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Biomedical subjects

J M Bennett

Publications and source records attributed to J M Bennett.

At least 181 records · Page 10Linked to original sources
PubMed1988

Echophonocardiographic estimation of pulmonary capillary pressure in acute myocardial infarction.

Non-invasive estimation of pulmonary capillary wedge (PCW) pressure by an echophonocardiographic technique is reported. The ratio of time interval from the Q-wave to the C-point (echocardiogram) (Q-C) and from aortic closing (A2) to the E-point (A2-E) correlated well with the measured PCW pressure (r = 0.89; P = 0.001). When these two intervals were subtracted (A2-E)-(Q-C) the correlation was r = -0.90 (P = 0.001).

Echocardiography↗
PubMed1988

Nonspecific esterase of acute promyelocytic leukemia (M3).

Leukemic cells of 43 patients with acute promyelocytic leukemia (M3) were investigated morphologically and cytochemically to determine the percentage of aberrant enzymes and whether or not the presence impacts on the clinical outcome. Twelve patients (27.9%) showed alpha-naphthyl acetate esterase (ANAE) activity in their leukemic cells, and two of these cases revealed remarkably low myeloperoxidase (MPO) positivity, a pattern seen in monocytic precursors. However, further cytochemical evidence for this monocytic feature, the inhibition of naphthol AS-D acetate esterase (NASDA) activity with sodium fluoride (NASDA-F), was found in only five of these nine patients. In 31 cases (72.1%), there was minimal ANAE activity. Of interest, two of these were devoid of naphthol AS-D chloroacetate esterase (CAE), which is prominently displayed in neutrophilic granulocytes, even though these leukemic cells were 100% intensely positive for MPO activity. Between the two groups with and without ANAE activity, there were no remarkable differences in the distribution of sex and age, hematological findings, and rates of complete response. Our study has confirmed the cytochemical heterogeneity of M3 with no obvious relationship between this heterogeneity and early therapeutic outcome.

Adolescent↗
PubMed1988

Guidelines for clinical protocols for chronic lymphocytic leukemia: recommendations of the National Cancer Institute-sponsored working group.

The National Cancer Institute (NCI)-sponsored Chronic Lymphocytic Leukemia (CLL) Working Group was convened to develop a set of standardized eligibility, response, and toxicity criteria for clinical trials. We recognized the previous efforts in 1967 (published again in 1973 as the report of the Chronic Leukemia-Myeloma Task Force [1] and 1978 of Cancer and Leukemia Group B (CALGB) [2]). We have used these reports for guidance during the current effort. Several noteworthy developments in the past few years have made it necessary to modify the previous guidelines. First, the diagnostic criteria for CLL and its clinical staging have been developed and well defined. Second, although staging systems facilitated entry of comparable and relatively homogeneous groups of patients in clinical trials, the definitions of response (CR) and partial response (PR) were not uniformly adopted from the previous guidelines in the clinical trials (Tables IA, IB); therefore, comparisons of results obtained in different studies became difficult. Third, there has been an improvement in our understanding of the immunology and biology of CLL. Finally, we are witnessing the emergence of several chemotherapy agents that promise impressive activity in CLL (e.g., 2'-deoxycoformycin [3], fludarabine monophosphate [4, 5]), and thereby offer the potential for improving survival time in this disease. To best identify regimens worthy of continued pursuit in large comparative trials, standardized guidelines for evaluation are essential. A number of laboratory investigations are also presented for which scientific interest is high yet relevance remains to be determined; thus, they are presented as companion studies to the clinical trials. This mechanism allows for flexibility in the testing of these questions and for additional ideas in the future without requiring modification of an entire treatment protocol. The following guidelines were developed to be used as a form of standardization for clinical trials, incorporating current technologies, yet remaining relevant to the general hematology/oncology community. Based on the membership of the Working Group, it is expected that these guidelines will serve as the criteria for most clinical trials in the near future.

Antineoplastic Agents↗
PubMed1988

Thallium-201 scintigraphy perfusion defect with dipyridamole in a patient with a myocardial bridge.

A patient with myocardial bridging and a thallium-201 scintigraphy perfusion defect after the administration of intravenous dipyridamole is presented. The same patient had a normal perfusion study on exercise stress testing. The effects of coronary vasodilators and dipyridamole on coronary artery flow patterns in patients with myocardial bridging are discussed. We suggest that coronary vasodilators may induce perfusion defects in patients with myocardial bridging and should be avoided in such patients.

Adult↗
PubMed1988

Effectiveness of attenuated chemotherapy in myelodysplastic syndromes: a preliminary report.

A small group of elderly male patients received attenuated doses of daunomycin, cytosine arabinoside (Ara-C), and 6-thioguanine for treatment of myelodysplastic syndrome (MDS). Three patients had refractory anemia with excess blasts (RAEB), and two had chronic myelomonocytic leukemia (CMMoL). All five patients had developed severe transfusion requirements for platelets and red blood cells before therapy was begun. One patient developed necrosis of the cecum and expired 19 days after therapy, but the other four all showed substantial benefit from treatment. Three of those patients received multiple courses of chemotherapy which led to improvement in peripheral blood counts in each case. Duration of responses as noted by improvement in peripheral blood counts compared to pretreatment levels ranged from 1.5 to 9 months. Despite considerable improvement in peripheral blood parameters, some of the abnormal morphologic features of MDS persisted after each course of chemotherapy. These results obtained with attenuated chemotherapy schedules in a small group of patients are sufficiently encouraging to warrant an expanded phase II trial, which is under way at the University of Rochester Cancer Center.

Aged↗
PubMed1988

Continuous infusion homoharringtonine (NSC 141633) in refractory acute nonlymphocytic leukemia. An ECOG pilot study.

Single-agent homoharringtonine (HH) was evaluated as induction therapy in 20 patients with advanced acute nonlymphocytic leukemia (ANLL) in a pilot study of the Eastern Cooperative Oncology Group (ECOG). HH was given by continuous intravenous (i.v.) infusion at 3.5 mg/m2 on the first day and at 6.0 mg/m2/day on days 2-8. Fourteen men and six women with a median age of 43 years were treated. Sixteen patients had clearing of peripheral blasts, 10 patients achieved marrow hypoplasia, and 2 patients had progressive disease. No complete remission occurred. Drug-induced hypotension was the most significant toxicity, causing a delay in treatment in 8 patients. The median survival was 15 weeks (range 1-65 weeks) from the start of HH treatment. Despite a definite antileukemic effect, HH as a single agent cannot be recommended as a useful salvage regimen in patients with far advanced ANLL.

Adolescent↗
PubMed1988

A randomized multicenter trial comparing mitoxantrone, cyclophosphamide, and fluorouracil with doxorubicin, cyclophosphamide, and fluorouracil in the therapy of metastatic breast carcinoma.

Three hundred thirty-one women with metastatic breast cancer were randomized to receive combination chemotherapy with either cyclophosphamide, Novantrone (mitoxantrone; Lederle Laboratories, Wayne, NJ), and fluorouracil (CNF) or cyclophosphamide, Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), and fluorouracil (CAF). Patients could not have had prior chemotherapy, although adjuvant chemotherapy was acceptable. Initial doses were 500 mg/m2 of cyclophosphamide and 500 mg/m2 of fluorouracil with either 10 mg/m2 of mitoxantrone or 50 mg/m2 of doxorubicin, administered intravenously (IV) on day 1 and repeated every 3 weeks. There were no statistically significant differences in pretreatment or prior therapy characteristics between the groups. For patients assigned to the CNF and CAF groups, respectively, 25 (18%) were premenopausal, 39 (40%) were estrogen receptor (ER) negative, 39 (38%) had a disease-free interval less than 1 year, and 24 (26%) had received prior adjuvant chemotherapy. All patients were compared for response rate, duration of response, time to progression or death, time to treatment failure (TTF), and survival. None of these parameters were statistically significant favoring one regimen over the other. The response rate (complete [CR] and partial response [PR]) was 29% for the CNF group (95% confidence interval of 22% to 37%) and 37% for the CAF group (95% confidence interval of 29% to 45%). The median response duration and TTF were 171 days and 125 days for the CNF group and 254 days and 147 days for the CAF group, respectively. The median survival times for the CNF group and the CAF group were 377 and 385 days, respectively. The major dose-limiting toxicity for both regimens was leukopenia, manifested as granulocytopenia. The incidence of stomatitis/mucositis was 10% in the CNF group and 19% in the CAF group. Alopecia occurred in 49% of CNF patients (severely for 4%) and in 86% of CAF patients (severely for 39%). Nausea/vomiting occurred in 80% of CNF patients and in 81% of CAF patients; the degree of severity was also comparable. There was significantly less cardiotoxicity observed in the CNF group compared with the CAF group. Although CNF is somewhat less effective in overall response rate, survival curves are identical. CNF can be offered to patients who reject anthracycline-containing regimens because of fear of alopecia.

Adult↗
PubMed1988

High peripheral blast count in adult acute myelogenous leukemia is a primary risk factor for CNS leukemia.

The lengthening remission duration achievable in acute myelogenous leukemia (AML) places patients at risks for CNS leukemic relapse. We reviewed the data on two Eastern Cooperative Oncology Group (ECOG) trials in acute nonlymphocytic leukemia to determine the incidence of CNS leukemia (CNSL). The incidence of CNSL was 5% (30 of 569 patients) overall, and 3% (ten of 331) in patients in complete remission (CR). A number of factors were evaluated for association with increased risk of CNSL. Men more frequently developed CNSL than women at a three to one ratio, and median presenting WBC counts were higher in affected than unaffected patients (44,200/microL v 17,000/microL, P = .01). The low incidence of CNSL in AML supports the view that CNS prophylaxis is unnecessary. However, because 68% of patients (13 of 19) who developed CNSL early in the course of disease had presenting WBC counts greater than 40,000/microL, screening lumbar punctures should be routinely obtained during induction therapy in patients presenting with high circulating blast cell counts.

Brain Neoplasms↗
PubMed1988

Maintenance chemotherapy prolongs remission duration in adult acute nonlymphocytic leukemia.

The value of maintenance therapy after the achievement of complete remission in adult acute nonlymphocytic leukemia (ANLL) has never been clearly established. A randomized Eastern Cooperative Oncology Group (ECOG) study of postremission therapy compared outcomes in patients who received no further therapy to those administered long-term maintenance chemotherapy. Adverse results in the group administered no further therapy led to early termination of this trial after only 51 patients were randomized. Patients receiving no postremission therapy experienced significantly inferior remission durations (P = .002) compared with patients receiving maintenance therapy. All 26 patients in the group administered no postremission therapy have relapsed, with a median duration of remission of 4.1 months. In contrast, four of 25 patients (16%) who received maintenance therapy remain disease free, with a median duration of remission of 8.1 months.

Acute Disease↗
PubMed1988

Reclassification of leukemia among A-bomb survivors in Nagasaki using French-American-British (FAB) classification for acute leukemia.

The concordance rate for diagnoses of atomic bomb-related cases of leukemia in Nagasaki was determined using the French-American-British (FAB) classification for acute leukemias and myelodysplastic syndromes (MDS). Two Radiation Effects Research Foundation (RERF) hematologists and one of the members (JMB) of the FAB cooperative group reviewed independently the peripheral blood and/or bone marrow smears from 193 people with leukemia or a related disorder. There was 85% agreement in the identification of types and subtypes of acute leukemia. There was almost complete agreement for the diagnoses of non-FAB disorders (chronic myeloid leukemia (CML), adult T-cell leukemia (ATL) and others) resulting in overall concordance of 88.2%. The present study suggests that the previously established leukemia types for about a quarter of the cases of acute leukemia and related disorders except CML should be changed. Considerable numbers of cases of ATL and MDS were involved in this series. The frequency of the former disease was not high in the high-dose irradiated group, but that of the latter was considerably high. All subtypes of AML except M3 and M6 were present in the high-dose group. The striking difference in CML incidence between Nagasaki and Hiroshima may continue to be a problem in relation to biological response to radiation exposure.

Acute Disease↗
PubMed1988

Aclacinomycin A and etoposide (VP-16-213): an effective regimen in previously treated patients with refractory acute myelogenous leukemia.

Thirty-five patients with acute myelogenous leukemia were treated with aclacinomycin A (60 mg/m2/day for 5 days) and VP-16-213 (100 mg/m2/day for 5 days). All were previously treated and had relapsed or were refractory to primary treatment. Most patients (28) had received prior DAT (daunorubicin, cytosine arabinoside, and 6-thioguanine) induction therapy followed by one or more courses of high-dose cytosine arabinoside (HD-Ara C) as consolidation therapy or as treatment for relapse. One patient was in her fourth relapse, one had relapsed acute megakaryoblastic leukemia (following remission with DAT and HD-Ara-C), one had a treatment-induced leukemia, and four patients were treated for primary treatment failures following two induction courses with DAT or a similar regimen. Fourteen patients had infections at start of therapy. Ten patients died within 14 days of treatment, all from sepsis or bleeding, before their marrow could be evaluated for leukemic response. Fourteen patients (40%) responded; 12 (34%) entered complete remission and two (6%) a partial remission (PR). Two of the four patients who were treated for primary treatment failures went into CR. The median CR duration was 99 days (range 30 to 455 days). Side effects from this treatment were similar to the conventional DAT regimen, although the gastrointestinal toxicity and mucositis appeared to be more severe. In addition, two of the patients had severe but reversible ventricular arrhythmias. The overall response (40%) and CR rate (34%) in this group of previously treated AML patients is encouraging, and further studies are needed to evaluate these preliminary findings.

Aclarubicin↗
PubMed1988

The prognosis and therapy of chronic lymphocytic leukemia under age 50 years.

Twelve percent of patients with CLL studied by the Eastern Cooperative Oncology Group (ECOG) were under age 50 years. Except for clinical stage (more unfavorable presentations), and sex distribution (all but one being male), presenting clinical and laboratory features were identical to the whole population. The response rates and response duration were similar as well. Despite the more advanced stage these patients appear to have a survival advantage over their older counterparts.

Adult↗
PubMed1987

[Evaluation of a new blood pressure cuff for patients with large and normal arm circumferences].

A new multisize blood pressure cuff (TriCuff; Inmed) which automatically adjusts to fit any size arm was tested against the routinely used 12 x 23 cm cuff in patients with an arm circumference less than 33 cm (group A = 30) and against the 15 x 33 cm cuff as well as the 12 x 23 cm cuff in patients with arm circumference greater than 33 cm (group B = 26). Arm circumference in group A was 25 +/- 3 cm and in group B 38 +/- 3 cm (P less than 0.01). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) in group A was 125 +/- 20 mmHg and 78 +/- 11 mmHg respectively with the TriCuff and 124 +/- 19 mmHg and 78 +/- 13 mmHg with the 12 x 23 cm cuff. In group B SBP and DBP with the TriCuff was 134.6 +/- 13.3 mmHg and 84 +/- 17 mmHg respectively compared with 132 +/- 15 mmHg and 83.8 +/- 16 mmHg measured by the 15 x 33 cm cuff. SBP and DBP with the 12 x 23 cm cuff was 139.8 +/- 16 mmHg and 90.8 +/- 14 mmHg respectively. Both these values are significantly higher (P less than 0.05) compared with the new cuff and the larger cuff. Using the 12 x 23 cm cuff in group B resulted in the false diagnosis of hypertension in 3 normotensive patients. The TriCuff gives accurate blood pressure measurements in patients with different arm circumferences and should prevent false-positive diagnoses of hypertension in obese patients.

Arm↗
PubMed1987

Autonomic neuropathy and atypical myocardial infarction in a diabetic clinic population.

The incidence of autonomic neuropathy in 52 insulin-dependent and 87 non-insulin-dependent diabetic subjects was studied as well as the relationship between the type and duration of diabetes, metabolic control and the association of atypical infarctions with autonomic neuropathy. No statistically significant relationship was found between any parameter and the presence of autonomic neuropathy. Atypical infarctions were not confined to subjects with autonomic neuropathy, but the incidence was considerably higher than that in the general population. Position of the infarction did not determine whether it was silent or not. It is suggested that physicians should be alert to the occurrence of silent infarctions in all diabetics and not only those with clinical evidence of autonomic neuropathy.

Adolescent↗
PubMed1987

Remissions in hairy-cell leukemia with pentostatin (2'-deoxycoformycin).

The Eastern Cooperative Oncology Group conducted a study of pentostatin (2'-deoxycoformycin) in 37 patients with hairy-cell leukemia. Among the 27 patients who met all the study's entry criteria, the response rate was 96 percent, with 16 patients (59 percent) entering complete remission and 10 patients (37 percent) partial remission. In one patient no response was observed. These results were not significantly changed by the inclusion of nine additional patients who were found retrospectively not to have fulfilled the entry criteria. When complete remission was attained, maintenance therapy was not given. Despite this, no patient has had a relapse, and the duration of complete remission ranges from 1 to 375 days. Pentostatin appears to be equally effective in untreated patients and in those who have progressive disease after splenectomy or after both splenectomy and treatment with interferon. Whether pentostatin is superior to splenectomy or interferon as therapy for hairy-cell leukemia will have to be assessed by direct comparison in randomized studies. Lengthy follow-up will be required to determine a median duration for the responses of hairy-cell leukemia to pentostatin.

Antineoplastic Agents↗
PubMed1987

Double valve replacement in a patient with osteogenesis imperfecta.

Successful mitral and aortic valve replacement in a patient with osteogenesis imperfecta (OI) is reported. The potential complications of valvular dehiscence and bleeding in patients with this connective tissue disorder is discussed with a short review of the reported experience of valvular surgery in patients with OI.

Adult↗