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 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This report describes the clinical, laboratory, and electrophysiologic features of 52 patients with ventricular tachycardia (VT) who had no clinical evidence of heart disease. The mean age of patients was 36 years, cardiovascular collapse occurred in 18 patients (35%), and exercise-related symptoms were present in 24 of 49 patients (49%). There were 20 patients with sustained monomorphic VT, 11 with incessant VT, and 21 with nonsustained VT. Abnormalities were present in 14 of 38 patients (37%) during echocardiography and in 21 of 47 patients (45%) who underwent cardiac catheterization. During baseline evaluation while patients were not receiving antiarrhythmic drugs, ambulatory monitoring and exercise testing showed an 88% and 57% incidence, respectively, of nonsustained or sustained monomorphic VT, whereas 31 of 50 patients (62%) had inducible VT (requiring an infusion of isoproterenol in 11 patients) during programmed electrical stimulation. The clinical VT (when a 12-lead electrocardiogram was available for analysis) had a left bundle branch block (LBBB) configuration in 20 of 33 patients (61%) and a right axis deviation in 17 of 33 patients (51%). The VT occurring during exercise testing and programmed electrical stimulation had the same configuration as the clinical VT in 22 of 22 patients. Three patients have received an antitachycardia pacemaker, and one patient underwent endocardial resection. Forty-eight patients (92%) were treated medically. One patient died of cancer; the remaining 47 patients were alive at a mean follow-up of 96 months after initial symptoms and 46 months after programmed electrical stimulation. We conclude that in patients without clinical evidence of heart disease, VT may be incessant, sustained, or nonsustained and that VT originates from the right ventricular outflow tract in more than 50% of patients. Although cardiac abnormalities may be found in more than 30% of patients, the exact significance of these abnormalities is unclear because of the absence of progressive changes and the excellent prognosis of this group of patients.
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PMID:Nonischemic ventricular tachycardia. Clinical course and long-term follow-up in patients without clinically overt heart disease. 271 78

The mortality experience of 13,385 tuberculosis patients treated between 1925 and 1954 in Massachusetts was determined through August 1986. Among 6,285 patients examined by X-ray fluoroscopy an average of 77 times during lung collapse therapy and followed for up to 50 yr (average = 25 yr), no increase in the total number of cancer deaths occurred [standardized mortality ratio (SMR) = 1.05, n = 424]. In contrast, the 7,100 patients treated by other means were at significant risk of dying from cancer (SMR = 1.3), especially of sites linked to cigarette smoking and alcohol use. Among the irradiated patients, estimates of mean radiation doses to the breast, lung, esophagus, and active bone marrow were 0.75, 0.84, 0.80, and 0.09 Gy, respectively. Cancers of the breast (SMR = 1.4, n = 62) and esophagus (SMR = 2.1, n = 14) were significantly increased. The risk of esophageal cancer, however, decreased with time since exposure. Lung cancer (SMR = 0.8, n = 69) and leukemia (SMR = 1.2, n = 17) were not elevated. Despite a wide range of doses to the lung, reaching over 8 Gy, there was no evidence of a dose response. Lung cancer risk also did not vary by time since exposure or age at exposure. Adjustment for smoking and the amount of lung tissue at risk did not appreciably modify these findings. These data suggest that frequent exposures to low doses of radiation over a period of several years increase the occurrence of cancer of the breast. When compared with studies of atomic bomb survivors, however, the fractionated exposures experienced by this cohort appear less effective in causing lung cancer than single exposures of the same total dose.
Cancer Res 1989 Nov 01
PMID:Cancer mortality in a radiation-exposed cohort of Massachusetts tuberculosis patients. 279 Aug 25

Early identification and treatment of epidural neoplasm, before the development of significant neurologic deficits, provides the best opportunity for a favorable outcome. Among the many patients with symptoms, signs, or scintigraphic or radiographic findings suggesting possible epidural disease, a small proportion will have the lesion. The selection of patients for definitive imaging of the epidural space should be based on a determination of the risk of this complication. In this study, the medical records, plain spinal radiographs, bone scintigraphs and myelograms of 43 patients were analyzed retrospectively to assess the risk of epidural disease associated with specific clinical, radiographic, and scintigraphic findings. Cervical, thoracic, and lumbosacral spinal segments were evaluated independently. Symptomatic segments (SS) (N = 41), defined by focal pain or neurologic dysfunction, were distinguished from asymptomatic segments (AS). At SS, epidural disease was found at 86% and 8% of abnormal and normal spinal radiographs, respectively (P less than 0.001), and at 69% and 0% of abnormal and normal scintigrams, respectively (P less than 0.001), whereas at AS epidural disease occurred in 43% and 3% of abnormal and normal spinal radiographs, respectively (P less than 0.001), and 14% and 7% of abnormal and normal scintigrams, respectively (P = NS). Vertebral collapse was highly predictive of an epidural lesion. Epidural disease occurred in 12% of SS and 0% of AS with an abnormal scintigram and normal radiograph, 86% of SS and 45% of AS with abnormalities on both scintigram and radiograph, and at two AS when both were normal. Decision analysis applied to these data yielded a specific conditional probability of epidural disease for each combination of clinical, scintigraphic, and radiographic findings. These data provide a basis for the selection of patients for additional evaluation of the epidural space before neurologic deficits develop.
Cancer 1989 Dec 01
PMID:Identification of epidural neoplasm. Radiography and bone scintigraphy in the symptomatic and asymptomatic spine. 280 11

With the use of cis-diamminedichloroplatinum(II), cisplatin, to enhance the effect of radiation a combined modality approach was designed to treat patients with inoperable, locally advanced NSCLC. The regimen consisted of radiation doses of 300 cGy for 4 days every week for 4 weeks with a 2 week split in between. Each radiation dose was followed by an i.v. injection of cisplatin 6 mg/m2 within 30 min. Hydration consisted on an oral fluid intake of 2 L only, enabling the patient to receive the treatment on an outpatient basis. Of 40 patients entered into the study, 37 were evaluable for toxicity and 33 for response. Overall response rate was 65% and complete response rate 22%. Median duration of local control was 7 months. The majority of all patients (76%) eventually progressed at the primary tumor site, while in 16 patients relapse occurred in distant sites first. Median duration of overall survival was 10.5 months, whereas that of complete responders was 29.5 months. Generally, acute side effects were transient and did not require discontinuation of treatment. One patient presented with thrombocytopenia 4 weeks after treatment had been finished. His death of cerebral bleeding was likely to be related with his therapy-resistant malignancy. Of late side effects three patients showed disabling symptoms consisting of uncontrollable pulmonary infections in the presence of tumor in two patients, one patient had radiation myelopathy and another experienced vertebral collapse with distal paresis. The combination of radiation and daily low-dose cisplatin is a tolerable treatment modality with most benefit for patients reaching a complete remission. Intensification of the regimen is being planned in those patients with inoperable, locally advanced squamous cell lung cancer to reach a complete remission.
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PMID:Phase II trial of combined radiotherapy and daily low-dose cisplatin for inoperable, locally advanced non-small cell lung cancer (NSCLC). 282 36

Cell transformation is associated with a dramatic collapse of a graphic fingerprint characteristic of normal cells, as measured by phase fluorimetry. This is demonstrated on adenosine deaminase (ADA, EC 3.5.4.4), an established malignancy marker. ADA activity is known to decrease markedly in chick embryo fibroblasts (CEF) transformed by Rous sarcoma virus. The high affinity between the catalytic small subunit ADA (SS-ADA) and its membranal complexing protein (ADCP) (which abounds on the plasma membrane of CEF) allowed the hybridization of fluorescent labeled SS-ADA with native ADCP on CEF. Multifrequency differential phase fluorimetry responded remarkably to the state of this hybrid membrane protein. The transformation process is shown to have led to increased membrane fluidity and rotational mobility of ADCP as well as to its reduced availability to SS-ADA binding. The hypothesis of protein vertical sinking into the lipid core of the membrane is now given support by our spectroscopic data. Additional models are considered. A regulatory role is thus suggested for the complexing protein, which may also account for (a) reduced ADA activity in transformed cells and (b) detachment, exclusive to normal cells, upon addition of SS-ADA in excess.
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PMID:Adenosine deaminase in cell transformation. Biophysical manifestation of membrane dynamics. 284 78

A second follow-up was conducted of 1742 women with tuberculosis who were treated in one of two sanatoria in Massachusetts between 1930 and 1956. One hospital treated only children under the age of 17. Patient follow-up was extended from 1975 through 1980, and an additional 18 breast cancers were identified from hospital records, death certificates, and responses to a mailed questionnaire. Vital status was established for 97% of the subjects. Among 1044 women who were examined an average of 101 times with X-ray fluoroscopies during lung collapse therapy, 55 breast cancers were observed in contrast to 35.8 expected, based on incidence rates from the general population. No excess was found for 698 women treated by other means (19 observed versus 22.8 expected). Excess breast cancer risk did not appear until 15 years after initial exposure and was present at the end of 50 years of observation. Risk appeared to decrease with increasing age at exposure. Estimates of radiation dose to the breast for individuals (mean = 96 rad) were based on the most current information for the numbers of fluoroscopies, reconstruction of exposure conditions, and absorbed dose calculations. The relation between dose and breast cancer risk was consistent with linearity up to 400 rads (4 Gy). For 10-year survivors, the absolute excess risk was 5.5/1 million woman-year-rad, the excess relative risk per rad was 0.73%, and the relative risk at 100 rad was 1.7. These data indicate that a woman's lifetime risk of breast cancer is influenced by events occurring in early reproductive life, that low-dose fractionated exposures are as effective as single exposures of the same total dose in inducing breast cancer, and that risk of radiogenic breast cancer persists for many years, and perhaps for life.
Cancer Res 1989 Jan 01
PMID:Breast cancer after multiple chest fluoroscopies: second follow-up of Massachusetts women with tuberculosis. 290 49

Septic shock results in activated coagulation, cell injury, metabolic changes, and altered blood flow through the microcirculation. If left untreated, the end result is multiple organ failure and death. Patients with cancer are at increased risk of developing shock because of both host-related and treatment-related risk factors. Nursing cognizance of high-risk patients should promote close observation for signs and symptoms of early septic shock. Septic shock may be managed on the unit but signs of impending circulatory collapse and respiratory failure may warrant transferring the patient to the intensive care unit (ICU). Nursing measures include assessment, patient teaching, monitoring of all body systems, and special attention to the patient's psychosocial needs.
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PMID:Septic shock: special needs of patients with cancer. 273 12

A case-control study of breast cancer among tuberculosis (TB) patients in Denmark (1937-1954) was conducted to provide additional information on the radiation risk associated with low-dose chest fluoroscopy exposures. Records of 46013 TB patients were linked to the Danish Cancer Registry and 125 subsequent female breast cancers identified. Medical records were located for 89 (71%) of these women who developed breast cancer and on 390 controls, who were individually matched to cases on age and calendar year of TB diagnosis, and survival. Common risk factors for breast cancer such as nulliparity (relative risk (RR) = 2.5) and high relative weight (RR = 2.6) were also identified in this population of TB patients. However no risk was evident with exposure to any type of fluoroscopy (RR = 0.6; 95% CI = 0.2-1.4), or to fluoroscopies performed to monitor lung collapse therapy (RR = 0.8; 95% CI = 0.5-1.4). Although based on only 7 breast cancers, there was a suggestion of an increased risk among women who received greater than 1 Gy to their breasts (RR = 1.6; 95% CI = 0.4-6.3). Because of the infrequent use of fluoroscopy in our study, the breast doses were too low, 0.27 Gy on average, to expect to detect a significant elevation in breast cancer risk overall. The findings do suggest, however, that current estimates of breast cancer risk following radiation are not greater than presently accepted, and that a relative excess of 40 per cent can be excluded with reasonable confidence following breast doses on the order of 0.3 Gy.
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PMID:Breast cancer following multiple chest fluoroscopies among tuberculosis patients. A case-control study in Denmark. 303 49

A total of 3 patients with germ cell cancer had pulmonary emboli while receiving cisplatin-containing chemotherapy. In addition to cisplatin, 1 patient was receiving etoposide plus doxorubicin, 1 vinblastine plus bleomycin and 1 etoposide plus bleomycin at the time of the vascular event. One patient died of cardiovascular collapse, while the other 2 presented with severe shortness of breath, hemoptysis and pleuritic chest pain. A review of vascular complications of cisplatin-containing chemotherapy is presented. Awareness and early recognition of pulmonary emboli in patients receiving these chemotherapeutic agents may minimize treatment-related morbidity and mortality.
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PMID:Pulmonary emboli as a complication of germ cell cancer treatment. 303 37

Total cancer deaths were not increased among 2,074 women and 1,277 men who were fluoroscopically examined an average of 73 and 91 times, respectively, during lung-collapse therapy for tuberculosis (TB). Patients who did not receive this form of therapy (2,141 women and 1,418 men) and general population rates were used for comparison. All subjects were discharged alive from eight TB sanatoria in Massachusetts between 1930 and 1954; the average follow-up was 23 years. Deaths due to breast cancer were not increased among exposed females [standardized mortality ratio (SMR) = 1.0, n = 24], and SMRs greater than 2.1 could be excluded with 95% confidence. In contrast to other series, our inability to detect a breast cancer excess was likely due to lower breast doses (66 rad) and higher average ages at exposure (28 yr) and thus lower sensitivity. A deficit of lung cancer among exposed males and females was observed (SMR = 0.8, n = 26), even though increased risks have been observed among other populations exposed to similar dose levels. The estimated average lung dose was 91 rad, and SMRs greater than 1.2 for lung cancer could be excluded with 95% confidence. Overall, this study indicates that the radiation hazard of multiple low-dose exposures experienced over many years is not greater than currently accepted estimates for breast and lung cancer. For lung cancer the radiogenic risk may be less than predicted from high-dose, single-exposure studies.
J Natl Cancer Inst 1987 Apr
PMID:Cancer mortality after multiple fluoroscopic examinations of the chest. 310 47


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