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N Tait

Publications and source records attributed to N Tait.

50 records · Page 3Linked to original sources
PubMed1987

High-dose megestrol acetate. A possible treatment for cachexia.

Weight loss and anorexia are significant complications of a variety of disorders and add morbidity to the underlying process. We observed marked weight gain (median, 5.1 kg; range, 0.9 to 20.1 kg) and appetite enhancement in 27 of the 28 patients with breast cancer receiving treatment consisting of high doses of oral megestrol acetate (480 to 1600 mg/d). Weight gain occurred regardless of pretreatment weight, extent of metastases, or response to therapy. Our results suggest a possible role for megestrol acetate in reversing anorexia and weight loss, thereby improving the quality of life of patients with cachexia. Further research is needed to establish the mechanism of weight gain and potential clinical applications.

Body Weight↗
PubMed1987

Management of diffuse peritonitis by prolonged postoperative peritoneal lavage.

Prolonged postoperative peritoneal lavage has been used as a part of the management of 55 patients with diffuse peritonitis. The lavage technique consisted of 60 min cycles of instillation and drainage of a lavage fluid into the peritoneal cavity via a peritoneal dialysis catheter. The lavage fluid was a slightly hypertonic salt solution containing antibiotics, usually cefotaxime and metronidazole. The overall mortality rate in the series was 11% (6/55). Only one of these patients had residual abdominal sepsis present at post-mortem, the remaining deaths being due to a progression of the pre-existing disease. Five patients showed evidence of further intra-abdominal sepsis. In three of these patients this was associated with the presence of a previously well established abscess cavity. The overall results indicate that, for this group of patients recognized to be at high risk of mortality or further sepsis, the use of prolonged postoperative peritoneal lavage is associated with an improved outcome.

Adolescent↗
PubMed1987

High-dose megestrol acetate for the treatment of advanced breast cancer: dose and toxicities.

Endocrine maneuvers have considerable use in the management of advanced breast cancer, and progestins are hormonal agents with considerable antitumor activity. Sequential studies suggest a steep dose-response relationship for medroxyprogesterone. Megestrol acetate, (Megace, Bristol-Myers Oncology Division, Evansville, IN) an easily used progestin, has activity in advanced breast cancer, but dose response for this agent has not clearly been shown. This study was initiated to evaluate the tolerability and toxicity of escalating doses of megestrol acetate. Forty patients with advanced breast cancer who were not eligible for treatment with other conventional hormones or chemotherapy were entered into the study. All patients had disease progression on previous treatments, and all with visceral disease had disease progression while on one or more chemotherapy regimens. Using specially formulated 160-mg tablets (Bristol-Myers Oncology Division), three patients were entered at each of three dose levels: 480,800, and 1,280 mg/d. Thirty-one patients were entered at 1,600 mg/d. There were 39 postmenopausal women and one man; the median age was 58 years; the median performance status was 80%. Among 31 patients with measurable disease, there were six complete responses (CRs) and five partial responses (PRs); 11 of the 31 had stable disease. Fourteen patients had received previous megestrol acetate with disease progression on treatment: Six had had primary treatment failure. One of these 14 achieved CR, three achieved PR, and eight acheived stable disease on the high-dose regimens. Toxicities were mild (grade 0 to 1) and included mild BP elevation, weight gain, increased appetite, hyperglycemia, edema, dyspnea, congestive heart failure, and other mild problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Liver trauma.

A series of 97 patients has been studied who were treated for liver injury at Westmead Hospital between January 1979 and January 1985. Patients were noted to be younger than those reported in previous series from Sydney, and to have suffered more frequent, significant, head injuries. Paramedical roadside intervention probably allowed more patients to reach hospital alive than was the case before the advent of the Intensive Care Ambulance system. Improved organ imaging has allowed more confident non-operative management of 13% of patients. Hepatic resection has been used infrequently (10%). Packing has been used in six patients as part of the definitive treatment of severe injuries and coagulopathy, and to allow the transfer of a further seven patients from peripheral hospitals. Ten of these 13 patients survived. Head injury continues to be a major cause of death in these patients. Death from the liver injury itself is usually associated with high grade damage to the liver and the associated hepatic veins and vena cava. It is speculated that improvement in the management of these lethal injuries will come about only from the early identification of patients likely to have suffered such trauma, and the pre-operative control of bleeding. Balloon catheter placement under radiological control, to tamponade the inferior vena cava and abdominal aorta, is suggested as one means by which this goal might be achieved.

Adolescent↗
PubMed1986

High-dose chemotherapy without autologous bone marrow transplantation in melanoma.

High-dose chemotherapy with BCNU, melphalan, or both, followed by autologous bone marrow transplantation (ABMT) has been reported to produce response rates in excess of 60% in patients with advanced melanoma. We tested doses of BCNU associated with reversible bone marrow toxicity and acceptable extramedullary toxicity without the use of ABMT in 19 patients with a diagnosis of advanced malignant melanoma. All patients were evaluable for toxicity and 18 were evaluable for response; one patient had a new primary tumor. The patient population had a median age of 44 years (range, 16 to 71) and a median Karnofsky performance status of 80 (range, 50 to 100). Ten were women and nine were men, all had visceral dominant disease, and none had received previous chemotherapy. Our purpose was to test the feasibility of treatment without ABMT, its toxicity and efficacy, and the possibility of administering sequential repeated courses of therapy. Vincristine was added to the regimen to potentially increase efficacy. Treatment consisted of BCNU (750 mg/m2) and vincristine (2 mg days 1 and 8). Six patients who recovered bone marrow function received melphalan (60 mg/m2) and vincristine (2 mg days 1 and 8). Twenty-two percent (95% confidence limits, 3% to 39%) of patients had remissions (all partial) and these were of short duration. Toxicity was substantial with 16% early lethality and 29% incidence of lethal drug-related complications. Two patients (11%) died toxic after a second course of BCNU. Our results suggest that there is no practical role for high-dose BCNU in the treatment of melanoma.

Adolescent↗
PubMed1986

High-dose megestrol acetate in the treatment of postmenopausal women with advanced breast cancer.

The optimal dose of progesterone compounds for the treatment of breast cancer is unknown, but there is evidence to suggest a dose-response curve. We are testing the tolerability and efficacy of megestrol acetate administered orally and continuously in doses three to ten times higher than the standard dose of 160 mg/d. We have so far treated 33 patients with metastatic breast cancer and positive or unknown tumor hormone receptor status. Thirty patients had had documented disease progression with previous hormonal therapy, and 22 had failed with previous chemotherapy. Twenty-five patients had objectively measurable metastases. In this heavily pretreated group, the objective response rate was 40%; in addition, 32% of patients had stabilization of disease. Interestingly, ten of 12 patients who had developed disease progression while on standard-dose megestrol acetate therapy had objective response or stabilization on the higher dose. Toxicity was acceptable and reversible and included mild elevations of blood pressure and weight gain. Our results indicate that high-dose megestrol acetate is well-tolerated and highly active in advanced refractory breast cancer, and suggest a dose-response curve for the drug in the treatment of breast cancer.

Adult↗
PubMed1986

Appetite stimulation with megestrol acetate in cachectic cancer patients.

Cachexia is often a severe problem in the management of cancer and other illnesses because it adds to the morbidity of the underlying disease and complicates its treatment. Megestrol acetate has been observed anecdotally to produce weight gain. A review of our experience, and our ongoing phase I/II study of high-dose megestrol acetate for breast cancer, revealed that weight gain occurred in nearly one third (27%) of patients at conventional doses (160 mg/d), and that a marked weight gain (median, 5.1 kg; range, 0.9 to 20.1 kg) occurred in 27 of 28 patients with breast cancer during treatment with high doses of megestrol acetate. Subjective improvement in appetite occurred in most patients at low doses and in most patients at high doses. Further, nearly one half (48%) of patients at conventional doses and virtually all patients at high doses experienced an increased sense of well-being. Our data suggest that megestrol acetate has a potential role in producing subjective improvement, sense of well-being, and increase in appetite and weight, and that the effect may be dose related. Further research is necessary to understand the mechanism of appetite stimulation and/or anabolic effect.

Adult↗
PubMed1984

Evaluation of a home based health record booklet.

Despite the widespread use of home based child health records of varying complexity in England, there is a notable absence of their evaluation. Such a record booklet developed in the West Lambeth Health Authority has been used by parents, doctors, and community nurses to build up an independent chronological record of a child's birth statistics, health, growth, immunisation, development checks, and contacts with health services. A randomised controlled evaluation of the record, analyses of entries in it, and a survey of the views of mothers and health professionals using the record have been carried out. The need for such a record was confirmed by those questioned and analyses of entries in the booklet helped to modify and improve it. The evaluation was unable to show, however, any effect of the record on immunisation and developmental assessment service uptake. Its value in improving communication between the numerous health and other care agencies was dependent on its proper use.

Body Weight↗
PubMed1980

The effect of differing concepts of the criteria that should be used for the diagnosis of asbestos disease.

The work of the Society for the Prevention of Asbestosis and Industrial Disease suggests that arbitrary rules, operated for the purpose of deciding which cases may benefit from employment insurance schemes, are adding to the recognized problems connected with the diagnosis of asbestos disease. As a result, statistics are unrealistic and do not include cases which show not only that workers in th asbestos manufacturing industry are at risk, but that asbestos, including chrysotile, affects the health of the community.

Asbestosis↗
PubMedDate not supplied

Alpha-fetoprotein expression in hepatocellular carcinoma: a clinical study.

Alpha-fetoprotein (AFP) levels were studied in 51 consecutive patients with hepatocellular carcinoma that presented to the Surgical Hepatobiliary Unit at Westmead Hospital over 12 years. Twenty-three were hepatitis surface antigen (HBsAg) positive and 13 of those patients were Asian. Thirteen patients drank more than 60 g of alcohol each day. A significantly raised level of AFP was defined as more than 20 ng/mL, and 31 of the 51 patients had AFP levels exceeding this at some stage during surveillance. Twenty-five demonstrated levels above 200 ng/mL. Univariate statistical methods suggested that men were more likely to express raised AFP than women, Asians more likely than other races, patients with chronic active hepatitis more likely than those without and those with chronic hepatitis B infection more likely than those who were HBsAg negative. Those who drank more than 60 g alcohol each day were less likely to demonstrate a raised serum AFP than those who drank less. Multivariate logistic regression demonstrated that HBsAg carriage was the only statistically significant independent determinant of a raised AFP. Age 65 years or more was associated with a chance of a raised AFP.

Adult↗
PubMedDate not supplied

Intercostal pedicle flap for thoracic oesophageal perforations.

Oesophageal perforations are associated with a high mortality and morbidity. Intrathoracic perforations especially are associated with mediastinitis and sepsis. The repair of these perforations may be difficult, particularly when there has been a delay to diagnosis. We report our use of a method to repair or buttress the suture line after repair with a vascularized intercostal muscle flap, having used it successfully in two patients with intrathoracic oesophageal perforations.

Aged↗
PubMedDate not supplied

Fine needle aspiration cytology and core biopsy histology in infiltrating syringomatous adenoma of the breast. A case report.

BACKGROUND: Infiltrating syringomatous adenoma is a rare tumor of the breast that can radiologically mimic invasive duct carcinoma. Detailed fine needle aspiration cytology and needle core biopsy findings on this lesion have not been previously described. CASE: The clinical, radiologic and pathologic findings of an infiltrating syringomatous adenoma of the breast in a 71-year-old female who presented with a subareolar lump are described. The cytology of the tumor was characterized by a combination of a background of plump, fibroblastoid cells and cohesive sheets of bland epithelial cells. Histologically the tumor showed infiltrating, duct-like structures with squamous metaplasia and a desmoplastic stroma. CONCLUSION: Fine needle aspiration cytology and needle core biopsy can distinguish infiltrating syringomatous adenoma from malignant disease of the breast.

Aged↗