Phase II study of combination chemotherapy with etoposide and amsacrine in relapsed adult leukemia.
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Adult↗
Biomedical subjects
R M Hansen
Publications and source records attributed to R M Hansen.
Pupillary changes during dark adaptation in human infants.
Pupillary diameter of 10 infants (age 10 weeks) and four adult subjects was measured during 30 min of dark adaptation following exposure to a full-field adapting light. Adult results confirm that, under these conditions, the course of pupillary recovery was reasonably well described by an exponential time course (t0 = 408 sec; SD = 42 sec), as is rhodopsin regeneration. Pupillary recovery of infants also could be described by an exponential course (average t0 = 399 sec; SD = 31 sec). These results, demonstrating similarities between adaptive functions of infants and adults, suggest that pupillographic techniques can be used to investigate dynamic processes accompanying dark adaptation in preverbal children.
Adult↗
Successful high-dose intravenous cytarabine treatment of parenchymal brain involvement from malignant lymphoma.
A patient with systemic recurrence of large-cell malignant lymphoma developed radiologic evidence of parenchymal brain metastasis. Treatment with systemic high-dose cytarabine resulted in complete regression of peripheral adenopathy and complete radiologic response in the central nervous system, with normalization of the brain computed tomographic scan. This case further demonstrates the ability of high-dose cytarabine to penetrate the blood-brain barrier and achieve therapeutic drug concentrations in the central nervous system, an area that might otherwise remain a pharmacologic sanctuary for tumor cells.
Brain Neoplasms↗
Retinal degenerations and brain abnormalities in infants and young children.
Of 51 infants and children who presented with visual impairment, developmental delays, and suspected brain abnormalities, 28 (55%) had clinical, electroretinographic, and cranial computed tomographic results indicative of cerebroretinal disorders. This report concentrates on the electroretinographic and psychophysical results from 12 patients who had evidence of progression of both brain and retinal disease. We believe these patients represent human cerebroretinal degenerative disorders that have yet to be completely characterized.
Brain↗
Undrained bloody pericardial effusion in the early postoperative period after coronary bypass surgery: a prospective blood pool study.
To assess the clinical importance of hemopericardium after cardiac surgery, serial blood pool scintigrams were performed in 13 random patients throughout the initial hours after coronary artery bypass graft surgery. Scintigraphic measurements of pericardial fluid accumulation and left ventricular ejection fraction were made. Hemodynamics, cardiac, output, and chest tube drainage were monitored; and symptoms of postpericardiotomy syndrome were recorded for a mean of 7.4 months after surgery. Seven of the 13 patients had no scintigraphic evidence of bloody pericardial effusion. Six patients had scintigraphic evidence of bloody pericardial effusion; three of these effusions were small, localized posteriorly, and evident throughout the study. In two other patients large collections of fluid (over 100 ml) developed. In one of these patients increased mediastinal drainage required reoperation. The other patient remained stable although mediastinal drainage decreased. The sixth patient showed a moderate effusion (95 ml) that decreased without evident effusion or drainage when the last image was taken. Two patients (one with evidence of a postoperative bloody effusion), had symptoms of postpericardiotomy syndrome in the follow-up period. This study reports the generally benign occurrence of bloody postoperative mediastinal effusions, the frequent accumulation of substantial amounts of undrained sanguineous fluid, and the lack of connection between the presence and or amount of pericardial blood and the postpericardiotomy syndrome. The importance of these scintigraphic findings can be interpreted only with knowledge of associated mediastinal drainage.
Aged↗
Accuracy of spatial localizations near the time of saccadic eye movements.
Two-dimensional eye movements were recorded while subjects used a hammer to strike targets that were flashed-on briefly before, during or up to 750 msec after a horizontal saccade. Mean position of hammer blows was 20 min arc (SD = 67 min arc) from the target when the only cue to target location was eye position. Position of responses varied slightly with time of target exposure relative to the saccade. These results show that observers can closely monitor small changes in eye position during and near the time of saccadic eye movements.
Eye Movements↗
Massive intravascular hemolysis without serum haptoglobin depletion.
Hyperplasia of marrow histiocytes with extensive hemophagocytosis was found in a patient with cytomegalovirus infection. He experienced massive intravascular hemolysis, but, unexpectedly, no depression of the serum haptoglobin level was found by either single radial immunodiffusion or rate nephelometry. The unexpectedly high haptoglobin value may have been the result of "blockade" of the monocyte-macrophage system, with resultant failure to clear haptoglobin-hemoglobin complex rapidly from the circulation. Use of the techniques described for the indirect estimation of unbound serum haptoglobin alone should avoid confusing results in similar clinical circumstances.
Adult↗
Visual acuity of infants and children with retinal degenerations.
Visual acuity for gratings was studied in 18 infants and children with generalized retinal degenerations using preferential looking (PL) procedures. Diagnoses were Leber's congenital amaurosis (12), Laurence-Moon-Bardet-Biedl-like syndromes (4) and metabolic disorders (2). ERG's were extinguished in 11 patients and much attenuated in seven patients. Acuities at all ages (two months to 12 years) were significantly poorer than normal, and patients with extinguished ERG's had the poorest acuity. Neurological abnormality or mental retardation, present in ten patients, was as likely in patients with 6/60 or poorer grating acuity as in patients with better than 6/60 acuity. A comparison group of 12 infants and children with oculocutaneous albinism showed significantly better grating acuities than the patients with retinal degeneration. Relatively good grating acuity in infants with no anatomic fovea (oculocutaneous albinism) and much poorer acuities of infants with generalized retinal degeneration suggest that parafoveal or peripheral retina is necessary and sufficient for normal, behaviorally-obtained grating acuity in infancy.
Adolescent↗
Failure to suspect and diagnose thalassemic syndromes. Interpretation of RBC indices by the nonhematologist.
A three-year review of the medical records of 76 patients with apparent thalassemic syndromes (mean corpuscular volume, greater than 75 cu micron; RBC count, greater than 5 X 10(6)/cu mm) was performed to assess overall physician response to this information at a midwestern teaching institution. Abnormal indices were recognized in only 50% of the cases; in only 32% of cases was a thalassemic syndrome considered in the differential diagnosis. Residents in internal medicine failed to recognize microcytic indices and to consider thalassemic syndromes 42% and 59% of the time, respectively. Even though hemoglobin electrophoresis was performed in 25 patients, in only 15 (56%) of the 25 cases was beta-thalassemia proved or alpha-thalassemia presumptively diagnosed. In 17% of all cases, the patients were treated with iron without diagnostic findings on iron studies and/or in spite of data suggesting a thalassemic syndrome. The RBC indices are an underused portion of the complete blood cell count, and readily apparent thalassemic syndromes are often not considered.
Erythrocyte Indices↗
Concurrent myelodysplasia and lymphoproliferation: a disorder of the true pluripotential stem cell?
The lymphoproliferative disorders and the myelodysplastic syndromes are thought to result from the clonal expansion of a single abnormal precursor cell. Seven patients who were found to have concurrent myelodysplasia and lymphoproliferation are described. In all cases myelodysplasia and lymphoproliferation were diagnosed simultaneously or myelodysplasia preceded overt lymphoproliferation by a brief interval. Thus, myelodysplasia in these patients was not related to treatment given for a lymphoproliferative disorder. Stem cell theory is reviewed with special reference to evidence for an adult human stem cell common to both haemopoietic and lymphoid cell lines (CFU-L-M). The presence of concurrent myelodysplasia and lymphoproliferation in these seven patients may be the result of the clonal expansion of an abnormal pluripotential stem cell. It may be possible in some cases to achieve remission of the lymphoproliferative disorder with return of normal haematopoiesis if residual normal stem cells are present and repopulate the marrow following cytotoxic therapy.
Adult↗
Gold induced aplastic anemia. Complete response to corticosteroids, plasmapheresis, and N-acetylcysteine infusion.
A 47-year-old woman with rheumatoid arthritis (RA) had been treated with greater than 7 g of gold sodium thiomalate over a 5 year period when aplastic anemia developed. Treatment with corticosteroids, plasmapheresis and infusion of N-acetylcysteine (NAC) resulted in complete hematologic remission. Infusion of NAC increased daily urinary excretion of gold and use of an ambulatory infusion pump with a Hickman catheter allowed protracted outpatient infusion for more than 4 months' duration. It is now 20 months since the onset of aplastic anemia and she remains in complete hematologic remission.
Acetylcysteine↗
Malignant lymphoma of the uterine cervix.
Three patients with primary malignant lymphoma of the uterine cervix are reported and the literature is reviewed. All of the patients in the current cases presented with irregular menstruation. Two patients were found to have diffuse histiocytic lymphoma, and one patient had diffuse mixed lymphoma. Histologic diagnosis was confirmed by outside expert pathologists in all cases. In spite of locally advanced disease according to FIGO's classification (Stage IVA-2 and Stage IIB-1), they responded well to external irradiation, and had control of tumor within the pelvis. All are alive at 13, 7, and 3 years, respectively, after the completion of irradiation. One patient developed disseminated disease 4.25 years after the completion of external irradiation, but was successfully treated with combination chemotherapy for 2 years, and is alive at 6.75 years after the completion of chemotherapy without disease. Review of the other 21 cases reported in the literature reveals that 14 were free of disease after treatment. The importance of distinguishing malignant lymphoma from undifferentiated carcinoma or sarcoma is emphasized since cervical malignant lymphoma can be successfully treated with irradiation in spite of locally advanced disease.
Adult↗
Hodgkin's disease with leptomeningeal involvement. Report of a case with long survival.
A 30-year-old white man with Stage IV B Hodgkin's disease, mixed cellularity type, developed leptomeningeal involvement shortly after relapsing on nitrogen mustard, Oncovin (vincristine), procarbazine, and prednisone (MOPP), and while receiving Adriamycin (doxorubicin), bleomycin, Velban (vinblastine), and dacarbazine (ABVD). Whole brain irradiation and intrathecal methotrexate were successfully incorporated into his treatment program. The patient has now been in complete remission for more than 40 months. A review of this rare complication of Hodgkin's disease is presented.
Adult↗
Benign mesothelial proliferation with effusion. Clinicopathologic entity that may mimic malignancy.
The clinical and pathologic features of five cases of a previously poorly defined syndrome, benign mesothelial proliferation with effusion, are described. Although this is a benign process, both the gross and the microscopic findings may mimic metastatic papillary adenocarcinoma. Three of five patients had dysynchronous involvement in more than one body cavity developing over intervals of one, two, and six years. The clinical course is unpredictable and is usually associated with a good prognosis, but two of three patients with pericardial involvement required pericardectomy for pericardial tamponade. The entity of benign mesothelial proliferation with effusion and its distinction from true malignant conditions are discussed.
Adult↗
Successful treatment of meningeal leukemia using systemic high-dose cytosine arabinoside.
Conventional therapy for leukemic meningitis includes cranial irradiation and intrathecal chemotherapy administered by repeated lumbar punctures or direct intraventricular instillation via an Ommaya reservoir. Several clinical reports have indicated that high doses of cytosine arabinoside (ara-C) are effective in the treatment of acute leukemia refractory to standard induction therapy. Pharmacokinetic studies have demonstrated that high doses of ara-C given intravenously obtain sustained therapeutic drug concentrations in the cerebrospinal fluid, suggesting that this approach may be useful in the treatment of systemic disease associated with meningeal involvement. Five consecutive patients with overt meningeal leukemia were treated using only systemic chemotherapy containing high-dose ara-C. In all patients there was prompt resolution of neurologic symptoms and signs accompanied by cytologic clearing of leukemic cells from the cerebrospinal fluid.
Acute Disease↗
Assessment of acuity in human infants using face and grating stimuli.
In a variety of ocular disorders, square-wave gratings yield more optimistic estimates of visual acuity than more complex stimuli such as letters. However, for clinical vision testing of preverbal patients, square-wave gratings are usually employed in conjunction with preferential looking procedures. We developed a complex stimulus--a schematic face--for use in preferential looking procedures. Using the method of constant stimuli, the acuities of 1-, 3-, and 5-month-old infants with normal eyes were estimated using schematic faces and square-wave gratings. Within each age group, thresholds for face and grating stimuli were not significantly different, but psychometric functions obtained with faces were significantly steeper than those obtained with square-wave gratings. This suggests that complex stimuli such as the schematic face could yield more precise acuity estimates than gratings in some pediatric eye patients.
Age Factors↗
Indolent diffuse histiocytic lymphoma with sclerosis and chylous effusions.
A case of diffuse histiocytic lymphoma with sclerosis and chylous pleural and peritoneal effusions spanning four years from onset to diagnosis is presented. Treatment with combination chemotherapy and consolidative radiotherapy resulted in clinical improvement and the patient remains free of disease 14 months after stopping treatment. The problems of chylous effusions and the subgroup of diffuse histiocytic lymphoma with sclerosis are discussed.
Chylous Ascites↗
Metastatic renal cell carcinoma presenting as shoulder arthritis.
Three patients with previously undiagnosed renal cell carcinoma presented with complaints of shoulder pain secondary to tumor metastases involving the clavicle or upper humerus. In two patients, bone scintigraphy and/or gallium scintigraphy demonstrated the primary renal lesion. One patient had been treated with anti-inflammatory drugs and intra-articular steroid injections for presumed arthritis before the cause of the symptoms was recognized. Review of the literature reveals that renal cell carcinoma frequently metastasizes to bones of the shoulder girdle, and that presenting complaints may relate to osseous metastases. Careful evaluation should be carried out before patients with shoulder pain are treated for presumed arthritis.
Adenocarcinoma↗