Search PubMed⌕ Search

Biomedical subjects

J Paul

Publications and source records attributed to J Paul.

At least 127 records · Page 7Linked to original sources
PubMed1995

Epirubicin chemotherapy and advanced breast cancer after adjuvant CMF chemotherapy.

There have been conflicting reports on the effect of prior adjuvant chemotherapy on the response of advanced breast cancer to primary chemotherapy. We report a retrospective review of the outcome of chemotherapy with epirubicin 100 mg/m2 for advanced breast cancer in 39 patients who had previously received adjuvant cyclophosphamide, methotrexate and 5-fluorouracil (CMF). The response rate (complete responses plus partial responses) was 38.5%, with a median duration of response of 33 weeks. There was no significant difference in the response rate or duration of survival when these patients were compared with matched controls who had not received adjuvant chemotherapy. However, the limitations of this study were such that an adverse effect of adjuvant CMF on the response to epirubicin cannot be excluded.

Adult↗
PubMed1995

Characterization of Streptococcus pneumoniae from human immunodeficiency virus--seropositive patients with acute and recurrent pneumonia.

Thirty-two isolates of clinically significant Streptococcus pneumoniae from 11 human immunodeficiency virus (HIV)-seropositive patients with single or multiple episodes of pneumonia were characterized by antibiotic susceptibility testing, serotyping, ribotyping, and repetitive extragenic palindromic polymerase chain reaction (REP-PCR). The isolates comprised 10 serotypes, 12 ribotyping patterns, and 12 REP-PCR patterns. There was close but not absolute correlation between techniques. By combining these characterization methods, 14 strains were identified. Five strains were found in > 1 patient, suggesting their frequent occurrence in this population. Two isolates of different serotype from 1 patient were highly related by ribotyping and REP-PCR, suggesting possible in vivo serotype change. Acute infection was associated with single strains or coinfection by distinct strains. Recurrent pneumonia was identified as relapse with the same strain or reinfection with new strains. The molecular characterization of pneumonococci from HIV-seropositive persons refines our understanding of pneumonococcal infection in these patients.

Acute Disease↗
PubMed1995

Predictors of repeat HIV testing among gay and bisexual men.

OBJECTIVE: To examine the prevalence and predictors of repeat HIV testing. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional data from two random household-based and bar-based samples of gay/bisexual men in two medium-size cities (Tucson, Arizona and Portland, Oregon) with substantial numbers of AIDS cases, in 1992 (n = 2602). MAIN OUTCOME MEASURE: The prevalence and predictors of repeat testing among men who reported being HIV-tested at least once but not being HIV-positive (n = 1583). RESULTS: In total, 51% of the sample had been tested three or more times, and 15% were tested more than once every 6 months. Men with higher risk were more likely to be repeatedly tested, although oral but not anal risk was a significant predictor of repeat testing in regression analyses. Men who did not know the HIV status of their primary partner were less likely to be repeatedly tested. Men who perceived that social norms favored secondary prevention, specifically adherence to medical recommendations for the treatment of HIV infection, and who communicated more often about testing were more likely to be repeatedly tested. CONCLUSIONS: Policy and clinical recommendations for repeat testing must be based on consideration of the complexity and multi-faceted nature of repeat testing. For some individuals, repeat testing may play a legitimate role in HIV prevention by reinforcing safe behavior and providing confirmation of HIV-negative status. However, for others repeat testing may indicate a need for different or more intensive interventions to encourage safe sex.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Does delayed diagnosis or scrotal incision affect outcome for men with non-seminomatous germ cell tumours?

OBJECTIVE: To ascertain whether delayed diagnosis or type of orchidectomy affected outcome for men with non-seminomatous germ cell tumours (NSGCT). PATIENTS AND METHODS: The case notes of 454 men resident in the west of Scotland with a diagnosis of NSGCT between 1975 and 1989 were retrospectively reviewed. The clinical record was available for 442 (97%) and included information on time to diagnosis in 92% and diagnostic surgery in 97%. The study end-point for orchidectomy was loco-regional recurrence and for diagnostic delay was survival. RESULTS: A significant minority of men (10.4%) underwent a scrotal orchidectomy or had a scrotal incision before an inguinal orchidectomy (9.4%). More scrotal incisions were performed on patients under the care of general surgeons (28%) than of urologists (12.1%). Of the men who had scrotal surgery, one of 78 (1.3%; 95% CI, 0-4%) developed loco-regional disease as the initial site of recurrence, compared with none of 318 men undergoing inguinal orchidectomy. The median time to diagnosis was 3 months. There was no relationship between time to diagnosis and tumour extent at presentation. A diagnostic delay of > 3 months was associated with inferior survival in univariate analysis, but delayed diagnosis was not an independent influence on survival after adjustment for the major prognostic factors--tumour extent, year of diagnosis and treatment unit. CONCLUSIONS: These results suggest that scrotal incision is unlikely to affect the risk of loco-regional recurrence and that effective cytotoxic therapy has probably reduced the prognostic importance of delayed diagnosis on survival of men with NSGCT.

Adolescent↗
PubMed1995

Rates of tibial osteotomies in Canada and the United States.

This study determined the temporal trends and factors associated with the rates of performance of tibial osteotomies from 1985 to 1990 in Ontario, Canada and the United States. The Health Care Financing Administration, Ontario Health Insurance Plan, and National Hospital Discharge Survey databases were used to determine the number of osteotomies from 1985 to 1990. Osteotomy rates decreased in both countries approximately by 11% to 14% per year in patients 65 years and older and by 3% to 4% per year in patients younger than 65 years. Men received twice as many osteotomies as women in both countries. In the United States, the average rate of tibial osteotomies was 2 to 3 times lower than in Ontario.

Age Factors↗
PubMed1995

A new experimental model and formula for flow determination and possible application in sizing of interatrial communication.

The concept of an artificial interatrial communication in application of the Fontan procedure in high risk patients has raised the problem to exactly determine the shunt amount. This experimental study shows that in vitro flow studies of interatrial communications can be performed without animal blood and PTFE membranes respectively. Furthermore the simulation of an pulmonary vascular venous flow is not necessary. Additionally a new formula with acceptable accuracy for flow estimation is derived from the presented data obtained by this study.

Animals↗
PubMed1995

Comparison of a generic (SF-36) and a disease specific (WOMAC) (Western Ontario and McMaster Universities Osteoarthritis Index) instrument in the measurement of outcomes after knee replacement surgery.

OBJECTIVE: The discriminant validity of a generic, health related quality of life (HRQL) measure, the SF-36, was compared with that of a disease specific HRQL measure, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), in patients aged 67-99 years who had undergone knee replacement surgery 2 to 7 years previously. METHODS: A stratified random sample of 1750 Medicare beneficiaries was surveyed and 1193 usable responses were obtained (after adjustment for ineligible, incapacitated, and deceased individuals). Discriminant validity of scale scores common to both instruments (pain, physical functioning, and overall score) were compared. RESULTS: Examination of discriminant validity, using Spearman correlations, showed that the WOMAC discriminates better among individuals with knee problems, while the SF-36 discriminates better among individuals with varying levels of self reported general health status and comorbidities. CONCLUSION: These scales measure 2 distinct but important aspects of patients' health. These results support inclusion of both a generic and a disease specific HRQL measure in cross sectional studies.

Aged↗
PubMed1995

Comparison of a generic and a disease-specific measure of pain and physical function after knee replacement surgery.

Generic and disease-specific health status instruments are commonly used to assess patients' outcomes. The hypothesis that they measure distinct but complementary aspects of patients' quality of life was tested using a sample of patients aged 67 to 99 years who had undergone knee replacement surgery 2 to 7 years previously. Patients' scores on a generic health-related quality-of-life (HRQOL) measure, the SF-36, were compared to those of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index; the WOMAC was developed specifically for patients with lower extremity arthritis, whereas the SF-36 is aimed at all conditions. A stratified sample of 1,750 Medicare beneficiaries was surveyed and an overall response rate of 80.3% achieved, resulting in 1,193 usable surveys (after adjustment for ineligible, incapacitated, and deceased individuals). The distribution of scores on the three dimensions common to both instruments (i.e., pain, physical function, and overall score) showed consistently higher scores on the WOMAC, on a scale of 0 (worst) to 100 (best), than on the SF-36, indicating less disability from arthritis than from other conditions after knee surgery in this elderly population. Statistically significant differences in the number of people with perfectly healthy scores were detected between the instruments; with regard to pain, 32.2% of the sample reported no pain due to arthritis on the WOMAC, compared with only 13.6% reporting no pain due to any conditions on the SF-36. The figures for physical function and overall score were 9.6% versus 1.4%, and 6.9% versus 0.2%, respectively. Examination for discriminant validity showed that the scores on the two scales followed hypothesized patterns: the WOMAC discriminated better among subjects with varying severity of knee problems, whereas the SF-36 discriminated better among subjects with varying levels of self-reported health status and comorbidity. The results of this study support the inclusion of both a generic and a disease-specific HRQOL measure to assess patient outcomes fully.

Aged↗
PubMed1995

[Prion, from crazy cows to iatrogenic Creutzfeldt-Jakob disease. Which risk in laboratory or in hospital?].

The long latency time, without any characteristic clinical sign, of transmissible degenerative encephalopathies, the transmissibility of the called "prion" infectious agent, associated with its exceptional resistance to normal inactivation methods, are resulting in accidental transmissions, both human (Creutzfeldt-Jakob disease), and animal (bovine spongiform encephalopathy). Among data about physical and chemical inactivation methods tested, we retain, to avoid professional or iatrogenic transmissions in the laboratory or in hospital, steam autoclaving and sodium hypochlorite or hydroxide treatment. But inactivation shall not be performed using the current processes as regarding parameters such as temperature, concentration and duration of exposure.

Animals↗
PubMed1995

Results of a model AIDS prevention program for high school students in the Philippines.

OBJECTIVES: To describe the sexual practices of high school students; to describe the process of development of a school-based AIDS prevention program; and to evaluate the effect of this program on students' AIDS-related knowledge, attitudes and AIDS-preventive behaviors. SUBJECTS AND METHODS: A cluster-randomized, controlled trial with pretest/post-test evaluation was conducted in four demographically similar public high schools in a semi-urban district of Metro Manila, the Philippines. Of 845 high school students who participated in the baseline survey, 804 (95%) completed a postintervention questionnaire. INTERVENTION: An AIDS prevention program was developed by public high school teachers together with local AIDS experts, social scientists and health educators. The teacher-led AIDS program was designed to provide students with accurate information about AIDS, particularly in dispelling misconceptions about casual contagion, to foster positive attitudes towards people with AIDS and to develop skills aimed at clarifying values and assessing intended behavior. RESULTS: At baseline, 11% of students (20% of males and 4% of females) reported ever having had sexual intercourse (mean age 14 years). Among these, condom use was low (24%). After implementation of the AIDS prevention program, statistically significant effects favoring the intervention group were observed in knowledge and attitudes towards people with AIDS. While there was no statistically significant overall effect on intended preventive behavior, the program appeared to delay the students' intended onset of sexual activity. CONCLUSIONS: A sizable number of Filipino high school students are sexually active but condom use is low. School-based AIDS prevention programs can be developed and implemented in developing countries with the assistance of school personnel to address sexual issues. Our program was successful in increasing AIDS-related knowledge and improving attitudes towards people with AIDS. Supplementation with other preventive activities may be needed to achieve lasting changes in students' risk-taking behavior.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Recurrence of HIV-related tuberculosis in an endemic area may be due to relapse or reinfection.

SETTING: Two Research Clinics within Nairobi, Kenya, one in the Infectious Diseases Hospital, the national referral centre for tuberculosis, and one in a community based project in Pumwani district, and the Bacterial Molecular Genetics Unit at the London School of Hygiene and Tropical Medicine. OBJECTIVE: To determine whether recurrence of tuberculosis after 'adequate' treatment was due to reinfection with a different isolate of Mycobacterium tuberculosis or to relapse of the original infection. DESIGN: A retrospective comparison by DNA fingerprinting of sets of isolates of M. tuberculosis from patients with recurrence of tuberculosis and in whom isolates from the original episode had been stored was made. Five patients with recurrence of tuberculosis two to nineteen months after adequate treatment and documented clearance of disease were studied. RESULTS: In one patient, fingerprints of the isolates of M. tuberculosis from the recurrence were quite different to those from the original episode; in the other four, the fingerprints were identical. CONCLUSION: Reinfection rather than relapse was the cause of recurrence in at least one patient. The high 'relapse' rates seen in HIV-related tuberculosis in Africa may in part be due to increased susceptibility to reinfection and not to treatment failure.

AIDS-Related Opportunistic Infections↗
PubMed1994

rhGM-CSF ameliorates neutropenia in patients with malignant glioma treated with BCNU.

Nitrosoureas are the drugs most effective in the treatment of patients with intracerebral malignant glioma. Their limiting toxicity is delayed myelosuppression. A prospective, randomised crossover study of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) was performed in patients receiving BCNU for relapsed glioblastoma, to investigate whether the resulting haematological toxicity profile could be modified by rhGM-CSF. Adequate data for analysis were obtained in 13 patients. Following BCNU, the nadir neutrophil count was higher in 12 out of 13 patients during the rhGM-CSF-protected cycles compared with the unprotected cycles. The median nadir was also significantly higher (1.79, CI 0.76-3.52, P < 0.005). Five episodes of neutropenia (< 2 x 10(9) l-1) occurred during the unprotected cycles compared with none in the rhGM-CSF-protected cycles (P = 0.076). There was no evidence of any effect on platelets. This result shows that the haematological toxicity profile following therapeutic doses of BCNU can be modified. It suggests that rhGM-CSF and other growth factors should be investigated for clinical efficacy in chemotherapy using nitrosoureas.

Adult↗
PubMed1994

Cyclic sequential endocrine therapy for advanced breast cancer using a combination of tamoxifen and megestrol acetate.

A cyclical, sequential combination of tamoxifen and megestrol acetate (group B) was compared with conventional therapy (tamoxifen alone, group A) in 261 breast cancer patients. There was no statistically significant difference between groups for overall response rate (complete+partial response: group A, 35.8%, group B, 40.8%; p = 0.505) or for median response duration in responders (group A, 128 weeks, group B, 136 weeks; p = 0.488). Median survival from randomization was longer in those patients receiving sequential therapy (group A, 90 weeks, group B, 134 weeks) with a significantly lower relative death rate (group B/group A = 0.67; p = 0.011). This survival benefit appears to be due to a delay in progression among nonresponders in the sequential therapy group.

Adult↗