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Biomedical subjects

S Brosman

Publications and source records attributed to S Brosman.

At least 19 recordsLinked to original sources
PubMed2001

Novel erythropoiesis stimulating protein (NESP) for the treatment of anaemia of chronic disease associated with cancer.

Anaemia is a common haematologic disorder in patients with cancer and has a multifactorial aetiology, including the effects of the malignancy itself and residual effects from previous therapy. Novel erythropoiesis stimulating protein (NESP, darbepoetin alfa), a protein with additional sialic acid compared with erythropoietin (EPO), stimulates erythropoiesis by the same mechanism as recombinant human erythropoietin (rHuEPO) but it is biochemically distinct. NESP, with its approximately 3-fold greater serum half-life, can maintain haemoglobin levels as effectively as rHuEPO in anaemic patients with chronic renal failure and do so with less frequent dosing. We investigated the ability of NESP to safely increase haemoglobin levels of anaemic patients with non-myeloid malignancies not receiving chemotherapy. NESP was administered under the supervision of a physician at doses of 0.5, 1.0, 2.25 or 4.5 mcg kg(-1)wk(-1)for a maximum of 12 weeks. This report includes 89 patients completing the study by November 2000. NESP was well tolerated, with no reported dose-limiting toxicities or treatment-related severe adverse events. Increasing doses of NESP corresponded with increased efficacy. The percentage (95% confidence interval) of patients responding ranged from 61% (42%, 77%) in the 1.0 mcg kg(-1)wk(-1)group to 83% (65%, 94%) in the 4.5 mcg kg(-1)wk(-1)group.

Adult↗
PubMed2000

Efficacy and safety of valrubicin for the treatment of Bacillus Calmette-Guerin refractory carcinoma in situ of the bladder. The Valrubicin Study Group.

PURPOSE: We assess the efficacy and safety of intravesical valrubicin for the treatment of carcinoma in situ in patients with failure or recurrence after bacillus Calmette-Guerin (BCG) and who otherwise would have undergone cystectomy. Total anthracycline recovery in urine samples obtained within 24 hours of valrubicin administration was assessed in a subset of patients. MATERIALS AND METHODS: A total of 90 patients with recurrent carcinoma in situ after failed multiple prior courses of intravesical therapy, including at least 1 course of BCG, participated in this open label, noncomparative study. Each patient received 6 weekly instillations of 800 mg. intravesical valrubicin. Disease evaluations were made at baseline and 3-month intervals following treatment. Evaluations included cystoscopy with biopsy and urine cytology. Toxicity was noted throughout treatment and followup. No evidence of disease recurrence for 6 months or greater was considered a complete response. RESULTS: Of 90 patients 19 (21%) had a complete response, including 7 who remained disease-free at the last evaluation, with a median followup of 30 months. Additionally, 14 patients who did not meet the strict protocol definition of complete response had superficial Ta disease only. Median time to failure and/or last followup for complete responders was greater than 18 months. Recurrence has been noted in 79 patients to date, including only 2 with clinically advanced disease (stage T2). Of these 79 patients 44 (56%, 4 responders and 40 nonresponders) underwent radical cystectomy. Of the 41 patients with known pathological stage 6 (15%) had stage pT3 or greater at cystectomy. Four patients died of bladder cancer during the median followup of 30 months, none of whom was a complete responder or underwent cystectomy following valrubicin. The main side effects of valrubicin therapy were reversible local bladder symptoms. CONCLUSIONS: Valrubicin was effective and well tolerated in patients with carcinoma in situ of the bladder refractory to BCG therapy. Delaying cystectomy while attempting salvage therapy with valrubicin does not pose an undue risk to most patients.

Adjuvants, Immunologic↗
PubMed1991

Long-term complete remission in bladder carcinoma in situ with intravesical TICE bacillus Calmette Guerin. Overview analysis of six phase II clinical trials.

Carcinoma in situ is a form of superficial transitional cell carcinoma, which is characterized by a lateral spread along the bladder epithelium, with high-grade malignancy and poor prognosis. Early radical cystectomy is considered the definitive treatment even in the absence of associated invasive cancer. In six prospective phase II studies, 123 carcinoma in situ patients were administered intravesical TICE bacillus Calmette-Guerin (BCG). Treatment consisted of at least six weekly instillations (induction) followed by twelve monthly instillations (maintenance) of BCG (50 mg: 1 to 8 x 10(8) colony-forming units). Of 119 evaluable patients, 90 (76%) achieved complete remission including 45 of 63 (71%) patients who received prior intravesical chemotherapy. Forty-five responders (50%) remain in complete remission with negative urine cytology with a median duration of response projected to be greater than or equal to forty-eight months. There is no difference in survival between BCG responders and nonresponders, but there is a significant difference in cystectomy rates: 10 of 90 (11%) responders vs. 16 of 29 (55%) nonresponders (P less than 0.0001, Fisher's exact test) and time to cystectomy (31 vs. 74 mos.) (P less than 0.001, log-rank test). Delaying cystectomy does not seem to affect survival and improves quality of life. Treatment was well tolerated with some major adverse effects. Intravesical TICE BCG is an effective treatment for bladder carcinoma in situ patients with or without prior chemotherapy.

Administration, Intravesical↗
PubMed1989

Intravesical bacillus Calmette-Guérin and second primary malignancies.

In an effort to answer the question, "Does intravesical bacillus Calmette-Guérin (BCG) therapy increase the incidence of second primary malignancies," the records of 153 patients treated with BCG for carcinoma in situ of the urinary bladder were reviewed. The weight of the available evidence suggests that intravesical BCG does not increase the incidence of second primary malignancies. While this question should be investigated, at the present time it appears that the advantage of intravesical BCG for high-risk patients with superficial bladder cancer outweighs the known disadvantages.

BCG Vaccine↗
PubMed1981

Depression of the generation of cell-mediated cytotoxicity by macrophage-like suppressor cells in bladder carcinoma patients.

Depressed T-lymphocyte function as assessed by delayed-type hypersensitivity reactions and in vitro proliferative response to mitogens is a characteristic finding in many types of solid tumors, including bladder carcinoma. Peripheral blood leukocytes from 16 patients with transitional cell carcinoma of the bladder were compared with age-matched, control subjects. Both the unfractionated leukocytes containing 10 to 30% monocytes and the lymphocyte-enriched preparations, obtained by monocyte depletion with iron filing ingestion, were analyzed. Mixed leukocyte culture-induced cytotoxicity was depressed in the patient group; the amount of depression was directly correlated to the extent of the disease. In patients who underwent surgical removal of tumor, the mixed leukocyte culture-induced cytotoxicity appeared normal. This mixed leukocyte culture-generated cytotoxic response was a more sensitive indicator of tumor effect than was the induced proliferative response. Removal of phagocytic or adherent monocytes from the responding cell population caused a significant increase in the generated cytotoxicity, especially in those patients with invasive disease. These suppressive effects could be partially reconstituted by quantitative addition of the separated monocytes back to the responding lymphocyte culture. The depressed lymphocyte-mediated cytotoxicity present in these bladder cancer patients was due, in a major part, to a circulating macrophage-like cell with active suppressor function.

Carcinoma, Transitional Cell↗
PubMed1979

Idiopathic calcinosis of scrotum.

A forty-three-year-old man complained of painless, firm scrotal nodules which had first appeared at age sixteen. These were diagnosed clinically as multiple epidermoid inclusion cysts and were excised. Histologically they were composed of calcified, amorphous, granular material, characteristic of idiopathic calcinosis of the scrotum. This is a rare, benign condition without any recognized underlying metabolic abnormalities. The cause of idiopathic calcinosis of the scrotum is unknown, but we believe it is due to dystrophic calcification of dartoic muscles.

Adult↗
PubMed1978

Renal artery trauma.

The ability to preserve renal function in patients with renal artery trauma is a goal sought by all urologists. We have reviewed our own experience as well as data published in the literature to formulate guidelines concerning which patients should be treated with revascularization and what factors are most likely to make this procedure successful.

Adolescent↗
PubMed1977

Immunological responsiveness in patients with bladder cancer.

Delayed cutaneous hypersensitivity tests, especially skin tests with dinitrochlorobenzene, are impaired increasingly as the amount of tumor increases. Recall antigens are less sensitive indicators of disease. Therapy, especially radiotherapy, also depresses cell-mediated immunity. Removal of tumor, however, allows these tests to return to normal. Dinitrochlorobenzene skin testing can contribute significantly to prognostic evaluation. An important facet of the tumor-host relationship is measured, and this reflects factors that are independent of tumor staging. Combination of tumor staging and dinitrochlorobenzene-delayed hypersensitivity testing can provide a strong indication of the clinical course, especially for the year following initial treatment of invasive or metastatic transitional cell carcinoma of the bladder.

Antigens↗
PubMed1976

Pseudotumor of adrenal gland.

A sixty-two-year-old male underwent medical evaluation because of hypertension. A suprarenal mass was detected on pyelography and subsequently confirmed by tomography, angiography, sonography, and adrenal venography. In spite of these positive diagnostic studies surgical exploration revealed a normal adrenal gland surrounded by dense fibroadipose tissue which appeared to account for the pseudotumor.

Adrenal Gland Neoplasms↗
PubMed1976

Immunotherapy and human tumor immunology.

Present knowledge about the immune response to tumors in man is briefly reviewed, and the effects of cancer on immune-system functions are noted. The concepts that human tumors elicit cell-mediated immune responses to tumor antigens are re-examined and modified; for example, cell-mediated immunity may be detectable only at certain stages of tumor growth. Introduction of more sensitive methods for detecting antibodies is providing additional evidence for humoral immune responses to tumor-associated antigens. The present proliminary approaches to immunotherapy, particularly the use of adjuvants such as BCG and Corynebacterium parvum, are assessed, and initial pharmacoimmunologic findings with these agents are reported. The field of tumor immunology is in a dynamic state of development, with input from many areas of immunology and oncology. Carefully controlled clinical trials of these therapeutic regimens will be required to establish the value and indications for the use of such procedures.

BCG Vaccine↗