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Biomedical subjects

M Greenberg

Publications and source records attributed to M Greenberg.

At least 163 records · Page 9Linked to original sources
PubMed1991

Cancer mortality in merchant seamen.

Cancer mortality excess has been reported repeatedly over the past hundred years to occur in merchant seamen. More recently lung cancer has been found to account for some of this excess and the question of the contribution made by cigarette smoking raised. In the one study where there was some information on smoking habit, it did not appear that cigarettes would have accounted for all the excess cancer observed. In other mortality studies, where excess cancer mortality was observed, the other cigarette-linked causes of death were not prominent. In a preliminary mortality analysis of a small population of merchant seamen, two cases of malignant mesothelioma have so far been identified, and in a national mesothelioma register 28 cases have been reported in seamen: both instances constitute abnormal occurrences. The presence of substantial amounts of asbestos-containing materials in naval construction which are continuously subjected to vibration and intermittently disturbed during servicing, and the detection of radiological stigmata consistent with asbestos exposure, add plausibility to the hypothesis that occupational asbestos exposure contributes to the apparent excess cancer mortality in merchant seamen. Methodologic deficiencies in epidemiologic studies reported to date make for uncertainty. Properly designed studies will be needed to quantify disease excess and to identify potentially causal associations. Even in the absence of such data it would be prudent to contain the asbestos currently installed and to promote smoking cessation programs.

Adolescent↗
PubMed1991

Acute lymphoblastic leukemia with t(4;11) translocation after osteogenic sarcoma.

The authors report a case of acute lymphoblastic leukemia (ALL) with t(4;11) (q21;q23) occurring 9 months after treatment of osteogenic sarcoma. Cell surface marker and molecular analyses suggest early B lineage involvement. This is the first report, to the knowledge of the authors, of t(4;11) ALL arising after an osteogenic sarcoma. The observations of the authors support the possibility of a causal relationship between exposure to carcinogens and the occurrence of leukemia with t(4;11).

Adolescent↗
PubMed1991

A landmark case in asbestosis.

The first published account of disease attributed to occupational asbestos exposure was that of Nellie Kershaw, who died in 1924. The circumstances relating to that case are described and explanations are given for its not having a greater impact on policy at that time. This case, starting in 1898, is set in the context of missed opportunities for preventing a major public health hazard. The effects of this hazard are still being witnessed today.

Adult↗
PubMed1991

Are non-whites at greater risk for occupational cancer?

All occupational cancer epidemiology articles that reported data on non-whites from four major journals were identified for the years 1984-1987. In addition to these 14 papers, four more papers were identified from computer searches, and another 13 were found by following up references from the original 14. Within these 31 papers, there were 36 analyzable cohorts (subgroups by job and sex). Five cohorts had elevated all-cancer mortality ratios in non-whites without an increase in whites. Sixteen cohorts showed elevated ratios in both racial groups, with 11 of the 16 having a higher non-white cancer mortality ratio than white cancer mortality ratio. For the 25 studies in which at least one racial group's cancer ratio was elevated, the non-white ratio exceeded the white ratio in 17 (68%). The overall paucity of articles on non-white cancer mortality, as well as the apparent trend toward increased occupational cancer mortality in non-whites, is discussed.

Bias↗
PubMed1991

Twice-daily tapering dexamethasone treatment during cranial radiation for newly diagnosed brain metastases.

Twenty evaluable patients with newly diagnosed brain metastases underwent treatment with a novel dose/schedule of dexamethasone aimed at reducing steroid toxicity during palliative radiation therapy. All patients received twice daily dexamethasone starting at 8 mg bid for four days then 4 mg bid for four days then 2 mg bid until the last day of radiation therapy. The radiation prescriptions were not standardized varying from 2000 cGy/5 fractions to 5800 cGy/29 fractions. Fourteen patients received dexamethasone for a minimum of 24 hours before their first radiation treatment and 7 (50%) experienced improvement in neurologic symptoms/signs prior to starting radiation treatments. Fourteen patients completed the planned course of radiation and dexamethasone. Only 1 patient needed to restart dexamethasone within 30 days of finishing radiation because of steroid reversible neurologic deficits. Steroid toxicity was mild including hyperglycemia (1), candida esophagitis (1), steroid pseudorheumatism (2), peripheral edema (1) and steroid withdrawal syndrome (1). Only two toxic events were recorded in patients receiving steroids less than 21 days. Twice daily dexamethasone appears to provide good clinical results with minimal morbidity.

Administration, Oral↗
PubMed1991

Communicating to an alarmed community about cancer clusters: a fifty state survey.

A survey of all 50 U.S. states conducted in 1989 showed that 1,300-1,650 requests for cancer cluster investigations were received by state health departments. Most states responded with a three-stage process aimed at prioritizing clusters at each stage. Those situations deemed most serious were passed on to the next stage of evaluation. Thirty-eight of the 50 states said that communicating risk information to informants was a productive outcome, and 26 states sent materials to informants explaining the causes of cancer, clusters, how clusters are investigated, and other health education materials. Many states requested detailed information about reported clusters from informants. States with a major commitment to protecting public health and environment were more likely to provide information than states with weaker programs. Some officials discouraged people from pursuing their requests by trying to convince informants that a problem did not exist and by overwhelming them with questions and information. We recommend that health departments train their respondents in risk communications and establish an organizational climate that provides financial resources and institutional support appropriate to the complex task of communicating risk information to a public alarmed about a cancer cluster.

Cluster Analysis↗
PubMed1991

Early experience with the smart laser in the treatment of atherosclerotic occlusions.

A dual-laser system (helium-cadmium and pulsed dye) capable of continuous computer analysis of spectroscopic characteristics of tissue fluorescence, which can distinguish atherosclerotic plaque from components of normal arterial wall, was used to deliver laser energy to ablate plaque. During a 1-year period this system was used to facilitate balloon angioplasty of short (3 to 17 cm) total occlusions of the superficial femoral or popliteal arteries only when standard angioplasty techniques were ineffective. During the year of the study, in one institution 415 patients were subjected to arteriography of the lower extremities for leg ischemia (397 for limb salvage indications). Standard angioplasty techniques were used in 94 of these patients; 218 patients were unsuitable for standard angioplasty, did not fulfill criteria for "smart" laser treatment, and underwent standard bypass operations. Only 11 patients (plus six others in the second institution) requiring treatment fulfilled the criteria for use of the "smart" laser. In 10 patients the occluding lesion was traversed by the laser wire (diameter 0.021 inch), and luminal patency was effectively restored by balloon angioplasty to greater than or equal to 70% of the most normal-appearing segment of that artery. Satisfactory luminal patency has persisted for 2 to 12 months (mean 6 months) in nine patients; the lesion in the tenth patient restenosed at 3 months. The laser procedure was unsuccessful in all three patients with occlusions greater than 10 cm and in four others. Although there were three microperforations with the laser wire, there were no clinically significant complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Preoperative chemotherapy for children with Wilms' tumor.

Five years ago, the use of preoperative chemotherapy for Wilms' tumor was adopted at this institution. Thirty children ranging in age from 5 months to 9 years had histologically confirmed Wilms' tumor (needle biopsy, n = 26; open biopsy, n = 4). Stage was determined by chest and abdominal computed tomography (CT) scan. Bilateral tumors were present in 6 children. All children received actinomycin D and vincristine from 3 weeks to 6 months before surgery. Seven children with bilateral tumors or stage IV disease also received adriamycin. CT-measured tumor masses shrunk in most cases. Subsequently, nephrectomy was performed in 23 patients and partial nephrectomy in 4, 2 of whom had bilateral disease. In 2 patients, residual bilateral well-differentiated epithelial tumor was not surgically resected. One child died before surgery. Reevaluation at delayed total or partial nephrectomy resulted in a downstaging of disease in 12 (41%). Further chemotherapy and radiation was based on the surgical stage. Postoperative chemotherapy (4 months to 2 years) was administered to all patients. The chest and/or abdomen were radiated in 12. Four patients (13%) died, 1 of radiation pneumonitis and 3 of the disease progression (2 with unfavorable histology, 1 of whom had bilateral disease). Two of 4 with unfavorable histology and 4 of 6 with stage IV disease have survived. It is concluded that this preoperative chemotherapy protocol is as effective as the National Wilms' Tumor Study (NWTS) protocol. The treated tumor is smaller, less friable, and easier to remove. Furthermore, because of downstaging, less radiation is necessary for cure.

Biopsy, Needle↗
PubMed1991

Fatal pulmonary arterial occlusive vascular disease following chemotherapy in a 9-month-old infant.

Fatal pulmonary hypertension developed in an infant during the 7-month period in which he received, via a central venous catheter, combination chemotherapy for stage IV neuroblastoma as well as intermittent parenteral feeding. In a lung biopsy and at autopsy, small pulmonary arteries showed diffuse medial hypertrophy and peripheral muscularization, very extensive concentric intimal fibrosis, and focal eccentric fibrosis evolving from organizing thrombi. Pulmonary veins were normal. Hypothetically, chemotherapeutic drug therapy (possibly potentiated either by the parenteral nutrition or simply by the vehicular fluids causing volume loading of the pulmonary circulation) could cause occlusive pulmonary arterial disease by several mechanisms, but the association has not been described previously, although use of such drugs has been reported with pulmonary veno-occlusive disease.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Reduction in tumor burden allowing partial nephrectomy following preoperative chemotherapy in biopsy proved Wilms tumor.

During the last 6 years a treatment protocol of radiographic staging along with percutaneous biopsy to establish a histological diagnosis has been used in 37 patients with Wilms tumor. Combination chemotherapy was given for 4 to 6 weeks before definitive surgical resection. In 9 patients tumor shrinkage was sufficient to permit preservation of a portion of the affected kidney(s). In stage V disease partial nephrectomy was accomplished in 5 patients. In 4 additional patients with unilateral disease downstaging also allowed partial nephrectomy. The radiological and histological changes that allowed this limited surgery are analyzed and compared.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Radiation-induced effects in multiprogrammable pacemakers and implantable defibrillators.

Twenty-three multiprogrammable pacemakers and four implantable cardioverter defibrillators (ICDs) containing either complementary metal-oxide semiconductor (CMOS) or CMOS/Bipolar integrated circuit (IC) technology were exposed to 6-MV photon and 18-MeV electron radiation at various dose levels. Of the 17 pacemakers exposed to photon radiation eight failed before 50 Gy, whereas four of the six pacemakers exposed to electron radiation failed before 70 Gy. Photon scatter doses were well tolerated. For the ICDs detection and charging time increased with accumulated radiation dose, the charging time increased catastrophically at less than 50 total pulses delivered when compared with the charging time of six implanted ICDs. Sensitivity and output energy delivered by the ICD pulse were constant during the test. It was found that devices using the shorter channel length IC technology (i.e., 3 microns CMOS) were per se harder to ionizing radiation than the devices using larger channel length IC technologies (i.e., either 8 microns CMOS or combined 5 microM CMOS/20 V Bipolar). In fact, none of the devices based on 3 microns CMOS IC technology failed before 76 Gy, which is above the highest dose level (70 Gy) normally used in radiation oncology treatments.

Electric Countershock↗
PubMed1991

Newspaper coverage of cancer clusters.

This study reports an analysis of 176 newspaper articles about cancer clusters. The type of diseases, number of diseases, and status of ongoing health investigations were reported in the majority of articles. But background information such as, comparison of actual and expected number of cases, environmental causes and their confounders, and the existence of other clusters were not reported as often. Statements about risk were reported in most articles and, contrary to our expectations, were relatively balanced among risk asserting, risk denying, and mixed opinions. We noted a preponderance of risk asserting statements in the beginning of stories. Cluster stories cited an average of three sources, and two of these three sources were usually government officials. The remaining sources were divided among citizens, representatives of environmental advocacy groups and industry, and unaligned experts. Drawing on these data, we offer some suggestions to improve communication between scientists and journalists.

Environmental Pollution↗
PubMed1991

Intracranial germ-cell tumors in children.

All patients with confirmed intracranial germ-cell tumors treated at the Hospital of Sick Children during the period January, 1952, to December, 1989, were reviewed. Of the 51 tumors reviewed, 16 were located in the suprasellar region, 32 in the pineal region, and three in both the pineal and the suprasellar regions. Forty-nine patients underwent surgical resection which was total in seven and partial in 20, and consisted of a biopsy in 22. Two patients were managed on the basis of serum and cerebrospinal fluid markers. Surgical tools such as the operating microscope, the ultrasonic surgical aspirator, and the laser beam allowed safe debulking and removal of the deep-seated tumors in the pineal region. There were no operative deaths in the 36 patients treated since 1972, who included 23 with pineal tumors. Twenty-five patients with germinomas received radiotherapy and had a 5-year survival rate of 85.1%. Thirteen patients with non-germinoma germ-cell tumors received radiotherapy and had a 5-year survival rate of 45.5%. On the basis of this review, the authors recommend resection of pineal and suprasellar germ-cell tumors in order to firmly establish an accurate histological diagnosis to guide the extent of adjuvant therapy. In the case of a pure germinoma without evidence of dissemination, adjuvant therapy consists only of local radiotherapy. On the other hand, for malignant non-germinoma germ-cell tumors, adjuvant therapy must include chemotherapy as well as craniospinal axis radiotherapy.

Adolescent↗
PubMed1991

Accidental use of low-dose 5-fluorouracil in pregnancy.

Five percent 5-fluorouracil (5-FU), an antineoplastic agent, is often applied to the lower genital tract in the treatment of vaginal and vulvar human papillomavirus infections. Little is known regarding possible teratogenic effects from its topical use in pregnancy. Five cases of antenatal lower genital tract 5-FU use were correlated with pregnancy outcome. Topical 5-FU was applied up to 16 weeks' gestation. Intravaginal doses ranged from 1 to 2.5 g; one patient applied 5-FU to the vulva. Antenatal ultrasound performed on four patients did not show any fetal structural abnormalities. One patient underwent antenatal genetic amniocentesis that detected a 47,XXX complement of chromosomes. All the pregnancies continued without complications and with subsequent term delivery of healthy infants. The unwitting vaginal and vulvar use of 5-FU in pregnancy did not result in significant morbidity or mortality; expectant management of such pregnancies should be considered.

Abnormalities, Drug-Induced↗