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Biomedical subjects

S Mani

Publications and source records attributed to S Mani.

At least 73 records · Page 4Linked to original sources
PubMed1996

Is "off-protocol" chemotherapy for androgen-independent carcinoma of prostate warranted?

It is acceptable to treat HRPC patients with off-protocol chemotherapy if these patients do not accept protocol therapy or are ineligible for such therapy. The choice of cytotoxic agent needs to be individually assessed, depending on range of tolerable toxicities and personal preferences of the physician and patient. At the present time, single-agent therapy with oral or intravenous cyclophosphamide or mitoxantrone/prednisone may offer optimal palliation without undue side effects in a predictable number of patients.

Androgens↗
PubMed1996

A population-based analysis of behavior problems in children with cerebral palsy.

Used the National Health Interview Survey, Child Health Supplement for 1981 and 1988, to analyze parent-reported behavior problems of children, ages 4-17 years, with cerebral palsy (n = 47), with mental retardation (n = 50), with other chronic conditions (n = 6,038), and with no known health problem (n = 5,930), using the Behavior Problem Index (developed by Zill & Peterson). Behaviors with scores greater than the 90th percentile of the entire sample were considered problem behaviors. Parent-reported behavior problems were 5 times more likely in children with cerebral palsy (25.5%) compared with children having no known health problem (5.4%). The adjusted odds ratio for behavior problems of children with cerebral palsy without mental retardation was 4.9 and of children with mental retardation without cerebral palsy was 7.9. Specific behaviors that were most problematic for children with cerebral palsy were identified as dependency, headstrong, and hyperactive.

Adolescent↗
PubMed1996

Single institution experience with recombinant gamma-interferon in the treatment of patients with metastatic renal cell carcinoma.

We report the clinical course of eight patients with metastatic renal cell carcinoma (RCC) who were treated with recombinant gamma-interferon (Immuneron) as part of a phase II-III study comparing the safety and efficacy of gamma-interferon with that of medroxyprogesterone acetate (Depo-Provera). There were no objective responders among the eight patients treated with recombinant gamma-interferon at an i.v. dose of 1 mg/m(2) daily for five days every other week for four weeks then 1 mg/m(2) three times a week given every other week until there was documented disease progression or complete response (CR). Overall median survival was 17.3 months (range 1.4 to 184). The major side effects of treatment included fever/chills (75%), mild anorexia and fatigue (75%), nausea/vomiting (80%), leukopenia (38%), and abnormal liver function tests (25%). There were no life-threatening side effects observed. At our institution, in a random cohort of eight patients with metastatic RCC, recombinant gamma-interferon when given at a dose of 1 mg/m(2) per day given three times per week on an every other week schedule yields no clinical antitumor activity. A review of the literature on the use of gamma-interferon for metastatic RCC suggests that low-dose combination therapy with other cytokines may yield the best response-to-side effect ratio. Higher doses yield more responses but an added cost of more toxicity.

Adult↗
PubMed1996

Recombinant beta-interferon in the treatment of patients with metastatic renal cell carcinoma.

We report on the clinical course of 15 patients with metastatic renal cell carcinoma (RCC) who were treated with recombinant beta-interferon as part of a phase I-II study. There were no objective responders among the 15 patients treated with recombinant beta-interferon at an i.v. dose escalating from 90 X 10(6) U given three times a week until there was documented disease progression or complete response (CR). Overall median survival was 24 months. One patient refused further treatment after 7 weeks. The major side effects of treatment included cardiovascular events (20%), mental status change requiring cessation of drug (6.7%), and grade 3 headaches/myalgias (26.7%). There were no life-threatening side effects observed; however, cardiac events led to the termination of treatment in three patients. Other minor toxicities included fatigue (46.7%), proteinuria (60%), diarrhea (6.7%), nausea and vomiting (13.3%), persistent fever (6.7%) and transient visual disturbance (6.7%). Thus, at our institution, in a cohort of 15 patients with metastatic RCC, recombinant beta-interferon when given i.V. at a dose < or equal to 720 X 10(6) U three times per week, yielded no clinical antitumor activity. A review of the literature on the use of beta-interferon for metastatic RCC suggests that there may be some efficacy, but our experience with escalating i.v. doses < or equal to 720 X 10(6) U given three times a week does not support it. Moreover, at these doses, one may find serious cardiovascular events although further studies need to be done in order to clearly define dose-related side effects as well as optimal efficacy-to-toxicity ratio.

Aged↗
PubMed1996

Promising new agents in oncologic treatment.

Over the past year, several new anticancer agents have entered the clinic and are undergoing further phase II clinical development at the time of this writing. There has been a sudden influx of rationally designed drugs with novel therapeutic effects ranging from direct cellular toxicity to inhibition of blood vessel formation and of metastases. This review focuses only on cytotoxic drugs that have been in clinical development for the past 5 years; however, only recently have these drugs found a "niche" in the clinic. These drugs include novel taxanes (eg, docetaxel), the camptothecin analogues (eg, irinotecan [CPT-11]), the newer generation of thymidylate synthase inhibitors (eg, raltitrexed [ZD 1694, Tomudex]), nucleoside analogues (eg, gemcitabine), and oral alternatives to intravenous 5-fluorouracil. Most of these agents have completed or have entered phase II or III testing, and the results of these trials will be available to us over the next few years.

Animals↗
PubMed1995

Detection of mammary tumor virus env gene-like sequences in human breast cancer.

Mouse mammary tumor virus (MMTV) has been related to human breast cancer (BC) in previous studies. Although suggestive sequence homology to MMTV has been described in BC DNA, the presence of human endogenous retroviruses (HERs) confounded these results. We have selected a 660-bp sequence of the MMTV env gene with very low homology to HER or to any other human or viral gene. We have searched for sequences homologous to it using the polymerase chain reaction. DNA was extracted from fresh or frozen tissues using primers and probes constructed to detect 660 bp; for paraffin-embedded tissues, we sought 250-bp sequences by similar methodology. The 660-bp sequence was detected in 121 (38.5%) of the 314 unselected BC samples, in cultured BC cells, in 2 (6.9%) of 29 breast fibroadenomas and in 2 (1.8%) of 107 breast specimens from reduction mammoplastias. The sequence was not found in normal tissues including breast, lymphocytes from BC patients, nor in other human cancers or cell lines. The 250-bp sequence was detected in 60 (39.7%) of the 151 BCs, and in 1 of 27 normal breast samples assayed from paraffin-embedded sections. Cloning and sequencing of the 660 bp and 250 bp demonstrated that they are 95-99% homologous to MMTV env gene, but not to the known HERs nor to other viral or human genes (< 18%). Southern blot analysis using labeled cloned sequences showed that the 660-bp sequences were present in low copy number as a 7-8-kb EcoRI fragment only in breast cancer samples and two breast cancer cell lines that were positive by PCR. These data indicate that 38-40% of human breast cancers contain gene sequences homologous to the MMTV env gene that are absent from other tumors and tissues. These MMTV env gene-like sequences may play a role in the etiology of a large proportion of human breast cancer.

Base Sequence↗
PubMed1995

Spleen size in health and disease: a sonographic assessment.

Ultrasonography was used to evaluate splenic size in normal patients as well as in patients with various clinical conditions. To express splenic size, a splenic volumetric index (SVI) was used. By grading the SVI on the basis of age and sex in normal patients, and in various diseases, characteristic distributions of SVI were obtained. Obtaining the SVI by the use of ultrasound appears to be a significant supplemental aid for evaluating spleen size, especially in patients whose spleens are not palpable.

Adolescent↗
PubMed1995

Prognostic factors for survival in patients with metastatic renal cancer treated with biological response modifiers.

PURPOSE: Clinical characteristics prognostic of survival in patients with metastatic renal cell carcinoma treated with biological response modifiers are poorly understood. Understanding these prognostic features may help with better stratification of patients in clinical trials and define further appropriate treatment for each prognostic subgroup. MATERIALS AND METHODS: A retrospective study of 84 patients with recurrent or metastatic renal cancer was conducted to identify prognostic factors for survival in patients who received biological response modifiers (alpha-interferon, beta-interferon, gamma-interferon and interleukin-2). RESULTS: Univariate analysis identified Eastern Cooperative Oncology Group (ECOG) performance status (1 versus 0, p < 0.001), bone metastasis (p = 0.008), recent weight loss (greater than 10% of total body weight versus no loss, p = 0.028), history of nephrectomy (no versus yes, p = 0.025), recurrence at the renal bed (p = 0.043) and sarcomatoid histology (yes versus no, p < 0.001) as important prognostic indicators. Multivariate analysis of prognostic factors in this patient population indicated that ECOG performance status, sarcomatoid histology and bone metastasis were most significant, while other factors were less significant (p > 0.05) after adjusting for ECOG performance status and sarcomatoid histology. Based on the total positive number of 5 risk factors defined previously the study population separates into 3 risk groups, with a median survival from the low to high risk groups of 14.4, 10.9 and 1.3 months, respectively. Prognostic scores based only on ECOG performance status, sarcomatoid histology and bone metastasis allowed for stratification of our patients into 3 distinct groups with median survivals of 18.6, 8.4 and 3.8 months, which were also predictive of survival (p < 0.05). CONCLUSIONS: Risk factors of ECOG performance status, sarcomatoid histology, bone metastasis, history of nephrectomy, recent weight loss and recurrence at the renal bed are predictive of survival in patients treated with biological response modifiers. In addition to previous findings of prognostic factors in renal cancer patients treated with chemotherapy, we identified sarcomatoid histology as an important risk factor in patients treated with biological response modifiers.

Bone Neoplasms↗
PubMed1995

Anemia of pregnancy.

A general work-up for anemia during pregnancy could follow a simplified flow diagram, such as the one shown in Figure 1. More specific laboratory tests should be selected as needed.

Anemia↗
PubMed1994

HIV and pulmonary hypertension: a review.

We describe two unique cases of pulmonary hypertension in association with the human immunodeficiency virus (HIV) and review the 28 previously reported cases in the world literature. Our first patient has coexistent chronic active hepatitis, which has previously been associated with the development of plexogenic pulmonary hypertension; however, our second case clearly demonstrates a closer link between HIV infection and pulmonary hypertension. Unlike previously reported cases, our latter case was devoid of all other coexistent factors including intravenous drug abuse, hepatitis B antigenemia, coexisting immunologic lung parenchymal injury, and hepatitis. Additionally, this is the first case documenting the presence of asymptomatic type II cryoglobulins in an HIV-positive patient with plexogenic pulmonary hypertension.

Adult↗
PubMed1994

Pericardial tamponade in chronic myelomonocytic leukemia.

We report four cases of malignant pleuropericardial effusions in patients with chronic phase myelomonocytic leukemia (CMML). Based on current literature, this event is rare and very poorly understood. Our cases shed light on three important clinical characteristics: (1) patients with CMML develop effusions during uncontrolled leukocytosis; (2) these effusions are very responsive to conventional chemotherapy; and (3) effusions may develop without clinical forms of disease in other sites of extramedullary hematopoiesis.

Aged↗
PubMed1994

Efficacy of electroconvulsive therapy after propofol and methohexital anesthesia.

Fifty-eight patients with major depression were randomly assigned to receive a hypnotic dose of either propofol or methohexital for their complete treatment series of electroconvulsive therapy (ECT). As expected, seizure duration was significantly shorter with propofol than with methohexital anesthesia. Both groups recovered from their depression at the same rate. There was a significant improvement in the Hamilton Rating Scale for Depression scores between the first and last ECT session. However, this was independent of the choice of propofol or methohexital as the anesthetic. This study supports previous reports that seizure duration does not influence recovery from depression.

Adolescent↗
PubMed1994

Octreotide treatment of carcinoid hypertensive crisis.

In the severe crisis of carcinoid syndrome the flush is usually accompanied by hypotension and occasionally shock. Injection of octreotide, the long-acting analog of somatostatin, usually prevents or aborts this vasomotor reaction. A small minority of carcinoid syndrome patients manifest hypertension during their crises and little has been reported in the literature on their management. We present the first case reports of the response of patients with hypertensive carcinoid crisis to treatment with octreotide. The world literature contains reports of 20 prior cases of hypertensive carcinoid crises occurring in association with the stress of surgery and anesthesia. Review of these cases reveals no common feature, other than hypertension, that might clearly distinguish them from the typical hypotensive carcinoid syndrome patient. It is hypothesized that the mechanism of action of octreotide correcting the blood pressure changes in all carcinoid crises is via its known inhibition of vasomotor product release from the tumor and blocking receptors for these substances. We suggest that hypertensive as well as hypotensive carcinoid crises respond to octreotide and that this agent should be considered for prophylactic and emergency use in all carcinoid syndrome patients prior to and during anesthesia and surgery.

Female↗