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Biomedical subjects

S G Spiro

Publications and source records attributed to S G Spiro.

At least 109 records · Page 6Linked to original sources
PubMed1983

High-dose cyclophosphamide with autologous marrow transplantation for small cell carcinoma of the bronchus.

Twenty-five patients with previously untreated small cell carcinoma of the bronchus have been treated with cyclophosphamide 160-200 mg/kg and subsequent radiotherapy to the primary site. Eighty-four percent of patients responded to the single cycle of chemotherapy, with 56% attaining a complete response. Median duration of remission was 43 weeks and median survival 69 weeks. 2-Mercaptoethane sulphonate was given to prevent urothelial toxicity. Autologous bone marrow transplantation was used to mitigate bone marrow depression but sequential delay in reinfusing cryopreserved bone marrow did not alter the period of cytopenia. Other toxicities were mild. The procedure proved safe and manageable. High-dose chemotherapy may prove to be useful in the initial management of this tumour.

Adult↗
PubMed1983

Treatment of obstruction of the superior vena cava by combination chemotherapy with and without irradiation in small-cell carcinoma of the bronchus.

In a randomised prospective trial of chemotherapy with and without radiotherapy in small-cell carcinoma of the bronchus, 37 of 366 patients presented with obstruction of the superior vena cava at the time of diagnosis. In the study all patients received four cycles of combination chemotherapy over a period of 12 weeks and, provided there was not progressive disease, then received either radiotherapy to the mediastinum and primary tumour followed by eight further courses of chemotherapy or eight cycles of chemotherapy alone. Of the 37 patients presenting with superior vena caval obstruction, nine had relapsed and treatment was stopped during or after the initial four cycles of chemotherapy. Of the remainder, 15 patients received radiotherapy plus chemotherapy and 13 chemotherapy alone. After four cycles of chemotherapy (12 weeks) 21 of the 37 patients had initial complete relief of symptoms secondary to superior vena caval obstruction, 10 had substantial but partial relief, and six had no relief. Twelve patients developed recurrence of superior vena caval obstruction, of whom six had received radiotherapy and four chemotherapy alone; two relapsed in the initial 12 weeks of the study. The median survival of the patients with superior vena caval obstruction allocated at diagnosis to either treatment arm was identical. The survival of patients with obstruction was similar to that of other patients in the main study. Chemotherapy is an effective treatment for superior vena caval obstruction and there appears to be no additional advantage in giving radiotherapy after 12 weeks of cyclical chemotherapy.

Antineoplastic Agents↗
PubMed1983

Comparison of vincristine and vindesine in the treatment of inoperable non-small cell bronchial carcinoma.

Sixty-three patients with inoperable symptomatic non-small cell carcinoma of the bronchus were randomly allocated to receive either vincristine (1.4 mg/m2) or vindesine (3 mg/m2). These drugs were given weekly for four doses, then every 2 weeks for two further doses, and then continued monthly if there had been a response. Only five partial responses (greater than 50% reduction) were obtained with vindesine and none with vincristine. Disabling toxic effects occurred in 13 patients. This was more common with vindesine, but this group also received more prolonged therapy. Vindesine has modest activity against non-small cell carcinoma of the bronchus and may be more effective than vincristine, with similar toxicity.

Adult↗
PubMed1982

Epipodophyllotoxin (VP16-213) in small cell carcinoma of the Bronchus resistant to initial combination chemotherapy.

Thirty-eight patients with small cell carcinoma of the bronchus resistant to initial chemotherapy with cyclophosphamide methotrexate and CCNU, were treated with VP16-213 alone in a dose of 120 mg/m2 i.v. on days 1, 3, and 5 every 3 weeks. Twelve patients died before three courses of treatment. In 26 patients who received three or more courses only one, transient partial response occurred. One or more components of the initial chemotherapy seems to confer resistance to the action of VP16-213 in this disease.

Bronchial Neoplasms↗
PubMed1982

High-dose cyclophosphamide with autologous marrow transplantation as initial treatment of small cell carcinoma of the bronchus.

Sixteen patients with untreated small cell carcinoma of the bronchus received cyclophosphamide in a total dose of 160-200 mg/kg. Autologous marrow transplantation was used to minimise the period of hypoplasia and 2-mercaptoethane sulphonate to prevent urothelial toxicity. The procedure was well tolerated, with predictable and manageable toxicity. Complete radiological and bronchoscopic response was achieved in seven patients and partial response in a further seven. High-dose cyclophosphamide may be a useful initial treatment for this disease.

Adult↗
PubMed1982

Tumor size, response rate, and prognosis in small cell carcinoma of the bronchus treated by combination chemotherapy.

Ninety-eight patients with small cell carcinoma of the bronchus (SCCB) were treated with a combination of cyclophosphamide, methotrexate with calcium leucovorin rescue, and lomustine (CCNU). VP-16-213 was given on relapse. Response rate and survival were analyzed according to extent of tumor, presence of the syndrome of inappropriate antidiuretic hormone production (SIADH), and, in 38 patients, size of intrathoracic tumor as measured by computerized tomographic (CT) scanning. The median survival of the entire group was 34.6 weeks. In patients with limited disease the median survival was 46 weeks compared to 29 weeks for those with extensive disease. This difference in survival between patients with limited and extensive disease was most marked in those showing a partial response (median survival, 45.9 and 28 weeks, respectively). Patients with ectopic antidiuretic hormone production had a poor prognosis even if they had achieved a complete response. Only one partial response to VP-16-213 occurred. There was a strong correlation between initial intrathoracic tumor size as assessed by total cross-sectional area on CT scan and response and survival. When the total area exceeded 30 cm2 there were no complete responders, but there were complete responses in eight of 21 patients when the area was less than 30 cm2. The relationship between intrathoracic tumor size and response rate was present when analyzed according to disease extent, age, sex, and performance status. A clear relationship between total tumor area and survival was also found. When SCCB is treated with chemotherapy alone, the prognosis is better for those patients who present with limited disease, without SIADH, and with small intrathoracic tumor. In this group it is possible that further intensification of therapy may result in prolonged survival.

Adult↗
PubMed1982

Computed tomography of the thorax in the diagnosis and management of malignant disease.

The role of computed tomography (CT) scanning in the investigation of patients with intrathoracic malignancy has not yet been clearly defined. Current evidence suggests that it is the most sensitive diagnostic imaging technique for identifying the extent of primary lung cancers and their relationship to intrathoracic anatomy. It is an advance in the staging of intrathoracic malignancy as it identifies adenopathy in the paratracheal region and the mediastinum more readily. Discovery of small (less than 0.8 mm) pulmonary nodules is common in patients with some extrathoracic malignant conditions, but differentiating malignant deposits from benign nodules remains a problem. CT has a potential place in radiotherapy field planning and in identifying lung cancers in the occasional patient presenting with suspicious symptoms or positive cytology and a normal chest radiograph.

Carcinoma, Small Cell↗
PubMed1981

Computerized axial tomography in the pretreatment assessment of small-cell carcinoma of the bronchus.

Computerized axial tomographic scans (CAT scans) of thorax and abdomen were used as part of the initial staging procedure of 50 consecutive patients with small-cell bronchogenic carcinoma (SCBC). The aims were to define the extent of the primary tumor and metastatic spread, and to compare the information obtained from CAT scans with conventional staging procedures. With CAT scanning, spread of the primary tumor was found to be far more extensive than originally believed when defined by conventional assessment. Of 35 patients conventionally staged as localized T1 or T2 tumors, 27 (77%) had their stage increased to extensive T3 disease. similarly, subcarinal lymph nodes were found in one patient when conventional methods were used (2%), but 16 patients (32%) were found when CAT scan was used. Unsuspected adrenal metastases were found in eight patients (16%) and retrocrural nodes in four patients (8%). Thirty-seven patients (74%) were found to have Stage III tumors when conventional staging was used; 47 patients (94%) were found to be Stage III following CAT scanning, demonstrating that, within the thorax, localized tumors are very uncommon. CAT scanning demonstrates the degree of intrathoracic spread very clearly, and has a valuable role in the initial investigation of patients with SCBC if the planned treatment includes radiotherapy.

Adrenal Gland Neoplasms↗
PubMed1981

An analysis of submaximal exercise responses in patients with sarcoidosis and fibrosing alveolitis.

An increase work rate exercise test was performed by 15 patients with sarcoidosis and by 20 patients with fibrosing alveolitis. The patients with sarcoidosis had a moderate reduction in total lung capacity (TLC) and transfer factor (DLCO), with chest radiographs showing widespread pulmonary infiltration but no evidence of fibrosis. The patients with fibrosing alveolitis had a significantly greater reduction in TLC and DLCO than those in the sarcoidosis group. Values for cardiac frequency (fH) and ventilation(V) were interpolated to the standard oxygen uptakes of 0.75, 1.0 and, where possible, 1.5 litres/min (33.5, 44.6 and 67 mmol/min respectively). The tidal volume at the ventilation of 20 and 30 litres/min was also determined. The exercise responses were compared to two groups of 20 normal men; each group being age matched to one group of patients. The fH at oxygen uptakes of 0.75, 1.0 and 1.5 litres/min were significantly higher in both patient groups than in the normal men. The submaximal indices for V were significantly greater in both patients groups than in the normal subjects at all three levels of oxygen uptake, and significantly greater in patients with fibrosing alveolitis than in those with sarcoidosis. The tidal volumes at 20 and 30 litres/min were smaller than normal in both patient groups but differences were removed by normalizing for differences in vital capacity. The maximum exercise ventilation measured in the patients with fibrosing alveolitis was significantly correlated with measurements of lung volume. Submaximal indices detect significant abnormalities during exercise in patients with pulmonary fibrosis and represent an alternative method for documenting abnormal exercise responses. Despite comparable radiological abnormalities the functional impairment in fibrosing alveolitis is much greater than in sarcoidosis. Thus the physiological abnormalities are not comparable quantitatively although they share a common qualitative difference.

Adult↗
PubMed1981

Reproducibility of flow rates measured with low density gas mixtures in exercise-induced bronchospasm.

We have studied the reproducibility of the change in maximum expiratory flow rates after breathing helium/oxygen (He/O2) mixtures in 12 asthmatics at rest and after exercise. Each subject performed four identical exercise tests which caused a similar degree of exercise-induced bronchospasm (EIB) on each occasion. We compared flow rates at 50% of the vital capacity (V50) breathing He/O2 to those breathing air at rest, and with the lowest V50 on air after exercise. Those subjects showing an increase of greater than 20% in V50 with He/O2 compared to the corresponding air value were termed "responders". At rest the responder status after He/O2 was more consistent than during EIB. Six subjects were non-responders consistently on up to 12 separate measurements at rest while the other five subjects were non-responders on all but one occasion and the remaining subject a responder on seven of eight measurements. During EIB all but one subject showed a He/O2 response. A response was seen consistently in six subjects but the actual percentage change in V50 with helium varied greatly. One subject remained a non-responder after exercise and the other five were He/O2 responders after only two or three of the four test runs, and non-responders on the remainder. The lack of consistency of our data, particularly during EIB makes the interpretation of the He/O2 breathing test less useful than originally claimed.

Adult↗
PubMed1981

Contractile properties and fatigue of the diaphragm in man.

We studied the pressure developed by the diaphragm in response to stimulation of the phrenic nerve in the neck, in three normal men. When the phrenic was electrically stimulated at increasing frequencies the diaphragm responded by increasing transdiaphragmatic pressure to give a frequency-pressure curve similar to the frequency-force curve for other skeletal muscles. The subjects than breathed through an inspiratory resistance for as long as possible and the frequency-pressure curve was repeated. It was found that the diaphragm developed low frequency fatigue, in the same way as previously described for other muscles. We conclude that the diaphragm has contractile properties similar to these of other skeletal muscles. Low frequency fatigue of the diaphragm could contribute to respiratory failure in patients with lung disease.

Adult↗
PubMed1981

Ketotifen in atopic asthma and exercise-induced asthma.

The efficacy of ketotifen, a tricyclic benzocycloheptathiophene derivative, was assessed in an outpatient clinical trial and in a group of 12 asthmatic subjects with exercise-induced asthma. Subjects in the outpatient trial had mild asthma and consisted of two groups: a group of 24 atopic asthmatics with at least one positive skin test reaction and with an associated history of bronchial reactivity to at least one allergen; and a group of eight asthmatics with one or more positive skin prick tests but not bronchial reactivity to an allergen. Both groups took four weeks medication of ketotifen 1 mg bd and placebo in a randomised double-blind crossover study. There was no difference between ketotifen and placebo for any measurement made during the study and consequently no evidence of drug efficacy. The exercise study followed a standardised protocol and each subject took in random double-blind order, placebo, 1 mg, 2 mg, and 4 mg ketotifen two hours before exercise. There was no difference in the mean decreases in lung function from pre-exercise baseline values after three doses of ketotifen than with placebo. Drug levels suggested ketotifen was well absorbed. It would appear that if given for a period of only four weeks ketotifen had no beneficial effects in the management of mild asthma, and that a single dose before exercise does not modify exercise-induced asthma.

Adolescent↗