Lack of effectiveness of intranasal administration of human factor VIII.
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Administration, Intranasal↗
Biomedical subjects
W A Robinson
Publications and source records attributed to W A Robinson.
Postburn serum inhibits in vitro production of colony-stimulating factor by mononuclear peripheral blood cells.
The effects of postburn serum (PBS) on the production of colony-stimulating factor (CSF) was evaluated in 13 burned patients by adding PBS to normal peripheral blood mononuclear cells (MNC) and assaying the MNC-conditioned media for CSF content. PBS inhibited CSF production by at least 50%. PBS from non-survivors significantly inhibited CSF production more than PBS from survivors. The addition of lithium chloride restored production of CSF in the presence of day 15 PBS but could not overcome the inhibitory effects of day 1 or day 8 PBS. The nature of the inhibitor(s) is uncertain, but correction of the CSF production defect by lithium chloride later in the course of thermal injury suggests that the defect may be reversible.
Adult↗
Regeneration of full layer necrosis of the skull following high voltage electrical injury.
Scalp and skull necrosis often follow high voltage electrical injury to the head. Classically reconstruction of the scalp and skull is performed after sequestration of the necrotic bone. The relatively frequent complication of epidural infection, however, detracts from this approach. As an alternative we have attempted to induce regeneration of devitalized bone by covering it with a vascular tissue flap. A typical patient is described in this report with results which indicate that at least partial regeneration of the necrotic tissue can occur, thus one-stage management of such wounds is possible.
Adult↗
Treatment of metastatic malignant melanoma with recombinant interferon alpha 2.
Fifty-nine patients with metastatic malignant melanoma were entered into a phase II trial of recombinant alpha-2 interferon given in a dosage of 10 million IU/M2 subcutaneously three times per week for one year. Forty-five of these were evaluable for response. Of five evaluable patients with ocular primaries, none responded to interferon treatment. Four of 40 patients (10%) with cutaneous primaries achieved complete remission, and 6 further patients (15%) had partial remissions for a combined response rate of 25%. Two patients remain in complete remission 15+ and 32+ months after starting treatment. Responses were limited to subcutaneous, lymph node and lung metastases. The treatment schedule was well tolerated with the majority of patients receiving more than 70% of their predicted doses. Flu-like symptoms were the most common side effect. No evidence of cumulative toxicity was seen. We conclude that interferon is an active agent in metastatic malignant melanoma of cutaneous origin and that further trials are indicated.
Adult↗
Recovery of blood and bone marrow stem cells following intense chemotherapy and autologous bone marrow transplantation.
Sixteen patients with advanced (stage III) malignant melanoma were treated with escalating doses of intravenous BCNU and melphalan starting at 400 and 35 mg/m2, respectively, and escalating to 1,000 and 110 mg/m2, respectively, combined with autologous marrow transplantation. The duration of granulocytopenia and time to granulocyte recovery was similar in all groups regardless of chemotherapy dose. Platelet recovery was delayed in patients receiving the highest doses of chemotherapy. This study showed that bone marrow colony-forming units in culture took as long as 6 months to recover. This was adequate to bring peripheral blood counts to normal but not to pretreatment levels. These studies indicate that autologous bone marrow transplantation is beneficial in enhancing short-term recovery, but may not be beneficial in the long-term hematopoietic recovery.
Agranulocytosis↗
Diagnosis of malignant melanoma with radiolabeled monoclonal antibodies: current status.
Since the advent of the technique for preparation of monoclonal antibodies in 1975, these agents have been used in a variety of experimental procedures, including investigations into the structure of the human genome. The increasing availability of these highly specific antibodies has also spawned the development of kits for in vitro diagnosis of a number of diseases, and now radiolabeled monoclonal antibodies are undergoing clinical trials to assist in vivo diagnosis of several different cancers. We report our results in four representative cases comparing the efficacy of 111Indium-labeled antimelanoma, type 96.5, monoclonal antibodies against standard diagnostic imaging techniques at accurately diagnosing metastatic malignant melanoma lesions. In some cases the monoclonal antibody studies provided unequivocal evidence of the existence of metastases. In other cases no localization occurred, and we suggest plausible reasons for this failure and modifications of imaging technique to improve the performance. Overall, we believe monoclonal antibodies represent a promising new clinical aid in disease diagnosis which may ultimately permit direct targeting of therapeutic agents.
Adult↗
Regeneration of full-layer necrosed skull after high-tension electrical injury.
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Adult↗
Oncologic emergencies in primary care. Five malignancy-associated conditions to watch for.
Acute problems requiring emergency management may occur in association with malignancy. The most common are superior vena cava syndrome, compression of the spinal cord or cauda equina, hypercalcemia, tumor lysis syndrome, and fever in the neutropenic patient. Successful management requires that the physician be aware of the potential for such an emergency in a cancer patient and give priority to treatment, based on clinical evidence and a few essential studies, over definitive diagnosis.
Bacterial Infections↗
Chromic acid burns and acute chromium poisoning.
The problems encountered during the treatment of a patient with burns covering 40 per cent of the body surface caused by hot chromic acid and the resulting chromium poisoning are described. Anuria developed on the second day after injury and the patient died on the sixth day.
Accidents, Occupational↗
Early vascular grafting to prevent upper extremity necrosis after electrical burns. Commentary on indications for surgery.
Early vascular grafting is the only effective form of treatment for electrical burns of the wrist which are severe enough to impair blood flow to the hand. Failure to appreciate the significance of early changes in blood flow and to take prompt appropriate action may result in the irreversible loss of blood supply and subsequent amputation. This report analyses the problems encountered in six patients where the early signs of impaired blood flow were not appreciated and amputations were subsequently required.
Adult↗
Thermal-crush injuries of the hands and forearms: an analysis of 60 cases.
The treatment of injuries inflicted on hands and occasionally forearms by crushing between hot rigid surfaces (thermal crush injury) is usually complex because of the possibility of fractures, nerve and tendon injuries, as well as heat destruction of the skin which also may be macerated. A review of the treatment of 60 patients with thermal crush injuries has defined the more important aspects of treatment including the choice of materials for wound coverage (split thickness skin or tube pedicle tissue graft) and the optimal time for surgical repair of the injury.
Adolescent↗
Role of escharotomy and fasciotomy as a first aid measure in the early treatment of an electrically burned arm and wrist.
The saving of the hand and forearm of a patient with a deep circumferential electrical burn of the wrist and forearm following contact with 10 000 V AC demonstrates the important role played by escharotomy and fasciotomy in the early treatment of electrically injured extremities.
Adult↗
Virus-induced leukopenia: Colorado tick fever as a human model.
Eight patients with Colorado tick fever were studied to determine whether alterations in the production of granulopoietic stimulatory or inhibitory factors (or both) could be found in association with the leukopenic state of the disease. The studies demonstrate that in the patients with Colorado tick fever the mononuclear cell production of colony-stimulating factor is decreased and that there is an increase in circulating inhibitory factors in the serum of such patients. The depressed mononuclear cell colony-stimulating activity does not appear to be reversible by addition of either endotoxin or normal human serum. Characterization of these serum inhibitory factors may facilitate understanding of leukopenia in human disease.
Adult↗
Granulocyte stem cells are decreased in humans with fatal burns.
The number of granulocytic stem cells (CFU-C) was measured in the peripheral blood of surviving and nonsurviving burned humans. It has been shown that the number of CFU-C in the peripheral blood of survivors increases over time and is elevated compared to the number found in normal humans. The number found in nonsurvivors, however, falls significantly in the later stages of burn injury, suggesting perhaps a defect in stem cell production and/or differentiation in patients with severe thermal injuries. The mechanism is unclear but its delineation may have an important bearing on understanding the nature of infectious complications following thermal injury.
Adult↗
Adult Hodgkin's disease in Saudi Arabia.
Hodgkin's disease (HD) has variable clinical and pathologic features in different geographic regions. The reasons behind this are not completely clear. We reviewed 81 cases of adult HD who presented to the Adult Oncology Unit of the King Faisal Specialist Hospital, Riyadh, Saudi Arabia between 1975 and 1982. Fifty-seven (70.4%) were males and 24 (29.6%) were females with median ages of 29.9 and 23 years, respectively. The male:female ratio was 2.38:1. Two distinct age peaks at 18 and 48 years were seen in both sexes, with bimodality being more striking in females. The most common histologic subtype encountered was mixed cellularity (59.3%). Most of the patients (67.9%) were either Stage III or Stage IV at the time of diagnosis. These patterns differ significantly from those seen in reported Western series, but are similar to those reported from other areas in the Middle East.
Adolescent↗
Vincristine, cisplatin, and bleomycin with surgery in the management of advanced metastatic nonseminomatous testis tumors.
Most effective treatment regimens for advanced nonseminomatous testis tumors (NSTT) employ vinblastine (V), cisplatin (CDDP), and bleomycin (B) and adjunctive surgery. The toxicity of many of these multidrug programs, primarily from vinblastine-induced myelosuppression has resulted in significant patient morbidity and even death. Since 1978, the authors of this report have used vincristine (VCR), CDDP, and B with adjunctive surgery in patients with advanced NSTT. In the first 29 patients treated with VCR, CDDP, and B and adjunctive surgery, a complete clinical remission (CR) was achieved in 27 (93%) with 3 (11%) recurrences; 24 (83%) remain in CR 18 to 46 months (mean and median of 31 months). Twenty-six (90%) patients had either maximal abdominal tumor (Stage B3) or maximal pulmonary and/or abdominal disease (Stage C). Twenty patients had adjunctive surgery. No patient developed serious chemotoxicity. This treatment regimen is less toxic and equally effective as V, CDDP, and B combinations.
Adolescent↗
Autologous marrow transplantation for patients with chronic myelogenous leukemia (CML) in blast crisis.
Even patients with chronic myelogenous leukemia (CML) in blast crisis were treated with chemotherapy, followed by infusion of autologous bone marrow that had been collected during the chronic phase of the disease and cryopreserved at -198 degrees C. The mean age of the nine females and two males in this study was 34 years with an average duration of the chronic phase of the disease of 5.5 years. Seven out of the 11 patients had a splenectomy prior to intensive chemotherapy. The median survival of the first four patients who received 6-thioguanine, cytosine arabinoside, daunorubicin (TAD) chemotherapy was 2.6 weeks and no patient reachieved the chronic phase of CML. The second group of seven patients received more intensive chemotherapy (MAdHAT), which included melphalan 30 mg/m2 days 1, 2, and 3; Adriamycin 50 mg/m2 intravenously (iv) day 1, hydroxyurea 1500 mg/m2 by mouth for 5-7 days, cytosine arabinoside 100 mg/m2 continuous infusion for 5-7 days, and VM-26 100 mg/m2 iv on day 3. Six out of these seven patients reachieved chronic phase CML after bone marrow reinfusion. The median survival was 29.9 weeks for all patients and 33 weeks for the six patients who reachieved chronic phase CML. All patients subsequently died of recurrent blast crisis. There was no correlation between the time of bone marrow storage and the duration of subsequent chronic phase CML. These studies have shown that autologous bone marrow transplantation after high-dose chemotherapy can result in bone marrow engraftment with reestablishment of chronic phase CML, and prolongation of survival.
Adult↗
Tumor lysis syndrome following VP-16-213 in chronic myeloid leukemia in blast crisis.
Several recent reports have emphasized the potentially serious and often fatal acute metabolic complications following cytotoxic chemotherapy in both solid tumors and leukemias. We present here a case of chronic myeloid leukemia in blast crisis who developed an acute tumor lysis syndrome following a single dose of VP-16-213 (Etoposide).
Adult↗