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Biomedical subjects

B Fisher

Publications and source records attributed to B Fisher.

At least 145 records · Page 8Linked to original sources
PubMed1993

The benefit of leucovorin-modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer: results from National Surgical Adjuvant Breast and Bowel Project protocol C-03.

PURPOSE: This study was designed to evaluate the efficacy of leucovorin-modulated fluorouracil (5-FU) as adjuvant therapy for patients with Dukes' stage B and C colon cancer. PATIENTS AND METHODS: Data are presented from 1,081 patients with Dukes' stage B and C carcinoma of the colon entered into National Surgical Adjuvant Breast and Bowel Project (NSABP) protocol C-03 between August 1987 and April 1989. Patients were randomly assigned to receive either lomustine (MeCCNU), vincristine, and 5-FU (MOF), or leucovorin-modulated 5-FU (LV + 5-FU). The mean time on study was 47.6 months. RESULTS: Comparison between the two groups indicates a disease-free survival advantage for patients treated with LV + 5-FU (P = .0004). The 3-year disease-free survival rate for patients in this group was 73% (95% confidence interval, 69% to 77%), compared with 64% (95% confidence interval, 60% to 68%) for patients receiving MOF. The corresponding percentage of patients surviving was 84% for those randomized to receive LV + 5-FU and 77% for the MOF-treated cohort (P = .003). At 3 years of follow-up, patients treated with postoperative LV + 5-FU had a 30% reduction in the risk of developing a treatment failure and a 32% reduction in mortality risk compared with similar patients treated with MOF. CONCLUSION: Treatment with LV + 5-FU significantly prolongs disease-free survival and results in a significant benefit relative to overall survival. These findings, when considered together with results from a recent meta-analysis demonstrating a benefit from LV + 5-FU in advanced disease, provide evidence to support the concept of metabolic modulation of 5-FU.

Chemotherapy, Adjuvant↗
PubMed1993

Laparoscopic evaluation of the argon beam coagulator. Initial report.

The objective of this study was to evaluate the safety and hemostatic properties of the argon beam coagulator (ABC) at laparoscopy. The study is composed of two parts: laparoscopic results in five anesthetized animals and a preliminary clinical trial in 35 volunteers undergoing laparoscopy. Animals were evaluated during a laparoscopic cholecystectomy training course. Private patients undergoing operative laparoscopy voluntarily consented to a hospital Investigational Review Board-approved protocol to evaluate the ABC. The pigs were 3-month-old, healthy females. The patients were healthy volunteers undergoing laparoscopy for pain, infertility or cholecystectomy. Both pigs and human volunteers underwent operative laparoscopic use of the ABC for hemostasis and selected tissue electrocoagulation using a prototype 10-mm laparoscopic probe. The safety of the ABC was evaluated in the pigs by continuously monitoring heart rate, oxygen saturation and end-tidal CO2. Patients had similar clinical monitoring during operative laparoscopy, with observation of tissue effects of the ABC for hemostasis and tissue electrocoagulation. Laparoscopic use of the ABC in animals and patients produced no observable anesthetic changes, with both pigs and patients recovering normally. The ABC allowed smokeless, hemostatic tissue electrocoagulation, with a rapid non-touching technique easy to apply laparoscopically. We conclude that the ABC can safely be used laparoscopically with excellent hemostasis and effective controlled tissue electrocoagulation. The lack of smoke and the non-touching technique for delivery allow rapid laparoscopic application. The prototype 10-mm delivery probe is cumbersome, and the argon gas flow rate of 4 L/min with firing requires constant venting of the peritoneum with close monitoring of intraperitoneal pressures.

Animals↗
PubMed1993

Patient access to records: expectations of hospital doctors and experiences of cancer patients.

The aim of this study was to examine cancer patients' reactions to the offer of access to their medical records, hospital doctors' preconceptions of patient access to medical records and the reality of access to records for both parties. Semistructured interviews were conducted with 32 patients and 21 hospital doctors. Hospital doctors were also shown letters from their department to the general practitioner and asked about any changes they would have made as a result of knowing about patient access to records. The results showed that most patients were able to judge for themselves if they wanted access or not and that patients who chose to look at their records found access to their records helpful and reassuring even if the news was bad. Doctors expected access to records to be harmful to patients but would not have wished to amend many of the letters they had written. Patient access to records can be a safe and useful adjunct to good patient care.

Attitude of Health Personnel↗
PubMed1992

Thermotolerance in the absence of induced heat shock proteins in a murine lymphoma.

Three murine lymphoma cell lines, CH1, a B-cell lymphoma, and VL3 and RDM4, both T-cell lymphomas, were tested for their ability to induce heat shock protein synthesis and thermotolerance after heat shock. All three lines could develop thermotolerance, but the persistence of tolerance was less than can be measured in nonlymphoid cell lines. Analysis of protein synthesis patterns by one-dimensional gel electrophoresis suggested that only the VL3 cells were capable of the induction of heat shock proteins. After two-dimensional gel analysis, however, the induction of one heat shock protein was evident in RDM4 cells. No induced heat shock proteins could be detected in the CH1 cells. These data provide strong evidence that, while the induction of heat shock proteins may be sufficient for development of thermotolerance, they are not necessary and that another mechanism is available to cells.

Animals↗
PubMed1992

Use of brainstem auditory-evoked response testing to assess neurologic outcome following near drowning in children.

OBJECTIVE: To determine a correlation between serial brainstem auditory-evoked response measurements and ultimate neurologic outcome in pediatric patients who suffered a cardiac arrest resulting from a submersion accident. DESIGN: Inception cohort, prospective correlational study. SETTING: A 15-bed pediatric ICU (within a 150-bed tertiary care pediatric hospital) admitting patients of all ages except nonsurgical neonates. PATIENTS: All previously normal pediatric patients who suffered a cardiac arrest after a submersion accident. Patients evaluated: 111; patients studied: 89. METHODS: Patients received serial brainstem auditory-evoked response testing within 6 hrs of resuscitation and then once daily for up to 10 days. Brainstem auditory-evoked response measurements included wave I-V interpeak latency, wave V amplitude, and wave I/V amplitude ratio. Upon discharge, patients were evaluated and classified into one of four neurologic outcome groups: normal, handicapped, vegetative, or dead. Patients classified into the handicapped group exhibited mild neurologic deficits after discharge. Vegetative patients were noninteractive with their environment and required full-time caretaker support. Serial brainstem auditory-evoked response measurements from the four outcome groups were compared with brainstem auditory-evoked response measurements obtained from a group of 39 healthy children of comparable age. MAIN RESULTS: Patients who recovered neurologically intact manifested brainstem auditory-evoked response measurements that were similar to controls. Brainstem auditory-evoked response measurements in the handicapped outcome group were also normal after resuscitation but showed significant reduction in wave V amplitudes over the ensuing days. When compared with controls, patients with a vegetative outcome manifested abnormally prolonged wave I-V interpeak latencies, diminished wave V amplitudes, and large-wave I/V amplitude ratios following resuscitation. However, I-V interpeak latencies normalized within 24 hrs after resuscitation. I-V interpeak latencies were no different than controls until hospital day 3, at which time they became significantly prolonged. Patients who were declared brain dead or died from cardiovascular collapse exhibited very abnormal brainstem auditory-evoked response measurements on admission and until death. Wave V could not be detected on admission in 19/31 patients within this group. CONCLUSIONS: Brainstem auditory-evoked response testing is useful as an aid in the assessment of neurologic outcome following submersion-induced cardiac arrest. However, standardization of brainstem auditory-evoked response testing and production of normative data are required before this modality can be more widely studied and applied.

Analysis of Variance↗
PubMed1992

Hypertonic saline lowers raised intracranial pressure in children after head trauma.

Eighteen pediatric patients who sustained traumatic brain injury were enrolled in a double-blind, crossover study comparing the effects of 3% saline and 0.9% saline infusions on raised intracranial pressure (ICP). After resuscitation, each patient received a bolus of each saline concentration, and ICP was monitored for 2 h. Initial mean ICP before 0.9% saline infusions equaled 19.3 mm Hg and averaged 20.0 mm Hg during the subsequent 2-h trials (p = 0.32). Baseline mean ICP before 3% saline administration equaled 19.9 mm Hg and averaged 15.8 mm Hg for 2 h postinfusion (p = 0.003). Central venous pressure did not change significantly in either group, nor did measurements of renal function. Serum sodium concentrations increased in all 18 trials of 3% saline. Maximal concentrations of serum sodium occurred 30 min after bolus administration of 3% saline. Three percent saline significantly reduces raised ICP after traumatic brain injury when compared with normal saline. Intravascular dehydration, as measured by central venous pressure, did not occur during the study period.

Journal Article↗
PubMed1992

Prognostic factors in NSABP studies of women with node-negative breast cancer. National Surgical Adjuvant Breast and Bowel Project.

Twenty-two pathologic (including estrogen and progesterone receptor status) and four clinical features of 950 node-negative stage I invasive breast cancers from 950 women enrolled in the National Surgical Adjuvant Breast and Bowel Project protocol B-06 were analyzed for their possible prognostic significance. Univariate analyses revealed 10 characteristics that were significant at the 1% level. Only three of these--notably nuclear grade, histologic tumor type, and race--were found to be significant when entered into a Cox regression model. Patients whose tumors exhibited a good nuclear grade fared significantly better than those whose tumors were scored as poor. Similarly, a significantly better prognosis was noted when the histologic type of cancer was found to be "favorable" (mucinous, tubular, or papillary) than when it was "intermediate" (NOS, "Not Otherwise Specified," combination; typical medullary; and lobular invasive) or "unfavorable" (NOS pure and atypical medullary). Blacks exhibited a worse prognosis than whites. Survival was 94% at 8 years when the nuclear grade was good and the tumor type favorable, but only 54% when the nuclear grade was poor and tumor type unfavorable. Patients with one favorable and one unfavorable feature exhibited an intermediate survival. A brief overview as well as our own preliminary experience indicates that the combined use of these two prognostic pathologic parameters may be as good as and in some instances a better predictor of survival in node-negative patients than information derived from more "objective" methodologies such as flow cytometry, receptor analyses and tumor labeling indices or the demonstration of oncogene overexpression. Assessment of the pathologic parameters is simple, universally available, and quick and requires only modest training to be reproducible.

Breast Neoplasms↗
PubMed1992

Systemic therapy in node-negative patients: updated findings from NSABP clinical trials. National Surgical Adjuvant Breast and Bowel Project.

This report updates findings from two National Surgical Adjuvant Breast and Bowel Project (NSABP) clinical trials conducted to evaluate the worth of systemic therapy for the treatment of node-negative breast cancer patients. In trial B-13, 737 women with estrogen receptor (ER)-negative tumors treated by sequential methotrexate and fluorouracil (MTX----5-FU) followed by leucovorin were compared with a control group treated by surgery alone. Findings for all patients through 5 years of follow-up indicate a 27% reduction in treatment failure as a result of MTX----5-FU (76% vs 67%). While patients 49 years old or less and 50 years old or more benefited significantly from MTX----5-FU, the effect on disease-free survival (DFS) was greatest in those 50 years or older, where a 50% reduction in treatment failure occurred (86% vs 72%). A 69% reduction in mortality resulting from MTX----5-FU was observed in the older group (95% vs 84%). Trial B-14 compared placebo with tamoxifen (TMX) in 2844 patients with ER-positive tumors. As originally reported, findings through 5 years of follow-up indicate a significant reduction (36%) in treatment failure as a result of the TMX (82% vs 72%). Improvement in DFS was highly significant in both age groups. In patients 49 years old or younger, there was a 44% reduction in DFS (81% vs 66%) and, in those 50 years old or more, a 31% reduction (82% vs 74%). A Cox proportional hazards model failed to indicate a benefit from MTX----5-FU and TMX in all patient subgroups. Both therapies reduced local-regional and distant recurrence, as well as breast tumor recurrence following lumpectomy. Updated findings from trials B-13 and B-14 continue to support our conclusions that (a) no subgroups of node-negative patients that we examined have such a good outcome as to preclude the use of effective systemic therapy in their treatment and (b) despite the benefits observed from MTX----5-FU and TMX, no subgroup of patients was so affected as to preclude use of a particular subgroup in assessing other therapy regimens in additional clinical trials. The identification and evaluation of markers to determine which patients should receive systemic therapy are of the highest priority. At present, however, the use of markers for therapeutic decision making regarding individual patients is tenuous.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Lumpectomy for breast cancer: an update of the NSABP experience. National Surgical Adjuvant Breast and Bowel Project.

The data in this report continue to indicate, as first noted in 1985, that lumpectomy followed by breast irradiation in all patients, and adjuvant chemotherapy in women with positive nodes, is appropriate therapy for negative- or positive-node patients with tumors 4 cm or less in size, provided that the margins of the resected specimens are free of tumor. The value of irradiation in reducing the incidence of tumor in the ipsilateral breast after lumpectomy continues to be significant in all patients regardless of nodal status, age, or tumor size. A multivariate analysis indicates that, in all patients, three covariates, ie, treatment, tumors with poor histologic type, and tumors with a maximum pathologic size greater than or equal to 2 cm, are significant predictors of breast tumor recurrence following lumpectomy. Of particular significance is the continuing observation that the distant disease-free survival (DDFS) and survival (S) of patients in the three treatment groups (total mastectomy, lumpectomy alone, and lumpectomy followed by breast irradiation) demonstrate no significant difference through 9 years of follow-up, despite the fact that the total mastectomy group (by virtue of breast removal) had no breast tumor recurrence, that lumpectomy patients treated with breast irradiation had a 10% ipsilateral tumor recurrence, and that patients treated by lumpectomy alone demonstrated a 40% recurrence of tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast Neoplasms↗
PubMed1991

DNA flow cytometric analysis of primary operable breast cancer. Relation of ploidy and S-phase fraction to outcome of patients in NSABP B-04.

Between 1971 and 1974, 1665 women with primary operable breast cancer were randomized into a National Surgical Adjuvant Breast and Bowel Project (NSABP) trial (B-04) conducted to evaluate the effectiveness of several different regimens of surgical and radiation therapy. No systemic therapy was given. Cells from archival paraffin-embedded tumor tissue taken from 398 patients were analyzed for ploidy and S-phase fraction (SPF) using flow cytometry. Characteristics and outcome of patients with satisfactory DNA histograms were comparable to those from whom no satisfactory cytometric studies were available. In patients with diploid tumors (43%), the mean SPF was 3.4% +/- 2.3%; in the aneuploid population (57%), the SPF was 7.9% +/- 6.3%. Only 29.9% +/- 17.3% of cells in aneuploid tumors were aneuploid. Diploid tumors were more likely than aneuploid tumors to be of good nuclear grade (P less than 0.001) and smaller size (P equals 0.03). More tumors with high SPF were of poor nuclear grade than were tumors with low SPF (P equals 0.002). No significant difference in 10-year disease-free survival (P equals 0.3) or survival (P equals 0.1) was found between women with diploid or aneuploid tumors. Patients with low SPF tumors had a 13% better disease-free survival (P equals 0.0006) than those with a high SPF and a 14% better survival (P equals 0.007) at 10 years than patients with high SPF tumors. After adjustment for clinical tumor size, the difference in both disease-free survival and survival between patients with high and low SPF tumors was only 10% (P equals 0.04 and 0.08, respectively). Although SPF was found to be of independent prognostic significance for disease-free survival and marginal significance for survival, it did not detect patients with such a good prognosis as to preclude their receiving chemotherapy. The overall survival of patients with low SPF was only 53% at 10 years. These findings and those of others indicate that additional studies are necessary before tumor ploidy and SPF can be used to select patients who should or should not receive systemic therapy.

Breast Neoplasms↗