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H Anderson

Publications and source records attributed to H Anderson.

At least 145 records · Page 8Linked to original sources
PubMed1993

DNA analysis as a predictor of the outcome of induction chemotherapy in advanced head and neck carcinomas.

We investigated whether flow cytometric DNA index and/or ploidy status are predictors of response to chemotherapy and survival. Fifty consecutive patients with previously untreated locally advanced squamous cell carcinomas of the head and neck received induction chemotherapy consisting of three courses of cisplatin (100 mg/m2) and a subsequent 120-hour infusion of fluorouracil (1000 mg/m2 per 24 hours) repeated every 3 weeks. Chemotherapy was followed by radiotherapy to a median target dose of 65 Gy and subsequent surgery for residual tumor. The median observation time was 27 months (range, 24 to 57 months). Flow cytometric DNA analysis was based on formalin-fixed and paraffin-embedded tissue from pretreatment tumor biopsy specimens. Complete response after induction chemotherapy was achieved in only 12% (2/17) of patients with diploid tumors compared with 39% (13/33) of those with nondiploid tumors. Among patients with nondiploid tumors, DNA index was higher for those responding to chemotherapy compared with the nonresponders. Complete response to chemotherapy was apparently a prerequisite for survival in the nondiploid group. Of the patients not responding to chemotherapy but responding to subsequent radiotherapy, survival was better among those with diploid tumors than among those with nondiploid tumors.

Adult↗
PubMed1993

Cancer morbidity in blood recipients--results of a cohort study.

Blood transfusions involve the transfer of relatively large volumes of body fluids and cellular material between individuals. A variety of pathogens like viruses, some of which are associated with development of certain tumours, are known to be transmitted by this route. Blood recipients were identified during 1981-1982 in the register of the hospital blood centre, and in-patients by the in-patient and discharge register of the hospital. Tumour occurrence and vital status were determined by means of the population-based regional tumour register. Age, gender and calendar-year specific rates from the general population were used to calculate expected values. In a cohort study of 3177 blood recipients, increased numbers of malignant lymphomas [13 vs. 4.8 expected, standard morbidity ratio (SMR) 2.70 95% confidence interval (CI) 1.44-4.62] and skin cancers [12 vs. 5.2 expected, SMR 2.29, 95% CI 1.19-4.01] were seen 3 to 9 years after transfusion. In a second cohort study of 29,910 hospitalised patients, a total of 37 (29.8 expected) malignant lymphomas was found in 28,338 patients with no transfusion and 10 (2.73 expected) in 1572 patients with a transfusion, 3 to 9 years after the hospitalisation. The incidence rate ratio between these groups was 3.11 (95% CI 1.56-6.20) using a Mantel-Haenszel estimator with age stratification. Non-melanomatous skin cancers had an incidence ratio of 2.74 (95% CI 1.25-6.00). We conclude that, in the cohorts discussed here, malignant lymphomas and skin cancer occur more often in blood recipients than in controls. It remains to be established whether this is due to factors covariating with transfusion or by the transfusion itself. Further studies on these putative associations are warranted, as are analytical studies of the epidemiology of malignant lymphomas, especially non-Hodgkin's lymphoma, whose aetiology is still poorly understood.

Adult↗
PubMed1993

A randomised study of bolus vs continuous pump infusion of ifosfamide and doxorubicin with oral etoposide for small cell lung cancer.

One hundred and fifty-nine previously untreated patients with small cell lung cancer (SCLC), who were not eligible for intensive chemotherapy, were entered into a randomised study of intravenous (i.v.) doxorubicin and ifosfamide (with mesna) and oral etoposide. The i.v. drugs were given either by bolus therapy or by a continuous infusion (CI) pump over 7 days via a central venous line. Therapy was given for 6 weeks only. On weeks 1, 3 and 5 IV doxorubicin 35 mg m-2 was given with 5 days of oral etoposide 100 mg m-2 daily. On weeks 2, 4 and 6 IV ifosfamide 5 g m-2 was given with equidose mesna. The overall median survival was 25 weeks for patients in the bolus arm and 30 weeks for the CI therapy (P = 0.45). The overall response rate was 64% (18% complete response-CR) and 69% (30% CR) respectively (P = 0.13). The median WHO score for haematological toxicity was 4 for bolus therapy and 3 for CI therapy (P = 0.0007). Despite a trend for less supportive care for patients on CI therapy there were no significant differences in the use of i.v. antibodies and blood or platelet transfusions. There were fewer treatment delays due to myelotoxicity in the CI arm (P = 0.04). The median WHO score for non-haematological toxicity was 2 in both treatment groups. There was significantly less nausea (P = 0.037) but more mucositis (P = 0.01) in the CI arm. Weekly chemotherapy using CI treatment was as effective as bolus therapy. It was well accepted by patients. The assessment of quality of life in a subgroup of patients showed a statistically significant reduction in anxiety and depression for both groups of patients during therapy.

Administration, Oral↗
PubMed1993

Blood lymphocyte clonal excess in advanced non-Hodgkin's lymphoma. Relation to clinical data and prognosis.

BACKGROUND: Increasingly sensitive methods, based on the monoclonal nature of NHL, are used to detect tumour spread and remaining disease. Since the lymphomas are thought to arise due to successive genetic changes, clonal cells in different compartments do not necessarily represent the same disease despite a common clonal origin. PATIENTS AND METHODS: In 179 patients with advanced NHL, clonal cells in peripheral blood were identified by light chain restriction analysed in flow cytometry, i.e. clonal excess (CE) analysis. RESULTS: CE was more common in low grade NHL (52%) than in high grade NHL (21%). In patients with a normal lymphocyte count CE was found in 23%. CE was significantly correlated to small cell histology and bone marrow involvement. In high grade NHL CE in peripheral blood was more common in those with discordant small or mixed cell involvement of the bone marrow. CE was significantly related to failure to achieve remission in both histologic subgroups. Survival was not influenced by CE in low grade NHL but in high grade NHL. In multivariate analyses however, CE did not emerge as an independent risk factor but age, B-symptoms and LDH were the major factors. CONCLUSIONS: The utility of blood CE analyses in clinical praxis has still to be settled and the prognostic value of CE per se seem limited in the current perspective. The existence of CE in high grade NHL might be a clue of different biology as compared to de novo high grade NHL.

Adult↗
PubMed1993

Time lag to diagnosis of bladder cancer--influence of psychosocial parameters and level of health-care provision.

Delay in diagnosis of carcinoma of the urinary bladder was studied in 343 patients. The median patient's delay (time from first symptom to first consultation) was 15 days, and was longer when the only presenting symptom was urgency of micturition than when it was haematuria (45 vs. 5 days, p < 0.001). In advanced (T2-T4) tumour, patient's delay was 21 days and in Ta-T1 it was 13 days (NS). The median doctor's delay (time from first consultation to diagnosis) was 62 days. It comprised two phases: A from consultation to first referral and B from first referral to diagnosis-respective medians 6 and 47 days. Median doctor's delay (A+B) was longer when the initial consultation was with a general practitioner than with a urologist (78 vs. 21 days, p < 0.001) and longer in patients older than 70 years (69 vs. 54 days, p < 0.01). Doctor's delay correlated with symptoms, being longest in cases with only urgency and shortest in haematuria plus pain (114 vs. 44 days, p < 0.001), and also with number of referrals (33, 63, 230 and 117 days, respectively, for 0, 1, 2 and 3 referrals). More women than men were referred a second or third time (25.6% vs. 8.6%, p < 0.001), and doctor's delay was longer for women (76 vs. 59 days, p < 0.05). A questionnaire completed by 203 of the 229 surviving patients revealed no significant correlation between psychosocioeconomic factors and patient's delay.

Age Distribution↗
PubMed1993

Reoperation for malignant astrocytomas: personal experience and a review of the literature.

All patients in a randomized study comparing chemotherapy with chemotherapy plus radiotherapy for patients with astrocytomas grade 3 and 4, were considered for reoperation when tumour progression was established. Fifty-eight patients were reoperated and 85 were not. Different prognostic factors, such as age, sex, Karnofsky performance status and reoperation were evaluated univariately and simultaneously in a multivariate model. The Karnofsky index and age were found to be independent prognostic factors, while re-operation could not be demonstrated to prolong life when controlled for age and the Karnofsky index. We review the literature on re-operation of malignant astrocytomas.

Analysis of Variance↗
PubMed1993

Venovenous compares favorably with venoarterial access for extracorporeal membrane oxygenation in neonatal respiratory failure.

Traditional extracorporeal membrane oxygenation via the venoarterial route requires cannulation and ligation of the internal jugular vein and common carotid artery. Concerns about ligation of the common carotid artery prompted development of a 14F double-lumen internal jugular vein cannula for venovenous oxygenation for neonates with respiratory failure. We retrospectively compared 22 patients supported by venovenous bypass and 20 patients supported with traditional venoarterial bypass. The two groups of patients were selected to be comparable in terms of diagnosis and severity of respiratory insufficiency. The diagnoses in both groups were limited to meconium aspiration syndrome or persistent pulmonary hypertension of the newborn. The average oxygenation indexes in the two groups were similar (46.6 venovenous, 47.2 venoarterial, p = not significant). Venovenous access allowed flow rates of more than 100 ml/kg per minute, which were adequate for gas exchange support. One patient required conversion from venovenous to venoarterial bypass because of hemodynamic instability. The average time of bypass support was 115 hours (range 24 to 338 hours) for venovenous bypass and 134 hours (range 47 to 361 hours) for venoarterial bypass (p < 0.05). The time to extubation after decannulation from extracorporeal membrane oxygenation was 133 hours (range 38 to 720 hours) for venovenous support and 100 hours (range 27 to 192 hours) for venoarterial support (p = not significant). One patient supported with venoarterial bypass had an intracranial hemorrhage. There were no documented neurologic injuries in the patients managed with venovenous bypass. There were no deaths in either group. Venovenous extracorporeal membrane oxygenation through a double-lumen cannula can adequately provide respiratory support for neonates with pulmonary failure and effectively avoids ligation of the common carotid artery.

Carotid Artery, Common↗
PubMed1993

Extracorporeal life support for adult cardiorespiratory failure.

BACKGROUND: Extracorporeal membrane oxygenation is routinely used for neonatal respiratory failure but is considered unsuccessful in adults based on old studies and old methods. We conducted a new phase 1 trial of modern extracorporeal life support (ECLS) in moribund adults with cardiorespiratory failure. METHODS: Criteria for initiation of ECLS were 90% mortality risk despite maximal conventional care, good potential for recovery, age < 60 years, and no contraindication to anticoagulation. Vascular access for ECLS was performed by operative or percutaneous cannulation. Continuous systemic heparinization was used, maintaining whole blood activated clotting time between 160 to 180 seconds. Blood components were transfused as necessary. Lung management included low rate and low pressure ventilation with an inspired oxygen fraction 0.5 or less. RESULTS: Forty patients were treated with ECLS, 30 with primary respiratory failure and 10 with primary cardiac failure. Twenty-two patients recovered lung or heart function, and 18 patients survived and were discharged from the hospital (14 with respiratory failure and four with cardiac failure, overall survival 45%). The major complication of ECLS was bleeding. CONCLUSIONS: With modern techniques, ECLS can be lifesaving in adult cardiorespiratory failure when conventional therapy has failed.

Adolescent↗
PubMed1992

Natural history of sinus node disease treated with atrial pacing in 213 patients: implications for selection of stimulation mode.

OBJECTIVES: This study was designed to analyze the incidence and determinants of complications and long-term survival in sinus node disease treated with atrial pacing. BACKGROUND: Knowledge of the natural history of sinus node disease treated with different pacing modes is imperfect, and controversy exists regarding the optimal pacemaker therapy. METHODS: A consecutive series of 213 patients with sinus node disease initially treated with atrial pacing was studied for a median follow-up period of 60 months. The end points studied were permanent atrial fibrillation, high grade atrioventricular (AV) block, P wave undersensing, pacing mode change, reoperation and death. Several prognostic factors were evaluated statistically and the survival rate was compared with that of a matched general population. RESULTS: The incidence rate of permanent atrial fibrillation during follow-up was 7% (1.4%/year). The risk of this arrhythmia increased substantially with age greater than or equal to 70 years at pacemaker implantation. Only 2 of the 15 patients who developed permanent atrial fibrillation required ventricular pacing. High grade AV block occurred in 8.5% (1.8%/year) and its incidence was much greater in patients with complete bundle branch block or bifascicular block (35%) than in patients without such conduction disturbances (6%). A change to ventricular or dual-chamber stimulation was necessary in 14% of all patients, primarily because of early lead dislodgment or high grade AV block. Surgical intervention with maintenance of atrial pacing was required in 7% of patients. The survival rates of 97% at 1 year, 89% at 5 years and 72% at 10 years did not differ significantly from those of a matched general population. CONCLUSIONS: In sinus node disease, atrial pacing can be successfully applied during long-term follow-up. Patients with complete bundle branch or bifascicular block in addition to sinus node disease should initially receive a dual-chamber pacemaker, but routine application of dual-chamber stimulation does not appear to be warranted.

Adolescent↗
PubMed1992

Infection risk in patients with small cell lung cancer receiving intensive chemotherapy and recombinant human granulocyte-macrophage colony-stimulating factor.

The effect of recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) was assessed in 17 patients with small cell lung cancer. GM-CSF was initially given alone by subcutaneous injection for 10 days at 50-500 micrograms/m2 per day. There was a significant rise in neutrophils and eosinophils and to a lesser extent in monocytes at all dose levels. During the next phase, patients received chemotherapy (etoposide, ifosfamide and doxorubicin), and GM-CSF was given on alternate cycles, the patients acting as their own controls, so that the amelioration of chemotherapy could be assessed. Despite partial abrogation of the neutropenia associated with chemotherapy (P = 0.04), GM-CSF failed to reduce the frequency of febrile episodes in association with neutropenia, with six episodes occurring on GM-CSF and seven while patients were not receiving GM-CSF after a total of 66 cycles of chemotherapy. After GM-CSF, there was a reduction in polymorph phagocytic ability and chemotaxis in 6/12 and 9/11 patients, respectively. Timed blood counts after GM-CSF administration showed that peak leucocytosis occurred at 8-12 h and fell to two-thirds of this level at 24 h. Toxicity consisting of lethargy, myalgia and bone pain occurred at all dose levels but was manageable. 2 patients had thromboembolism. This study failed to demonstrate a reduction in the infection risk associated with moderately intensive chemotherapy for small cell lung cancer despite the partial abrogation of neutropenia.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Predicting septic complications of chemotherapy: an analysis of 382 patients treated for small cell lung cancer without dose reduction after major sepsis.

The incidence and risk of septic complications in 382 patients treated for small cell lung cancer with combination chemotherapy at a single centre have been analysed. Full protocol doses were employed throughout with no dose reduction after episodes of severe or life-threatening sepsis (SLTS). 50 (13%) patients experienced 66 episodes of SLTS associated with 1978 cycles of chemotherapy (3.2% cycles affected). 20 (5.2%) patients died due to sepsis (SD) of whom only 4 had experienced SLTS with a previous cycle of treatment. The others died as a result of their first septic episode. A model comprising four variables, age (< or = 50 or > 50 years), Karnofsky performance status (KP < or = 50 or > 50), treatment (two- or three-drug regimen) and previous sepsis (SLTS or no SLTS with previous cycles) was found to satisfactorily describe the incidence of SLTS and SD in the study population and once validated in another patient groups this model should allow identification of high-risk individuals before treatment starts. If so, we propose that high-risk patients (age > 50 years, KP < or = 50, treatment with three-drug regimen) receive 50% of protocol doses in the first cycle of treatment with escalation to 75% and eventually 100% doses in subsequent cycles if sepsis does not supervene. Those with one or two risk factors present run a relatively low risk of SLTS or SD and we consider that full-dose chemotherapy should be used throughout in these individuals.

Age Factors↗
PubMed1992

Chromosome abnormalities are associated with unfavorable outcome in prostatic cancer patients.

Potential clinico-cytogenetic correlations were assessed in 57 patients with prostatic cancer in whom cytogenetic analysis of the primary tumor had been successful. Clonal karyotypic abnormalities were found in 15 tumours, 18 had normal karyotypes with nonclonal structural abnormalities and 24 had normal karyotypes only. The study began in January 1987 and all patients were monitored regularly until death or through September 1990 (median followup from diagnosis 2.6 years and from surgery 1.3 years). Survival curves were estimated by the Kaplan-Meier method, and the log rank test was used in univariate analyses of possible prognostic factors. The patients with clonal karyotypic abnormalities had shorter survival times (1.3 years) than those with normal karyotypes (greater than 3 years). The difference in survival after surgery was statistically significant (p less than 0.05) when all causes of death and when death from prostatic cancer alone were considered. The Cox proportional hazards regression model was used to evaluate the additional prognostic information of chromosomal changes in excess of that attributable to other well known prognostic factors, such as tumor stage and differentiation, acid and alkaline phosphatases, and performance status. In this analysis there also was a tendency for patients with clonal chromosome aberrations to have an unfavorable outcome but the association was not significantly (p = 0.13), possibly due to the rather small number of patients and short followup. Thus, our study suggests that the presence of clonal karyotypic changes in the tumor cells is associated with an unfavorable outcome in prostatic cancer patients.

Adenocarcinoma↗
PubMed1992

Response after withdrawal of tamoxifen and progestogens in advanced breast cancer.

Tumor response after withdrawal of endocrine therapy for advanced breast cancer with estrogens and androgens is well described. There have been few reports of withdrawal responses (WRs) after cessation of treatment with the newer antiestrogens and progestogens. We assessed WR in women after cessation of adjuvant therapy at first relapse, and after progression on first, second or third line endocrine therapy for advanced disease. One of seven patients (14%) responded after cessation of tamoxifen adjuvant therapy at relapse. Sixty-five of 72 patients were evaluable for WR after cessation of tamoxifen as first line therapy for advanced disease. There were five partial responses (8%) and 14 (22%) 'no change' with a median duration of WR of 10 months (range 3-40 months). WR were seen mainly in soft tissue disease but there were two responses in lung and two in bone. Four of 21 (19%) patients had a WR after cessation of norethisterone acetate (3) and tamoxifen (1), all used as second line therapy. WR are therefore demonstrable after cessation of tamoxifen and norethisterone acetate with durations of response similar to those found with additive therapy. Assessment of WR may represent a way of prolonging the overall response duration in patients with relatively indolent metastatic breast cancer, particularly in soft tissues.

Adult↗
PubMed1992

2-Mercaptoethanol influences the in vitro function of bovine peripheral blood mononuclear cells.

The effects of 2-mercaptoethanol (2-ME) on some in vitro functions of bovine peripheral blood mononuclear cells (PBMC) were examined. It was shown that 2-ME enhanced, in a dose-dependent manner, the production of antibodies to bovine coronavirus. In this test the optimal concentration of 2-ME was 50 microM. This molarity of 2-ME was also optimal for the pokeweed mitogen (PWM)-induced proliferation of PBMC obtained from the 7 cattle tested. Similarly, the spontaneous proliferation of PBMC from 4 out of these cattle was enhanced. Thus, 2-ME evoked an increase (up to 2.5 times) or a decrease (at most 10 times) of the quota between the PWM-induced and the spontaneous proliferation (stimulation index). In general, the presence of 50 microM 2-ME enhanced the in vitro production of interferon by bovine PBMC. On the contrary, the highest proliferative response of PBMC to stimulation with bovine virus diarrhoea virus was achieved in cultures without 2-ME or in cultures with 0.5 or 5 microM 2-ME. Since the effects of 2-ME varied, for different tests as well as for cattle tested, attention should be paid to the use of 2-ME in cultures of bovine PBMC.

Animals↗
PubMed1992

Effects of amino acid dialysate on appetite in CAPD patients.

The use of amino acid (AA) dialysate in CAPD patients may have theoretical disadvantages, since protein ingestion is known to suppress food intake in humans disproportionately to its energy value. Therefore we measured subjective appetite and food intake of CAPD patients in a cross-over study of 16 subjects (age 22-75 years, BMI 19-31, > 3 months on CAPD, non-diabetic and not protein malnourished). They received, in random order, either 4 weeks of dextrose only (their usual treatment), or one AA (1%) exchange replacing the first dextrose exchange each day. Subjective measurements of food intake (3 day food record) and quantitative measurements of lunch time food intake were obtained during a morning dextrose exchange after 28 days of each regimen. Except for a reduction in feelings of fullness during the AA treatment, there were no effects on feelings of hunger/satiety, food appeal, lunch-time food intake, or on 3-day food intake. We conclude that the use of a daily AA (1%) dialysate for 4 weeks does not affect subjective appetite or food intake of CAPD patients. There may even be a beneficial effect as the feeling of fullness decreased with the AA treatment.

Adult↗