Search PubMed⌕ Search

Biomedical subjects

S Rubin

Publications and source records attributed to S Rubin.

At least 109 records · Page 6Linked to original sources
PubMed1991

Responses to second-line cisplatin-based intraperitoneal therapy in ovarian cancer: influence of a prior response to intravenous cisplatin.

Phase II trials of second-line intraperitoneal (IP) cisplatin-based therapy in patients with ovarian cancer have demonstrated the ability of this approach to produce objective antitumor responses, including surgically defined complete responses (CRs), in individuals with persistent small-volume disease after front-line cisplatin-based intravenous (IV) treatment. To examine the influence of a prior response to systemic cisplatin on the activity of second-line IP cisplatin, we retrospectively analyzed two phase II trials of cisplatin-based IP therapy in persistent/recurrent ovarian cancer conducted at our institution. Of the 89 assessable patients on the two trials, 52 (58%) had previously responded to IV cisplatin. The overall response and CR rates to second-line IP cisplatin-based therapy in this previously responding population were 56% and 33%, respectively, compared with overall response and CR rates in the 37 nonresponders to IV cisplatin of 11% and 3%, respectively (P less than .001; chi 2, 1 df). In the 36 patients responding to systemic cisplatin and whose largest tumor mass measured less than 1 cm at IP cisplatin initiation, a 42% CR rate was observed, compared with a 7% CR rate in the 14 patients with the same bulk of disease who had previously failed to respond to systemic cisplatin (P less than .025). We conclude that a prior response to systemic cisplatin strongly influences the antineoplastic activity of second-line IP cisplatin in ovarian cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Intraperitoneal cisplatin and cytarabine in the treatment of refractory or recurrent ovarian carcinoma.

Preclinical evaluation has suggested impressive concentration-dependent cytotoxic synergy between cisplatin and cytarabine in ovarian carcinoma. To further evaluate the clinical relevance of these observations, 39 patients with refractory or recurrent ovarian carcinoma were entered onto a phase II trial of intraperitoneal (IP) cisplatin (100 to 105 mg/m2 per course) plus cytarabine (600 to 900 mg per course). Treatment was administered over 2 or 3 days for a maximum of five monthly courses, followed by surgical reevaluation in patients without clinical evidence of disease. The 3-day regimen was discontinued secondary to the development of severe thrombocytopenia (five of 12 courses platelets decreased to less than 50,000/mm3). Additional toxicities included abdominal pain (moderate to severe at some time during therapy in 46% of patients), fever without evidence of infection (44%), and bacterial peritonitis (10%). Three patients declined surgical reassessment. Fourteen of 36 (39%; 95% confidence interval [CI], 23% to 55%) assessable patients demonstrated surgically defined responses, including 12 of 23 (52%; 95% CI, 32% to 72%) patients with tumor nodules less than 1 cm in diameter and only two of 13 (15%; 95% CI, 0% to 34%) patients with any lesion greater than 1 cm. There were seven (30%; 95% CI, 11% to 49%) surgically defined complete responses (CRs) in patients with less than 1 cm disease and none in patients with larger tumor nodules. IP cisplatin/cytarabine results in a high surgically defined response rate in patients with minimal residual ovarian carcinoma, but activity is low in patients with bulky intraabdominal disease.

Adult↗
PubMed1991

Sex or survival: trade-offs between quality and quantity of life.

Patients with localized prostate cancer may be treated with either surgery (radical prostatectomy) or radiotherapy. Although controversial, many physicians believe that surgery offers a higher survival rate. However, the surgical treatment may also produce a higher rate of sexual impotency. Our study assessed how men value survival and sexual potency when asked to trade off one for the other. Using the treatment-choice technique, we interviewed 50 men aged 45 to 70 years without known prostate cancer. At hypothetical rates of survival (90% at 5 years for surgery) and impotency (90% for surgery and 40% for radiotherapy) representing published estimates, 32% of respondents were unwilling to trade off any survival, but 68% were willing to trade off a 10% or greater advantage in 5-year survival (by choosing radiotherapy) to maintain sexual potency. The median 5-year survival traded off was 10% (range, 0% to 80%). Willingness to trade off survival for sexual potency was significantly related to level of education, but not to age, interest in sex, frequency of sexual intercourse, or ability to achieve erection. We conclude that some men may choose treatment with lower long-term survival to increase their chance of remaining sexually potent. Because these men may be difficult to identify in clinical practice, physicians should thoroughly discuss both surgery and radiotherapy options with patients who have localized prostate cancer.

Aged↗
PubMed1991

Second-line platinum therapy in patients with ovarian cancer previously treated with cisplatin.

In an effort to critically define the incidence and clinical characteristics of secondary responses to cisplatin-based therapy in patients with ovarian cancer previously treated with a cisplatin-based program, a retrospective review was undertaken of patients at the Memorial Sloan-Kettering Cancer Center who received greater than or equal to two cisplatin/carboplatin-based programs. Eighty-two patients were identified who met the entry criteria of having had a cisplatin-free interval (CFI) of more than 4 months between the completion of their first regimen and the institution of a second cisplatin/carboplatin program. Of the 72 assessable patients (10 had no measurable disease, and a laparotomy was not performed to assess response), 31 (43%) responded, including 10 surgically defined complete responses (S-CRs). The overall response rates (and S-CR rate), based on duration of CFI, were 5 to 12 months, 27% (5%); 13 to 24 months, 33% (11%); and more than 24 months, 59% (22%). Twenty-nine patients (35%) received noncisplatin/carboplatin-containing treatments between the cisplatin programs. Patients without any treatment for more than 24 months from the completion of their initial therapy experienced a 77% (17 of 22) response rate and a 32% (seven of 22) S-CR rate. In conclusion, secondary responses to cisplatin/carboplatin-based treatment are common in patients with ovarian cancer who have previously responded to the agents and increase in frequency with greater distance from the initial therapy.

Adult↗
PubMed1991

Phase II trial of weekly or biweekly intraperitoneal mitoxantrone in epithelial ovarian cancer.

Previous experimental and clinical evaluation has suggested that ovarian cancer is sensitive to the cytotoxic effects of mitoxantrone at concentrations achievable within the peritoneal cavity after intraperitoneal (IP) administration. Unfortunately, the use of the drug delivered IP at high doses (20 mg/m2 in 2 L normal saline [NS]) on a monthly schedule is compromised by severe local effects secondary to the irritant properties of the drug. To reduce toxicity and take advantage of minimal systemic drug exposure following IP administration, we treated 28 patients with a lower drug concentration of mitoxantrone (10 mg/m2 in 2 L NS), but on a weekly or every other week schedule (total, 12 courses). Compared with the monthly program, this regimen caused less pain, allowed for a higher cumulative dose of mitoxantrone to be delivered, and resulted in less serious treatment-related morbidity. Four of 13 assessable patients (31%) whose largest tumor was less than or equal to 1 cm in diameter demonstrated a surgically defined response. All responding patients had failed previously or exhibited a minimal response to cisplatin. Despite the improved toxicity profile of this regimen, the overall response rate was similar to the monthly program, probably secondary to inadequate IP drug distribution in many patients. Future investigative efforts using IP mitoxantrone as therapy for ovarian cancer might focus on developing methods to improve drug delivery to all sites of tumor within the peritoneal cavity (eg, intraoperative therapy, increased treatment volumes, and antiinflammatory agents to reduce adhesion formation).

Adult↗
PubMed1991

Weight change in cardiac transplant patients.

The perception exists that excessive weight gain commonly occurs after cardiac transplantation. To examine this perception, 91 transplant patients from one to eight years post-transplant responded to a questionnaire eliciting data on premorbid and post-transplant weights, exercise frequency, and fat intake. Only 37% of subjects weighed more post-transplant than premorbidly. More than half of the subjects were over their ideal weights premorbidly and post-transplant. On t-test there was no significant difference (p less than .05) between weight gainers and weight losers in exercise frequency (t = .63; p = .53), or fat intake (t = -.80; p = .43). Findings of the study dispute the perception of excessive weight gain post-transplantation. This perception may be due to the comparison of cachectic pre-transplant weight with well weight post-transplant. Since more than half of the subjects were over their ideal weight post-transplantation, teaching regarding weight control remains important. Future research on effective methods of weight control is needed.

Adult↗
PubMed1991

Congenital syphilis in New York City: 1985-1990.

The Bureau of STD Control continues to combat NYC's epidemic of congenital syphilis. The demographic profile of this population has remained constant with only a clearer identification of previously reported risk factors: most notably poor prenatal care and substance abuse. There is a suggestion of a plateau having occurred in adult and congenital syphilis, possibly caused by saturation effect on the high-risk population. During the period 1989 through 1990, the rates for cocaine/crack use have remained relatively constant among mothers infected with syphilis. A recent study by the Division of Substance Abuse Services of New York State school-age children demonstrated a drop in cocaine use from 14% in 1983 to 6%. If a similar decline is seen in substance abuse in other age groups, the rate of congenital syphilis may diminish.

Adolescent↗
PubMed1991

Early syphilis in New York City: 1985-1990.

The resurgence of syphilis since 1986 and 1987 in NYC has been mirrored in other major urban centers nationwide. Since 1988, P&S syphilis have declined, but early latent and congenital syphilis have continued to increase. A number of features characterize this most recent epidemic: Starting in 1987, Brooklyn replaced Manhattan as the borough with the most number of cases of early syphilis. The age distribution of reported cases has remained constant. Women constitute a growing proportion of early syphilis, and in fact, are the majority of cases of EL syphilis. As in other parts of the nation, this may be due to diminishing risk behavior among male homosexuals and the continuing effect of the cocaine epidemic and "drugs for sex," prostitution. The black and Hispanic communities continue to be disproportionately infected. Public Health education and control efforts should continue to be focused on the communities most affected.

Adult↗
PubMed1990

Gastric volvulus complicating Nissen fundoplication.

Two cases of gastric volvulus in children are reported, one complete and one partial. Both occurred subsequent to Nissen fundoplication for gastroesophageal reflux. The symptoms at presentation, and the factors predisposing to volvulus postfundoplication are discussed.

Child, Preschool↗
PubMed1990

Beam's eye view based prostate treatment planning: is it useful?

Prostate cancer is a common malignancy often treated with radiation therapy. Treatment optimization may improve local control while reducing acute and long-term complications. We routinely obtained CT scans on prostate cancer patients in treatment position after simulation. We analyzed the impact and implications of using our 3-D Beam's Eye View (BEV) capability on field definition and blocking for 12 consecutive patients. Conclusions include: (a) it is necessary to use multiple bony landmarks to align BEV images with simulator films; (b) it is difficult to enter volumes precisely, that is, the exact inferior extent of prostate; (c) Beam's Eye View-based plans show more individual variability in field size and position than are allowed for by recommendations in the literature; and (d) in this small series we found no significant correlation between prostate volume and clinical staging. In addition, computerized Beam's Eye View capability enables us to do normal tissue dosimetry. We have used Dose Volume Histograms (DVH) to study the impact of Beam's Eye View on optimization of dose to the bladder and rectum while adequately treating the prostate, with or without the seminal vesicles. Dose Volume Histograms using Beam's Eye View are compared with Dose Volume Histograms using target volumes from the literature. The results will be discussed, as well as the relative advantages of using Beam's Eye View for prostate cancer on a routine basis.

Evaluation Studies as Topic↗
PubMed1990

Phase II trial of intraperitoneal mitoxantrone in the management of refractory ovarian cancer.

To define both the toxicity and efficacy of intraperitoneal mitoxantrone in the treatment of refractory ovarian carcinoma, 31 patients were entered onto a phase II trial of this agent delivered in a 2 L treatment volume on a monthly basis. Due to excessive local pain at the initial dose level (30 mg/m2), the amount of drug delivered with each treatment course was reduced to 20 mg/m2. Despite this reduction, 74% of patients required narcotic analgesia during treatment. In addition, there were four episodes of bowel obstruction (one requiring surgical intervention) during therapy, and two patients developed bowel obstruction and intraabdominal abscesses following the completion of treatment. Six of 18 evaluable patients (33%) whose largest tumor diameter was less than or equal to 1 cm at protocol initiation experienced surgically documented responses, compared with one of 11 patients (9%) whose largest tumor was greater than 1 cm in diameter. If the two patients exhibiting what we called a mixed response to treatment are included, seven of 21 patients previously treated with intraperitoneal cisplatin responded to this treatment program, including four patients who had failed to respond to intraperitoneal cisplatin. No responding patient has demonstrated clinical evidence of relapse with a median follow-up of 7 months (range, 3+ to 13+ months) from response laparotomy. Intraperitoneal mitoxantrone is an active treatment program in patients with small-volume refractory ovarian carcinoma, but local toxicity can be severe. Due to the toxicity encountered with this specific program, its use cannot be recommended for standard clinical practice. However, in view of the activity observed in refractory ovarian carcinoma, including responses in patients who had previously failed intraperitoneal cisplatin, it is important to continue to explore alternative therapeutic regimens using intraperitoneal mitoxantrone to reduce local toxicity while maintaining or improving efficacy.

Carcinoma↗
PubMed1989

Intraperitoneal cisplatin and etoposide in the treatment of refractory/recurrent ovarian carcinoma.

To determine the efficacy of a 6-month course of combination intraperitoneal (IP) chemotherapy with cisplatin and etoposide in patients with refractory or recurrent advanced ovarian carcinoma, 67 patients were entered into this prospective, nonrandomized, single-institution trial. Cisplatin at 100 mg/m2 and etoposide at 200 mg/m2 were administered IP on day 1 every month for 6 months. Exploratory laparotomy was performed before protocol entry and was planned after the completion of 6 months of IP therapy to surgically document response. All patients had received prior intravenous (IV) chemotherapy with a cisplatin-based regimen. At protocol entry, 18 (27%) patients had surgically defined residual tumor (maximal tumor diameter) greater than 2.0 cm, 17 (25%) patients greater than 0.5 cm - less than or equal to 2.0 cm, and 32 (48%) patients less than or equal to 0.5 cm. Sixteen patients (24%) who had experienced a treatment-free interval of more than 1 year prior to study entry were considered as having recurrent disease and the remaining 51 (76%) patients were considered as having refractory disease. Toxicity was tolerable: four patients (6%) had nadir fever, three (4%) had culture-documented bacterial peritonitis, five (7%) had IP catheter-related complications, and 27 (40%) had an increase in serum creatinine greater than 1.5 mg/dL. Among the 57 patients who are fully evaluable for response, the overall surgically defined response rate, complete (CR), and partial response (PR), was 40% (23/57), and the CR rate was 21% (12/57). Among the patients with recurrent disease, eight of 13 (62%) responded, with responses seen among all categories of residual disease. Among the patients with refractory disease, 15 of 44 (34%) had surgically documented responses. However, responses were more frequent in patients with residual disease less than 0.5 cm; 11 of 20 (55%) versus four of 24 (17%) with residual greater than 0.5 cm, P = .019 (chi 2, one degree of freedom, Yates correction). The duration of the CRs ranges from 4 to 18+ months. Longer follow-up is needed to determine if there is any impact on survival.

Adult↗
PubMed1989

Intraperitoneal chemotherapy as treatment for ovarian carcinoma and gastrointestinal malignancies: the Memorial Sloan-Kettering Cancer Center experience).

Several different chemotherapy trials via either combined systemic and intraperitoneal or only via the intraperitoneal route were investigated. The administration of systemically and intraperitoneally infused 5-fluorouracil (5-FU) in patients with ovarial carcinoma did not shown in any patient a complete or partial remission, but showed severe side effects. In a patient with a metastasizing adeno carcinoma of the appendix this chemotherapy protocol led to a complete remission. Investigations with intraperitoneally infused cisplatin showed that 50% of all patients came into remission with tumor nodules less than 0.5 cm, but showed only 20% objective remissions in patients with tumor nodules greater than 0.5 cm. The intraperitoneal administration of mitoxantrone showed in several patients with cisplatin refractory ovarial carcinoma tumor remission with, however, severe local toxicity.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Phase I trial of concurrent intraperitoneal and continuous intravenous infusion of fluorouracil in patients with refractory cancer.

In an effort to maximize both local-regional and systemic drug exposure to tumor in the peritoneal cavity, a phase I study was conducted that examined the simultaneous daily intraperitoneal (IP) and continuous intravenous infusion (CVI) of fluorouracil (5-FU) to 32 patients with refractory cancer. IP 5-FU administered at 1,000 mg/d with concurrent 5-FU by CVI at 1,000 mg/m2/d for four consecutive days was well tolerated. One patient with a primary gastrointestinal (GI) malignancy with minimal volume disease experienced a surgically defined complete remission. In theory, this regimen may demonstrate clinical utility as an adjuvant treatment of certain GI malignancies. Future studies are planned in this clinical setting.

Drug Administration Schedule↗
PubMed1988

A phase I trial of intraperitoneal recombinant gamma-interferon in advanced ovarian carcinoma.

The interferons are a class of biological agents that have demonstrated antineoplastic activity in a variety of tumors both in vitro and in vivo. Previous reports have suggested that interferons can be safely administered by the intraperitoneal (IP) route with a pharmacokinetic advantage for peritoneal cavity exposure compared with the systemic circulation and with objective antitumor activity being demonstrated. On the basis of these reports and laboratory data suggesting activity for recombinant gamma-interferon (r-GIFN) against several malignant cell lines, we treated 27 refractory ovarian carcinoma patients, including six with very-small-volume residual disease, with this agent delivered by the IP route. While r-GIFN was found to be remarkably well tolerated, with a 150- to 200-fold pharmacokinetic advantage for peak levels achieved in the peritoneal cavity compared with the plasma, no objective responses were observed. Despite the lack of demonstrated activity for single-agent IP-administered r-GIFN in this clinical setting, there remains considerable interest in this agent when delivered by the IP route because of in vitro data suggesting concentration-dependent synergy between r-GIFN and other biological agents.

Adult↗
PubMed1988

Expanded role nurse. Part I. Role theory concepts.

This is the first article of a two-part series describing implementation of Expanded Role Nurse positions at University Hospital, London, Ontario. Part I presents a review of the literature on expanded roles for nurses and the background to implementation of the ERN role at University Hospital. Concepts or role theory are applied to role development and implementation. Expanded role nurse positions have been created at University Hospital in order to maintain high quality patient care in the face of resident cutbacks. These positions provide exciting opportunities for nurses who wish to develop clinical expertise while remaining at the bedside.

Heart Diseases↗