Search PubMed⌕ Search

Biomedical subjects

H Anderson

Publications and source records attributed to H Anderson.

At least 91 records · Page 5Linked to original sources
PubMed1998

Restenting malignant oesophageal strictures.

BACKGROUND: Self-expanding metal stents are used to palliate malignant strictures of the oesophagus. This study was designed to identify the characteristics of patients requiring restenting of malignant oesophageal strictures. METHODS: Fifty-three stents were inserted in 42 patients. Thirty-two patients did not require further stenting (once-stented group). Ten patients received second stents for recurrent oesophageal obstruction (restented group), with one patient requiring restenting a second time. Comparisons were drawn between the once-stented and restented groups with regard to survival, patient, tumour and procedural characteristics. RESULTS: There were no significant differences with regard to tumour grade, tumour type, involvement of the cardia, procedural difficulties or the need for postprocedural oesophageal dilatation between the two groups. Survival from initial stenting was significantly greater in the restented group (median 24 (range 4-43) weeks) than in the once-stented group (median 9.5 (range 1-84) weeks) (P < 0.05). The mean length of stents used in the once-stented group was significantly greater than that of the initial stents used in the restented group (12 versus 10 cm, P = 0.032). CONCLUSION: Inserting a covered stent through a previously inserted uncovered stent is an uncomplicated and well tolerated technique which maintains palliation from obstructing oesophageal carcinoma. The need for restenting cannot be predicted on the basis of tumour characteristics alone.

Adenocarcinoma↗
PubMed1998

Determining anatomic injury with computed tomography in selected torso gunshot wounds.

BACKGROUND: Changes in the management of torso gunshot wounds (TGSWs) have evolved in recent years as a result of differences between military and civilian injuries and increasing interest in avoiding nontherapeutic invasive procedures. The objective of this study was to establish the utility and accuracy of computed tomography (CT) in the evaluation of selected patients with TGSWs. METHODS: Retrospective review for a 6-year period of patients who sustained TGSWs and underwent CT solely for the purpose of trajectory determination. Patients had complete physical examinations and plain radiographic evaluations by a dedicated group of in-house trauma surgeons. When trajectory was indeterminate after evaluation, CT was performed. In some cases, CT was used when trajectory was determined to be intracavitary but organ injury was believed to be unlikely or amenable to nonoperative management. RESULTS: Fifty TGSW patients underwent 52 computed tomographic scans. Abdominal/pelvic CT was performed in 37 patients, and thoracic CT was performed in 15 patients. All patients were stable and none sustained complications attributable to CT or delay in therapy. Twenty of 37 abdominal/pelvic computed tomographic scans excluded transabdominal or pelvic trajectory. Seventeen of 37 scans proved transabdominal or pelvic trajectory; nine laparotomies were performed, and eight patients were observed. Nine of 15 thoracic computed tomographic scans excluded transmediastinal trajectory. Six of 15 scans suggested vascular proximity and prompted further workup, which was positive in two cases. CONCLUSION: CT of selected TGSW patients is safe and may reduce the incidence of invasive diagnostic procedures. A prospective evaluation of CT for TGSW patients is warranted.

Abdominal Injuries↗
PubMed1998

Three into one will go! Collaborative practice in practice.

This paper is concerned with three speech and language therapy services from neighbouring NHS trusts and the single education authority they all share. The authors have always been committed to working collaboratively with local services but found the competitive health care environment of the late 1980s and early 1990s often-made this difficult. It describes how the three services came together to identify common service issues for children of school-age with speech and language difficulties and how these were addressed.

Age Factors↗
PubMed1998

Dose intensity in small cell lung cancer.

Evidence from preclinical models and from clinical trials describing the importance of dose intensity in securing a better treatment outcome is reviewed. Recent randomized trials have shown statistically significant survival benefits with higher-dose, accelerated chemotherapy regimens with and without granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor. The novel use of peripheral blood progenitor cells contained in whole blood autotransfusions, which allow a marked increase in dose intensity of an ifosfamide/carboplatin/etoposide regimen, could provide a much easier method of delivering dose-intensive chemotherapy than previously available.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1998

Blood transfusion at delivery and risk of subsequent malignant lymphoma in the mother.

BACKGROUND AND OBJECTIVES: Blood transfusion has been shown to be a risk factor for non-Hodgkin's lymphoma (NHL). MATERIALS AND METHODS: In a cohort of 77,928 women with bleeding complications at delivery in the period of 1973-1986, subsequent NHL cases were identified and the number was compared with the number expected from national incidence rates. In a case-control study the proportion of transfused NHL cases was compared with the proportion of transfused controls. RESULTS: The observed number of NHL in the cohort was 18 versus 22.0 expected. Information on transfusion was obtained for 15 of the NHL cases and none (0%) was transfused versus 32 out of 136 controls (23%). CONCLUSIONS: Blood transfusion at delivery is not a risk factor for NHL. The immune tolerance induced by pregnancy may reduce the risk of NHL associated with the transfusion of allogeneic blood cells.

Adult↗
PubMed1998

Never on a Saturday (or a Sunday): the case against using weekend urine specimens to assess arsenic exposure.

The Wisconsin Department of Health and Family Services Bureau of Public Health recently investigated two cases of suspected arsenic poisoning. These cases involved four adults whose urinary arsenic levels ranged from 340 to 1485 ug/L (normal 0-30 ug/L). These findings were initially interpreted as evidence of an ongoing exposure to a toxic form of arsenic, however follow-up investigations determined that all of the urine specimens had been collected on a weekend and that each of these individuals had consumed fish within 48-hours of urine collection. Most of the fish was consumed at "Friday night fish fries" which are a popular tradition at many local restaurants. Urine samples collected after these individuals eliminated fish from their diets contained normal arsenic levels. This report suggests the need for laboratories to differentiate non-toxic forms of arsenic that are present in fish and seafood products from other species of this element. Until more specific analytical methods become available, patients should be instructed to omit fish and seafood from their diets for several days prior to collecting urine for arsenic analysis. In addition, elevated urinary arsenic levels should be interpreted cautiously and exposure to toxic forms should be confirmed before a diagnosis of arsenic poisoning is entertained.

Adult↗
PubMed1997

Femoral complications and bed rest duration after coronary arteriography.

This randomized study using a pneumatic compression device found no significant difference in the femoral complication rate between 4 and 6 hours of bed rest after Judkin's coronary arteriography. The positive implications for the organization of an efficient service in busy tertiary centers include reduced patient discomfort, earlier ambulation and discharge, efficient staff deployment, and enhanced throughput.

Adult↗
PubMed1997

Surveillance for silicosis, 1993--Illinois, Michigan, New Jersey, North Carolina, Ohio, Texas, and Wisconsin.

PROBLEM/CONDITION: Silicosis is an occupational respiratory disease caused by the inhalation of respirable dust containing crystalline silica. Public health surveillance programs to identify workers at risk for silicosis and target workplace-specific and other prevention efforts are currently being field-tested in seven U.S. states. REPORTING PERIOD COVERED: Confirmed cases ascertained by state health departments during the period January 1, 1993, through December 31, 1993; the cases and associated workplaces were followed through December 1994. DESCRIPTION OF SYSTEMS: As part of the Sentinel Event Notification System for Occupational Risks (SENSOR) program initiated by CDC's National Institute for Occupational Safety and Health (NIOSH), development of state-based surveillance and intervention programs for silicosis was initiated in 1987 in Michigan, New Jersey, Ohio, and Wisconsin and in 1992 in Illinois, North Carolina, and Texas. RESULTS: From January 1, 1993, through December 2, 1994, the SENSOR silicosis programs in Illinois, Michigan, New Jersey, North Carolina, Ohio, Texas, and Wisconsin confirmed 256 cases of silicosis that were initially ascertained in 1993. Overall, 185 (72%) were initially identified through review of hospital discharge data or through hospital reports of silicosis diagnoses; 188 (73%) were associated with silica exposure in manufacturing industries (e.g., foundries; stone, clay, glass, and concrete manufacturers; and industrial and commercial machinery manufacture). Overall, 42 (16%) cases were associated with silica exposure from sandblasting operations. Among the 193 confirmed cases for which information was available about duration of employment in jobs with potential exposure to silica, 37 (19%) were employed < or = 10 years in such jobs and 156 (81%) were employed > or = 11 years. A total of 192 primary workplaces associated with potentially hazardous silica exposures were identified for the 256 confirmed silicosis cases. Of these, nine (5%) workplaces were inspected by state health department (SHD) industrial hygienists, 19 (10%) were referred to the Occupational Safety and Health Administration (OSHA) for follow-up, and seven (4%) were routinely monitored by the Mine Safety and Health Administration. Of the 157 (82%) remaining workplaces, follow-up activities determined that 82 were no longer in operation, eight were no longer using silica, 18 were assigned a lower priority for follow-up, six were associated with building trades and could not be inspected because of the transient nature of work in the construction industry, and 43 workplaces were not inspected for other reasons. Fourteen (7%) of the 192 workplaces were inspected. At 10 of the 14 workplaces, airborne levels of crystalline silica were measured; in nine, silica levels exceeded the NIOSH-recommended exposure level of 0.05 mg/m, and in six, airborne silica levels also exceeded federal permissible exposure limits. ACTIONS TAKEN: Employee-specific and other preventive interventions have been initiated in response to reported cases. In addition, special silicosis prevention projects have been initiated in Michigan, New Jersey, North Carolina, Ohio, Texas, and Wisconsin. To facilitate the implementation of silicosis surveillance by other states, efforts are ongoing to identify and standardize core data needed by surveillance programs to describe cases and the workplaces where exposure occurred. These core variables will be incorporated into a user-friendly software system that states can use for data collection and reporting.

Female↗
PubMed1997

Improving quality of life in patients with non-small cell lung cancer: research experience with gemcitabine.

Alongside objective response rate, quality of life of patients is important in the treatment of cancer, particularly in the palliative setting. Quality of life is difficult to define precisely and is correspondingly difficult to assess. However, a number of methods have been devised and self-report questionnaires are now widely used. Patients with metastatic non-small cell lung cancer (NSCLC) have a poor prognosis with few patients surviving longer than 8 or 9 months. Curative treatment is often not possible and few patients receive active treatment. Although some patients will accept toxic treatments in return for increased survival, it is generally hoped that any treatment, curative or palliative, will not adversely affect patients' quality of life. In three studies in which gemcitabine was used as a single agent in metastatic NSCLC, objective response rates of 20% were obtained. Gemcitabine was well tolerated. Symptoms improved in the studies where disease-related symptoms were assessed. The degree of improvement compared well with historical data on the relief offered by standard radiotherapy and combination chemotherapy. These findings have led to the initiation of a randomised trial to compare the relief offered by gemcitabine plus best supportive care with best supportive care, using quality of life assessments as a primary endpoint.

Adult↗
PubMed1997

In vitro anti-HIV activity of biflavonoids isolated from Rhus succedanea and Garcinia multiflora.

Eleven biflavonoids, including amentoflavone (1), agathisflavone (2), robustaflavone (3), hinokiflavone (4), volkensiflavone (5), morelloflavone (7), rhusflavanone (9), succedaneaflavanone (10), GB-1a (11), GB-1a 7"-O-beta-glucoside (13), and GB-2a (14) isolated from Rhus succedanea and Garcinia multiflora, as well as their methyl ethers, volkensiflavone hexamethyl ether (6), morelloflavone heptamethyl ether (8), and GB-1a hexamethyl ether (12), were evaluated for their anti-HIV-1 RT activity. The results indicated that compounds 3 and 4 demonstrated similar activity against HIV-1 reverse transcriptase (RT), with IC50 values of 65 microM. Compounds 1, 2, 7, 11, and 14 were moderately active against HIV-1 RT, with IC50 values of 119 microM, 100 microM, 116 microM, 236 microM, and 170 microM, respectively. Morelloflavone (7) also demonstrated significant antiviral activity against HIV-1 (strain LAV-1) in phytohemagglutinin-stimulated primary human peripheral blood mononuclear cells at an EC50 value of 6.9 microM and a selectivity index value of approximately 10. The other biflavonoids were either weakly active, inactive, or not selective against HIV-1 in human lymphocytes.

Anti-HIV Agents↗
PubMed1997

The significance of ulcer disease on late mortality after partial gastric resection.

OBJECTIVE: To study the causes of long-term mortality after peptic ulcer surgery with special attention to the impact of underlying ulcer disease. DESIGN: Retrospective cohort investigation. PATIENTS: A cohort of 1305 patients who had surgery for gastric and duodenal ulcer disease 29 to 59 years ago. At the end of follow-up 80% of gastric ulcer patients, and 64% of duodenal ulcer patients were dead. RESULTS: Overall mortality was significantly higher among gastric ulcer patients: standardized mortality ratio (SMR) 1.17 (95% confidence interval (CI) 1.05-1.29); duodenal ulcer patients had an overall mortality comparable to the reference population: SMR 1.06 (CI 0.97-1.15). Excess mortality among gastric ulcer patients was found to be due to neoplasms in gastrointestinal organs (SMR 1.54 (CI 1.11-2.11) which developed more than 20 years postoperatively, and to respiratory diseases and suicide unrelated to time since surgery. An increased mortality due to malignant tumours, respiratory diseases and suicide was also found among duodenal ulcer patients but this increased mortality was offset due to a significantly decreased mortality in diseases of the heart and vascular system (SMR 0.86 (CI 0.75-0.97)), evident mainly after 20 years postoperatively. Excess mortality due to gastrointestinal cancers outnumbered excess mortality from carcinomas in the respiratory organs, and was due to cancers in the stomach, colon and pancreas. CONCLUSION: An increased mortality due to gastrointestinal carcinoma, especially gastric and pancreatic carcinoma, is apparent regardless of underlying ulcer disease. As preventive measures against these tumours have yielded little benefit in prospective trials, and as smoking-related diseases and tumours together with suicide constitute 75% of the excess mortality, measures to combat smoking and suicide might be more worthwhile to reduce mortality in this cohort.

Adolescent↗
PubMed1997

Histopathologic and ultrastructural alterations of white liver disease in sheep experimentally depleted of cobalt.

Many cobalt-deficient sheep develop liver lesions known as ovine "white liver" disease, but the etiology of these changes is controversial. It has been suggested that cofactors are required for development of liver damage in cobalt-deficient sheep. In this study, one group of lambs (n = 5) was fed a diet low in cobalt (4.5 micrograms/kg) while a group of control lambs (n = 4) received the same diet after it had been supplemented with cobalt (1000 micrograms/kg). All cobalt-depleted lambs had reduced growth rate, anorexia, lacrimation, and alopecia, and they eventually became emaciated (mean body weight at end of study: 83% of initial body weight). Plasma concentrations of bilirubin and serum activity of glutamate-oxaloacetate transferase were elevated in these animals, while plasma concentrations of vitamin B12 were reduced (less than 220 pmol/L from day 42). Fatty degeneration of the liver associated with reduced concentrations of vitamin B12 (14.5 pmol/g) was seen in these animals at necropsy at 196 days. Microscopic liver lesions included accumulation of lipid droplets and lipofuscin particles in hepatocytes, dissociation and necrosis of hepatocytes, and sparse infiltration by neutrophils, macrophages, and lymphocytes. Ultrastructural hepatocytic alterations included swelling, condensation and proliferation of mitochondria, hypertrophy of smooth endoplasmic reticulum, vesiculation and loss of arrays of rough endoplasmic reticulum, and accumulation of lipid droplets and lipofuscin granules in cytoplasm of hepatocytes. No liver lesions were seen in control lambs. The results of this study indicate that cofactors are not a prerequisite to development of hepatic damage in cobalt-deficient sheep. Reduced activities of the vitamin B12-dependent enzymes, methylmalonyl CoA mutase and methionine synthase, and lipid peroxidation are of likely pathogenetic importance in the development of the lesions.

5-Methyltetrahydrofolate-Homocysteine S-Methyltran↗
PubMed1997

Health advisories for consumers of Great Lakes sport fish: is the message being received?

Nationwide, 45 states issue health advisories for sport fish consumers. Chemical contaminants in some Great Lakes (GL) sport fish include compounds suspected of causing adverse reproductive and developmental effects. Although advisories to reduce consumption of contaminated fish, especially by women, have been issued by GL states (i.e., Illinois, Indiana, Michigan, Minnesota, New York, Ohio, Pennsylvania, and Wisconsin) since the mid-1970s, little is known about advisory awareness and GL sport fish consumption in the general population. To estimate the prevalence of GL sport fish consumption and health advisory awareness, we conducted a population-based telephone survey of 8,306 adult residents of the eight GL states. We gathered information concerning respondents' demographic characteristics, fish consumption during the preceding year, and sport fish consumption advisory awareness. The survey response rate was 69%. GL sport fish were eaten during the preceding year by 8.4% -95% confidence interval (CI), 7.6-9.2- of adults in the GL states, approximately 4.7 million persons. Women accounted for 43.9% (CI,39. 4-48.4) of consumers. Although 49.9% of GL sport fish consumers were aware of a health advisory, awareness varied significantly by sex: 58.2% (CI, 51.7-64.7) of males and 39.1% (CI, 32.6-45.6) of females were aware. Using logistic regression, we found awareness associated with male sex -odds ratio (OR) = 2.3; CI, 1.5-3.5), white race (OR = 4.2; CI, 1.9-9.1), college degree (OR = 3.1; CI, 1.3-7.6), and consuming >=24 GL sport fish meals/year (OR = 2.4; CI, 1.4-4.3). Only half of GL sport fish consumers reported awareness of a health advisory concerning eating GL sport fish. Awareness was especially low among women, suggesting the need of targeted risk communication programs for female consumers.

Adolescent↗
PubMed1997

Heat-related illness and death, Wisconsin, 1995.

This article examines heat-related illnesses and deaths that occurred in Wisconsin during the summer of 1995, which was among the warmest seasons on record. Death certificates that listed heat exposure as a contributing or underlying cause of 154 deaths and ambulance run reports for 454 heat-related emergency calls were analyzed. The time and place of these events and patient information were used to evaluate risk factors such as age, medical condition, physical activity, and environmental temperature. Three-fourths of the deaths and nearly half of the heat-related illnesses occurred during or shortly after two days of intense heat. Major risk factors for these heat-related illnesses and deaths included age, underlying chronic illness, physical exertion, and lack of air-conditioning. To reduce the number of illnesses and deaths that occur during future heat waves, all residents should be advised to install air-conditioning systems in their homes or apartments and encouraged to use them when indoor temperatures are uncomfortably warm. Summer weather forecasts should include heat index information. During periods of extreme heat, public health advisories should be issued encouraging residents to seek shelter in air-conditioned areas and to avoid strenuous outdoor activities and prolonged sun exposure. Region-specific criteria and procedures for issuing public health advisories should be developed jointly by the National Weather Service and the US Centers for Disease Control and Prevention.

Adolescent↗
PubMed1997

Gemcitabine in the treatment of elderly patients with advanced non-small cell lung cancer.

Gemcitabine is active against non-small cell lung cancer (NSCLC), with single-agent response rates of 20% or more in previously untreated patients. Its mild toxicity profile suggests that it should be well tolerated by older patients. To assess the impact of age on the efficacy and tolerance of gemcitabine, the results of four phase II trials of single-agent gemcitabine for the treatment of NSCLC were analyzed retrospectively. Starting doses for gemcitabine ranged from 800 to 1,250 mg/m2/wk, and in all studies gemcitabine was administered weekly for 3 weeks followed by a 1-week rest period. Response rates, toxicity, and dose delivery were compared for two age groups, less than 65 years (255 patients) or > or = 65 years (105 patients). The pretreatment characteristics for both patient groups were well balanced. Overall response rates were 16% and 24% for the younger and older patients, respectively (P = .072). Median survival and 1-year survival rates were 8.1 months and 27% and 9.1 months and 36%, respectively, for patients aged less than 65 years and > or = 65 years. Hematologic and nonhematologic toxicities were similar for both age groups. The number of cycles associated with dose reductions or dose omissions and the mean number of treatment cycles administered were also similar. In summary, gemcitabine is active and well tolerated in elderly patients with NSCLC, and is a promising new alternative for the treatment of this patient population.

Aged↗
PubMed1997

Gemcitabine: symptomatic benefit in advanced non-small cell lung cancer.

Recent studies have indicated that chemotherapy not only provides some survival benefit, but also reduces tumor-related symptoms and improves the performance status of patients receiving chemotherapy. Data from single-agent gemcitabine studies demonstrate improvements in a range of tumor symptoms, including cough, hemoptysis, pain, dyspnea, and anorexia, as well as increases in performance status. Indeed, more patients benefit from gemcitabine chemotherapy than suggested by the objective response rate. Surveys also have shown that patients are much more likely to accept chemotherapy for what is perceived by health care professionals as potentially small benefits. Gemcitabine has a role in the palliative treatment of patients with advanced non-small cell lung cancer.

Antimetabolites, Antineoplastic↗
PubMed1997

Single-agent paclitaxel in advanced non-small cell lung cancer: single-center phase II study using a 3-hour administration schedule.

The efficacy and safety of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) administered as a 3-hour infusion was investigated in a phase II study involving 21 patients with stage III/IV non-small cell lung cancer. The study included two quality of life assessments (the Hospital Anxiety and Depression Scale and the Rotterdam Symptom Checklist) to test their suitability for use in a future randomized phase III trial of paclitaxel and best supportive care versus best supportive care alone. Four (19%) of the 21 patients (95% confidence interval, 8% to 38%) achieved a partial response. The median time to disease progression for all patients entered was 19 weeks. Paclitaxel was well tolerated, with dose reduction required in only one patient because of arthralgia/myalgia. No dose reductions, delays, or discontinuations were required for hematologic toxicity. Completion and compliance with quality of life questionnaires was high, and these research tools proved to be acceptable for future use in phase III studies with paclitaxel.

Adult↗