Metabolic acidosis and renal solute load in relation to the protein intake of low birth weight Malaysian neonates.
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Biomedical subjects
Publications and source records attributed to R O Johnson.
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The treatment of advanced base of tongue carcinoma with concurrent radiation therapy and 5-fluorouracil versus radiation therapy alone is compared. Although the results are inconclusive, it is noteworthy that all the 5-year survivors were patients given combined treatment. Important questions regarding optimization of time-dose relationships with combined therapy were generated. Accordingly, 18F-5 fluorouracil was synthesized in an attempt to answer some of these questions.
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A poorly differentiated adenocarcinoma of the rectum developed in a 43-year-old man 37 years after ureterosigmoidostomy for epispadias with urinary incontinence. The review of literature indicates that patients who have undergone ureterosigmoidostomy have an increased risk for the development of large bowel neoplasia. The median time interval between the procedure and the diagnosis of the neoplasm is 21 years, and the median age at diagnosis is 33 years. The majority of the lesions are malignant and seem to occur at the site of ureteric anastamosis. The suggested etiologic mechanisms and the clinical aspects of colonic neoplasia following ureterosigmoidostomy are discussed.
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By means of the new rod lens telescopic endoscopes, the diagnosis of H- or N-type tracheoesophageal fistula in infants and children can now be made definitively without the difficulties and complications previously described, and the numerous methods recommended in the literature, all of which have their inconsistensies, failures, errors, and dangers. Using these advanced endoscopes the fistula is demonstrated by bronchoscopy, a small Fogarty catheter is threaded through the opening in the trachea under direct view of the telescope and passed through the fistula into the esophagus. The balloon is inflated and the bronchoscope removed, leaving the catheter in place. A proper incision is then made in the neck or chest, depending on the location of the lesion, and the fistulous tract is quickly located by palpation of the balloon and catheter. Then with minimal and accurate dissection, correction is carried out.
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A previous study showed activity of megestrol acetate in advanced breast cancer; as a result the study was expanded. Of 101 patients treated with this compound, 26 (26%) met our criteria of improvement. The drug was well tolerated and produced no toxicity and, as opposed to androgens and estrogens, no endocrine effects were observed. Prior hormonal or cytotoxic compounds, including alkylating agents, did not appear to reduce the subsequent responsiveness to this potent progestational compound. We now include it, often as the initial hormonal trial in postmenopausal patients, in our sequential treatment of disseminated breast cancer because of its favorable therapeutic ratio.
In 1961, a randomized study was begun at the University of Wisconsin Medical Center in which the treatment of advanced squamous cell carcinoma of the head and neck with radiation therapy was compared with combined treatment with radiation therapy and 5-Fluorouracil. One hundred and thirty-six patients with primary lesions in the oral cavity, the base of the tongue, and the oropharynx were analyzed. Both local control and survival were better in the combined treatment group than in the group with radiation therapy alone. However, in only the oral cavity patient population was the difference statistically significant. Both acute and late complications were also increased in this group of patients who received combined treatment.
The major toxic effects of DTIC are nausea and vomiting, leukopenia, and thrombocytopenia. It is an effective drug in the treatment of malignant melanoma with better response rates in women than in men. The addition of other drugs to DTIC therapy does not produce a higher response rate. Preliminary results indicate that as an adjuvant to standard surgical therapy DTIC does not appear beneficial to patients with a high risk for recurrence.
Co-operative investigation of clinical therapy for cancer is used to test hypotheses developed in single institutions and in animal research laboratories. The present studies in a large co-operative organization, the Central Oncology Group, are being conducted in seven major solid tumors in adults; in these studies patients with a poor surgical prognosis are being treated with preoperative or postoperative chemotherapy, preoperative radiotion therapy of these modalities. Results of studies currently underway or recently completed in 1,278 patients are summarized. In most instances, the research has demonstrated little or no apparent improvement in the disease free interval or the survival time from adjuvant therapy, although only on of the studies has been completed and fully evaluated thus far. In carcinoma of the colon and rectum and melanoma, mild toxicity from drug therapy has been associated with statistically significant improvement in survival times. These studies have produced base line information on disease free intervals, time to progression and survival time in patients with cancer who are seen in the participating institutions. These observations are expected to useful in the planning of future adjuvant studies.
A total of 419 patients with progressive liver disease, in nearly all cases metastatic from gastrointestinal primaries, were treated by intrahepatic arterial infusion with 5-FU. Three-fourths of these patients had had prior trials with intravenous 5-FU for 1 or 2 months to several years and had been switched to the infusion upon the development of progression. Catheters were placed percutaneously and the patients infused with 5-FU at a dose of 20 to 30 mg/kg/day X 4, then 15 mg/kg/day X 17, at which point the catheter was removed and the patient sent home on weekly i.v. doses at 15 mg/kg. Toxicity, morbidity, and mortality were minimal with the intrahepatic arterial infusion treatment and the rigid criteria of improvement were met by 55% of the study cases. The survival rate of those patients who responded to the treatment was greater than the survival rate of those who failed to respond.
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