Aseptic techniques for lung function testing.
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Cross Infection↗
Biomedical subjects
A Barrett
Publications and source records attributed to A Barrett.
A technique for measuring carbon monoxide uptake in mice.
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Animals↗
Infradiaphragmatic presentation of Hodgkin's disease.
Twenty patients with infradiaphragmatic presentations of Hodgkin's disease were seen at the Royal Marsden Hospital, London, between 1970 and 1977, 13% of the total number of patients with Stage I and II Hodgkin's disease seen in this period (20 out of 153). All the patients were male. Lymphocyte predominance was seen in 35%, nodular sclerosis in 30%, mixed cellularity in 30% and lymphocyte depletion in 5%. There is a lower incidence of nodular sclerosis than seen with supradiaphragmatic presentations. The average age was highest in patients with nodular sclerosing disease. All clinical Stage I patients had negative laparotomies. An approach to staging and treatment similar to that used for clinical supradiaphragmatic disease appears to yield equally good results.
Adolescent↗
Non-seminoma germ cell tumours (malignant teratoma) of the testis. Results of treatment and an analysis of prognostic factors.
The results of treatment of 126 patients with non-seminoma germ cell tumours (malignant teratoma) of the testis are presented. Of this group 81% are alive and 70% disease-free. Of 98 patients who had had no prior treatment 83% are alive and 76.5% disease-free. Of 43 early-stage patients 41 (95%) are alive and tumour-free despite a 21% relapse rate after radiotherapy. The disease-free rate in patients with advanced disease treated with chemotherapy, and in some cases radiotherapy and/or surgery, ranged from 100 to 9% and was strongly dependent upon the volume of metastatic tumour and the histology. Patients with malignant teratoma undifferentiated (embryonal carcinoma) showed a significantly higher disease-free survival rate than those with malignant teratoma intermediate (teratocarcinoma). Twenty-six men with advanced disease received radiotherapy after chemotherapy and of these 23 (88%) are alive and 21 (81%) are disease-free. No difference in disease-free survival rate was seen between advanced-stage patients receiving vinblastine and bleomycin and those receiving, in addition, cis-platinum. The overall drug-related mortality was 4.5%. Serum alpha-fetoprotein (AFP) and beta-human chorionic gonadotrophin (beta-HCG) levels were valuable monitors in advanced disease but not prognostically significant if allowance was made for tumour volume. Fifteen patients had surgical resection of residual masses and one died post-operatively.
Castration↗
Evaluation of computed tomography in the management of testicular teratoma.
An analysis has been made of data obtained by computed tomography (CT) scanning in 100 patients with testicular teratoma. The results have been compared with information obtained by conventional staging procedures and changes in patient management occurring as a direct result of CT have been noted. Although these tumours are rare, their pattern of metastasis to the retroperitoneum, mediastinum, lungs and liver is consistent. Thus the value of CT scanning can be tested in all of these sites in each patient and the indications for scanning clearly defined.
Humans↗
Elective delayed excision of bulky para-aortic lymph node metastases in advanced non-seminoma germ cell tumours of testis.
Forty-one patients with advanced non-seminoma germ cell testicular tumours were treated by chemotherapy, with or without radiotherapy, followed by excision of residual para-aortic lymph node masses. All para-aortic metastases were initially greater than 2 cm, 35 were larger than 5 cm, and 9 were over 10 cm in diameter. Seven patients also had nodal deposits above the diaphragm and 18 had distant metastases. The residual masses were excised completely in all except 3 cases. Residual malignancy was found in 7 (18%) of 38 operable cases; of these 7, only 2 remain alive and disease-free. In contrast, 28 (90%) of 31 operable cases with necrosis and fibrosis, or with fully differentiated teratoma, are alive and disease-free. Elevated serum markers were found in 6 of 9 cases with resectable or unresectable residual malignancy, but in only 1 of 32 who were tumour-free. Residual malignancy was found in 3 (9%) of 34 cases with normal marker levels. Malignancy was not found in any residual mass less than 4 cm diameter. We conclude that excision of para-aortic lymph node masses should be electively delayed until serum markers become normal and until shrinkage of the mass has ceased. The presence of residual malignancy in the excised tissue then provides a clear indication for further chemotherapy.
Humans↗
Total-body irradiation in advanced non-Hodgkin's lymphoma.
Thirty-seven patients with advanced non-Hodgkin's lymphoma who were treated by total-body irradiation (TBI) at the Royal Marsden Hospital are reviewed. Twenty-four patients had received no previous therapy; 13 patients were in relapse. The overall response rate was 73% for nodular lymphomas and 80% for those with diffuse disease. THe duration of complete response ranged from two to 41 months (median 12 months). Subsequent chemotherapy was given successfully except in patients with prolonged thrombocytopenia which appeared to be related to an initially involved bone marrow. Hemibody irradiation (HBI) was the least myelosuppressive form of TBI and is now being used in complete remission following chemotherapy.
Adult↗
Mediastinal seminomas.
A series of malignant seminomas of the mediastinum is presented and compared with previously reported series. The difficulty of conclusively excluding occult primary gonadal disease is noted. Primary mediastinal seminomas are associated with a better prognosis than teratomas of this site, mainly because of their radiosensitivity. A case report of a patient with mediastinal seminoma and two congenital abnormalities (ventricular septal defect and congenital absence of a thoracic hemivertebra) is presented and its relationship to the possible origin of these tumors discussed.
Adolescent↗
The place of bone-marrow transplantation in acute myelogenous leukaemia.
28 patients with acute myeloid leukaemia (AML) in first remission were maintained on chemotherapy, consisting of courses of cytosine arabinoside and daunorubicin, and immunotherapy with irradiated AML cells and BCG. The relapse rate and survival rate of these patients were compared with those of a simultaneously treated group of 22 patients in first remission who received sibling bone-marrow transplants after cyclophosphamide (60 mg/kg) given for 2 days and followed by a single dose of 1000 rads total body irradiation. Substantially fewer transplanted patients (4 out of 22) than chemo-immunotherapy patients (19 out of 28) relapsed (p less than 0.005) and 14 (64%) transplanted patients remain alive, well, and disease-free. Survival curves of the two groups of patients show that the transplanted patients never fared worse than the chemo-immunotherapy patients. We suggest that when possible young AML patients in remission should be offered transplantation as an alternative form of treatment.
Adolescent↗
Cyclosporin A to prevent graft-versus-host disease in man after allogeneic bone-marrow transplantation.
Cyclosporin A has been used in conjunction with allogeneic bone-marrow transplantation in the treatment of 23 patients--21 with acute leukaemia, 1 with chronic granulocytic leukaemia, and 1 with aplastic anaemia. The drug was given twice daily from the day before transplant. At the start of the study cyclosporin prophylaxis was stopped in 3 patients within 44 days of transplantation because of non-specific rashes and/or deteriorating renal function. All 3 patients had acute graft-versus-host disease (GVHD) and died. Thereafter the drug was not stopped because of possible toxic manifestations, and 20 patients have been studied (median follow-up 7 months; maximum 13 months). 2 patients have acquired GVHD; 1 patient died of acute GVHD and 1 has chronic mild disease. 3 other patients have died, 2 of recurrent leukaemia and a third of staphylococcal pneumonia with renal failure. Of the remaining patients, 1 has recurrent leukaemia and 1 has moderately severe renal failure. Several toxic effects of cyclosporin A have been observed but they are mostly reversible and no second malignant neoplasm has developed.
Adolescent↗
VP16-213 as a single agent in advanced testicular tumors.
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Drug Evaluation↗
Mediastinal involvement in early-stage Hodgkin's disease. Response to treatment and pattern of relapse.
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Hodgkin Disease↗
The role of surgery in the combined management of metastases from malignant teratomas of testis.
Thirty-three patients with malignant testicular teratomas and para-aortic metastases exceeding 2 cm in diameter have been treated with radiotherapy, chemotherapy (vinblastine and bleomycin, with or without cis-platinum) or both, followed by surgical excision of the residual para-aortic mass. Removal of a poorly functioning ipsilateral kidney was necessary in 7 cases (21%) and a segment of vena cava was resected in 2 (12.5%) of 16 patients with primary right-sided tumours. Removal was incomplete in only one patient, who had femoral nerve root involvement, and he subsequently died of secondary haemorrhage (operative mortality 3%). Undifferentiated tumour was found in 8 (61%) of 13 patients (Group 1) after radiotherapy, compared with only 2 (15%) of 13 (Group 2) after chemotherapy and radiotherapy, and 4 (57%) of 7 (Group 3) who had chemotherapy only prior to surgery; however, 3 of the Group 3 patients were referred because of evidence of activity in the para-aortic region.
Adolescent↗
Pancreatic insufficiency following abdominal irradiation.
A case is reported of pancreatic insufficiency following abdominal irradiation for Hodgkin's disease in a man aged 47 years. The effects of radiation on the pancreas are discussed. It is suggested that post irradiation steatorrhoea may have a pancreatic as well as an enteric cause.
Celiac Disease↗
The interpretation of marker protein assays: a critical appraisal in clinical studies and a xenograft model.
Although useful in the management of malignant testicular tumours, alphafoetoprotein and human chromonic gonadotrophin are not perfect parameters of tumour bulk. In a series of 65 patients with marker-positive advanced disease, 23 showed the phenomenon of discordance of markers or dissociation from tumour response. Transplantable human malignant teratoma xenografts were established in immune-suppressed mice as models of the human disease. In the model system, it was demonstrated that tumour AFP concentration was reflected by AFP titres in the blood, but that tumour AFP (or blood AFP) did not correlate well with tumour size. One xenograft line illustrated the evolution of marker-negative tumour cells from a patient who was initially AFP-positive.
Animals↗
Combined management of malignant teratoma of the testis.
Intensive chemotherapy with bleomycin and vinblastine was used as initial treatment in patients with advanced testicular teratoma and after relapse following lymph-node irradiation in patients with early-stage disease. Between January, 1976, and March, 1978, 84 patients, 28 with early disease and 56 with advanced disease, were treated. All 28 men with early-stage disease are alive and disease-free. Patients with advanced disease were divided into two groups. Patients with bulky multiple lung metastases and those with liver involvement did poorly, only 4 of 23 (17.4%) being disease-free. Conversely, patients with bulky abdominal nodes and those with limited lung disease did well, 17 of 21 previously untreated patients (80.9%) being alive and disease-free. Within the latter group, 16 patients were managed with chemotherapy and radiotherapy and/or surgery. Of these, 15 (93.4%) are disease-free.
Abdominal Neoplasms↗
Three years' experience with Ch1VPP (a combination of drugs of low toxicity) for the treatment of Hodgkin's disease.
In 3 years, 118 patients with Hodgkin's disease have completed chemotherapy with chlorambucil, vinblastine, procarbazine and prednisolone (Ch1VPP). The complete remission rates were 90% for 29 patients previously treated with radiotherapy, 67% for 73 patients previously untreated and 44% for 16 patients with prior chemotherapy. The 3-year survival rates for the first 70 patients in the series were 83% for previously irradiated patients, 84% for previously untreated patients and 67% for those with prior chemotherapy. Forty-seven previously untreated or previously irradiated patients in this group achieved complete remission. The 3-year disease-free survival rates for these patients were 71% and 67% respectively. This regimen gives complete remission and survival rates comparable with results obtained with combinations including nitrogen mustard, while producing fewer side-effects.
Adolescent↗
Total body irradiation and marrow transplantation for acute leukaemia. The Royal Marsden Hospital experience.
The experience with total body irradiation at the Royal Marsden Hospital is described for an elective program of transplantation in patients with acute myeloid leukaemia (AML) in first remission. Dose rate appears to be a critical factor in the reduction of radiation-associated damage and careful monitoring of the actual dose distribution and dose received is mandatory.
Adolescent↗