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Biomedical subjects

Hilary Thomas

Publications and source records attributed to Hilary Thomas.

40 records · Page 3Linked to original sources

Pregnancy, illness and the concept of career.

This paper explores a neglected area of women's reproductive experience, namely major illness during pregnancy. It draws on a qualitative study of 15 women who had either a pre-existing illness or developed a major health problem during pregnancy, and explores in detail the accounts of four contrasting case histories. Analysis is framed by the concept of career. It is argued, however, that an understanding of the women's experiences requires that pregnancy and illness are treated as separate, but co-existent, career paths. Pregnancy and illness were more than a concatenation of contingencies for each other. Pregnancy and the subsequent birth were influenced by the preceding and envisaged course of the illness, and the experience of illness was partly configured by the events of pregnancy. The paper considers the conceptual implications of multiple career analysis, and argues that a multiple career analytic approach has relevance for an understanding of other areas of health care, such as the experience of patients suffering from two or more concurrent illnesses.

Attitude to Health↗

Role of weekly paclitaxel in the treatment of advanced ovarian cancer.

Dose-dense weekly administration of paclitaxel has the potential advantage of allowing a larger percentage of cancer cells to enter the vulnerable phase of their cell cycle when cytotoxic paclitaxel concentrations are present. The lower doses and shorter infusion times used with weekly dosing should also minimize bone marrow suppression and other toxicities associated with standard paclitaxel 3-weekly administration. Clinical studies have confirmed that paclitaxel can be safely delivered on a weekly schedule as a 1-h infusion to patients with advanced ovarian cancer. Weekly administration of paclitaxel also appears to be better tolerated than 3-weekly administration. Single-agent weekly paclitaxel is associated with response rates of 20-65%. Combination therapy with weekly paclitaxel has mainly involved carboplatin and response rates with such regimens range from 60-88%. Triple-drug combination therapy has produced response rates of 42-67.5%. Such therapy has included weekly paclitaxel in combination with carboplatin/cisplatin plus topotecan, and carboplatin plus doxorubicin. In an attempt to avoid problems with high corticosteroid doses, dexamethasone doses of 10 and 8 mg have been used successfully in premedication regimens for weekly paclitaxel in ovarian cancer.

Adenocarcinoma↗

Endometrial adenocarcinoma following the insertion of a Mirena IUCD.

BACKGROUND: The case histories of two patients who developed endometrial adenocarcinoma with a Mirena intrauterine system (IUS) in place are reported. CASE: Two patients had a Mirena IUS inserted to treat abnormal vaginal bleeding. After 12 and 36 months with the device in place they presented with a recurrence of their heavy, irregular menstrual bleeding. Endometrial biopsies confirmed the presence of endometrial adenocarcinoma, and hysterectomies were performed. In one patient the cancer was localized and below the stem of the device, in the other metastatic disease had developed. CONCLUSION: These cases raises important issues regarding the use of the Mirena IUS to treat menorrhagia.

Adenocarcinoma↗

Overcoming multidrug resistance in cancer: an update on the clinical strategy of inhibiting p-glycoprotein.

BACKGROUND: Multidrug resistance (MDR) is a significant obstacle to providing effective chemotherapy to many patients. Multifactorial in etiology, classic MDR is associated with the overexpression of P-glycoprotein (P-gp), resulting in increased efflux of chemotherapy from cancer cells. Inhibiting P-gp as a method to reverse MDR in cancer patients has been studied extensively, but the results have generally been disappointing. METHODS: The development of P-gp inhibitors is reviewed, including a discussion of early agents that are no longer being developed and third-generation agents that are currently in clinical trials. RESULTS: First-generation agents (eg, cyclosporin, verapamil) were limited by unacceptable toxicity, whereas second-generation agents (eg, valspodar, biricodar) had better tolerability but were confounded by unpredictable pharmacokinetic interactions and interactions with other transporter proteins. Third-generation inhibitors (tariquidar XR9576, zosuquidar LY335979, laniquidar R101933, and ONT-093) have high potency and specificity for P-gp. Furthermore, pharmacokinetic studies to date have shown no appreciable impact on cytochrome P450 3A4 drug metabolism and no clinically significant drug interactions with common chemotherapy agents. CONCLUSIONS: Third-generation P-gp inhibitors have shown promise in clinical trials. The continued development of these agents may establish the true therapeutic potential of P-gp-mediated MDR reversal.

ATP Binding Cassette Transporter, Subfamily B, Mem↗