Massive retroperitoneal liposarcoma.
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Aged↗
Biomedical subjects
D Galvin
Publications and source records attributed to D Galvin.
Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP): a randomized trial design of the effect of a community pharmacist intervention program on serum cholesterol risk.
OBJECTIVE: To determine the efficacy of a program of intervention by pharmacists on lipid risk management in patients at high risk for cardiovascular events. METHODS: Randomized, multicenter (44 sites in Alberta and Saskatchewan) study of community pharmacist intervention versus usual care in 1000 patients. Patients are those at high risk of vascular events (existing atherosclerotic vascular disease, or diabetes with > or = 1 other risk factor). After obtaining consent, the pharmacist calls the Project Office to randomize. Patients allocated to intervention receive a brochure and education about cardiovascular risk factors. Pharmacists also complete a physician contact form, which lists the patient's risk factors, medications, and any recommendations. A point-of-care cholesterol test is performed, the result is discussed with the patient, and it is entered on the contact form. If appropriate, the patient is asked to see his or her primary care physician for further assessment and/or treatment, and the form is faxed to the physician. Patients are followed up at two, four, eight, 12, and 16 weeks. During follow-up visits, pharmacists provide educational reinforcement and check for primary end point occurrence. Patients allocated to usual care receive the brochure only, with minimal follow-up. The primary end point is a composite of measurement of a complete lipid panel by the physician, or addition or modification of lipid-lowering drug therapy. Substudies will evaluate economics (third-party payer and pharmacy manager perspective), patient satisfaction, and quality of life. CONCLUSIONS: SCRIP (Study of Cardiovascular Risk Intervention by Pharmacists) is a unique ongoing trial that is evaluating a community pharmacist intervention designed to optimize cholesterol risk management in patients at high risk for cardiovascular events.
Aged↗
Efficacy of oral ondansetron, a selective antagonist of 5-HT3 receptors, in the treatment of nausea and vomiting associated with cyclophosphamide-based chemotherapies. Ondansetron Study Group.
We evaluated the efficacy and safety of oral ondansetron, a selective antagonist of 5-HT3 receptors, for the treatment of nausea and vomiting associated with cyclophosphamide-based chemotherapy (> 500 mg/m2). In this trial 324 chemotherapy-naive cancer patients, mostly females with breast cancer, were randomized to receive either placebo or ondansetron 1 mg, 4 mg, or 8 mg three times per day for 3 days. There were no differences in the doses of cyclophosphamide, doxorubicin, and methotrexate between the study groups. All ondansetron dose groups were superior to the placebo control group (p < .001) for all measured efficacy parameters (complete response, number of emetic episodes, therapeutic failures, need of rescue antiemetics). No emetic episodes were reported by 9 (12%), 29 (37%), 48 (64%), and 47 (66%) of the placebo patients and the 1-mg, 4-mg, and 8-mg dose of ondansetron patients, respectively. Nausea was reduced and food intake was improved for all the ondansetron groups. A more severe emetic response was observed in patients receiving cyclophosphamide and doxorubicin combination chemotherapy. In this subgroup of patients, 66%, 38%, 25%, and 16% of the placebo group and 1-mg, 4-mg, and 8-mg ondansetron patients, respectively, required rescue antiemetics. No significant toxic effects were observed in this study. A higher incidence of headaches and gastrointestinal complaints (constipation, abdominal pain) were observed in the three ondansetron groups. In conclusion, oral ondansetron is an effective and well-tolerated antiemetic treatment in the management of cancer patients receiving ambulatory cyclophosphamide-based chemotherapy. These results support the view that serotonin and 5-HT3 receptors play an important role in cyclophosphamide-induced nausea and vomiting.
Administration, Oral↗
Efficacy of oral ondansetron in the prevention of emesis in outpatients receiving cyclophosphamide-based chemotherapy. The Ondansetron Study Group.
OBJECTIVE: To evaluate the efficacy and safety of oral ondansetron (Zofran) as an antiemetic in patients receiving cyclophosphamide-based chemotherapy. DESIGN: A multicenter, randomized, double-blind, stratified, placebo-controlled trial conducted between March 1989 and January 1990. SETTING: Twenty-seven oncology centers including university hospitals, community cancer centers, and private medical oncology practices. PATIENTS: A total of 349 chemotherapy-naive patients having their first cycle of cyclophosphamide (> or = 450 mg/m2)-based chemotherapy. Patients also received methotrexate (> or = 30 mg/m2) or doxorubicin (> or = 35 mg/m2). All patients were evaluated for safety and 318 (91%) were evaluated for efficacy. INTERVENTIONS: Patients were randomly assigned to one of four treatment groups: placebo, 1 mg, 4 mg, or 8 mg of ondansetron. Assigned study medication was taken three times per day for 3 consecutive days. MEASUREMENTS: Time and number of emetic episodes as well as degree of nausea were recorded by patients for each of the 3 study days. RESULTS: Compared with placebo, all three doses of ondansetron were superior (P < 0.001) in preventing vomiting and controlling nausea. A complete response (no emetic episodes) was observed in 19%, 57%, 65%, and 66% of patients in the placebo, 1-mg, 4-mg, and 8-mg ondansetron groups, respectively. For patients who received higher-dose cyclophosphamide and doxorubicin, a dose-related trend in antiemetic efficacy of ondansetron was observed. Mild headache and constipation were the most frequently reported adverse events. No extrapyramidal reactions were observed. CONCLUSION: Oral ondansetron is a safe and effective antiemetic that is more efficacious than placebo for patients receiving cyclophosphamide-based chemotherapy.
Administration, Oral↗
The influence of prostaglandin E1 on systemic and pulmonary haemodynamics after aortic surgery.
The influence of a peroperative prostaglandin E1 (PGE1) infusion on systemic and pulmonary haemodynamics in a porcine model of aortic surgery was studied. Twenty-four pigs were randomised to PGE1 (100 ng/kg/min) or 0.9% Saline as placebo. Haemaccel was then infused to maintain a central venous pressure (CVP) of greater than 4 less than 6 mmHg and pulmonary artery wedge pressure (PAWP) of greater than 3 less than 5 mmHg. Standardised aortic surgery consisted of midline laparotomy, small bowel exteriorisation, 1.5 h aortic clamping and 1 h shock before resuscitation. Serial measurements of blood pressure (BP), cardiac output (CO), pulmonary vascular resistance (PVR), pulmonary shunt (A-V shunt), and arterial PO2 (PaO2) were recorded during and three days after surgery. Volume loading with Haemaccel prevented a significant fall in initial BP on PGE1 at 95.1 +/- 48 mmHg compared to 102 +/- 4.9 mmHg in control animals with similar CO in the two groups. Following release of the aortic clamp all animals became profoundly hypotensive with BP falling to 74.6 +/- 3.0 and 68.7 +/- 3.2 mmHg for PGE1 and placebo respectively, but CO was protected in those animals receiving PGE1 at 1.92 +/- 0.04 compared to 1.67 +/- 0.1 L/min/m2 on placebo and remained significantly higher following resuscitation and three days later (P less than 0.05). PGE1 also reduced the marked rise in pulmonary vascular resistance to 922 +/- 84 dynes-s/cm5/m2 during shock in control animals to only 555 +/- 30 (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Alprostadil↗
Fractured penis: a clinical misnomer!
BACKGROUND: A 'fracture' of the penis refers to a tear in the deep layer of the tunica albuginea (Buck's fascia) and may be associated with a urethral injury. AIM: To describe a classical case of a 'fractured' penis and discuss the management options. METHOD: A case report of a 30-year-old man presented with a 'fractured' penis and who underwent surgical intervention. CONCLUSION: This rare occurrence represents a urological emergency and necessitates imaging and repair of the cavernosal defect in order to prevent poor functional outcome.
Adult↗