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Biomedical subjects

S H Krasnow

Publications and source records attributed to S H Krasnow.

At least 37 records · Page 2Linked to original sources
PubMed1988

Carotid sinus syndrome associated with an occult primary nasopharyngeal carcinoma.

A patient presented with syncope, and a diagnosis of carotid sinus syndrome was established. Further evaluation revealed a large nasopharyngeal carcinoma invading the left petrous bone. There were no cervical metastases. The tumor partially regressed with radiation therapy, and there was complete resolution of the carotid sinus syndrome, but the patient died three months later of metastatic disease. Autopsy confirmed petrous bone involvement by the mass but no cervical metastatic disease. This is the first reported case (to our knowledge) of malignancy-associated carotid sinus syndrome attributable to a primary nasopharyngeal carcinoma. The literature on malignancy-associated carotid sinus syndrome is reviewed, with emphasis on pathophysiology and treatment.

Aged↗
PubMed1987

Clearance of continuous intravenous morphine for severe cancer pain.

Four cancer patients with intractable pain received continuous morphine infusions in doses of 15-275 mg/h for a time period ranging from 4 to 27 days. Serum morphine concentrations were determined periodically following adjustments in infusion rates. As doses were changed and continued at static hourly rates, serum morphine concentrations were relatively constant 20 hours and beyond the time of the respective change, thus suggesting morphine elimination half-lives of less than or equal to 4 hours. High doses did not influence the time required to achieve steady-state concentrations. Steady serum morphine concentrations corresponded with hourly morphine doses in a parallel manner. High interpatient variabilities in clearances and steady-state serum morphine concentrations were noted. These data suggest that at morphine infusions up to 275 mg/h elimination pathways permit handling of increasing concentrations of morphine without nonlinear blood level increases. Also, marked interpatient and intrapatient variations in patient dose requirements were noted.

Female↗
PubMed1987

Hickman catheter clots: a common occurrence despite daily heparin flushing.

Central vein thrombosis is the major Hickman catheter complication in our patient population. After noting clots attached to the disposable infusion plug of these catheters, we prospectively determined whether the presence of clots indicated a high-risk group for thrombosis. Forty-three patients (41 with solid tumor, two with acute leukemia) were studied. Catheters were flushed daily with heparin (10 units/ml), and urokinase (5000-10,000 units) was injected when blood could not be drawn. Clots within the catheter lumen were detected visually after expressing, onto a 4 X 4-inch gauze pad, the first 5-10 ml of admixed blood and flush solution or iv infusion fluid drawn from the catheter prior to blood drawing. Clots were detected in 153 of 508 specimens (30%). Forty of 43 patients had clots, varying in length from fragments to 5 cm, in at least one specimen. Inpatients and outpatients had a similar percentage of clotted specimens. Eight patients developed clinical (six) or autopsy-proven (two) thrombosis. There was no difference between patients with and without thrombosis in percent of discards positive for clots. This study indicates that clots are frequently present in the lumina of Hickman catheters. It is likely that these clots embolize to the lungs when catheters are flushed. Consequences of embolization are unknown.

Blood Specimen Collection↗
PubMed1986

Patient-controlled analgesia for severe cancer pain.

Concern with the suboptimal management of pain in hospitalized patients has led to the development of a patient-controlled analgesia system. In this system, a preset amount of narcotic is delivered intravenously when the patient activates the demand button. We tested the safety and efficacy of this mode of treatment in eight patients with cancer suffering from severe pain. Respiratory rates, mental status, and pain relief were recorded at baseline and during the study period. Morphine sulfate doses ranged from 1 to 5 mg, and lockout intervals from 15 to 90 minutes. Patients had a higher analgesic demand, ie, self-administered more doses, during the first four hours than during the remaining time of treatment. Respiratory rates decreased during the first four hours of treatment, but no cases of significant respiratory depression were encountered during this period or thereafter in the study. Significant pain relief was produced in all patients without causing undue sedation. Patient acceptance of this mode of therapy was excellent, and the majority of patients preferred this type of analgesia to other forms of pain treatment. In conclusion, patient-controlled analgesic is effective and safe therapy for cancer pain.

Consumer Behavior↗
PubMed1985

Hickman catheter tip displacement.

In a series of 60 consecutive patients in whom Hickman catheters were placed for treatment of malignancy, four properly positioned catheter tips migrated secondarily from the superior vena cava to the ipsilateral jugular vein 2, 4, 21, and 25 days after placement. Three of the four patients had begun to have catheter dysfunction when the displacement was diagnosed. No satisfactory explanation for this rarely reported complication was evident in three of the cases. Maneuvers such as coughing, Valsalva's maneuver, and forceful heparin flushing produced no motion in three normally directed catheter tips in other patients observed under fluoroscopy. The phenomenon may be more common than previously reported. Evaluation of any new Hickman catheter dysfunction should include a chest x-ray film to ascertain the position of the catheter.

Adult↗
PubMed1985

Antiemetic efficacy of levonantradol compared to delta-9-tetrahydrocannabinol for chemotherapy-induced nausea and vomiting.

The antiemetic efficacy of im levonantradol, a synthetic cannabinoid, given at a dose of 1 mg every 4 hours, was compared to oral delta-9-tetrahydrocannabinol (THC) given at a dose of 15 mg every 4 hours in a double-blind crossover study. Twenty-six patients receiving emetogenic cancer chemotherapy were evaluated. For each drug, 28% of treated patients had no nausea. The median number of emetic episodes with levonantradol was 2.0 versus 3.0 for THC (P = 0.06). Side effects occurred in 91.7% and 97.3% of levonantradol and THC patients, respectively, with drowsiness and dizziness most commonly seen. Side effects were generally well-tolerated, with only 13.9% of levonantradol and 21.6% of THC patients discontinuing treatment because of side effects. Levonantradol appears to be at least as effective an antiemetic as THC and is the only cannabinoid available for parenteral use.

Adult↗
PubMed1985

Drug precipitation within i.v. tubing: a potential hazard of chemotherapy administration.

Because relatively undiluted concentrations of drugs are maintained for prolonged periods in the Y-side arm of rapidly flowing iv infusions, we visually determined compatibilities of ten commonly used cancer chemotherapy drugs and four adjunctive drugs including droperidol, metoclopramide, furosemide, and heparin. Droperidol was found to be incompatible with furosemide, methotrexate, leucovorin, heparin, and 5-FU. Furosemide was incompatible with metoclopramide, doxorubicin, vincristine, and vinblastine in addition to droperidol. Doxorubicin was incompatible with heparin. If these drugs were administered sequentially into the Y-side arm of an iv infusion, precipitation would be expected with drug inactivation and possible drug embolization to the pulmonary circulation. Flushing the Y-side arm with a compatible solution after drug administration will prevent this problem.

Antineoplastic Agents↗
PubMed1984

Safety and efficacy of continuous intravenous morphine for severe cancer pain.

To study the efficacy and safety of continuously administered intravenous morphine for cancer pain unrelieved by standard narcotic therapy, bolus intravenous injections of 2 to 5 mg of morphine were given every 10 minutes until pain relief was achieved. Within the next hour, continuous intravenous morphine infusion was begun with the hourly dose equal to the cumulative bolus dose. Respiratory rate, pulse, blood pressure, arterial blood gas values, mental status, and pain relief were recorded at baseline and during the study period. A reduction in arterial oxygen pressure (PaO2) and/or increase in arterial carbon dioxide pressure PaCO2 of more than 20 percent of baseline values occurred, during the first 24 hours of infusion, in a minority of patients. This did not require changes in hourly morphine dose. Despite subsequent increases in morphine dose, blood gas values tended to remain at or return toward baseline values. Severe toxicity occurred during one trial and was heralded by bradypnea and marked somnolence. Major pain relief was achieved in 11 of 15 trials. Therefore, continuous intravenous morphine is effective and safe therapy. Bradypnea associated with marked somnolence is a cause for dose reduction.

Acute Disease↗
PubMed1984

Combined therapy for stage III-IV head and neck cancer: preliminary results.

As part of a combined modality treatment program using chemotherapy, surgery, and/or radiotherapy, 25 patients with previously untreated stage III or IV head and neck cancer received initial combination chemotherapy. Pathologically confirmed complete remission was noted in nine patients (36%). The overall objective major response rate (with all patients included in analysis) was 68%. The chemotherapy regimen included bleomycin, cisplatin, vinblastine, methotrexate, and 5-fluorouracil. A novel concept of drug scheduling was used, based on chemotherapy-induced improvement in RBC deformability. The underlying concept is that improved RBC deformability results in improved capillary blood flow and thereby, increased drug delivery to tumor cells. Treatment resulted in moderate hematologic and renal toxicity with no treatment-related deaths. This exceptionally high, pathologically confirmed complete response rate will hopefully provide a mechanism by which combined modality therapy can adequately be tested for its ability to prolong survival of patients with advanced head and neck cancer.

Adult↗
PubMed1984

An active chemotherapy regimen for squamous cell lung cancer.

A new concept of chemotherapy scheduling was evaluated in 20 patients with inoperable squamous cell lung cancer. The complete plus partial response rate was 85%, with 15% complete responses. The drugs utilized included vinblastine, bleomycin, methotrexate, 5-FU, cisplatin, and leucovorin. The hypothesis leading to the chosen drug schedule was that impaired rbc deformability (RBCD) found in cancer patients may produce stasis of flow in tumor capillary beds and decrease drug delivery to cancer cells. Drug schedules were designed to take advantage of chemotherapy-induced improvement in RBCD. After an initial drug treatment, a second treatment was given when RBCD increased at least 25% over pretreatment values (usually 4-6 days after the first chemotherapy dose). Drug doses were weighted so that more drug was given when RBCD was greatest. Treatment toxicity was predominantly hematopoietic and renal. This type of chemotherapy approach opens up new avenues of investigation in squamous cell cancer and other common neoplasms.

Adult↗
PubMed1984

Tumor seeding associated with bone marrow aspiration and biopsy.

A 53-year-old man with small-cell lung carcinoma underwent bone marrow aspirations and biopsies for tumor staging and harvest for autologous bone marrow infusion. Fourteen months after bone marrow aspiration and biopsy, a subcutaneous lesion grew over the posterior iliac crest, and a biopsy specimen disclosed small-cell carcinoma. To our knowledge, this is the first case report of tumor seeding associated with bone marrow aspirate and biopsy.

Biopsy, Needle↗
PubMed1983

Superior vena cava syndrome due to non--small-cell lung cancer. Resolution with chemotherapy alone.

Three patients with superior vena cava syndrome due to non--small-cell lung cancer were treated with chemotherapy alone. Symptomatic relief began within three days of treatment and substantial resolution of the syndrome occurred in all three patients. One patient had complete remission of tumor and the other two had more than a 50% tumor reduction within the first month of therapy. These are the first case reports indicating that combination chemotherapy may be effective as initial management of the superior vena cava syndrome due to non--small-cell lung cancer.

Antineoplastic Agents↗
PubMed1982

Clinical, hematological, and biochemical features of Hb SC disease.

Twenty-seven patients were seen and followed at our Sickle Cell Center over a period of seven years. Their clinical, hematological, and biochemical features were determined and compared to those of patients with sickle cell anemia who were concurrently investigated. The data indicate that the mild anemia of hemoglobin (Hb) SC disease is slightly microcytic and hyperchromatic. Parameters of hemolysis and the complications of chronic hemolytic anemia (cholelithiasis, leg ulcers, hepatomegaly, and cardiomegaly) are milder in Hb SC disease than in sickle cell anemia. Asplenia and its sequelae (increased platelet count and reduced serum IgM levels) are less frequent in Hb SC disease. Cerebrovascular accidents and the decreased leukocyte alkaline phosphatase scores are similar in both diseases. Thromboembolic complications, retinopathy, and renal papillary necrosis are more frequent in Hb SC disease.

Adolescent↗
PubMed1981

Balanced globin synthesis in idiopathic myelofibrosis.

Four patients with idiopathic myelofibrosis were found to have microcytic and/or hypochromic red cell indexes. The alpha/beta globin synthetic ratio determined by incubating peripheral blood with [14C]leucine was within normal limits in all patients studied. This is unlike a recent report of acquired hemoglobin H disease with decreased alpha/beta synthetic ratio in primary myelofibrosis. This indicates that mechanisms other than alpha-thalassemia-like defects may also be involved in the production of microcytic and hypochromic red cells in myelofibrosis.

Aged↗