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Biomedical subjects

A Gray

Publications and source records attributed to A Gray.

324 records · Page 18Linked to original sources
PubMedDate not supplied

Adjuvant chemotherapy with vincristine, doxorubicin, and cyclophosphamide in the treatment of postenucleation high risk retinoblastoma.

PURPOSE: To study risk factors and outcome of children with high risk retinoblastoma who receive postenucleation vincristine, doxorubicin, and cyclophosphamide. PATIENTS AND METHODS: Charts of all patients who received adjuvant chemotherapy for retinoblastoma were reviewed. Thirty-six patients were identified who received chemotherapy for high risk histopathologic features. Histopathology slides of these 36 patients were retrieved and reviewed, and the disease was staged according to the modified St. Jude staging system. The disease was unilateral in 23 patients (64%). There were 9 patients with stage I disease, 18 with stage II, and 9 with stage III. Twenty-four patients (67%) completed 12 of the 12 scheduled chemotherapy cycles, and 11 patients (30%) received 4 to 11 cycles because of relapse, disease progression, or family reasons. A life-threatening complication developed in one patient after the first cycle, and this patient received no further chemotherapy. RESULTS: Five (3 with unilateral and 2 with bilateral disease) of the 36 patients developed distant metastasis and subsequently died. All had massive tumors; three had choroidal and up to surgical margin optic nerve invasion, and two had tumor extending posterior to lamina cribrosa. Six other patients had local relapse or progressive disease. All of these six patients had bilateral disease and failed in the intact eye during (three patients) or after (three patients) chemotherapy. Only two of the six patients were alive with no disease 50 and 102 months from diagnosis. With a median follow-up of 5.6 years, the 5-year and 10-year actuarial overall survival rates were 86% and 74%, respectively. The 5-year survival rates for patients with modified St. Jude stage I, II, and III disease were 100%, 91% (95% confidence interval, 57% to 100%), and 58% (95% confidence interval, 22% to 94%), respectively (P = 0.008). The survival rate was significantly different among patients with optic nerve involvement anterior to lamina cribrosa, posterior to lamina cribrosa, and surgical margin involvement (100%, 55%, and 41%, respectively; P = 0.003). Multivariate analysis showed that only the degree of optic nerve involvement (and therefore, modified St. Jude stage) was predictive of poor outcome. CONCLUSION: Patients with retinoblastoma involving the optic nerve beyond the lamina cribrosa have low survival rate despite local therapy and adjuvant chemotherapy with vincristine, doxorubicin, and cyclophosphamide. Progression of disease in the intact eye of three patients receiving chemotherapy is of concern. Alternative chemotherapeutic agents should be considered for patients with such high risk features.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Extramedullary myeloid tumors in children: the limited value of local treatment.

PURPOSE: To determine the incidence of extramedullary tumors (EMT) in Saudi Arabian children with acute myeloid leukemia, the factors associated with these tumors and the impact of local treatment on local tumor control, complete remission and survival rates. PATIENTS AND METHODS: One hundred children, median age 6 years, who received their primary treatment for acute myeloid leukemia at King Faisal Specialist Hospital and Research Center, from 1983 to 1997 were studied. EMT at diagnosis occurred in 18 (18%) patients at 25 sites. Meningeal leukemia, hepatosplenomegaly, lymph node enlargement, gingival hypertrophy, and cutaneous infiltration were not included in the definition of EMT. With these exclusions, children with EMT were younger than those without EMT (median age, 3.5 v. 7.5 years) and were more likely to have meningeal leukemia at diagnosis (33% v. 10%). The t(8;21) translocation was associated with a 47% EMT incidence compared with 23% without the translocation. Local radiation treatment was given to 16 of 25 (64%) EMT sites. RESULTS: The overall 5-year survival rate for all patients was 28%, and this was not significantly influenced by the drug regimen used, meningeal leukemia at diagnosis, the presence of the (8;21) translocation, M4 and M5 morphology combined, or EMT at diagnosis. Significant differences were observed in the 5-year survival rates for patients who underwent allogeneic bone marrow transplantation (52%; N = 37) and those who attained complete remission (CR) but did not undergo transplantation (21%; N = 44) and those who did not achieve complete remission with initial therapy (5%; N = 19). Systemic and local EMT CR was achieved in 17 of 18 patients with EMT, including 12 patients who underwent radiation treatment and 5 of 6 of those who did not. Isolated relapse was not seen at an EMT site and was not noted at any later stage of the disease. CONCLUSIONS: Permanent local control at sites of EMT was achieved in all patients who attained a bone marrow CR, whether or not the site was irradiated. Local radiation treatment of an EMT site did not appear to contribute to overall CR and survival rates. The use of radiation treatment should be conservative and limited to patients in whom there is a real and immediate threat to vision or renal function or when the spinal cord is compromised.

Acute Disease↗
PubMedDate not supplied

The emergence of gentamicin-resistant klebsiellae in a large general hospital.

Between March and December, 1975, an outbreak of infection with gentamicin-resistant Klebsiella pneumoniae (klebsiella (Gmr)) occurred at the Royal Melbourne Hospital. The klebsiellae were considered to be causing significant infection in 24 of 42 patients harbouring the microorganism. Commonest culture sources were urine and sputum, all but one of the significant urinary infections being associated with indwelling bladder catheters. Antibiotic therapy had been given to 40 patients before the isolation of klebsiella (Gmr), and of these 22 had received gentamicin. Cross infection was a major factor in the outbreak, and control measures (to limit this aspect and curtail the usage of gentamicin) have prevented wider spread within the hospital; at the time of writing the microorganism had been eradicated from all but one of the infected patients. It was shown that klebsiella (Gmr) carry an R-factor capable of transferring gentamicin resistance. Of 22 isolates tested quantitatively, 20 were resistant to 10 mug/ml of gentamicin.

Australia↗
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Improving blood transfusion: a patient-centred approach.

More than three million blood components are transfused every year in the UK, providing life-saving and life-enhancing treatment to thousands of patients (McClelland 2001). However, transfusion error, resulting in the patient receiving the incorrect blood component, remains the largest risk related to transfusion in the UK. By developing accessible blood transfusion policies, auditable performance standards and training, and educational initiatives, nurses can increase compliance in high-risk areas of the transfusion process and reduce the potential for errors.

Blood Transfusion↗
PubMedDate not supplied

Distal myopathy with focal granular degenerative change in vacuolated type 2 fibers.

A slowly progressive distal myopathy with raised blood (CK) level commencing in the second decade was associated with large vacuoles found only in type 2 fibers. The vacuoles consisted of sarcoplasmic spaces without limiting membranes, containing granular and fibrillar material. This material probably represented degenerative products derived from myofibrils. A distinction is drawn between these degenerative vacuolar changes and those reported in other cases of sporadic or hereditary distal myopathy in which autophagic vacuoles are characteristic.

Adult↗
PubMedDate not supplied

Neurofibrillary neuronal degeneration in dialysis dementia: a feature of aluminum toxicity.

Neurofibrillary material was found in cortical neurons in two patients who died with dialysis encephalopathy. The cytoplasm of these neurons contained large amounts of aluminum and whole-brain and blood aluminum levels were high. These findings suggest that in dialysis encephalopathy aluminum has a specific effect on neuronal protein synthesis, resulting in the accumulation of neurofilaments in cortical neurons. This neurofibrillary neuronal degeneration resembles that found in experimental aluminum toxicity, but differs in several respects from the neurofibrillary tangles characteristic of Alzheimer's disease.

Adult↗
PubMedDate not supplied

Sickle cell disease.

Explore the source record for details and available documents.

Anemia, Sickle Cell↗
PubMedDate not supplied

Shifting involvements: the British health care reforms.

The British National Health Service is currently undergoing the most far-reaching reforms since it began in 1948. The purpose of this article is to trace the background of these reforms, their progress, and their likely future impact on key groups such as nurses.

Health Care Reform↗
PubMedDate not supplied

The future of general medicine: lessons from an admissions ward.

OBJECTIVE: To define the expertise required of general physicians by surveying the work of an admissions ward. DESIGN: Observational study during a three-year period. SETTING: A 30-bed medical admissions ward in a district general hospital. MAIN MEASUREMENTS: Demography, diagnoses and management of 30,798 patients admitted. RESULTS: Patients admitted as emergencies through the admissions ward made up the bulk of inpatients in general medical and health care of the elderly wards. The most common age group was 70-79 years, and there was a slight predominance of men. Fifty-eight per cent of patients came to hospital as a result of emergency ambulance calls, without the involvement of a general practitioner. Cardiovascular diagnoses were most common (40% of patients) but virtually all medical conditions were represented. Twenty-nine per cent of patients were discharged within 24 hours and few were readmitted. CONCLUSIONS: Management of patients according to different age groups, or by specialties, does not seem feasible. Although specialty expertise is needed in a district general hospital, only a physician with an interest and training in general medicine can handle the scale and scope of medical emergencies. The majority of physicians still need to be 'general physicians with a special interest'.

Adult↗