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Biomedical subjects

J M Cruz

Publications and source records attributed to J M Cruz.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Neuroleptic malignant syndrome in the elderly: description of 4 patients].

The neuroleptic malignant syndrome is a fulminant, life-threatening reaction to neuroleptic medication. It is characterized by fever, rigidity, autonomic disfunction and fluctuating consciousness. Usually described in young adults with psychiatry illnesses, its presentation in an elderly population has received scant attention in medical literature. We describe the clinics and evolutive characteristics of 4 cases of this syndrome in elderly which a mean age of 78 years. We emphasise about the existence of a brain organic illness with dementia as a predisposing factor, and the correct evolution of the showed cases in probably relation with measures and drug therapy.

Aged↗
PubMed1996

Octreotide acetate in refractory bone marrow transplant-associated diarrhea.

OBJECTIVE: To evaluate the effectiveness of octreotide acetate in the treatment of refractory bone marrow transplant-associated diarrhea. DESIGN: Case series encompassing 30 months. SETTING: A 12-bed bone marrow transplant unit at a tertiary care medical center. PARTICIPANTS: Twenty-four patients with bone marrow transplant-associated diarrhea who did not improve with supportive or attapulgite therapy. INTERVENTIONS: Patients received subcutaneous octreotide acetate at doses ranging from 50 to 250 micrograms 2 to 3 times daily. Concurrent treatment with antimotility or antisecretory agents did not occur. MAIN OUTCOME MEASURES: The number of bowel movements and stool volumes were recorded daily. Complete response to octreotide therapy was defined as a reduction of both stool output and stool frequency by more than 50% within 72 hours. Partial response was defined as a reduction of either stool output or stool frequency by more than 50% within 72 hours. Treatment failure occurred if neither of the two parameters decreased by 50% within the designated time period. RESULTS: Twenty-eight treatment challenges were initiated in the 24 patients evaluated. Diarrhea completely or partially subsided in 23 of 28 challenges (82.1%) within 72 hours. Stool output decreased from 1143 +/- 595 at baseline to 252 +/- 356 mL/d within 72 hours (p < 0.005). Stool frequency decreased from a baseline of 7.5 +/- 3.4 to 2.7 +/- 2.2 stools per day within 72 hours (p < 0.005). Adverse effects associated with octreotide were pain or burning at the injection site (24.1%), abdominal pain (13.8%), and increased stool output (6.9%). CONCLUSIONS: These data suggest octreotide acetate significantly reduces stool output and frequency in patients with refractory bone marrow transplant-associated diarrhea. Additional research is necessary before this agent can be recommended for routine use in this patient population.

Adolescent↗
PubMed1996

Urinary elimination of cyclophosphamide alkylating metabolites and free thiols following two administration schedules of high-dose cyclophosphamide and mesna.

Twenty patients with a variety of neoplastic diseases were treated with preparative regimens containing high-dose cyclophosphamide (CY) administered as a 2-h infusion (60 mg/kg) for 2 days or by continuous infusion (1500 mg/m2/day) for 4 days. In patients receiving CY by 2-h infusion, the uroprotectant 2-mercaptoethane sulfonate (MESNA) was administered as an intermittent, bolus intravenous infusion (20% of CY dose) every 6 h. In patients receiving continuous infusion CY, MESNA was administrated concomitantly at an equivalent dose to CY by continuous infusion. During the first 24 h of CY administration, urine was collected at 2-h intervals and analyzed for free thiols and CY-alkylating metabolites. In patients receiving CY by short infusion and MESNA by intermittent bolus infusion, urinary concentrations of alkylating metabolites peaked at 4-8 h. During each dose of MESNA, urinary free thiols peaked at 2 h following administration but fell to pre-treatment levels at subsequent intervals. In patients receiving CY by continuous infusion, CY alkylating metabolites increased gradually over the 24-h study period while free thiols remained at a constant level during this period. With bolus administration of CY and intermittent bolus administration of MESNA every 6 h, there are periods where urinary CY-alkylating metabolites are elevated and free thiol concentrations are diminished. During continuous infusion of CY and MESNA, urinary CY alkylating metabolites reached peak concentrations at 18-22 h while the exposure of the bladder to free thiols remained constant. Recommendations are provided to increase the exposure of free thiols in the bladder when MESNA is administered by bolus or continuous infusion.

Adult↗
PubMed1996

Quality of life in breast cancer patients before and after autologous bone marrow transplantation.

The purpose of this study was to compare pre- and posttreatment quality of life (QOL) in breast cancer patients undergoing high-dose chemotherapy with autologous bone marrow transplantation (ABMT). Fifty-two female breast cancer patients were assessed on overall QOL, mood status, and social support before transplantation. After ABMT, 24 patients were assessed on the same measures as well as a measure of depressive symptoms and specific concerns identified in a structured interview. Mean pre- and post-transplant scores on the quality of life measure, mood scores and social support were not significantly different. Eight patients (33%) reported depressive symptoms post-transplantation. In the structured interview, a percentage of patients reported concerns in the following areas: job or work situation (25%); finances (42%); general physical health (50%); general frame of mind (25%); appearance (33%); health or life insurance (37%); personal or intimate physical relations (33%); planning for the future (38%). QOL and mood following ABMT improved slightly and compares favorably with breast cancer patients treated with conventional treatment. However, approximately 30% of patients had problems with sexuality, fatigue and depressive symptoms and may need follow-up psychosocial care in these areas. ABMT may pose no more threat to quality of life than conventional chemotherapy.

Adult↗
PubMed1995

The initial electrocardiogram pattern is a strong predictor of outcome in acute myocardial infarction.

We analyzed the significance of the initial electrocardiogram on the clinical outcome of 205 consecutive patients with a first myocardial infarction. Three different patterns of the electrocardiogram were defined: (A) Tall symmetric T waves in the involved leads; (B) ST segment elevation > 0.1 mV in two or more adjacent leads; and (C) ST segment elevation together with distortion of the terminal portion of the QRS complex in two or more adjacent leads. Twelve patients were considered to have an initial 'A' electrocardiogram, 151 an initial 'B' electrocardiogram, and 42 an initial 'C' electrocardiogram. Four factors were significantly related to mortality: age, ST, Killip class and electrocardiographic pattern. The mortality rate was 0% in group A, 7.9% in group B, and 26.2% in group C (P = 0.0019). Patients with type C electrocardiograms had a significantly worse Killip classification and a significantly higher sum of ST segment elevation. Among patients with inferior infarction, the mortality rate was 1.4% in type B vs. 24.1% in type C (P = 0.0005). Among patients with anterior infarction, the mortality rate was 13% in type B vs. 30.8% in type C (P = 0.089). We conclude that the pattern of the initial electrocardiogram is a strong predictor of outcome in acute myocardial infarction, especially if it is inferior.

Adult↗
PubMed1995

Local anesthesia by jet-injection device in minor dermatologic surgery.

BACKGROUND: Pain and needle-phobia can be a problem during the application of local anesthesia with syringe and needle. OBJECTIVE: To evaluate a jet-injection device (without needle) to deliver local anesthesia. METHODS: Two hundred and six minor dermatological procedures using a jet-injection device for administering local anesthesia into skin tissue were performed. We comment on the technical procedures, application, usefulness in relation to areas involved and the anatomical location of lesion, and total dosage of the anesthetic agent. RESULTS: Total absence of pain during installation of anesthetic (N = 194; 94%). Good level of anesthesia in all patients. No local adverse effects. CONCLUSION: The jet-injection device is easy to handle, it is harmless, it provides good levels of anesthesia, and the dosage of anesthetic agent is smaller than the dosage administered with conventional methods.

Ambulatory Surgical Procedures↗
PubMed1995

Reactivation toxoplasmic retinochoroiditis in patients undergoing bone marrow transplantation: is there a role for chemoprophylaxis?

The objective of this study was to report the occurrence of reactivation ocular toxoplasmosis in bone marrow transplant (BMT) recipients and to propose guidelines for identification and chemoprophylaxis of high-risk patients. The study design was a series of cases from the tertiary care university hospital which has an active BMT program. The patients were two recipients of autologous BMTs with past histories of toxoplasma retinochoroiditis who developed symptomatic reactivation of ocular toxoplasmosis as documented by formal opthalmologic examination in the early post-transplant period. Opthalmoscopic examinations in the two patients with non-Hodgkin's lymphoma who received autologous transplants and then developed decreased visual acuity in the first week after transplant revealed recurrent retinochoroiditis adjacent to old toxoplasma lesions. Pre-transplant eye examinations in both patients had demonstrated only inactive chorioretinal scars. Therapy with sulfadiazine, pyrimethamine and prednisone ultimately led to resolution of retinitis in both patients. BMT recipients who are seropositive for antibody to T. gondii and have findings consistent with previous toxoplasma retinochoroiditis on pre-transplant ophthalmologic examination appear to be at risk for reactivation of ocular toxoplasmosis in the early post-transplant period and may warrant preventive chemoprophylaxis for toxoplasmosis.

Animals↗
PubMed1995

Phase I study of continuous infusion 6-thioguanine in patients with acute leukemia.

6-Thioguanine (6-TG) was administered as a continuous i.v. infusion for 7 days to 24 patients with relapsed or refractory acute leukemia or in the blast phase of chronic granulocytic leukemia. The daily dose of 6-TG was escalated from 37.5 mg/m2 to 160 mg/m2. Stomatitis was dose-related and dose-limiting with a maximum tolerated dose of 120 mg/m2 daily. Cutaneous reactions were dose-related but not dose-limiting. The recommended dose for phase II trials in acute leukemia is 120 mg/m2 per day as a continuous infusion for 7 days. There were two complete and four partial remissions among all patients. At the suggested phase II dose of 120 mg/m2 there were two complete remissions and one partial remission in five evaluable patients.

Acute Disease↗
PubMed1994

[Acute renal failure after the administration of enalapril as presentation form of Takayasu's arteritis].

The case of a 19 year old patient with Takayasu arteritis with exclusive involvement of the abdominal aorta and without involvement of the renal arteries who presented severe arterial hypertension during the acute phase of the disease is referred. The administration of a dose of 20 mg of enalapril maleate was followed in less than 24 hours by lameness of the lower limbs and acute oligoanuric renal failure, both of which were reversible after discontinuation of the drug. During the inflammatory phase of the disease, treatment with high doses of prednisone was effective in the control of the general symptoms and the biologic parameters of inflammation. Surgical revascularization was successfully carried out 5 months after diagnosis. Two years later the patient continues to be normotense and asymptomatic.

Acute Kidney Injury↗
PubMed1994

Outcome of patients with diabetes and unstable angina. A subgroup analysis in the Spanish Multicentre Trial of trifusal in unstable angina. Grupo de Estudio del Trifusal en la Angina Inestable.

We analyzed the clinical characteristics of the 58 diabetic and 218 nondiabetic patients enrolled in the Spanish multicentre trial of trifusal in unstable angina. After 6 months of follow-up, 25 suffered from myocardial infarction or death, 10 of which were diabetics (17.2%) and 15 nondiabetics (6.9%) (P = 0.0146). This difference remained significant after multivariate analysis. We conclude that diabetes is an independent predictor of adverse outcome in patients with medically treated unstable angina.

Aged↗
PubMed1994

Transient myocardial injury after elective electrical cardioversion.

A patient with recent myocardial infarction underwent elective direct current countershock because of atrial fibrillation. After several shocks, the ST segments were strikingly raised throughout the precordial leads, which disappeared with the administration of a perfusion of nitroglycerin. This case is evidence that electrical cardioversion can cause myocardial damage.

Aged↗
PubMed1994

Tamoxifen versus high-dose oral medroxyprogesterone acetate as initial endocrine therapy for patients with metastatic breast cancer: a Piedmont Oncology Association study.

PURPOSE: To determine in a prospective randomized trial whether high-dose orally administered medroxy-progesterone acetate (MPA) was superior to tamoxifen in patients with recurrent or metastatic breast cancer who had received no prior endocrine therapy in either the adjuvant or advanced setting. PATIENTS AND METHODS: Patients initially received either tamoxifen 20 mg/d orally or MPA 1 g/d orally. At the time of disease progression, patients were crossed over to the other regimen. Eligibility required patients to be age > or = 18 years, performance status 0 to 3, and estrogen receptor (ER)- or progesterone receptor (PR)-positive or unknown. RESULTS: One hundred eighty-two eligible patients were entered and 166 were assessable for response. Complete plus partial response rates for tamoxifen and MPA were 17% and 34%, respectively (P = .01). Patients with bone metastases had a significantly higher partial response rate with MPA compared with tamoxifen (33% v 13%). Median time to treatment failure was 5.5 months for tamoxifen and 6.3 months for MPA (P = .48). The median survival duration was 24 months for tamoxifen and 33 months for MPA (P = .09). Multivariate analysis showed that treatment significantly influenced response rate, but not time to treatment failure or survival. After treatment failure following MPA, six of 42 patients (14%) treated with tamoxifen responded, compared with six of 49 (12%) treated with MPA following tamoxifen. Both agents were associated with minimal toxicity, but 35% of patients on MPA gained more than 20 lb as opposed to only 2% on tamoxifen. CONCLUSION: In this trial, initial treatment with MPA of endocrine-naive metastatic breast cancer patients was associated with a significantly higher response rate but not with improvement in time to treatment failure or survival, when compared with initial treatment with tamoxifen. Further randomized trials in patients with bone metastases are warranted to determine if high-dose progestin therapy is superior to tamoxifen in these patients.

Administration, Oral↗
PubMed1992

Menogaril in the treatment of relapsed multiple myeloma. A phase II trial of the Cancer Center of Wake Forest University.

Fifteen patients with relapsed multiple myeloma (MM) were treated with menogaril 160 mg/m2 intravenously (IV) every 28 days. No responses were seen: 8 patients had stable disease, 4 progressed after one course of therapy, and 3 patients were removed from study after 1 course for other reasons. Four of the 8 patients with stable disease had an improved performance status, and 3 had a decrease in analgesic use. The major toxicity was myelosuppression. The median progression-free interval was 3.0 months with a range of 0.7 to 22 months and median survival was 11.3 months with a range of 0.7 to 39+ months. Menogaril displays little activity in patients with previously treated MM.

Antineoplastic Agents↗
PubMed1992

Rapid intravenous infusion of amphotericin B: a pilot study.

PURPOSE: The administration of amphotericin B in the conventional prolonged infusion over 4 to 6 hours is complicated by the acute toxicities of fevers and chills in 50% to 90% of patients and the chronic toxicities of increased creatinine levels and hypokalemia in 60% to 80% of patients. To determine the safety and toxicity of rapid infusions, we conducted a prospective, nonrandomized study in patients with clinical indications for antifungal therapy. PATIENTS AND METHODS: Twenty-five granulocytopenic adults with acute leukemia and myelodysplastic syndromes were enrolled in a phase I trial using four sequentially shorter infusion durations: a standard infusion over 4 hours (n = 3) and shortened infusion durations at 3 hours (n = 3), 2 hours (n = 4), and 1 hour (n = 15). Toxicity was assessed by daily examinations of study subjects by one of the study investigators, by documentation of all infusion-related fevers and chills, and by daily monitoring of serum levels of creatinine, potassium, magnesium, and aspartate aminotransferase. RESULTS: Temperatures greater than 38 degrees C occurred in 16 of 25 (64%) patients, but only two had temperatures exceeding 40 degrees C. Chills were observed in 13 of 25 (56%) patients, but only one had severe symptoms. Serum creatinine increased more than 0.5 mg/dL (44.20 mumol/L) above the pretreatment baseline in 17 of 25 (68%) patients, and the absolute creatinine level was greater than or equal to 2.0 mg/dL (176.8 mumol/L) in 10 of 25 (40%) patients. Serum potassium levels dropped below the normal limit of 3.5 mEq/L (3.5 mmol/L) in all patients, but no patient had potassium levels below 2.5 mEq/L (2.5 mmol/L). Intravenous potassium supplementation was administered to all patients and exceeded 100 mEq/d in 12 of 25 (48%) patients. CONCLUSIONS: Rapid infusions of amphotericin B are safe, are associated with similar toxicity as prolonged infusions, and facilitate inpatient care by decreasing nursing time needed for administration and minimizing scheduling conflicts with other necessary intravenous medications. Shorter infusions also facilitate outpatient and home administration of amphotericin B.

Aged↗
PubMed1992

High-dose progestin therapy for metastatic breast cancer.

Progestin therapy has become an established endocrine modality for the treatment of metastatic breast cancer, with medroxyprogesterone acetate and megestrol acetate being the most widely used agents. Both drugs display similar effectiveness as initial and secondary therapy for patients with advanced disease, with combined complete and partial response rates of approximately 30% to 40%. Uncontrolled trials have suggested that high doses of medroxyprogesterone may be more effective than lower doses, but randomized trials have yielded conflicting results. Clinical trials of megestrol acetate have demonstrated it to be an affective, well-tolerated oral progestin, and a recent randomized trial has suggested that higher megestrol acetate doses may be associated with not only improved response but also improved time to disease progression and survival. Further trials of high-dose megestrol acetate for both initial and secondary therapy are under way, and their results will provide valuable information concerning the role of such treatment.

Breast Neoplasms↗
PubMed1992

Prevention of myocardial infarction by nitroglycerin plus intravenous beta-blockers.

Seven patients with ongoing angina with ST-segment elevation, refractory to oral nifedipine and intravenous nitroglycerin, were treated by adding intravenous beta-blockers. Chest pain resolved in all of them in a few minutes, and myocardial infarction did not develop in 5 patients. We recommend this approach for patients to whom thrombolytics are contraindicated or have been very recently administered, although further investigation is needed to extend its application more widely. It does not preclude the use of other therapies, if considered necessary.

Adrenergic beta-Antagonists↗
PubMed1992

High-dose megestrol acetate as third-line endocrine therapy for metastatic breast cancer.

High-dose megestrol acetate (800 mg/day) was administered to 34 patients as third-line endocrine therapy for metastatic breast cancer after progression on standard-dose megestrol acetate (160 mg/day). Among the 32 evaluable patients, no complete or partial response occurred. Ten patients remained stable and 22 progressed. No patients remained on study. Median time to progression was 2 months (range, 1-13 months). The use of high-dose megestrol acetate did not result in objective responses but may have been effective in delaying progression in one third of patients.

Adult↗