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Biomedical subjects

A J Clayton

Publications and source records attributed to A J Clayton.

At least 19 recordsLinked to original sources
PubMed2004

Incidence of cerebral metastases in patients treated with trastuzumab for metastatic breast cancer.

Trastuzumab is an effective treatment for patients with metastatic breast cancer (MBC) that overexpresses HER-2. A high incidence of brain metastases (BM) has been noted in patients receiving trastuzumab. A retrospective chart review was conducted of 100 patients commencing trastuzumab for metastatic breast cancer from July 1999 to December 2002, at the Christie Hospital. Seven patients were excluded; five patients developed central nervous system metastases prior to starting trastuzumab, and inadequate data were available for two. Out of the remaining 93 patients, 23 (25%) have developed BM to date. In all, 46 patients have died, and of these 18 (39%) have been diagnosed with BM prior to death. Of the 23 patients developing BM, 18 (78%) were hormone receptor negative and 18 (78%) had visceral disease. Univariate analysis showed a significant association between the development of cerebral disease and both hormone receptor status and the presence of visceral disease. In conclusion, a high proportion of patients with MBC treated with trastuzumab develop symptomatic cerebral metastases. HER-2-positive breast cancer may have a predilection for the brain, or trastuzumab therapy may change the disease pattern by prolonging survival. New strategies to address this problem require investigation in this group of patients.

Adult↗
PubMed1998

Germ cell cancer and dermatomyositis.

Although the association of dermatomyositis and malignancy is well recognized, there have been few previous reports of germ cell tumours occurring in this context. Two cases of teratoma with dermatomyositis have presented at the Wessex Medical Oncology Unit in Southampton, which prompted a review of the literature.

Adult↗
PubMed1989

AIDS in Canada.

Since the first case of AIDS was diagnosed in 1982, there have been over 2,300 cases, as of February 1989, in Canada. The epidemiological pattern of the cases in Canada follows that of the United States with the exception of intravenous drug users. In 1983, the federal government created a National Advisory Committee which is active in advising the Minister of National Health and Welfare on issues for the control and management of AIDS in Canada. In 1985, a $39 million program was announced. An enhanced program of AIDS control was established in July of 1987 with the creation of the Federal Center for AIDS (FCA). This has involved a substantial increase in financial and personnel resources. Canada plays a significant role internationally vis-à-vis AIDS; $10 million has been provided to the World Health Organization. The FCA is a WHO Collaborating Centre. In June of 1989, Canada will host the Vth International Conference on AIDS in Montreal.

Acquired Immunodeficiency Syndrome↗
PubMed1989

The Canadian national AIDS program.

Canada's federal AIDS program is orchestrated by the Federal Center for AIDS (FCA), created in 1987. The Center is made up of six bureaus: Program Analysis and Resources, the focal point for policy and program development; AIDS Prevention and Services Program, which focuses on education, liason with health care workers and community groups, and the psychosocial aspects of the epidemic; AIDS Epidemiology and Surveillance, which monitors trends and assesses the extent of the disease; Laboratories and Research, which provides reference services for laboratories engaged in HIV screening and diagnosis, and collaborates with national and international researchers; External Cooperation, which promotes international collaboration in AIDS research, policy, and programs; and Clinical Studies, which promotes studies on drugs and vaccines. The fight against AIDS is also assisted by the National Health Research and Development Program, provincial and territorial governments, and community-based support groups.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Acquired immune deficiency syndrome in Canada: the first 5 years of surveillance.

In the first 5 years of surveillance of reports of the acquired immune deficiency syndrome (AIDS) in Canada, from February 1982, the Laboratory Centre for Disease Control, Ottawa, was notified of 1133 cases reported through provincial ministries of health that met the case definition developed by the US Centers for Disease Control, Atlanta. Most cases (82.2%) were reported from the homosexual/bisexual risk group. Other risk groups were less frequently represented, in contrast to the experience in the United States, where a higher proportion of cases in drug abusers has been observed, and in Africa, where heterosexual spread is far more common. The presenting clinical picture and length of survival after diagnosis were similar to those reported for other countries. Differences between projected estimates of the number of AIDS cases obtained with polynomial and logistic growth models emphasize the need for solid epidemiologic data on the number of people infected with human immunodeficiency virus, the rates of transmission and the rates of progression to disease.

Acquired Immunodeficiency Syndrome↗
PubMed1984

A hospital contingency plan for exotic communicable diseases.

The exotic communicable diseases are highly virulent, transmissible, conditions which occur most often in tropical areas. Since the late 1960s, there have been occasions when these diseases have been exported to the US and Canada. Advance planning will facilitate the care of patients infected with these diseases in health care facilities. Hospitals should develop a contingency plan which addresses the management of patients that present themselves to the emergency department as well as patients diagnosed after admission. The plan should address such topics as the isolation room, protective clothing, disinfection of the environment and equipment as well as the management of waste and handling of corpses. A well thought out plan will prevent subsequent transmission of infection to attending personnel, other patients and the surrounding community.

Communicable Disease Control↗
PubMed1982

Toxic shock syndrome in Canada.

Since 1976, 53 confirmed or suspected cases of toxic shock syndrome (TSS) have been reported in Canada. Twenty-two cases occurred in 1980, and by October 1981 another 21 had been reported. In Canada, like the United States, where nearly 1200 cases have been recorded, TSS appears to be associated with tampon use, although a few cases have occurred in males and in nonmenstruating women. Of the 53 patients 3 died. The enterotoxin produced by Staphylococcus aureus is probably responsible for TSS. Manufacturers of tampons have now placed warning labels on tampon boxes and information on TSS in the instruction inserts. Women should select tampons of appropriate absorbency for the various stages of menstruation.

Adolescent↗
PubMed1982

Toxic shock syndrome in Canada.

Fifty-three cases of toxic shock syndrome were reported in Canada from 1976 to 31 October 1981. Three of the 50 women with this syndrome died. Thirty-seven cases were associated with menstruation and all but one of these cases were in tampon users. Staphylococcus aureus has been isolated from eight patients, and enterotoxin was found in seven. The Canadian government has asked tampon manufacturers to print a warning statement on tampon boxes and to include a package insert informing users about toxic shock syndrome. Generally, the incidence of communicable disease in Canada is one tenth that of the United States, reflecting the population differential of 1:10 between the two countries. This ratio has not been found with respect to toxic shock syndrome.

Adolescent↗
PubMed1980

Controlling the exotic diseases: 1. Isolation facilities.

The exotic diseases are highly virulent transmissible conditions that include Lassa fever, some viral hemorrhagic fevers, smallpox and plague. Any of these diseases could be brought into or diagnosed in Canada as the result of natural or laboratory acquired infection. The patients must be isolated until the presumptive diagnosis is proved. High-security isolation is necessary and needs to be backed up by high-security laboratory services. In Canada facilities for high-security isolation are generally not available; therefore, hospitals must preplan and be ready to effect the best possible isolation under the existing conditions. The plan should address construction, ventilation, filtration, temperature and humidity, together with protective measures for staff and careful handling of laboratory specimens. Materials the patient has contacted and areas or vehicles he or she has been in will have to be decontaminated, and appropriate, safe disposal of corpses must be considered.

Canada↗
PubMed1980

Controlling the exotic diseases: 2. Nursing management.

Advance planning can facilitate the care of a patient with an exotic disease who is admitted to a hospital that lacks facilities for high-security isolation. The Department of National Health and Welfare contingency plan for dealing with such patients lacks specific information in a number of areas of medical care, as described in this paper. Consideration must be given to the number of personnel trained and readied for employment, the criteria for selection and special preparation. The protective clothing generally used for hospital isolation procedures is inadequate. Several types of special clothing, including a respirator, are available for total protection of personnel; the clothing may be uncomfortable when worn for long periods, and does restrict movement, vision and communication. All persons entering the isolation suite must change into fully protective clothing, and double layers of clothing are required for direct patient care. All personnel must shower and change before leaving the isolation suite. Suitable facilities for dressing and showering, together with entry and exit routines, must be considered. Hand washing, daily cleaning procedures and disposal of liquid and solid wastes all require special procedures. The social and psychologic problems of patients and their families must also be considered. Preplanning is required to decrease the risks involved in monitoring vital signs and implementing emergency procedures requiring contact with the patient's blood.

Communicable Diseases↗
PubMed1979

Lassa fever, Marburg and Ebola virus diseases and other exotic diseases: is there a risk to Canada?

There are seven exotic diseases of concern; three of these, the most unpredictable and least understood, are Lassa fever, Marburg virus disease and Ebola virus disease. In this article the epidemiologic aspects of these diseases are discussed, with particular emphasis on exportation from their indigenous areas in Africa and on the occurrence of secondary cases. Any of these conditions could be brought into Canada either by aeromedical evacuation or inadvertently. Between 1972 and 1978 there were seven occasions when Canada could have been involved with handling cases of Lassa fever. The Government of Canada has purchased several containment bed and transit isolators. These units, with filtered air under negative pressure, accommodate infectious patients being transported and cared for without contaminating medical attendants or the environment.

Adult↗
PubMed1979

Containment aircraft transit isolator.

The Containment Aircraft Transit Isolator is a self-contained unit capable of transporting a patient with a highly virulent disease and at the same time providing maximum microbiological security while full nursing care and treatment are carried out. The isolator was employed in a trans-Atlantic simulated aeromedical evacuation in a Canadian Forces Boeing 707. During the exercise, flight testing was undertaken and nursing care, treatment, and decontamination procedures were developed and evaluated. Flight medical personnel were trained in the use of the unit. It was concluded that flight-trained medical teams, well versed in general aviation medicine and with a detailed familiarity with the isolator, are necessary for safely transporting patients with exotic diseases.

Adult↗
PubMed1976

Study of the microbiological environment within long- and medium-range Canadian Forces aircraft.

Because of a possible requirement to carry patients with highly virulent communicable diseases, a study was undertaken to observe smoke patterns within Canadian Forces transport aircraft. This was followed by the quantitative evaluation of the spread on non-pathogenic organisms disseminated within a Boeing 707 and a C13OE (Hercules). Thirdly, an attempt to recover respiratory tract viruses during transatlantic flights was made. Smoke patterns showed that an infected patient should be placed at the rear of the aircraft. The spread of the nonpathogenic organisms in a 707 indicated that contamination was largely confined to the rear, except when the aircraft was in an unpressurized mode. In the C13OE, contamination was shown to occur throughout the whole aircraft. No respiratory tract viruses were recovered during the transatlantic flights. It is essential that a 707 should be utilized for aeromedical evacuations. If a C13OE is being considered, then a portable self-contained isolation care unit is mandatory.

Aerospace Medicine↗
PubMed1973

Trials of aqueous killed influenza vaccine in Canada, 1968-69.

The appearance of the pandemic A/Hong Kong/1/68 (H3N2) influenzavirus strain provided an opportunity for a clinical field trial of influenza vaccines in Canada during the winter of 1968-69. As by November 1968 there were reports of influenza B activity and as supplies of A2/HK/68 vaccines were limited, it was decided to make a series of strictly randomized double-blind trials comparing A2/HK/68 vaccines not only with B/Mass/66 vaccines but also with a bivalent vaccine that was already in production and contained B/Mass/66 and A2/Mtl/68, the latter a strain isolated in Canada during January 1968. In 4 trials, a total of 13 729 military personnel and 4 795 primary schoolchildren were vaccinated. Reported vaccine reactions were less than 0.1% with zonally-purified vaccines and 2.6% with the "standard" aqueous killed bivalent vaccine. Three children had serious reactions. Surveillance detected an outbreak of influenza in the first two trials on the military. The 3 vaccines containing A2 strains gave similar clinical protection conservatively estimated at 42-55% but probably about 80%. The effectiveness of the A2/Mtl/68 vaccine, which was in production before the Hong Kong variant had been isolated, was unexpected. In the absence of a vaccine specific to a new pandemic strain, it should not be assumed that a vaccine made from another recent strain could not be useful.

Canada↗