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R Blum

Publications and source records attributed to R Blum.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Ultrasound detection of rib fractures for verifying fracture diagnosis. A pilot project].

Since the diagnosis of rib fractures caused by blunt thoracic trauma is often missed on X-ray, attempt have been made to detect unknown fractures with ultrasound. Ultrasound was initially researched, as a diagnostic technique in a preliminary study of 10 patients with known rib fractures. Subsequently, in the main study, 21 patients with clinically suspected rib fractures but normal thoracic X-rays were examined with ultrasound, and rib fractures were detected in 16 patients. The diagnosis of rib fractures by ultrasound was substantiated by an increase of activity in the technetium scintigram in 11 of 11 patients. We found further increases of activity in the scintigram in two more ribs in 7 of these 11 patients. This finding is explained by the presence of nondislocated rib fractures that are veiled to ultrasound when a disconnection of the rib's contour is missed during respiration. The diagnostic procedure is explained with reference to case studies. In summary, findings recorded in this study showed that ultrasound investigation is a more reliable method of diagnosis than X-rays examination.

Accidents, Traffic↗
PubMed1994

Intrathecal melphalan therapy of human neoplastic meningitis in athymic nude rats.

We report the activity and toxicity of intrathecal melphalan in the treatment of human neoplastic meningitis in the subarachnoid space of athymic nude rats. Animals received injections via chronic indwelling subarachnoid catheters with 5 x 10(5) or 5 x 10(6) TE-671 human rhabdomyosarcoma cells or 5 x 10(6) D-54 MG human glioma cells and were treated with melphalan on days 8, 5, or 5, respectively. Melphalan toxicity in nontumor-bearing rats was assessed at single doses of a 2.0, 3.0, 4.0, or 5.0 mM solution, with clinical and histological evidence of neurotoxicity observed at the 4.0 and 5.0 mM levels. Multiple-dose toxicity studies using a dosing schedule of twice a week for two weeks with a 0.25, 0.5, 0.75, 1.0, 1.5, or 2 mM solution revealed dose-dependent clinical and histological evidence for toxicity at all dosages. Treatment of TE-671 with a single dose of 2.0 mM intrathecal melphalan produced an increase in median survival of 442% compared with saline controls (P < 0.003). Comparison of a single dose of 1.0 or 2.0 mM melphalan with a multiple dose regimen at 0.25 or 0.5 mM melphalan in the treatment of TE-671 revealed increases in median survival of 50% for 1.0 mM, 57% for 2.0 mM, 79% for 0.5 mM, and 111% for 0.25 mM concentrations. Comparison of a single dose of 1 mM melphalan with multiple doses of 0.25 mM melphalan in the treatment of D-54 MG revealed an increase in median survival of 475+% for each of the regimens. Intrathecal melphalan may be an important new addition in the treatment of neoplastic meningitis and is currently being evaluated clinically in a Phase 1 trial.

Animals↗
PubMed1994

Cisplatin plus doxorubicin plus cyclophosphamide in metastatic or recurrent thymoma: final results of an intergroup trial. The Eastern Cooperative Oncology Group, Southwest Oncology Group, and Southeastern Cancer Study Group.

PURPOSE: The purpose of this study was to evaluate the impact of cisplatin, doxorubicin, and cyclophosphamide (PAC) in patients with advanced thymoma with respect to response rate, duration of remission, and overall survival. PATIENTS AND METHODS: Assessable patients with thymoma (n = 29) or thymic carcinoma (n = 1) with metastatic or locally progressive recurrent disease following radiotherapy were treated with intravenous cisplatin (50 mg/m2), doxorubicin (50 mg/m2), and cyclophosphamide (500 mg/m2) with normal saline hydration. Courses were repeated every 3 weeks for a maximum of eight cycles of therapy. RESULTS: Toxicity, which was primarily hematologic, was mild, with only one patient developing a fever associated with neutropenia. Three complete responses (CRs) and 12 partial responses (PRs) were observed (CR+PR rate, 50%; 95% confidence interval, 31.3% to 68.7%). Ten patients had stable disease. The median duration of response was 11.8 months (range, 0.9 to 70.5+), the time to treatment failure 18.4 months (range, 0.8 to 91.9+), and median survival time 37.7 months (range, 2 to 91.9+). CONCLUSION: This trial demonstrates that objective response rates and prolonged survival can be achieved in patients with advanced thymoma.

Adult↗
PubMed1993

Alternating chemotherapy and twice-daily thoracic radiotherapy in limited-stage small-cell lung cancer: a pilot study of the Eastern Cooperative Oncology Group.

PURPOSE: This pilot study was undertaken to determine the efficacy and feasibility of alternating cisplatin and etoposide with multiple daily fractions of thoracic radiotherapy (TRT) in patients with limited-stage small-cell lung cancer (SCLC). PATIENTS AND METHODS: Thirty-four SCLC patients received four courses of cisplatin (30 mg/m2/d x 3) plus etoposide (120 mg/m2/d x 3) (PE) every 3 weeks. TRT was administered twice daily (1.5 Gy per fraction) for 5 consecutive days in the week after cycles 1, 2, and 3 of chemotherapy (total TRT dose, 45 Gy). Patients who achieved a complete response (CR) received one course of late-intensification (LI) treatment consisting of cyclophosphamide (4 g/m2) and etoposide (900 mg/m2). Prophylactic cranial irradiation (PCI) was optional. RESULTS: Nineteen of 32 assessable patients achieved a CR (59%) and 12 had a partial response (38%), for an overall response rate of 97% (95% confidence interval [CI], 84% to 99%). Median survival was 18 months, while 2-year progression-free survival was 47%. Leukopenia < or = 1,000/microL occurred in 12% of induction treatment cycles. Severe esophagitis was uncommon. Pulmonary fibrosis that was asymptomatic or minimally symptomatic was observed in eight patients (25%). There was one episode of adult respiratory distress syndrome (ARDS) during LI chemotherapy. Life-threatening neutropenia (< or = 500/microL) developed in all patients who underwent LI chemotherapy, with a median duration of 10 days (range, 8 to 19). Two patients died of sepsis during LI chemotherapy. CONCLUSION: Alternating PE and TRT as performed in this trial is an effective brief induction regimen for limited-stage SCLC. However, this particular regimen did not appear to be substantially different in terms of efficacy or toxicity compared with regimens using concurrent chemotherapy and standard-fraction TRT. LI chemotherapy was associated with unacceptable toxicity and did not appear to have a favorable impact on survival.

Aged↗
PubMed1992

Blastomycosis in patients with the acquired immunodeficiency syndrome.

OBJECTIVE: To describe the clinical, demographic, radiographic, diagnostic, and therapeutic aspects of blastomycosis in patients with the acquired immunodeficiency syndrome (AIDS). DESIGN: A retrospective survey. SETTING: Ten university medical centers and community hospitals, six in geographic areas endemic for Blastomyces dermatitidis, and four outside the endemic area. PATIENTS: We identified 15 patients with blastomycosis and positive serologic test results for human immunodeficiency virus (HIV). MEASUREMENTS: A diagnosis of blastomycosis was based on a positive culture (14 patients) or typical histopathologic features (one patient) for B. dermatitidis in clinical specimens. RESULTS: Twelve of 15 patients had a previous or concomitant AIDS-defining illness at the time of diagnosis of blastomycosis, and only one patient had a CD4 lymphocyte count of greater than 200 cells/mm3. Two patterns of disease emerged: localized pulmonary involvement (seven patients), and disseminated or extrapulmonary blastomycosis (eight patients). Central nervous system involvement was common (40%). Six patients died within 21 days of presentation with blastomycosis, including four patients with disseminated and two with fulminant pulmonary disease. Among the nine patients who survived longer than 1 month, all received amphotericin B as initial antifungal therapy, and most received subsequent therapy with ketoconazole. Only two of these nine patients died with evidence of progressive blastomycosis. CONCLUSIONS: Blastomycosis is a late and frequently fatal infectious complication in a few patients with AIDS. In these patients, overwhelming disseminated disease including involvement of the central nervous system is common, and it is associated with a high early mortality. Initial therapy with amphotericin B is appropriate in patients with AIDS and presumptive blastomycosis.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Effect of the anti-inflammatory agent tenidap on the pharmacokinetics and pharmacodynamics of prednisolone.

The effect of tenidap, a new nonsteroidal anti-inflammatory agent, on the pharmacokinetics and pharmacodynamics of prednisolone was studied in healthy male subjects. In a randomized crossover study, 12 subjects received either tenidap sodium 120 mg daily or placebo orally for 28 days. On day 21, each subject received a single dose of either 0.8 mg/kg oral prednisone or 0.66 mg/kg intravenous prednisolone followed by the other steroid on day 28. Blood and urine samples were collected, and the pharmacokinetic parameters of prednisone and prednisolone were determined in each treatment period. Pretreatment with tenidap did not cause any significant changes in the overall disposition of prednisone or prednisolone. For example, for free prednisolone, the intravenous area under concentration was 1,144 +/- 195 ng.h/mL and 1,244 +/- 140 ng.h/mL, and the systemic availability after oral prednisone was 53 +/- 10% and 51 +/- 12% with placebo and tenidap, respectively. The renal clearance of prednisolone was significantly reduced after tenidap pretreatment, however (from 143 to 77 mL/min/1.73 m2). The suppression of plasma cortisol and whole blood histamine levels were analyzed to evaluate the potential pharmacodynamic interactions between tenidap and prednisolone. There were no significant changes in the pharmacodynamic parameters between placebo and tenidap groups. The excretion of less than 20% of the dose of prednisolone in urine makes the overall effects of tenidap on prednisolone kinetics and dynamics of inconsequential clinical importance.

Adolescent↗
PubMed1992

Demography of sexual orientation in adolescents.

This study was undertaken to explore patterns of sexual orientation in a representative sample of Minnesota junior and senior high school students. The sample included 34,706 students (grades 7 through 12) from diverse ethnic, geographic, and socioeconomic strata. Five items pertaining to sexual attraction, fantasy, behavior, and affiliation were embedded in a self-administered survey of adolescent health. Overall, 10.7% of students were "unsure" of their sexual orientation; 88.2% described themselves as predominantly heterosexual; and 1.1% described themselves as bisexual or predominantly homosexual. The reported prevalence of homosexual attractions (4.5%) exceeded homosexual fantasies (2.6%), sexual behavior (1%), or affiliation (0.4%). Gender differences were minor; but responses to individual sexual orientation items varied with age, religiosity, ethnicity, and socioeconomic status. Uncertainty about sexual orientation diminished in successively older age groups, with corresponding increases in heterosexual and homosexual affiliation. The findings suggest an unfolding of sexual identity during adolescence, influenced by sexual experience and demographic factors.

Adolescent↗
PubMed1990

Good tolerance of weekly oral idarubicin: (4-demethoxydaunorubicin): a phase I study with pharmacology.

Idarubicin (4-demethoxydaunorubicin) is an orally active anthracycline. We treated 26 patients with 37 courses of the drug on a schedule of oral administration weekly x 3 followed by a 3-week rest period. The maximum tolerated dose on this schedule was 22.5 mg/m2 weekly x 3 every 6 weeks, with consistent myelosuppression being the dose-limiting toxicity; other toxicity was minimal. Pharmacologic studies showed a mean alpha half-life of 1.6 +/- 0.3 h and a beta half-life of 39 +/- 8.4 h for idarubicin. This schedule was well tolerated, with consistent toxicity patterns seen. Pharmacologic studies confirmed prolonged exposure to the drug and its active metabolite. In comparison with other schedules, this one may offer advantages in terms of consistent hematologic toxicity and prolonged exposure to both the parent compound and its active metabolite. Dose intensity was comparable with that on other schedules.

Adult↗
PubMed1990

Television and teens: health implications. Executive summary.

Throughout the study group deliberations, there were issues that cross-cut all discussions and suggestions. While the focus of the conference was on television, it is not possible to talk about television without including advertising, cable, and independent stations as well as the networks. In addition, television cannot be discussed in isolation from movies, for with VCRs and television reruns, movies are an integral part of the television scene. A second theme that transcended most discussion was a reluctance to call upon external regulatory mechanisms to control what many see as the excesses of television. There was sensitivity and concern for striking a balance between safeguarding basic freedoms, on one hand, and assuring the health and well being of the nation on the other. In terms of specific recommendations, there were some key general agreements: 1. Need for Interdisciplinary Dialog. Repeatedly, concern was voiced on how little understanding there is among and between those who are primarily concerned with the health and development of young people and those who develop programs viewed by that population.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Phase II study of N-methylformamide, spirogermanium, and 4-demethoxydaunorubicin in the treatment of non-small cell lung cancer (EST 3583): an Eastern Cooperative Oncology Group study.

One hundred forty-four patients with non-small cell lung cancer, the majority (72%) of whom had received previous chemotherapy, were evaluable in this randomized phase II study of N-methylformamide (N-MF), spirogermanium, and 4-demethoxydaunorubicin. There were two partial responses, one each with spirogermanium and 4-demethoxydaunorubicin. There were eight life-threatening complications (mostly hematologic) and two lethal complications (N-MF, hematologic; 4-demethoxydaunorubicin, gastrointestinal). The overall survival ranged from 9 days to 533 days with a median of 17.6 weeks. The following factors were associated with poor survival: Poor initial performance status, prior weight loss, presence of liver or subcutaneous metastases.

Aged↗
PubMed1989

Phase I study of low-dose zidovudine and acyclovir in asymptomatic human immunodeficiency virus seropositive individuals.

PURPOSE: The combination of zidovudine and acyclovir has shown in vitro antiretroviral activity and led to short-term improvement in patients with symptomatic human immunodeficiency disease (HIV) disease. We performed a phase I study of zidovudine (500 mg/day) plus acyclovir (2 or 4 g/day) in asymptomatic HIV-seropositive men to investigate pharmacokinetics, safety, tolerance, and immunologic effects of the combination. SUBJECTS AND METHODS: Fifty HIV-seropositive homosexual or bisexual men from the San Francisco City Clinic Cohort Study were recruited for the study; of these, 20 met the eligibility criteria. Treatment with zidovudine and acyclovir was open label. Pharmacokinetic, virologic, immunologic, and clinical data were collected periodically over a 24-week period. RESULTS: Pharmacokinetic analysis showed no drug interaction. The combination was generally well tolerated, and hematologic parameters remained stable through 24 weeks. There were no significant changes in total lymphocytes, T4 lymphocytes, overall skin test reactivity, or ability to culture virus from peripheral blood. CONCLUSION: This combination of agents is safe in this population for at least six months. Conclusions about long-term tolerance and efficacy await the results of larger trials with longer follow-up.

Acyclovir↗
PubMed1987

Contemporary threats to adolescent health in the United States.

Over the past 30 years, adolescents have been the only population in the United States who have not experienced improvement in their health status. Violence has replaced communicable diseases as the primary cause of juvenile mortality and, currently, over 77% of adolescent deaths are caused by accidents, suicide, and homicide. Increasingly, poverty, life-style, and risk-taking behaviors are influencing the morbidities of youth, with associated sequelae of trauma, adolescent pregnancy, substance abuse, physical/sexual abuse, and most other major health problems of adolescents. Clinicians seem to be interested in addressing the shifting nature of adolescent morbidity, yet are insufficiently trained to be effective. The physician must go beyond traditional clinical medicine and address the social, environmental, and behavioral factors that underlie current morbidity.

Accidents↗
PubMed1987

Physicians' assessment of deficiencies and desire for training in adolescent care.

Over the past decade, there has been growing awareness among medical educators and care providers of the deficits in the training of primary care physicians to meet the health care needs of adolescents. The study reported here is the first national survey of primary care physicians' perceptions of their competency in dealing with adolescents' health concerns. In the survey, 351 internists, family practitioners, and pediatricians rated their competency in 19 areas of adolescent health care. Approximately three-quarters or more of the internists indicated deficits in all 19 areas. In areas related to gynecologic concerns, more pediatricians reported deficits than family physicians; but more family physicians than pediatricians reported deficiencies in managing acute conditions of youth (growth and developmental problems, endocrinopathies, school-based problems, and chronic illnesses). All physicians indicated deficiencies in dealing with high-risk health behaviors: eating disorders, drug and alcohol abuse, homosexuality, and delinquency. Finally, more than 45 percent of the physicians overall reported deficiencies in areas related to social and/or emotional concerns, including suicide, depression, and family conflicts. Despite these acknowledged deficits, most of the primary care physicians did not indicate adolescents to be the least desirable age group with which to work. However, few of the physicians expressed a desire to improve their skills. Overall, in none of the 19 areas did more than 30 percent of the physicians who had reported deficiencies in an area express interest in improving their competency.

Adolescent↗