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Biomedical subjects

J Dale

Publications and source records attributed to J Dale.

At least 91 records · Page 5Linked to original sources
PubMed1995

[Treatment of urinary bladder cancer--a retrospective analysis].

Data on 482 stage A-0--D2 bladder cancer patients referred between 1975-86 were analyzed. Prognosticators of survival were stage, histologic subtype and differentiation. 143 patients with disease localized to the pelvis (stage A-0--D1) received definitive radiotherapy with 60 Gy or more, and 25 underwent preoperative irradiation and cystectomy. Later, a group of 56 selected patients with stage B--D1, referred between 1988-1991, received neo-adjuvant MCV chemotherapy (methotrexate, cisplatin and vinblastine) preceding either definitive radiotherapy or surgery. The 2-year overall actuarial survival rates were similar: 63% for radiotherapy only, 72% for cystectomy and 68% for neo-adjuvant chemotherapy; they were also similar when broken down by stage and grade.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Wilms' tumor: the Northern Israel Oncology Institute experience.

Between 1971 and 1992, 42 children (median age = 2 years) with histologically proven Wilms' tumor were evaluated at the Northern Israel Oncology Institute. Most patients were staged according to National Wilms' Tumor Study (NWTS) criteria by which 18 were clinical stage I-II and 24 were III-IV. Combined therapy (surgery, chemotherapy, and radiotherapy) was given with a change to lower dose radiotherapy (< 2,000 cG) after 1981. The pre-1981 group (13 patients) suffered six relapses, most of which were pulmonary, whereas the 1981-1992 group (29 patients) had three relapses. The actuarial 5-year survival rate using Kaplan-Meier tables was 79% for the entire group but 100% for the 1981-1992 group and 38% for the 1971-1980 group. One case of immediate hepatic toxicity and one sudden death, unknown cause, of a patient in remission occurred in the group. Late deleterious effects were seen in five other patients; four had scoliosis and one developed osteoid osteoma of a rib. Despite these encouraging results, the necessity of ongoing monitoring for further long-term toxicities is apparent.

Child, Preschool↗
PubMed1995

Primary Hodgkin's disease of the bone.

A primary extranodal presentation occurs in less than 0.25% of patients with Hodgkin's disease (HD) and we describe the primary clinicopathologic findings in a rare case of a 21-year-old female with primary bony involvement of Hodgkin's disease. The patient presented with microcytic, hypochromic anemia and shoulder pain. The diagnosis of HD (lymphocyte depleted type) was made by biopsy taken from a lytic lesion in the lateral third of the clavicle. Staging work-up revealed an additional lesion in the ilium, but there was no evidence of lymph node involvement. MOPP/ABV (nitrogen mustard, Oncovin, procarbazine, prednisone/adriamycin, bleomycin, and vinblastine) chemotherapy resulted in complete response lasting, to date, 36 months. To the best of our knowledge, this is only the second reported case of disseminated primary Hodgkin's disease of the bone and all have had a favourable response to combination chemotherapy. A review of the literature is also presented.

Adult↗
PubMed1995

Cardiac tamponade as the initial manifestation of primary pericardial mesothelioma.

Although cardiac tamponade is a known complication of malignancy, it is rarely the initial manifestation. We report a 46-year-old male who presented with malignant cardiac tamponade 6 months prior to the definitive diagnosis of primary pericardial mesothelioma. A thorough literature search has not revealed a similar care.

Cardiac Tamponade↗
PubMed1995

5-Fluorouracil and low-dose leucovorin in metastatic colorectal cancer: a pilot study.

A total of 56 consecutive patients with metastatic colorectal cancer received treatment with 5-fluorouracil (5-FU) given at 425 mg/m2 by rapid intravenous infusion, immediately preceded by leucovorin (LV) given at 20 mg/m2, with cycles being repeated every 4 weeks. Of 48 evaluable patients undergoing this treatment, a tumor response was observed in 16 (33%); a complete response, in 2 (4%); and a partial response, in 14 (29%). The median survival was 8.5 months for all patients and 16.5 months for responders. An improvement in symptoms was seen in 9 (26%) of 34 symptomatic patients. In all 15 (27%) of 44 evaluable patients showed an improvement in performance status. The most significant toxicity attributable to the treatment was mucositis of grade 3 or 4, seen in 27% of the patients. Altogether, 2 patients (3.5%) were hospitalized for treatment-related toxicity. We conclude that the combination of 5-FU and low-dose LV is active in advanced colorectal cancer and is associated with acceptable toxicity.

Adenocarcinoma↗
PubMed1995

Patient expectations: what do primary care patients want from the GP and how far does meeting expectations affect patient satisfaction?

There is growing recognition of the importance of patients' expectations in general practice. This study aimed to investigate the types of expectations adult primary care patients have prior to consulting the GP, and how far meeting expectations is associated with increased satisfaction. Patients (n = 504) attending general practitioners (n = 25) at 10 London general practices were included in the study. The Patients Intentions Questionnaire (PIQ) was administered prior to the consultation to investigate patients' expectations and the Expectations Met Questionnaire (EMQ) was administered after the consultation to find out what the patient reportedly obtained. Satisfaction with the consultation was also measured using the Medical Interview Satisfaction Scale (MISS). The results of a principal components analysis of PIQ item scores indicated that the most wanted items were for 'explanation of the problem'. There was less desire for 'support' or 'tests and diagnosis'. Many of the 'support' items could potentially be provided to all patients, yet a proportion of patients reported not receiving these items from the GP. The results of one-way ANOVAs revealed that patients with greater numbers of their expectations met reported significantly higher satisfaction with the consultation than those with lower numbers met. The PIQ and EMQ could be potentially useful self-audit tools for use by general practitioners and trainee GPs.

Adolescent↗
PubMed1995

Replication slippage in the evolution of potyviruses.

Recently published evidence for sequence repetition in potyvirus genomes prompted us to analyse the published complete genome sequences and coat protein gene sequences of viruses of this family for evidence of replication slippage. Five of nine complete genomic sequences and 17 of 32 coat protein genes had significant sequence repetitions. Most of these were in coat protein genes, although the 5' region of the turnip mosaic virus genome also showed evidence of slippage. The results suggest that replication slippage may be involved in the evolution of viruses, as well as prokaryotes and eukaryotes, and that slippage can occur in both RNA and DNA when it is being replicated.

Biological Evolution↗
PubMed1995

Providing health-care advice by telephone.

Telephone advice systems can deliver a high-quality, responsive service. There is potential for development of the practice nurse role as telephone adviser in primary care. This study identifies a need for training nurses in the role of telephone adviser.

Attitude of Health Personnel↗
PubMed1995

Wound dressings on the Drug Tariff.

Nurses in the community need to be aware of the range of dressings available. Hospital nurses also need this knowledge to inform discharge planning.

Bandages↗
PubMed1994

Radiation therapy in an elderly African population with Kaposi's sarcoma.

There are no published studies on the efficacy of modern radiation therapy in elderly populations with the endemic African type of Kaposi's sarcoma (AKS). The present retrospective analysis of 20 elderly AKS patients treated by radiotherapy attempts to supply information relevant to the older age group. It demonstrates that excellent symptomatic relief with minimal side effects can be attained and suggests that the role of radiotherapy as the treatment of choice in this particular group should be emphasized.

Africa↗
PubMed1994

Radiation therapy for non-AIDS associated (classic and endemic African) and epidemic Kaposi's sarcoma.

PURPOSE: A retrospective analysis of patients with non-AIDS and AIDS-related Kaposi's sarcoma, who were treated with radiation therapy. METHODS AND MATERIALS: Between 1978 and 1992, 56 patients with one of the three major types (classical, endemic, epidemic) of Kaposi's sarcoma received radiation therapy as their sole treatment modality. Extent of fields, daily fractionation, and total dose were applied on a clinical basis. These lesions received superficial x-ray therapy, Co-60 teletherapy, or 6-8 MeV electron beams. Field sizes depended on extent of the lesion. Total dose administration ranged from 8-12 Gy in one exposure, or a total of 24-30 Gy fractionated over 2-3 weeks. RESULTS: The majority of patients responded to radiation therapy. Symptomatic relief was achieved in 80-100% of patients irrespective of the type of Kaposi's sarcoma, treatment modality, or schedule. Side effects were tolerable in all but three patients with epidemic type Kaposi's sarcoma, who developed severe mucositis. CONCLUSION: Radiotherapy is the most useful mode of palliative treatment for all forms of Kaposi's sarcoma in southern African patients.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Identifying feelings engendered during triage assessment in the accident and emergency department: the use of visual analogue scales.

Feelings engendered during 585 triage nursing assessments made by a total of 10 nurses were studied. Marked differences in nurses' feelings were demonstrated towards patients attending the accident and emergency (A&E) department with 'primary care' needs compared with those assessed as having 'A&E' needs. In particular, nurses demonstrated more negative feelings, in the form of less sympathy, more irritation and less motivation to help, towards patients with 'primary care' needs. Nurses' feelings were adversely affected by delays in patient presentation following the occurrence of illness or injury. Nurses perceived patients' attendance as illegitimate when it had deviated from expected norms of health-care-seeking behaviour. These findings were elicited using visual analogue scales completed immediately following the triage assessment of the patients. This work is part of a larger study into developing the primary care role of accident and emergency nurses. The culture of the A&E department is discussed, and the need to challenge and change this culture to ensure it becomes more responsive to individual patients' needs is advocated. This paper calls for development of triage training and education and further investigation into the effects of nurses' attitudes on patient assessment.

Adolescent↗
PubMed1994

Use of CA-125 response to predict survival parameters of patients with advanced ovarian carcinoma.

The prognostic value of serum CA-125 levels both before chemotherapy and after each cycle of one or two courses was assessed in 48 patients with advanced ovarian adenocarcinoma. All patients received a minimum of six courses of either cyclophosphamide and cisplatinum (CP) or cyclophosphamide, doxorubicin and cisplatinum (CAP). Patients with serum CA-125 values below the normal value of 35 U/ml after two courses had a significantly longer median survival (p < 0.0001) and longer disease-free survival (p = 0.007) than did those patients whose CA-125 levels dropped to normal after the third or a later course of chemotherapy. A response in CA-125 levels after the first two courses of chemotherapy may indicate which patients should continue with the current chemotherapy regimen and which patients should be offered salvage therapy.

Adenocarcinoma↗
PubMed1994

Treatment of muscle invasive bladder cancer. Is there a role for neoadjuvant chemotherapy?

PURPOSE: Because 5-year survival with advanced bladder cancer is still poor, the search for optimal treatment continues as dose the necessity of clarifying goals of treatment. PATIENTS AND METHODS: We compared the outcome of 3 different but widely accepted treatment protocols for bladder cancer in order to find which, if any, was superior, with particular emphasis upon the performance of the newest treatment, neoadjuvant chemotherapy. Data on 224 bladder patients treated at our institution (1975 to 1991) with 1 of the 3 protocols was analyzed. Those protocols were: 1. radiotherapy > 60 Gy (143 patients); 2. low dose radiotherapy followed by cystectomy (25 patients); 3. chemotherapy followed by either definitive radiotherapy or surgery (56 patients). Because the latter group was also a chronologically newer group with a shorter possible follow-up, we compared all treatments on the basis of 2-year survival, using Kaplan-Meier life tables. We briefly reviewed those modalities which are bladder-sparing because of the significance to quality of life of this factor. RESULTS: Two-year survival figures for the patients were: 63% for those who received only radiotherapy; 72% for those undergoing cystectomy: 68% for the group to whom neoadjuvant chemotherapy was administered. The differences were not statistically significant. However, 23% of those patients treated neoadjuvantly were alive with intact bladders at 2 years. CONCLUSION: These results do not suggest that a superior survival advantage is associated with any of these 3 protocols and neoadjuvant chemotherapy, in particular, cannot be seen as conferring a new and important survival advantage. However, neoadjuvant chemotherapy followed by radiotherapy does permit bladder conservation and, given that life span will often be reduced, the importance of helping to keep the remainder of the patient's life as comfortable as possible, can hardly be overestimated.

Aged↗
PubMed1994

Update on nasopharyngeal carcinoma in northern Israel.

PURPOSE: Because Israel is one of the world's intermediate risk areas for nasopharyngeal carcinoma (NPC), we continue to analyze retrospectively all referred cases. PATIENTS AND METHODS: We previously reported our work with 49 NPC patients, and we now extend our analysis to include an additional 26 patients. All our 75 patients were treated between 1968 and 1991 at the Northern Israel Oncology Center in Haifa. They were typical in the preponderance of male sex (74%), Mediterranean origin (80%) and late stage presentation (91%). All patients received a combination of photon and electron radiotherapy to the tumor site, base of skull and neck, with an average dose to the nasopharynx of 6095 cGy. Nearly 40% of the patients received combined modality treatment (CMT), i.e., cisplatin-based chemotherapy prior to radiotherapy. RESULTS: There was an overall complete response (CR) of 88%, with 44% of the patients experiencing recurrence. Serious complications occurred in 5%. We found a 5-year survival rate of 48% and a 10-year survival rate of 44%, with some indication that CMT was advantageous to later-stage patients with non-keratinizing histologies, but not to earlier stages nor to those with keratinizing squamous cell carcinoma (SCC). Pediatric patients had better survival rates. CONCLUSIONS: 1. The somewhat better survival performance of Arabs and Sephardic Jews may reflect their greater tendency to have the non-keratinizing histological variants (lymphoepithelioma and undifferentiated carcinoma). 2. Ethnicity was consistently prognostic, both as risk and survival factors. 3. The role of CMT in advanced non-keratinizing NPC should be explored in future randomized trials.

Adolescent↗