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Biomedical subjects

M Baum

Publications and source records attributed to M Baum.

At least 343 records · Page 19Linked to original sources
PubMed1990

Measurement of quality of life in advanced breast cancer.

Before the twentieth century the treatment of advanced breast cancer comprised either willful neglect or futile mastectomy. Recent years have seen the introduction of therapies capable of shrinking disease volume although the concept of a cure still remains remote. Many of these treatments are unpleasant and the burden they force the patient to bear may not be compensated by the reduction in tumour size. Decisions on the value of initiating or continuing such treatment have been taken by the clinician largely since no suitable instruments have been available to measure individual 'quality of life'. Several means have now evolved and in advanced breast cancer, where the treatment may profoundly affect the patient's sense of wellbeing, effort is being made to find out how much.

Breast Neoplasms↗
PubMed1990

The design of advanced breast cancer trials. New approaches.

The treatment of advanced breast cancer is always palliative. Only a modest prolongation of life is achieved even in the best series, and the traditional criteria of assessment of response take no account of factors other than tumour bulk. Restrictive entry criteria have resulted from the inability to quantify any other measurement of response, and so the power of such chemotherapy trials has been unnecessarily curtailed. We report on the progress being made in this department to develop a self-assessment diary to record quality of life in these patients and to mount a pragmatic trial of two different regimens in advanced breast cancer using this measure.

Breast Neoplasms↗
PubMed1990

[Weaning an asthmatic using biphasic positive airway pressure together with continuous sufentanil administration].

A patient presenting with acute severe asthma associated with protracted hypoventilation (paCO2 = 90 mmHg) and impaired consciousness underwent sedation and controlled mechanical ventilation. The peak airway pressure could be reduced by constant-volume mechanical ventilation and analgosedation with midazolam and ketamine. When the gas exchange had stabilized, the first attempt at weaning was made by synchronized intermittent mechanical ventilation (SIMV). After this and two other attempts had failed, the patient was given continuous sufentanil (0.8-1.0 micrograms/kg), as well as additional bolus injections of 2 micrograms/kg and 0.35 micrograms/kg for analgosedation. Controlled mechanical ventilation was replaced by the system of biphasic positive airway pressure (BIPAP). The mechanical ventilatory support was gradually reduced, as was the dose of continuous sufentanil. Extubation was possible at a dose of 0.2 micrograms/kg per h sufentanil and CPAP. From this case, it is not possible to determine whether the BIPAP system or the analgosedation with Sufentanil was the decisive factor in the therapeutic success. It may well have been the combination of both therapeutic measures that--in our opinion--supplemented each other in an ideal way.

Fentanyl↗
PubMed1989

Postoperative radiotherapy and late mortality: evidence from the Cancer Research Campaign trial for early breast cancer.

OBJECTIVE: To identify any excess mortality caused by adjuvant radiotherapy for early breast cancer. DESIGN: Prospective randomised clinical trial. Two thousand subjects needed for study to have a 90% chance of detecting a difference in survival rate of 7% with 95% significance. Patients were followed up until June 1988, giving follow up of 158-216 months. SETTING: A multicentre trial mainly drawing patients from centres in the United Kingdom. PATIENTS: 2800 Women presenting with clinical stage I or II carcinoma of the breast from June 1970 to April 1975. INTERVENTIONS: One group of women (n = 1376) had simple mastectomy followed by immediate postoperative radiotherapy (1320 to 1510 rets). The remaining women (n = 1424) had simple mastectomy with subsequent careful observation of the axilla, radiotherapy being delayed until there was obvious progression or recurrence of disease locally. END POINT: Increased mortality in patients treated with radiotherapy from causes other than breast cancer. MEASUREMENTS AND MAIN RESULTS: Survival was measured from time of first treatment to death or last follow up. Deaths from any cause and from specified causes were counted as events. Comparison over the whole follow up showed a slight excess mortality in the group treated with radiotherapy (relative risk 1.04; 95% confidence interval 0.94 to 1.15). The relative risk of death from breast cancer was 0.97 (0.87 to 1.08) but that of death from other causes was 1.37 (1.09 to 1.72), the increase mainly being in women who had had tumours of the left breast (1.61 (1.17 to 2.24)) and had been treated with orthovoltage (1.85 (1.27 to 2.71)). Analysis of causes of death after five years showed a relative risk of 2.11 (1.25 to 3.59) for new malignancies and of 1.65 (1.05 to 2.58) for cardiac disease, the increase in cardiac mortality being most pronounced in patients who had had tumours of the left breast and whose treatment had included orthovoltage radiation (relative risk 2.67 (1.28 to 5.55)). CONCLUSIONS: Adjuvant radiotherapy after simple mastectomy for early breast cancer produces a small excess late mortality from other cancers and cardiac disease. The risk has to be balanced against the higher risk of local recurrence when immediate postoperative radiotherapy is not given. The balance has to be assessed for each patient, and for many patients radiotherapy will still be desirable in the initial treatment of their early breast cancer.

Breast Neoplasms↗
PubMed1989

Veterinary use of exposure techniques in the treatment of phobic domestic animals.

Exposure techniques as a treatment for human phobias are reviewed, as well as exposure's use in the extinction of avoidance behavior in laboratory animal studies. A third arena in which exposure is employed is reconsidered--in the veterinary treatment of phobic domestic animals. Veterinary use of exposure is illustrated, and the advantages and disadvantages of the veterinary study of exposure are discussed.

Animals↗
PubMed1989

A novel binding site for a synthetic progestagen in breast cancer cells.

A novel, high-affinity saturable binding site for the synthetic 19-nor testosterone progestagen, 17 alpha-ethinyl-13 beta-ethyl 17 beta-hydroxy-4,15-oestradiene-3-one (gestodene) has been detected using a sensitive affinity chromatography technique. This binding site is present in a range of malignant breast-derived cells lines, regardless of the presence of oestrogen and progesterone receptors, but is absent from endometrial carcinoma cells that contain both oestrogen and progesterone receptors. Competition studies show that this binding is not attributable to the receptors for the progestagens, androgens, glucocorticoids or mineralocorticoids. Cytosolic gestodene binding is refractory to competition with oestradiol but nuclear gestodene binding is completely abolished by oestradiol. The binding of oestradiol to the oestrogen receptor is reduced 40-50% by competition with gestodene. Non-dissociating polyacrylamide gel electrophoresis and size-exclusion high performance liquid chromatography reveal that this binding activity is associated with a protein of mean molecular mass 47 +/- 9 kDa. Ligand binding studies with a range of other cell lines indicates that this binding site appears to be specific to breast cancer cells. These data show the presence of a partly oestrogen competable novel binding protein in breast cancer cells which does not appear to be due to any of the conventional steroid receptors.

Animals↗
PubMed1989

Limitations of nonscience in surgical epistemology. The second-look laparotomy.

Decision-making in medicine is a very complex process that demands input both from the doctor and from the client. From the doctor's point of view, the most important component for this decision concerns the quality of evidence available that the recommended intervention is the best available in terms of both cost and benefit. Good quality evidence demands good quality science. The randomized controlled trial is the expression of this scientific process at work within medical practice. This article reviews both the rationale and the ethics of randomized controlled trials in the epistemology of surgery. The ethical dilemma is accentuated because surgery by its very nature is invasive and often irreversible. As an illustration of the scientific and ethical dilemmas arising out of randomized controlled trials in surgery, a description of the CEA directed second-look laparotomy trial in the United Kingdom is provided. This trial may be judged essential because of the clash of attitudes between surgeons in the United States and the United Kingdom. It is unlikely that the truth lies entirely with one or other national groupings of surgeons, and this randomized trial will eventually resolve a conflict of ideas to the ultimate benefit of all patients with operable colorectal cancer.

Colorectal Neoplasms↗
PubMed1989

Treatment outcomes and quality of life.

Physicians through the ages have practiced their trade with more or less regard to the effects of their treatment on their patients' sense of well-being, if not as much as on the disease itself. Until recently, however, little attempt has been made to measure the effect of disease upon quality of life and how this quality is or is not improved by the treatment. Several means have now evolved and in areas of medicine where the treatment may profoundly affect the patient's sense of well-being, effort is being made to gauge these consequences.

Evaluation Studies as Topic↗
PubMed1989

Adjuvant radiotherapy in breast cancer. Consideration of cost-benefits in relation to the CRC (Cancer Research Campaign) (King's/Cambridge) trial.

The Cancer Research Campaign (CRC) Trial demonstrates a decreased incidence of local recurrence for patients randomized to prophylactic radiotherapy following mastectomy. Irradiated patients alive after 5 years, however, have a small increased risk of dying from causes other than breast cancer. How to estimate the cost-benefit of such therapy is discussed.

Breast Neoplasms↗
PubMed1989

Detection of breast cancer by measuring areolar blood flow--a pilot study.

Regional blood flow in the areola was measured by using the non-invasive transient thermal clearance method in normal breasts and in breasts involved with cancer. Areolar blood flow (ABF) in normal breasts was almost constant for women in the age range 20-60y, but decreased at higher ages. ABF in breasts involved with cancer was higher than that in the contralateral breast, and higher than the average normal ABF in the corresponding age group. The effect was more prominent in the left breast. The transient thermal clearance method provides a potential non-invasive means for detection of breast cancer.

Adult↗
PubMed1989

Influence of end-expiratory lung volume on carbon dioxide elimination during high frequency ventilation in dogs.

We have examined the effect of varying end-expiratory lung volume on carbon dioxide elimination in 10 mongrel dogs undergoing conventional mechanical ventilation at 12 b.p.m. and forced diffusion ventilation (FDV) at 6 Hz and 50 Hz and continuous flow. End-expiratory volumes were altered by changing the pressure in a plethysmographic box in which the dogs underwent ventilation. The pressures studied were atmospheric, sub-atmospheric (box pressure -1.0 kPa) and increased atmospheric (box pressure + 0.5 kPa). The results indicated that more carbon dioxide was eliminated at low lung volumes and this was most pronounced with HFV at 50 Hz and continuous flow. It is postulated that changes in airway geometry and different lung volumes may alter the distance between the gas interface in the conductive airways and the respiratory zone and so alter the efficiency of ventilation during FDV.

Anesthesia↗
PubMed1989

Influence of high frequency ventilation at different end-expiratory lung volumes on the development of lung damage during lung lavage in rabbits.

The effects of high frequency ventilation in combination with sustained inflations was studied in the surfactant-deficient lungs of 18 New Zealand White rabbits (weight 1.9-2.1 kg) during anaesthesia with urethane and neuromuscular block with pancuronium. Lung damage was induced by repeated lung lavage. In nine rabbits (group I) baseline ventilator settings were maintained constant throughout the study and airway pressure was readjusted to achieve a constant tidal volume. In the other nine rabbits (group II), ventilation was reinstituted after lung lavage with one period of four sustained inflations followed immediately by high frequency ventilation. In group I there was a significant decrease in gas exchange for oxygen and deterioration in pulmonary mechanics, whereas in group II there was little change in baseline blood-gas values or pulmonary mechanics. These data suggest that, with adequate ventilatory management during the period of lung lavage, the lung damage produced by this manoeuvre may be obviated.

Anesthesia, Intravenous↗