Search PubMed⌕ Search

Biomedical subjects

W Peters

Publications and source records attributed to W Peters.

At least 397 records · Page 22Linked to original sources
PubMedDate not supplied

Quality of life in patients surviving at least 12 months following high dose chemotherapy with autologous bone marrow support.

BACKGROUND: Over the past decade, high dose chemotherapy with autologous bone marrow (HDC-ABMT) support has been used increasingly in the treatment of patients with breast cancer. In evaluating the results of HDC-ABMT in patients with breast cancer, an assessment of quality of life can add to the traditional endpoints (toxicity, and disease-free and overall survival) that are routinely assessed in clinical trials. PURPOSE: This study evaluated the quality of life (QOL) of breast cancer patients who had survived 1 or more years following high dose chemotherapy with autologous bone marrow transplant (HDC-ABMT) support. METHODS: Eighty-two patients who had undergone HDC-ABMT were surveyed by written questionnaire and follow-up telephone interview at least 1 year following HDC-ABMT. Patients were asked to complete the Functional Living Index-Cancer (FLIC), the Symptom Distress Scale (SDS), and a survey of sexual function developed as part of the study. RESULTS: The mean FLIC score among all patients was 130 +/- 19.1 (possible range 22-154). FLIC scores were significantly lower in patients with evidence of recurrent disease than in patients who were free of disease. The most commonly reported symptoms after HDC-ABMT were insomnia, fatigue, and pain. Sexual interest and sexual activity were reported to be lower after participation in HDC-ABMT than prior to the procedure. The majority of patients who were employed outside the home prior to HDC-ABMT returned to work with a median time away from work of 48 weeks. CONCLUSIONS: Patients with breast cancer who survive 1 or more years following HDC-ABMT rate their QOL at a relatively high level and frequently return to work. Less than one-third of patients who were interviewed reported moderate to severe symptoms. Problems with sexual functioning were common. IMPLICATIONS: Future research is needed on long-term outcomes after HDC-ABMT and on specific areas of concern, such as sexual functioning.

Adult↗
PubMedDate not supplied

A review of the literature on the etiology of capsular contracture and a pilot study to determine the outcome of capsular contracture interventions.

The etiology of capsular contracture is unclear and probably multifactorial. This review covers the literature on several proposed contracture factors, including filler material, implant placement, surface texture, and bacterial infection. The pilot study's goal was to test the feasibility of a data collection form, which could be used in a scaled-up study analyzing multiple surgeon's records. The goal of the expanded version of this study will be to determine the efficacy of available interventions for capsular contracture, including surveillance. The Breast Implant Public Health Project, LLC (BIPHP), piloted a retrospective review of outcomes in women who had interventions to relieve capsular contracture or had chosen a wait-and-watch approach. An evaluation of the efficacy of various treatments can help women decide if they want to pursue treatment at all and, if so, which treatment might offer them the best solution. BIPHP researchers (E.E.A., M.E.) developed a data collection form after reviewing records of three surgeons (B.C., W.P., V.L.Y.). During the data collection using the same records, we tested a randomization process to identify women with capsular contracture who underwent various interventions, including a wait-and-watch strategy, and those who had no mention of any intervention or waiting approach. Data were gathered on a total of 90 breasts with capsular contracture (scored Baker I-IV or qualitatively), of which 45 underwent a total of 102 interventions for capsular contracture. Interventions were classified as "closed capsulotomy," "surgical," or "watchful waiting." Closed capsulotomy was performed most often (47%), followed by surgery (29%) and watchful waiting (21%). Presurgical Baker scores averaged higher in breasts that underwent surgery (3.1) than for watchful waiting (2.5) or closed capsulotomy (2.3). Though closed capsulotomies had 100% of outcomes scoring "improved" or "same," 58% of the breasts underwent the procedure more than once, suggesting that the favorable outcome was short-lived. The wait-and-watch approach resulted in scores of either "same" or "worse"; surgery (open capsulotomy, repositioning, or capsulectomy) resulted in 79% improved, 16% same, and 5% worse outcomes in breasts with outcomes listed. In all intervention procedure categories, outcomes were frequently unavailable; they were noted only 60% of the time (52/87). The missing 40% may have resulted from the doctor's failure to note it in the chart, satisfied patients not returning for additional treatment, or dissatisfied patients seeking treatment elsewhere. Generally, the data collection forms and procedures were workable; however, we uncovered issues to address in the scale-up of this pilot study: (1) the outcome report rate was 60%; (2) though Baker scores are commonly used to evaluate the degree of capsular contracture, it seems that grade I may have different meanings for different surgeons, which would need to be clarified; (3) participating surgeons will need to divulge standard-of-care items that they may not have included in medical records, but routinely performed (e.g., patient massage, use of prophylactic antibiotics); and (4) records were initially separated by "implant," then researchers realized that a more useful collection would be by "breast." The latter approach captures the history of the breast in one record, which may be more important to contracture than the differences in implants. With the modifications discussed, the study can be scaled up to encompass as many records as necessary to achieve robust statistical power. These data will add to the existing literature regarding factors associated with capsular contracture and identify factors that affect the successful outcome of capsular contracture interventions.

Breast↗
PubMedDate not supplied

Factors associated with breast implant rupture: pilot of a retrospective analysis.

This pilot study's goal was to test the feasibility of a data collection form which will be used in a scale-up study analyzing multiple surgeons' records. The goal of this expanded study will be to develop identifying factors for women who are at greater risk for having ruptured implants and, if necessary, target them for screening, surveillance, or intervention. In the pilot study, we compared factors associated with implant rupture in women with and without rupture. Similar studies have considered one or a few factors at a time and, generally, have given little attention to implant generation. We developed a data collection form after reviewing records of three surgeons. A total of 92 records was collected and analyzed. An important feature in the pilot was to compare the results of patients whose implants the surgeons had both implanted and explanted (n = 34) with those of patients whose implants the surgeons had only explanted (n = 55) (unknown = 3). This comparison could show if including all explantation patients in a surgeon's practice would bias the sample; however, based on this pilot data, concerns regarding this type of bias seem to be minimal. Similar amounts of data (e.g., implant information, history of capsular contracture, etc.) were collectable on patients whose surgeons both implanted and explanted them (87%) and who had different surgeons for implantation and explantation (84%). Though the data from this limited sample cannot offer firm conclusions on rupture associations, a few factors stood out: size of implants (38. 3% of ruptured versus 15.9% of intact implants were 100-200 cm3), history of mammography (46.8% of ruptured versus 24.4% of intact had mammograms, which is likely due to older women with older implants having more mammograms), and history of closed capsulotomy (85.1% of ruptured versus 68.9% of intact). Interestingly, additional procedures performed on the breast (e.g., scar revision, wound repair, etc.) did not affect rupture: both the ruptured and the intact groups had an average of 1.7 procedures performed. The data collection form tested very well in this pilot study. Also, including all patients in the study sample, instead of excluding those who received their implants elsewhere, did not change the results. Though there are not enough data to draw any firm conclusions regarding rupture factors, the collection instrument was rigorously tested and should perform well in an expanded study.

Breast Implantation↗
PubMedDate not supplied

Leishmania infecting man and wild animals in Saudi Arabia. 5. Diversity of parasites causing visceral leishmaniasis in man and dogs in the south-west.

Kala-azar (VL), mainly affecting infants and young children, is being increasingly reported in the south-west of Saudi Arabia, 305 cases being diagnosed in 1988. Most cases arise in scattered locations in the foothills west of the Asir mountains at altitudes between about 500 and 1000 m, although case clusters are apparent in some villages. Some cases also occur between the foothills and the Red Sea coast. The incidence in the south-west was calculated to be of the order of 6 to 8/10,000 population per year, but a random serological survey using the enzyme-linked immunosorbent assay and direct agglutination techniques indicated a seropositivity rate of about 3.7% in 706 apparently healthy children. Most patients are Saudi or Yemeni and cases are being increasingly identified also in the Yemen Arab Republic. In the foothills of both countries the causative organism is Leishmania donovani s.l. zymodeme LON-42, which also occurs on the eastern littoral of Ethiopia. By isoenzyme electrophoresis, it is readily separated from L. infantum, which has been identified in feral dogs, the 2 organisms being sympatric. The infection was found in 6.7% of 89 dogs, but their seropositivity rate was 19.3%. Although L. infantum has not yet been recognized in man in Saudi Arabia, it has been identified in a child in the coastal plain of the Yemen Arab Republic. Further research needed to provide a rational basis for control is discussed.

Adolescent↗
PubMedDate not supplied

Leishmania infecting man and wild animals in Saudi Arabia. 6. Cutaneous leishmaniasis of man in the south-west.

Cutaneous leishmaniasis (CL) is common on the high plateaux and foothills of the Asir range in the south-west of Saudi Arabia and Yemen. In 1987 1198 and 1104 cases were reported among the Saudi populations of Asir and Al-Baha provinces, representing an estimated annual incidence of 12 and 38 per 10,000 respectively. The incidence rises from October to December, then declines to a minimum between May and August. The prevalence of Phlebotomus sergenti, a proven local vector in the highlands, is roughly in inverse proportion. Cases occur at all ages, over 60% have only a single lesion, and the head and neck are most commonly affected. Apart from a few patients who develop leishmaniasis recidivans, most respond well to sodium stibogluconate, or self-heal. Of 44 isolates typed by isoenzyme electrophoresis, 42 were Leishmania tropica belonging to 5 distinctive zymodemes. LON-72 (34 isolates), LON-73 (1), LON-71 (2) and LON-10 (2) were found at altitudes around 2000 m, 3 of them in a single village. Three isolates of LON-63 were found at altitudes between 600 and 1000 m in widely separated foci. L. tropica LON-10 and LON-71 have been isolated also from P. sergenti from highland foci. LON-72 failed to produce lesions in BALB/c mice and gave rise to only transitory lesions in the footpads of hamsters.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMedDate not supplied

Leishmania infecting man and wild animals in Saudi Arabia. 8. The influence of prior infection with Leishmania arabica on challenge with L. major in man.

A clinical trial is described of an attempt to protect against Leishmania major by prior vaccination with live L. arabica. After a single, previously leishmanin-negative, adult male volunteer was bitten by 8 Phlebotomus papatasi infected with L. arabica, no infected lesions were observed. He remained leishmanin-negative and his lymphocytes reacted weakly to antigens of L. arabica or L. major. Subsequently he and 3 other leishmanin-negative adult male volunteers were vaccinated with cultures containing 4 x 10(6) promastigotes of L. arabica. All remained leishmanin-negative but their lymphocytes showed some response to both L. arabica and L. major antigens. 96 d after vaccination these 4, and another, non-vaccinated, volunteer were challenged with 2 x 10(6) promastigotes of L. major. Active cutaneous, ulcerated lesions developed in all 5 volunteers. The lesions in 3 vaccinated volunteers were associated with marked lymphadenitis and beading, but the lesions started to heal spontaneously within 120-250 d after challenge. The lesion in the fourth vaccinated volunteer was less severe and lymphadenitis was not observed. The lesion in the unvaccinated subject developed more slowly and was smaller, but more chronic, than those in the vaccinated individuals. Marked cross-reactivity in terms of lymphocyte proliferation and interferon-gamma production was observed between L. major and L. arabica in both directions in subjects exposed first to one or the other organism. Although the procedure followed in this trial failed to give protection against L. major, further studies in volunteers should be considered.

Adolescent↗
PubMedDate not supplied

Leishmania infecting man and wild animals in Saudi Arabia. 7. Partial protection of mice against Leishmania major by prior infection with L. arabica.

A survey of inbred mouse strains showed that strain C3H/he was the most comparable to man in respect of its susceptibility to Leishmania major and the subsequent healing of lesions produced by this organism. L. arabica proved to have a lower virulence than L. major and prior inoculation with the former resulted in a decrease of the lesion sizes following subsequent L. major challenge. Moreover, L. major lesions that did develop in mice previously inoculated with L. arabica generally healed faster.

Animals↗
PubMedDate not supplied

Studies on the leishmaniases in the Sudan. 1. Epidemic of cutaneous leishmaniasis in Khartoum.

A recent outbreak of cutaneous leishmaniasis (CL) in Khartoum province, the first ever reported, involved about 10,000 recorded cases. The peak incidence was in September 1986. It was widespread all over the province, but the most affected areas were along the banks of the River Nile. People of both sexes, all age groups, different ethnic origins, and all socio-economic classes were equally affected, suggesting that this epidemic was a new occurrence among a non-immune population. A leishmaniasis clinic was established and 736 cases were treated and studied. The control measures, responsible parasite, possible animal reservoir, and vector are discussed. Possible contributory factors were mass population movement from known endemic areas of CL in Khartoum, expanding towns and new settlements in previously uninhabited areas, high population densities of sandflies, and an increase in the rodent population, including Arvicanthis species.

Disease Outbreaks↗
PubMedDate not supplied

Studies on the leishmaniases in the Sudan. 2. Clinical and parasitological studies on cutaneous leishmaniasis.

In the Omdurman Hospital for Tropical Diseases, Sudan, from 6 October to 1 December 1986, 736 patients with cutaneous leishmaniasis (CL) were studied. The duration of the lesions varied from a few days to 4 months, usually (56%) 1-3 months. Multiple lesions ranging from one to 50 (mean = 4) were present in 80% of cases. Ulcerative lesions were found in 44%, nodulo-ulcerative in 31%, nodular in 31% and others, including infiltrated, fungating and warty lesions, in 5% of patients. The lower limbs were involved in 66%, upper limbs in 50%, face in 6%, back in 4%, chest in 2%, abdomen in 1% and buttocks in 0.1%. Lesions were also found on the ear, scalp, genitalia and mucocutaneous junctions. Lymphatic involvement was present in 11% of the patients, secondary infection in 18%, fever in 17%, pain in 38% and itching in 61%; 3% of the patients were diabetics. Features of diffuse cutaneous leishmaniasis were noted in one patient and three cases presented with an 'id' reaction. A slit-skin smear was positive in 88% of the cases. Using thin-layer starch gel electrophoresis, 23 stocks from man and one from Arvicanthis niloticus were identified by the characterization of 12 enzymes as Leishmania major zymodeme LON-1. Various therapeutic regimens are discussed. Only patients with severe lesions (approximately 15%) were given 3 to 4 weeks' treatment with intravenous Pentostam, to which all except 2 responded satisfactorily with minimal side effects.

Adolescent↗
PubMedDate not supplied

Studies on the leishmaniases in the Sudan. 3. Clinical and parasitological studies on visceral and mucosal leishmaniasis.

The epidemiological, clinical and laboratory findings of 27 patients with visceral leishmaniasis (VL) and six with mucosal leishmaniasis (ML) in Sudan are described. The diagnosis was confirmed by the demonstration of amastigotes in bone-marrow in 20 cases with VL (80%) and impression smears in 2 cases with ML. The enzyme-linked immunosorbent assay and direct agglutination test were positive in all the sera tested. The leishmanin test was positive in all patients with ML, the diameter of the reaction ranging from 18 to 28 mm (mean 23 mm). Only one isolate (from a patient with VL) grew sufficiently well in culture to be typed and this was characterized by isoenzyme electrophoresis as Leishmania donovani zymodeme LON-46. The possibility that the ML isolate could have been L. major zymodeme LON-1 is discussed. The importance of further research to isolate and identify by biochemical procedures a more representative range of isolates of Leishmania from different clinical types in the Sudan, in order to elucidate questions such as the relationship between the vectors and possible animal reservoirs, is emphasized.

Adolescent↗
PubMedDate not supplied

Enzyme-linked immunosorbent assay for the detection of anti-Giardia specific immunoglobulin G in filter paper blood samples.

Conventional diagnosis of infection with Giardia duodenalis is by faecal examination but the sensitivity of a single examination is low. Serological tests, although not always positive, are more acceptable to patients and are useful in determining the prevalence of giardiasis in large populations. We show here that blood collected on filter paper and dried provides an excellent source of material for enzyme-linked immunosorbent assays; using samples from a group of 88 stool-negative and 45 positive patients, the optimum results were obtained by taking the control mean optical density plus one standard deviation as the negative/positive cut-off value. The sensitivity was 91% (2/45 false negatives), and the specificity 95% (4/88 false positives). This method should be particularly useful for large-scale surveys in developing countries or wherever serological testing is done in central laboratories.

Animals↗
PubMedDate not supplied

Plants as sources of antimalarial drugs, Part 4: Activity of Brucea javanica fruits against chloroquine-resistant Plasmodium falciparum in vitro and against Plasmodium berghei in vivo.

Extracts of Brucea javanica fruit have been prepared and monitored for their in vitro and in vivo antiplasmodial activities. The antimalarial activity of the fruit was found to be attributable to its quassinoid constituents. Nine of the quassinoids possessed in vitro IC50 values between 0.046-0.0008 microgram/ml against the chloroquine resistant Plasmodium falciparum strain (Kl) tested. The two quassinoid glycosides tested were considerably less active in vitro than the aglycones. Four quassinoids were found to possess activity in vivo against Plasmodium berghei infections in mice after oral dosing. All five quassinoids tested in vivo showed some toxicity.

Animals↗