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Biomedical subjects

R E Johnson

Publications and source records attributed to R E Johnson.

At least 343 records · Page 19Linked to original sources
PubMed1975

Total body irradiation (TBI) as primary therapy for advanced lymphosarcoma.

The natural history of lymphocytic lymphomas is such that diffuse involvement usually is present at diagnosis. Extensive lymphatic irradiation with tumoricidal doses is seldom an appropriate form of treatment, as most patients require systemic therapy. We have investigated total body irradiation (TBI) as an alternative to chemotherapy. A series of 39 consecutive untreated patients with generalized disease is reviewed. Actuarial 5-year survival rates for the well-differentiated, poorly differentiated nodular, and poorly differentiated diffuse histologic types are 100%, 78%, and 56% respectively. The single major complication, acute myelocytic leukemia, has developed in 2 of the 8 patients given extensive nodal irradiation as a supplement to TBI. None of the 31 patients receiving only TBI as initial therapy has shown evidence of a myeloproliferative disorder to date.

Adult↗
PubMed1975

Combined modality therapy of Ewing's sarcoma.

Since 1964, 66 consecutive patients with Ewing's sarcoma have been treated at the National Cancer Institute with local irradiation of the primary site combined with adjuvant regimens of progressively more intensive systemic chemotherapy. Actuarial survival rates for the total series show a 56% 2-year and 35% 5-year survival. The 43 patients without clinically detectable metastases at diagnosis have 64% 2-year and 52% 5-year survival rates. The current protocol, alternating high-dose pulses of adriamycin and cyclophosphamide-vincristine, is providing improved disease-free survival as compared to previous protocols, and indicates further progress toward the ultimate goal of complete tumor eradication. In addition to the problems of diagnostic accuracy in evaluating treatment results, other major factors influencing prognosis include initial metastatic disease, site of the primary tumor, age at diagnosis, and presence of systemic symptoms. At least these, and probably others, must be taken into account in developing randomized prospective trials for determination of optimal adjuvant therapy.

Adolescent↗
PubMed1975

Hematologic and immunologic status in Hodgkin's disease 5 years after radical radiotherapy.

The hematologic and immunologic status was evaluated after 5 years of continuously disease-free survival for 71 consecutive patients treated for Hodgkin's disease by radiotherapy. There was no evidence of residual hematologic depression, even in those patients treated initially with total nodal irradiation. Similarly, quantitative immunoglobulin levels were within the normal range, and the response to delayed hypersensitivity skin testing was intact in nearly all patients. These immunologic studies were consistent with the observed absence of an unusual incidence of infectious complications in these long-term survivors.

Adolescent↗
PubMed1975

The effect of severity, consistency, and typicalness information on clinicians' causal attributions.

Sixty-four clinicians responded to a brief description of a depressed student by indicating the extent to which each of four possible causes contributed to the depression. The descriptions were varied systematically so that the student's depression was described as either mild or severe, typical or atypical, and as having occurred before or as never having occurred before. Results indicated greater attribution of the depression to internal causal factors when the individual's depression was described as atypical and greater attribution to stable causal factors when the depression was described as having occurred previously. When the depression was described as severe, the clinicians tended to attribute it to external unstable causes. It was suggested that clinicians may differ from other populations in some of the causal attributions that they make for psychological difficulties.

Depression↗
PubMed1975

Therapy of advanced lymphocytic lymphoma a preliminary report of a randomized trial between combination chemotherapy (CVP) and intensive radiotherapy.

The initial results of a randomized clinical trial comparing intensive cyclical combination chemotherapy (CVP) and total body radiation therapy in the treatment of advanced (Stage III and IV) lymphocytic lymphoma is presented. Sixty-five patients have been entered and randomized according to stage. Of the chemotherapy treated patients, (22/27 (81%) achieved a response with 55% complete responders. The radiation group or those treated with radiation 27/32 (84%) responded with 56% in complete response. There is no significant difference in overall survival between the two groups. Nodular lymphoma (44 patients) responds more often and has s significantly longer survival than diffuse lymphoma (21 patients). Approximately 50% of the complete remitters have relapsed but reinduction of disease control was possible in almost all cases.

Adult↗
PubMed1975

Role of the pharmacist in primary health care.

The provision of primary health care to a rural American Indian population by a pharmacist is discussed. The training and responsibilities of the pharmacist are described. An evaluation of the care provided by the pharmacist to 393 patients is presented.

Adolescent↗
PubMed1975

Hyperphosphatemia and hypocalcemia in Burkitt lymophoma. Complications of chemotherapy.

In two patients, metabolic complications, previously unreported to our knowledge, of severe hyperphosphatemia and hypocalcemia in addition to hyperkalemia nad hyperuricemia were demonstrated after treatment with cyclophosphamide. In one patient, elevated blood and ascites lactate levels were measured. The levels decreased rapidly to normal following chemotherapy. The hyperphosphatemia and hyperkalemia may have been due to rapid tumor lysis and the hypocalcemia may have been caused by the hyperphosphatemia. The reduction in blood and aseties lactate levels may reflect the lysis of anaerobically metabolising tumor cells. Renal dialysis was required in the management of both cases. Because of the potential for cardiac arrythmias related to electrolyte imbalance, it is recommended that whenever possible reanl dialysis be available before treating cases of Burkitt lymphoma with large tumor burden.

Abdominal Neoplasms↗
PubMed1975

Patterns of involvement with malignant lymphoma and implications for treatment decision making.

Decision making in cancer therapy has traditionally evolved through careful observation of the clinical course subsequent to various treatment approaches. This method has also served to delineate the wide spectrum of primary manifestations and patterns of biological behaviour characterizing the malignant lymphomata. Marked disparity has been consistently appreciated between the natural history of lymphomata originating in lymph nodes in contrast to those primary in extranodal sites. The former are usually anatomically generalized at diagnosis whereas primary extranodal lymphomata are commonly localized and more closely resemble carcinomata of the respective organs with their propensity for both regional lymphatic extension and haematogenous spread. Prospective staging of 100 consecutive patients with previously untreated malignant lymphoma has been consistent with this past experience in demonstrating the presence of disseminated involvement in the majority of patients. It has also become apparent that reliance upon either clinical or surgical staging of disease extent is often misleading since widespread disease frequently develops even in those patients staged as having localized involvement and thereby treated with local irradiation. High dose, wide field lymphatic irradiation "á la Hodgkin's disease" seldom constitutes appropriate treatment for patients having lymph node presentations of lymphoma. There is rather a need to recognize the importance of systemic treatment for most cases, negating the utility of routine exhaustive staging since treatment decisions can be based upon readily assessed clinicohistological determinants in the majority of cases.

Adolescent↗
PubMed1975

Management of generalized malignant lymphomata with "systemic" radiotherapy.

The natural history of lymphocytic lymphomata is such that anatomical generalization of disease is usually present at the time of diagnosis. Tumour infiltration of extralymphatic sites such as the liver and bone marrow is identifiable with particular frequency in those cases presenting with lymph node manifestations of disease. Even in the absence of detectable extralymphatic dissemination, the lymphatic involvement is often sufficiently diffuse to mitigate against extensive lymph node irradiation "à la Hodgkin's disease" as appropriate or technically feasible form of treatment. Rather, systemic treatment must be recognized as imperative for the majority of newly diagnosed patients and we have investigated "systemic" radiotherapy as an alternative to chemotherapy during the past decade. Our experience with 57 consecutive patients with lymphocytic lymphoma has been reviewed. Total body irradiation (TBI) has been found to yield high remission rates despite a lack of serious toxicity or constitutional reactions. Rigorous diagnostic staging was not employed but despite the advanced stage of disease which was clinically obvious in most cases, survival rates have been strikingly high. Actuarially calculated 5-year survival rates for the well differentiated (diffuse and nodular combined), nodular poorly differentiated and diffuse poorly differentiated subtypes are 85%, 69% and 51% respectively. Furthermore, initial management with radio-therapy as described has not negated with effective use of subsequent chemotherapy when selectively required.

Adult↗
PubMed1975

Percutaneous liver biopsy, peritoneoscopy and laparotomy: an assessment of relative merits in the lymphomata.

The relative merits of percutaneous liver biopsy, peritoneoscopy directed liver biopsy and wedge liver biopsy during laparotomy were examined in a series of 100 consecutive untreated patients with non-Hodgkin's lymphoma. Sixteen of 77 patients had positive findings on percutaneous liver biopsy specimens, with the best yield in patients with nodular (21%) and diffuse (33%) poorly differentiated lymphocytic lymphoma. Forty-nine of the 61 patients having negative percutaneous biopsies were subjected to peritoneoscopy and 9 additional positive biopsies were obtained. Thirty-two of the 40 patients having negative percutaneous and peritoneoscopy findings underwent laparotomy and wedge biopsy of the liver, and 8 specimens (25%) were positive for liver involvement; all but one of these were in patients with nodular or diffuse poorly differentiated lymphocytic lymphoma. This study indicates that over two-thirds of untreated patients with non-Hodgkin's lymphoma can be shown to have Stage IV disease without undergoing laparotomy, and that in the remaining patients, laparotomy proved of consistent value only in patients with poorly differentiated lymphocytic lymphoma.

Biopsy↗