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Biomedical subjects

D Cunningham

Publications and source records attributed to D Cunningham.

355 records · Page 20Linked to original sources
PubMedDate not supplied

Decrease in clonogenic tumour cells in bone marrow aspirates from multiple myeloma patients due to the incorporation of cyclophosphamide into treatment with vincristine, adriamycin and methyl prednisolone.

A study of 32 patients receiving cyclophosphamide (CY) and verapamil (VER) in addition to the drug combination vincristine, adriamycin and methyl prednisolone (VAMP) was made in which the clinical response and growth of clonogenic myeloma cells (MY-CFUc) from bone marrow aspirates were compared. At presentation, MY-CFUc were grown from 72 per cent (23/32) of the patients. After treatment with CY-VAMP or VERCY-VAMP, MY-CFUc were grown from 25 per cent (8/32) of patients of whom only 50 per cent responded clinically. The overall clinical response rate for patients receiving CY-VAMP and VERCY-VAMP was 64 per cent (9/14) and 72 per cent (13/18) respectively of whom 14 per cent in each group achieved complete remission. There was no concomitant increase in normal tissue toxicity as measured by granulocyte-macrophage colony (GM-CFUc) formation. Comparison of these data with our previous study of patients receiving VAMP alone, suggests that the addition of CY to the regimen may increase the tumour cell kill. Further clinical studies will determine whether there is a significant increase in the complete remission rate.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

CT evaluation of the resectability of gastric cancer postchemotherapy.

BACKGROUND: To determine the accuracy of CT in the postchemotherapy assessment of resectability of gastric cancer. METHODS: Thirty patients deemed to have unresectable gastric cancer on CT were studied. This was verified at laparotomy in 10 of these patients. Following initial assessment, all received three to eight cycles of chemotherapy aiming for disease control and potential resection. Serial CT examinations, endoscopy, and biopsy were performed after the fourth, sixth, and eighth cycle of treatment. The primary tumor and lymph nodes seen on CT were compared with operative findings. RESULTS: After completion of chemotherapy, CT findings were correct in 23 patients. Fourteen of them had operable tumors and nine were inoperable. However, the CT findings were either equivocal or incorrect in the remaining seven patients. CONCLUSION: Chemotherapy is now able to downstage a previously inoperable gastric cancer, and CT is an accurate method in identifying those patients who can proceed to resection.

Adenocarcinoma↗
PubMedDate not supplied

4-Hydroxyandrostenedione treatment for postmenopausal patients with advanced breast cancer.

We have treated 128 postmenopausal women with advanced breast cancer with 4-hydroxyandrostenedione. Of these, 118 were assessable for toxicity and 100 for response to treatment. Response to therapy was seen in 34% of patients and stabilization of disease in 12 patients. Three dose regimens were used (500 mg intramuscularly weekly; 250 mg intramuscularly every 2 weeks; and 500 mg orally daily). There was no difference in response in these three groups. Side effects were minimal and local reaction to injected drug was seen in 13% of patients. The sole severe side effect observed was neutropenia which was transient and reversible on discontinuing therapy. 4-Hydroxyandrostenedione is an effective nontoxic agent in the treatment of breast cancer.

Administration, Oral↗
PubMedDate not supplied

Evaluation of clinical efficacy of new medical treatments in advanced colorectal cancer. Results of a workshop organized by the EORTC GITCCG. European Organization for Research and Treatment of Cancer. Gastrointestinal Tract Cancer Cooperative Group.

During the last few years several factors have contributed to an increasing change in the medical treatment of advanced colorectal cancer. Among them are the more general acceptance of the impact of chemotherapy on quality of life and survival in first as well as in second-line treatment, the introduction of new drugs and the definition of novel endpoints which can roughly be defined as "patient benefit". For this reason the European Organization for Research and Treatment of Cancer (EORTC) Gastrointestinal Tract Cancer Cooperative Group (GITCCG) felt it was appropriate to organize a workshop with experts from different countries and national groups to discuss in depth several aspects concerning the treatment of patients with advanced colorectal cancer.

Clinical Trials as Topic↗
PubMedDate not supplied

The challenge for medicine.

The biggest challenge for clinicians is their relationship with patients and the public. As knowledge and technical possibilities have advanced, there is evidence that the healthcare system is falling down in the more mundane aspects of healthcare. What has gone wrong with healthcare? Four published case studies are discussed. The government and the General Medical Council are determined to put the patient at the centre of healthcare. Examples of what this means are given from the NHS Plan, the Duties of a Doctor and recommendations from a Leeds Castle healthcare symposium. The changes involved are articulated from clinicians' perspectives and the patient perspective draws on recent publications documenting three (journalist) patients' experiences. Professionals will have to be trained more with the patient in mind. Allegiances will be to patients and teams rather than institutions and teams must be clearly accountable. We are ready.

Aged↗
PubMedDate not supplied

Government directives and changes: the potential impact on clinical practice.

Since publication of The new NHS: modern, dependable we have had more guidance and circulars from central government than have ever before been received in such a short space of time: 242 in 1998 and already well over 100 in 1999. Furthermore, 'joined-up government' may not have been achieved yet, but it certainly means that all agencies are being changed or modernised simultaneously, and so are all in the same position. This paper examines the impact that some of these directives and changes may have on clinicians and clinical practice. The paper does not deal with the issue of setting up primary care groups (PCGs), which could form the basis of an article on its own.

Delivery of Health Care↗