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Biomedical subjects

C M Norris

Publications and source records attributed to C M Norris.

17 recordsLinked to original sources
PubMed1992

A drug usage review of omeprazole.

A drug use review of omeprazole was carried out at two centres in the Yorkshire Region from December 1990 to April 1991. Data collection documents were used and 66 patients in total were audited. Thirteen patients (19.7%) were treated for indications outside the product licence and 18 patients (27.3%) were treated for longer than 8 weeks. Twenty-eight patients (42.4%) received 40 mg daily. Fifty-one patients (77.3%) had received previous therapy with H2-receptor antagonists and in 33% of these patients it was at an inadequate dose or for an inadequate period of dosing or both. The results indicate a need for a prescribing policy for omeprazole.

Dose-Response Relationship, Drug↗
PubMed1990

Continuous infusion high-dose leucovorin with 5-fluorouracil and cisplatin for untreated stage IV carcinoma of the head and neck.

STUDY OBJECTIVE: To study the activity of continuous infusion cisplatin, 5-fluorouracil, and high-dose leucovorin (PFL) as induction chemotherapy in patients with previously untreated, advanced squamous cell carcinoma of the head and neck. DESIGN: Nonrandomized, prospective trial. SETTING: A comprehensive cancer center. PATIENTS: Thirty-five patients (4 patients [11%], stage III; 31 patients [89%], stage IV [MO]), all evaluable for response and toxicity. INTERVENTIONS: Two to three cycles of PFL before definitive, local-regional therapy (surgery and radiation therapy or radiation therapy alone). Chemotherapy included continuous intravenous infusion of cisplatin (25 mg/m2 body surface area daily, days 1 through 5); 5-fluorouracil (800 mg/m2 body surface area daily, days 2 through 6); and leucovorin (500 mg/m2 body surface area daily, days 1 through 6) administered once every 28 days. Pathologic response was evaluated by surgical resection or biopsy. Serum-reduced folates were measured before and 18 hours after the initiation of chemotherapy. RESULTS: A clinical response to PFL was achieved in 28 of 35 (80%) patients: 23 (66%) patients had a complete response (90% CI, 50% to 79%) and 5 (14%) patients, a partial response. A complete response was confirmed pathologically in 14 of 19 (74%) patients. The most common toxicity was mucositis (grade 2 to 3; 94% of patients). Dose reduction for toxicity was necessary in 11 (31%) patients. There were no treatment-related deaths. Serum levels of leucovorin and (6S)5-methyltetrahydrofolate were measured in 7 patients. After 18 hours, the mean leucovorin level (+/- SD) was 34.3 +/- 1.5 mumol/L, of which only 8.0 +/- 0.5% was the active 6S isomer. The mean serum (6S)5-methyltetrahydrofolate was 9.2 +/- 0.6 mumol/L. CONCLUSIONS: Continuous infusion cisplatin, 5-fluorouracil, and high-dose leucovorin is a new and highly active chemotherapy regimen that can achieve clinical and pathologically confirmed complete responses in a substantial proportion of patients with advanced, local-regional squamous cell carcinoma of the head and neck. Further studies are needed to confirm the activity of PFL and to determine its potential impact on local tumor control and disease-free and overall survival.

Adult↗
PubMed1987

Cyclophosphamide, doxorubicin, and cisplatin combination chemotherapy for advanced carcinomas of salivary gland origin.

Thirteen patients with carcinomas of major and minor salivary gland origin (nine adenoid cystic carcinomas and four adenocarcinomas) were treated with cyclophosphamide (500 mg/m2), doxorubicin (50 mg/m2), and cisplatin (50 mg/m2) (CAP) by intravenous injections on the first day of a 28-day regimen. Sixty-one cycles of CAP were administered (mean, 4.7 cycles per patient). Eleven patients were treated for palliation of recurrent disease (locoregional, ten; lung, ten; liver, three; and bone, three). Two patients untreated previously, one with extensive local disease involving the base of the skull and one with a solitary lung metastasis (resected with a positive margin) and an initially unappreciated base of tongue primary, received two cycles of CAP followed by local treatment and adjuvant CAP. Previous therapy for the 11 patients with recurrent disease included surgery (ten), radiotherapy [RT(11)], chemotherapy (three), or hormonal therapy (two). Three complete and three partial responses to chemotherapy were noted for an overall response rate of 46%. The median duration of response in palliative patients was 5 months (range, 2 to 9). Of the two patients receiving induction CAP, one relapsed with distant disease 26 months after treatment, and the other remains disease-free after 60 months of follow-up examination. Chemotherapy was well tolerated generally, and no chemotherapy-related deaths occurred. One hypertensive patient suffered a stroke after 3 cycles of therapy. CAP is an active regimen against salivary gland carcinomas and deserves further study. Also, it may be of value as induction or adjuvant treatment for patients with advanced disease untreated previously.

Adenocarcinoma↗
PubMed1987

An analysis of induction and adjuvant chemotherapy in the multidisciplinary treatment of squamous-cell carcinoma of the head and neck.

This study examines the role of combination chemotherapy with surgery and/or radiotherapy in the initial treatment of patients with advanced stage III and IV squamous-cell carcinoma of the head and neck (SCCHN). Two courses of initial (induction) cisplatin, bleomycin, and methotrexate with oral calcium leucovorin (PBM) were used with the principal intent of increasing the effectiveness of subsequent surgery and/or radiotherapy. Following induction chemotherapy and local treatment, disease-free patients who had responded to initial chemotherapy were entered into a randomized trial of adjuvant PBM. The response rates to induction PBM chemotherapy were a complete response (CR) rate of 26% and a partial response (PR) rate of 52%, for an overall response rate of 78%. A response to induction PBM was highly correlated with failure-free survival (P less than .0001). A Cox multistep regression analysis of potential prognostic factors was performed. After adjusting for the significant prognostic factors of performance status, initial tumor size, and primary tumor site, a response to induction chemotherapy remained independently associated with improved survival (P = .0002). The randomized trial of adjuvant chemotherapy demonstrated that such treatment significantly improved failure-free survival by decreasing local-regional failures. The benefit of adjuvant chemotherapy was particularly evident in patients who had a PR to induction chemotherapy (P = .01). The toxicity of this multidisciplinary approach was predictable and acceptable. Surgery and radiotherapy were not compromised by induction or adjuvant chemotherapy. Definitive evidence that chemotherapy can favorably influence survival awaits confirmation of these results by a randomized trial using a control arm of patients treated with conventional surgery and/or radiotherapy alone.

Aged↗
PubMed1985

Treatment complications after sequential combination chemotherapy and radiotherapy with or without surgery in previously untreated squamous cell carcinoma of the head and neck.

One hundred consecutive patients with previously untreated advanced squamous cell carcinoma of the head and neck were treated with induction combination chemotherapy followed by definitive surgery and/or radiotherapy, and were evaluated for radiotherapy related toxicity. The induction regimen consisted of cisplatin, bleomycin and methotrexate/leucovorin. Acute toxicity consisted predominantly of mucositis and weight loss, and was mild or moderate by degree in 94% of patients. Six percent of patients experienced severe or life threatening acute toxicities. Two acute toxic deaths were noted in this series, one from a combination of mucositis, weight loss and infection and one from hypoglycemia of unknown origin. Thirty-five percent of patients had radiation treatment interrupted briefly because of acute toxicity. Toxicity was greatest in patients who were nonresponders to induction chemotherapy and such may have been related to the continued presence of advanced tumor. Radiotherapy dose, surgical intervention and age did not have an impact on the presence or degree of acute toxicity. Late toxicities included: hypothyroidism in 32% of patients tested: osteoradionecrosis in 5% of patients, associated primarily with a composite resection (4 of 5 cases); and soft tissue ulcerations in 3%. Taken together, these data indicate that induction combination chemotherapy did not significantly increase the toxicity of subsequent radiotherapy with or without surgery.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1979

Self-care.

Explore the source record for details and available documents.

Attitude to Health↗
PubMed1976

Current developments in bronchoscopy. The role of the flexible fiberscope.

The development and increasing use of flexible fiberoptic bronchoscopy has added immeasurably to the potential of diagnostic and therapeutic bronchoscopy. However, neither the flexible nor rigid (open tube) bronchoscope should be regarded as the "primary instrument", but the use of one or the other in the individual case should depend on relative indications. Ideally, bronchologists should be proficient with both rigid and flexible instruments; it is preferable that those experienced only in flexible bronchoscopy work in collaboration with those who are familiar with open tube bronchoscopy as well. In any case, the need for facility in management of airway obstruction, indirect and direct laryngoscopy, and proper administration of topical anesthetics to the larynx and tracheobronchial tree should be recognized. Indications, instrumentarium and technique, special applications, contraindications and complications of flexible bronchoscopy are reviewed.

Airway Obstruction↗
PubMed1975

Role and limitations of vertical hemilaryngectomy.

Two types of vertical hemilaryngectomy are discussed. The frontolateral operation is indicated for infiltrating lesions of the cord, anterior to the vocal process, which approach or involve the anterior commissure. It should not be used for carcinomas which extend posteriorly beyond the tip of the vocal process, into the ventricle or below the inferior surface of the cord. The "extended" frontolateral operation is useful for infiltrative cordal lesions showing (1) posterior extension to or beyond the tip of the vocal process, but not into the posterior commissure, (2) beginning impairment of motility without actual fixation of the cord, (3) limited and superficial extension to the ventricle or margin of the ventricular band, or (4) subglottic extension amounting to no more than a few millimeters. The lesions are removed en bloc, along with a large portion of the thyroid cartilage and usually the entire arytenoid. Accurate delineation of the gross extent of the lesion is essential if these techniques are to be successfully applied. Failures are likely if attempts are made to over-extend the indications.

Aged↗
PubMedDate not supplied

Desmoplastic squamous cell carcinoma of the tongue simulating myositis or fasciitis.

An unusual form of squamous cell carcinoma of the tongue is reported, the "de novo" submucosal evolution of which is unique. Histologic definition of this malignancy and its distinction from clinically similar benign and malignant conditions are detailed through a brief review of the relevant differential diagnoses. The importance of circumspect diagnostic reassessment when the clinical behavior of a lesion contradicts apparent histologic benignancy is emphasized and treatment inferences are drawn.

Adult↗