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Biomedical subjects

J Dalton

Publications and source records attributed to J Dalton.

At least 37 records · Page 2Linked to original sources
PubMed1998

Cutaneous T-cell Lymphoma.

BACKGROUND: Cutaneous T-cell lymphoma (CTCL) represents a spectrum of diseases composed of malignant helper T lymphocytes. An accurate diagnosis of early CTCL is difficult because of the varied clinical and histologic expressions of the disease. METHODS: The authors review the epidemiology, possible risk factors, clinical manifestations, diagnostic techniques, staging, prognosis, and treatment options for CTCL. RESULTS: The varied and often nonspecific clinical and histologic presentations of CTCL may delay diagnosis and staging, thus necessitating further studies such as immunophenotyping, flow cytometry, and T-cell receptor gene rearrangement analysis. CONCLUSIONS: A multidisciplinary approach to the diagnosis, staging, and treatment of CTCL assists in optimizing outcomes from management of patients with this disease.

Journal Article↗
PubMed1997

Proteinases secreted by Fasciola hepatica: time course of the inhibitory effect of serum from experimentally infected rabbits demonstrated by gelatin-substrate polyacrylamide gel electrophoresis.

Fasciola hepatica secretes proteolytic enzymes to aid it to penetrate and migrate through the host tissues. Two of these proteinases have been purified and shown to be cathepsin L-like, and are termed, CL1 (27.5 kD) and CL2 (29 kD). The immunogenicity of these proteinases was investigated over the course of an experimental infection and following drug treatment. Four groups of rabbits were studied: group 1: orally infected with 50 metacercariae; group 2: infected and treated 8 weeks after infection; group 3: infected, treated at week 8 and reinfected at week 13 and group 4: non-infected control group. Sera were collected weekly from each group until week 20 postinfection. CL1 and CL2 were incubated with the different sera and then analysed by gelatin substrate polyacrylamide gel electrophoresis (GS-PAGE). Analysis of groups 1, 2 and 3 showed that CL1 and CL2 neutralizing antibodies appear at week 5 post-infection. In group 1, these remained throughout the 20 weeks of infection. In group 2, neutralizing antibodies disappeared at week 13, that is, 5 weeks after anti-Fasciola treatment. In group 3, CL1 and CL2 neutralizing antibodies disappeared at week 13 but reappeared by week 15, that is 2 weeks after reinfection. Pooled sera from group 4, showed no inhibitory capacity. ELISA results using CL1 and CL2 as antigen, correlate very well with the inhibitiory time course observed by GS-PAGE. These results suggest that purified cathepsin Ls are antigenic molecules recognized early in the infective process and capable of inducing a specific humoral response, strong enough to neutralize, at least partially, their enzymatic activity.

Animals↗
PubMed1997

Combined modality therapy for stage II and stage III pancreatic carcinoma.

PURPOSE: To study the outcome achieved with three-drug chemotherapy and split-course external-beam radiotherapy as a treatment for unresectable stage II and III pancreatic carcinoma. PATIENTS AND METHODS: Radiotherapy was given in three cycles of 2 Gy/d on days 1 to 5 and 8 to 12 (total dose, 54 Gy) concurrently with fluorouracil (FU) 1,000 mg/m2/d by continuous infusion for 4.5 days, streptozocin (STZ) 300 mg/m2 on days 1, 2, and 3 and cisplatin (P) 100 mg/m2 on day 3 of each every-28-day cycle. Subsequent treatment consisted of leucovorin (LV) 200 mg/m2 and FU 600 to 1,000 mg/m2 every 14 days. RESULTS: The median survival time for the 35 patients was 15 months and 26% of patients were alive at 24 months. Fifteen patients (42.8%) had objective responses to therapy. Six (17%) had a complete response (CR). Three of nine patients with partial responses (PRs) achieved a radiographic CR within the next 3 months. Nine patients underwent attempts at surgical resection: five were resected (median survival time, 31 months; range, 12.8 to 44.7+), two had no residual disease found at complete resection, and three others also had a complete resection. Of four others who could not be resected, three underwent intraoperative radiotherapy and one had occult metastatic disease. Of primary tumors, 91% did not produce either back pain or local gastrointestinal complications for 2 years. The rates of severe side effects were stomatitis 15%, anemia 14%, granulocytopenia 6%, and thrombocytopenia 6%. CONCLUSION: Palliation and survival compare favorably with other series, including many surgical series. The response findings encourage studies of both unresectable and (as neoadjuvant therapy) resectable tumors.

Adenocarcinoma↗
PubMed1996

The assessment of discomfort in elderly confused patients: a preliminary study.

With the increasing numbers of older adults in our population, nurses are reexamining all aspects of nursing care in order to best meet the needs of these individuals. Normal age changes, the impact of decades of environmental challenges, successful adaptations, acute illnesses, trauma and chronic illnesses combine to create a challenge for accurate and effective assessment of elderly patients. The nurse finds her assessment skills challenged with increasing frequency by the elderly patient who is also acutely confused and experiencing discomfort. The purpose of this study was to explore the clinical utility, validity and reliability of four different approaches to nursing assessment of discomfort with this particularly vulnerable group of elders.

Aged↗
PubMed1994

Simultaneous interstitial radiotherapy with regional or free-flap reconstruction, following salvage surgery of recurrent head and neck carcinoma. Analysis of complications.

OBJECTIVE: Reports on complications following brachytherapy offer conflicting views on the benefit of locoregional flap coverage of the implanted tumor bed. This study reviews complications following pedicled and free-flap coverage of brachytherapy sources after salvage surgery for recurrent head and neck carcinoma. DESIGN: Retrospective chart review. SETTING: Academic tertiary referral center. PARTICIPANTS: Fifteen patients with advanced, radiorecurrent carcinomas of the head and neck, treated between 1988 and 1992. INTERVENTION: All patients underwent surgical resection and implantation of the tumor bed with iridium 192 after-loading catheters (13 patients) or iodine 125 seeds (two patients). The average dose of interstitial radiotherapy supplied was 50.24 +/- 45.19 Gy (mean +/- SD). Coverage of the implanted tumor bed was achieved with regional myocutaneous flaps in 10 patients and microvascular free flaps in five patients. OUTCOME MEASURE: All wound and healing complications were identified. Patients were followed up for a minimum of 3 months. RESULTS: No significant complications were encountered. No flap, pedicled or free, demonstrated any degree of necrosis. Four minor complications developed in the group of patients who underwent reconstruction with pedicled myocutaneous flaps. One orocutaneous fistula developed in a patient in whom a radial forearm was used to reconstruct a posterior pharyngeal wall defect. CONCLUSIONS: An expectation of increased postoperative morbidity should not interfere with the decision to proceed with multimodality salvage therapy of patients with advanced, recurrent head and neck tumors. The advantages of free tissue transfer in the reconstruction of head and neck defects are not compromised when the flaps are simultaneously utilized to provide coverage for brachytherapy sites.

Adult↗
PubMed1993

Survival after combined modality therapy for pancreatic cancer.

Twenty consecutive patients with unresectable, locally advanced pancreatic cancer were treated with split courses of radiotherapy (RT) and simultaneous multidrug chemotherapy consisting of 5 fluorouracil, continuous infusion, streptozotocin, and cisplatin. A separate, retrospective study identified a group of 28 contemporary patients with less advanced pancreatic cancers, all of which were successfully resected. The survival rate of the two groups were similar over the first 2 years, although it initially favored the unresectable group. This pattern of survival among patients treated with combined modality therapy provides a basis for new studies. At the two clinical extremes, these include treatment of unresectable tumors previously considered ineligible for this treatment and initial treatment before resection of stage I tumors.

Adenocarcinoma↗
PubMed1993

Tissue infiltration in a CD8 lymphocytosis syndrome associated with human immunodeficiency virus-1 infection has the phenotypic appearance of an antigenically driven response.

HIV-1 infection may initiate to an HLA-associated response designated diffuse infiltrative lymphocytosis syndrome, characterized by increased numbers of circulating CD8 T cells that infiltrate salivary glands, lungs, gastrointestinal tract, and kidneys. Since this response could either be an antigenically driven process induced by HIV-1 or a lymphoproliferation of cells with neoplastic or unusual features, we sought to define the phenotype of the cellular populations, the nature of tissue derangement, and the tissue localization of virus in diffuse infiltrative lymphocytosis syndrome. Circulating CD8 T cells were greatly increased while CD4 T cell numbers remained in the range found in asymptomatic seropositive persons. The majority of CD8 and CD4 T cells in both blood and tissues had the memory phenotype of CD29+ (beta 1 integrin) and CD11a+/CD18 (beta 2 integrin) expression, but lacked markers of recent activation. A proportion of the circulating CD8 T cells also expressed CD57 (Leu 7) but not other markers of natural killer cells. HIV-encoded proteins were identified in tissue macrophages located in periacinar areas of the salivary glands. CD54 (intercellular adhesion molecule-1), a ligand for the CD11a integrin, was strongly expressed on postcapillary venule endothelium within lymphoid foci, and HLA-DR molecules were found on limited regions of ductular epithelium adjacent to lymphoid aggregates. These findings suggest that (a) the visceral lymphocytic infiltration in diffuse infiltrative lymphocytosis syndrome is an antigen-driven, and MHC-determined, host immune response to an element associated with HIV-1 infection, and (b) that the specific adhesive molecule interactions mediating the cellular influx, as well as the subsequent tissue damage, reflect altered patterns of gene expression in tissues undergoing an immune response.

AIDS-Related Complex↗
PubMed1993

Combined modality therapy increasing local control of pancreatic cancer.

Twenty patients with inoperable locally advanced Stage II and III pancreatic cancer were treated with combined modality therapy. Radiotherapy consisted of split courses of 2000 cGy each and, as needed, an additional 1400 cGy, separated by 2-week intervals. Simultaneous multidrug regimen chemotherapy consisted of 5-fluorouracil, continuous infusion, 1 g/m2 days 1-5; streptozotocin, 300-500 mg/m2 days 1, 2, 3; and cisplatin, 100 mg/m2 day 3 of every 4-week radiotherapy course (RT-FSP). Primary tumors decreased more than 50% in volume in 11 of 20 patients. Computed tomography scans demonstrated apparent complete disappearance of the primary tumor in 7 patients. Only 3 patients had tumor regrowth within the radiotherapy field, all after the end of radiotherapy. Local control improved as measured by increased frequency of tumor shrinkage and decreased frequency of primary tumor growth, recognizing the limitations of a pilot study and comparisons to best historical results achieved with standard short 5-fluorouracil schedules and radiotherapy. Successful local control largely eliminates the most common cause of refractory pain and may decrease the need for some forms of early palliative surgical intervention. Tumor shrinkage sometimes downstages tumors, creating frequent investigational opportunities for either elective extirpative surgery or intraoperative radiotherapy. This pilot experience also supports testing of expanded eligibility staging criteria for combined modality treatment and testing of new drugs as part of 5-fluorouracil-radiotherapy-based regimens.

Adenocarcinoma↗
PubMed1992

Recurrent intravenous leiomyomatosis with cardiac extension.

A case of recurrent intravenous leiomyomatosis with cardiac extension and a temporally extended presentation is described. Complete excision was achieved employing simultaneous sternotomy and laparotomy and deep hypothermia with circulatory arrest. Coronary revascularization was performed concomitantly with complete tumor resection. Diagnostic, operative, and pathologic considerations are reviewed and a preferred surgical approach discussed.

Female↗
PubMed1992

Diminished ratio of estrogen receptors to progesterone receptors in breast carcinomas of women who have had multiple miscarriages.

We examined the relationship of a history of miscarriage to the ratio of tumor estrogen receptors to progesterone receptors in 74 women with breast carcinoma evaluated between 1988 and 1990. Only women who had been pregnant and whose tumor contained both estrogen and progesterone receptors were included. Women with breast carcinoma and a history of two to four miscarriages had significantly lower ratios (less than 1) of tumor estrogen receptors to progesterone receptors than women with a history of zero or one miscarriage (greater than 1). This finding may be the result of a genetic anomaly in breast cancer patients that also affects the uterine environment during the reproductive years.

Abortion, Habitual↗
PubMed1990

Oestrogen receptor B-region polymorphism and spontaneous abortion in women with breast cancer.

To examine whether a variant human oestrogen receptor gene, which differs from the wild-type gene in the B region, was associated with spontaneous abortion, obstetric histories of breast cancer patients with this variant were compared with those of breast cancer patients with the wild-type gene. In women with the B-variant, 50% of pregnancies ended in spontaneous abortion, compared with 10% for women homozygous for the wild-type gene. B-variant women also had a higher proportion of spontaneous abortions and a higher number of spontaneous abortions per woman than did those with the wild-type gene.

Abortion, Habitual↗
PubMed1990

Clinical features and treatment outcome of patients with epithelial carcinoma of the ovary metastatic to the central nervous system.

Involvement of the central nervous system with carcinoma of the ovary is being noted with increasing frequency. We report on six patients who presented with central nervous system metastases between 2-61 months after diagnosis. Five patients had elevated serum CA 125 values at the time of diagnosis of central nervous system disease and presenting symptoms, and findings on neurologic examination generally correlated with computed tomography-documented lesions. Eighty-three percent of our patients were symptomatically relieved with a course of 30 Gy given to the whole brain; however, there were no long-term survivors (range 2-24 months). Survival did not appear prolonged in the four patients who received systemic chemotherapy as well as whole-brain irradiation.

Aged↗
PubMed1989

Chemotherapy in the management of intraocular lymphoma.

Six patients with intraocular (vitreous) lymphomas were treated with high-dose intravenous cytosine arabinoside (Ara-C). Four patients were previously untreated, one patient had previously received ocular and central nervous system radiation therapy and relapsed, and one patient had previously received chemotherapy for systemic lymphoma. Five responses were observed: one complete and four partial. High-dose Ara-C is active in intraocular (vitreous) lymphoma, but complete response is uncommon. Adjunctive use of Ara-C in combination with ocular irradiation may be a useful form of therapy in this uncommon lymphoma.

Adult↗