Cardiovascular health in men attending for abdominal aortic aneurysm screening.
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Age Factors↗
Biomedical subjects
F Sheehan
Publications and source records attributed to F Sheehan.
Limited stage small cell lung cancer.
The management of limited stage small cell lung cancer begins with a firm pathologic diagnosis and careful staging. Patients with adequate pulmonary function, ambulatory performance status, and no evidence of metastatic disease outside a "tolerable" local radiotherapy volume should have consultation from both medical and radiation oncology disciplines for planning of integrated therapy. The chemotherapy prescription recommended is cisplatin plus etoposide at standard doses for four chemotherapy cycles. Thoracic irradiation should be administered concurrently with the first or second cycle of cisplatin and etoposide. Patients with complete response and excellent partial response should receive prophylactic cranial irradiation after completion of all chemotherapy.
Antineoplastic Combined Chemotherapy Protocols↗
Morphologic features of the rheumatic mitral regurgitant valve by three-dimensional echocardiography.
BACKGROUND: Rheumatic fever remains a significant worldwide cause of mitral regurgitation (MR). We describe morphologic features of the rheumatic MR valve by quantitative 3-dimensional (3D) echocardiography. METHODS: Eight healthy subjects and 16 patients with less than moderate (n = 7) or more than or equal to moderate (n = 9) rheumatic MR underwent 3D echocardiography by use of freehand transthoracic scanning. Left ventricular (LV) borders, mitral chordae, papillary muscles and annuli were traced at end-diastole (ED) and end-systole (ES) with LV surfaces and mitral annulus reconstructed in 3D. Regional LV function was quantified by myocardial thickening. Regional LV shape was assessed by alignment of diseased ED endocardial surfaces to a reference normal surface. RESULTS: In the diseased group, LVs were more spheric and had regional shape abnormality in the area of anterior papillary muscle attachment. LV volumes, ejection fraction, and regional function in the areas of papillary attachment were not different. Mitral annular length and area were increased and correlated with LVED volume but were no different in height, sphericity, or beat-to-beat deformity. Chordal and papillary muscle lengths were not reduced. The interchordal angle (between the anterior and posterior chordae) was more acute in MR. CONCLUSION: Alterations in LV geometry and mitral apparatus morphologic features contribute to rheumatic regurgitant disease. Consequent changes include malalignment of the papillary muscles and a narrowed interchordal angle that is opposite to the widening seen in MR from dilated cardiomyopathy. We hypothesize that leaflet involvement with retraction causes increased tension on the chordae, a reduction in the interchordal angle, and a consequent coaptation defect.
Adolescent↗
Measurement of right ventricular mass and volume by three-dimensional echocardiography by freehand scanning.
OBJECTIVE: Three-dimensional echocardiography (3D echo) by freehand scanning provides highly accurate measurements of left mass & volume using the piecewise smooth subdivision surface reconstruction method. The complexity of right ventricular (RV) geometry presents a challenge in accurate 3D assessments of its physical parameters. The authors measured the accuracy of their 3D echo technology in measuring RV mass and volume. METHODS: From 10 bovine hearts, the freewall mass and endocardial volume were measured. The hearts were imaged by 3D and the RV contours were manually traced. The endo- and epicardial surfaces were reconstructed. RV volume and mass from the reconstructions were compared to true measurements. RESULTS: 3D echo RV volume overestimated true volume (y=1.2x, r=0.998, SEE=3.2 ml, p<0.001), over a range of volumes (14-62 ml). The mean overestimation of RV volume by 3D echo was 6.2 ml, or 15.8% of the mean true volume. 3D echo mass agreed well with RV mass (y=1.0x, r=0.996, SEE=4.5 g, p=0.031) over a range of 47 to 79 g. Mean difference between 3D and true mass was 3.4 g, or 5.4% of the mean true mass. CONCLUSION: RV mass and volume can be measured accurately from 3D echocardiograms acquired using freehand scanning and reconstruction by the piecewise smooth subdivision method.
Animals↗
New combination of the old drugs for elderly patients with small-cell lung cancer: a phase II study of the PAVE regimen.
PURPOSE: A regimen of cisplatin, doxorubicin, vincristine, and etoposide (PAVE) was designed for patients with small-cell lung cancer (SCLC) who were older than 65 years, with the following objectives compared with standard chemotherapy regimens: maintain efficacy, diminish toxicity, enhance compliance, and improve chemotherapy administration convenience at an acceptable cost. PATIENTS AND METHODS: The PAVE regimen consisted of cisplatin 30 mg/m2 intravenously (i.v.) day 1; doxorubicin 40 mg/m2 i.v. day 1; vincristine 1.0 mg/m2 i.v. day 1; and etoposide 100 mg/m2 i.v. day 1 and orally days 3 and 5. Cycles were repeated every 3 weeks for four cycles. Patients with limited-stage disease and selected patients with extensive-stage disease received thoracic irradiation delivered concurrently with etoposide-cisplatin (EP) at the time of the second chemotherapy cycle. RESULTS: Sixty-six eligible patients were treated, which included 25 patients with limited-stage disease and 41 patients with extensive-stage disease. Median survival was 70 weeks and 5-year survival was 25% for limited-stage disease. Median survival was 46 weeks for extensive-stage disease. Only one treatment-related death occurred and severe toxicity was infrequent. The median delivered dose-intensity was according to protocol and the mean delivered total dose was 80% of intended. CONCLUSION: The treatment outcome achieved with PAVE in a phase II study of elderly patients compared favorably with published results of standard regimens in patient populations with better prognostic factors. Because the PAVE regimen can be delivered with good compliance, has acceptable toxicity, and is associated with logistic advantages compared with standard regimens, this protocol is suitable for further investigative trials in elderly patients with SCLC.
Age Factors↗
The use of radiologically placed gastrostomy tubes in head and neck cancer patients receiving radiotherapy.
PURPOSE: Patients undergoing radiotherapy to the head and neck area frequently experience radiation reactions that can markedly restrict oral intake, require hospitalization, and occasionally cause treatment interruptions. The Vancouver Cancer Center (VCC) has recently employed radiologically placed gastrostomy tubes (G-tubes) in the management of this problem. A review of the patients on whom this procedure had been performed is the subject of this review. METHODS AND MATERIALS: Thirty-four patients had gastrostomy tubes inserted under radiologic guidance. This group is compared to a control group matched for age, sex, irradiated volume, and radiation dose, who did not have gastrostomy tubes. Patients with gastrostomy tubes were divided into two categories: (a) patients who had tubes inserted in anticipation of severe reactions, and (b) patients who developed severe radiation reactions necessitating nutritional support. RESULTS: The gastrostomy group consisted of 65% males with an average age of 59 years and stage range of II (12%), III (24%), and IV (65%). In both the elective group and the nonelective group, patients maintained their weight at 95 to 97% of the pretreatment weight, at follow-up of 6 weeks and 3 months. This compared with an average weight loss in the control group of 9% at 6 weeks and 12% at 3 months. The length of hospitalization was a mean of 4.9 days in the elective group and 19 days in the nonelective group. Complication were low compared to those documented in the literature, but included two tube migrations, two aspirations, and one gastrointestinal bleed. CONCLUSIONS: We believe that gastrostomy tubes contribute significantly to the management of patients with head and neck cancer, particularly in maintanence of nutrition, and they may decrease the need for hospitalization.
Enteral Nutrition↗
A phase II study of delta-9-tetrahydrocannabinol for appetite stimulation in cancer-associated anorexia.
PURPOSE: To evaluate the appetite-stimulating properties of delta-9-tetrahydrocannabinol (THC) in patients with anorexia due to advanced cancer. PATIENTS AND METHODS: Nineteen patients with various malignancies were entered. All had cancer-associated anorexia and a life expectancy greater than four weeks. Patients were started on THC 2.5 mg p.o. t.i.d. one hour after meals for four weeks. Evaluations for side effects, efficacy, acceptability and satisfaction were conducted at two and four weeks. RESULTS: 18 patients were evaluable. Ten patients completed the entire 28-day study. Four patients experienced grade I toxicity and three withdrew at their request. Thirteen patients reported an improved appetite. CONCLUSION: THC is an effective appetite stimulant in patients with advanced cancer. It is well tolerated at low doses. Further studies are needed to determine the most appropriate dose and the specific population most likely to respond.
Administration, Oral↗
Significance of defect severity in technetium-99m-MIBI SPECT at rest to assess myocardial viability: comparison with fluorine-18-FDG PET.
UNLABELLED: The pathophysiological significance of 99mTc-MIBI uptake at rest for assessing myocardial viability in patients with coronary artery disease (CAD) is still controversial. Therefore, we studied the relationship of 99mTc-MIBI uptake at rest and preserved or absent uptake of 18FDG as assessed with PET in 111 consecutive patients after overnight withdrawal of their antianginal medication. METHODS: Each ventricle was evaluated in 13 segments derived from 25 regions of interest (ROIs) in short-axis cuts and 18FDG uptake was normalized to the intraindividual normal reference ROI (ROI with maximal = 100% 99mTc-MIBI uptake). Segments with a normalized 18FDG uptake > 70% were defined as viable while segments with a 18FDG uptake < 50% were defined as nonviable. RESULTS: Five to 11% of segments with 99mTc-MIBI uptake at rest < or = 30% of peak activity were viable and 80%-84% nonviable. Of moderate to severe 99mTc-MIBI defects at rest (31%-70% of peak), 13%-61% were viable. Segmental 99mTc-MIBI uptake and normalized 18FDG uptake were linearly correlated (r = 0.61, n = 1443, p < 0.001). In segments revealing severely reduced 99mTc-MIBI uptake (< or = 50% of peak) the correlation was considerably lower (r = 0.44, n = 295, p < 0.001). CONCLUSIONS: In patients with CAD, 99mTc-MIBI uptake underestimates myocardial viability in comparison to 18FDG-PET. Myocardial 99mTc-MIBI uptake therefore appears to reflect myocardial blood flow rather than myocardial viability. Patients with moderate and severe 99mTc-MIBI defects at rest may benefit from additional metabolic PET imaging prior to final therapeutic decisions.
Adult↗
Hepatocellular carcinoma in idiopathic haemochromatosis.
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Carcinoma, Hepatocellular↗
Scintigraphic quantification of myocardial necrosis in patients after intravenous injection of myosin-specific antibody.
The Fab fragments of antimyosin antibodies, labeled with 99mTc, were used in the scintigraphic examination of 30 patients with myocardial infarction. The ability to detect necrosis and determine its extent from the antimyosin scan were compared with the results of quantitative regional wall motion analysis by contrast ventriculography at 10 to 14 days and 99mTc-pyrophosphate imaging. Antimyosin images recorded by planar and single photon-emission computed tomography (SPECT) delineated areas of myocardial necrosis in 27 of 30 patients (90%) compared with a 91% sensitivity of pyrophosphate in 21 of 23 patients. Infarct size was determined by both antimyosin and pyrophosphate SPECT images. Results by both techniques showed a significant correlation with computer-derived hypokinetic segment length (r = .79 for both, p = .002) and peak creatine kinase (r = .9 for both, p less than .01). Although sensitivity for and correlations with markers of necrosis were similar with both techniques, infarct size by pyrophosphate SPECT was 1.7 times larger than infarct size by antimyosin SPECT (p less than .01). Certain zones in the infarct area were differentially labeled; the nature and irreversibility of injury within these zones remains to be clarified.
Antibodies↗
Coronary anatomy and left ventricular function in the first 12 hours of acute myocardial infarction: the Western Washington Randomized Intracoronary Streptokinase Trial.
The relationships among clinical variables, coronary anatomy, and left ventricular function during the early hours of acute myocardial infarction (AMI) were evaluated from data acquired in the Western Washington Intracoronary Streptokinase Trial. All patients had symptoms and electrocardiographic changes typical of AMI. All data were obtained before treatment with streptokinase. Mean time to catheterization was 4.1 hr after onset of symptoms. Coronary angiograms (n = 245) were analyzed for location of infarct-related occlusion and collateral flow to the infarct bed. Left ventricular ejection fraction and regional left ventricular function were quantitated in 227. Sixty-two percent of occlusions were in the most proximal segment of the involved coronary artery. Collateral circulation was seen in 42% overall, in 31% with left anterior descending artery (LAD) occlusion, and in 52% with right coronary artery (RCA) occlusion (p less than .005). Left ventricular ejection fraction was lowest and regional function was most abnormal in the group with proximal LAD occlusion. Hyperkinesis was present in 32%; in those with hyperkinesis, hyperkinetic segment length was longest in those with RCA or circumflex occlusion. Multivariate analysis identified proximal LAD occlusion as the factor most closely associated with left ventricular ejection fraction and with measures of left ventricular regional hypofunction. We conclude that (1) AMI is usually caused by occlusion or subtotal occlusion in the most proximal portion of the involved coronary artery, (2) collateral circulation is more frequent with RCA than with LAD occlusion, and (3) location of the infarct-related occlusion is the most important determinant of global and regional left ventricular function in the early hours of AMI.
Aged↗
Descending venography.
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Catheterization↗
Descending venography.
Patients with chronic venous insufficiency may have a combination of problems. The veins in the lower extremity can be affected by post phlebitic changes, obstruction, venous valvular incompetence or any mixture of these. Correct medical and/or surgical treatment hinges on the accurate assessment of the venous system. Complete studies of the lower extremity should incorporate ascending and descending venography as well as the clinical presentation. The methods described above easily enable one to achieve this accuracy with a minimal of time and discomfort to the patient. The incidence of primary venous valvular incompetence, may be higher than first anticipated and only by performing descending venography will this cause chronic, venous insufficiency to be unmasked. When employed in the appropriate patient, descending venography is an invaluable asset to diagnosis and ultimate treatment.
Adult↗
Assessing postpartum adjustment. A pilot study.
Utilizing crisis theory, the stages of growth and development, and a theory of role transition and enactment, a series of questionnaires was developed as a clinical tool to study women's adaptation to motherhood during six weeks postpartum. The tool was tested on six women. Results suggest that the postpartum is indeed a critical period of identity reformation and role transition. Theories are developed for a framework, and a timetable for nursing intervention is given.
Adaptation, Psychological↗