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Biomedical subjects

R Wesley

Publications and source records attributed to R Wesley.

65 records · Page 4Linked to original sources
PubMed1981

A prospective randomized study of adjuvant parenteral nutrition in the treatment of advanced diffuse lymphoma: influence on survival.

The efficacy of adjuvant parenteral nutrition (PN) in cancer patients is not well defined. Twenty-one of 42 patients with advanced diffuse lymphoma were randomly selected to receive PN during an aggressive program of multiple-drug chemotherapy. These patients received 56 courses of central venous PN support during the first 14 days of the 28-day cycles of early and late phases of chemotherapy. PN patients received an average of 2,216 kcal/day, and their oral intake was 836 kcal/day during therapy. PN patients had marked weight gains, and standard nutrition (SN) patients had stable weights both during cycles of therapy and over the entire course of therapy. Lean body mass, as indicated by total body potassium, anthropomorphic measurements, serum albumin, creatinine-to-height ratio, total iron-binding capacity, and total lymphocyte count, was not improved in PN patients as compared to SN patients. PN therapy was complicated by symptomatic subclavian vein thromboses, septic catheters, and pneumothoraxes. The actuarial survival rate at 2 years was 68.8% +/- 10.9% (estimate +/- SD) for PN patients and 65.8% +/- 12.2% (estimate +/- SD) for SN patients. These results suggest that the weight gained by PN patients was composed of fat, water, or both. A lack of improvement in nutritional status and survival rates and a significant complication rate were associated with adjuvant PN during chemotherapy.

Adult↗
PubMed1981

Treatment of acute lymphoblastic leukemia in relapse: efficacy of a four-drug reinduction regimen.

The experience of 47 similarly-treated patients with acute lymphoblastic leukemia who developed hematologic relapse was reviewed to determine the effectiveness of reinduction therapy. The majority of patients were treated with a four-drug regimen utilizing L-asparaginase, vincristine, daunomycin, and prednisone. This regimen produced second, third, and fourth remissions in approximately 90% of patients, all of whom had experienced relapse while on chemotherapy. Eighteen percent of all patients who achieved second remissions are alive in prolonged second remissions, including four individuals who experienced relapse while receiving maintenance chemotherapy. These encouraging results underscore the efficacy of the four-drug regimen and emphasize the necessity for intensive treatment of recurrent acute lymphoblastic leukemia.

Adolescent↗
PubMed1981

Factors predicting long-term survival in diffuse mixed, histiocytic, or undifferentiated lymphoma.

Clinical and histopathologic material from 151 cases of diffuse mixed, diffuse histiocytic, and diffuse undifferentiated non-Burkitt's lymphomas have been reviewed to determine the factors that predict long-term survival. Median survival of all patients was 34 mo with 43% alive at 70 mo. Factors associated with a poor prognosis include: male sex, constitutional symptoms, advanced stage, bone marrow involvement, huge (greater than 10 cm) abdominal masses with gastrointestinal involvement, hepatic involvement, hemoglobin greater than 12 g/dl, or serum LDH greater than 250 U. The best prediction of a given patient's survival was defined by a set of four variables, which includes sex, symptoms, bone marrow status, and the presence or absence of a huge abdominal mass with gastrointestinal involvement. In contrast, classification of these patients according to the histopathologic categories of Rappaport of Strauchen did not define patient groups with significant differences in survival, nor did these categories correlate with the previously described clinical factors. Knowledge of the distribution of these prognostic factors in any clinical trial is needed before therapeutic results can be compared. In addition, such data may define subsets of patients for whom current therapy is inadequate and conversely those patients for whom current therapy yields excellent long-term survival.

Abdominal Neoplasms↗
PubMedDate not supplied

Anorectal infections in patients with malignant diseases.

Fifty-seven episodes of anorectal infection in 44 patients with malignant diseases primarily leukemia or lymphoma, have been retrospectively reviewed. Seventeen patients died in hospital, but only in seven cases was the anorectal infection a major contributing cause of death. The most important prognostic indicator of outcome was number of days of neutropenia during the infectious episode. Cultures obtained at the time of surgical drainage or by needle aspiration of the wound revealed multiple organisms in 26 of 29 instances, and anaerobic organisms were the commonest isolates. Anorectal infection was controlled in 28 (55%) of 51 treatment courses when antibiotics were the only treatment given. However, if the antibiotic regimen included both an aminoglycoside and an antibiotic with anaerobic coverage, control of infection was observed in 15 (88%) of 17 cases. There were 26 surgical procedures performed, with acceptable morbidity. Infection was controlled in 19 (73%) of 26 cases treated with surgery and antibiotics. The results support managing most of these infections initially with medical treatment, using an antibiotic regimen that includes an aminoglycoside and a specific drug against anaerobes. Surgery is recommended if there is obvious fluctuance, a significant amount of necrotic tissue evident, or progression of the infection locally or continued sepsis after an adequate antibiotic trial.

Adolescent↗
PubMedDate not supplied

Iron supplementation of total parenteral nutrition: a prospective study.

A prospective study to evaluate the iron dosage needed to restore serum iron levels was performed on patients receiving prolonged total parenteral nutrition (TPN). Intravenous iron intakes of 0, 25, 87.5, and 175 mg/wk were sequentially studied. No untoward responses were seen in 42 patients studied for 2758 patient days. When compared to pre-TPN levels, serum iron levels increased significantly with increasing iron dosage (p less than 0.002). In every single patient at the two highest dosage levels, serum iron levels at 3 wk rose from the pre-TPN level. Hemoglobin, reticulocyte count, transfusion requirement, total iron binding capacity, and red cell indices were not affected by iron dosage. There was no increased incidence of sepsis in patients who received increasing iron dosage. Both the 87.5 and 175 mg/wk iron doses increased serum iron levels from pre-TPN values, but the highest dose increased serum iron levels above the normal range in 80% of patients after 3 wk of administration allowing us to recommend the 87.5 mg/wk dose.

Adult↗
PubMedDate not supplied

Modified oral ondansetron regimen for cyclophosphamide-induced emesis in lupus nephritis.

OBJECTIVE: To evaluate the antiemetic efficacy of a modified regimen of oral ondansetron and dexamethasone in patients with lupus nephritis undergoing treatment with cyclophosphamide whose conventional antiemetic regimen had failed. DESIGN: A before-after prospective observational pilot project. SETTING: A federal research hospital. PATIENTS: Fourteen outpatients with lupus nephritis receiving intravenous cyclophosphamide 0.75-1.0 g/m2 had previously experienced chemotherapy-induced emetic events (vomiting or retching) while receiving a standard combination intravenous antiemetic regimen. The regimen consisted of four doses of thiethylperazine 10 mg and diphenhydramine 25 mg every 6 hours, and two doses of lorazepam 0.5 mg every 6 hours starting at 1 hour prior to cyclophosphamide. A subset of 8 patients previously completed a blinded study in which they received the intravenous formulation of ondansetron (4 doses of 4-16 mg q4h) administered orally beginning 30 minutes prior to the cyclophosphamide infusion. MAIN OUTCOME MEASURES: The number of emetic events and cost of drug administration were assessed for the modified ondansetron intervention and compared with those of the standard antiemetic regimen. The incidence of emetic events and visual analog nausea scores for the subset of eight patients were also evaluated. INTERVENTIONS: To account for the delayed onset of emesis associated with cyclophosphamide, patients received both ondansetron 8 mg orally every 4 hours (3 doses) and dexamethasone 10 mg orally (1 dose) beginning 4 hours after the cyclophosphamide infusion. This is different from the manufacturer's recommended dose schedule, in which ondansetron is administered prior to chemotherapy. RESULTS: No emetic events were observed following the administration of oral ondansetron/dexamethasone. The 95% confidence interval for the true rate of emesis was 0% to 19.3%. There was a significant difference in efficacy between ondansetron/dexamethasone and the triple antiemetic regimen (p < 0.0002). None of the patients experienced adverse effects while receiving the ondansetron/dexamethasone regimen. Cost comparisons (including admixture and nursing administration times) for standard combination therapy and oral ondansetron/dexamethasone were $109.09 and $70.24, respectively. No difference in emetic events or nausea ratings was observed between oral ondansetron/dexamethasone tablets and oral administration of ondansetron using the intravenous formula. CONCLUSIONS: This study suggests that a modified oral ondansetron/dexamethasone regimen is safe and efficacious, and costs less than alternative regimens to prevent cyclophosphamide-induced emesis in patients with lupus nephritis.

Administration, Oral↗
PubMedDate not supplied

A comparison of the attitudes of obstetricians and family physicians toward obstetric practice, training, and hospital privileges of family physicians.

Responses of national samples of 329 residency-trained family physicians and 237 obstetricians were studied to determine the attitudes of family physicians and obstetricians toward the practice of obstetrics by family physicians. The attitudes of obstetricians and family physicians varied greatly, and the attitudes of obstetricians toward obstetric care provided by family physicians tended to become less supportive following the time of the obstetricians' training. In particular, obstetricians felt strongly that family physicians were inadequately trained to provide uncomplicated obstetric care. These negative attitudes were reflected in obstetricians' opinions regarding hospital obstetric privileges for family physicians. From a list of 11 obstetric privileges, obstetricians indicated that residency-trained family physicians should be granted a mean of 2.2 privileges, while family physicians who currently practice obstetrics indicated a mean of 6.6 (P less than .001). Family physicians who felt well supported by obstetricians during their obstetric training were more likely to develop positive attitudes toward obstetric practice than those who were not well supported. Both obstetricians and family physicians indicated that the adequacy of maternity care in rural areas would decline if family physicians withdrew from maternity care. There was strong agreement that rising malpractice premiums may soon force family physicians to stop delivering babies. This study concludes that there are vast differences among obstetricians and family physicians in perceptions regarding obstetric practice by family physicians which may adversely affect such practice.

Adult↗