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Biomedical subjects

R Livingston

Publications and source records attributed to R Livingston.

At least 37 records · Page 2Linked to original sources
PubMed1995

Chemoradiotherapy with or without granulocyte-macrophage colony-stimulating factor in the treatment of limited-stage small-cell lung cancer: a prospective phase III randomized study of the Southwest Oncology Group.

PURPOSE: This phase III randomized trial was designed to determine if granulocyte-macrophage colony-stimulating factor (GM-CSF) reduces the hematologic toxicity and morbidity induced by chemoradiotherapy in limited-stage small-cell lung cancer (SCLC). METHODS: This multicenter prospective trial randomized 230 patients to receive chemotherapy and radiotherapy (RT) with or without GM-CSF given on days 4 to 18 of each of six cycles. The primary end point was hematologic toxicity. Secondary end points included the following: nonhematologic toxicities; days of (1) fever, (2) antibiotics, (3) hospitalization, and (4) infection; number of transfusions; drug doses delivered; and response rates and survival. RESULTS: There was a statistically significant increase in the frequency and duration of life-threatening thrombocytopenia (P < .001) in patients randomized to GM-CSF. GM-CSF patients had significantly more toxic deaths (P < .01), more nonhematologic toxicities, more days in hospital, a higher incidence of intravenous (IV) antibiotic usage, and more transfusions. Patients randomized to GM-CSF had higher WBC and neutrophil nadirs (P < .01), but no significant difference in the frequency of grade 4 leukopenia or neutropenia. Patients randomized to GM-CSF had a lower complete response rate (36% v 44%), but the differences were not significant (P = .29). There were no significant differences in survival (median, 14 months on GM-CSF and 17 months on no GM-CSF; P = .15). CONCLUSION: GM-CSF, as delivered in this study, should not be included with concurrent chemoradiotherapy treatment programs for limited-stage SCLC. The simultaneous use of hematopoietic colony-stimulating factors (CSFs) and chemoradiotherapy should be performed only in experimental settings. Chemoradiotherapy programs with cisplatin and etoposide ([VP-16] PE) and simultaneous chest RT produce grade 4 neutropenia and thrombocytopenia in a small-enough proportion of patients that prophylactic hematopoietic growth factors are clinically unnecessary.

Adult↗
PubMed1995

Families who somatize.

This investigation extends a previous study of children of people with somatization disorder and children of less severely affected somatizers. We used the revised Diagnostic Interview for Children and Adolescents, revised, and abstracted medical records to compare families in which a child as well as a parent had unexplained somatic complaints; we also identified parental predictors of children's somatization. Children in families with somatizing children had more emergency room use, more suicidal behavior, and more disability. Children in families of somatization disorder adults had 11.7 times as many emergency room visits as less severely affected somatizers and missed 8.8 times as much school. Parental somatization, substance abuse, and antisocial symptoms predicted children's somatization. Physicians in primary care should be aware of the frequency with which somatization occurs in other members of a family when it is identified in one member.

Adolescent↗
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

Cognitive, behavioral, and family factors in the differentiation of depressive and anxiety disorders during childhood.

Contribution of cognitive, behavioral, and family environment variables to the differentiation of depressive and anxiety disorders in children was explored. Fifty-nine children from Grades 4-7 (14 diagnosed with a depressive disorder, 16 diagnosed with depressive and anxiety disorders, 11 diagnosed with an anxiety disorder, and 18 nondisturbed controls) completed measures of the depressive cognitive triad, depressive cognitions, social skills, family environment, and maladaptive family messages. Results of a stepwise discriminant function analysis indicated that 2 discriminant functions composed of 7 variables from the cognitive, behavioral, and family environment domains accounted for 91% of the between-groups variance. Results suggest that depressive disorders can be distinguished from anxiety disorders on the basis of ratings of cognition, social skills, and family environment. Implications for existing research and a model of depression during childhood are discussed.

Adolescent↗
PubMed1993

Children of people with somatization disorder.

OBJECTIVE: The author investigated psychopathology, suicidal behavior, child abuse, somatization, and health care utilization in 34 children with a parent who has somatization disorder (SD-P) and two comparison groups: 41 children with a somatizing parent (SOM) (fewer symptoms than required for diagnosis of SD-P), and 30 pediatrically ill controls (CON). METHOD: Child and parent versions of the Diagnostic Interview for Children and Adolescents were scored for diagnosis and symptom counts in specified categories. Medical records were obtained and abstracted. RESULTS: Children of SD-P had significantly more psychiatric disorders and suicide attempts than did children of SOM or the CON. SD-P and CON had significantly more unexplained physical symptoms than SOM. SD-P showed a trend toward more hospitalizations and experienced significantly more maltreatment. CONCLUSIONS: Children of SD-P are at significant risk in several respects. Clinical implications of these findings include a need for awareness and cooperation among general psychiatrists, primary care physicians, and child and adolescent psychiatrists to facilitate detection and treatment of these children's problems.

Adolescent↗
PubMed1993

Season of birth and neurodevelopmental disorders: summer birth is associated with dyslexia.

OBJECTIVE: Increased risk for certain psychiatric disorders has been associated with season of birth. This study was undertaken to look for hypothesized season-of-birth effects for dyslexia, schizophrenia spectrum disorders, and neurological soft signs in children and adolescents. METHOD: Month of birth and the diagnostic findings in question were examined based on charts from a clinic population of 585 boys. Odds ratios and etiological fractions were calculated. RESULTS: Neurological soft signs showed a sporadic peak for June births and schizophrenia spectrum showed a peak for August and November. A smooth curve suggesting true seasonality was evident in dyslexia for births in May, June, and July. For different 5-year birth cohorts, early summer birth accounts for 24 to 71% of cases of dyslexia. CONCLUSIONS: The authors suggest that viral infection, especially influenza, during the second trimester of pregnancy is the most attractive hypothesis to explain these findings. If this hypothesis is supported, immunization in women of child-bearing age could reduce the incidence of dyslexia. Secondary prevention could also be enhanced by early identification and treatment of children who were exposed in utero.

Adolescent↗
PubMed1993

Predictors of self-reported psychopathology in children abused repeatedly by a parent.

OBJECTIVE: This study was designed to test the influence of gender, type of abuse, and other factors on the development of psychopathology in abused children. METHOD: Forty-one children who had been abused repeatedly either physically or sexually by a parent or parent figure were given the revised Diagnostic Interview for Children and Adolescents. RESULTS: Logistic regression analyses showed: conduct disorder was predicted by male gender and increasing age regardless of type of abuse; post-traumatic stress disorder was predicted by number of stressors other than abuse and not by sexual abuse versus physical abuse. Predictors of somatization, psychotic symptoms, suicidal ideation, and separation anxiety also were identified. CONCLUSIONS: Gender, age, and stressors other than abuse contribute to the prediction of psychiatric disorder in abused children. Early interventions with young abused boys could help prevent development of violent behavior or conduct disorder; case work to reduce other stressors and treatments designed to reduce the impact of stressors may ameliorate developing post-traumatic stress disorders and other emotional disorders in abused children.

Adolescent↗
PubMed1993

Human brain fluoxetine concentrations.

Data on 22 subjects treated with fluoxetine suggest that magnetic resonance spectroscopy (MRS) of fluorine-19 can measure brain concentrations of fluoxetine/norfluoxetine in vivo. Fluoxetine accumulates in the human brain relative to plasma, with brain concentrations of fluoxetine/norfluoxetine ranging up to 10.7 micrograms/ml. Brain concentrations may reach a plateau between 6 and 8 months of treatment. The apparent concentration in brain relative to plasma is 20:1, roughly parallel to brain antidepressant concentration ratios in animal studies.

Adolescent↗
PubMed1993

Extended administration of oral etoposide and oral cyclophosphamide for the treatment of advanced non-small-cell lung cancer: a Southwest Oncology Group study.

PURPOSE: We designed an all-oral regimen of etoposide and cyclophosphamide for use in advanced non-small-cell lung cancer. PATIENTS AND METHODS: Eligible patients were chemotherapy-naive and had histologically confirmed assessable or measurable stage IV non-small-cell lung cancer. Patients received etoposide 50 mg/m2/d orally days 1 through 14 and cyclophosphamide 50 mg/m2/d orally days 1 through 14 every 28 days. Doses on later cycles were adjusted for myelosuppression. RESULTS: Sixty-six patients (64 eligible patients) received 192 cycles of oral extended etoposide/cyclophosphamide therapy (median, two cycles; range, zero to 15). Therapy was well tolerated with the mean dose per cycle being 104% of the originally scheduled dose. Two patients (3%) achieved a complete response and six (9%) achieved a partial response. Leukopenia, anemia, nausea/vomiting, and alopecia were the most common toxicities. Median survival was 6 months, and the 1-year survival rate was 25.6%, comparable to more intensive treatments. CONCLUSION: Oral extended etoposide/cyclophosphamide is a well-tolerated alternative for the treatment of stage IV non-small-cell lung cancer and can be used as a basis for the design of further outpatient regimens.

Administration, Oral↗
PubMed1993

Sororicide in preteen girls. A case report and literature review.

All means of exploring the psychological and environmental antecedents of murder by a child should be used toward preventing lethal outcomes in future. The authors present the case of a ten year old girl who killed her sister with details of the sisters' relationship, the perpetrator's psychological characteristics and the family situation. Sibling-rivalry, family stressors, and the perpetrator's compulsive and narcissistic traits and preoccupation with a violent television fantasy are discussed. A literature review and suggestions for future research are provided.

Anger↗
PubMed1992

Psychotic symptoms and suicidal behavior in hospitalized children.

Association of psychotic symptoms with suicidal behavior was studied in 90 hospitalized prepubertal children. Children with psychotic symptoms were more likely to have threatened or attempted suicide. The association of visual hallucinations with suicidal behavior was stronger than that of auditory hallucinations or psychotic ideation. The authors speculate that psychosis in general and visual hallucinations especially may be indicators of suicide risk among children.

Age Factors↗
PubMed1991

Treatment of relapsed non-Hodgkin's lymphomas with dexamethasone, high-dose cytarabine, and cisplatin before marrow transplantation.

Combination chemotherapy is capable of curing many patients with newly diagnosed intermediate- and high-grade non-Hodgkin's lymphomas (NHL), but treatment of relapsed NHL remains problematic. Bone marrow transplantation (BMT) offers the best chance for disease-free survival, but interim chemotherapy is often necessary while awaiting BMT, especially for patients with bulky disease. We report here 39 patients (median age, 44 years) who failed primary therapy with doxorubicin-based regimens and subsequently were treated with one to six cycles of dexamethasone, 40 mg intravenous (IV) every day on days 1 to 4, cisplatin 100 mg/m2 by continuous infusion on day 1, and cytarabine 2 g/m2 IV every 12 hours x two doses on day 2 (DHAP) before the planned BMT. Histologies included 16 diffuse large-cell, six diffuse mixed, five diffuse small-cleaved, four lymphoblastic, and eight other. Twenty-eight patients had stage IV disease, 13 had B symptoms, and 20 had an elevated lactate dehydrogenase (LDH). Patients had been treated with a median of three previous chemotherapy regimens. Sixty-one percent of patients had high tumor burdens according to the MD Anderson criteria. Objective responses to DHAP were seen in 26 patients (67%) including nine complete responses (CRs) (23%) and 17 partial responses (PRs) (44%), and responses lasted a median of 7.5 months. Myelosuppression was the major toxicity, but there were no treatment-related deaths. To date, 17 patients have undergone subsequent BMT with a projected 3-year disease-free survival of 15%. We conclude that the DHAP regimen is effective short-term salvage therapy for relapsed NHL patients, but the long-term prognosis of multiply relapsed patients remains poor.

Adolescent↗
PubMed1989

Focused utilization review strategies.

Researchers from the Michigan Health Care Education and Research Foundation, a research affiliate of Blue Cross and Blue Shield of Michigan, compared three focused utilization review (UR) strategies to determine which method most effectively and efficiently identifies nonacute inpatient hospital admissions. Intensity, Severity, Discharge-Appropriateness (ISD-A) criteria were used to identify nonacute admissions in 8,973 cases in 73 Michigan hospitals. Significant proportions of nonacute admissions were found in medical, psychiatric, and substance abuse cases; surgical admissions had the lowest rates. Strategies involving the concentration ratio were most effective at indicating potential efficiency gains. Focused UR on Diagnosis-Related Groups (DRGs) with nonacute rates greater than 15% captured 41% of admissions and accounted for 85% of nonacute admissions, 85% of nonacute days, and 80% of potential dollar savings. This suggests that UR efforts focused primarily on DRGs with high nonacute rates would significantly improve the efficiency and effectiveness of the overall UR process.

Acute Disease↗
PubMed1988

Effect of color of questionnaire on emotional responses.

We examined whether paper color affects the kind of emotional response obtained from questionnaires. University of Utah students (N = 221) read three vignettes, each describing a murder or rape, and responded by answering a set of eight questions for each case. A three-way analysis of variance was performed in which color (pink, blue, white), type of verdict (guilty, not guilty) and sex were the main effects. The results showed that there were significant differences for color and verdict but not for sex.

Color Perception↗