Cases reported "Neoplasms"

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1/17. diphenhydramine as an analgesic adjuvant in refractory cancer pain.

    Clinical and animal data suggest that antihistamines may have efficacy in the management of pain. While many mechanisms of action have been proposed for the analgesic action of antihistamines, the exact mechanism is unknown. Controlled clinical trials in different pain models have demonstrated that antihistamines have direct and adjuvant analgesic activity. We report three patients with advanced cancer pain refractory to adjuvants and oral, intravenous, and epidural opioids, who achieved sustained pain relief after the repeated administration of diphenhydramine. diphenhydramine may be useful in the treatment of neuropathic and nociceptive pain that has failed to respond to treatment with opioids and adjuvant analgesics. We suggest a starting dose of 25 mg of oral or parenteral diphenhydramine every 6 to 8 hours, with titration to effect.
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2/17. analgesia for pelvic and perineal cancer pain by intrathecal steroid injection.

    BACKGROUND: Corticosteroids are used systemically in patients with advanced cancer to alleviate pain. Intrathecal administration of steroids is rarely performed but analgesic effects of intrathecal steroids have been reported in animal studies. We administered betamethasone intrathecally in three cancer patients with uncontrollable pain. CASE REPORT: Intrathecal injection of betamethasone (1-4 mg) with saline (total volume = 2 mL) was performed in three patients with advanced pelvic or perineal cancer, in whom pain could not be controlled in spite of various analgesic therapies. After obtaining the patient's informed consent for the procedure, betamethasone was administered intrathecally through the L4/5 intervertebral space. Intrathecal betamethasone produced rapid analgesia within 10 min and subsequent long-lasting analgesia for 5 days or more. sleep, appetite and activity improved. No adverse effects were observed in any of the patients. CONCLUSIONS: Intrathecal injection of betamethasone may be a useful approach in some patients with intractable cancer pain.
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3/17. hyperparathyroidism, humoral hypercalcemia of malignancy, and the anabolic actions of parathyroid hormone and parathyroid hormone-related protein on the skeleton.

    So what have we learned from the Takeuchi case? It has been 80 years since malignancy-associated hypercalcemia was described. It has been 45 years since HHM was first described. It has been 15 years since PTHrP was identified, and 12 years since PTHrP immunoassays became available for clinical research. We now know almost everything about HHM in pathophysiological terms, and we can reproduce the cardinal features of the syndrome in laboratory animals and humans. The Takeuchi case reminds us that we still have a few things to learn about HHM. Specifically, "Why is the regulation of 1,25(OH)2D different in patients with HHM and HPT?" and "Why is normal osteoblast-osteoclast coupling dysregulated in HHM?" or more fundamentally, "What regulates osteoblast-osteoclast coupling, and why is it deranged in HHM?" Given the rate of accumulation of new information about HHM, about the anabolic effects of PTH and PTHrP, and about osteoblast-osteoclast coupling over the past 10 years, there is reason to be optimistic that the answers to these questions will soon become clear.
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4/17. immunotherapy of hematologic malignancies and metastatic solid tumors in experimental animals and man.

    New approaches are needed for maximizing specific responses against tumor cells resistant to chemotherapy. While cytokine therapy may amplify natural resistance against minimal residual disease, more robust anti-leukemia reactivity can be provided by allogeneic bone marrow transplantation (BMT) in conjunction with myeloablative, hence hazardous, conditioning, at the cost of graft-versus-host disease (GVHD). documentation of the capacity of donor lymphocyte infusion (DLI) given late post BMT, when patients were off immunosuppression, in early 1987, with successful reversal of relapse and cure of patients fully resistant to maximally tolerated doses of chemoradiotherapy, with many patients alive and well >10-15 years later, indicated two important facts. First, resistant tumors are unlikely to be cured with higher doses of chemoradiotherapy that may harm the patient but not eliminate all his clonogenic tumor cells. Second, that under condition of tolerance to donor alloantigens, DLI may provide a cure to otherwise resistant patients. These observations paved the road for clinical application of non-myeloablative stem cell transplantation (NST), in the early 90s, based on a two-step procedure, first involving induction of transplantation tolerance to donor alloantigens by engraftment of donor stem cells, following safe lymphoablative rather than myeloablative conditioning. Second, use of donor lymphocytes for elimination of residual tumor or otherwise abnormal hematopoietic cells by immune-mediated graft-versus-host effects inducible by mobilized blood stem cell allografts containing larger inocula of donor T cells, or supported by post-grafting DLI when patients were off immunosuppressive modalities.
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5/17. Three cases of human sarcocystis infection with a review of human muscular sarcocystosis in malaysia.

    Three cases of muscular sarcocystosis from West malaysia are reported. The morphological features of the parasites from these three cases are similar to the eight cases previously reported from this country. A review of this total of eleven cases of muscular sarcocystosis showed that they were all incidental findings, where man acted as intermediate hosts of as yet unknown sarcocystis spp. These cases of muscular sarcocystosis were probably zoonotic in origin and associated with close contact with definitive hosts (both domestic and wild animals) thus permitting the contamination of food and drink with sporocysts shed by these definitive hosts. These infections were probably acquired locally as most of the subjects were born in malaysia and none had ever left the country to stay elsewhere. Eight of the eleven cases reported were associated with malignancies, especially of the tongue and nasopharynx.
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6/17. Neuropathological findings after continuous intrathecal administration of S( )-ketamine for the management of neuropathic cancer pain.

    Questions have been raised about the potential neurotoxicity of the neuraxial use of ketamine although ketamine and its active enantiomer S( )-ketamine have been used intrathecally and epidurally (caudally) for the management of perioperative pain and in a variety of chronic pain syndromes. Clinical experience following neuraxial administration of S( )-ketamine has been documented without reference to local central nervous system toxicity following this approach. In addition, there are no preclinical safety data regarding stability, compatibility, and neurotoxicity on intrathecal use of single S( )-ketamine or combinations of S( )-ketamine, morphine, bupivacaine, and clonidine. In the present case, the continuous intrathecal administration of S( )-ketamine, in combination with morphine, bupivacaine, and clonidine resulted in adequate pain relief in a patient suffering from intractable neuropathic cancer pain. However, postmortem observation of the spinal cord and nerve roots revealed severe histological abnormalities including central chromatolysis, nerve cell shrinkage, neuronophagia, microglial upregulation, and gliosis. Based on our results, neuraxial administration of S ( )-ketamine cannot be recommended for clinical practise before a systematic study of toxicology of neuraxial S( )-ketamine in animals or humans has been performed.
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7/17. Polybrominated biphenyl exposure and human cancer: report of a case and public health implications.

    This is a human case report of documented exposure to polybrominated biphenyls (PBBs), with serial PBB determinations, obtained over an 11 year period, and signs and symptoms characteristic of PBB exposure, culminating in cancer. No epidemiological studies of PBB and cancer are available, but structure-activity relationships and animal studies were predictive of malignancy. The patient did not have the risk factors of alcoholism or cigarette smoking.
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8/17. Phase I study of 2-amino-5-bromo-6-phenyl-4(3H)-pyrimidinone (ABPP), an oral interferon inducer, in cancer patients.

    2-Amino-5-bromo-6-phenyl-4(3H)-pyrimidinone (ABPP) was given to 59 patients in a Phase I study. The agent was selected because it is an interferon inducer and an immunotherapeutic agent in animal tumor models. The study was conducted in two phases. In the first phase, the drug was administered as a single oral dose of 25-2,000 mg/m2. In the second part, the highest tolerated dose reached during part one was used as the initial dose in a multiple-dose scheme of treatment. patients were treated weekly. The dose was escalated each week, starting with a dose of 2 g/m2 and escalating to 3, 4, and 5 g/m2. No cardiac, hematologic, hepatic, or renal toxicity was observed. The most common toxicity was nausea and vomiting, which occurred in 18% of the patients; others were headache (8%), abdominal pain (8%), and diarrhea (6%). No consistent induction of interferon and no major modification of host defense parameters occurred. One patient with malignant melanoma showed evidence of tumor regression. Pharmacologic studies demonstrated a significant decrease in the bioavailability of the drug as it was administered in this study. Further studies of ABPP with a preparation that has good availability are indicated to determine the potential antitumor activity of this agent or this class of agents in humans.
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9/17. A histological assessment of the four-day subrenal capsule assay (SRCA).

    A four-day subrenal capsule assay (SRCA) was developed, since fragments of human tumours implanted under the renal capsule of immunocompetent mice became rejected by the host within six days. The assay requires a histological assessment of both its exploitability and the extent of drug-induced anti-tumour lesions. 45 tumours from 43 patients with solid tumour were submitted to an SRCA in 1410 male B6D2F1 mice. After being biopsied each tumour was dissected by a pathologist, cut into 50 pieces (1.5 mm3), and one piece was implanted under the renal capsule of 35 mice; the mean tumour diameter was measured on day 0. The mice were randomized into groups of 6 to 10 animals each. On days 1, 2 and 3, the mice were treated with either placebo (control group) or with various anticancer agents. On day 4 the animals were sacrificed, the mean tumour diameter measured, the tumour bearing kidney fixed in Bouin's picroformol solution and processed for histological analysis after staining with hematein. Fragments of fresh explants of human tumours retained their proliferative and metabolic capacity: mitoses were observed as well as keratinizing cells in epidermoid carcinomas and melanin-producing cells in melanomas. Proliferation of tumour cells was seen along the renal capsule suggesting their affinity for connective tissue. capillaries filled with mouse erythrocytes were also seen. No or minimal lymphocytic infiltration was found. Drug oncolytic effects ranged from minor cellular degeneration to almost complete necrosis and were documented by the scoring of histologic lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
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10/17. Attempt at local administration of anticancer agents in the form of fat emulsion.

    A fat emulsion when injected into tissue is scarcely taken up by the blood vascular system but is retained within the tissue over a relatively extended period, and is distributed slowly into the surrounding tissues and to the regional lymph nodes. Attempts were made to use this property of the emulsion in the local administration of anticancer agents in emulsion, both in experimental animals and in man. The concentrations of bleomycin in the tumor tissue of rats were significantly higher after the intratumoral injection of the emulsion form than when the drug was administered in the aqueous solution, either systemically or intratumorally. Experimental antitumor activity against this tumor was superior after the bleomycin emulsion, as well. In the clinical trials six of eight patients with either squamous cell carcinoma of skin or local recurrence of adenocarcinoma of the breast responded favorably to this treatment.
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