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Biomedical subjects

M E O'Brien

Publications and source records attributed to M E O'Brien.

At least 55 records · Page 3Linked to original sources
PubMed1994

Phase I study of mitozantrone, methotrexate and mitomycin with granulocyte colony-stimulating factor (filgrastim) in patients with advanced breast cancer.

The combination of mitozantrone, methotrexate and mitomycin (3M) gives a response rate of around 50% in patients with advanced breast cancer. The predominant toxicity is haematological. In this study, previously untreated patients were given 3M with increasing doses of mitozantrone (7-14 mg m-2) with recombinant human granulocyte colony-stimulating factor (metHuG-CSF) (filgrastim) to prevent marrow toxicity. Doses administered were 7 mg m-2 mitomycin i.v. 6 weekly, methotrexate i.v. 35 mg m-2 (maximum 50 mg) 3 weekly and mitozantrone i.v. 3 weekly as follows: 7 mg m-2, six patients (group 1); 10 mg m-2, six patients (group 2); 12 mg m-2, six patients (group 3); 14 mg m-2, six patients (group 4); all on day 1 for six cycles at the assigned dose. All patients received filgrastim (Amgen 0.3 mg ml-1) at a dose of 5 micrograms kg-1 subcutaneously daily on days 4-17 of each cycle. All treatment was given on an out-patient basis. A total of 24 patients were entered into the study. The median age was 63 years (range 48-75). ECOG performance status was 0 in ten, 1 in 11 patients and 2 in three patients. Locoregional disease alone was present in seven patients. The remainder had one or more sites of metastases. The actual dose administered to the 24 patients was as follows. The six patients in group 1 all completed six courses of treatment as per protocol. In group 2, three patients completed six courses, two stopped because of toxicity after one and four courses and one had progressive disease after one course. In group 3, three patients completed and three stopped early because of progressive disease. In group 4, two patients completed, one progressed after four courses and three responding patients stopped treatment because of toxicity. The maximum tolerated dose of mitozantrone in the 3M combination was 12 mg m-2. The use of filgrastim with increasing doses of chemotherapy prevents neutropenia, but other toxicities, namely thrombocytopenia and lethargy, then become dose limiting.

Aged↗
PubMed1994

The endodermal sinus tumour and clear cell ovarian cancer.

There are similarities between clear cell epithelial ovarian carcinoma and endodermal sinus tumours. Apart from the morphological and clinical characteristics there are immunohistochemical markers of value in differentiating these 2 tumours and the detection of a raised serum AFP is characteristic of endodermal sinus tumours. These 3 cases we describe show the fallibility of the classical differentiating criteria between these two tumours.

Adenocarcinoma, Clear Cell↗
PubMed1994

Aggressive management of doxorubicin-induced cardiomyopathy associated with 'low' doses of doxorubicin.

There is a dose-effect relationship between doxorubicin and the incidence of symptomatic cardiac failure. It is generally thought that doses below 500-550 mg/m2 are safe but, when objective measures of cardiac function are used, it becomes apparent that degrees of cardiac failure occur at doses below this. We present here the case histories of two patients who developed very severe cardiac failure at cumulative doses well below 500 mg/m2 but who survived their initial cardiac illness due to aggressive intervention. In one case, the patient was successfully treated by orthotopic cardiac transplantation.

Adolescent↗
PubMed1994

Information needs prior to breast biopsy.

Biopsy is the definitive diagnostic procedure for breast cancer. The fear of cancer may make the breast biopsy itself a distressing experience for women and their significant others. Information seeking is believed to be a primary mode of coping with distressful events. The purpose of this study was to describe the information needs of women and their significant others prior to a breast biopsy and to explore the influence of information on the breast biopsy experience. Semi-structured, audiotape-recorded interviews with 11 women and 8 significant others were conducted prior to breast biopsy, and categories arising from the data were developed. The primary information need identified by the participants was to know "Is it cancer?" Participants' uncertainty regarding the outcome of the biopsy led to feelings of distress. The major strategy used to reduce distress was information management, in which the amount and type of incoming information was controlled. Nursing interventions based on the study findings are presented.

Adult↗
PubMed1994

Phase II study of continuous infusion fluorouracil with epirubicin and cisplatin in patients with metastatic and locally advanced breast cancer: an active new regimen.

PURPOSE: To investigate the efficacy and toxicity of continuous infusion fluorouracil (5-FU) with every-3-weeks epirubicin and cisplatin (ECF) in advanced breast cancer in a phase II study. PATIENTS AND METHODS: Forty-three patients with metastatic (n = 29) or locally advanced/inflammatory (n = 14) breast cancer were treated with 5-FU 200 mg/m2/d via a Hickman line using an ambulatory pump for 6 months with epirubicin 50 mg/m2 intravenously (IV) and cisplatin 60 mg/m2 IV every 3 weeks, for eight courses. RESULTS: The overall response rate (complete plus partial) was 84% (95% confidence interval [Cl], 76% to 96%), with a complete response rate of 24% (95% Cl, 9% to 40%) in patients with metastatic disease and 36% (95% Cl, 11% to 61%) in patients with locally advanced disease. The main World Health Organization [WHO] grade 3 or 4 toxicities included leukopenia, emesis, and alopecia. CONCLUSION: Infusional ECF is a highly active regimen in advanced breast cancer and warrants evaluation in high-risk early breast cancer.

Adult↗
PubMed1994

Fludarabine in lymphoproliferative disorders: the Royal Marsden Hospital experience.

Fludarabine 25 mg/m2 was given on five consecutive days every four weeks to 85 patients with B- and T-cell malignancies. The median number of courses given was five. All patients except one had received previous chemotherapy. The overall response rate in non-Hodgkin's lymphoma (NHL) was 50% (five complete responses (CR) and 19 partial responses (PR)). The response rate in chronic lymphocytic leukemia (CLL) was 43% (four CR and 12 PR). Responses were seen in all groups of B-cell malignancies, but no T-cell malignancies (n = 4) responded. The median duration of CR has not been reached and the median duration of PR was 14 months for NHL and 16 months for CLL. The median survival from starting fludarabine for patients who achieved a CR or PR in NHL has not been reached and the median duration of PR in CLL was 23 months. The median duration of survival in non-responders was five months. Fludarabine was well tolerated and the main toxicity was myelosuppression. Our results suggest that even in patients who have never responded to any chemotherapy, regardless of the number of treatment regimens previously given, there is a 36% chance of response. In addition, this is the first report of fludarabine activity in Franklin's disease.

Adult↗
PubMed1994

Evaluation of a hemodialysis patient education and support program.

This study examined the effects of a hemodialysis educational and support program (HESP) on patients' physical and psychosocial adaptations to end stage renal disease. The study employed a pretest/posttest modified Solomon experimental design with control group. Data were collected at 3-month intervals following the educational intervention. Results of the study indicated that nurses can have an impact on the patient learning experience by providing support and one-to-one teaching sessions, and actively involving patients in their own care. Additionally, nurses can facilitate active patient learning through enhanced teaching methods.

Adult↗
PubMed1994

The dementia syndromes. Distinguishing their clinical differences.

Dementia is one of the most devastating illnesses that affect the elderly. The progressive decline in memory, judgment, intellectual function, and adaptive ability places an immense burden on families, healthcare providers, and communities. Because advancing age is the leading risk factor for most types of dementia, the prevalence of this tragic disorder will increase as the population ages. How can primary care physicians help?

Aged↗
PubMed1993

Clear cell epithelial ovarian cancer (mesonephroid): bad prognosis only in early stages.

Clear cell ovarian carcinoma accounts for 4.5% of all cases of ovarian cancer at this center; 43% of patients presented with stage I disease. Stage for stage patients with advanced disease (II-IV) did no worse than other subtypes of epithelial tumors but patients with stage I disease did significantly worse at both 5 (P < 0.05) and 10 years (P < 0.02). Young age (< 60 years), advanced stage, and the presence of vascular invasion are independently poor prognostic factors, while the presence of a predominantly (> 75%) papillary or tubulocystic morphological pattern independently predicts a better prognosis.

Adenocarcinoma↗
PubMed1993

Primary medical (neo-adjuvant) chemotherapy for operable breast cancer.

84 patients with large operable breast cancer have been treated with primary medical chemotherapy rather than mastectomy in three sequential studies. 86% had tumours greater than 4 cm in diameter; median diameter was 6 cm (range 1-12). Median age was 46 years (range 23-66). In the first two studies 64 patients were treated with either CMF [cyclophosphamide 100 mg orally days 1-14, methotrexate 50 mg intravenously (i.v.) days 1 and 8, and 5-fluorouracil 1 g i.v. days 1 and 8, repeating at 28-day intervals for six courses] or MMM (mitozantrone 8 mg/m2 i.v. once every 3 weeks, methotrexate 50 mg i.v. once every 3 weeks, mitomycin C 8 mg/m2 once every 6 weeks, for 8 courses). 69% achieved an overall response including 17% complete remissions. 27% have had local relapse but only 3% uncontrolled local relapse. Only 14% have required mastectomy. In the third study which is ongoing, 19 patients have been treated with infusional FEC (5-fluorouracil 200 mg/m2 i.v. 24 hourly by continuous infusion via a Hickman line for 6 months, epirubicin 50 mg/m2 i.v. bolus once every 3 weeks for 6 months, cisplatin 60 mg/m2 i.v. once every 3 weeks for 6 months with appropriate intravenous hydration). Overall response rate so far is 84% with 58% complete remissions. There have been no local relapses and no patient has required mastectomy. This study demonstrates that primary medical chemotherapy can be used to avoid mastectomy in the great majority of patients presenting with large operable primary breast cancer. Infusional FEC may be more active than conventional chemotherapy in terms of overall response and complete remission rate, and infusional FEC chemotherapy now needs to be compared with conventional chemotherapy. The concept of primary medical therapy should also be compared with conventional mastectomy followed by adjuvant chemotherapy.

Adult↗
PubMed1993

A toxic interaction between mitomycin C and tamoxifen causing the haemolytic uraemic syndrome.

A comparison of patients receiving combination chemotherapy with mitomycin C, mitozantrone and methotrexate (3M) with and without tamoxifen for treatment of primary breast cancer indicates an increased risk of anaemia (P < 0.0001) and thrombocytopenia (P < 0.001), but not leucopenia for patients receiving tamoxifen with their chemotherapy compared to those receiving the chemotherapy alone. Furthermore, 9 out of 94 patients receiving tamoxifen with 3M developed progressive anaemia, thrombocytopenia and abnormal renal function as early features of microangiopathic haemolytic anaemia, progressing on to various degrees of the haemolytic uraemic syndrome (HUS). This is only rarely seen with patients receiving mitomycin C alone at higher doses than used in the 3M combination and in the presence of active metastatic disease. This syndrome can be fatal and 1 of our 9 patients died. These observations indicate that there may be an interaction between tamoxifen and mitomycin C, causing an increased incidence of anaemia, thrombocytopenia and an increased risk of HUS. The combination of these two drugs should be avoided or carefully monitored.

Adult↗
PubMed1993

Dietary induced subclinical vitamin K deficiency in normal human subjects.

A subclinical vitamin K deficiency was induced in 32 healthy subjects (four groups of eight males and females) aged 20-40 and 60-80 yr residing in the Metabolic Research Unit of the Human Nutrition Research Center on Aging at Tufts University. Volunteers were initially fed (4 d) a baseline-period diet containing the recommended daily allowance for vitamin K which is equivalent to 80 micrograms/d of phylloquinone (vitamin K1). During the baseline period various parameters of vitamin K nutritional status were monitored. The baseline period was followed by a 13-d depletion period during which the subjects were fed a very low vitamin K1 diet (approximately 10 micrograms/d). After depletion, the subjects entered a 16-d repletion period (four stages lasting 4 d each) during which time they were repleted with 5, 15, 25, and 45 micrograms of vitamin K1 per day. Vitamin K1 depletion dramatically and significantly decreased plasma vitamin K1 levels (P < 0.0001) in both elderly and young groups to values 13-18% of day 1 (elderly 0.22 nM, young 0.14 nM). Repleting the subjects with up to 45 micrograms of vitamin K1 per day failed, in the case of the young subjects, to bring plasma vitamin K1 levels back into the normal range. Dietary vitamin K1 restriction induced different responses in the urinary excretion of gamma-carboxyglutamic acid between the young and the elderly subjects with values decreasing significantly (P < 0.03) in the young while remaining unchanged in the elderly. The vitamin K1 depletion period had no significant effect on either prothrombin and activated partial thromboplastin times, or Factor VII and protein C (as determined by antigenic and functional assays). By using a monoclonal antibody, decarboxy prothrombin was found to increase slightly but significantly in both groups (P < 0.05) as a consequence of the low vitamin K1 diet. This study clearly shows that a diet low in vitamin K1 can result in a functional subclinical deficiency of vitamin K (decreased urinary gamma-carboxyglutamic acid excretion) without affecting blood coagulation.

1-Carboxyglutamic Acid↗
PubMed1993

Carboplatin in the treatment of advanced breast cancer: a phase II study using a pharmacokinetically guided dose schedule.

PURPOSE: We performed a phase II study of single-agent carboplatin against metastatic/locally advanced breast cancer using a pharmacokinetically guided dose schedule, to define further the potential role for this agent in combination and high-dose therapy. PATIENTS AND METHODS: Forty patients with metastatic/locally advanced breast cancer were treated with carboplatin based on glomerular filtration rate (GFR) to achieve an area under the concentration-versus-time curve (AUC) of 7 mg/mL.min, with each course repeated at 4-week intervals. The median age was 57 years (range, 37 to 71). RESULTS: Ten patients achieved a partial response (PR), for an overall response rate of 25% (95% confidence interval, 13% to 41%). One of 13 (8%) previously treated patients responded compared with nine of 27 (33%) patients who had not received previous chemotherapy. Median response duration was 18 weeks (range, 10 to 68). World Health Organization (WHO) grade 2 or greater toxicity was as follows: anemia, 42%; leukopenia, 20%; thrombocytopenia, 35%; nausea/vomiting, 39%; and infection, 9%. CONCLUSION: This study confirms other reports indicating that carboplatin has moderate activity in previously untreated patients, but not in previously treated patients. In our view, carboplatin is a more appropriate agent than cisplatin for inclusion in high-dose chemotherapy schedules with autologous bone marrow rescue, and our results support the concept of calculating dose escalation on the basis of the area under the dose-response curve using the Calvert formula, rather than on surface area.

Adult↗
PubMed1993

Physical and psychosocial nursing care for patients with HIV infection.

As suggested earlier we have chosen in this article to discuss only a small group of key physical and psychosocial concerns and needs associated with HIV and AIDS. These were the issues most frequently discussed by a study group of people living with HIV. We recognize, however, that holistic nursing intervention considers the totality of the individual living with HIV: body, mind, and spirit. It is to that end that the discussed nursing diagnoses and interventions are directed. Ultimately, the successful identification of and intervention in HIV related problems rests in the unique relationship between nurse and patient sharing as collaborators in the healing experience. The body of contemporary nursing and behavioral science research in the area of HIV/AIDS continues to grow. Presently the National Center for Nursing Research is supporting studies focusing on such areas as the use of designated versus general care settings for HIV patient care, quality of nursing care in HIV/AIDS, the effects of nurse-managed home care for AIDS patients, stress and coping in caregivers of AIDS children, the testing of interventions for black women with AIDS, and prevention studies (National Center for Nursing Research, personal communication, 1992). Nevertheless, as the HIV pandemic continues to grow and expand its demographic parameters, more research, particularly with such populations as women and children, is urgently needed. Studies exploring prevention issues and symptom management also are most important. Some suggestions for future study include examination of cultural variables associated with coping with HIV and AIDS; longitudinal research on surviving HIV over time; intervention studies to test specific nursing therapeutics in various settings such as hospital, home, and clinic; and finally, research describing the impact of HIV and AIDS on family functioning and adaptation. It is only through continued study of the impact of HIV, on both the individual living with HIV, and his or her significant others, that we will expand nursing knowledge and strengthen nursing care for those impacted with this fearsome and life-threatening condition.

Acquired Immunodeficiency Syndrome↗