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Biomedical subjects

J Hanson

Publications and source records attributed to J Hanson.

At least 181 records · Page 10Linked to original sources
PubMed1989

Adjuvant chemoimmuno- and immunotherapy in Dukes' stage B2 and C colorectal carcinoma: a 7-year follow-up analysis.

A prospectively randomised controlled clinical trial of adjuvant therapy was undertaken, at a single-centre, population-based cancer institute, in patients with Dukes' stages B2 and C colorectal carcinoma after curative surgery. Between 1976 and 1983, 253 patients were randomised to either control (no further therapy after surgery), immunotherapy (oral bacille Calmette-Guérin [BCG] 120 mg once a month) for 5 years or chemoimmunotherapy (oral BCG as above with methyl-cyclohexyl-chloroethyl nitrosourea [meCCNU] 130 mg/m2 on day 1 and 5-fluorouracil [5-FU] 325 mg/m2/day on days 1-5 and 375 mg/m2/day on days 36-40) repeated every 10 weeks for 8 cycles. The median follow-up of patients is now 6.95 years. Of the control, immunotherapy, and chemoimmunotherapy groups 22.35%, 39.28%, and 28.57%, respectively, have relapsed. The log-rank analysis of results shows no disease-free or overall survival advantage for patients receiving adjuvant therapy compared with the control group. Patients receiving adjuvant immunotherapy for stage B2 appear to have a significantly inferior disease-free survival compared with other groups, but their overall survival is similar. There are no significant differences in disease-free or overall survival in the three groups of patients with stage C tumour. Of 82 patients dying, 78.05% died of progressive colorectal carcinoma, 13 patients developed a second malignancy; the remainder died of seemingly unrelated causes.

Adenocarcinoma↗
PubMed1989

Risk factors and 10-year breast cancer survival in northern Alberta.

1,121 women in northern Alberta diagnosed as having breast cancer between 1971-74 were followed for 10 years. Risk factors for breast cancer were studied with respect to their possible influence on survival by comparing survival curves, using both Logrank and Cox's regression model, and controlling for intercurrent death, stage and axillary node status. A complex interaction was found between age and menopausal status and survival rates. Premenopausal women aged 45-55 had a better survival rate than postmenopausal women of the same age. However, one subgroup of premenopausal women aged 35-39 had a significantly worse prognosis than those aged 40-44 as did a group of post menopausal women aged 70-74. No cause was found other than the effect of age. There was a significant trend to worsening survival with heavier weight at time of diagnosis and with breast feeding. Parity of five or more and family history of breast cancer were less consistently associated with worse survival. Oral contraceptive use was only associated with worsened prognosis significantly when stage was controlled for; there was no overall effect. Age at menarche and age at first birth did not influence prognosis. Theories to explain the findings are discussed.

Adult↗
PubMed1989

Peritoneal dialysis following open heart surgery in children.

Over the course of the last 5 years, we have instituted peritoneal dialysis on 26 (7.7%) of 338 complex postoperative cardiac bypass cases. The mean age of dialysis patients was 0.64 +/- 0.75 years with a range of 0.1-2.5 years. The indications for the start of dialysis were oliguria (15 cases), fluid overload (three cases), hyperkalemia (one case), and anuria (seven cases). There were no complications as the result of dialysis, although two of the dialysis catheters had to be replaced. Dialysis successfully treated the starting indication in all cases. Dialysis was instituted at 47 +/- 50 (12-240) h after bypass, and lasted 111 +/- 134 (18-552) h; early institution of dialysis had no effect on mortality. Low cardiac output was a significant predictor of death in dialysis patients (p = 0.015). Age was a significant determinant of death (p = 0.0001) and the need for dialysis (p = 0.0043) in the total bypass population; the younger the patient, the greater was the likelihood of death or the need for dialysis. Age, however, was not a predictor of mortality in the peritoneal dialysis group.

Aging↗
PubMed1989

Performance evaluation of a dual-energy x-ray bone densitometer.

We tested a dual-energy bone densitometer (LUNAR DPX) that uses a stable x-ray generator and a K-edge filter to achieve the two energy levels. A conventional scintillation detector in pulse-counting mode was used together with a gain stabilizer. The densitometer normally performs spine and femur scans in about 6 minutes and 3 minutes, respectively, with adequate spatial resolution (1.2 x 1.2 mm). Total body scans take either 10 minutes or 20 minutes. The long-term (6 months, n = 195) precision of repeat measurement on an 18-cm thick spine phantom was 0.6% at the medium speed. Precision error in vivo was about 0.6, 0.9 and 1.5% for spine scans (L2-L4) at slow, medium and fast speeds, while the error was 1.2 and 1.5 to 2.0%, respectively, for femur scans at slow and medium speed. The precision of total body bone density was 0.5% in vitro and in vivo. The response to increasing amounts of calcium hydroxyapatite was linear (r = 0.99). The densitometer accurately indicated (within 1%) the actual amount of hydroxyapatite after correction for physiological amounts of marrow fat. The measured area corresponded exactly (within 0.5%) to that of known annuli and to the radiographic area of spine phantoms. There was no significant effect of tissue thickness on mass, area, or areal density (BMD) between 10 and 24 cm of water. The BMD values for both spine and femur in vivo correlated highly (r = 0.98, SEE = .03 g/cm2) with those obtained using conventional 153Gd DPA. Similarly, total body BMD correlated highly (r = 0.96, SEE = .02 g/cm2) with DPA results.

Absorptiometry, Photon↗
PubMed1989

Living related renal transplantation in Ireland: a sixteen year review.

Between January 1972 and December 1987, a total of 777 transplants were performed of which 135 (17%) were living related. There were 108 sibling donors, 25 parent to child and 2 child to parent. All sibling transplants were HLA identical. Conventional immunosuppression with Prednisone and Azathioprine was used in all cases. Actuarial patient survival were 95%, 91% and 88% at 1, 5 and 10 years respectively. Corresponding actuarial graft survivals were 90%, 80% and 60%. Graft survival in the sibling compared to the parent to child group was 87% versus 60% at 5 years. There were 13 deaths during the study interval and 32 grafts were lost. Five year patient/graft survivals of 91/80% compare favourably with other reported series. The poorer outcome in parent to child transplants has led us to modify the immunosuppressive protocol to include Cyclosporin A in this group. The increased availability and improved survival of cadaveric grafts in recent years and our one year patient/graft survival of 92/88% has led us to reduce emphasis on living related transplantation in our renal replacement programme.

Adolescent↗
PubMed1989

The Edmonton staging system for cancer pain: preliminary report.

Fifty-six consecutive patients with pain due to cancer were admitted to a prospective study designed to test a clinical staging system for cancer pain. The system classifies patients in stage 1 (good prognosis) to stage 3 (poor prognosis) according to the mechanism of pain, characteristics of pain, previous narcotic exposure, cognitive function, psychological distress, tolerance and past history of drug addiction or alcoholism. During day 1 patients were staged after being seen by one of the investigators. Patients were treated for 21 days, when a final diagnosis of pain control was made. Eighteen of 22 patients in stage 1 achieved good pain control (82%) vs. 2/22 patients in stage 3 (10%; P less than 0.01). Sensitivity, specificity and negative predictive value of the system were 0.75, 0.86 and 0.80, respectively. We conclude that this is a simple and reliable system for clinical staging that can be used for clinical research and management of patients with cancer pain.

Female↗
PubMed1989

Association between asthenia and nutritional status, lean body mass, anemia, psychological status, and tumor mass in patients with advanced breast cancer.

Sixty-four consecutive patients with advanced breast cancer were included in a study designed to determine the prevalence of asthenia and its association with other clinical features. The Asthenia Score (AS, the average of four tests designed by our group to assess asthenia) was 59 +/- 9 for patients versus 88 +/- 7 for a group of 68 normal controls (p less than 0.001). Twenty-six patients (41%) scored below the tenth percentile of normal controls and were considered asthenics. AS was correlated with depression and the general severity index of the SCL-90 R test. No association was found between AS and nutritional status, lean body mass, tumor mass, anemia, or type of treatment. We conclude that asthenia is a frequent symptom in patients with advanced breast cancer, which, in our series, showed independent correlations only with psychological distress.

Aged↗
PubMed1989

Reassessment of the relationship between M-protein decrement and survival in multiple myeloma.

The relationship between percentage M-protein decrement and survival is assessed in 134 multiple myeloma patients. The correlation did not achieve statistical significance (P = 0.069). Multivariate analysis using the Cox proportional hazards model, including a number of previously recognised prognostic factors, showed only percentage M-protein decrement, creatinine and haemoglobin to be significantly correlated with survival. However, the R'-statistic for each of these variables was low, indicating that their prognostic power is weak. We conclude that neither the percentage M-protein decrement nor the response derived from it can be used as an accurate means of assessing the efficacy of treatment in myeloma. Mature survival data alone should be used for this purpose.

Actuarial Analysis↗
PubMed1989

[Precancerous diseases and the early recognition of pharyngeal and laryngeal carcinomas].

Precursors and early symptoms of pharyngeal cancers generally appear without specificity. Mostly they are recognized in the stage of progressive carcinoma, so requiring a more radical therapy. Another situation you will find in laryngeal tumours. The early detection of laryngeal cancers has been mainly influenced by the favourable experiences of gynecologists with portio precancerous diseases. So an essential contribution to early detection of laryngeal cancer was given here by using a system of graduated methods regarding precursors and early stages of laryngeal carcinoma supplied by critical evaluation of early symptoms (hoarseness, disturbances of swallowing). The principle of clinical diagnostics turns out to be an exact observation of laryngeal mucosa surface by means of microscope, occasionally supported and extended by means of further investigations, e.g. exfoliative cytology and supravital staining. Moreover, for instance laryngostroboscopy permits to record vocal folds' movements so enabling a careful registration of laryngeal function. Nevertheless therapy of precancerous epithelial lesions in the larynx can be determined by histology only. Thereto we could demonstrate by means of evaluation of numerous patients' data as by scanning electron microscopic investigations of the laryngeal mucosa, that the rate of malignant transformation of localized (leukoplasia, pachyderma, keratosis) and diffuse epithelial lesions (chronic laryngitis) obviously seems to be greater in cases of verrucous or papillary surface structure of mucosa than in plain one. Finally, general recommendations for diagnostics and therapy of epithelial dysplasias and carcinoma in situ of the larynx according to the ORL society of the GDR are presented now.

Carcinoma in Situ↗
PubMed1988

Patient-controlled subcutaneous hydromorphone versus continuous subcutaneous infusion for the treatment of cancer pain.

Twenty-five patients with pain due to advanced cancer were randomized to receive patient-controlled sc injections (PCIs) of hydromorphone (HM) versus continuous sc infusion (CSCI) of HM by means of a Pharmacia 5200 pump. Each self-injection of HM during PCI was equivalent to 4 hours of CSCI. After 3 days, a crossover occurred, and patients received the alternate treatment for 3 days. During both phases of the study, patients could request extra doses of HM from their nurses. In 22 patients able to be evaluated, pain intensity (visual analogue, 0-100 mm) at 9:00 a.m. and 4:00 p.m. was 31 +/- 23 and 28 +/- 18 mm, respectively, on PCI versus 28 +/- 18 and 27 +/- 17 mm, respectively, on CSCI [P = not significant (NS)]. The total dose of HM was 168 +/- 197 and 181 +/- 234 mg on PCI and CSCI, respectively (P = NS). No significant difference was found in nausea, drowsiness, or number of hours of sleep. The total number of extra doses of HM was 6 +/- 7 on CSCI versus 2 +/- 3 on PCI (P = .007). At the end of the study, patients chose PCI and CSCI in seven and 10 cases, respectively (P = NS; 5 patients expressed no preference). We conclude that both methods were similar in regard to effectiveness and toxic effects in short-term hospital use.

Female↗
PubMed1988

Dose intensity analysis of melphalan and prednisone in multiple myeloma.

The average relative dose intensity (DI) of conventional oral melphalan and prednisone therapy received by 93 newly diagnosed multiple myeloma patients was correlated with survival and with percent reduction in M-protein. A survival advantage was shown with increasing average relative DI of melphalan and prednisone. Multivariate analysis showed survival to correlate with increasing DI of prednisone (P = .05) but not with the DI of melphalan (P = .93) nor with the percent decrement in M-protein (P = .10). These results suggest that the initial management of myeloma should be reassessed, with particular emphasis on more intensive therapy employing high-dose steroids.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Towards a model social work curriculum for practice with the chronically mentally ill.

Social work is well-positioned to mount a major curriculum initiative focused on practice with the chronically mentally ill. The profession's historical legacy, conceptual compatibility with current service needs, and its significant contribution to practice and research are a firm base upon which to build. This paper suggests the content needed to adequately prepare future cadres of professionals and proposes a variety of curriculum strategies for organizing such content. In addition, attention is devoted to the preparation of management personnel.

Chronic Disease↗
PubMed1988

Hippel-Lindau disease: MR imaging.

Hippel-Lindau disease is an auto-somal-dominant disorder characterized by tumors arising from the central nervous system and abdominal viscera. Because of its progressive nature, frequent multisystem radiologic evaluation of affected persons and family members at risk is desirable for early detection and treatment. During a 2-year study, magnetic resonance (MR) imaging of the head, spine, and abdomen was used for screening and follow-up in 26 members of nine families with the disease. In addition to 13 previously diagnosed cases, five cases were newly diagnosed during the study. Lesions causing significant morbidity and mortality--such as cerebellar and spinal cord hemangioblastoma, renal cell carcinoma, and pheochromocytoma--were correctly depicted with MR imaging, sometimes before symptoms had developed and before the lesions could be seen with other imaging modalities. Central nervous system abnormalities were most clearly shown, but MR imaging also adequately demonstrated abdominal visceral abnormalities. It is therefore highly useful in the diagnosis and follow-up of Hippel-Lindau disease.

Adolescent↗
PubMed1988

Multimodality detection of metastatic melanoma.

A retrospective evaluation of radionuclide liver and spleen scintigraphy (LS), ultrasonography (US), and computed tomography (CT) was performed in 88 patients who had pathologically proven cutaneous melanoma. In patients who had all three examinations (n = 24), the matrix analysis showed that CT was significantly more sensitive (0.94) in detecting intra-abdominal metastasis when compared to US (0.62, P less than 0.05) and LS (0.38, P less than 0.01). Sixty-four patients had only US and LS studies. In this group of patients US was found to be more sensitive than LS, 0.88 and 0.54 respectively (P less than 0.01). Furthermore, when CT was compared with US, CT was shown to detect metastases significantly earlier than US (P = 0.03). Overall, CT provided the most accurate means for detecting the intra-abdominal metastases of cutaneous melanoma.

Abdominal Neoplasms↗
PubMed1988

Information on response requirements compared with information on food density as a reinforcer of observing in pigeons.

On a variable-interval schedule, pecking the key to the pigeon's right (observing response) produced red or green displays relating to the delivery of grain and its dependence on pecking the key to the left (food key). During various blocks of sessions, mixed (no stimulus change) schedules including the following pairs of components were temporarily converted by the observing response to their corresponding multiple (correlated stimuli) schedules: variable-interval 60-s, extinction; variable-interval 60-s, variable-time (response-independent) 60-s; extinction, variable-time 60-s. Differences in food delivery maintained substantial rates of responding on the observing key, without regard to pecking requirements on the food key. Although stimuli correlated with differences in the response requirement on the food key maintained higher observing rates than those maintained by uncorrelated stimuli, they were much lower than those based on food. The value of predictive stimuli as reinforcers is determined by the value of the events predicted. In particular, the cost of pecking appears to be low, and this may place limitations on the applicability of energy-based and economic models of behavior.

Journal Article↗