Biomedical subjects

J E Nevin

Publications and source records attributed to J E Nevin.

11 recordsLinked to original sources

PubMed1996

Community-oriented primary care.

Community-oriented primary care (COPC) combines elements of clinical medicine and public health to provide an effective strategy in tackling today's health problems. A primary care practice or program that develops a partnership with an identified community to describe and prioritize health concerns and design and monitor the impact of an intervention can make a difference to the health of a community. The key ingredient to a successful COPC venture is a motivated practitioner. Familiarizing health care providers with the COPC model will enable them to form enriching relationships with the communities they serve.

Community Health Services↗

PubMed1983

The use of intravenous phenylalanine mustard followed by supervoltage irradiation in the treatment of carcinoma of the ovary.

Between 1970 and 1980, 50 patients with carcinoma of the ovary were treated sequentially with six courses of IV phenylalanine mustard (L-PAM), second look surgery, and radiotherapy using the strip technique. Seven patients had advanced Stage I disease and six patients had Stage II disease; all of these patients are alive and well with no evidence of disease (NED) with a mean survival of five years. Thirty-seven patients had Stage III disease: ten of these patients did not respond to L-PAM (26%); 17 patients had a partial response (48%), and four of these (22%) are alive with NED and a mean survival of five years; ten patients (26%) had a complete response to L-PAM and all are alive and well with a mean survival of five years. The presence of a minimal tumor burden after the initial surgery, a mixed histology, a low-grade differentiation, suppression of leukocyte count to below 2000/mm3 after the first course of chemotherapy, and a complete response to L-PAM, were all factors that contributed to the probability of a long-term survival. Tumors responding to L-PAM and then recurring also responded to a combination of cisplatin and adriamycin, and hexamethylmelamine.

Adult↗

PubMed1982

Radiotherapy as an adjuvant in the treatment of carcinoma of the breast.

During the period from 1950-1974, 510 patients with a diagnosis of invasive ductal carcinoma treated with the standard Halsted radical mastectomy were reviewed retrospectively from the records of the Tumor Clinic of The Memorial Hospital, Danville, Virginia. The primary aim of the study was to determine whether postoperative adjuvant radiation therapy (POART) as delivered in a community hospital setting contributed to better cancer control and effectively influenced five and ten year survival rates. The results of the review indicated that the use of POART whether from an orthovoltage or cobalt source did not differentially influence the patient's disease outcome. The use of POART did not improve the five- and ten-year survival rates regardless of lesion location in patients with Stages I, II, and III disease with positive lymph nodes. POART did cause a significant decline in five- and ten-year survival rates of patients with Stage II and III disease with negative nodes when compared to the survival of patients with the same stage of disease that did not receive POART, i.e., 75% versus 94% five-year difference, and a 65% versus 85% ten-year difference. These results suggest that radiotherapy may have a detrimental effect on immunocompetence and thus alter survival rates in certain circumstances. Therefore, any clinical investigation measuring the results of various therapeutic modalities singularly or in combination should be based on pathologic staging rather than clinical staging so that these factors can be adequately evaluated.

Breast Neoplasms↗

PubMed1980

Minimal breast carcinoma.

Fifty-three patients with intraductal and microinvasive carcinoma of the breast were analyzed. Comparison of two groups of patients, one treated before 1969 and the other since, revealed a decrease in the mean age from 50 to 44 years, an increase in the annual rate from 0.6 to 5.0 percent and an increase in bilateral disease from 0 to 40 percent. The study also showed that patients with microinvasive disease (invasion up to 0.5 cm) had the same excellent prognosis as those with intraductal cancer. The results of this study suggest that (1) simultaneous random mirror-image biopsies of the contralateral breast should be performed with intraductal cancer of the breast, and (2) total mastectomy with lymph node sampling is the maximal treatment necessary in both intraductal and microinvasive cancer of the breast.

Adult↗

PubMed1976

Carcinoma of the gallbladder: staging, treatment, and prognosis.

Sixty-six cases of carcinoma of the gallbladder treated at The Memorial Hospital, Danville, Virginia, and the Medical College of Virginia, Richmond, were staged according to depth of invasion and spread and graded histologically; the findings were correlated with survival. Results from the two hospitals were essentially identical and the survival figures correlated well with 399 reported cases in the medical literature which could be staged according to the depth of invasion. A simple method combining staging and histologic grading of cancer of the gallbladder, which can easily be applied to all cancers of the gallbladder removed surgically and which should prove useful in the management of this disease, is described. Essentially all of the carcinomas of the gallbladder in the series were incidental findings at surgery for gall stones which may explain a relatively high proportion of superficial carcinomas which are cured by the removal of the gallbladder.

Gallbladder Neoplasms↗

PubMed1975

Use of arterial infusion of 5-fluorouracil either alone or in combination with supervoltage radiation as a treatment for carcinoma of the prostate and bladder.

Arterial infusion of 5-fluorouracil either alone or in combination with supervoltage radiation achieves a definite objective improvement in patients with estrogen-resistant adenocarcinoma of the prostate. This improvement has been documented by a decrease in tumor size, improvement in intravenous pyelograms, and a change in cancer grade from undifferentiated to well differentiated. The quality of life in each case has been good, with 45 per cent of the patients treated in this category currently alive and well. The use of protracted arterial infusion of 5-fluorouracil in patients with stage C and D adenocarcinoma and transitional cell carcinoma of the bladder has had an even more satisfying outcome. Of those patients treated, 90 per cent are still alive and free of disease from six to sixty-six months. Eight of the patients have survived over two years with an excellent quality of life. A long-term outpatient infusion program is necessary to achieve these good results. It is also difficult and time-consuming. In addition to having well trained paramedical personnel constantly available, the patients must live within a reasonable radius of the treatment center so they can be treated almost immediately if problems develop. A fairly large number of patients must be treated in order to develop familiarity with the technics and to maintain a level of proficiency.

Adenocarcinoma↗

PubMed1975