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Biomedical subjects

A V Simmons

Publications and source records attributed to A V Simmons.

At least 19 recordsLinked to original sources

Five-year follow-up of a prospective randomised multi-centre trial of weekly chemotherapy (CAPOMEt) versus cyclical chemotherapy (CHOP-Mtx) in the treatment of aggressive non-Hodgkin's lymphoma. Central Lymphoma Group.

BACKGROUND: Weekly alternating regimen known as CAPOMEt is compared to standard cyclical chemotherapy (CHOP-Mtx) in aggressive non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS: Three hundred and eighty-one patients with aggressive NHL were randomised to receive either cyclophosphamide, doxorubicin, vincristine, prednisone and methotrexate (CHOP-Mtx) on a cyclical basis or a weekly regimen incorporating the same drugs with the addition of etoposide (CAPOMEt). RESULTS: After pathological review, 281 patients were deemed eligible. At the census date of 31 March 1994, 158 patients were alive with a median follow up of 5.9 years (minimum 3.0 years). Analysis of all patients and eligible patients showed no significant treatment differences in the rates of complete remission (CR), failure free survival (FFS) or overall survival (OS) between the two arms. The actuarial median OS was 24 months for CAPOMEt compared with 31 months for CHOP-Mtx, with five-year actuarial survival rates of 37% and 43%, respectively. Myelosuppression was significantly more severe with CHOP-Mtx and neurotoxicity was much more common with CAPOMEt. CONCLUSION: Weekly CAPOMEt is equally effective as standard cyclical CHOP-Mtx treatment in aggressive NHL.

Adolescent↗

Gonococcal arthritis complicated by acute pericarditis and pericardial effusion.

A woman of 23 presented with a painful, swollen left knee. A thick yellow fluid aspirated from the joint cavity grew Neisseria gonorrhoeae. Central pleuritic chest pain and ST segment elevation developed 48 hours after presentation. These signs and symptoms of pericarditis had settled two months after the acute illness.

Adult↗

Hepatic tumors with hyperglucagonemia. Response to treatment with human lymphoblastoid interferon.

A 62-year-old man had necrolytic migratory erythema in association with hyperglucagonemia and multiple hepatic tumors. A diagnosis of metastatic glucagonoma was made. He was treated with human lymphoblastoid interferon given subcutaneously in the dose of 2.8 to 7.1 X 10(6) IU/day. This produced a considerable fall in plasma glucagon and resolution of the associated rash. The treatment was continued for 10 weeks over a 4-month period. Computed tomography demonstrated a reduction in hepatic tumor mass.

Adenoma, Islet Cell↗

Leucocyte zinc in non-Hodgkin's lymphoma and Hodgkin's disease.

Zinc status and the effect of zinc supplementation were assessed in groups of patients with non-Hodgkin's lymphoma and Hodgkin's disease; patients were either untreated or in remission. In the patients in remission, plasma zinc was normal; and whereas 30% of untreated patients had low plasma zinc, the group as a whole did not differ from normal. For mononuclear cell zinc, the range of values in the disease group was far wider than in controls, but there was no significant difference between the means of the groups. Granulocyte zinc was significantly lower in both the groups of patients in remission from non-Hodgkin's lymphoma and Hodgkin's disease compared with the control group. Significant increases were found in the plasma copper, ceruloplasmin, and the copper-to-zinc ratio in several of the patient groups. Plasma zinc increased by 23% with zinc supplementation (50 mg elemental Zn/day), but there was no effect on mononuclear cell or granulocyte zinc. Apart from granulocyte zinc, there is little evidence of zinc deficiency in non-Hodgkin's lymphoma or Hodgkin's disease. However, the presence of depleted granulocyte zinc levels could modify the immune function of this cell population.

Adult↗

Acne vulgaris and malignancy.

Seventy patients with lymphomas and leukaemias were interviewed. Details of past acne vulgaris were recorded and a clinical examination performed. A history of acne was less common in the patients than in matched controls. In addition, fewer patients had received treatment prescribed by a medical practitioner for their acne than had the controls. Examination revealed fewer patients with acne. These results suggest a reduced incidence of acne or its more severe forms in patients who have developed lymphomas and leukemias, and provide some support for the hypothesis that increased exposure or response to P. acnes, as appears to occur with acne, could confer protection against malignant disease.

Acne Vulgaris↗

Oesophageal lichen planus.

A 50-year-old woman with severe oral lichen planus complained of painful dysphagia. Fiberoptic endoscopy revealed erosive lichen planus of the oesophagus which responded to treatment with systemic corticosteroids.

Esophageal Diseases↗

A retrospective evaluation of mediastinal tomograms, isotope liver scans, and isotope bone scans in the staging and management of patients with lymphoma.

The influence of mediastinal tomograms and isotope scans of liver and bone on the initial staging and management of patients with lymphoma has been studied. There appears to be only a small role for these investigative procedures, and it is suggested that considerable savings in time and money can be made by a more judicious use of these techniques.

Adolescent↗

A pilot study of cyclical chemotherapy with high-dose methotrexate and CHOP (MTX-CHOP) in poor-prognosis non-Hodgkin's lymphoma (NHL).

In a pilot study of cyclical chemotherapy in patients with poor-prognosis non-Hodgkin's lymphoma (NHL), high-dose methotrexate (MTX) 1 g/m2 with folinic acid rescue was given as initial treatment and then between cycles of a single-arm CHOP combination administered every 4 weeks. Of 21 patients with previously untreated or minimally treated grade 2 (high-grade) histology stage II/III/IV NHL, 13 (62%) achieved complete remission (CR); the CR rate for stage III/IV patients was 56%. Of all 25 patients with grade 2 stage II/III/IV NHL, including previously treated patients, 16 (64%) achieved CR. The median follow-up of patients who completed treatment is currently 22 months and only 1 relapse has been recorded in the CR group. Only five of 24 grade 2 patients given the initial 'test' MTX failed to show any response, and eight patients achieved partial remission (PR) as a result of this single treatment. The response to MTX-CHOP in nine patients with grade 1 (low-grade) histology NHL was poor; only two achieved CR. These findings lend support to other data which indicate a useful role for MTX in the induction chemotherapy of advanced high-grade NHL, though the optimum dosage and drug sequence have yet to be determined.

Adolescent↗

Cimetidine: an advance in gastric ulcer treatment?

Sixty patients with endoscopically confirmed gastric ulceration took part in a single-blind trial of cimetidine 1 g daily compared with conventional treatment--namely, carbenoxolone in patients aged under 60 and Caved-(S) in those over 60. Twenty-nine patients received cimetidine: in 12 (41%) ulcer healing was complete after one month, in 26 (90%) healing was complete after two months, and all ulcers were healed after three months of treatment. In the under-60s, ulcers were healed in a greater proportion of patients given cimetidine than in those given carbenoxolone. The difference, however, was significant only at the 5% level, which owing to small numbers was of doubtful clinical validity. In the over-60s cimetidine and Caved-(S) were of similar efficacy. The 54 patients with healed ulcers are being followed up for two years; so far there have been 16 recurrences (30%). Further trials are needed, which should include maintenance treatment aimed at lowering the unacceptably high recurrence rate.

Adult↗

Plasma zinc after myocardial infarction.

Plasma levels of zinc and albumin have been measured for eight consecutive days in patients suffering chest pain due to myocardial infarction or myocardial ischaemia. A substantial diurnal variation has been found in both controls and patients. Plasma zinc falls after myocardial infarction reaching the lowest level on day 2, thereafter returning to normal by day 8. The lowest plasma zinc levels occur within 48 h of a myocardial infarction and in some patients herald the development of a serious cardiac arrhythmia. Plasma albumin falls progressively after myocardial infarction, being lowest on day 8. The fall in plasma zinc is not totally explained by the fall in plasma albumin.

Adult↗

Interpretation of serum creatine kinase in suspected myocardial infarction.

Serum creatine kinase (CK) was measured in blood donors, patients admitted to hospital with suspected myocardial infarction, and healthy hospital personnel to investigate the normal range, the daily variation in healthy people, and the effect of intramuscular injections of pentazocine or diamorphine.There was considerable daily variation in the healthy controls, apparently related to exercise. In defining both the normal range and the significance of day-to-day increases in the serum CK account should be taken of this factor. An upper limit of normal of 210 IU/1. Should apply to previously ambulant patients and of 165 IU/1. to patients previously at rest. An increase greater than 85% in successive daily values is uncommon in health.Intramuscular injections of both pentazocine and diamorphine caused a significant rise in the serum CK in six out of 25 patients. The highest rise observed was from 64 IU/1. to 395 IU/1. Caution is therefore urged in the diagnosis of myocardial infarction from the serum CK values when these intramuscular injections have been given.

Circadian Rhythm↗