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Biomedical subjects

M J Cunningham

Publications and source records attributed to M J Cunningham.

At least 55 records · Page 3Linked to original sources
PubMed1997

Primary radiation, cisplatin, and 5-fluorouracil for advanced squamous carcinoma of the vulva.

OBJECTIVE: To evaluate a regimen of radiation and chemotherapy as an alternative for those patients in whom the location and extent of advanced vulvar carcinoma make pelvic exenteration the only surgical option. METHODS: Between December 1988 and March 1995, 14 patients with primary squamous carcinoma of the vulva who were not candidates for standard radical vulvectomy were treated with radiation therapy in combination with cisplatin and 5-fluorouracil (5-FU) chemotherapy at the Albany Medical Center. Patients ranged in age from 40 to 90 years, mean 68. Tumors were stage III in 9 patients and stage IV in 5 patients. Treatment included two cycles of chemotherapy with cisplatin (50 mg/m2) and 5-FU (1000 mg/m2/24 x 96 hr) in addition to radiation therapy. Total radiation doses to the vulva and groins ranged from 50 to 65 Gray (Gy), with pelvic doses of 45 to 50 Gy. Surgical excision of the primary site was not performed in patients who had complete clinical response. RESULTS: Acute complications included desquamation requiring treatment interruptions in 5 patients and deep venous thrombosis in 1 patient. Delayed complications were limited to small bowel obstruction and colonic stricture in one patient. There was a 92% response rate with complete responses in 9 patients (64%). Among patients with complete clinical response, there has been only one recurrence with follow-up of 7-81 months, mean 36.5. All patients with partial responses died, with survival of 8-25 months, mean 15.7. CONCLUSIONS: This combination of chemoradiation was found to be effective therapy for locally advanced vulvar carcinoma, with acceptable morbidity even in an elderly population. Surgical excision of the primary site is not necessary in patients with complete response.

Adult↗
PubMed1997

Extended field radiation and cisplatin for stage IIB and IIIB cervical carcinoma.

OBJECTIVE: The aim of this study was to investigate local regional control, survival, and morbidity in patients with FIGO IIB and IIIB squamous cell carcinoma of the cervix treated with primary extended field (prophylactic paraaoratic radiation) radiation and weekly cisplatin. METHODS: Sixty-seven patients (44 IIB and 23 IIIB) with carcinoma of the cervix received cisplatin at 1 mg/kg (up to 60 mg) weekly and extended field radiation therapy including the paraaortic nodes and brachytherapy. RESULTS: After the scheduled therapy 94.1% of the patients were complete responders. Seventy-five percent are alive without evidence of disease with a mean follow-up of 47.5 months. CONCLUSION: This study confirms the ability to give concomitant weekly cisplatin and prophylactic paraaortic radiation with minimal morbidity. The encouraging Kaplan-Meier survival of 75% and only eight pelvic failures warrants further investigation.

Adult↗
PubMed1997

Paw preference, rotation, and dopamine function in Collins HI and LO mouse strains.

Mice have paw preferences that are consistent upon repeated measurement. The Collins HI and LO strains are two populations of mice that have been selectively bred to differ markedly in the degree of paw preference. They represent a unique genetic model of functional cerebral lateralization. Rotation (or circling) behavior in normal unlesioned animals reflects an endogenous lateralization of the functioning brain dopamine (DA) systems. In the present study, rotational behavior and lateralized brain DA neurochemistry were assessed in the Collins HI and LO strain mice. Confirming Collins findings, HI strain mice exhibited stronger paw preferences than LO strain mice. HI strain mice also showed stronger percent directional preferences during nocturnal tests of spontaneous rotation. Neurochemical differences were also apparent between the strains. DA and its metabolites were measured in the medial prefrontal cortex (PFC), nucleus accumbens (NAS), and striatum. Degrees of rotational and paw preference in HI, but not LO, mice were correlated with PFC asymmetries in DA and the DA metabolite dihydroxyphenyl acetic acid (DOPAC), respectively. Hemisphere, paw preference, turning preference, and strain interacted in a complex way to determine measures of DA utilization in the NAS and striatum. Even though the directions of paw preference and rotation were not correlated, HI and LO mice of differing paw and rotational directional preferences showed differences in DA neurochemistry in the NAS and striatum.

Animals↗
PubMed1997

Rapid membrane effects of steroids in neuroblastoma cells: effects of estrogen on mitogen activated protein kinase signalling cascade and c-fos immediate early gene transcription.

Rapid effects of steroid hormones have been observed in neuronal cells for many years. We show here, that in the human neuroblastoma cell line SK-N-SH, the membrane impermeable conjugated 17beta-estradiol (E2BSA) activates mitogen activated protein kinase kinase (MAPKK or MEK) and induces the phosphorylation and activation of both ERK-1 and ERK-2 (mitogen activated protein kinase or MAPK). Additionally, E2BSA induces the transcription of a reporter gene construct driven by the promoter of the mouse c-fos proto-oncogene. The effects of this membrane impermeable estrogen on c-fos transcription are not inhibited by the estrogen receptor antagonists Tamoxifen or ICI 182,780, further excluding the involvement of the intracellular estrogen receptor. This is also illustrated by the observation that E2BSA does not activate estrogen response element (ERE) mediated transcription. This is the first report of rapid membrane effects of 17beta-estradiol on growth factor related signalling pathways in neuronal cells, and indicates a potential mechanism by which 17beta-estradiol might affect the expression of genes whose promoters do not contain EREs but are responsive to factors acting through other response elements such as AP-1 and SRE sites.

Animals↗
PubMed1996

Downregulation of mu-opioid receptor mRNA in the mediobasal hypothalamus of the female guinea pig following morphine treatment.

Ribonuclease protection assays were performed on the basal hypothalamus (BH), the preoptic area (POA) and the thalamus (THAL) from female guinea pigs that were ovariectomized and implanted with morphine (n = 8) or placebo (n = 8) pellets for 1 week. An antisense [32P]rUTP labeled riboprobe, representing a 280 bp fragment of the guinea pig mu-opioid receptor gene (spanning putative TM II through eight residues of TM IV), protected a single RNA band of 280 bp. In contrast to the rat, the guinea pig THAL expressed less mu-opioid receptor mRNA than both POA and BH. Morphine treatment caused a significant decrease (15.6 +/- 5.8%) in mu-opioid receptor mRNA expression in the BH, while POA and THAL were not different from placebo controls. Therefore, in conjunction with our previous findings of a downregulation of mu-opioid receptors, mu-opioid receptor mRNA is downregulated in the mediobasal hypothalamus of female guinea pigs following chronic morphine treatment.

Analgesics, Opioid↗
PubMed1996

Odontogenic keratocysts in the pediatric population.

OBJECTIVE: To review the characteristics and treatment of odontogenic keratocysts in the pediatric population at our institution in light of a comprehensive literature review of odontogenic keratocysts in the general population in the hope of elucidating clinical, radiological, or pathological factors that would suggest a different therapeutic approach to odontogenic keratocysts in the pediatric as opposed to the adult population. DESIGN: A 19-year retrospective medical chart review of children with mandibular or maxillary masses of odontogenic keratocyst origin. SETTING: Two academic tertiary care institutions. PATIENTS: Eleven children had pathologically confirmed odontogenic keratocysts. Age at diagnosis ranged from 8 to 18 years (mean, 13.4 years). RESULTS: A cystic mass with dentition displacement was characteristic clinically and radiographically. Treatment principally consisted of enucleation with or without extraction of teeth. Follow-up ranged from 1 to 8 years. Seven patients remained free of disease. Recurrences or second primary lesions occurred in 4 patients, all of whom had a family history of nevoid basal cell carcinoma syndrome or multiple cysts suggestive of this diagnosis. The maximum 8-year interval between initial treatment and recurrence is noteworthy. CONCLUSIONS: The diagnosis of odontogenic keratocyst deserves consideration in children who have a mass of the mandible or maxilla. The clinical behavior of this lesion in its initial occurrence and response to conservative treatment seems to be similar to that reported in adults. Odontogenic keratocysts, especially those that are multiple or recurrent, should alert the clinician to the possible underlying diagnosis of nevoid basal cell carcinoma syndrome.

Adolescent↗
PubMed1996

Transcatheter aspiration of atheroma prolapsing through saphenous vein graft stents.

Endoluminal stenting has often become the percutaneous treatment of choice for older vein grafts. We report a case of successful stenting of a degenerated vein graft that was complicated by prolapse of atheroma through the stents leading to ischemia that was successfully reversed by catheter aspiration of the prolapsed atheroma.

Atherectomy, Coronary↗
PubMed1996

Peripheral infusion ports for central venous access in patients with gynecologic malignancies.

During treatment for gynecologic malignancies, many patients require frequent or prolonged intravenous access. Implantable permanent venous access devices are useful in assuring adequate access and improving quality of life. A new technique for central venous access by peripheral placement of a subcutaneous infusion port was evaluated in 18 women undergoing treatment for gynecologic malignancies. Patients were followed prospectively with a mean follow-up of 105 days. Six catheters required removal because of complications, including 1 patient with a catheter site infection and 5 patients (26%) with catheter-related thrombosis. Although the rate of immediate insertion-related complications was low, the incidence of deep venous thrombosis was markedly increased over that reported with other central venous access devices.

Antineoplastic Agents↗
PubMed1995

Percutaneous gastrostomy for decompression in patients with advanced gynecologic malignancies.

The objective of this study was to evaluate the use of percutaneous decompression gastrostomy in patients with gynecologic malignancies. Decompression gastrostomy tubes were inserted percutaneously in patients with recurrent gynecologic malignancies and small bowel obstruction or fistulae. The technique was evaluated for successful gastric decompression, acute and long-term complications, and palliation of symptoms. Twenty patients underwent placement of percutaneous gastrostomy tubes for decompression. Tube placement was successful in all patients, and all had significant relief of symptoms. There were no acute complications. Seven patients required replacement of tubes due to accidental dislodgment, balloon malfunction, obstruction or leakage around the tube, or systemic disease. Tubes remained in place for 7 to 184 days (mean 53). Sixty percent of patients returned home for palliative care for 3 to 173 days (mean 70). It was concluded that percutaneous decompression gastrostomy can be successfully performed in patients with recurrent gynecologic malignancies, and offers significant relief of symptoms and improvement in quality of life.

Adult↗
PubMed1995

Pseudodacryocystitis arising from anterior ethmoiditis.

The contiguous spread of inflammation from infected ethmoid sinuses to the surrounding tissues of the lacrimal drainage system can produce symptoms easily confused with acute dacryocystitis. We report the cases of two patients with presumed dacryocystitis whose patency of the lacrimal apparatus was established by probing, irrigation, and dacryocystography. Computerized tomography and magnetic resonance imaging demonstrated opacification of anterior ethmoid air cells adjacent to the region of the lacrimal sac. A greater awareness of this diagnostic possibility of pseudodacryocystitis arising from anterior ethmoiditis, together with improved noninvasive imaging techniques, will likely increase the observed incidence of this disease. This distinction is important since anterior ethmoidectomy, rather than dacryocystorhinostomy, is the treatment of choice when such pseudodacryocystitis proves unresponsive to antibiotic therapy. In misdiagnosed patients who undergo dacryocystorhinostomy, it is the coincidental limited anterior ethmoidectomy and not the lacrimal-nasal fistula that provides the cure.

Acute Disease↗
PubMed1995

Lateral sinus thrombosis associated with otitis media and mastoiditis in children.

Lateral sinus thrombosis (LST) is an infrequent complication of otitis media and mastoiditis in the antibiotic era. A recent case of LST in a 7-year-old boy, the third such case at our institutions in the past 5 years, prompted a review of the modern day English literature concerning LST in pediatric patients. Our goal was to highlight the clinical findings suggestive of LST in the antibiotic era as well as to analyze retrospectively the diagnostic and therapeutic modalities of greatest benefit based on the outcomes reported in the reviewed studies.

Anti-Bacterial Agents↗
PubMed1994

Treatment of primary ovarian angiosarcoma with ifosfamide and doxorubicin.

Angiosarcoma originating in the female genital tract is exceedingly rare with only 15 cases of angiosarcoma of the ovary described to date. All have been highly aggressive tumors, and no response to treatment has ever been reported. A case of primary ovarian angiosarcoma is described in which a short remission was achieved with intensive chemotherapy using ifosfamide and doxorubicin.

Adult↗
PubMed1994

Comparison of computed tomography and surgical findings in deep neck infections.

Computed tomography is routinely used in the evaluation of patients suspected to have deep neck infections. This 10-year retrospective study compares preoperative computed tomography scan reports with intraoperative findings in 38 patients who underwent surgical exploration of the parapharyngeal or retropharyngeal space within 48 hours of their radiographic assessment. Overall, intraoperative findings confirmed computed tomography scan interpretation in 76.3% of the patients. The false-positive rate was 13.2%, and the false-negative rate was 10.5%. The sensitivity of computed tomography scan for detection of parapharyngeal space or retropharyngeal space abscess was 87.9%. This study's documentation of false-positive computed tomography scans in the evaluation of deep neck infections emphasizes the importance of correlating radiologic interpretation with clinical examination before surgical intervention.

Adolescent↗