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Biomedical subjects

Robert Morgan

Publications and source records attributed to Robert Morgan.

At least 19 recordsLinked to original sources
PubMed2006

A phase I study of oxaliplatin in combination with gemcitabine: correlation of clinical outcome with gene expression.

PURPOSE: Oxaliplatin has in vitro activity similar to or higher than other platinum agents. Preclinically, gemcitabine has demonstrated synergy when combined with platinum compounds. These facts formed the rationale for determining the maximum tolerated dose (MTD) of gemcitabine in combination with oxaliplatin. METHODS: Eligible patients with advanced incurable solid tumors were given oxaliplatin 130 mg/m2 as a 2-h infusion on day 1 followed by escalating doses of gemcitabine given over 30 min on day 1 and 8 of a 21-day cycle. RESULTS: A total of 43 patients were enrolled, including 30 patients at the MTD in an expanded cohort. At a gemcitabine dose of 800 mg/m2, 1/6 patients had a dose limiting toxicity (DLT) (grade 3 blurred vision and memory loss). At 1,000 mg/m2, 1/6 patients had a DLT (grade 3 increase in AST). At 1,200 mg/m2, 2/3 patients had a DLT (grade 4 thrombocytopenia and grade 3 confusion). The MTD of gemcitabine with 130 mg/m2 of oxaliplatin was therefore 1,000 mg/m2. The clearances of gemcitabine and ultrafilterable platinum are within the ranges previously reported for single agents. A patient with colon cancer had a partial response, and 21 patients had a best response of stable disease. In patients with tumor biopsies treated at the MTD, decreased ribonucleotide reductase M2 expression correlated with response. CONCLUSION: Treatment with gemcitabine and oxaliplatin was well tolerated with primarily hematologic toxicity at the MTD. Study of biochemical correlates of response remain of interest thought current results remain exploratory.

Adult↗
PubMed2006

Cutting balloons for the treatment of vascular stenoses.

The aim of this article is to review the mechanism, technical characteristics, biological response and clinical applications of cutting balloon angioplasty in peripheral vessels. The cutting balloon is a non-compliant, balloon catheter equipped with three-to-four microtome-sharp atherotomes. When used appropriately, it is safe and easy to use, with a high immediate success rate and few complications, provided oversizing is avoided. There is some evidence that pre-dilation with a standard or high-pressure balloon may also predispose to vascular rupture. The cutting balloon has proved to be beneficial in treating difficult complex lesions in the coronary arteries. Early experience in non-coronary vessels shows that cutting balloon angioplasty can be used to treat peripheral bypass anastomotic and haemodialysis fistula stenoses that are resistant to conventional high-inflation pressures. Its application in de novo peripheral arterial lesions and non-coronary in-stent restenosis is still under discussion. Theoretically, this device induces a smaller degree of vessel wall injury localised to the area of incisions and sparing the interincisional segments; however, this postulated reduction in restenosis rates has not been confirmed in clinical practice.

Angiography↗
PubMed2006

Potential community and public health impacts of medically supervised safer smoking facilities for crack cocaine users.

There is growing evidence of the public health and community harms associated with crack cocaine smoking, particularly the risk of blood-borne transmission through non-parenteral routes. In response, community advocates and policy makers in Vancouver, Canada are calling for an exemption from Health Canada to pilot a medically supervised safer smoking facility (SSF) for non-injection drug users (NIDU). Current reluctance on the part of health authorities is likely due to the lack of existing evidence surrounding the extent of related harm and potential uptake of such a facility among NIDUs in this setting. In November 2004, a feasibility study was conducted among 437 crack cocaine smokers. Univariate analyses were conducted to determine associations with willingness to use a SSF and logistic regression was used to adjust for potentially confounding variables (p < 0.05). Variables found to be independently associated with willingness to use a SSF included recent injection drug use (OR = 1.72, 95% CI: 1.09-2.70), having equipment confiscated or broken by police (OR = 1.96, 95% CI: 1.24-2.85), crack bingeing (OR = 2.16, 95% CI: 1.39-3.12), smoking crack in public places (OR = 2.48, 95% CI: 1.65-3.27), borrowing crack pipes (OR = 2.50, 95% CI: 1.86-3.40), and burns/inhaled brillo due to rushing smoke in public places (OR = 4.37, 95% CI: 2.71-8.64). The results suggest a strong potential for a SSF to reduce the health related harms and address concerns of public order and open drug use among crack cocaine smokers should a facility be implemented in this setting.

Journal Article↗
PubMed2006

Secondary conditions in a community-based sample of women with physical disabilities over a 1-year period.

OBJECTIVE: To examine prevalence and predictors of secondary conditions in women with physical disabilities. DESIGN: Cross-sectional. SETTING: Women were recruited through private and public health clinics and various community organizations. PARTICIPANTS: A sample of 443 predominantly ethnic minority women with physical disabilities. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Health Conditions Checklist interference score. RESULTS: Aggregated data over a 1-year period showed that nearly the entire sample reported interference from pain (94.5%) and fatigue (93.7%) and that at least three quarters of the sample reported problems with spasticity (85.4%), weakness (81.8%), sleep problems (80.2%), vision impairment (77.9%), and circulatory problems (77.9%). Obesity was substantially more prevalent in this sample (47.6%) than in the general population of women (34.0%). The mean number of secondary conditions per woman +/- standard deviation was 14.6+/-6.2 (range, 1-42), with 75% of the sample endorsing 10 or more conditions. On average, women reported experiencing 5.7+/-4.03 (range, 0-20) conditions that they rated as significant or chronic. A third (33.4%) of the variance in interference scores was accounted for in the regression analysis, with significant variance accounted for by race, disability type (women with joint and connective tissue disorders and women with postpolio reported the highest overall interference scores), greater functional limitations, and lower levels of general mental health. CONCLUSIONS: Secondary conditions in women with physical disabilities are substantially more problematic than reported previously in the literature. Further research is needed to determine health disparities of women with and without disabilities. Measurement issues and the clinical relevance of these findings are discussed.

Activities of Daily Living↗
PubMed2005

Risk factors of intrahepatic cholangiocarcinoma in the United States: a case-control study.

BACKGROUND & AIMS: The incidence of intrahepatic cholangiocarcinoma has been recently increasing in the United States. In this case-control study, we used the Surveillance, Epidemiology, and End Results-Medicare database to evaluate the prevalence of known risk factors for intrahepatic cholangiocarcinoma and explore other potential risk factors. METHODS: We identified all patients with intrahepatic cholangiocarcinoma aged 65 years and older diagnosed between 1993 and 1999 in the population-based Surveillance, Epidemiology, and End Results registries (14% of the US population). Controls were randomly chosen from individuals without any cancer diagnosis in the underlying population of the Surveillance, Epidemiology, and End Results regions. We obtained information on risk factors from Medicare claims (parts A and B) for all cases and controls with at least 2 years of continuous Medicare enrollment. Unadjusted and adjusted odds ratios were calculated in logistic regression analysis. RESULTS: A total of 625 cases and 90,834 controls satisfied the inclusion and exclusion criteria. Cases were older than controls (78.7 vs. 76.5 years; P=.02) and were more likely to be male (48.3% vs. 36.8%; P <.0001). The racial composition was similar between cases and controls. Several risk factors were significantly more prevalent among cases. These included nonspecific cirrhosis (adjusted odds ratio, 27.2; P <.0001), alcoholic liver disease (adjusted odds ratio, 7.4; P <.0001), hepatitis C virus infection (adjusted odds ratio, 6.1; P <.0001), human immunodeficiency virus infection (adjusted odds ratio, 5.9; P=.003), diabetes (adjusted odds ratio, 2.0; P <.0001), and inflammatory bowel diseases (adjusted odds ratio, 2.3; P=.002). CONCLUSIONS: This population-based study shows that in addition to previously well described risk factors, several others could be associated with intrahepatic cholangiocarcinoma. These include hepatitis C virus, human immunodeficiency virus, liver cirrhosis, and diabetes.

Aged↗
PubMed2004

Prognostic indicators and survival in patients with stage IIIB inflammatory breast carcinoma after dose-intense chemotherapy.

PURPOSE: To improve treatment outcome for patients presenting with inflammatory breast cancer (IBC), we have sequentially developed and tested single and tandem dose-intense chemotherapy regimens (DICT). Tumor- and treatment-related factors were analyzed to generate a prognostic model. PATIENTS AND METHODS: Between May 1989 and April 2002, 120 patients received conventional-dose chemotherapy, surgery, and sequentially developed single- or tandem-cycle DICT. Disease- and treatment-specific features were subjected to univariate and multivariate analysis to correlate with outcome. RESULTS: At a median follow-up of 61 months (range, 21 to 161 months), estimated 5-year relapse-free survival (RFS) and overall survival (OS) were 44% (95% CI, 34% to 53%) and 64% (95% CI, 55% to 73%), respectively. In an age-adjusted multivariate analysis, RFS was better in patients with estrogen receptor (ER)/progesterone receptor (PR)-positive tumors (P =.002), for patients with fewer than four involved axillary nodes before DICT (P =.01), and in patients treated with radiation therapy (P =.001) and tandem DICT (P =.049). OS was improved in patients with ER/PR-positive tumors (P =.002), in those with fewer than four involved axillary nodes before DICT (P =.03), and in patients treated with radiation therapy (P =.002). CONCLUSION: This retrospective analysis suggests that either single or tandem DICT can be administered safely and may benefit selected patients with stage IIIB IBC. Those with receptor-negative IBC and with four or more involved axillary nodes before DICT need improved neoadjuvant and postadjuvant intensification therapy. A prospective randomized trial of single versus tandem DICT would be required to confirm the potential benefit of tandem DICT in the setting of IBC.

Adult↗
PubMed2004

Neurophysiological study of peripheral neuropathy after high-dose Paclitaxel: lack of neuroprotective effect of amifostine.

PURPOSE: To determine if there is a beneficial effect of amifostine in preventing or reducing the neuropathy induced by high-dose paclitaxel. METHODS: Breast cancer patients receiving high-dose infusional paclitaxel (725 mg/m(2)/24 h) in combination with doxorubicin (165 mg/m(2)/96 h) and cyclophosphamide (100 mg/kg/2 h; ACT) were studied on two autologous peripheral blood stem cell transplant protocols, one with and one without amifostine (740 mg/m(2) administered over 10 min before and 12 h after initiation of the paclitaxel infusion). Patients were evaluated before ACT and 20-40 days later with neurological examination, a composite peripheral neuropathy score, peroneal and sural nerve conduction studies, and quantitative sensory testing. RESULTS: There was no significant difference in paclitaxel maximum concentration, systemic clearance, or area under the curve determinations. Narcotic requirement as well as recovery of hematopoietic counts were also similar in subjects with or without amifostine. After ACT was administered, there was a decrease in peroneal nerve compound muscle action potential amplitude and sural nerve sensory action potential amplitude, as well as an increase in vibratory and cold detection thresholds. Clinical composite peripheral neuropathy scores were similar despite amifostine treatment; and logarithm to the base 2 ratios post/pre ACT showed no significant effect of amifostine on peroneal nerve compound muscle action potential, sural nerve sensory action potential, vibratory detection thresholds, or cold detection thresholds. All subjects had acroparesthesias and lost their ankle deep-tendon reflexes after administration of ACT. CONCLUSIONS: Single high-dose paclitaxel produces predictable clinical and neurophysiological changes so that patients receiving high-dose therapy are ideal subjects to test the effectiveness of neuroprotective agents. Amifostine was ineffective in preventing or reducing the neurotoxicity of high-dose paclitaxel.

Adult↗
PubMed2004

Pre-myomectomy uterine artery embolisation minimises operative blood loss.

Women with massive fibroids (extending beyond the level of the umbilicus) are conventionally offered a hysterectomy, rather than myomectomy, which is considered too technically challenging, with risks of excessive haemorrhage. Some women desire fertility, or may simply wish to preserve their uterus. Uterine artery embolisation is a relatively new treatment for fibroids, and complication rates are thought to be high with massive fibroids. We have performed uterine artery embolisation immediately prior to myomectomy, and found a reduction in blood loss. Uterine artery embolisation may be a useful adjunct to surgery in women with massive fibroids or for whom uterine artery embolisation alone is considered inadequate primary treatment, those with previous myomectomy where surgery might be complicated by extensive adhesions, in Jehovah's Witnesses and in other women who refuse blood transfusion.

Arteries↗
PubMed2004

Challenges and strategies for proper pediatric nutrition and weight control.

Pediatric and adolescent obesity are a growing problem in New Jersey and throughout the United States. The long-term health consequences may produce a generation of children with a shorter life expectancy than their parents have. A coordinated effort by parents, teachers, physicians, public health organizations, schools, and peers is essential in encouraging children who are currently overweight to lose weight and attain a normal body mass index and to prevent other children from becoming overweight.

Adolescent↗
PubMed2004

Challenges and strategies for improving the mental health of New Jersey children and adolescents.

Mental health issues facing children and adolescents in New Jersey are an under-recognized health care issue. Insufficient data are available to fully define the scope of the problem. Current resources for early diagnosis and treatment do not meet the need. In an era in which the usual stress of adolescence is compounded by violence in schools and the threat of terrorism, more needs to be done to ensure the mental health of all of our children and adolescents.

Adolescent↗
PubMed2003

Current treatment methods for postcatheterization pseudoaneurysms.

Pseudoaneurysms are a recognized complication of arterial catheterization. Until recently, the standard method of treatment has been surgical. The past decade has seen the introduction of several minimally invasive techniques that have largely replaced surgical treatment of pseudoaneurysms. The most commonly used methods are ultrasound-guided compression and percutaneous injection of thrombin into the pseudoaneurysm. This review article describes all the methods available for the treatment of postcatheterization pseudoaneurysms, presents results from the largest published series, and discusses the relative merits of each technique.

Aneurysm, False↗
PubMed2003

Embolization of a renal artery aneurysm using ethylene vinyl alcohol copolymer (Onyx).

PURPOSE: To report the embolization of a renal artery aneurysm using Onyx, a radiopaque nonadhesive liquid embolic agent. CASE REPORT: A 28-year-old woman with hypertension and fibromuscular dysplasia presented with a 20-mm renal artery aneurysm. In order to avoid any migration of embolic material into the parent vessel, a compliant balloon was inflated to exclude the aneurysm from the blood flow while injecting the liquid embolic agent. Complete aneurysm exclusion was achieved immediately, with no angiographic or duplex evidence of distal embolization or intra-aneurysmal flow. The Doppler ultrasound at 6 months confirmed aneurysm exclusion. CONCLUSIONS: The ease of use and nature of this material makes Onyx an effective and safe option in the treatment of wide-necked renal aneurysms.

Adult↗
PubMed2002

Phase I pharmacodynamic study of time and sequence dependency of hydroxyurea in combination with gemcitabine: a California Cancer Consortium Trial.

Preclinical studies in our laboratory have demonstrated that prior exposure to hydroxyurea increases the percentage of cells in S phase, enhancing the cytotoxicity of subsequent gemcitabine treatment in human oropharyngeal KB cells. To evaluate the clinical implications of this time- and sequence-dependent potentiation, we performed a phase I trial of hydroxyurea given over 24 h followed by a 30-min infusion of gemcitabine in weeks 1 and 2 of a 3-week cycle. The dose of hydroxyurea was fixed at 500 mg orally every 6 h for four doses starting 24 h before each dose of gemcitabine. The initial dose level of gemcitabine was 250 mg/m(2) on days 2 and 9, and this was escalated stepwise to 1000 mg/m(2) on days 2 and 9. Gemcitabine pharmacokinetics were determined on days 2 and 9 of the first cycle. Of 27 patients enrolled (12 female, 15 male), 24 were evaluable for response and 23 were evaluable for toxicity. Their median age was 56 years (range 27-76 years). Tumor types included lung, head and neck, pancreas, breast, colon, prostate, stomach, ovary, esophagus, germ cell, thyroid, gallbladder, and unknown primary. A total of 80 cycles of treatment were completed. One patient (unknown primary) had an objective partial response lasting 21 months, and 12 patients had stable disease. All observed dose-limiting toxicities were related to myelosuppression. The gemcitabine maximum tolerated dose was established at 750 mg/m(2) on days 2 and 9. Hydroxyurea had no effect on the plasma pharmacokinetics of gemcitabine. These results suggest that hydroxyurea followed by gemcitabine can be safely administered and has activity on this schedule. We are presently developing a phase II trial of this regimen for patients with platinum-resistant head and neck cancer.

Adult↗
PubMed2002

Endovascular repair of contained rupture of the thoracic aorta.

PURPOSE: To assess the efficacy of stent-grafts for the treatment of acute rupture of the thoracic aorta. METHODS: Four patients with acute contained ruptures of the thoracic aorta were treated by insertion of stent-grafts. The underlying aortic lesions were aneurysm, acute aortic ulcer, acute type B dissection and giant cell aortitis. The procedures were performed under general anesthesia in three patients and local anesthesia in one patient. RESULTS: All stent-grafts were successfully deployed. All patients survived the procedure and are now alive and well at follow-up (mean 6.3 months, range 44 days-16 months). One patient underwent a second stent procedure 10 days after the first procedure because of a proximal endoleak. All hemothoraces have resolved. There were no complications. CONCLUSION: Treatment of acute contained ruptures of the thoracic aorta by the insertion of stent-grafts is feasible. The technical success rates, complication rates and patient survival compare favorably with emergency surgery.

Aged↗
PubMed2002

Autologous thrombin: a new embolization treatment for traumatic intrasplenic pseudoaneurysm.

PURPOSE: To report the use of autologous thrombin for transcatheter embolization of a traumatic parenchymal splenic pseudoaneurysm. CASE REPORT: A 15-year-old boy presented with a splenic parenchymal laceration after blunt abdominal trauma. The patient was managed conservatively but developed an intrasplenic pseudoaneurysm (grade III AAST scale) with subcapsular contrast extravasation after 3 weeks. Autologous thrombin was isolated from the patient's blood and subsequently delivered to the lesion by transcatheter superselective injection into the aneurysm neck. The patient was asymptomatic after the procedure. Nine months' follow-up demonstrated a normal spleen with completely homogenous parenchyma. CONCLUSIONS: Autologous thrombin injection to induce thrombosis of intrasplenic pseudoaneurysm represents a new treatment option for traumatic abdominal organ injuries. Intrasac thrombosis can be safely induced to successfully restore the splenic parenchymal integrity without introduction of foreign material and associated risks of adverse reactions or infection that might accompany the use of commercial thrombin preparations.

Adolescent↗