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Biomedical subjects

B McLaren

Publications and source records attributed to B McLaren.

13 recordsLinked to original sources
PubMed2001

Carboplatin AUC8 in combination with etoposide and bleomycin in the treatment of intermediate and poor-risk metastatic germ cell tumours: a phase II study.

PURPOSE: Carboplatin has demonstrated significantly poorer response rates in non-seminomatous germ cell tumours. A phase II study of higher than standard doses of carboplatin was conducted because of suspicion that the poorer response might have been due to suboptimal dosing. PATIENTS AND METHODS: A group of 19 patients with advanced germ cell tumours (International Germ Cell Cancer Collaborative Group intermediate and poor prognosis) were treated with carboplatin at an AUC of 8 mg/ml.min (using Calvert's formula) on day 1, etoposide 120 mg/m2 days 1-3 and bleomycin 60,000 U over 2 days (EBCa). Treatment was repeated every 3 weeks and a maximum of four courses was given. RESULTS: Of the 19 patients, 7 (37%) achieved complete remission, of whom 6 (32%) remained long-term progression-free. Post-chemotherapy surgery and further chemotherapy salvaged an additional 26%, leading to an overall disease-free survival rate of 58%. No relationship between outcome and degree of myelosuppression could be established. CONCLUSION: Dose-escalated carboplatin in combination, although feasible, did not improve the results and led to poorer results than those expected with cisplatin-based therapy. There is no evidence that the patients relapsing following this were easier to salvage. Further investigation of this regimen cannot be recommended.

Adolescent↗
PubMed2000

Response rates of Victorian general practitioners to a mailed survey on miscarriage: randomised trial of a prize and two forms of introduction to the research.

AIMS: To identify whether the form of introduction to a study and knowledge of a substantial prize influence the response rate of general practitioners (GPs) to a postal survey. METHODS: A postal survey of 700 randomly selected Victorian GPs concerning management of early pregnancy bleeding and miscarriage, incorporating two randomised-controlled trials of recruitment methods; analysis of response rates and costs at 4 weeks and 11 weeks. RESULTS: The response rate was 61.5% of eligible participants. Doctors made aware of a prize were more likely to respond in the first four weeks (difference in response rate 10.2%, 95% confidence interval (CI) 2.8%-17.6%). This difference diminished after the first four weeks. Doctors introduced to the survey by a telephone call were no more likely to respond than those introduced by a postcard. The use of a postcard saved 73% of the cost of introducing the survey by telephone. Female doctors were more likely than males to reply (difference 12.3%, 95% CI 4.7%-19.9%). Rural doctors were no more likely to reply than urban doctors. Very few doctors (16.2%) completed a Practice Assessment activity associated with the survey. CONCLUSIONS: A valuable prize will accelerate response to a survey by GPs, thereby reducing the costs of follow-up. The cost of telephoned introductions is not justified, when compared with a brief written introduction.

Abortion, Spontaneous↗
PubMed1997

Systemic lupus erythematosus-associated lymphoproliferative disorder: report of a case and discussion in light of the literature.

A case of autoimmune disease-associated lymphadenopathy (ADAL) with histological, immunophenotypic, Epstein-Barr virus (EBV) in situ hybridization, and genotypic analyses is presented. The patient had a well-documented history of systemic lupus erythematosus (SLE) and was found at autopsy to have massive lymphadenopathy, thymic enlargement, pulmonary nodules, and polyclonal serum dysproteinemia. Histological examination revealed a polymorphous lymphoid infiltrate containing many plasma cells, rare immunoblasts, and a pronounced arborizing vasculature. No foci of necrosis were found and there was no evidence of lymphocyte depletion. The plasma cells were immunophenotypically polyclonal and no EBV mRNA (EBER-1) or gene rearrangements were identified. The unusual gross features, which resembled a malignant lymphoproliferative process, as well as the unusual histological features make this case a notable addition to the spectrum of atypical lymphoproliferative disorders associated with an autoimmune disorder. We conclude that although reminiscent of angioimmunoblastic lymphadenopathy with dysproteinemia (AILD), this case lacks the diagnostic features of AILD, and is, perhaps, best classified as an autoimmune disease-associated lymphadenopathy (ADAL).

Adult↗
PubMed1996

Renal failure in Arnhem Land: missed opportunities for prevention and treatment.

This is a brief clinical description of a group of people from an Arnhem Land community with a population of about 1500. The community has five people on full-time dialysis in Darwin, about 400 km away, and another four people who are being actively prepared for dialysis. Of these nine people, three come from within two generations of one clan: that is, from a group of about 40. This apparent family tendency is one of many factors producing kidney disease in Northern Territory Aboriginal people, who suffer extreme rates of end-stage renal failure (ESRF). Our understanding of these causes is quite embryonic. Despite several years of lobbying by Aboriginal health organisations the Northern Territory government has no coherent plans for ongoing prevention and management of kidney problems, and no services outside the main urban centres. The issues involved are discussed from the perspective of our bush clinic, kilometres away from renal biopsies and formal clinical research.

Adult↗
PubMed1995

Reflections on 18 months in a remote aboriginal practice.

This article aims to address some issues glossed over by the literature on Aboriginal health. An attempt is made to balance the joys and pitfalls of practising in such a setting. I hope doctors considering working in the bush will find it encouraging and informative.

Adolescent↗
PubMedDate not supplied

Medical care patterns at the onset of insulin-dependent diabetes mellitus: association with severity and subsequent complications.

The hospitalization of a child at the onset of insulin-dependent diabetes mellitus (IDDM) has become routine in many parts of the world, although controversy exists about its necessity. We examined the patterns of medical care use and the prognosis for acute complications after diagnosis for children with newly diagnosed IDDM in Colorado from 1978 to 1982. We reasoned that if children cared for entirely in outpatient settings at diagnosis had no more frequent acute complications after diagnosis than hospitalized children, we would be encouraged to further explore other potential benefits of outpatient care at onset. Twelve percent of 305 children studied statewide received only outpatient care during the first 2 wk after diagnosis, and, prognostically, their subsequent hospitalization and ketoacidosis rates were 2-3.7 times lower than those of children who received any inpatient care. No differences were noted for severe insulin reaction rates. Children classified as "severe" at onset, or with parents of lower education and income, or aged 10-14 yr at onset, regardless of care setting, had 2-4 times higher subsequent acute complication rates after onset than children without these characteristics. These findings, together with data on nights hospitalized and average length of stay in hospital at onset, suggest that a 42% reduction in total nights hospitalized could occur if children with "mild" or "normal" severity at onset were treated largely in the outpatient setting.

Acidosis↗