Biomedical subjects

Amy E French

Publications and source records attributed to Amy E French.

6 recordsLinked to original sources

PubMed2006

Initial chemotherapy followed by surgical cytoreduction for the treatment of stage III/IV epithelial ovarian cancer.

OBJECTIVE: The purpose of this study was to evaluate differences in morbidity, progression-free interval, and survival in women with advanced epithelial ovarian cancer treated with initial chemotherapy versus initial surgery. STUDY DESIGN: All women with epithelial ovarian cancer who were treated surgically at our hospital between January 1, 1995, and January 1, 2003, were eligible; the cases of 200 patients met the criteria and underwent retrospective chart review. RESULTS: Ninety-eight patients (49%) had initial chemotherapy, and 102 patients (51%) had initial surgery. Patients who received initial chemotherapy were more likely to have stage IV disease (initial chemotherapy, 27%, vs initial surgery, 8%; P = .042) and grade 3 disease (initial chemotherapy, 73%, vs initial surgery, 61%; P = .025). Optimal cytoreduction was achieved more often in patients who received initial chemotherapy (initial chemotherapy, 86%, vs initial surgery, 54%; P < .001). Only optimal cytoreduction (P = .022), and not treatment choice (P = .089), had an impact on median survival. CONCLUSION: Initial chemotherapy is a reasonable alternative to initial surgery for the treatment of selected patients with advanced epithelial ovarian cancer.

Antineoplastic Agents↗

PubMed2005

Umbilical cord stricture: a cause of recurrent fetal death.

BACKGROUND: Umbilical cord stricture is a recognized cause of fetal demise, but the exact etiology remains unknown. The risk of recurrence has generally been thought to be low. CASE: Three of 4 fetuses of a single patient died between 28 and 30 weeks of gestation; all were found to have stricture of the umbilical cord at the fetal insertion. Her one surviving infant was delivered emergently at 25 weeks. All infants were growth restricted but had no anatomic abnormalities. CONCLUSION: Umbilical cord stricture was diagnosed as the cause of all 3 fetal deaths. Patients with a demise attributed to umbilical cord stricture should be counseled that the risk of recurrent cord stricture is undetermined.

Adult↗

PubMed2003

Folic acid food fortification is associated with a decline in neuroblastoma.

BACKGROUND: Neuroblastoma, an embryonic tumor, is the second most common pediatric tumor and is the most prevalent extracranial solid tumor in children. Results of previous studies have suggested that maternal vitamin intake may decrease the risk of several childhood cancers. In January 1997, Canada began fortifying flour with folic acid for the prevention of neural tube defects. The effect of folic acid fortification on the rate of neuroblastoma in offspring is not known. METHODS: We investigated the rates of neuroblastoma (<1 year), acute lymphoblastic leukemia, and hepatoblastoma registered by the Pediatric Oncology Group of Ontario, which captures 95% of all pediatric cancers in Ontario, before and after the introduction of folate fortification. RESULTS: An interventional time series analysis showed that the incidence of neuroblastoma declined from 1.57 cases per 10,000 births before to 0.62 case per 10,000 births after folic acid fortification (P <.0001). The crude incidence rate ratio (0.40; 95% confidence interval, 0.25-0.64) remained significant after adjustment for both age and disease stage at diagnosis (adjusted incidence rate ratio, 0.38; 95% confidence interval, 0.23-0.62). In contrast, there was no significant change in the rate of infant acute lymphoblastic leukemia (incidence rate ratio, 0.97; 95% confidence interval, 0.41-2.27) or hepatoblastoma (incidence rate ratio, 0.81; 95% confidence interval, 0.35-1.89). CONCLUSIONS: Folic acid fortification was associated with a 60% reduction in neuroblastoma but was not associated with any change in the rate of infant acute lymphoblastic leukemia or hepatoblastoma. Further investigation is needed into the role of metabolism in the formation and prevention of neuroblastoma and other embryonically determined cancers.

Canada↗

PubMed2003

Milk transfer and neonatal safety of tacrolimus.

OBJECTIVE: To report the first case of tacrolimus measurement in human milk following maternal dosing in a woman who breast-fed while taking the medication. CASE REPORT: A 32-year-old white woman who had taken tacrolimus 0.1 mg/kg/d throughout pregnancy contacted the Motherisk Program at 35 weeks' gestation inquiring about the safety of breast-feeding during maternal tacrolimus therapy. After benefit-risk assessment, the mother decided to breast-feed the baby. METHODS: Manually expressed milk samples were collected over 12 hours following the first tacrolimus dose of the day; pre-dosing and 1-hour post-dosing blood concentrations were also determined. The samples were analyzed for tacrolimus by tandem-mass spectrometry. Breast milk and blood samples were collected at steady-state. RESULTS: The highest and mean concentrations of tacrolimus in milk were 0.57 and 0.429 ng/mL, respectively. From these measurements, the exclusively breast-fed infant would ingest, on average, 0.06 micro g/kg/d, which corresponds to 0.06% of the mother's weight-adjusted dose. Given the low oral bioavailability of tacrolimus, the maximum amount the baby would receive is 0.02% of the mother's weight-adjusted dose. The milk-to-blood ratios of tacrolimus at pre-dosing and 1-hour post-dosing concentrations were calculated to be 0.08 and 0.09, respectively. At 2.5 months of age, the infant was developing well both physically and neurologically. COMMENT: This report is the first to measure tacrolimus concentrations in established human milk using tandem-mass spectrometry to detect drug while the infant was exclusively breast-fed by the mother, and in which the infant's growth and development were reported. CONCLUSIONS: Our results suggest that maternal therapy with tacrolimus for liver transplant may be compatible with breast-feeding.

Adult↗

PubMed2003

Effect of methotrexate on male fertility.

QUESTION: Several men with psoriatic arthritis have asked whether the methotrexate they take for rheumatoid arthritis will affect their fertility or the outcome of any of their partners' future pregnancies. What is known regarding risks to fertility and to fetuses? ANSWER: To date, there are no reports of adverse pregnancy outcomes among men exposed to methotrexate before conception. Opinions in the literature differ on the effects of methotrexate on male fertility. Several case reports and studies report no effect; others report reversible sterility. One limitation to several of these studies is the concurrent administration of other chemotherapeutic agents. Small studies reporting on methotrexate use with no other agents suggest no increased infertility. Motherisk is currently following men who are taking methotrexate alone for psoriatic arthritis to see whether it affects fertility.

Arthritis, Psoriatic↗

PubMed2003

Taking bisphosphonates during pregnancy.

QUESTION: Several of my female patients take bisphosphonates for low bone mineral density (BMD). Two of them are of reproductive age. Are these drugs safe during pregnancy? ANSWER: Very little is currently known about the effects of bisphosphonates on human pregnancy. There have been only two reports of bisphosphonate use during late pregnancy. Animal studies suggest that biphosphonates cross the placenta and that the effect is an extension of the expected pharmacologic effect of bisphosphonates on both fetus and mother. Risks and benefits should be carefully weighed.

Animals↗