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Biomedical subjects

L Evans

Publications and source records attributed to L Evans.

At least 109 records · Page 6Linked to original sources
PubMed1991

Granulocyte-macrophage colony-stimulating factor mitigates the neutropenia of combined interferon alfa and zidovudine treatment of acquired immune deficiency syndrome-associated Kaposi's sarcoma.

The combined use of zidovudine (ZDV) and interferon (IFN) alfa-2a has been shown to have antiretroviral and antitumor potential benefit in the treatment of acquired immune deficiency syndrome (AIDS)-associated Kaposi's sarcoma (KS). However, the clinical use of this combination is frequently complicated by the overlapping myelotoxicity of these agents. We report here the results of a phase I/II study in which granulocyte-macrophage colony-stimulating factor (GM-CSF) was used for those KS patients who became neutropenic while receiving ZDV (1,200 mg/d) and IFN (9 x 10(6) U/d). Nineteen of 29 patients (66%) developed an absolute neutrophil count (ANC) of less than 1,000 cells per cubic millimeter and were begun on GM-CSF. All experienced a prompt increase in the ANC. Those patients receiving GM-CSF/ZDV/IFN alfa-2a had an improved end of study ANC when compared with the ZDV/IFN alfa-2a group, but did not have an increased rate of tumor response, end of study CD4 cell count, or improvement in any other hematologic variable. The use of GM-CSF was not associated with increased toxicity and, in particular, was not associated with a change in serum human immunodeficiency virus (HIV) p24 antigen. Tumor response was noted in 50% of the assessable patients (33% overall) despite "high-risk" characteristics in 80%. Of the responding patients, seven were on GM-CSF and might have otherwise required an alteration in ZDV/IFN alfa-2a dose level. Further study of GM-CSF as an alternate to dose modification of this (ZDV/IFN alfa-2a) and other combination therapies for AIDS patients is warranted.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Long term follow-up of agoraphobics treated by brief intensive group cognitive behavioural therapy.

This study reports the long term efficacy of a brief intensive (2 days) group cognitive behavioural programme for the treatment of agoraphobia with panic attacks. A total of 97 patients was included in the study. Seventy-four patients were in the treated group and 23 were on the waiting list control group. The Fear Questionnaire (FQ), Fear Survey Schedule (FSS), Maudsley Personality Inventory (MPI), the Hostility and Direction of Hostility Questionnaire (HDHQ) and a clinical assessment based on structured interview to assess current levels of functioning were used as dependent measures. The results show that patients in the treated group show significant improvement on FSS and FQ when compared with the patients in the control group. Clinical rating shows that 85% of the patients were either symptom free or their symptoms had been reduced and these effects of treatment were shown to be maintained at follow-up which was on average 1 year after the treatment.

Adaptation, Psychological↗
PubMed1991

Primary pancreatic tuberculosis.

A 71-year-old man developed weight loss, nausea, and night sweats. A PPD skin test was positive; chest films were normal. Abdominal computerized tomography revealed a mass in the head of the pancreas. Laparotomy revealed a 3 cm by 5 cm multi-loculated abscess cavity. Cultures grew Mycobacterium tuberculum. The diagnostic criteria for abdominal tuberculosis include skin test positivity, localized disease, and culture verification. This is the first reported case that fulfills diagnostic criteria for primary pancreatic tuberculosis.

Aged↗
PubMed1990

Interferon alfa-2a combined with phototherapy in the treatment of cutaneous T-cell lymphoma.

Escalating doses of recombinant interferon alfa-2a (Roferon-A), administered intramuscularly three times weekly, combined with psoralen plus ultraviolet light irradiation (PUVA), were tested in a phase I trial for the therapy of patients with cutaneous T-cell lymphomas (CTCL). Interferon doses were escalated in groups of three patients from 6 million to 30 million IUs three times weekly. Disease stages ranged from IB to IVB. Eighty percent of the patients entered in this trial had failed at least one prior therapy. Complete remissions were obtained in 12 of 15 patients, and partial responses were seen in two of 15 patients, for an overall response rate of 93%. The median duration of response exceeded 13 months (range, 3-15+). All patients who responded have been maintained on therapy. The dose-limiting toxic effects were constitutional symptoms such as fevers and malaise (93.3%), leukopenias (40.0%), mental status changes consisting of depression and confusion (33.3%), and photosensitivity (26.6%). These side effects were reversible with a decrement in dose or discontinuation of the interferon. No patient tolerated 30 million IU of the interferon for extended periods; the maximally tolerated dose was 18 million IU. Interferon plus PUVA appears to be a highly effective regimen for the treatment of patients with CTCL. Phase II studies investigating this combination, using 18 million IU of interferon alfa-2a three times weekly, should be undertaken to expand these findings, and to attempt to reduce the toxic effects associated with this therapy.

Combined Modality Therapy↗
PubMed1990

The fraction of traffic fatalities attributable to alcohol.

The vast literature on alcohol's effect on traffic safety does not contain even a moderately satisfactory answer to one of the most basic questions, namely "What is the fraction of all traffic fatalities attributable to alcohol use?" A published estimate of 23.7% based on an erroneous calculation has been widely quoted. This paper combines 1987 Fatal Accident Reporting System (FARS) data from 26 states that recorded blood alcohol concentrations for over 84% of fatally injured drivers with published estimates on how alcohol affects crash risk. By categorizing all traffic fatalities as either nonoccupants of vehicles, or occupants killed in single-vehicle, two-vehicle or three-or-more-vehicle crashes, and developing calculation procedures appropriate for each category, the fraction of all fatalities due to alcohol was inferred. The main finding was that eliminating alcohol would reduce traffic fatalities by (47 +/- 4)%. It was also concluded that alcohol use changes from 1982 to 1987 have reduced traffic fatalities by 12% (6,400 fatalities), which helps explain the absence of the fatality increase predicted because of a buoyant economy. Reducing the fraction of fatalities due to alcohol from the 1987 value of 47% to 42% (say) would reduce all traffic fatalities by 8%.

Accidents, Traffic↗
PubMed1990

Restraint effectiveness, occupant ejection from cars, and fatality reductions.

The effectiveness of air cushion restraint systems, or airbags, in preventing fatalities is estimated by assuming that they do not affect ejection probability, and protect only in frontal, or near frontal, crashes with impact-reducing effectiveness equal to that of lap/shoulder belts. In order to compute airbag effectiveness, lap/shoulder belt effectiveness and the fraction of fatalities preventable by eliminating ejection are estimated using Fatal Accident Reporting System (FARS) data. Ejection prevention is found to account for almost half of the effectiveness of lap/shoulder belts (essentially all for lap belts only). Airbag effectiveness is estimated as (18 +/- 4)% in preventing fatalities to drivers and (13 +/- 4)% to right front passengers. Drivers switching from lap/shoulder belt to airbag-only protection increase their fatality risk by 41%.

Accidents, Traffic↗
PubMed1990

Involvement of older drivers in multivehicle side-impact crashes.

Side impacts were studied using three separate analyses. National Accident Sampling System (NASS) and National Crash Severity Study (NCSS) cases were reviewed on multivehicle crashes involving fatal chest and abdominal injury by interior contact. Twenty-five cases were analyzed and showed an unusually high involvement of older occupants. Analyses of the 1975-1986 FARS confirmed an overinvolvement. Sixty-four percent of near-side seated occupants were over 50 years old and 36% over 70 in fatal multivehicle side impacts. In contrast, 26% of victims in single-vehicle frontal crashes were over 50 and 8% over 70 years old. Analysis of the 1982-1986 NASS showed that single-vehicle side impacts are not an important injury risk for older drivers, except on icy or wet roads. In contrast, the risk of injury in multivehicle side impacts increases steadily with age and is a major problem for older drivers. The individual NASS and NCSS cases also showed that 88% of the multivehicle side crashes took place at an intersection and that the driver of the struck vehicle frequently caused the crash by driving error (48%) or traffic violation (16%). The majority of cases occurred in daylight hours, on dry roads, and without alcohol involvement. Changes in visual perception, judgment and attention of the older driver may be factors in their missing a traffic signal or turning in front of traffic under the right-of-way. In addition, a reduced tolerance to impact force probably contributes to the injury. Although an analysis of photographs of the side-impacted vehicle indicated that 44% had side-structure deformation that was similar to that produced in the National Highway Traffic Safety Administration (NHTSA) moving deformable barrier test, only 24%-32% of the cases actually addressed the proposed NHTSA dynamic side-impact test. The results of this analysis bear on the agency's preliminary regulatory impact analysis.

Abdominal Injuries↗
PubMed1990

Neuroticism and age of onset for agoraphobia with panic attacks.

The study of the age of onset of psychiatric conditions can provide some clues to the aetiology of these disorders. A number of studies have examined the age of onset in agoraphobia but results have varied. This may be associated with small sample sizes or differences in populations. There has been very little work examining the factors determining age of onset. The present study examines age of onset in relation to sex and personality. Results indicate no sex differences in age of onset, but an association with age and high levels of neuroticism.

Adolescent↗
PubMed1990

Attributional style and panic disorder.

This study investigated the relationship between the development of panic disorder and attribution style by administering the Attribution Style Questionnaire (ASQ) to 28 subjects with panic disorder with agoraphobia and 21 subjects with other anxiety disorders who had experienced a panic attack at some time. No significant differences were found between the groups suggesting that cognitive style as assessed by the ASQ may not predispose to the development of panic disorders. A factor analysis of the results indicated that the ASQ may not be appropriate for the assessment of patients with panic disorder. Alternative hypotheses for the development of panic disorder are discussed.

Adult↗
PubMed1990

Phase II study of recombinant alpha-interferon in malignant melanoma.

Ninety-seven evaluable patients with measurable, advanced, malignant melanoma were treated with recombinant alpha interferon in a cooperative phase II efficacy trial, whose primary objective was to estimate the response rate. Interferon (rIFN alpha-2a, Roferon-A) was injected subcutaneously daily for 70 days. Dose was escalated in four steps from three million units to 36 million units over ten days. Eight patients responded objectively and six patients (6%) had a complete response. The median duration of complete response was 11 months. Patients achieving complete response had only cutaneous, nodal, or pulmonary disease; some had extensive prior therapy; some could tolerate no more than three million units per day. Few patients could tolerate the target dose of 36 million units daily for 70 days. Limiting toxicity was primarily fatigue. Interferon in tolerable doses is effective in a small subset of patients with melanoma. Comparison of published trials of dacarbazine and recombinant alpha interferon indicates the two drugs have similar activity.

Adult↗
PubMed1990

Utility and validity of the STAI with anxiety disorder patients.

Factor analytic studies of the State-Trait Anxiety Inventory (STAI) have provided support for the concepts of state and trait anxiety. This article reports the factor structure of the STAI (Form X) using 205 panic-disordered patients with and without agoraphobia. Results show that a two-factor oblique solution is the most appropriate, accounting for 41.1 per cent of the variance. Eighteen of the A-State items had salient loadings on factor 1 (state anxiety) and all 20 of the A-Trait items had salient loadings on factor 2 (trait anxiety). This study demonstrates the utility of the STAI in measuring anxiety in clinical populations and further supports the theoretical distinction between state and trait anxiety.

Adolescent↗
PubMed1990

Hyperventilation and panic attacks.

The role of hyperventilation in the aetiology of panic attacks is still unclear. This paper briefly reviews the role of hyperventilation and abnormal respiration to panic attacks and examines the experimental evidence. Evidence has been found that physiological variables such as paCO2 and pH are involved in the aetiology of panic attacks and panic disorder but the extent and the nature of the involvement of cognitive variables is undetermined. Based on current evidence, there is a need to integrate cognitive variables with the physiological framework proposed by the hyperventilation theory. Until clear experimental evidence is produced about the relationships between cognitive and physiological factors, the applicability of hyperventilation in the aetiology and treatment of panic attacks remains in question.

Agoraphobia↗
PubMed1989

Declining prevalence of hydrocephalus.

Data from the Glasgow Register of Congenital Anomalies were used to compare the recent prevalence of primary hydrocephalus with that of anencephalus and spina bifida. Between 1974 and 1985, the prevalence rates of all three conditions declined significantly and virtually in parallel, a phenomenon suggestive of a common aetiology.

Anencephaly↗
PubMed1989

Relative fatality risk in different seating positions versus car model year.

Fatality risk of drivers compared to right-front passengers is examined vs. car model year (MY) using Fatal Accident Reporting System (FARS) data for 1975 through 1986. Confounding effects are removed by comparing unrestrained occupants matched in sex and age (to within three years). MY greater than or equal to 1968 cars, which complied with Federal Motor Vehicle Standard 203 (impact protection for the driver) and FMVSS 204 (rearward column displacement), are compared to MY less than or equal to 1966 cars, which did not comply with these standards. It is found that, compared to right-front passengers in the same cars, drivers had higher relative fatality risks in MY greater than or equal to 1968 cars and lower relative fatality risks in MY less than or equal to 1966 cars. Because there are so few fatal frontal crash data for MY 1966 and MY 1968 cars, definitive conclusions regarding the effectiveness of FMVSS 203 and 204 in reducing driver fatalities are not possible. However, our analysis, together with the assumption that right-front-passenger fatality risk was the same in 1966 and 1968 MY cars, does suggest that a previous 12% effectiveness estimate is more likely to be high than low.

Accidents, Traffic↗
PubMed1989

Potential fatality reductions through eliminating occupant ejection from cars.

The percent of occupant fatalities preventable by eliminating ejection is calculated using Fatal Accident Reporting System (FARS) data for 1975 through 1986. The calculation requires estimates of two quantities. First, the fraction of all fatally injured occupants who were ejected; this is obtained directly from the FARS data. Second, the probability that an ejected occupant was killed compared to the probability that the occupant would have been killed in a similar crash in the absence of ejection; this quantity is estimated using the double pair comparison method, and its dependence on occupant age and sex and on car mass and model year is examined. High precision estimates of the reduction in fatalities that would result from eliminating ejection as functions of these same variables are thereby obtained. These estimates depend on assuming that whatever method is used to prevent ejection would cause the formerly ejected occupant to acquire the same fatality risk as a nonejected occupant in a similar crash; the study does not address how to prevent ejection. It is concluded that ejection elimination would decrease fatalities to unrestrained car occupants by 18 +/- 1%. The fatality reductions are independent of car seating position (19%, 19%, 17%, 16%, 19%, and 18% for drivers, middle front, right front, left rear, middle rear, and right rear passengers, respectively); they decrease with driver age, from 25% at age 18 years to 7% at 70 years; they decrease with increasing mass, but remained relatively independent of car model year since the early 1970s, being somewhat higher for earlier model years.

Accidents, Traffic↗
PubMed1989

Phobic disorders and anxiety states: how do they differ?

A review of the clinical literature to date has shown that the nature of the relationship between phobic disorders and anxiety states is still unclear. As a wide range of symptoms are shared by patients with all DSM-III anxiety disorder diagnoses, at this stage there is still a need to investigate the latent dimensions which distinguish the anxiety disorder subtypes. In the present study 176 patients with the DSM-III diagnoses of agoraphobia with panic attacks, social phobia, panic disorder and generalized anxiety disorder completed the Fear Survey Schedule, Fear Questionnaire, Hostility and Direction of Hostility Questionnaire, Maudsley Personality Inventory, and the Hamilton Anxiety and Depression Scales. Group membership was significantly predicted by a discriminant analysis which yielded a Fear Questionnaire agoraphobia function and a social phobia function. The results from discriminant analysis suggests that agoraphobia and anxiety states may be closely related. Classification errors were also determined, providing further evidence with which to refute the claim that agoraphobia has "all or none" characteristics.

Anxiety Disorders↗