A phase II study of cyclophosphamide followed by PIXY321 as a means of mobilizing peripheral blood hematopoietic progenitor cells.

Fourteen patients with stage II-IV breast cancer were enrolled in a phase II study of cyclophosphamide followed by PIXY321 as a means of mobilizing peripheral blood progenitor cells (PBPC). All 14 women tolerated PIXY321 well, with the predominant toxicities being erythema at the injection site, fever, and arthralgias. A median of two aphereses yielded a mean of 1.

Review article: the medical management of Crohn's disease.

The choice of medical therapies for Crohn's disease continues to grow. Although our understanding of the mechanisms of the disease is incomplete, increasing knowledge of the pathogenesis of inflammation in general and Crohn's disease in particular allows targeting of therapies at various points in the immunoinflammatory cascade. In addition, the division of Crohn's disease into subtypes by location, aggressiveness, and the presence or absence of perianal and fistulizing disease allows the tailoring of medical therapy to the individual patient.

Tandem high-dose chemotherapy supported by hematopoietic progenitor cells yields prolonged survival in stage IV breast cancer.

The aim of this phase II study was to determine the feasibility of using two (tandem) courses of high-dose alkylating agents with bone marrow or peripheral blood progenitor cell support in women with stage IV breast cancer. Women with stage IV breast cancer who had achieved a CR or PR during conventional chemotherapy were enrolled in a phase II trial of high-dose cyclophosphamide 7500 mg/m2 and thiotepa 675 mg/m2 (C+T) followed within 180 days by high-dose melphalan (M) 140 mg/m2. Bone marrow and/or GM-CSF mobilized peripheral blood hematopoietic progenitor cells were used to support high-dose C+T and high-dose M.

Morbidity of subtotal colectomy in patients with severe ulcerative colitis unresponsive to cyclosporin.

Purpose: The aim of this study was to document the morbidity of urgent subtotal colectomy and ileostomy in patients with severe ulcerative colitis who failed cyclosporin treatment.

Methods: We reviewed the charts of patients with severe ulcerative colitis who did not respond to cyclosporin treatment and underwent urgent subtotal colectomy and Brooke ileostomy at two inflammatory bowel disease centers over the 12-month period ending April 1994.

Results: Fourteen patients (6 males; mean age, 34 years) required an urgent subtotal colectomy and Brooke ileostomy after failing treatment with cyclosporin.

New therapeutic approaches.

Clinicians have witnessed an evolution from sulfasalazine and hydrocortisone to alternative aminosalicylates and steroids. Revolutionary changes beyond these, however, and other "nonspecific" anti-immunoinflammatory compounds require clarification of the primary events either activating inflammatory cascades or preventing the down-regulation of homeopathic inflammation. The authors remain encouraged by advances in basic research pertaining to IBD and optimistic that novel empiric observations and therapeutic trials will focus bench-side investigation as clinicians strive to improve the quality of life for patients.

Acute myeloid leukemia and myelodysplasia following intensive chemotherapy for breast cancer.

Two major classes of therapy-related acute myeloid leukemias (t-AML) and myelodysplastic syndromes (t-MDS) have been described following the use of conventional doses of alkylating agents and epipodophyllotoxins. They are characterized by distinct clinical presentations and chromosomal abnormalities. We report 2 cases of t-AML and 1 case of t-MDS in 3 out of 36 women who underwent high-dose chemotherapy and attempted ABMT for breast cancer.

Duration of recurrent ileitis after ileocolonic resection correlates with presurgical extent of Crohn's disease.

Crohn's disease of the terminal ileum recurs in a predictable sequence proximal to the ileocolonic anastomosis after surgical resection. To confirm the suspicion that the duration of recurrent ileitis correlates with the extent of presurgical disease, this study investigated 23 consecutive patients with recurrent Crohn's disease symptoms who had undergone ileocaecal resections between 1982 and 1992 at our institution and had both preoperative and postoperative small bowel follow through studies available for comparison. All films were reviewed by a blinded gastrointestinal radiologist using uniform criteria.

Quality-of-life results of double-blind, placebo-controlled trial of mesalamine in patients with Crohn's disease.

Seven quality-of-life parameters were assessed in a trial of mesalamine in Crohn's disease. The results with regard to efficacy and safety have been previously published. A total of 310 patients were enrolled in this double-blind, parallel trial and randomized to receive placebo, or 1, 2, or 4 g/day of mesalamine in controlled-release capsules for 16 weeks.

Safety and efficacy of controlled-release mesalamine for maintenance of remission in ulcerative colitis. Pentasa UC Maintenance Study Group.

This 12-month, double-blind, placebo-controlled study randomized 205 ulcerative colitis patients in remission to placebo or controlled-release mesalamine at 4 g/day for 12 months. Patients were stratified to either pancolitis or left-sided disease, based on previous diagnosis. Maintenance of remission was defined as a sigmoidoscopic index of < 5, less than five stools per day, and the absence of rectal bleeding.

The management of ulcerative colitis.

The treatment of ulcerative colitis (UC) remains empiric because of undetermined etiology and pathogenesis and incomplete understanding of the underlying immunoinflammatory events. However, considerable progress has been made in the management of this disease with the availability and wider use of newer aminosalicylates and immunomodulating agents. The clinician confronted with a patient with chronic ulcerative colitis must weigh the advantages of continued medical therapy against the potential curability with improved surgical techniques.

Medical therapy of inflammatory bowel disease.

Despite advances in pharmacologic approaches, the treatment of ulcerative colitis and Crohn's disease remains a challenge. Prior standards of therapy, sulfasalazine and corticosteroids, are gradually being replaced by mesalamine and alternative immune modulating agents. This article discusses the important pharmacologic properties, mechanisms of action, indications, and complications necessary to apply the expanding armamentarium in clinical practice.

Cyclosporine in severe ulcerative colitis refractory to steroid therapy.

Background: There has been no new effective drug therapy for patients with severe ulcerative colitis since corticosteroids were introduced almost 40 years ago. In an uncontrolled study, 80 percent of 32 patients with active ulcerative colitis refractory to corticosteroid therapy had a response to cyclosporine therapy.

Methods: We conducted a randomized, double-blind, controlled trial in which cyclosporine (4 mg per kilogram of body weight per day) or placebo was administered by continuous intravenous infusion to 20 patients with severe ulcerative colitis whose condition had not improved after at least 7 days of intravenous corticosteroid therapy.

Cigarette smoking and ulcerative colitis: a case-control study.

Objective: To determine whether the previously reported decreased risk of ulcerative colitis in current smokers and increased risk in former smokers are explained by age, sex, race, ethnicity, or socioeconomic status.

Design: We conducted a case-control study at a university hospital gastroenterology clinic.

Material And Methods: One hundred patients with ulcerative colitis and 100 age- and sex-matched community control subjects were randomly selected for a telephone interview to collect information on smoking habits, race, religion, income, education, and occupation.