41 research outputs found
Assessment of insertion techniques and complication rates of dual lumen central venous catheters in patients with hematological malignancies
One hundred and twenty-three dual lumen silicone rubber central venous catheters were inserted into 101 patients with hematological malignancies undergoing intensive treatment. There was a perioperative complication rate of 13%. Open and closed techniques for inserting the catheter were compared. The operating time needed for introducing the catheter by the closed technique (average, 51 minutes) was significantly shorter (p< 0.001) than the time needed for the open technique (70 minutes), whereas complication rates were equal in both techniques. On average, the catheters functioned for 149 days. Complications leading to removal were observed in 29.3% of patients, most of which were catheter-related infections (20.4%). Thromboembolic complications leading to removal were less frequent (4.1%) and appeared significantly earlier (p<0.001). These data indicate that introduction of the catheter by direct puncture of the subclavian vein is a quick and safe technique, and that this type of catheter is suitable for long-term use, both for infusion and for blood sampling
Heterogeneous X inactivation in trophoblastic cells of human full-term female placentas
In female mammalian cells, one of the two X chromosomes is inactivated to
compensate for gene-dose effects, which would be otherwise doubled
compared with that in male cells. In somatic lineages in mice, the
inactive X chromosome can be of either paternal or maternal origin,
whereas the paternal X chromosome is specifically inactivated in placental
tissue. In human somatic cells, X inactivation is mainly random, but both
random and preferential paternal X inactivation have been reported in
placental tissue. To shed more light on this issue, we used PCR to study
the methylation status of the polymorphic androgen-receptor gene in
full-term human female placentas. The sites investigated are specifically
methylated on the inactive X chromosome. No methylation was found in
microdissected stromal tissue, whether from placenta or umbilical cord. Of
nine placentas for which two closely apposed samples were studied, X
inactivation was preferentially maternal in three, was preferentially
paternal in one, and was heterogeneous in the remaining five. Detailed
investigation of two additional placentas demonstrated regions with
balanced (1:1 ratio) preferentially maternal and preferentially paternal X
inactivation. No differences in ratio were observed in samples
microdissected to separate trophoblast and stromal tissues. We conclude
that methylation of the androgen receptor in human full-term placenta is
specific for trophoblastic cells and that the X chromosome can be of
either paternal or maternal origin
Biopsy of nonpalpable cervical lymph nodes: Selection criteria for ultrasound-guided biopsy in patients with head and neck squamous cell carcinoma
The course of neuropathy after cessation of cisplatin treatment, combined with Org 2766 or placebo
Peripheral neuropathy is an important and disabling side-effect of cisplatin treatment. A new drug, Org 2766, has been found to prevent this neuropathy up to 1 month after treatment. A group of 18 patients with ovarian cancer, who participated in an earlier randomized study with placebo or Org 2766, together with cisplatin and cyclophophamide, were thereafter prospectively followed up to 2 years after discontinuation of treatment to monitor the development of neurological signs and symptoms and vibration perception threshold (VPT). Exploratory, descriptive data analysis shows that between 1 and 4 months after the last cycle the average sum score for neurological signs and symptoms and VPT had deteriorated compared with 1 month after treatment. Thereafter a gradual but incomplete improvement was seen between 4-12 and 12-24 months after treatment. These changes were seen in all patients regardless of previous treatment with Org 2766 or placebo, but deterioration was less pronounced in patients previously treated with Org 2766. These results suggests that treatment with Org 2766 to prevent a cisplatin-induced neuropathy should possibly be continued up to 4 months after the last cycle of cisplatin
Effect of an ACTH(4-9) analogue on cisplatin neuropathy of longstanding duration: A phase II study
The efficacy of Org 2766, an ACTH(4–9) analogue, on the recovery of cisplatin neuropathy of longstanding duration was investigated in a phase II study. Twenty-two patients were treated with Org 2766 during a period of 4 months and vibration perception threshold (VPT) and sum scores for neuropathic symptoms and signs were compared with pre-treatment values. No change in VPT could be detected. Although there was a small improvement of clinical measures for neuropathy, no clear evidence for repair could be obtained. These results indicate no beneficial effect of Org 2766 on recovery of a longstanding cisplatin neuropathy
Muscle invasive bladder cancer treated by transurethral resection, followed by external beam radiation and interstitial iridium-192
Purpose: To evaluate the results of transurethral resection (TUR), external beam radiotherapy (EBRT), and interstitial radiation (IRT) with iridium-192, using the afterloading technique in patients with muscle invasive bladder cancer. Methods and Materials: From May 1989 until September 1995. 66 patients with primary, solitary muscle invasive bladder cancer were treated with TUR, EBRT, and IRT, aiming at bladder preservation. According to the protocol, in three patients low-dose EBRT was applied, whereas 63 patients received high-dose EBRT. Immediately prior to IRT, 42 patients underwent a lymphnode dissection, and in 16 cases a partial cystectomy was performed. For IRT, two to five catheters were used and IRT was started within 24 h after surgery. The majority of patients received 30 Gy of IRT, with a mean dose rate of .58 Gy/h. In three patients, additional EBRT was applied following IRT. Follow-up consisted of regular cystoscopies, mostly done during joint clinics of urologist and radiation oncologist, with urine cytology routinely performed. The median follow-up period was 26 months. The Kaplan-Meier method was used for the determination of survival rates. Results: In seven patients, a bladder relapse developed. The probability of remaining bladder relapse free at 5 years was 88%. The bladder was preserved in 98% of the surviving patients. Metastases developed in 16 patients, and the probability of remaining metastasis free at 5 years was 66%. The cumulative 5-year overall and bladder and distant relapse free survival were 48% and 69%, respectively. Acute toxicity was not serious in the majority of cases; surgical correction of a persisting vesicocutaneous fistula was necessary in two patients, whereas a wound toilet had to be performed in another patient. Serious late toxicity (bladder, RTOG Grade 31 was experienced by only one patient. Conclusions: Interstitial radiation preceded by TUR and EBRT, in a selected group of patients with muscle invasive bladder cancer, yields an excellent bladder tumor control rate with a high probability of bladder preservation. Survival was mainly dependent on the development of distant metastases. Serious acute and late toxicity was rare
Weekly low-dose mitoxantrone plus doxorubicin as second-line chemotherapy for advanced breast cancer
Weekly low dose mitoxantrone (3 mg/m2) plus doxorubicin (8 mg/m2) was administered as second-line chemotherapy to 33 patients with advanced breast cancer. Four out of 28 evaluable patients (14%) obtained a partial response with a median duration of 34 weeks (range 18-67+ weeks), while 8 patients (29%) showed stable disease with a median duration of 28 weeks (range 11+-60 weeks). Gastrointestinal toxicity and alopecia were mild. Grade II and III leukopenia occurred in 63% of the courses without serious infectious disease. Four patients experienced an asymptomatic drop of 16-20% in the left ventricular ejection fraction (LVEF) after relatively low cumulative doses of each drug, and one patient with a history of pericarditis carcinomatosa and mediastinal irradiation developed a heart failure. In conclusion, this second-line combination treatment had moderate activity in breast cancer and caused only few subjective side effects, especially with respect to gastrointestinal symptoms
The somatostatin analog Sandostatin (SMS201-995) in treatment of DMBA-induced rat mammary tumors
The effects of treatment with a somatostatin analog (Sandostatin, SMS201-995) were investigated in female rats with dimethylbenzanthracene(DMBA)-induced rat mammary tumors. A 3-week treatment was performed using sandostatin, the LHRH-agonist buserelin alone, or buserelin in combination with sandostatin. Twice daily sandostatin treatment was performed with dosages of 0.05 μg, 0.2 μg, 1 μg, 5 μg, and 20 μg. Buserelin was used in a 2 × 5 μg/day dosage. The combined results from six different experiments show that the various dosages of sandostatin caused no tumor growth inhibition. Somatostatin receptors could not be demonstrated in these mammary tumors. Sandostatin treatment by daily injections did not suppress levels of growth hormone, prolactin, or epidermal growth factor-like activities. Estrogen (ER) and progest
The urokinase system of plasminogen activation and prognosis in 2780 breast cancer patients
The antigen levels of components of the urokinase-type plasminogen
activator (uPA) system of plasminogen activation are correlated with
prognosis in several types of cancers, including breast cancer. In the
present study involving 2780 patients with primary invasive breast cancer,
we have evaluated the prognostic importance of the four major components
of the uPA system [uPA, the receptor uPAR (CD87), and the inhibitors PAI-1
and PAI-2]. The antigen levels were determined by ELISA in cytosols
prepared from primary breast tumors. The levels of the four factors
significantly correlated with each other; the Spearman rank correlation
coefficients (r(s)) ranged from 0.32 (between PAI-2 and PAI-1 or uPAR) to
0.59 (between uPA and PAI-1). The median duration of follow-up of patients
still alive was 88 months. In the multivariate analyses for relapse-free
survival (RFS) and overall survival (OS), we defined a basic model
including age, menopausal status, tumor size and grade, lymph node status,
adjuvant therapy, and steroid hormone receptor status. uPA, uPAR, PAI-1,
and PAI-2 were considered as categorical variables, each with two cut
points that were established by isotonic regression analysis. Compared
with tumors with low levels, those with intermediate and high levels
showed a relative hazard rate (RHR) and 95% confidence interval (95% CI)
of 1.22 (1.02-1.45) and 1.69 (1.39-2.05) for uPA, and 1.32 (1.14-1.54) and
2.17 (1.74-2.70) for PAI-1, respectively, in multivariate analysis for RFS
in all patients. Compared with tumors with high PAI-2 levels, those with
intermediate and low levels showed a poor RFS with a RHR (95% CI) of 1.30
(1.14-1.48) and 1.76 (1.38-2.24), respectively. Similar results were
obtained in the multivariate analysis for OS in all patients. Furthermore,
uPA and PAI-1 were independent predictive factors of a poor RFS and OS in
node-negative and node-positive patients. PAI-2 also added to the
multivariate models for RFS in node-negative and node-positive patients,
and in the analysis for OS in node-negative patients. uPAR did not further
contribute to any of the multivariate models. A prognostic score was
calculated based on the estimates from the final multivariate model for
RFS. Using this score, the difference between the highest and lowest 10%
risk groups was 66% in the analysis for RFS at 10 years and 61% in the
analysis for OS. Moreover, separate prognostic scores were calculated for
node-negative and node-positive patients. In the 10% highest risk groups,
the proportion of disease-free patients was only 27 +/- 6% and 9 +/- 3% at
10 years for node-negative and node-positive patients, respectively. These
proportions were 86 +/- 4% and 61 +/- 6% for the corresponding 10% lowest
risk groups of relapse. We conclude that several components of the uPA
system are potential predictors of RFS and OS in patients with primary
invasive breast cancer. Knowledge of these factors could be helpful to
assess the individual risk of patients, to select various types of
adjuvant treatment and to identify patients who may benefit from targeted
therapies that are currently being developed