What is a good decision?
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Decision Making↗
Biomedical subjects
R Fisher
Publications and source records attributed to R Fisher.
Thymidine-analog and multi-nucleoside resistance mutations are observed in both zidovudine-naive and zidovudine-experienced subjects with viremia after treatment with stavudine-containing regimens.
OBJECTIVE: The type and frequency of mutations in the human immunodeficiency virus type 1 (HIV-1) reverse transcriptase coding region observed in virus from antiretroviral therapy (ART)-experienced, zidovudine (ZDV)-naive subjects receiving stavudine (d4T)-based therapies were compared with mutations observed in virus from ART-experienced subjects with previous ZDV exposure. METHODS: Plasma HIV-1 RNA was isolated from 67 ART-experienced subjects. Reverse transcriptase mutations were assessed by sequencing polymerase chain reaction products. RESULTS: Thirty-four subjects (51%) were ZDV-experienced (Z(exp)) and 33 (49%) were ZDV-naive and d4T-experienced (d(exp)Z(naive)). Human immunodeficiency virus type 1 from 16 of 33 (48%) d(exp)Z(naive) subjects and from 16 of 34 (47%) Z(exp) subjects had thymidine analog mutations (TAMs). Multi-nucleoside resistance (MNR) mutations were observed in virus from 5 of 33 (15%) d(exp)Z(naive) subjects and 3 of 34 (9%) Z(exp) subjects. At least one TAM or MNR mutation was identified in 18 of 33 (55%) of the former and in 19 of 34 (56%) of the latter group. CONCLUSIONS: These results confirm recent reports that TAMs and MNR mutations can arise in subjects receiving d4T-based therapy who are naive with respect to ZDV.
Adult↗
A comparison of the effectiveness of two systems for the prevention of radiation caries.
The purpose of this study was to compare the effectiveness of two systems for the prevention of dental caries in patients who have received radiation treatment (mean number of rads; 5672 +/- 1113) for head and neck cancer. The baseline examination of 184 dentulous patients included measures of DMFS and the Root Caries Index (RCI), field of radiation, gingival inflammation, oral hygiene status, pocket depth and attachment loss. The patients were assigned randomly into two treatment groups. One group was instructed to use 0.4% Sn2 gel while toothbrushing everyday, and the other group was instructed to use a 1.1% neutral NaF gel for three months, followed by twice daily rinsing with a remineralizing mouthrinse (Salminsol Solutions, Iowa City, Iowa). One hundred and forty-three patients were re-examined after one-year, and 69, 56 and 18 patients continued in the NaF gel/remineralizing mouthrinse, SnF2 and non-compliant groups, respectively. Inter-group comparisons showed that the incidence of MT, DMFT, and DF surfaced, and the RCI were significantly higher in the non-compliant group compared to either the SnF2 or NaF gel/remineralizing mouthrinse groups (P less than 0.05). Also, the NaF gel/remineralizing mouthrinse group demonstrated a significantly higher incidence of carious root surfaces compared to the SnF2 group (P less than 0.05). Also the incidence of radiation caries was significantly higher when the field of radiation exposed a greater surface area of the major salivary glands.(ABSTRACT TRUNCATED AT 250 WORDS)
Analysis of Variance↗
Magnetic resonance imaging in congenital dysplasia of the hip.
This study was designed to determine the usefulness of magnetic resonance imaging (MRI) in managing congenital hip dysplasia and dislocation. We compared various hip parameters using bony and cartilaginous landmarks. MRI determined that the bony acetabular index (AI) accurately reflects the cartilaginous AI. Bony acetabular indices greater than 30 degrees indicated hip dysplasia, subluxation, or dislocation. MRI demonstrates qualitative information not available on plain films; however, it does not provide further quantitative data, so we do not recommend its routine use in the evaluation of congenital hip dysplasia. The true benefit of MRI may be its ability to identify a group of patients with bone dysplasia but normal cartilaginous growth potential.
Child↗
The removable orthopedic/orthodontic approach. An overview.
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Humans↗
Lack of relationship between parity and level of carcinoembryonic antigen in women with breast cancer.
Women with high parity appear to be protected against the development of breast cancer. It has been suggested that those tumours which secrete carcinoembryonic antigen (CEA) are destroyed in women who develop cell-mediated immunity to embryonic antigen at the time of pregnancy or childbirth at an early age. A study of 335 patients with breast cancer was designed to test the hypothesis that circulating levels of CEA would be lower in women with high parity and an early age at first pregnancy or live birth. CEA levels were higher if measured in the presence of tumour metastasis. There was no association between CEA levels and parity, age at first live birth, age at diagnosis or cigarette smoking. Thus we have no evidence that breast cancers which express embryonic antigens, such as CEA, are preferentially destroyed by an immune response which has arisen from embryonic inoculation during or around an early childbirth.
Adult↗
[The philosophy of palliative care].
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Humans↗
[The control of pain--a summation].
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Humans↗
Phase II evaluation of cis-dichlorodiammineplatinum(II) in advanced malignancies of the genitourinary and gynecologic organs: a Southwest Oncology Group Study.
One hundred and forty-seven fully and partially evaluable patients with advanced measurable malignancies of the genitourinary and gynecologic organs were given cis-dichlorodiammineplatinum(II) at a dose of 75 mg/m2 iv every 3 weeks. Thirty-six patients with testicular neoplasms were studied; five complete responses (13.9%) and seven partial responses (PR) (19.4%) were noted. Thirty-seven patients with ovarian adenocarcinoma were evaluated; five PRs (13.5%) were seen. One complete response (11.1%) and two PRs (22.2%) were obtained among nine patients with urinary bladder cancer. Four PRs (19.0%) were seen among a group of 21 patients with advanced prostate cancer. One PR (4.8%) was noted among 21 patients with renal cell cancer and no responses were seen in eight patients with cervical cancer. There was a highly statistically significant (P less than 0.001) survival advantage for the responding testicular tumor patients. Toxicity was similar to that previously reported, with gastrointestinal side effects and nephrotoxicity most commonly seen. Prospective and sequential analysis of renal function provided strong evidence for cumulative nephrotoxicity in these patients given bolus injections of cis-dichlorodiammineplatinum(II) without prehydration or treatment with fuosemide or mannitol.
Cisplatin↗
Treatment of recurrent lymphomas with vincristine, BCNU, doxorubicin, and prednisone (VBAP): a Southwest Oncology Group Study.
Chemotherapy with vincristine, BCNU, doxorubicin, and prednisone (VBAP) was administered to 75 patients with malignant lymphoma, including both Hodgkin's disease and non-Hodgkin's lymphoma. All patients had prior chemotherapy with or without radiation therapy. Remissions were achieved in 41% of all patients, with only minor toxicity. The median duration of remission for Hodgkin's disease and non-Hodgkin's lymphoma was 51 and 22 weeks, respectively. The median survival for all patients was 34 weeks. The VBAP program is effective palliative chemotherapy for advanced malignant lymphoma.
Adult↗
Clearing the chaos. 1. How the system would work.
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Education, Nursing↗
The acute paediatric scrotum.
The essentials of management remain the same whatever the cause of the acutely painful scrotum. 1. History is paramount. At what time did the pain come on and with what severity? Has this changed in any way? Is there any aggravation or relief and with what is the pain associated? Are there any urinary symptoms of note? Have there been any previous episodes of pain, possibly of lesser severity? How does the patient feel? 2. Always examine the whole child. Does he look unwell or in pain? Does he have a fever? Is he tachycardic? Is his abdomen soft? 3. Stand the boy up and note the position in which he stands. Look at the scrotum. Does the skin look normal or oedematous? What is its colour? What is the lie of the testis? Remember the left usually sits a little lower than the right. Do the testes hang transversely or at an angle? Is there any swelling of the groin that might indicate a hernia? 4. Elicit the cremasteric reflex on both sides, starting with the unaffected. Examine the normal, unaffected side and determine the anatomy. Ask if you can palpate the affected side. Isolate the testis and grasp it transversely, as anteriorly as possible. Establish whether tenderness is global, superior or posterolateral. If possible, stretch the skin gently over the upper aspect and look for the 'blue dot'. 5. There are no investigations of choice save prompt surgical opinion and exploration. Remember the relative incidences of the various diagnoses.(ABSTRACT TRUNCATED AT 250 WORDS)
Acute Disease↗
Reduction in oral mucosa micronuclei frequency following alpha-tocopherol treatment of oral leukoplakia.
Micronuclei frequency, a marker of genotoxicity, was studied within a trial of alpha-tocopherol for chemoprevention of oral leukoplakia. Oral swabs were obtained from two sites, the leukoplakia lesion and normal-appearing mucosa, at baseline and following 24 weeks of therapy with 400 international units of alpha-tocopherol twice daily. These specimens were analyzed for micronuclei frequency. The major risk factors for oral carcinogenesis in the group studied were cigarette smoking and alcohol consumption. alpha-tocopherol therapy produced a significant reduction in micronuclei frequencies in specimens from both the visible lesions (P < 0.01) and the normal-appearing mucosa (P < 0.01). The micronuclei frequencies, both at baseline and following therapy, were greater in specimens taken from the lesion than in those from the normal-appearing mucosa. Although these results indicate that alpha-tocopherol has a beneficial effect in oral carcinogenesis, there was no significant clinical or histological response associated with the change in micronuclei frequency. Micronuclei frequency has not yet been validated as a biomarker for cancer incidence, and consequently, its utility as an intermediate end point for chemoprevention trials is not known. Determining clinical significance of micronuclei frequency patterns in oral carcinogenesis and chemoprevention will require further study.
Adult↗
Vinblastine, bleomycin, and cis-dichlorodiammineplatinum(II) in disseminated testicular cancer: preliminary report of a Southwest Oncology Group Study.
Combination induction chemotherapy consisting of vinblastine, bleomycin, and cis-dichlorodiammineplatinum(II) was administered to 126 patients with advanced germ cell tumors of the testis. Following this 4-month induction therapy, maintenance treatment consisting of chlorambucil and actinomycin D alternating monthly with vinblastine was given for an additional 20-month period. Sixty-four patients (51%) achieved a complete remission, while 33 patients (26%) achieved a partial response. Responses were observed in all histologic categories. Seven patients (11%), who were in complete remission, have relapsed at a median time of 5 months. Median duration of remission is greater than 12 months for complete responders and 4 months for partial responders. Significant leukopenia was noted in 57% of evaluable courses and significant thrombocytopenia was noted in 18%. Less than 20% of patients were noted to have nephrotoxicity. Other toxic effects observed were gastrointestinal (42%), dermatologic (15%), pyrexia (14%), neuromuscular (9%), and pulmonary (less than 5%). Several pretreatment parameters are currently being evaluated to determine the impact on complete remission rate and survival.
Antineoplastic Agents↗
Occupational health nursing in the pharmaceutical industry.
The occupational health nurse's traditional role of evaluating occupational hazards is uniquely difficult in the pharmaceutical industry due to the continuous discovery of new compounds. Awareness of new chemicals and knowledge about their hazards are essential. The authors address these specific challenges as well as nurses' changing roles in industry.
Drug Industry↗