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Biomedical subjects

S Wallace

Publications and source records attributed to S Wallace.

At least 325 records · Page 18Linked to original sources
PubMed1983

Treatment of hepatic neoplasm through extrahepatic collaterals.

Twenty-nine patients with hepatic artery occlusion were treated with additional hepatic infusion or embolization through extrahepatic collaterals. Seventeen courses of hepatic infusion were performed in 13 patients through the inferior pancreaticoduodenal artery, left gastric artery, or right gastric artery. Twenty-five hepatic embolization procedures were performed in 16 patients through the right and left phrenic arteries, left and right gastric arteries, pancreaticoduodenal artery, gastroduodenal artery, or omentoepiploic artery. In one patient gastric ulcers developed following left gastric artery infusion. No complication related to the embolization procedure was observed in the embolization group. The extrahepatic collaterals are important alternative routes for continuous transcatheter management of hepatic neoplasms following hepatic artery occlusion.

Adult↗
PubMed1983

Apudomas metastatic to the liver: treatment by hepatic artery embolization.

Eighteen patients with various apudomas metastatic to the liver underwent hepatic artery embolization. In one group of 14 patients, hepatic artery embolization was the only antineoplastic therapy used during the study period. Three deaths occurred in this group. A partial remission of the hepatic metastases occurred in eight of the 11 living patients. In addition to hepatic artery embolization, a second group of four patients received concurrent hepatic artery infusions of chemotherapeutic agents. A partial remission occurred in three of these patients. Hepatic artery embolization may offer significant palliation for patients with apudomas metastatic to the liver by reducing the tumor bulk and thus decreasing the production of pharmacologically active substances secreted by functioning tumors. The impact of this treatment on the median survival time of patients with apudomas could not be demonstrated.

Adult↗
PubMed1983

Treatment of primary osteosarcoma with intra-arterial and intravenous high-dose methotrexate.

In an effort to achieve high concentrations and prolonged exposure times, high-dose methotrexate (MTX) was administered by the intra-arterial route over 6 hours at a dose of 12.5 g/m2 to nine patients with osteosarcoma. This was followed by citrovorum factor (CF) rescue, which was initiated 12 hours after completion of the infusion (MTX-CF). The regimen achieved high local concentrations over a finite period. No toxicity was encountered. Treatment was administered at weekly intervals, during which intravenous MTX-CF was interposed if facilities for intra-arterial administration were not available. However, despite increases in local venous concentrations and exposure times, only four of nine patients (44%) responded. This is similar to responses achieved with 7.5 g/m2 (48%) with CF initiated 2 hours after completion of the infusion. Higher MTX doses, intra-arterial administration, and prolongation of cytotoxic exposure time did not confer a therapeutic advantage as opposed to "conventional" intravenous high doses.

Adolescent↗
PubMed1983

Sterilized metastases: a diagnostic and therapeutic dilemma.

The usual indication of improvement in metastatic cancer is diminution of the mass. When a mass persists after treatment, it is presumed the lesion either does not respond or has stopped responding to the therapy. Two patients with brain metastases, one biopsy proven, from breast cancer and eight patients with presumed metastatic testicular cancer to the lung, liver, or retroperitoneum have been identified in whom surgery or autopsy revealed only necrosis and/or fibrosis in the persistent mass; the mass had been "sterilized." Although this phenomenon is not frequent, it is not uncommon in testicular cancer. Our observations are offered to make others aware that persistent mass need not indicate viable tumor. When sufficient examples are accumulated, some clues to predicting this phenomenon may help resolve the therapeutic dilemma it presents.

Adolescent↗
PubMed1983

Diazepam prophylaxis of contrast media-induced seizures during computed tomography of patients with brain metastases.

The effect of 5 mg of intravenous diazepam (Valium) on contrast media-associated seizure incidence was studied in a randomized controlled trial involving 284 patients with known or suspected brain metastases undergoing cerebral computed tomography. Of these patients, 188 were found to have brain metastases, and it is estimated that for this subgroup prophylactic diazepam reduces the risk of contrast-associated seizure by a factor of 0.26. Seizures occurred in three of 96 patients with metastases on diazepam and in 14 of 92 patients with metastases but without diazepam. Factors related to increased risk of contrast media-associated seizures are: (1) prior seizure history due to brain metastases and/or prior contrast, (2) progressive cerebral metastases, and (3) prior or concurrent brain antineoplastic therapy. Factors not related to an increased risk of these seizures are: (1) contrast media dosage, chemical composition, or osmolarity, (2) computed tomographic appearance of metastases, and (3) type of primary malignancy. Concomitant therapeutic levels of diphenylhydantoin (Dilantin) do not protect completely against contrast media-associated seizures. Pathophysiology of contrast media-associated seizures is discussed in view of the risk factors determined by this study.

Aged↗
PubMed1983

Chemical cholecystitis associated with hepatic artery infusion chemotherapy.

The gallbladder often is included within the infusion territory during hepatic arterial chemotherapy, because the cystic artery usually originates from the right hepatic artery. Symptomatic cholecystitis associated with hepatic arterial infusion of mitomycin C and floxuridine or 5-fluorouracil was observed in four instances out of over 700 hepatic arterial infusions of chemotherapeutic agents performed over a 3-year period at two institutions. Arterial infusion chemotherapy is generally well tolerated by the gallbladder, and the true incidence of associated cholecystitis is unknown. Occasionally, angiographic features of cholecystitis are observed in asymptomatic patients after hepatic arterial infusion chemotherapy.

Adult↗
PubMed1983

Superselective catheterization technique in hepatic angiography.

The techniques for superselective catheterization of hepatic artery are described. The catheters have five major configurations in various sizes: (1) simple curve, (2) reverse curve, (3) double curve, (4) modified double curve, and (5) hepatic and splenic curves. Since the celiac artery may be directed caudad, horizontally, or cephalad, the techniques vary accordingly. The basic approach of the system described is to tailor the catheter to fit the vascular anatomy. These various techniques have produced a 95% success rate in the hepatic artery catheterization of 1,000 patients.

Catheterization↗
PubMed1983

Arterial perfusion with Tc-99m macroaggregated albumin (MAAAP) in monitoring intra-arterial chemotherapy of sarcomas.

Thirty infusion studies with Tc-99m-labeled macroaggregated albumin were carried out in 21 patients who had histologically proven peripheral tumors. Three patterns of tumor perfusion were noted: increased central radioactivity in 13 patients, decreased central radioactivity with or without increased peripheral radioactivity in four, and absence of radioactivity in four. In the last category, all four patients had no evidence of tumor neovascularity by contrast angiography. In all 21 patients the intraneoplastic patterns showed very good correlation between contrast angiography and radionuclide angiography. Pulmonary tracer uptake was documented in all 14 patients who had counts performed over the lungs; one had no evidence of tumor neovascularity by either angiographic study, and only 8 of the 13 remaining (61%) showed evidence of appreciable tumor arteriovenous shunting by contrast angiography. Decreased tumor perfusion, presumably due to vessel spasm, was found in one patient.

Adolescent↗
PubMed1983

Clinical pharmacology of intraarterial cis-diamminedichloroplatinum(II).

After intraarterial (30 patients) or i.v. (seven patients) administration of cis-diamminedichloroplatinum, X-ray fluorescence spectrometry was used to measure platinum concentrations in plasma and urine. Arteries infused included hepatic (seven patients), carotid (six patients), iliac (ten patients), brachial (three patients), and femoral (four patients). All patients received i.v. mannitol. Pharmacokinetic parameters after intraarterial administration were similar to those after i.v. administration, although differences existed for different intraarterial routes of administration. Mean for all patients combined were: Co, 2.67 +/- 0.97 (S.D.) microgram/ml; t1/2 beta, 71.1 +/- 26.6 hr; clearance, 0.72 +/- 0.25 liters/hr/sq m; total volume of distribution, 45.2 +/- 17.0 liters/sq m; C x t, 167 +/- 72 mg/hr/liter; and 24-hr urinary excretion, 20 +/- 10% of the administered dose. Intrahepatic infusion of the drug was associated with a significantly lower Co (1.88 +/- 0.50 g/ml) and C x t (140 +/- 25 mg hr/liter) and significantly higher clearance (0.91 +/- 0.24 liters/hr/sq m) and volume of distribution (67.6 +/- 4.6 liters/sq m) than administration by other routes, suggesting first pass extraction of drug by liver. In addition, an apparent minor late rise in serum platinum concentration may suggest enterohepatic recirculation of drug. High fluid intake was associated with a low Co and a high volume of distribution, consistent with expansion of the central compartment by fluids. Low serum albumin (less than 3.5 g/dl) was associated with significant shortening of the t1/2 beta (50.5 +/- 21.6 hr), suggesting that the amount of unbound filterable drug may possibly be higher in patients with low serum albumin concentrations. Plasma from veins draining an infused area has a higher Co and C x t during infusion than concurrent plasma from peripheral veins. Thus, intraarterial administration of cis-diamminedichloroplatinum results in increased drug exposure of tumor in the infused area without substantially decreasing exposure of systemic tumor.

Cisplatin↗
PubMed1982

Adriamycin therapy by continuous intravenous infusion in patients with metastatic breast cancer.

Patients with metastatic breast cancer previously treated with non-Adriamycin containing chemotherapy were treated with Adriamycin at a dose of 60 mg/m2 administered as a continuous infusion through a central venous catheter. The duration of Adriamycin infusion was escalated by 100% increments from 24-96 hours, but the majority of patients were maintained on 96-hour infusions. Thirteen of 27 patients achieved objective response (1 CR, 12 PR), six improved, and eight failed to respond to Adriamycin. Administration of Adriamycin by infusion led to a decrease in the severity of nausea and vomiting, but had no effect on myelosuppression and alopecia secondary to Adriamycin. The cardiac toxicity of Adriamycin was reduced in patients who received maintenance therapy with 96-hour infusions of Adriamycin.

Adult↗
PubMed1982

Transcatheter intraarterial infusion of chemotherapy in advanced bladder cancer.

Bilateral internal iliac artery infusion of chemotherapeutic agents in patients with advanced bladder carcinoma, Stage D, resulted in a 50% response or greater in nine of 15 patients with a median survival, thus far, of 52 weeks. Hematuria was controlled in eight of ten patients, and pain was relieved in 12 of 15 patients. Three additional patients were treated as adjuvants after their residual tumor was removed surgically or irradiated before chemotherapy. Cis-diamminedichloroplatinum (CDDP) was infused at a dose of 80--120 mg/m2 over a 24-hour period. When CDDP failed or in the presence of impaired renal function, a combination of 5-fluorouracil (5-FU) infused intraarterially while Adriamycin and mitomycin C were delivered intravenously, salvaged two patients. Complications were tolerable, consisting of transient acute tubular necrosis in two patients, a lower extremity embolus in one, and skin reactions due to 5-FU in two patients.

Adult↗
PubMed1982

Intraarterial management of giant-cell tumors of the spine in children.

Transcatheter arterial management of giant cell tumors of the spine was performed in two female patients aged 12 and 15 who had failed to respond to conventional therapy. Response was determined clinically by alleviation of pain and radiographically by regression and/or calcification of the tumor. Minor side effects included transient nausea, elevated body temperature, and pain.

Adolescent↗
PubMed1982

Experimental percutaneous renal embolization using BCG-saturated gelfoam.

Adult mongrel dogs (20-25 kg) were used to evaluate the administration of Bacillus Calmette-Guerin (BCG) in conjunction with total renal embolization for possible application in the management of metastatic renal cell carcinoma (RCC). Kidneys were surgically removed at 1, 2, and 3 weeks postembolization, examined grossly and microscopically, and then compared with kidneys embolized in the same manner without BCG. The procedure stimulated the reticuloendothelial system more than did renal embolization alone, and although a high dose (6 X 10(8) organisms) of BCG was administered, no complications were encountered. These results warrant a clinical trial of this technique in patients with advanced RCC.

Adenocarcinoma↗
PubMed1982

Cranial computed tomography of breast carcinoma.

Cranial computed tomographic (CCT) manifestations of brain metastases were reviewed in 304 patients with carcinoma of the breast. Metastases were demonstrated in 103 patients; 13 had other significant abnormalities. Single lesions were found in 55 (54%) patients (cerebral hemisphere, 48; cerebellar hemisphere, 4; pineal, 1; pituitary and optic chiasm, 1; vermis, 1) and multiple metastases were found in 48 patients. Continuity with bony metastases was seen in 4 patients. Prior to contrast infusion, 13 (12.5%) patients with metastases had a normal CCT, and 13 (12.5%) showed lesions of increased attenuation. All metastases demonstrated enhancement following contrast infusion; 74 (72%) had a zone of surrounding "edema." Histopathologic-CCT correlation was available in 54 patients. Precontrast, increased attenuation of metastases was associated with hemorrhage or calcification, or both. Calcification accompanied by necrosis was the result of previous treatment. Following therapy, 3 patients demonstrated lesions that were impossible to differentiate from metastases by CCT, but proved histologically to have no viable tumor cells present.

Adult↗