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Query: UMLS:C0085584 (encephalopathy)
 18,178 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A prognostic study based on 127 untreated patients with hepatocellular carcinoma was undertaken to evaluate their survival time and to find clinical and biologic criteria which allow the selection of patients with a survival time longer than 60 days who could enter a therapeutic trial. Twenty-eight clinical and biologic variables were assessed using univariate and multivariate semiparametric regression (Cox's) models. Ten variables were isolated by univariate analysis. Multivariate analysis found a negative relationship between a survival time longer than 60 days and five of these variables; these variables were in decreasing order: encephalopathy, alcohol consumption, aspartate amino transferase (AST), blood urea nitrogen, and total bilirubin. Prevalence, positive, and negative predictive values of encephalopathy were 20%, 27.5%, and 97% respectively. When three other criteria: ASAT greater than four times the upper limit of the normal (N), blood urea nitrogen greater than N, and total bilirubin greater than 2N were added, their prevalence, positive, and negative predictive values were 72%, 89.7%, and 57.1% respectively. These results suggest that in countries where incidence of hepatocellular carcinoma is low and recruitment of patients difficult, absence of encephalopathy must be the only criterion for selection of patients with hepatocellular carcinoma in therapeutic trials; whereas, in countries with a high incidence of hepatocellular carcinoma the other criteria may be added.
Cancer 1987 Jun 15
PMID:Prognostic factors in patients with hepatocellular carcinoma. Attempts for the selection of patients with prolonged survival. 303 3

The neurologic sequelae of human immunodeficiency virus (HIV) infection may be divided into primary (= HIV-induced) and secondary (= opportunistic infections and malignancies) manifestations. Our experience with 215 HIV-infected patients indicates that major clinical symptoms are due to a few, albeit important, neurologic diseases, although in a given patient rare and sometimes multiple complications have to be considered. The clinical features of acquired immunodeficiency syndrome (AIDS) encephalopathy and CNS toxoplasmosis that represent the major primary and secondary neurologic manifestations of AIDS are discussed in detail.
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PMID:Primary and secondary involvement of the CNS in HIV infection. 305 40

Thirty patients with symptomatic, progressive squamous cell carcinoma of the uterine cervix no longer amenable to surgery or radiotherapy were entered in a phase II study of ifosfamide (IFX). Patients were treated with IFX (5 g/m2 iv given over 24 hours) and concomitant mesna (total dose, 9.2 g/m2 iv given over 36 hours) every 21 days. One complete response (duration, 10+ months) and nine partial responses were observed, with an overall median response duration of 6.5 months. The median survival of responding patients was 11 months. Objective response rates for lesions arising in previously irradiated sites (four of 22) were significantly lower than for lesions arising in nonirradiated sites (15 of 28) (P = 0.018). There were two treatment-related deaths: one due to leukopenia-associated infection in a patient with peritonitis and severe central nervous system toxicity and one due to central nervous system toxicity without complicating factors. One other patient developed severe but reversible encephalopathy. In all remaining patients hemorrhagic cystitis and hematological and gastrointestinal toxic effects were predictable and manageable. Treatment was delayed for 1 week due to toxicity on seven of 101 occasions: four of these delays were due to mild, reversible impairment of renal function and three were due to leukopenia. Complete though reversible alopecia occurred in 22 of 30 patients. The results indicate that IFX is active in cervical cancer and deserves further study in this setting.
Cancer Treat Rep 1986 Jun
PMID:Phase II study of ifosfamide in cervical cancer. 308 96

Ifosfamide and mesna were administered to 77 patients with advanced malignancies. Seven (9%) experienced a severe but reversible encephalopathy. In 56% of patients in whom EEG data was available, characteristic changes were seen with or without mild clinical toxicity. Discriminant analysis identified low serum albumin concentration, high serum creatinine concentration and the presence of pelvic disease as variables which predispose patients to the development of severe encephalopathy. A nomogram has been constructed which can be used to determine the probability that an individual patient may be given ifosfamide and mesna safely. This has important implications for the clinical use of a highly active chemotherapy regimen.
Eur J Cancer Clin Oncol 1986 Jul
PMID:Prediction of ifosfamide/mesna associated encephalopathy. 309 21

Early results with ifosfamide plus mesna in soft tissue sarcoma showed an initial response rate of 38% in 42 patients. All these patients treated at The Royal Marsden Hospital plus 30 more (total 67) have now been analysed. Single doses of 5 or 8 g/m2 ifosfamide were given over 24 h by infusion in dextrose saline together with 400 mg/m2 or 600 mg/m2, respectively, of mesnum every 4 h to give a total of 9 doses. A diuresis of 200 ml/hour was maintained during therapy. Treatment was repeated 3-weekly. CR was seen in 6 and PR in 10 patients. More recently doxorubicin was added to ifosfamide therapy in an attempt to improve on these results. At first only 20 mg/m2 doxorubicin was given but this was escalated to 40 mg/m2 and 60 mg/m2. Mesna has been given in higher dosage (5 g/m2 over 24 h), but otherwise the schedule is as above. In all 60 patients have been treated and most are now evaluable for response. Encephalopathy has been seen with both regimens. The incidence and patient characteristics are reported.
Cancer Chemother Pharmacol 1986
PMID:Ifosfamide plus mesna with and without adriamycin in soft tissue sarcoma. 310 88

One hundred and seventy-one patients with advanced soft tissue sarcoma entered a randomized crossover phase II study comparing cyclophosphamide (CYCLO) with a new analogue, ifosfamide (IFOS), both administered as 24 h i.v. infusions every 3 weeks. The doses used were CYCLO 1.5 g/m2 and IFOS 5 g/m2, with provision for dose escalation. All patients received mesna 400 mg/m2 as an i.v. bolus 4 hourly X 9 doses, commencing at the start of the oxazophosphorine infusion. Patients who had received previous chemotherapy were eligible provided this did not include a classical alkylating agent. There were 22 patients who were ineligible, and response could not be evaluated in 12 additional patients. IFOS produced two complete and ten partial remissions, for an overall response rate of 18%. CYCLO was significantly (P = 0.04) less active, producing one complete and five partial remissions, an overall response rate of 9%. Stabilization of disease was similar in both arms (27% and 24% respectively), but fewer patients showed progression on IFOS. The response rate was higher (20% vs 5%) for patients who had not received previous chemotherapy, and also for female compared with male patients (21% vs 5%). When only patients who had not received previous chemotherapy were considered, the respective response rates for IFOS and CYCLO were 24% and 15%. There were no responses in previously treated patients receiving CYCLO. There were four partial responses in 33 patients crossing from CYCLO to IFOS, but no responses in 18 patients receiving CYCLO after IFOS. Leucopenia was significantly more pronounced (P = 0.0004) with CYCLO, both after the first course and throughout treatment, although the incidence of severe infections, 6%, was the same in both arms. Nausea and vomiting were more severe with IFOS (P = 0.022), but other toxicities were mild. Grade 1 or 2 bladder (haematuria) or renal (rise in serum creatinine) toxicity was slightly more frequent with IFOS (7 vs 3 patients) and was a reason for stopping treatment for one patient in each arm. Three episodes of mild to moderate drowsiness after IFOS were reported, but no severe encephalopathy. A higher response rate with less myelosuppression suggests that IFOS may have advantages over CYCLO in combination with such active agents as adriamycin.
Cancer Chemother Pharmacol 1986
PMID:Cyclophosphamide versus ifosfamide: preliminary report of a randomized phase II trial in adult soft tissue sarcomas. 310 89

The AIDS Surveillance System in Japan was set up in 1984 and by 1987, 29 AIDS patients had been reported. 10 were homosexuals, 16 were hemophiliacs and 3 were heterosexuals. 9 out of 16 hemophiliacs with AIDS had A-type hemophilia. 2 females were also reported as victims of AIDS. 19 patients have died 5 male homosexuals (4.4%) out of 113 (93 Japanese and 20 Foreigners) individuals were anti-HIV-positive. In 1984 sera from 65 hemophiliacs, 85 hemodialysis patients and 304 healthy volunteer blood donors were examined and 10 (15.4%) of the hemophiliacs proved to be anti-HIV positive. On the other hand, in Tokyo and Nagasaki 50-60% were positive, but in Tottori and Osaka only 25-28% were positive. The enzyme-linked immunosorbent assay (ELISA) test is widely used to detect antibodies, however, the test often gives false-positive reactions, and the blood must be reexamined by means of the Western-blot test or IF method. Therefore, a simple particle agglutination (FA) assay was developed by the authors using gelatin beads as the artificial antigen carrier. This assay is extremely sensitive as compared to IF and ELISA. Among HTLV-1/ATLV-carrying T-cell lines, all except one (TCL-As) were susceptible to HIV infection and showed cytopathic effect (CPE). HIV has quite a broad host range in vivo and in vitro. HIV was detected in brain macrophages from AIDS patients with encephalopathy. HIV may also infect nerve cells or glial cells. The MT-4 cell line was found to be most prone to HIV infection. In order to evaluate the virus-induced CPE of infected MT-4 cells, the H-thymidine incorporation method (cell proliferation assay) was developed that involved that involves measuring the survival of the cells. Inhibition of DNA synthesis in infected MT-4 cells was detected by this assay when the CPE was observed microscopically. This assay system is also useful for measuring the amount of infectious virus. Many chemicophysical agents such as suramin, antimoniotungstate (HFA-23), phosophonoformic acid, ribavirin, 3-azido-3-deoxythymidine (AZT) have suppressive effects on the replication of HIV in vitro. Glycyrrhizin administration was responsible 1 or improvement of immune function in 6 of 7 asymptomatic HIV carriers. Prostaglandin E2 (PGE2) and 12-0-tetradecanoylphorbol-13- acetate (TPA) were found to enhance the production of HIV significantly in infected MT-4 cells. The cell proliferation assay is used for the mass screening of neutralizing antibodies whose presence in the sera from 21 patients with AIDS, 10 individuals with ARC, 20 healthy male homosexuals and 10 healthy males was examined. The assay was sensitive enough to detect neutralizing antibodies up to a dilution of 1:10 thousand. The system using MT-4 cells seems to be suited for this purpose.
Jpn J Cancer Res 1987 May
PMID:AIDS studies in Japan. 311 53

An animal model of intracerebral osteogenic sarcoma has been developed to evaluate blood-brain barrier disruption as an adjunct to chemotherapy of intracerebral tumors. Adult Sprague-Dawley rats (n = 225) were inoculated intracerebrally with transplantable, methotrexate sensitive, osteogenic sarcoma cells and 3 days later randomized to receive either no treatment or methotrexate with or without blood-brain barrier disruption using intracarotid mannitol. Methotrexate was administered i.v., i.p., or directly into the carotid artery (i.c.) in doses of 2.5, 10, 20, 50, or 100 mg/kg. Survival was the study's end point. Surgery, anaesthesia, or blood-brain barrier disruption with mannitol did not affect survival. However, there was a significant effect of dose and route of administration of methotrexate on survival. The shortest survival was in rats receiving no treatment in which death occurred reproducibly at 7.6 +/- 0.2 days (n = 29) and the longest survival was 12.7 +/- 0.3 day (p less than 0.001) in those given methotrexate 50 mg/kg i.c. (n = 6). The i.c. route was most effective in prolonging survival followed by i.v. and the least effective was the i.p. route of methotrexate administration. Blood-brain barrier disruption followed by methotrexate (i.v. or i.c.) was deleterious to survival (two-way analysis of variance, p less than 0.003 and p less than 0.011, respectively) and the reduced survival was in part related to early complications such as intratumor hemorrhage or possibly a methotrexate induced encephalopathy. It is concluded that this is a useful model for the study of the chemotherapy of cerebral tumors, that blood-brain barrier disruption did not appear to improve the dose-response curve but resulted in reduced survival. We caution against the use of this procedure in the treatment of cerebral tumor in humans.
Cancer Res 1987 Dec 01
PMID:Blood-brain barrier disruption and methotrexate in the treatment of a readily transplantable intracerebral osteogenic sarcoma of rats. 311 95

In a phase II study, 16 adult patients with locally advanced or metastatic soft tissue sarcomas were treated with i.v. infusions of ifosfamide/mesna 5 g/m2 plus i.v. doxorubicin 40 mg/m2. Courses were given every 3 weeks up to a maximum of six courses in responding patients. Six patients (37.5%) had either complete (1 patient) or partial responses (5 patients). Confidence limits for this response rate were 15.2%-64.5% (95% confidence level). There was one toxic death in association with encephalopathy, renal and bone marrow failure. Unilateral pneumothoraces occurred in 2 patients with large pulmonary metastases. Recurrent severe ifosfamide/mesna encephalopathy occurred in 2 patients at risk for this complication; patients who develop severe ifosfamide/mesna encephalopathy should not be retreated with this drug. Ifosfamide/mesna with doxorubicin is an active combination to treat adult soft tissue sarcoma but, despite the feasibility of the combination, sequential monotherapy with these drugs might provide similar or better clinical benefit.
Cancer Chemother Pharmacol 1988
PMID:A phase II study of ifosfamide/mesna with doxorubicin for adult soft tissue sarcoma. 312 71

A case of reversible encephalopathy after one dose of ifosfamide/mesna in an epileptic 15-year-old girl is reported. No other pathology could be responsible for the symptoms. An epilepsy or a toxicity induced by vincristine were discussed. Nevertheless, the possible role of phenobarbital, known to induce hepatic microsomal activity, seems the more probable mechanism.
Bull Cancer 1988
PMID:Ifosfamide/mesna related encephalopathy: a case report with a possible role of phenobarbital in enhancing neurotoxicity. 313 98


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