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Biomedical subjects

J M Merrill

Publications and source records attributed to J M Merrill.

At least 55 records · Page 3Linked to original sources
PubMed1985

Aziridinylbenzoquinone in recurrent, progressive glioma of the central nervous system. A Phase II study by the Illinois Cancer Council.

Aziridinylbenzoquinone (AZQ) was studied in a Phase II protocol for persons with glioma of the central nervous system (CNS) recurrent or progressive after surgery and radiotherapy. Patients received AZQ, 30 mg/m2 intravenously every 3 weeks if previously untreated or 27.5 mg/m2 if previously exposed to cytotoxic drugs. Partial response was defined as a reduction of at least 50% reduction in the product of the two longest perpendicular diameters of the indicator lesion persisting for a minimum of 28 days. Twenty-eight patients are evaluable for response at this time. Objective response (OR) occurred in four (14.3%): two complete and two partial. Stabilization of disease (SD) was seen in 7 (25.0%). Median survival, in weeks, was greater than 46.0 for responders, 41.7 for SD, and 19.3 for those with progressive disease. The survival experiences are significantly different (P = 0.030 [Breslow]). The OR rate was 21.1% in 19 without prior chemotherapy and 0% in 9 previously treated patients. There were two AZQ-related deaths in patients with prior exposure to nitrosoureas (1 CNS hemorrhage; 1 aspiration pneumonia). One patient had an anaphylactic reaction. Three patients whose tumor initially increased in size subsequently had marked tumor shrinkage. AZQ is an active agent that must be used with added caution in patients who have received nitrosoureas. Initial tumor enlargement may precede response. Although response appears to prolong survival, the correlation between stabilization of disease and survival is not well-defined.

Adolescent↗
PubMed1984

Adjuvant doxorubicin hydrochloride and radiation in stage D bladder cancer: a preliminary report.

The prognosis of patients with stage D bladder cancer is dismal. This report expands the results of our efforts to modify the clinical course of such patients by administration of doxorubicin hydrochloride sandwiched around pelvic radiation. Pathologic stage D bladder cancer was recognized in 19 patients by evaluation of tissue obtained by radical cystectomy and pelvic lymphadenectomy (8), pelvic lymph node dissection (5) or biopsies (3), ileal conduit and pelvic lymph node biopsy (1), or transurethral biopsy of the bladder and prostate (2). Treatment of these patients with doxorubicin hydrochloride before and after radiation was initiated 3 to 4 weeks postoperatively. The treatment regimen consisted of 1) 60 mg. per M.2 doxorubicin intravenously every 3 weeks for 3 cycles, 2) 5,000 rad external radiation to the entire pelvis in 5 to 6 weeks and 3) doxorubicin for 5 cycles. The observed survival rates were 37 per cent at 3 years and 28 per cent at 5 years. The median survival time was 16 months. Five patients had no evidence of disease 13 to 63 months postoperatively. One patient underwent salvage cystectomy for recurrent bladder carcinoma at 33 months and had no evidence of disease at 74 months. One patient was alive with recurrent disease at 13 months. Three patients who died did not complete the protocol owing to metastatic disease, 8 lived 6 to 52 months without recognized disease and died of metastases, and 1 died of a second primary. The extent of surgical excision was not associated significantly with survival. Of 8 patients treated with radical cystectomy 7 suffered a significant obstruction of the small bowel that required decompression or bypass surgery and all 7 recovered completely. These preliminary observations indicate encouraging results with a high but manageable morbidity for this regimen.

Aged↗
PubMed1983

Evidence of a treatment dose response in acute nonlymphocytic leukemias which occur after therapy of non-Hodgkin's lymphoma.

We evaluated the occurrence of second cancers among 517 patients with non-Hodgkin's lymphoma (NHL) treated at the National Cancer Institute. Nine cases of acute nonlymphocytic leukemia (ANL) were observed compared to 0.08 cases expected (ratio of observed to expected cases, 105; 95% confidence limits, 48; 199). The excess risk of ANL was 4.1 cases per 1000 patients per year; the cumulative risk of ANL at 10 years was 7.9 +/- 3.2% (S.E.). A case-control study within the NHL cohort revealed that patients treated with both radiation and chemotherapy were at greater risk of ANL than were patients who received single-modality therapy (relative risk, 6.0; p less than 0.05), especially if the therapy included total-body or hemibody radiation. A positive correlation between cumulative radiation dose to the bone marrow and risk of ANL was demonstrated, independent of chemotherapy duration. A similar correlation between chemotherapy dose and risk of ANL was suggested but could not be proven with the available data. An apparent association between ANL risk and indolent NHL histological subtypes was due to the significantly larger amounts of potentially leukemogenic therapy to which these patients were repeatedly exposed. Only one case of ANL occurred among NHL patients whose initial therapy produced a durable complete remission. Our data are compatible with a multistep model of leukemogenesis and also underscore the need for curative NHL treatment regimens which minimize the duration and quantity of therapy required for optimum patient management.

Adult↗
PubMed1982

Treatment of stage D bladder cancer with adjuvant doxorubicin hydrochloride and radiation.

pathologic Stage D bladder cancer was recognized in 16 patients by evaluation tissue obtained by radical cystectomy and pelvic lymphadenectomy (7), pelvic lymph node dissection (3) or biopsies (3), ileal conduit and pelvic lymph node biopsy (1), or transurethral biopsy of the bladder and prostate (2). Treatment of these patients with radiation preceded and followed by doxorubicin hydrochloride (Adriamycin) was initiated three to four weeks postoperatively. The treatment regimen consisted of the following: (1) doxorubicin 60 mg/M2 intravenously every three weeks for three cycles; (2) 5,000 rad external radiation to the whole pelvis in five to six weeks; and (3) doxorubicin for five cycles. The mean survival was twenty-three months. The survival rate was as follows: one year, 10 of 15 patients at risk; two years, 6 of 11; three years, 5 of 9; four years, 1 of 4; and five years, 0 of 2. Ten patients died six to thirty-six months (mean 13.6) postoperatively. In 6 of the patients significant obstruction of small bowel developed. These preliminary observations indicate encouraging therapeutic results with an acceptable morbidity for this regimen.

Aged↗
PubMed1982

Comparative trial of two teniposide-based combination chemotherapy regimens for the treatment of advanced malignant lymphomas.

One hundred and twenty-three patients with advanced measureable malignant lymphomas resistant to conventional chemotherapy were entered in a prospectively randomized trial of two teniposide (VM-26)-based combination chemotherapy regimens: V-PLAT (VM-26, cisplatin, and prednisone) and V-HEX (VM-26, hexamethylmelamine, and prednisone). Ninety-seven eligible and evaluable patients received protocol therapy. Sixteen percent of the patients had Hodgkin's disease, and 84% had non-Hodgkin's lymphoma. All patients were ambulatory (Eastern Cooperative Oncology Group Performance status 0, 1, or 2), 70% had stage IV disease, 59% had "B" symptoms, and all had failed either two or three previous chemotherapy regimens. Toxicity was mainly hematologic and significantly greater with V-PLAT. Objective tumor responses were seen in nine of 45 patients (20%) treated with V-PLAT (duration, 4-35 + weeks) and in four of 51 patients (8%) treated with V-HEX (duration, 10-65 + weeks). Among the 12 patients with histologically confirmed histiocytic lymphoma treated with V-PLAT, five (42%) experienced objective tumor responses, including two complete responses. Overall median survival was approximately 6 months, with no difference between treatment regimens. Limited antitumor activity of these combination regimens in patients with advanced malignant lymphomas has been demonstrated. However, the objective response rates were not higher than we have previously seen with either VM-26 (22%) or hexamethylmelamine (27%) given in maximum tolerable doses as single agents.

Adult↗
PubMed1980

Relocating primary care patients from tertiary hospital to neighborhood health centers.

A national commission recently recommended that public general hospitals assume the initiative in arranging neighborhood-based primary care. A survey of medically underserved census tracts conducted in Houston 11 years ago revealed that 80% of residents interviewed stated that if neighborhood clinics were developed they would use them. After ten years' experience with eight neighborhood clinics, 300,000 ambulatory visits continue to be made annually to tertiary care hospitals, and more than 19.7 +/- 2.1% of 90,000 yearly visits to the emergency room are for primary care problems, though a neighborhood clinic is less than half this distance from the patient's home. Therefore, before communities embark on implementing the commission's recommendations, they should consider carefully the health care attitude, knowledge, and utilization behavior of their prospective patients.

Attitude to Health↗
PubMed1980

"Ecologic niche" of undetected hypertensives at increased risk.

The "ecologic niche" where large numbers of young black hypertensive males can be found is in the emergency clinics of our public general hospitals. Unfortunately, present medical practices in these clinics do not adequately identify the hypertensive patient. Because educational measures are unlikely to change this deficiency, the present organization and management of the emergency clinics must be changed to give these hypertensive patients effective treatment. As the public becomes more aware of the successes in treating mild hypertension, we can anticipate that health care practices of both hypertensive patients and their physicians will improve.

Adolescent↗
PubMed1979

Bleomycin in combination chemotherapy of metastatic Wilms tumor: a late recurrent case, refractory to conventional therapy.

A patient with a late recurrence (13 years) of Wilms tumor is presented. After relapse with conventional chemotherapy, an objective partial remission was obtained with bleomycin, vinblastine, cyclophosphamide, and cis-platinum. Stable disease was noted when bleomycin was withheld. Bleomycin in this combination appeared to effect a good response, and further studies of chemotherapy of Wilms tumor should include bleomycin in combination with other active agents.

Antineoplastic Agents↗