Search PubMed⌕ Search

Biomedical subjects

W R Richli

Publications and source records attributed to W R Richli.

At least 19 recordsLinked to original sources
PubMed2000

Adenovirus-mediated p53 gene transfer in sequence with cisplatin to tumors of patients with non-small-cell lung cancer.

PURPOSE: To determine the safety and tolerability of adenovirus-mediated p53 (Adp53) gene transfer in sequence with cisplatin when given by intratumor injection in patients with non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Patients with advanced NSCLC and abnormal p53 function were enrolled onto cohorts receiving escalating dose levels of Adp53 (1 x 10(6) to 1 x 10(11) plaque-forming units [PFU]). Patients were administered intravenous cisplatin 80 mg/m(2) on day 1 and study vector on day 4 for a total of up to six courses (28 days per course). Apoptosis was determined by the terminal deoxynucleotidyl- transferase-dUTP nick-end labeling assay. Evidence of vector-specific sequences were determined using reverse-transcriptase polymerase chain reaction. Vector dissemination and biodistribution was monitored using a series of assays (cytopathic effects assay, Ad5 hexon enzyme-linked immunosorbent assay, vector-specific polymerase chain reaction assay, and antibody response assay). RESULTS: Twenty-four patients (median age, 64 years) received a total of 83 intratumor injections with Adp53. The maximum dose administered was 1 x 10(11) PFU per dose. Transient fever related to Adp53 injection developed in eight of 24 patients. Seventeen patients achieved a best clinical response of stable disease, two patients achieved a partial response, four patients had progressive disease, and one patient was not assessable. A mean apoptotic index between baseline and follow-up measurements increased from 0.010 to 0.044 (P =.011). Intratumor transgene mRNA was identified in 43% of assessable patients. CONCLUSION: Intratumoral injection with Adp53 in combination with cisplatin is well tolerated, and there is evidence of clinical activity.

Adenoviruses, Human↗
PubMed1999

Adenovirus-mediated p53 gene transfer in advanced non-small-cell lung cancer.

BACKGROUND: Preclinical studies in animal models have demonstrated tumor regression following intratumoral administration of an adenovirus vector containing wild-type p53 complementary DNA (Ad-p53). Therefore, in a phase I clinical trial, we administered Ad-p53 to 28 patients with non-small-cell lung cancer (NSCLC) whose cancers had progressed on conventional treatments. METHODS: Patients received up to six, monthly intratumoral injections of Ad-p53 by use of computed tomography-guided percutaneous fine-needle injection (23 patients) or bronchoscopy (five patients). The doses ranged from 10(6) plaque-forming units (PFU) to 10(11) PFU. RESULTS: Polymerase chain reaction (PCR) analysis showed the presence of adenovirus vector DNA in 18 (86%) of 21 patients with evaluable posttreatment biopsy specimens; vector-specific p53 messenger RNA was detected by means of reverse transcription-PCR analysis in 12 (46%) of 26 patients. Apoptosis (programmed cell death) was demonstrated by increased terminal deoxynucleotide transferase-mediated biotin uridine triphosphate nick-end labeling (TUNEL) staining in posttreatment biopsy specimens from 11 patients. Vector-related toxicity was minimal (National Cancer Institute's Common Toxicity Criteria: grade 3 = one patient; grade 4 = no patients) in 84 courses of treatment, despite repeated injections (up to six) in 23 patients. Therapeutic activity in 25 evaluable patients included partial responses in two patients (8%) and disease stabilization (range, 2-14 months) in 16 patients (64%); the remaining seven patients (28%) exhibited disease progression. CONCLUSIONS: Repeated intratumoral injections of Ad-p53 appear to be well tolerated, result in transgene expression of wild-type p53, and seem to mediate antitumor activity in a subset of patients with advanced NSCLC.

Adenoviridae↗
PubMed1998

Outpatient management of pneumothorax after fine-needle aspiration: economic advantages for the hospital and patient.

PURPOSE: To evaluate the efficacy and cost savings of outpatient management of post-fine-needle aspiration (FNA) pneumothoraces with small-caliber catheters. MATERIALS AND METHODS: The authors retrospectively reviewed the medical and hospital billing records from 74 patients with enlarging or symptomatic post-FNA pneumothoraces treated with a small-caliber catheter. Forty patients (54%) were treated on an outpatient basis, 17 patients (23%) were treated on an inpatient basis, and 17 patients (23%) were monitored overnight in the emergency department. Only one patient initially treated on an outpatient basis had to return for inpatient observation and suction because of a persistent pneumothorax. RESULTS: The catheters remained in place overnight in 46 patients (33 outpatients, 12 emergency department patients, and one inpatient). The number of days the catheters were left in place was prolonged (range, 2-13 days) in seven outpatients, five emergency department patients, and 16 inpatients. The mean cost per patient for lung biopsy and pneumothorax management was as follows: outpatients, $1,689; emergency department patients, $2,403; and inpatients, $3,950. Elevated inpatient expense was related to the number of chest radiographs obtained, pharmacy charges, and room charges. Cost elevation for emergency department patients was related to pharmacy charges and the cost of overnight observation. CONCLUSION: Outpatient management of simple pneumothoraces with placement of small-caliber catheters attached to one-way chest drain valves proved to be safe, efficient, and economical.

Adult↗
PubMed1993

An anatomical study of the tarsal tunnel using low pressure compartmental infusion.

The anatomy of the tarsal tunnel is demonstrated using a low-pressure compartmental infusion technique. This is done by infusing colored radiopaque contrast material into three fresh cadaveric specimens. Thin section photography and computed tomography are then used to identify the boundaries and contents of the tarsal tunnel as it traverses the ankle, hindfoot, and midfoot. The tarsal tunnel is shown to communicate proximally with the deep posterior compartment of the leg and distally with the intermediate compartment of the forefoot. The relationships of the structures contained within the tarsal tunnel are shown in detail.

Ankle↗
PubMed1991

MDA-image: an environment of networked desktop computers for teleradiology/pathology.

MDA-Image, a project of The University of Texas M. D. Anderson Cancer Center, is an environment of networked desktop computers for teleradiology/pathology. Radiographic film is digitized with a film scanner and histopathologic slides are digitized using a red, green, and blue (RGB) video camera connected to a microscope. Digitized images are stored on a data server connected to the institution's computer communication network (Ethernet) and can be displayed from authorized desktop computers connected to Ethernet. Images are digitized for cases presented at the Bone Tumor Management Conference, a multidisciplinary conference in which treatment options are discussed among clinicians, surgeons, radiologists, pathologists, radiotherapists, and medical oncologists. These radiographic and histologic images are shown on a large screen computer monitor during the conference. They are available for later review for follow-up or representation.

Clinical Laboratory Information Systems↗
PubMed1991

Open-floored concave compensating filter for angiography.

An open-floored concave compensating filter was designed that produced a radiograph of uniform density, caused no artifacts due to its shape or position, and required little or no increase in exposure in most applications. Selective celiac, hepatic, shoulder, and pelvic angiography was performed with use of the filter; image quality was noticeably improved.

Angiography↗
PubMed1991

MR appearance of the distended iliopsoas bursa.

The purpose of this essay is to illustrate the MR appearance of the distended iliopsoas bursa. The bursa must be recognized on MR scans to avoid confusing it with malignant neoplasms and other lesions.

Aged↗
PubMed1990

Fine needle aspiration biopsy in lymphoma.

Patients with lymphoma undergo excisional biopsy of an affected lymph node for initial classification of their disease because accurate classification depends on the histologic characteristics of the neoplasm. However, fine needle aspiration cytology has a role in the management of lymphoma patients, particularly in those with recurrent or residual masses following treatment. Moreover, immunologic markers, nucleic acid flow cytometry, cytogenetics, and molecular genetics, which do not depend on histologic characteristics and can be performed on fine needle aspirates, are acquiring more importance in the management of patients with these diseases, particularly in those with non-Hodgkin's lymphoma. These latter tests add objectivity to the cytologic diagnosis of the B-cell lymphomas and increase its accuracy. In most series, the accuracy of fine needle aspiration in patients with lymphoma approaches 90%, with minimal complication rates.

Biopsy, Needle↗
PubMed1989

Gastrointestinal and pancreatic endocrine tumours.

The radiological diagnosis and interventional management of neuroendocrine tumours of the gastrointestinal tract and pancreas are challenging, demanding the complete gamut of available resources. Carcinoid tumours are most commonly found in the appendix and small bowel. Barium studies usually disclose a small solitary mucosal or submucosal mass in the distal ileum at times associated with smooth muscle hypertrophy and thickening of the mucosal folds. Intussusception and bowel obstruction may be the presenting finding. Mesenteric involvement may evoke a desmoplastic reaction with rigidity, fixation, angulation and tethering of small bowel loops. Angiography may demonstrate a hypervascular primary neoplasm but more frequently reveals vascular encasement and distortion from the mesenteric desmoplastic reaction. Pancreatic islet cell tumour is best defined radiologically by angiography and computed tomography as a well circumscribed hypervascular mass which enhances with contrast material. Portal venous sampling is of considerable assistance in localizing insulinoma. Metastases from neuroendocrine tumours to lymph nodes and to the liver are usually hypervascular. In the evaluation of the liver by CT scanning prior to contrast as well as dynamic scanning during the bolus intravenous injection of contrast material are necessary. At times the precontrast scan is more revealing. Computed tomography with the catheter in the superior mesenteric artery followed by selective hepatic arteriography is the most accurate combination for the detection of hepatic metastases. Interventional radiological management by sequential hepatic arterial embolization is the treatment of choice for multiple hepatic metastases from neuroendocrine tumours. Thus far, the maximum number of embolic episodes in a single patient has been 13. The carcinoid syndrome has been controlled in 87% while 79% of islet cell tumour hepatic metastases have responded. Contraindications to HAE includes a combination of all of the following: (i) replacement of more than 50% of the liver by tumour, (ii) serum lactic dehydrogenase above 425 mU/ml, (iii) serum glutamic oxaloacetic transaminase above 100 mU/ml, and (iv) bilirubin above 2 mg/dl. In the face of occlusion of the portal vein by intravascular neoplasm, HAE is contraindicated only if portal flow through collateral vein is away from the liver.

Diagnostic Imaging↗
PubMed1989

Osteosarcoma: angiographic assessment of response to preoperative chemotherapy.

Adjuvant chemotherapy prolongs the survival of patients with high-grade osteosarcoma. Preoperative chemotherapy allows identification of effective agents for adjuvant chemotherapy based on response of the primary tumor. Preoperative determination of tumor response has therapeutic implications, and angiography offers a less subjective means of assessing it than do conventional radiography or computed tomography. Changes in tumor vascularity, as seen angiographically, after two courses and at the time of the last of several courses of preoperative chemotherapy were correlated with histologic tumor necrosis of resected specimens in 81 patients. Angiographically, 40% of the histologic responders and 91% of the nonresponders were identified after two courses of preoperative chemotherapy. After a median of four courses of chemotherapy, 91% of the responders but only 50% of the nonresponders were identified angiographically. Angiographic assessment of tumor vascularity, although not of absolute value, offers a useful guideline for determining the preoperative chemotherapy strategy.

Adult↗
PubMed1989

Percutaneous drainage and feeding gastrostomies in 100 patients.

Percutaneous gastrostomy was performed in 100 cancer patients. In 67 patients with bowel obstruction, the procedure was performed for gastric drainage with 24-28-F Malecot catheters inserted in one sitting. The remaining 33 patients had supragastric obstructions or fistulas and required 10-14-F pigtail catheters for feeding purposes. Average postgastrostomy hospitalization was 3.6 days. Drainage gastrostomies were ready for use immediately after the procedure, whereas use of feeding gastrostomies started on average within 2 days of tube insertion. There were no major complications or deaths related to the procedure. Percutaneous gastrostomy is a simple and safe procedure even when large-caliber catheters are used, and it does not require gastric fixation to the abdominal wall to prevent spillage into the peritoneum.

Adult↗
PubMed1989

Chemotherapy and embolization via the inferior epigastric artery for the treatment of primary and metastatic cancer.

We evaluated the results of arterial chemotherapy and embolization via the inferior epigastric artery and its branches in 10 patients with a variety of primary and metastatic neoplasms supplied by that vessel. A total of 15 infusions and five occlusions were performed. There were no complications related to arteriography, indwelling catheters, or arterial occlusion. The effects on tumor bulk ranged from complete necrosis in one patient to partial necrosis in three patients. Surgical resection was facilitated in four of six patients. Local recurrence of tumor occurred in two of these patients. Three of four patients with intractable pain had effective relief. Our experience suggests that transarterial therapy of tumors supplied by the inferior epigastric artery or its branches is a safe procedure and may be useful in tumor management.

Abdominal Neoplasms↗
PubMed1988

Atrophy with compensatory hypertrophy of the liver in hepatic neoplasms: radiographic findings.

Focal hepatic atrophy has numerous causes and in many cases is associated with compensatory hypertrophy. We have observed this phenomenon on CT in patients with hepatic neoplasms. Of 12 patients studied, eight had hepatic metastases, two had hepatocellular carcinoma, and two had bile-duct carcinoma. Focal changes in liver morphology (i.e., atrophy with compensatory hypertrophy) were found in five patients at presentation and developed after treatment with systemic or intraarterial chemotherapy in the others. Atrophic changes affected the right lobe in eight patients, the left lobe in three, and part of both lobes in one. Compensatory hypertrophy of part or all of the unaffected liver was found. Ten patients had obstruction of the portal vein branch to the atrophic segment, four of these 10 also had hepatic vein obstruction, and two of these 10 also had bile duct obstruction. Portal vein obstruction appears to be the most important element in the production of focal hepatic atrophy in patients with hepatic neoplasms. After treatment with chemotherapy, tumor regression and atrophy may be associated with compensatory hypertrophy and enlargement of the uninvolved part of the liver. This must not be mistaken for progression of disease.

Adaptation, Physiological↗
PubMed1988

Arterial embolization of adrenal tumors: results in nine cases.

Adrenal arterial embolization was performed in nine patients, four with inoperable adrenal cortical carcinoma and five with metastatic adrenal tumors. Embolic agents used were polyvinyl alcohol foam (Ivalon) in seven patients, stainless steel coils in four, ethanol in three, and surgical gelatin (Gelfoam) in two. In eight patients, embolization was performed for palliation, either to decrease tumor bulk (all patients), suppress tumor hormonal function (three patients), or relieve pain (four patients). One patient had an embolization to facilitate subsequent adrenalectomy. In four patients in whom it was possible to assess the effect of embolization on tumor bulk by follow-up CT, a striking reduction in size has occurred in one, the lesions remained stable in size for 12 months in two, and the tumor continued to increase in size in the fourth. A striking reduction in the production of the cortisol for 12 months was seen in two of three patients with Cushing syndrome. This reduction was considered due at least in part to embolization. Adrenal embolization resulted in effective palliation of pain in three of four patients and may have contributed to palliation in the fourth. Apart from a hypertensive episode in one patient, the cause of which was unclear, no serious side effects occurred. Adrenal arterial embolization may play an effective role without serious side effects in palliation of pain and reduction of hormone production in inoperable adrenal lesions.

Adrenal Gland Neoplasms↗
PubMed1987

Repositioning misplaced central venous catheters.

Central venous catheters inserted through the subclavian or basilic veins may be misplaced in the internal jugular vein. A simple technique employing a deflector guide wire allows catheter reposition in a very short time without the need for catheter withdrawal. In this manner, radiation exposure, the risk of catheter contamination, and patient discomfort are lessened.

Catheterization, Central Venous↗