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Biomedical subjects

J Rubin

Publications and source records attributed to J Rubin.

At least 217 records · Page 12Linked to original sources
PubMed1986

Effect of intraperitoneal insulin on solute kinetics in CAPD: insulin kinetics in CAPD.

The authors evaluated the transport kinetics of insulin and inulin administered intraperitoneally to six diabetic patients undergoing continuous ambulatory peritoneal dialysis. The mass transfer coefficients (MTC) calculated from dialysate to blood for 1.5% and 4.25% dextrose dialysate were (ml/min): insulin 2.9 +/- 0.9, 2.0 +/- 0.5; inulin 3.3 +/- 1.4; 2.9 +/- 1.7, respectively. The MTC for inulin calculated from blood to dialysate was 2.0 +/- 0.7 ml/min. Because insulin disappears from the peritoneal cavity at a rate similar to inulin, it suggests that insulin transport can be defined by diffusion. The derived MTC values for glucose were not altered by the addition of intraperitoneal insulin. The derived MTCs for eight diabetic to thirteen nondiabetic patients were compared. The MTC derived for urea was less among the diabetics (16.6 +/- 2.2 vs. 24.6 +/- 2.6 p less than 0.05), but there were no differences for creatinine, uric acid, glucose, inulin, and protein. The derived values were found to be normally distributed and patients in the upper quartile for one solute were generally in the upper quartile for other solutes.

Ascitic Fluid↗
PubMed1986

The importance of the abdominal viscera to peritoneal transport during peritoneal dialysis in the dog.

The authors sought to evaluate the dialyzing surfaces important for peritoneal dialysis. They reasoned that the most definitive way to evaluate whether any of the gut and associated membranes contributed to transport was to see if transport changed when they were removed. Paired studies measuring rates of peritoneal uptake of glucose, urea, and inulin were carried out in dogs. In the morning, the animals were tested with all peritoneal membranes intact. In the afternoon, the studies were repeated after evisceration. The mass transfer coefficients (MTC ml/min)--glucose (viscera 4.4 +/- 0.7, no viscera 4.9 +/- 0.3)--urea (viscera 16.8 +/- 2.4, no viscera 13.8 +/- 1.0);--inulin (viscera 1.6 +/- 0.6, no viscera 2.2 +/- 0.7) were not changed nor was the amount of mass absorbed significantly different. MTC and peritoneal absorption were unaffected by omentectomy, mesenterectomy, or evisceration. Whether these results were due to nonparticipation of these structures in peritoneal transport or other mechanisms await further studies.

Absorption↗
PubMed1986

Randomized trial of tamoxifen alone or combined with aminoglutethimide and hydrocortisone in women with metastatic breast cancer.

A randomized clinical trial was performed to compare the efficacy of tamoxifen (TAM) alone with that of TAM plus aminoglutethimide (AG) and hydrocortisone (HC). Patients failing TAM could receive AG and HC. Objective responses to therapy were seen in 21 of 49 TAM patients (43%) and 25 of 51 TAM, AG and HC patients (49%). Time to disease progression and survival distributions were not significantly different between the treatment arms. Toxicity was greater for patients treated with TAM, AG, and HC and the trial was discontinued early for this reason. Twenty-four patients received AG and HC after TAM therapy and three (12%) achieved a response. We conclude that the combination of TAM, AG, and HC is not recommended over TAM alone because toxicity appears to outweigh any potential therapeutic advantage.

Adult↗
PubMed1986

A phase II study of combined 5-fluorouracil, doxorubicin, and cisplatin in the treatment of advanced upper gastrointestinal adenocarcinomas.

In a phase II study of 67 patients with upper gastrointestinal carcinomas and measurable disease without previous chemotherapy, we have evaluated the combination of intensive course 5-fluorouracil (5-FU) (300 mg/m2/d for five days) doxorubicin (40 mg/m2 on day 1), and cisplatin (60 mg/m2 on day 1). Courses were repeated every 5 weeks. Among 26 patients with gastric carcinoma, a 50% regression rate was obtained with a median survival for all patients of 9 months. Among 29 patients with pancreatic carcinoma, the regression rate was 21% and the median survival was 4 months. Regressions were also observed in smaller numbers of patients with carcinomas of the gallbladder and ampulla of Vater, as well as in cholangiocellular carcinoma of the liver. Toxic reactions were usually clinically tolerable and consisted primarily of nausea, vomiting, stomatitis, diarrhea, leukopenia, and alopecia. Phase III studies are in progress to place the value of this experimental regimen into clinical perspective.

Adenocarcinoma↗
PubMed1986

Continuous ambulatory peritoneal dialysis as treatment of severe congestive heart failure in the face of chronic renal failure. Report of eight cases.

Eight patients with severe heart failure and renal insufficiency whose conditions were refractory to diuretics were treated by continuous ambulatory peritoneal dialysis. Seven of the eight patients died. Although the patients no longer had uncontrolled congestive heart failure, hospitalization rates failed to improve due to dialysis complications and underlying heart disease. The one long-term survivor was being treated with diuretics alone after peritoneal dialysis was used to control heart failure. Although survival was short after initiation of dialysis (median survival, 225 days), this therapy may merit further study in patients less ill.

Aged↗
PubMed1986

Phase I trial of parenteral 6-thioguanine given on 5 consecutive days.

For almost 30 years, 6-thioguanine (6-TG) has been administered p.o. for treatment of various human cancers, especially leukemias, even though the systemic availability of the drug given p.o. is known to be low and highly variable. Parenterally administered 6-TG has been studied in detail in humans only on a single-day intermittent schedule, although multiple-day intermittent schedules are known to produce maximal cytotoxic effects in several animal species. To develop a multiple-day regimen for parenteral 6-TG therapy, we carried out a dose-seeking and pharmacokinetic study of the drug given i.v. daily for 5 days in patients with various refractory advanced solid tumors. Dose-limiting myelosuppression without other significant toxicity occurred at 55-65 mg/m2 daily for 5 days. After i.v. administration at 65 mg/m2, the mean peak plasma concentration of 6-TG ranged from 6-10 microM. These concentrations are 8-300 times greater than peak plasma concentrations of 6-TG in plasma reported to occur after p.o. administration at 100 mg/m2. We suggest that the antitumor activity of 6-TG be reassessed against human cancers in regimens of i.v. administration on multiple-day intermittent schedules.

Adult↗
PubMed1985

Intra-arterial diazepam. A report of 2 cases.

Two patients are described who suffered severe complications after inadvertent intra-arterial administration of diazepam. The effects of intra-arterial diazepam are discussed and the prevention of this disaster is emphasized.

Adult↗
PubMed1985

Abdominal aortic aneurysm resection--operative risk and long-term results.

The aim of the study was to assess the early results of abdominal aortic aneurysm resection in relation to cardiac and other operative risk factors, assess the magnitude of the procedure, and evaluate longer-term postoperative rehabilitation; 176 patients (mean age 67,1 years) were assessed, of whom 160 (90,9%) had operations. Using the multifactorial index of cardiac risk in non-cardiac surgical procedures (Goldman) the majority fell into the low-risk category (groups I and II). Other risk factors evaluated were respiratory disease, renal insufficiency, hypertension and diabetes. The majority of these patients had creatinine clearance rates of less than 50% of the theoretical normal rate for age. Of 7 postoperative deaths (operative mortality rate 4,4%) 4 followed myocardial infarction, and all the latter patients fell into cardiac risk grade III. The other risk factors did not significantly influence the mortality or complication rates. The highest complication rate occurred in patients who underwent aortic bifurcation graft placement and the lowest in patients who underwent simple infrarenal tube grafting. Of 153 survivors, 10 have been lost to follow-up and 141 have returned to full activity. In conclusion, the cardiac risk index used is a valuable predictor of operative risk. If the patient survives surgery, excellent longer-term rehabilitation can be expected.

Adult↗
PubMed1985

Serial plasma oncotic pressure levels and echoencephalography during and after delivery in severe pre-eclampsia.

Plasma colloid osmotic pressure (PCOP) and echoencephalograms were monitored serially during and after labour in nine nulliparous severe pre-eclamptics receiving parenteral fluids, including infusions of magnesium sulphate and hydralazine. Nine normotensive, age-matched, nulliparous women in labour served as controls. PCOP, lower in the pre-eclamptics (16.1 +/- SD 0.6 mm Hg vs 19.9 +/- 0.7 mm Hg in controls, p less than 0.001) before the start of parenteral infusions, decreased in both groups and at delivery it was 14.1 +/- 0.5 mm Hg in the hypertensive women and 17.2 +/- 0.6 mm Hg in the controls p less than 0.001). After reaching a nadir between 16 and 18 h post partum (pre-eclamptics: 13.8 +/- 0.5 mm Hg; controls 16.2 +/- 0.8 mm Hg; p less than 0.001) the levels rose and at 6 weeks post partum they were greater in the pre-eclamptics (26.2 +/- 1.1 mm Hg vs 22.7 +/- 0.8 mm Hg; p less than 0.01) although the blood pressure in this group had returned to normal. Middle cerebral ventricle width was similar in the pre-eclamptic and normotensive women and remained unchanged during labour and 1 day and 6 weeks post partum. No echographic evidence of brain swelling or symptoms suggestive of pulmonary congestion were observed in either group. The potentially dangerous low PCOPs during and after labour in pre-eclamptic women emphasise the need for minimising crystalloid therapy in pre-eclamptics during labour.

Adolescent↗
PubMed1985

High-dose vitamin C versus placebo in the treatment of patients with advanced cancer who have had no prior chemotherapy. A randomized double-blind comparison.

It has been claimed that high-dose vitamin C is beneficial in the treatment of patients with advanced cancer, especially patients who have had no prior chemotherapy. In a double-blind study 100 patients with advanced colorectal cancer were randomly assigned to treatment with either high-dose vitamin C (10 g daily) or placebo. Overall, these patients were in very good general condition, with minimal symptoms. None had received any previous treatment with cytotoxic drugs. Vitamin C therapy showed no advantage over placebo therapy with regard to either the interval between the beginning of treatment and disease progression or patient survival. Among patients with measurable disease, none had objective improvement. On the basis of this and our previous randomized study, it can be concluded that high-dose vitamin C therapy is not effective against advanced malignant disease regardless of whether the patient has had any prior chemotherapy.

Aged↗
PubMed1985

Clinical trial of adjuvant chemotherapy after surgical resection of colorectal cancer metastatic to the liver.

Adjuvant chemotherapy consisting of 5-fluorouracil and semustine was given to 26 patients who had undergone resection (with curative intent) of hepatic metastatic lesions from a primary colorectal carcinoma. Our objective was to obtain preliminary observations regarding the effectiveness of this regimen for improving the long-term survival associated with hepatic resection alone in these patients (the overall 5-year survival after hepatic resection is 25% at our institution). At the time of analysis, the malignant disease had progressed in 19 of our patients, and 17 patients had died. For all patients who receive adjuvant chemotherapy, the median duration of survival is 34 months, and the estimated 5-year survival is 15%. Statistical analysis indicated no significant advantage in survival for the study patients in comparison with 26 control patients who were treated with hepatic resection only and were closely matched for prognostic factors. Because 5-fluorouracil plus semustine conferred no apparent beneficial effects as an adjuvant treatment in this exploratory study, we do not recommend a definitive randomized trial of this regimen.

Adult↗
PubMed1985

A double blind trial of dipyridamole in CAPD.

Since we had previously shown that dipyridamole augmented inulin and glucose clearance during intermittent peritoneal dialysis we sought to extend our study to the patient undergoing continuous ambulatory peritoneal dialysis. We carried out a double blind study in which patients received either 75 mg of active drug or placebo for a 2-week period. At the end of this period the mass transfer coefficients, between plasma and dialysate, were measured for selected solutes. We did not find any drug effect. The results of our first study together with the results of this study suggest that dipyridamole has no place in the chronic management of patients undergoing peritoneal dialysis.

Administration, Oral↗
PubMed1985

Evaluation of a peritoneal dialysis solution containing polymer.

Glucose is used in peritoneal dialysate to produce the gradient for ultrafiltration. The peritoneal membrane's low reflection coefficient for glucose imposes a demand for high transmembrane concentrations, perhaps adding unwanted body burden of glucose. A polymer with a lower permeation rate used as an osmotic agent would circumvent this. We evaluated the mass transfer coefficient (mtc), T1/2 disappearance from the peritoneal cavity and ultrafiltration capabilities of a 900 dalton (Mn) starch derived polymer. We compared an 8% (455 mOsm/L) and a 10% (484 mOsm/L) polymer (Pol) solution to available dialysate solutions containing 2.5% (399 mOsm/L) and 4.25% (491 mOsm/L) X glucose (Glc). The dialysate compositions were otherwise similar. Using a randomized complete block design, 5 anephric dogs maintained on chronic peritoneal dialysis were studied. The mtc (ml/min) was greater for the glucose than the polymer solutions (p less than 0.05): 2.5%-13 and 4.25%-14 vs 8%-5 and 10%-6. The T1/2 disappearance (min) was also greater (p less than 0.05): 2.5% Glc-112 and 4.25% Glc-111 vs 8% Pol-281 and 10% Pol-252. Over a 180 min. period the 2.5% glucose solution generated the least volume of ultrafiltrate (ml, p less than 0.05): 2.5% Glc-113 and 4.25% Glc-589 vs 8% Pol-640; 10% Pol-912. We conclude that the lower permeation rate of the polymer yields ultrafiltration at a lower dialysate osmolality. A polymer solution may be a feasible alternative to glucose.

Animals↗