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Biomedical subjects

R L Goodman

Publications and source records attributed to R L Goodman.

At least 109 records · Page 6Linked to original sources
PubMed1983

Psychological aspects of primary radiation therapy for breast carcinoma.

Fifty-one patients who received primary radiation therapy as an alternative to radical mastectomy for the treatment of early breast cancer were studied in depth. They chose radiation therapy to avoid the disfigurement, difficulty with emotional adjustment, and adverse effects on their sexual lives they anticipated from mastectomy. Most of these women (median age 49) were leading active sexual lives in which their breasts play an important role. Their breasts also played an important role in enabling them to feel feminine, attractive, and sexually desirable. Forty-three percent of the patients who had had suicidal ideation because of feelings about breast cancer no longer were troubled by suicidal thoughts after learning about primary radiation therapy and the fact that they would not have to have a mastectomy. Recent reports that radiation therapy causes more psychic distress than other forms of cancer treatment appear to be incorrect in this particular population.

Adult↗
PubMed1982

The role of mammography in evaluating patients with early carcinoma of the breast for tylectomy and radiation therapy.

The value of mammography in treatment planning for early breast cancer following excisional biopsy was studied in 38 patients. One-third of the post-biopsy mammograms yielded information useful for therapy or follow-up, specifically the presence or absence of gross residual tumor [11] and detection of occult lesions in the opposite breast or axillary nodes [3]. They also proved valuable as base-line studies, since scars seen on post-therapy mammograms may simulate new or recurrent tumor [3]. Approximately half [21] of the post-biopsy studies were nondiagnostic because of dense parenchyma [14] or biopsy-related distortion [7]. Four were considered falsely positive for residual tumor. These results indicate that mammography can contribute significantly to the management of patients undergoing tylectomy and primary radiotherapy for breast cancer.

Adult↗
PubMed1982

Lumpectomy and irradiation in the treatment of early carcinoma of the breast.

In the past two decades, the increasing ability of radiation to control local tumors in many organs, including the breast, has been well documented. In the past five years, the use of chemotherapy has also assumed a major role in treating micrometastases in breast cancer in selected premenopausal and postmenopausal patients. These two developments have forced a reappraisal of local modalities in the treatment of breast cancer. Even before the advent of chemotherapy it was known that mastectomy alone was not successful in providing local control and thus adjunctive irradiation when axillae were histologically positive has been used to substantially reduce local recurrence rate. Studies now show that excisional biopsy followed by definitive irradiation accomplishes essentially the same local control, stage by stage, as mastectomy with adjunctive radiation therapy in selected cases. Also, similar five- and ten-year survival rates have been obtained in all recent series. Irradiation appears to be at least comparable with mastectomy for control of cancer of the breast, but with better functional and cosmetic results.

Breast Neoplasms↗
PubMed1981

The sites of action of ovarian steroids in the regulation of LH secretion.

In the monkey, estradiol appears to exert both its negative and positive feedback actions on gonadotropin secretion primarily at the hypophysial level. In the rat, inhibitory and stimulatory effects of estradiol on the pituitary are also evident, but additional actions on the medial basal hypothalamus (MBH) and preoptic area must be postulated to fully account for the negative and positive feedback effects of estradiol in this species. The available evidence points to the MBH as a site for the negative feedback action of progesterone in the rat. In both species, progesterone probably acts in the central nervous system to block the positive feedback action of estradiol while the facilitation of luteinizing hormone release by this steroid appears to be at a hypophysial level.

Animals↗
PubMed1981

Ovarian feedback control of follicle-stimulating hormone in the ewe: evidence for selective suppression.

The role of estradiol and progesterone in the feedback control of FSH secretion during the ovine estrous cycle was examined in three experiments. In the first, FSH was monitored in serum obtained every 4 h throughout the normal cycle. Although there was considerable variability among animals, the mean FSH concentration was elevated 1-2 days after estrus, then declined gradually to a midluteal phase nadir, and remained there until the preovulatory FSH surge on estrus. In the second study, the contribution of estradiol and progesterone to the determination of this pattern was analyzed. Ewes were ovariectomized 2 days after estrus, and the physiological pattern and level of each steroid were reproduced, alone or in combination, by sequential additions and removals of Silastic implants. None of the treatments maintained physiological concentrations of FSH, although some suppression by steroids was evident. In contrast, the time course of LH in ewes receiving estradiol plus progesterone was virtually identical to that in intact ewes. In the last study, the feedback actions of the preovulatory estradiol rise were examined by producing a variety of physiological estradiol increments under conditions which simulated the follicular phase of the cycle. Again, the estradiol rise could not account for the low basal level of FSH typical of the follicular phase, whereas basal LH was normal. A normal FSH surge, however, was reliably induced by estradiol. These results support the hypothesis that an ovarian hormone other than estradiol or progesterone contributes to the feedback control of tonic FSH secretion during the ovine estrous cycle. Further, since these two steroids can account for secretion of LH, this putative hormone most likely selectively suppress FSH.

Animals↗
PubMed1981

The endocrine basis of the synergistic suppression of luteinizing hormone by estradiol and progesterone.

The basis of the synergism between estradiol and progesterone in suppressing tonic (pulsatile) LH secretion was examined in the ewe, making use of the observation that progesterone exerts its inhibition selectively on LH pulse frequency, while estradiol decreases only pulse amplitude. To accomplish this, we analyzed changes in LH pulse patterns produced by a low level of progesterone in ovariectomized ewes treated with Silastic estradiol implants from the time of gonadectomy. A serum progesterone level of about 1 ng/ml was chosen because it inhibits LH only in the presence of estradiol. Under these circumstances, a decrease in LH pulse amplitude during progesterone treatment would suggest that progesterone increased the response to the existing level of estradiol; a decrease in pulse frequency would suggest that estradiol increases the effectiveness of progesterone. It was found that the low level of progesterone produced a decrease in LH pulse frequency in estradiol-treated ovariectomized ewes without altering pulse amplitude. These results are consistent with the hypothesis that the synergism of these two steroids reflects, at least in part, an estradiol-induced increase in the sensitivity of the central nervous system to the negative feedback action of progesterone.

Animals↗
PubMed1981

Importance of variations in behavioural and feedback actions of oestradiol to the control of seasonal breeding in the ewe.

Seasonal variations in the behavioural and feedback actions of oestradiol in the ewe were examined by determining the ability of various physiological oestradiol concentrations to elicit oestrous behaviour, induce an LH surge, and suppress tonic LH secretion at four times of the year. These tests were performed in acutely ovariectomized animals pretreated with oestradiol and progesterone to minimize seasonal differences in their endocrine status. Although smaller amplitude LH surges were observed in anoestrus, the dose-response curves for the induction of LH surges were virtually identical at all times of the year. Oestradiol was slightly less effective in eliciting oestrous behaviour in anoestrus and during the transition to the breeding season than at other times. This seasonal variation was, however, observed only with relatively low oestradiol concentrations; serum oestradiol levels of 3 pg/ml or greater induced oestrus in almost all ewes regardless of season. In contrast, there was a marked seasonal change in the negative feedback action of oestradiol. In anoestrus, basal oestradiol levels of 1-3 pg/ml suppressed LH to low levels (0.3 ng/ml), whereas in the breeding season, even peak oestradiol concentrations of 10 pg/ml were not able to produce this degree of inhibition. These results thus support the hypothesis that the annual breeding cycle of the ewe is governed primarily by shifts in the extent to which oestradiol can suppress tonic LH secretion.

Animals↗
PubMed1981

Phase I trials of WR2721 in combination with radiation therapy and with the alkylating agents cyclophosphamide and cis-platinum.

Three phase I trials of the radioprotector S-2-(3-aminopropylamino) ethylphosphorothioic acid (WR2721) have accessed 60 patients. Study 1 is devised to determine the maximum tolerated dose (MTD) of a single dose of the protector 15 to 30 minutes before a single radiation treatment of a size used routinely in palliative management. Study 2 plans to determine the MTD for up to 15 daily doses of the drug over 3 weeks during palliative radiotherapy. Also, the multipe-dose study will establish the MTD before palliative irradiation for fewer than five fractions a week. Study 3 uses the existing single-dose MTD determined in Study 1 as pretreatment 15 to 30 minutes before cyclophosphamide or cis-platinum. Toxic symptoms include emesis, hypotension, hypertension, somnolence, and sneezing. Only one serious episode of hypotension, considered idiosyncratic, and one instance of moderate to severe vomiting have occurred. Forty-one patients have been entered in Study 1 and a dose of 600 mg/m2 has been reached. The next step is to proceed to the planned highest level of 740 mg/m2. Of five patients in the multiple-dose study, one has been given, without toxicity, WR2721 at the level of 100 mg/m2 for 15 fractions over 3 weeks. Fourteen patients are accessed to the alkylating agent study. Using protector doses of 450 mg/m2, a cyclophosphamide level of 1500 mg/m2 has been accomplished. However, two of three patients who received 450 mg/m2 of WR2721 before 120 mg/m2 of cis-platinum have shown moderate elevation of the serum creatinine, both of which returned to normal.

Amifostine↗
PubMed1981

Radiation therapy for soft tissue sarcoma.

Soft tissue sarcomas can be adequately treated with wide local excision and postoperative irradiation, rather than the amputation of the affected extremity. Local control and good function can be achieved in the great majority of patients treated with radiation therapy, with particularly good results (95% local control) obtained for lesions of the distal extremity i.e., below the elbow or knee. The most common site of failure is distant metastasis, and the outstanding prognostic indicator is histologic grade. Disease-free survival correlates strongly with grade, with 85%, 51%, and 17% 2-yr disease-free survival for grades 1, 2, and 3, respectively. Lymph node metastasis is an uncommon first site of failure, and prophylactic nodal irradiation or lymphadenectomy is not recommended. The value of chemotherapy or immunotherapy is not firmly established as far as enhancing local control. It is hoped that distant metastasis can be prevented by the use of such adjuvant therapy. Locally advanced, nonresectable sarcoma may be better treated with high linear energy transfer (LET) radiation, and promising results have been reported with fast neutron treatment.

Breast Neoplasms↗
PubMed1980

Pulsatile secretion of luteinizing hormone: differential suppression by ovarian steroids.

In sheep, physiological levels of estradiol and progesterone each suppress the pulses of LH characteristics of tonic LH secretion, but do so by completely different mechanisms. Estradiol treatment decreases LH pulse amplitude but not frequency and also inhibits the height of the LH peak resulting from the administration of gonadotropin-releasing hormone (GnRH). In contrast, progesterone decreases the frequency of LH pulses without reducing their amplitude or the response to exogenous GnRH. This suggests that progesterone suppresses tonic LH secretion by acting in the brain to decrease the frequency of GnRH pulses, while estradiol may suppress the response of the pituitary to GnRH and thereby decrease LH pulse amplitude.

Animals↗