Newer concepts in managing pulmonary fat embolism.
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Adrenal Cortex Hormones↗
Biomedical subjects
M L Bernstein
Publications and source records attributed to M L Bernstein.
Idarubicin and cytosine arabinoside reinduction therapy for children with multiple recurrent or refractory acute lymphoblastic leukemia: a Pediatric Oncology Group study.
PURPOSE: This study was designed to determine the toxicity of and response to idarubicin and cytosine arabinoside in children and adolescents with acute lymphoblastic leukemia (ALL) who had refractory or recurrent bone marrow disease. PATIENTS AND METHODS: Patients <21 years of age with ALL in second or later bone marrow relapse or refractory to induction therapy were eligible. Some patients also had concurrent central nervous system (CNS) relapse. Therapy consisted of cytosine arabinoside, 1 g/m2/day given as a 6-h infusion, followed by bolus idarubicin, 5 mg/m2/day, both daily for 6 days. Children achieving remission received maintenance therapy with 3 days of etoposide, 100 mg/m2/day, followed by ifosfamide, 2.8 g/m2/day, alternating every 3 weeks with 3 days of cytosine arabinoside and idarubicin in the dosages described earlier. All courses of therapy were followed by granulocyte colony-stimulating factor (G-CSF). Removal from study to undergo bone marrow transplantation (BMT) was encouraged. RESULTS: Eighty-two patients were entered. There were 14 deaths (nine early), mostly from documented or presumed bacterial or fungal sepsis. Overall, 30 patients achieved complete remission (37%). These were mostly of brief duration--only one patient was still alive at 600+ days after BMT. CONCLUSIONS: Cytosine arabinoside and idarubicin showed moderate activity in heavily pretreated children with ALL.
Administration, Oral↗
Phase I and pharmacokinetic study of CI-980 in recurrent pediatric solid tumor cases: a Pediatric Oncology Group study.
To establish the maximum tolerated dosage (MTD), the dose-limiting toxicities (DLTs), and pharmacokinetic parameters of CI-980, a novel tubulin binder, in children with solid tumors refractory to standard therapy. Patients 21 years of age or younger with adequate nutritional, hematopoietic, renal, and hepatic function were eligible. The patient must not have been pregnant. Patients with brain tumors were not eligible for any dosage level until it was demonstrated the level did not produce DLT in patients with extracranial solid tumors. The starting dosage level was 3.5 mg/m2/day, for 3 days, administered as a continuous intravenous infusion (80% of the adult MTD). If a dosage level was associated with dose-limiting myelotoxicity, growth factors were to be added. Thirty-three patients received CI-980. Twenty-four had solid tumor; 9 had brain tumor. The MTD achieved without granulocyte colony stimulating factor (G-CSF) was 3.5 mg/m2/day (DLT: neutropenia) and with G-CSF, it was as follows: patients with brain tumor, 4.2 mg/m2/day (DLT: myelosupression); and patients with solid tumor, 5 mg/m2/day (DLT: cortical toxicity). Several responses were seen, most notably prolonged stable disease in two of five patients with medulloblastoma. Pharmacokinetic data showed a mean steady state level of 1.74 ng/mL for two patients treated with the 5 mg/m2/day regimen, with rapid decay after the termination of the infusion. CI-980 showed preliminary evidence of activity in recurrent pediatric malignancies, with tolerable, reversible toxicities.
Adolescent↗
Perforation of congenitally deformed aortic valve resulting in aortic insufficiency. Report of case successfully treated by aortic valve replacement.
This 40-year-old male presented with the signs and the symptoms of acute aortic insufficiency and underwent aortic valve replacement. At surgery a deformed aortic valve with perforation was found. This represents a unique example of a congenitally deformed aortic valve complicated by acute perforation with resultant valvular incompetence.
Aortic Valve↗