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Biomedical subjects

A G Nash

Publications and source records attributed to A G Nash.

At least 37 records · Page 2Linked to original sources
PubMed1989

A pilot trial to evaluate the acute toxicity and feasibility of tamoxifen for prevention of breast cancer.

Epidemiological and experimental evidence indicates that oestrogens are involved in the carcinogenic promotion of human breast cancer. We have undertaken a pilot trial of tamoxifen, an anti-oestrogen, compared to placebo given to 200 women at a high risk of developing breast cancer. The results of this trial show that acute toxicity is low and that accrual and compliance are satisfactory. Furthermore, biochemical monitoring of lipids and clotting factors indicate that tamoxifen may reduce the risk of cardiovascular deaths. At this stage no untoward long-term risks have been identified, and it is therefore proposed that a large multicentre trial should be started.

Adult↗
PubMed1986

A double blind randomised clinical trial of adjuvant aminoglutethimide versus placebo given to post menopausal patients with histologically confirmed stage II breast cancer.

A multicentre double blind trial is underway to evaluate aminoglutethimide (AG) (Orimeten, Ciba) 1.000 mg/day with hydrocortisone (HC) 20-40 mg/day versus placebo for adjuvant treatment of post menopausal patients with histologically confirmed stage II breast cancer. An interim analysis in February 1985 indicates that of 338 patients randomised 165 received AG + HC and 173 received placebo. At this time 143 AG + HC patients and 141 placebo patients were eligible and assessible for analysis. Of those who received AG + HC 41 have developed metastases and 27 died compared to placebo patients, 53 of whom have developed metastases (p = 0.04) and 34 have died (p = 0.21). These results are similar to the reported advantages for adjuvant tamoxifen given for stage II breast cancer.

Aged↗
PubMed1986

Prognostic significance of micrometastases in bone marrow in patients with primary breast cancer.

Metastatic breast cancer cells were found in the bone marrow of 60 (23%) of 269 patients with primary breast cancer, none of whom had metastatic disease disclosed by any other investigation, including bone scanning and radiological skeletal survey. We estimated the number of cancer cells as less than or more than 20 cancer cells seen. Twenty-six patients had less than 20 cancer cells present, and 34 had 20 or more. At a median follow-up time of 22 months, 53 patients had relapsed, 19 of 60 (31.7%) in the group found to have micrometastases and 34 of 195 (17.2%) in the group that had normal bone marrow. Patients with micrometastases are relapsing at a faster rate than those without micrometastases (P = less than 0.05). Patients with less than 20 cancer cells present are relapsing faster than those with no cancer cells but slower than those with 20 or more cancer cells (P = less than 0.01). We conclude that the presence of cancer cells in the marrow at primary diagnosis is a prognostic factor in patients with primary breast cancer.

Bone Marrow Diseases↗
PubMed1985

Breast reconstruction after failed conservation.

We report our experience of using latissimus dorsi myocutaneous flaps after failed conservation for breast carcinoma. Twenty-nine patients were treated by two methods of reconstruction. Seventeen patients with central recurrent tumours and three patients with radiation necrosis of the breast were treated by total mastectomy and latissimus dorsi reconstitution with silicone implant. Nine patients underwent latissimus dorsi reconstruction with preservation of the nipple for recurrent peripheral tumours. After a mean follow up period of 20.2 months no local recurrences have been observed but a longer period of follow-up is necessary to evaluate the likely long term recurrence rate.

Adult↗
PubMed1984

Treatment of disseminated breast cancer with tamoxifen, aminoglutethimide, hydrocortisone, and danazol, used in combination or sequentially.

222 patients with disseminated breast cancer have been randomised to receive either a combination of hormone therapies using tamoxifen, aminoglutethimide with hydrocortisone, and danazol (TAD), or tamoxifen alone. The response to the combination was significantly better (43%) than that to tamoxifen alone (31%). Patients who relapsed after response or failed to respond to tamoxifen were subsequently treated with aminoglutethimide and then, if possible, with danazol. Some patients who received TAD were subsequently treated with alternative endocrine therapy, which was usually medroxyprogesterone acetate. Of the 111 patients who initially received tamoxifen, 43 responded to the tamoxifen and/or subsequent endocrine therapy. Of the 111 patients who initially received TAD, 50 responded. Although the duration of response to TAD was the same as for tamoxifen, the TAD patients achieved remission more quickly. The total time in endocrine remission for patients receiving TAD is 303 months to date, compared with 264 months for patients receiving tamoxifen. Survival for patients randomised to receive TAD or tamoxifen is the same.

Aminoglutethimide↗
PubMed1984

The relaxant action of hymecromone and lignocaine on induced spasm of the bile duct sphincter.

The retained stone in the common bile duct remains a problem for the surgeon. Although more effective methods are available, mechanical flushing of the bile duct is, when successful, a simple solution. Pharmacological dilatation of the sphincter of Oddi is a logical adjunct to flushing. Pressure changes in the bile duct during flushing were studied in 20 postoperative patients with T-tube drains and the effectiveness of two drugs in reducing Omnopon induced spasm of the sphincter was compared. Hymecromone intravenously and lignocaine via the T-tube were equally effective, reducing sphincter activity in the majority of patients, but there was considerable individual variation.

Adult↗
PubMed1983

Central breast carcinoma treated by simultaneous mastectomy and latissimus dorsi flap reconstruction.

Simultaneous mastectomy with latissimus dorsi flap reconstructions have been performed on 15 women with primary central breast cancer and on 5 women with local recurrence after local excision and deep X-ray treatment. The indications and technique are discussed. There was no mortality and no initial morbidity. No prosthesis has become infected. One prosthesis has slipped laterally, requiring removal and re-insertion at the time of nipple reconstruction. In all patients an acceptable cosmetic result, as assessed by the patient and the surgeon, has been achieved. Follow-up is very brief, 1-18 months, but there is as yet no sign of local recurrence.

Adult↗
PubMed1983

Oral cholecystographic findings and the incidence of wound infection after cholecystectomy.

Six hundred and sixty-one patients undergoing cholecystectomy were reviewed, and the over-all incidence of postoperative wound infection was found to be 18.6 per cent. Of the 274 patients who underwent cholecystography preoperatively, 150 were found to have functioning nonobstructed stone filled gallbladders. There were 12 postoperative wound infections in this group, 8 per cent. One hundred and twenty-four patients had nonfunctioning and obstructed gallbladders, 31 of whom, 25 per cent, had wound infections develop. The finding of an obstructed gallbladder upon oral cholecystography was associated with a high incidence of wound infection. This group should be considered for prophylactic antibiotics.

Adolescent↗
PubMed1982

Tamoxifen, aminoglutethimide and danazol: effect of therapy on hormones in post-menopausal patients with breast cancer.

Gonadotrophins, oestradiol, androstenedione, testosterone and dehydroepiandrosterone sulphate (DHAS) were measured sequentially in 72 patients with advanced breast cancer receiving endocrine therapy of various types. Tamoxifen significantly reduced gonadotrophins but did not effect other hormones. Danazol also reduced gonadotrophins. Aminoglutethimide (AGT) reduced oestradiol and DHAS but had not effect on gonadotrophins. The effects of administering tamoxifen, AGT and danazol together (TAD) together were therefore examined. This combination reduced gonadotrophins, oestradiol and DHAS, but no further than tamoxifen and AGT alone. The degree and duration of hormone suppression were similar in both responders and non-responders to tamoxifen, AGT or TAD, though patients responding to AGT showed more complete suppression at the end of the course of treatment, perhaps because they were treated longer. On relapse, adequate gonadotrophin and steroid suppression was demonstrated in patients receiving tamoxifen and AGT respectively. We conclude that (a) response to endocrine therapy is unlikely to be related to the degree of endocrine suppression produced by the therapy; (b) combination endocrine therapy does not further reduce serum-hormone concentrations and (c) relapse is unlikely to be due to escape from the hormone-inhibitory effects of endocrine agents.

Aminoglutethimide↗
PubMed1980

Assessment of biochemical tests to screen for metastases in patients with breast cancer.

Of ten tumour markers measured every 3 months after mastectomy in patients with apparently localised primary breast cancer, plasma levels of alkaline phosphatase, carcinoembryonic antigen, and gamma-glutamyl transpeptidase were the most useful in detecting metastatic disease. With these three tests a "lead interval" of 3 months or more was obtained in about half the 23 patients who developed overt metases. Clinical examination, chest X-ray, and these three markers proved the most useful combination of tests in screening for metastases, since at least one test was abnormal in 46 of 47 patients at the time of the development of metastases as judged by more detailed physical tests.

Alkaline Phosphatase↗
PubMed1978

Aminoglutethimide in treatment of metastatic breast carcinoma.

42 patients with metastatic breast carcinoma were treated with aminoglutethimide, which inhibits adrenal steroid hormone synthesis. Treatment was stopped in 2 patients before response could be assessed; of the other 40, 15 (37.5%) had an objective response, 1 (2.5%) showed a response in bone but not in soft tissue, and 4 (10%) had complete or very great relief of metastatic bone pain but no radiological evidence of improvement. 19 (53%) of 36 patients with bone metastases responded to treatment (15 had X-ray evidence and 4 had pain relief), as did 5 (45%) of 11 patients with soft tissue metastases, 2 (25%) of 8 with malignant marrow infiltration, 1 (14%) of 7 with lung metastases, and none of 13 with liver metastases. Response was commonest in patients who had previously responded to other forms of endocrine therapy. Side-effects, usually mild and transient, occurred in a few patients; the most important were an initial period of somnolence in 9 patients and a rash in 5.

Administration, Oral↗
PubMed1978

Combination chemotherapy of metastatic breast cancer with vincristine adriamycin and prednisolone.

Fifty patients with metastatic breast cancer were treated with a combination of vincristine, Adriamycin and prednisolone (VAP) at four weekly intervals. Response rates of 78% for soft tissue disease, 66% for parenchymal lung disease, 67% for liver disease, and 64% for pleural effusions were seen. Only 26% of patients with bone metastases showed an objective response. These figures are as good as any previously reported for chemotherapy of breast cancer.

Aged↗