Biomedical subjects

E Robinson

Publications and source records attributed to E Robinson.

At least 145 records · Page 8Linked to original sources

PubMed1994

Visual function and long-term chloroquine treatment.

Ophthalmic examinations and selected tests of visual function were performed on 64 patients with rheumatoid arthritis who had received daily doses of 200 mg chloroquine sulphate for periods ranging from 3 to 11 months. Visual fields were determined by Humphrey automated perimetry and Amsler grids and a further battery of four tests of macular function (visual evoked potentials, critical flicker fusion threshold, Cambridge contrast sensitivity and the macular dazzle test) were administered. No case of retinal pigmentary abnormalities plus visual loss was found, but 2 patients were advised to cease chloroquine therapy on the basis of funduscopic findings. A small group of patients with relatively poor scores on one or more tests had normal visual fields and ophthalmic findings. There were no significant partial correlations between test results and the cumulative dose of chloroquine. These results support the opinion that currently recommended doses of chloroquine pose a minimal risk of retinal toxicity.

Adolescent↗

PubMed1993

[Hodgkin's disease in childhood--northern Israel cancer center experience, 1971-1990].

Records of children treated for Hodgkin's disease between 1971-1990 were analyzed retrospectively, and 102 cases of children younger than 18 years when diagnosed were reviewed. There were 54 boys and 48 girls, with male predominance in those younger than 10 years. 44 patients were of Arab ancestry and 58 were Jewish; the incidence was similar in both groups. Most common were the nodular sclerosing and mixed cellularity types, the latter more common in the younger age group. The outcome of various treatments was evaluated. At diagnosis, 64% were in stages I or II and 34% in stages III or IV. 20 of those in stages I-II received radiotherapy (RT) alone, 10 chemotherapy (CT) alone, and 35 combined CT and RT. Survival rates and median disease-free intervals were statistically similar with all 3 modalities. However, relapse rates were higher with either RT or CT alone (35% and 38%, respectively) than with combined therapy (14%). We conclude that combined CT and RT is superior to RT or CT alone.

Adolescent↗

PubMed1993

Prevalence of diabetes mellitus among the James Bay Cree of northern Quebec.

OBJECTIVE: To determine the prevalence of diabetes mellitus among the James Bay Cree in northern Quebec. DESIGN: Chart survey of physician-diagnosed cases of diabetes. The biochemical criteria of the World Health Organization were used to confirm the diagnoses. SETTING: Eight James Bay Cree communities: six remote and two rural. SUBJECTS: All James Bay Cree with diabetes whose names were in a chronic disease registry or on a diabetes clinic list kept at each community clinic. OUTCOME MEASURES: Prevalence rates, both crude and standardized to the 1986 Canadian population, were estimated by sex, age group and type of diabetes. RESULTS: A total of 235 cases of diabetes were confirmed, for a crude prevalence of 2.7%. The age-standardized rate of non-insulin-dependent diabetes mellitus was 6.6% among people 20 years and over. The prevalence increased as the latitude decreased. CONCLUSIONS: Our crude prevalence resembles that in similar native linguistic and cultural groups elsewhere in Canada. Diabetes is becoming an important disease in the Cree population of Quebec. A better understanding of the sociocultural changes in this population is necessary.

Adult↗

PubMed1993

Lung cancer after radiation therapy for breast cancer.

BACKGROUND: Radiation, including radiation therapy (RT) for a variety of conditions, is known to be a lung carcinogen. METHODS: Data from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute for 1973-1986 were utilized to investigate whether RT for breast cancer affects the risk of subsequent lung cancer. The relative risk was calculated by comparing the incidence rate in patients with irradiated breast cancer with that in those with nonirradiated breast cancer. RESULTS: It was found that the risk of lung cancer overall was increased in women who underwent irradiation compared with those who were not irradiated 10 years after the initial breast cancer diagnosis with a relative risk of 2.0 (95% confidence interval, 1.0-4.3). In addition, the risk of lung cancer was in the ipsilateral lung compared with the contralateral lung for irradiated women. This increase was observed after 10 years for lung cancer overall and for the three major histologic subgroups (small cell, squamous cell, and adenocarcinoma). Specific information on RT doses and treatment plans and cigarette smoking were not available. CONCLUSIONS: It was concluded that RT for breast cancer may increase the risk of lung cancer after a latency period of 10 years.

Adult↗

PubMed1993

Survival of first and second primary breast cancer.

BACKGROUND: A second primary tumor (SPT) in the breast is the most common one seen in clinical practice. There are conflicting reports regarding the incidence and survival of patients with SPT in the breast. METHODS: To elucidate this, data on 139,932 patients with primary breast cancer, reported to the Surveillance, Epidemiology, and End Results Program between 1973 and 1986, were analyzed. Of these, 3431 patients had a contralateral metachronous breast cancer (interval, > 6 months). RESULTS: Survival from the date of diagnosis of the metachronous breast tumors was compared with that of patients with single breast tumors, controlling for age at diagnosis, stage, race, and treatment. In the multivariate analysis, age and stage at diagnosis of first and second tumors were the only variables that significantly influenced survival. The survival of patients with localized SPT was similar to that of patients with a localized single breast tumor. Patients with regionally advanced SPT lived for a shorter time than did corresponding patients with only one tumor. CONCLUSIONS: Patients with single breast cancer were at increased risk of having a SPT in the breast. As a result, efforts for early detection by physical examination and mammography of survivors of single breast cancer are advocated because the survival of patients with a localized SPT in the breast is as good as that of those with a single localized tumor.

Age Factors↗

PubMed1993

The pattern of diagnosis of a second primary tumor in the breast.

One hundred and sixty-seven patients with metachronous bilateral breast cancer were diagnosed at the Northern Israel Oncology Center during the years 1950-1989. The group at high risk to develop a second breast tumor included Jewish women born in Europe whose first tumor was diagnosed when the patient was under the age of 55. The mean time interval between tumors was 88 months. Seventy percent of the patients were diagnosed within nine years of the diagnosis of the first tumor. The characteristics of the 27% of patients with single breast cancers who did not comply with follow-up recommendations were compared to those who did comply. Patients who were under follow-up had smaller tumor and less lymph node involvement. Nevertheless, their survival rate did not differ from those who did not keep their follow-up appointments. This was ascribed to the fact that follow-up procedures for many years used mainly clinical examination and this was not enough to decrease mortality. The diagnosis of non-palpable breast cancer by routine yearly mammography has proved to reduce mortality in patients over the age of 50 with single breast cancers. Therefore, yearly mammography of the contralateral breast in patients with single breast tumors must be done in order to increase the cure rate of contralateral breast cancer. Less patient delay in diagnosis was found before the diagnosis of the second tumor than in patients with a single tumor.

Adult↗

PubMed1993

Topical toremifene: a new approach for cutaneous melanoma?

The distribution of topically applied toremifene (0.5-1 mg/day for 5 days) in the ultraviolet B (UVB)-induced Monodelphis domestica opossum melanoma model was examined. The mean concentration of toremifene measured in the skin was 1200 nmol/g, or > 500 times that detected in any other tissues (blood, brain, liver, testicles, heart, uterus, eyes). In plasma, toremifene could be detected in only one animal of six (0.04 nmol/ml). Intraperitoneal administration of 0.5 mg toremifene daily for 5 days in three female animals resulted in a mean uterus concentration of 22.9 nmol/g, or 400-fold that achieved by topical administration of 0.5 mg/day in three other female Monodelphis (0.05 nmol/g). The cytostatic effect of toremifene was studied in three human melanoma cell lines and three experimental cell lines derived from UVB-induced melanocytic nevi in M. domestica. Toremifene had a cytostatic effect on all cell lines (50% growth-inhibitory concentrations, 5.8-9.6 microM). Topical toremifene administration yields high local concentration with minimal systemic distribution. In addition, toremifene has a cytostatic effect at achievable concentrations in a variety of melanomatous cell lines.

Administration, Topical↗

PubMed1993

In vivo modulation of natural killer cell activity by tamoxifen in patients with bilateral primary breast cancer.

Natural killer (NK) cell activity, the autologous mixed lymphocyte reaction (AMLR) and proportions of T cell subpopulations (CD3+/CD4+ and CD3+/CD8+) and NK cells (CD16+) were studied in 21 patients with bilateral primary breast cancer (BBC), 10 patients with single-breast cancer (SBC) and 20 healthy controls. All patients studied had no evidence of disease and had been off radiotherapy and/or chemotherapy for at least 1 year. Ten patients with BBC were also treated with tamoxifen. Patients with SBC had NK cell activity, AMLR responses and T cell subpopulations that were comparable to those of normal controls. In patients with BBC, a significant (P < 0.01) increase in NK activity compared to that in normal controls (42 +/- 13% versus 21 +/- 10%, effector-to-target cell ratio, 25:1) and a significant (P < 0.05) decrease in CD4+ T cell proportions (30 +/- 15% versus 49 +/- 13%) and absolute numbers (472 +/- 82/mm3 versus 953 +/- 131/mm3) were found. However, the proliferative response of BBC patients' T lymphocytes in AMLR was in the range of the normal controls. Lymphocytes derived from 10 BBC patients treated with tamoxifen exhibited NK cell activity that was comparable to that of normal controls and patients with SBC, and was significantly (P < 0.01) reduced compared to the pretreatment period. BBC patients who received tamoxifen also show a reduction in the proportion of CD4+ T cells and in AMLR proliferative responses, which decreased compared to levels in normal controls. Taken together, these results indicate that long-term tamoxifen treatment modulates immune responses in BBC patients.

Adult↗

PubMed1993

The multicentre transcervical balloon tuboplasty study: conclusions and comparison to alternative technologies.

Transvaginal tubal catheterization procedures have been suggested as an alternative to microsurgery and in-vitro fertilization (IVF) in the treatment of women with proximal tubal occlusion. A transcervical balloon tuboplasty (TBT) catheter was specifically developed and tested in a prospective multicentre trial. A total of 151 women with confirmed bilateral or unilateral tubal occlusion were studied. The primary study population included 106 women who, after exclusion of patients for protocol violations, represented those females who were treated for complete tubal occlusion with TBT. TBT is an ambulatory, minimally invasive catheter procedure, performed under paracervical block or mild sedation, which utilizes a co-axial balloon catheter under fluoroscopic guidance. Re-canalization, pregnancy and reocclusion rates following the procedure were documented. A total of 28 patients demonstrating uni- or bilateral tubal patency after either hysterosalpingography and/or selective salpingography represented the control population. TBT established tubal patency of at least one Fallopian tube in 95/106 patients (90%) and in 167/205 obstructed oviducts (82%). Clinical pregnancies occurred in 37/106 females (35%), with a life table adjusted rate of 37%. Patients without distal disease had significantly higher pregnancy rates than those with bipolar tubal disease (49% versus 12%, life table adjusted rate; P = 0.0002) but pregnancy rates were independent of underlying aetiology for tubal disease. Pregnancy rates in control patients who did not reach TBT because of tubal patency after hysterosalpingography and/or selective salpingography were significantly lower than in those successful treated with TBT (P = 0.027), and occurred only for four cycles after hysterosalpingography and with approximately a 1 year delay after selective salpingography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

A cost-effective alternative to air therapy bed rentals.

Rental products are often a large expense in healthcare institutions. Desert Samaritan Medical Center in Mesa, AZ, took a look at the equipment rental dollars being spent on air therapy beds to determine if a new approach could result in significant cost savings. They identified the potential purchase and in-house maintenance of air therapy devices as an opportunity to increase productivity and service levels while simultaneously reducing expenses. After conducting a thorough product evaluation of various products, the institution purchased four portable mattress replacement systems, four beds complete with air therapy, in-bed scales and dynamic blowers and continue to rent air-fluidized therapy beds on an as-needed basis. Duties for supplying, cleaning and maintaining the equipment were shared between Materials Management, Patient Transport, Environmental Services, Clinical Engineering and Plant Services and Nursing. The hospital has realized a $90,000 expense reduction as a result and improved patient outcomes.

Arizona↗

PubMed1993

Descriptive epidemiology of non-insulin-dependent diabetes mellitus in the James Bay Cree population of Quebec, Canada.

In July 1989, 230 non-insulin-dependent subjects were identified in the James Bay Cree population through medical chart review of physician diagnosed diabetes mellitus cases. Data extracted from the medical files included type and rate of complications, life-style, anthropomorphic and metabolic descriptors as well as clinical care practices. Mean age at diagnosis was 48.3 years and mean duration of illness at time of study was 60.4 months. Furthermore, 77.3% were overweight and 65.4% obese. Microvascular disease (diabetic nephropathy or retinopathy) was the most frequent group of complications (19.6%). Moreover, 76.4% of the Cree diabetics showed poor glycemic control. Diet combined with oral hypoglycemic medication was the current treatment of choice. A medical practice profile was produced in order to provide a comparison basis with recommended baseline care. Diabetes is becoming a major illness in the native population of Canada. Health promotion strategies are of some urgency in order to contribute to the control of diabetes.

Adult↗

PubMed1992

[Familial breast cancer in Arabs].

500 surviving Arab cancer patients in follow-up were interviewed with regard to other cases of cancer in their families. Among 73 who had breast cancer, in 15 (20.3%) there was another case of breast cancer among first-degree relatives. The incidence of both primary and familial breast cancer was higher among Christian than among Moslem women. We conclude that Arab women with breast cancer in their families are at high risk for developing breast cancer themselves.

Breast Neoplasms↗

PubMed1992

[Primary breast cancer: conservation therapy].

A series of 200 patients with primary breast cancer, treated with breast conservation between 1981 and 1988, was analyzed retrospectively. The mean age was 54 +/- 14 years and mean follow-up 36 months. 58 patients (29%) were in pathological Stage I, 85 (42.5%) in II A, 34 (17%) in II B, and 7 (3.5%) in III. 16 (8%) were in clinical Stages I-II; 40 (20%) had multifocal tumors and 40 intraductal components. 45% of the lesions were excised with good margins, 13.5% with close margins (0.5 cm), 9% with microscopic residual, 4% with macroscopic residual and in 57 (28.5%) margins could not be determined. Level II axillary lymph node dissection was performed in 193 (96.5%). Adjuvant therapy (combined chemotherapy and/or hormones) was given to 105 (52.5%). Radiotherapy usually consisted of 50 GY tangential photon irradiation to the whole breast in 25 fractions. Electron or photon boost to the tumor bed was given to 112 (59%). Most patients received 20 GY, and most node-positive patients 50 GY to the lymphatic drainage. 69% tolerated combined radiotherapy-chemotherapy well and radiotherapy did not have to be interrupted. A year after completion of radiotherapy the cosmetic result was rated as good in 166/173 (96%) and fair in 7 (4%); there were no poor ratings. 11 (5.5%) developed breast recurrence and 5 (2.5%) supraclavicular or axillary lymph node metastases. 1 (0.5%) developed local recurrence and supraclavicular lymph node metastases simultaneously. 50 (10%) developed distant metastases, of whom 2 developed loco-regional recurrences simultaneously.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

Diversity in fine specificity and T cell receptor usage of the human CD4+ cytotoxic T cell response specific for the immunodominant myelin basic protein peptide 87-106.

Multiple sclerosis (MS), a human demyelinating disease, is thought to be caused by an autoimmunologic process, and myelin basic protein (MBP) is considered a likely autoantigen. Studies of T cell lines (TCL) responding to different parts of the MBP molecule have indicated that amino acids 87 through 106 contain an immunodominant epitope of MBP. We have demonstrated previously that amino acids 89 through 99 represent the core of this 87-106 peptide epitope. Importantly, this epitope is not only encephalitogenic in SJL/J mice and Lewis rats but also has been shown to be recognized by human cytotoxic TCL in the context of four HLA-DR molecules that are associated with MS in different geographic areas. If the immune response to MBP peptide 87-106 was homogeneous with respect to epitope specificity and TCR usage, specific immunotherapies targeting the interaction of peptide, MHC, and TCR might be possible. In this study, the fine specificity of 29 CD4+ cytotoxic, long term, and limiting dilution TCL that had been generated against whole MBP and were derived from four MS patients and two healthy relatives was dissected using truncated and alanine-substituted peptides for the 87-106 peptide. In addition, the TCR alpha and beta chain usage of 15 CD4+ TCL was determined. Using truncated peptides, the presence of several nested immunogenic epitopes within amino acids 87 to 106 was demonstrated. TCL with identical restriction elements and similar responses to truncated peptides could be differentiated further using alanine-substituted peptides. Finally, heterogeneity of TCR usage was shown not only for those lines that differed in their peptide specificity but also for some that showed identical responses and were restricted by the same HLA-DR antigen. In conclusion, the CD4+ cytotoxic T cell response to the immunodominant MBP peptide 87-106 demonstrates a high degree of heterogeneity at the level of fine specificity and TCR usage. These findings indicate that specific immunotherapies aimed at TCR in MS will probably be more complicated than previously anticipated.

Adult↗

PubMed1992

A comparison of the clinical characteristics of second primary and single primary sarcoma: a population based study.

The clinical characteristics of 240 patients with sarcoma as a second metachronous primary neoplasm (SPN) were compared with those of 8,815 patients with sarcoma as a single tumor. The data were obtained from patients registered during the period 1973-1986 in the Surveillance, Epidemiology and End Results (SEER) Program in the United States. Seventy-four of the 240 SPN patients had postirradiation sarcoma (PIS) while the other 153 patients developed the sarcoma as a second tumor in an area which was not exposed to prior radiotherapy (non-PIS). The stage of disease at diagnosis was more advanced in patients with PIS than in those with single sarcomas but the difference did not reach statistical significance. Overall, in comparable clinical stage localized and regional disease there was no statistically significant difference in survival between PIS and non-PIS sarcoma patients after adjusting for age. The survival of patients with localized or regionally advanced sarcoma as a second tumor was significantly worse than of those with single sarcomas with the same stage. There was no difference in survival between first or second sarcomas with metastatic disease.

Adolescent↗

PubMed1992

Salvage therapy for non-Hodgkin's lymphoma with a combination of dexamethasone, etoposide, ifosfamide, and cisplatin.

A total of 30 consecutive patients with refractory or relapsing non-Hodgkin's lymphoma (NHL) were treated with a combination of dexamethasone, etoposide (VP-16), ifosfamide, and cisplatin (DVIP). In all, 9 subjects (30%) showed a partial response and 10 (33%) achieved a complete response (CR) lasting from 2.5 to 24+ months. Aggressive histology, no prior therapy with VP-16, a CR to previous chemotherapy, and a treatment-free interval of greater than 6 months prior to the present study were associated with the high CR rate. DVIP caused pronounced myelosuppression (median granulocyte nadir and median platelet nadir, 380/mm3 and 73.000/mm3, respectively), but no drug-related death occurred. We conclude that DVIP is an effective salvage combination, especially in aggressive NHL, that produces acceptable toxicity.

Adult↗

PubMed1992

Clinical, demographic, and follow-up characteristics of patients with two primary metachronous tumors, one of them being in the colon.

The clinical characteristics of 152 patients diagnosed with two primary metachronous tumors--one or both of them in the colon--were studied. Nineteen patients had both primary tumors in the colon (Group I), 59 had the first primary tumor in the colon and the second tumor elsewhere (Group II), and 74 had the second primary tumor in the colon and the first primary tumor elsewhere (Group III). The group in which the second primary tumor was in the colon included significantly more female patients than did the other two groups, with a younger median age at diagnosis of first tumor. The median time interval between the two primary tumors was 44, 57, and 62 months in Groups I, II, and III, respectively. The number of clinic visits during the year before diagnosis of the second primary was similar in all groups, but only 60 percent of the patients kept their follow-up appointment. In most instances, the diagnosis was made after the patients' symptoms, although only a small percentage of the second primary tumors (15-30 percent) were diagnosed during routine follow-up. The second primary tumor occurred in the field of radiotherapy of the first primary tumor in 27 of 35 patients who received radiotherapy. To increase the number of patients diagnosed in an earlier stage of disease, they should be urged to keep their follow-up appointment, and physicians following patients with single tumors should be aware of the increased likelihood of a second tumor. To increase the cure rate of those tumors, efforts toward early diagnosis are warranted. This includes physical examination and mammography to detect breast cancer in women, annual occult blood tests and rectal examination, and sigmoidoscopy or colonoscopy at three-year intervals to detect colon cancer early.

Aged↗

PubMed1992

Denture base resins: comparison study of color stability.

Several denture base resins have been recently introduced that provide easier or faster processing. Although these materials have adequate strength properties, the color stability is also of interest. This study evaluated the color stability of five denture base acrylic resins and one denture base repair resin. The samples were subjected to conditions of accelerated aging to test color stability. Five samples of each material were processed and aged for 100 and 300 hours. The color stability was quantitatively measured using the Minolta Chroma Meter II. Color measurements were made before weathering and at 100 and 300 hours the color difference delta E was calculated for all samples. At 300 hours the color change of the materials was significantly different at p less than 0.01. It was found that: (1) the color of Lucitone Hy-pro and Acron was least affected by conditions of accelerated aging; (2) Triad, Accelar 20, and Perm demonstrated noticeable color changes; and (3) Compak-20 had an appreciable color change and was the least color-stable of the materials tested.

Acrylic Resins↗