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Biomedical subjects

L Hopkins

Publications and source records attributed to L Hopkins.

35 records · Page 2Linked to original sources
PubMed1991

An evaluation of the potential cost reductions resulting from the use of clodronate in the treatment of metastatic carcinoma of the breast to bone.

The reported studies of clodronate in the management of osteolytic bone metastases suggest a significant palliative role for this drug. In this paper we report on analysis of the hospital costs associated with the management of osteolytic metastatic disease, and an estimate of the potential cost/benefit impact of clodronate therapy. Two separate patient populations were assessed retrospectively. The first, a sample of 120 patients with symptomatic bone metastases who had died from metastatic breast cancer over the period 1980-1990, was used to define the natural history of the disease. A second non-concurrent patient group of 337 patients was evaluated to determine the mean cost of all hospital admissions for patients with bone metastases from breast carcinoma. The length of stay and costs for hospital admissions related to the bone metastases were also assessed, in addition to the cost of out-patient radiation therapy. Our cost/benefit value analysis suggests that there are significant savings to be gained from the use of clodronate if a 20% or greater reduction occurs in the incidence of fractures, hypercalcaemia, and hospital-based treatment for pain control (via radiotherapy). We also speculate that the quality of life of patients with osteolytic bone metastases may be improved with this agent.

Ambulatory Care↗
PubMed1986

Moxalactam myoclonus, seizures, and encephalopathy.

Severe myoclonus, generalized seizures, and marked stupor occurred in a 39-year-old woman with chronic renal insufficiency after one week of moxalactam 2 g iv q8h. Moxalactam serum levels far exceeded the recommended therapeutic range. The drug half-life was 17 hours (normal 1.9). Excessively high levels of moxalactam, which penetrates the blood-brain-barrier relatively easily, may provoke seizures and encephalopathy.

Adult↗
PubMed1980

Immunologic function in patients with carcinoma of the pancreas.

The immune fuction of 41 patients with duct cell adenocarcinoma of the pancreas or carcinoma of the periampullary region was studied by skin testing with 2,4-dinitrocholorobenzene and common microbial antigens, in vitro lymphocyte reactivity to mitogens, T-lymphocyte and B-lymphocyte cell counts and measurements of complement levels. Results show that a great proportion of patients had depressed immune function. Depression is particularly severe in lymphocyte reactivity. Positive response to skin tests with a microbial antigen carries a slightly better prognosis. The complement level is usually normal or elevated. Correlation between immune function, prognosis and tumor resectability in individual patients is generally poor.

Adenocarcinoma↗
PubMed1977

Type A botulism from commercially canned beef stew.

Two of three persons who ate lunch together became ill with symptoms characteristic of botulism. One died before botulism was suspected and before specimens could be collected for laboratory testing, but a serum specimen from the other patient, who survived, yielded botulinal toxin, type A. The third person remained asymptomatic, but Clostridium botulinum type A was cultured from his stool. The three persons had shared two canned foods: home-canned green beans and commercially canned beef stew. The green beans were initially assumed to be the cause of the outbreak. However, the empty stew can was recovered from the garbage, and washings from the can yielded C botulinum, type A, and its toxin.

Aged↗
PubMedDate not supplied

Primary chemotherapy and adjuvant tumor debulking in the management of advanced-stage epithelial ovarian cancer.

The aim of this article was to review the experience with neoadjuvant chemotherapy and interval surgical debulking in patients with metastatic epithelial ovarian cancer. A retrospective chart review was carried out to identify patients treated with neoadjuvant platinum/Taxol chemotherapy and interval debulking. Cox regression modeling was used to identify significant predictors of progression-free interval. The Kaplan-Meier method was used to estimate the survival statistic for the study group. Sixty-one patients were identified after being treated with neoadjuvant chemotherapy and interval debulking surgeries. All surgeries were performed after three cycles of platinum/Taxol combination chemotherapy. Eighty percent of patients had a residual disease status of 2 cm or less after surgery. Suboptimal debulking was statistically associated with tumor involvement of the upper abdominal organs (P < 0.001) and non-normalization of CA125 before surgery (P= 0.03). The perioperative complication rate was 7%. At a mean follow-up time of 19 months, 77% of patients were still alive. Cox regression modeling identified the microscopic tumor residual status as the only significant predictor of progression-free interval. The estimated median survival for the group was 41.70 months (95% confidence interval = 13.84-69.56 months). Neoadjuvant chemotherapy with interval debulking surgery appeared to be safe and feasible in patients with metastatic epithelial ovarian carcinoma.

Adult↗
PubMedDate not supplied

Quality of life assessments in epithelial ovarian cancer patients during and after chemotherapy.

To study the immediate and long-term effects of chemotherapy on quality of life (QoL) of advanced ovarian cancer patients. All consecutive patients undergoing chemotherapy for metastatic ovarian cancer and those presenting for follow-up post chemotherapy were recruited. Participants were asked to fill out a short QoL questionnaire (Functional Assessment Cancer Therapy-Ovarian) during each clinic visit. Two-factor analysis of variance analyses were used to examine the effects of chemotherapy treatment and current disease status on QoL scores. Ninety-four patients on chemotherapy and 159 follow-up patients participated. Patients on chemotherapy for recurrent disease had a significantly worsened overall, emotional, and ovarian cancer-specific concerns QoL scores compared to those receiving first-line chemotherapy. There were favorable significant differences between those on follow-up compared to those on chemotherapy in the mean overall QoL scores and in the means of physical, functional, and concern scores. There were significant differences favoring patients with complete response compared to those with partial response or progressive disease in the mean overall QoL scores as well as the physical, emotional, functional, and concern domains mean scores. There were improvements in most QoL measures after completion of chemotherapy. Complete disease remission remained important in maintaining improved QoL.

Female↗
PubMedDate not supplied

Prognostic significance of tumor necrosis in ovarian cancer patients treated with neoadjuvant chemotherapy and interval surgical debulking.

The objective of this study was to study the significance of tumor necrosis documented at the time of interval surgical debulking after neoadjuvant chemotherapy. Retrospective chart reviews were carried out from 1997 to 2005 to identify ovarian cancer patients treated with neoadjuvant chemotherapy. Patients' demographics together with disease characteristics, treatment-related variables, and outcomes were recorded. Cox proportional hazard models were built to model time to progression using predictor variables such as age, cancer stage, tumor grade, residual disease, percentage change in CA125 level from baseline, and degree of necrosis in resected tumor specimens. One hundred one patients were included in the study. Optimal debulking was achieved in 74% of the patients. Cox regressions revealed three significant predictive variables of time to first progression: younger age (hazard ratio [HR] = 0.95, 95% CI 0.92-0.98, P= 0.004), residual disease (P= 0.048), and the absence/minimal tumor necrosis after three cycles of neoadjuvant chemotherapy (HR = 1.97, 95% CI 1.01-3.87, P= 0.048). The estimated median survival was 50.66 months (95% CI 46.12-55.20). The lack of or minimal tumor necrosis after neoadjuvant chemotherapy is an independent risk factor for recurrent disease.

Adenocarcinoma, Clear Cell↗
PubMedDate not supplied

Psychologic morbidities prior to loop electrosurgical excision procedure in the treatment of cervical intraepithelial neoplasia.

The objective of this study was to assess and compare anxiety and distress in patients undergoing colposcopic examinations and loop electrosurgical excision procedure (LEEP). Patients seen for evaluation of cervical intraepithelial neoplasia (CIN) and LEEP were recruited. All patients received further teaching with respect to their abnormality right after the colposcopic evaluation by nursing staff. The Hospital anxiety and Depression Scale (HADS) and the Psychosocial Effects of Abnormal Pap Smears (PEAPS) questionnaires were used to measure and compare distress between the two groups. Linear regression models were built to identify significant predictive variables for psychologic morbidities. Twenty-one colposcopy and 20 LEEP patients participated in this study. No significant demographic differences were noted. Eighty-one percent of patients having colposcopy and 65% of those undergoing LEEP can be classified as having significant anxiety and depression based on the HADS questionnaire. Patients undergoing LEEP scored significantly better than colposcopy patients on the mean total PEAPS score and on the self-belief/cancer concern and effects on sexual relationship dimension scores. Significant psychologic morbidities exist in patients diagnosed with CIN. Face-to-face individualized education and support after colposcopy can decrease patients' distress at subsequent treatment visits.

Adult↗
PubMedDate not supplied

Intraperitoneal chemotherapy for advanced epithelial ovarian cancer: A Canadian perspective.

The objectives of this study were to: a) assess the position of Canadian gynecological oncologists (GOC) toward intraperitoneal (IP) chemotherapy as primary treatment for ovarian cancer, b) initiate a process of communication among GOC, and c) assess the perception of barriers to implementing IP chemotherapy across Canada. An electronic practice survey was mailed to all GOC in January 2006. The response rate was 62%. GOC accept IP chemotherapy as the standard of care in the primary treatment of optimally debulked epithelial ovarian cancer. The majority of respondents were working on implementation strategies at their local institutions. The cost of administration and use of additional resources were identified as sources of moderate and high concerns, respectively. Moderate concerns were expressed with regard to the management of systemic and local toxicity, catheter complications, patients' acceptance, and quality of life. Catheter insertion issues were of low concern to most respondents. Previous experience with IP administration did not significantly impact the perceived level of concern. GOC support the use of IP chemotherapy for appropriate patients with ovarian cancer. This survey identifies important implementation challenges of IP therapy for Canada, and processes must be developed before successful delivery of IP chemotherapy can be realized. This survey serves to initiate a process of communication among GOC. A collaborative effort will be needed to facilitate this change in practice. Further study of the implementation process is warranted as more experience is gained with this modality of treatment.

Antineoplastic Agents↗