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J Dale

Publications and source records attributed to J Dale.

At least 109 records · Page 6Linked to original sources
PubMed1993

Pathological stage I endometrial carcinoma: the role for adjuvant radiotherapy.

BACKGROUND: In order to assess the efficacy of adjuvant radiotherapy in the treatment of pathological stage I endometrial carcinoma, we performed a retrospective analysis of 158 patients with this diagnosis who after surgery were either treated with radiation therapy or only followed from January 1980 through December 1987. METHODS: Patients were divided into two prognostic categories, high and low risk, on the basis of three known predictors of survival: histology, differentiation, and depth of myometrial invasion. All patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy but only the high risk group received radiotherapy as well. RESULTS: After a median follow up time of 59 months the survival rates of the two groups were similar. The 5-year disease-free survival of the surgery alone group was 92% compared to 89% for the postoperative radiotherapy group. Side effects of treatment were minimal. CONCLUSIONS: Postoperative radiation therapy for high risk pathological stage I endometrial carcinoma is an effective adjuvant therapy and confers an excellent prognosis.

Carcinoma↗
PubMed1993

The management of metastatic spinal cord compression: a radiotherapeutic success ceiling.

PURPOSE: In assessing the effectiveness of the management of metastatic spinal cord or cauda equina compression, we performed a retrospective analysis of 70 patients with this complication whom we treated from 1985 to 1989. METHODS AND MATERIALS: The most frequent primary diagnoses in our series were carcinomas of unknown origin and of the breast, lymphoproliferative disease, lung cancer, and prostatic carcinoma. We used the Findlay classification to group all patients according to their pre-therapeutic functional motor status as Grade I (24 patients or 34%), Grade II (27, or 39%) or Grade III (19 or 27%). Treatment consisted of 30-45 Gy of irradiation (using two different schedules) together with high-dose dexamethasone; in only five cases was there surgical intervention. RESULTS: We found that a powerful predictor of response to radiotherapy was the patient's neurologic status (Findlay grade) at the time of diagnosis: 66% of previously ambulatory patients remained so, whereas 30% of non-ambulatory patients and only 16% of paraplegic patients regained the ability to walk. Another important predictor of response was primary tumor histology, with the most favorable responses to radiation therapy having been observed in lymphoproliferative diseases and in breast cancer, but with some response in other radiosensitive malignancies as well. CONCLUSION: The similarity of our results to those of other centers leads us to conclude that a radiotherapeutic success ceiling of 80% may have been reached for Findlay Grade I patients with metastatic spinal cord compression. In view of this, we suggest that future therapeutic endeavour would be best directed toward early diagnosis of the condition.

Adolescent↗
PubMed1993

[Prehospital treatment of acute myocardial infarction].

Mortality from acute myocardial infarction is high. The pre-hospital phase is particularly important, because it involves a high risk for the patient. Cardiac arrest is not uncommon. Other arrhythmias may arise, or reduced left ventricular function may induce pulmonary oedema or cardiogenic shock. The patient should therefore be transported to hospital as soon as possible, and should be given morphine and oxygen. Several therapeutic principles reduce mortality from acute myocardial infarction. Nitrates and acetylsalicylic acid can be administered before transport to hospital. Nitrates, intravenous diuretics, morphine and oxygen are important for treating pulmonary oedema, and should be administered as soon as possible. If equipment and expertise are available, a diagnosis of ventricular fibrillation or tachycardia can be verified and defibrillation performed. Intravenous atropine should be tried in cases of bradycardia. Thrombolytic therapy represents a challenge, because early start of the treatment is essential in order to salvage threatened myocardium. Optimal treatment depends on quick transport to hospital, information to the hospital, and effective routines i hospital itself.

Anti-Arrhythmia Agents↗
PubMed1993

Classical disseminated Kaposi's sarcoma in HIV-negative patients; an unusually indolent subtype.

Kaposi's sarcoma is a rare neoplasm of characteristic chronicity. The classical form which occurs most often in elderly men of Eastern European origin, comprises both an indolent, cutaneous type marked by spontaneous regression with prolonged survival, and a rarer, disseminated variant is more fulminant. Seven elderly Jewish patients with classical, disseminated, visceral Kaposi's sarcoma were studied; they were neither homosexual nor drug-abusers. All immunologic parameters were normal and serum tests for HIV antibodies, CMV, and EBV were negative. Five of these patients were treated and four responded well, including two complete remissions. The prolonged survival of these patients (82% at 5 years) suggests the existence of an indolent subtype or forme fruste of the usually aggressive form of classical Kaposi's sarcoma.

Adult↗
PubMed1993

Left ventricular thrombosis and arterial embolism after thrombolysis in acute anterior myocardial infarction: predictors and effects of adjunctive antithrombotic therapy.

The prevalence of left ventricular (LV) thrombosis and incidence of arterial embolism after acute anterior myocardial infarction (AAMI) treated with streptokinase 1.5 x 10(6) IU intravenously was studied in 136 patients enrolled consecutively in five cardiological centres. Adjunctive antithrombotic therapy was administered according to the routine of each centre. Thrombus formation was studied by two-dimensional echocardiography, and events of arterial embolism recorded. LV thrombosis was found in 37 (27.2%) of the patients. In a subgroup of 53 patients receiving post-thrombolytic therapy with acetylsalicylic acid only, a thrombus developed in 14 (26.4%). The thrombus prevalence among patients given high-dose heparin was significantly lower than among those receiving either low-dose heparin or no heparin (4/30 vs 33/106, P = 0.045). Logistic regression analysis suggested that severe LV wall motion abnormality (P < 0.001) and avoidance of treatment with high-dose heparin (P = 0.023) were independent predictors of LV thrombus formation. Only one patient (0.7%) suffered arterial embolism (ischaemic stroke). In conclusion, LV thrombosis is frequent after thrombolytic therapy for AAMI, and impaired LV wall motion represents an independent predisposing factor. Low-dose heparin and acetylsalicylic acid seem less effective for LV thrombus prophylaxis than high-dose heparin. The incidence of arterial embolism is low.

Age Factors↗
PubMed1993

Adverse effect of warfarin in acute myocardial infarction: increased left ventricular thrombus formation in patients not treated with high-dose heparin.

In a prospective non-randomized study, 229 patients with a verified first acute anterior myocardial infarction (AAMI) underwent echocardiography before discharge in order to study left ventricular (LV) thrombus formation. Antithrombotic therapy was given according to the routine of each centre. Patients receiving high-dose heparin had few LV thrombi, irrespective of warfarin therapy (6/32 vs 3/25, P ns). In patients not given heparin, however, a significantly higher prevalence of LV thrombi was found in a subgroup of patients treated with warfarin as compared to those who did not receive warfarin (8/13 vs 17/68, P 0.02). A similar, but non-significant difference was observed in patients given low-dose heparin (42% vs 27%, P ns). Within the non-heparin and low-dose heparin groups, age, infarct size, occurrence of Q-wave infarction, congestive heart failure and LV wall motion impairment did not differ between those treated or not treated with warfarin. In conclusion, high-dose heparin seems effective in the prevention of LV thrombosis irrespective of warfarin therapy after AAMI. The start of warfarin therapy in patients not receiving heparin was, however, associated with an increased prevalence of LV thrombosis.

Administration, Oral↗
PubMed1993

Left ventricular thrombosis and arterial embolism in acute anterior myocardial infarction.

To study left ventricular thrombus (LVT) formation and arterial embolism (AE), 106 consecutive patients with a first acute anterior myocardial infarction (AAMI) underwent two-dimensional echocardiography before discharge. Repeated assessments for detection of AE were performed. Patients were non-randomly allocated to either no heparin, low-dose heparin or high-dose heparin. LVT was found in 25 (26.9%) of 93 patients with technically satisfactory echocardiograms. Left ventricular (LV) wall motion impairment (P = 0.0017) and treatment with either heparin or low-dose heparin (P = 0.0019) were independent predictors of LVT formation. AE, all strokes, occurred in 10 patients (9.4%) and was strongly associated with high age (P = 0.0013). In conclusion, LVT and AE are frequent complications to AAMI. LV wall motion impairment predisposes for LVT and low-dose heparin seems not to prevent these complications.

Adult↗
PubMed1993

Total skin electron irradiation: efficacy in early mycosis fungoides.

The rare, indolent, but lethal malignancy, mycosis fungoides (MF), is amenable to durable remissions if treated topically at an early stage with nitrogen mustard, PUVA, or radiotherapy. A modification of conventional therapeutic irradiation which utilizes electron beams rather than photons, has been in use since 1951. This method, termed total skin electron irradiation (TSEI), has achieved consistently good CR rates (95-100%) at a variety of centres in the U.S.A., England, France, and Italy, despite troublesome differences in staging systems. In northern Israel we have treated 37 MF patients with TSEI during the past 13 years. All 21 of our early stage patients achieved CR, which is no longer regarded as an unusual result. However, most workers in the field acknowledge that issues of optimal dosing and curative potency remain unresolved.

Adult↗
PubMed1993

Anaplastic seminoma and spermatocytic seminoma--a retrospective analysis.

Through the years 1968-1990, 10 patients with anaplastic seminoma and 7 patients with spermatocytic seminoma were referred to the Northern Israel Oncology Center, Haifa, Israel. These patients represent 20% of a total of 85 seminoma patients referred for treatment and follow-up. All patients underwent orchiectomy. Metastatic work-up revealed stage I disease in all patients. Sixteen patients received postoperative prophylactic radiation therapy to the para-aortic lymph nodes and the ipsilateral iliac region, dose range 25-30 Gy (daily fractionation 200 cGy). With a mean follow-up of 98 months, 15 patients are alive with no evidence of disease or long-term side-effects of treatment. One patient died of ischaemic heart disease without evidence of recurrent tumour. One patient with anaplastic seminoma died from progressive disease. In the light of our experience and a review of the literature, it is suggested that treatment of stage I non-pure seminoma should be based on the extent of disease alone and not on the degree of histological differentiation. Stage I non-pure seminoma has the same good long-term survival and low complication rate as typical seminoma when treated with adjuvant radiotherapy. Prospective, randomised trials are required to evaluate the role of a surveillance policy alone in stage I non-pure seminoma.

Adult↗
PubMed1992

Co-administration of progabide inhibits haloperidol-induced oral dyskinesias in rats.

Vacuous chewing movements in rats may be an animal analogue of the human motor disorder, tardive dyskinesia. The movements are phenomenologically and pharmacologically similar to tardive dyskinesia. The pathophysiology of these involuntary oral movements, and perhaps of tardive dyskinesia, are likely to include both dopamine receptor changes, and alterations in GABA (gamma-aminobutyric acid) system function. In an attempt to test the involvement of GABA system dysfunction in these movements, we treated rats chronically with water alone, haloperidol alone, the GABA agonist progabide alone, and haloperidol plus progabide. Sprague-Dawley rats received haloperidol (1.5 mg/kg per day) in their drinking water and progabide (100 mg/kg per day) in their food for 12 months. After 12 months of treatment, haloperidol had induced vacuous chewing movements when administered alone, but the prevalence of the movements was decreased by 40% with the coadministration of progabide. Moreover, the haloperidol-progabide-treated animals did not merely demonstrate movement suppression but actual inhibition of movement onset, as determined by an additional progabide-withdrawal experiment. These data would suggest that progabide and perhaps other GABAmimetic compounds can prevent the development of tardive dyskinesia in man.

Administration, Oral↗
PubMed1992

The nucleotide sequence of the coat protein gene and 3' untranslated region of papaya ringspot virus type W (Aust).

The nucleotide sequence of the 3' terminal region of the Australian isolate of papaya ringspot virus type W [PRSV-W (Aust)] was determined. An open reading frame (864 bp), encoding the putative coat protein gene, occurs upstream of the putative 3' untranslated region (206 bp) and poly(A) tail. A 23 amino acid sequence was obtained from N-terminal analysis of the coat protein from purified virions. This sequence has 100% homology with a region of the amino acid sequence inferred from the nucleic acid sequence of the coat protein gene. However, this region is 13 amino acids downstream from the N terminus predicted for two American isolates of PRSV. The coat protein gene of PRSV-W (Aust) was shown to have 96.8% and 96.4% nucleotide sequence similarity with American isolates of PRSV-W and PRSV-P, respectively.

Amino Acid Sequence↗
PubMed1992

Primary care in accident and emergency and general practice: a comparison.

This paper reviews the way in which literature describing 'inappropriate' attenders at Accident and Emergency (A & E) departments in Britain has suggested that they could be provided for in General Practice and that their attendance at A & E departments therefore implies a 'failure' of general practice in urban areas. One problem with much previous research is that 'inappropriate' attenders have been retrospectively identified. The comparative survey of attenders at a London A & E department and patients visiting their GP in the same district reported here prospectively identified A & E attenders with primary care problems and examined the differences between them and the GP attenders. Patients attending the hospital A & E department were similar to the GP attenders in terms of socio-economic indicators, but had problems which were not typical of the general practice workload and were in different circumstances. The results suggest that there will be a continuing demand for hospital-provided primary care in urban areas, and that attempts to deflect such care to the community will meet with limited success.

Adolescent↗