Biomedical subjects
Publications and source records attributed to C Bailey.
A new anti-cancer agent, misonidazole, is now available for investigational purposes. It is a radiation sensitiser, and a national trial is described for its use in the curative treatment of carcinoma of the bladder. The co-operation of doctors is sought in referring patients for this study.
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Two patients are presented who developed radiation myelitis as a complication of treatment for medulloblastoma. These patients had been entered onto a pilot study to evaluate the therapeutic efficacy of combined treatment with radiation therapy and actinomycin-D (AMD). AMD is a known radiation enhancer in all tissues but the nervous system. Both of these patients received a full course of cranio-spinal irradiation plus AMD 15 mcg/kg for the first five days of therapy. One patient developed myelitis at 4 months, and the other at 12 months after treatment. Both patients are surviving three years posttreatment without any evidence of recurrent disease. The myelitis in one patient has improved, and it is stable in the other patient. It is concluded that AMD enhances the effect of radiation therapy on the central nervous system. This has never been reported but is important to note now, since radiation enhancers are included in multimodal treatment regimens for a variety of malifnant conditions. Reduction of radiation dose may be necessary when large volumes of the nervous system are treated.
Systolic time intervals are of value in measuring left ventricular function. The ratio of the pre-ejection period to the left ventricular ejection time (PEP/LVET) was determined serially in 60 children with cancer receiving anthracycline drugs. Measurements were examined for their predictive value in determining incipient anthracycline cardiomyopathy. An increase in the PEP/LVET ratio was not followed by clinical failure in the majority of patients. Of two patients who developed presumed anthracycline cardiomyopathy, only one demonstrated an increase in the ratio prior to going into heart failure. The value of the PEP/LVET ratio in children for predicting anthracycline cardiomyopathy appears limited, based on the results of this study.
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Twenty-five head-injured patients with localized theta bursts on standard or 24 h ambulatory EEG were administered a standardized interview for neuropsychiatric symptoms associated with complex partial seizures (e.g. olfactory hallucinations, memory gaps) and a battery of neuropsychological tests. Although the formal neuropsychological test performances of these patients were relatively normal they reported an abundance of seizure-like behavioural symptoms. While the frequency of these symptoms was high, they did not occur in a stereotyped complex or sequence. These findings suggest that localized theta bursts may be diagnostic of an underlying neuroelectrical disorder.
The aim of evidence-based guidelines is primarily to improve patient outcomes without adding to the existing cost of care because both payers and policymakers want to identify health care costs that do not result in benefit to the patient. The purpose of the reported project was to generate a practice guideline for the treatment of uncomplicated acute cystitis in a female population, to determine the extent to which the guideline would be used by providers and to measure the cost and quality of outcomes from its use. A retrospective chart review was used to gather pre-guideline practice and cost data. Measurements included the type, frequency, and duration of antibiotic therapy and the use of urine cultures and both complications and routine followup visits. The implementation of an outpatient practice guideline resulted in a significant change in antibiotic prescribing and a trend toward a change in ordering cultures and clinic followup. There was also a significant decrease in treatment costs.