukemic patients.

The recovery of an adequate granulocyte count after chemotherapy is the most important prognostic factor in neutropenic patients. In granulocytopenic patients, the risk of infection is very high and its course usually severe. Empiric antibiotic treatment must be started as soon as fever rises and blood cultures have been taken. The combination of an anti-pseudomonas penicillin with an aminoglycoside is presently the standard empiric therapy for febrile granulocytopenic patients. If the clinical response is inadequate, antimicrobial therapy should be adjusted to a bactericidal activity of greater than 1:16 in the serum. If antibiotic therapy fails, a fungal infection should be considered and amphotericin B added empirically. Patients must be closely supervised for superinfections. Therapeutic transfusions of granulocytes have proven useful in severe granulocytopenia and when antibiotic therapy has failed.

Amphotericin B↗
PubMed1983

Treatment of gram-negative bacillary septicemia with cefoperazone.

Cefoperazone, a new broad-spectrum cephalosporin, was administered by continuous infusion or intermittent injection to 20 and 25 patients respectively with gram-negative bacillary septicemia most of whom had severe underlying disease. No difference was observed in the clinical response of the two groups. The overall rate of favourable response was 76%. Of the 40 non-neutropenic patients treated three died of infection despite sensitivity of the organism, three improved temporarily and three died as the result of superinfection. Three of the five neutropenic patients treated failed to respond to cefoperazone therapy, despite adequate serum bactericidal activity. Tolerance to cefoperazone was satisfactory. Emergence of cefoperazone-resistant strains leading to relapse or superinfection was not a major cause of failure.

Adult↗
PubMed1983

Lactic acidosis: a metabolic complication of extensive metastatic cancer.

Lactic acidosis is a rare metabolic complication of cancer. An analysis of the cases reported in the English and French literature shows that all the patients have extensive neoplastic disease. Metastatic hepatic lesions are present in the large majority of cases, suggesting that alteration of liver function is part of the clinical picture. Chemotherapy against the neoplastic disease is the only effective treatment of this type of lactic acidosis.

Acidosis↗
PubMed1983

Oral prophylaxis with miconazole or ketoconazole of invasive fungal disease in neutropenic cancer patients.

Ketoconazole or miconazole was randomly administered to 42 and 46 neutropenic patients respectively. Of the total number of stool cultures 12% were positive for yeasts in both groups; 4% of the total number of cultures from other sites (nose, throat, skin) were positive in both groups. Candida albicans was the most common isolate, but other fungal species were also identified. No patient developed fungemia; 5/88 patients developed severe oropharyngeal candidiasis while receiving prophylaxis. Among the 21 autopsies performed, 5 cases of pulmonary aspergillosis and 2 local and 1 disseminated candidiasis were demonstrated in 7 patients. Although there was no placebo group of patients in this study, post-mortem data suggest that miconazole or ketoconazole might reduce the incidence of disseminated candidiases in neutropenic patients.

Agranulocytosis↗
PubMed1983

Vancomycin therapy of oxacillin-resistant Staphylococcus aureus infections.

Infections caused by oxacillin-resistant staphylococci were studied in 27 patients, who received vancomycin therapy as soon as the resistance of the pathogenic staphylococcal strain to oxacillin was documented. Therapy with vancomycin was usually started not later than 48 h after the onset of empiric therapy with oxacillin or cefamandole. In spite of high bactericidal activity in the serum of the patients receiving vancomycin, only 16 (59%) out of 27 patients responded to the treatment. Favourable clinical responses were usually associated with bacteriological cure, but super-infection by Gram-negative bacillary rods was a common complication in this series; it occurred in eight (30%) of the 27 patients studied. The overall death rate was 33% (9/27); death was associated in six patients with persisting staphylococcal infection and in three patients with Gram-negative bacillary superinfection of the bronchopulmonary tract, with or without persistent staphylococcal infection.

Adolescent↗
PubMed1983

Serum bactericidal activity of cefoperazone and ceftazidime at increasing dosages against Pseudomonas aeruginosa.

Serum bactericidal activity (SBA) greater than or equal to 1:8 correlates with the clinical effectiveness of antibiotics. Ten healthy young volunteers received iv on separate days cefoperazone 1, 2, or 3 g and ceftazidime 1, 2, or 3 g. The serum levels 1 and 6 h after the administration of cefoperazone 1, 2 and 3 g were respectively 52 and 7 mg/l, 122 and 13 mg/l, 190 and 22 mg/l. The serum levels of ceftazidime 1, 2 and 3 g, after 1 h and 6 h were 28 and 8, 56 and 9, 78 and 13 mg/l. The SBA was determined against seven strains of Pseudomonas aeruginosa with MBC of 1.6-12.5 mg/l of cefoperazone and 0.8-6.2 mg/l of ceftazidime. Increased dosage of cefoperazone and ceftazidime led to a significant increase in the SBA's greater than or equal to 1:8 at 1 h (P less than 0.01). In sera obtained 1 h and 6 h after the injection of the antibiotics, 97% and 51% of the strains were inhibited by ceftazidime 2 g, while 1 g was inhibitory on 84% (1 h) and 8% (6 h) of the strains. Ceftazidime 1 g produced SBA's greater than or equal to 1:8 significantly more often than did cefoperazone 3 g (P less than 0.01) at 1 h. The rate of killing with all ceftazidime regimens was similar and slightly higher than that of any cefoperazone regimen. Ceftazidime seems more effective than cefoperazone against Ps. aeruginosa; however, increased MBC values were observed during killing curves studies with both drugs.

Adult↗
PubMed1983

Therapy of staphylococcal infections with cefamandole or vancomycin alone or with a combination of cefamandole and tobramycin.

Eighty adult patients with microbiologically demonstrated staphylococcal infections were included in a comparative trial of cefamandole and cefamandole plus tobramycin. Patients with cefamandole-resistant pathogens were treated with vancomycin, if the initial therapy consisted of cefamandole, but were continued on cefamandole plus tobramycin if already started on that combination. Of the patients infected with cefamandole-susceptible strains, 91% (20/22) responded favorably to treatment with cefamandole alone, and 88% (30/34) responded favorably to cefamandole plus tobramycin. Of the patients infected with cefamandole-resistant staphylococci, 70% (7/10) responded to treatment with cefamandole plus tobramycin, and 86% (12/14) responded to treatment with vancomycin, even though vancomycin therapy was started 24 to 48 h later than cefamandole-plus-tobramycin therapy. No major side effects were observed; however, cefamandole plus tobramycin was associated with a rise in the serum creatinine level in 11% (4/44) of the patients. The bactericidal activity of the serum in cefamandole-treated patients and in cefamandole-plus-tobramycin-treated patients was identical against cefamandole-susceptible strains. Against cefamandole-resistant strains, 87% of the vancomycin-containing sera were bactericidal at a dilution of 1:8, whereas only 57% of the cefamandole-plus-tobramycin-containing sera were active at that dilution.

Anti-Bacterial Agents↗
PubMed1983

Serum bactericidal activity of ceftazidime and cefoperazone alone or in combination with amikacin against Pseudomonas aeruginosa and Klebsiella pneumoniae.

Sera of volunteers receiving ceftazidime (2 g) or amikacin (500 mg), alone or in combination, or cefoperazone (2, 4, or 6 g) or cefoperazone (2 g) with amikacin (500 mg) were evaluated for bactericidal activity against Klebsiella pneumoniae and Pseudomonas aeruginosa. Serum bactericidal activities were similar for ceftazidime and ceftazidime plus amikacin, but were definitely lower for amikacin alone. Against P. aeruginosa, a 6-g dose of cefoperazone resulted in a higher frequency of peak serum bactericidal activities greater than or equal to 1:8 than a 2-g dose of cefoperazone plus amikacin. Killing studies, performed in 1:8 diluted serum, demonstrated a higher killing rate for cefoperazone plus amikacin than for a 6-g dose of cefoperazone, the more resistant P. aeruginosa excepted. Emergence of resistance was found with a 2-g dose of cefoperazone for K. pneumoniae and with a 6-g dose of cefoperazone for P. aeruginosa, but not with cefoperazone plus amikacin.

Amikacin↗
PubMed1983

Gram-negative bacillary meningitis in neurosurgical patients.

The authors report 34 cases of Gram-negative bacillary meningitis related to traumatic cranial lesions or neurosurgery observed between 1973 and 1980 at two neurosurgical units (Institut J. Bordet, Brussels, and Inselspital, Bern). As a typical nosocomial infection, meningitis developed after prolonged hospitalization in most patients, and was mainly due to highly resistant organisms, such as P. aeruginosa and Klebsiella sp. At least 65% of the patients were colonized with the pathogen responsible for the meningitis before the onset of the infection. Ventriculitis, including four cases of ventricular empyema, complicated meningitis in all the 17 patients in whom a ventricular tap was performed. The results of treatment were unsatisfactory. Fifty percent of the patients were cured of their infection, but only 30% survived; 15% of the patients died within 48 hours following diagnosis. The optimum treatment of postsurgical Gram-negative meningitis remains in doubt. The choice of initial antibiotics should take into account the sensitivity patterns of colonizing microorganisms. Chloramphenicol is ineffective against most pathogens commonly involved in this infection. Intrathecal aminoglycosides may fail in the presence of ventriculitis. Intraventricular aminoglycosides are probably justified in critically ill patients. The role of the newer cephalosporins and of co-trimoxazole remains to be defined.

Adolescent↗
PubMed1983

Complications of treatment of small cell carcinoma of the lung.

Improvements in therapy for small cell carcinoma of the lung have been achieved with treatment regimens that result in significant toxicity. The workshop of the International Association for the Study of Lung Cancer focused on the following complications of chemotherapy and radiotherapy: leukopenia and resultant infections, esophagitis, pneumonitis and pulmonary fibrosis, cardiac toxicity, second malignancies, neurologic complications, and psychosocial effects. The data regarding the incidence and management of these complications are briefly reviewed, and recommendations for further studies are noted.

Aged↗
PubMed1983

Antimicrobial prophylaxis of infections in head and neck cancer surgery.

429 patients undergoing surgery for head and neck tumors were involved in 4 consecutive, randomized clinical trials of antimicrobial prophylaxis: placebo versus ampicillin plus cloxacillin (2 g of each daily for 6 days), ticarcillin (5 g X 12, 8-hourly) versus carbenicillin (10 g X 12, 8-hourly) short carbenicillin prophylaxis (1 day) versus prolonged carbenicillin prophylaxis (4 days) and clindamycin (900 mg, 4 daily doses) versus clindamycin plus netilmicin (90 mg, 4 daily doses). Aerobic gram-negative strains were the microorganisms most frequently isolated either from colonized or infected wounds. The first controlled study showed a significant decrease in the rate of postoperative bacterial infections in the treated group as compared to the placebo-treated group (p less than 0.05). In all the subsequent treatment groups, postoperative infection rates ranged from 6 to 16%. Short prophylaxis was as effective as prolonged prophylaxis. A regimen directed mainly against anaerobes (clindamycin) did not seem of less value than broad spectrum regimens covering most aerobic gram-negative bacilli.

Anti-Bacterial Agents↗