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Biomedical subjects

F A Shepherd

Publications and source records attributed to F A Shepherd.

143 records · Page 8Linked to original sources
PubMed1984

VP-16 alone and in combination with cisplatin in previously treated patients with small cell lung cancer.

Fifty-four patients with small cell cancer of the lung (SCCL) who failed to respond to induction chemotherapy or relapsed within 3 months of its completion were treated either with VP-16 alone or VP-16 and cisplatin. Fifty-two patients were initially treated with cyclophosphamide, doxorubicin (Adriamycin) and vincristine (CAV), and two were treated with cyclophosphamide, methotrexate, and vincristine. Nine patients also received other drug combinations either as maintenance therapy or as treatment for relapse. Fourteen of 18 patients treated with VP-16 alone were evaluable for response, and there was only one partial remission. On the other hand, 15 of the 34 evaluable patients (44%) treated with VP-16 and cisplatin had a partial response, and an additional 11 patients (32%) showed substantial tumor regression and were classified as improved. Two patients had stable disease, and six (18%) progressed. Five of the nine (55.6%) limited-disease patients achieved a partial response compared with 10 of 25 (40%) with extensive disease. The median survival time from the date of first treatment with the combination was 17 weeks (29 weeks for patients achieving a partial response; 19 weeks for those showing improvement; 11 weeks for those with stable disease; and 13 weeks for patients with disease progression). Gastrointestinal toxicity was mild relative to that of CAV-induction therapy but myelosuppression, particularly thrombocytopenia, was common. Mild nephrotoxicity occurred in four patients, but no other important toxicities were identified.

Adult↗
PubMed1984

Acute lymphoblastic leukemia. Possible origin from a mediastinal germ cell tumor.

The case of acute lymphoblastic leukemia developing shortly after the diagnosis and treatment of a mediastinal germ cell tumor, is reported. The close temporal relationship of these two rare diseases and the presence of a population of mononuclear cells with features of lymphoblasts in the resected germ cell tumor, suggest that the leukemic process originated from the mediastinal tumor.

Adolescent↗
PubMed1984

Anti-IgA-mediated transfusion reactions in Canada.

During a 6-year period (1977 to 1982) blood samples from 152 Canadian patients were referred to the national reference laboratory of the Canadian Red Cross Society because the referring hospitals had not been able to determine the cause of the patients' severe nonhemolytic transfusion reactions. Twenty-one patients were found to be IgA deficient, and 12 of them had strong class-specific anti-IgA antibodies, which were presumed to have been responsible for the reactions. The spectrum of symptoms that accompanied these violent reactions was documented for 10 of the patients. As a probable minimum, the incidence of anti-IgA-mediated reactions averaged 1.3 per million units of blood or blood products transfused during this period.

Antibodies, Anti-Idiotypic↗
PubMed1984

Phase II evaluation of Lonidamine in patients with advanced malignancy.

Lonidamine, a substituted indazole carboxylic acid with unique effects on cellular respiration, was studied in 27 patients with advanced malignancies. Of the 18 evaluable patients, 5 had small-cell lung cancer, 3 had non-small-cell lung cancer, 3 sarcoma, 2 breast cancer, and 5 other tumour types. All but 1 had had extensive prior treatment. A partial response was seen in 1 patient with metastatic synovial sarcoma, and tumour growth inhibition was demonstrated in 2 other cases. The major toxicity encountered was myalgia (66.6%) which was incompletely ameliorated by prednisone and required dose reduction in 2 patients and cessation of drug in 3. Other toxicities included auditory changes, anorexia, nausea and vomiting, diarrhoea, skin sensitivity, and conjunctivitis. No added toxicity was seen, when Lonidamine was combined with other chemotherapeutic agents. No correlation between Lonidamine dose and serum lactate levels was seen, although 4 patients showed a progressive increase in lactate levels over time, thought to be related to their increasing tumour burden. 5 patients demonstrated a dramatic fall in serum testosterone levels 4-8 weeks after starting Lonidamine which was accompanied by an increase in luteinizing hormone levels in 3 patients. In summary, modest antitumour activity was demonstrated in 3 patients; moderate toxicity was seen in most patients, but was usually tolerable. Further studies of Lonidamine are warranted in less heavily treated patients, alone or in combination with other chemotherapeutic agents.

Adult↗
PubMed1984

Combined modality induction therapy without maintenance chemotherapy for small cell carcinoma of the lung.

One hundred fifty-three patients with limited and 167 with extensive small cell carcinoma of the lung (SCCL) were evaluable for response to treatment with six courses of chemotherapy (cyclophosphamide, doxorubicin, and vincristine), irradiation to intrathoracic disease, and prophylactic cranial irradiation (PCI). No maintenance chemotherapy was given. Fifty-two percent of patients with limited disease (LD) and 10% of extensive disease patients (ED) achieved a complete response. The median survival times for LD and ED patients were 49 and 34 weeks, respectively. These results were compared to a previous experience with 147 patients who were treated with three courses of similar induction chemotherapy and thoracic irradiation, as well as one year of maintenance chemotherapy (CCNU, procarbazine, and methotrexate) but without PCI. Although the use of PCI was found to reduce the frequency of brain metastases as the site of first relapse, detailed comparisons of response rates and survival showed no significant differences between the two study populations. Prolonged maintenance chemotherapy of the type used in the first study does not favorably influence outcome after intensive induction therapy for SCCL.

Adult↗
PubMed1984

Changes in body composition in patients with small-cell lung cancer. The effect of total parenteral nutrition as an adjunct to chemotherapy.

y composition was studied in 31 patients receiving chemotherapy for small-cell lung cancer. Patients were randomly assigned to receive either 4 weeks of total parenteral nutrition (study group) or to continue a self-regulated oral diet (control group). The relationship between height and total body nitrogen was altered initially for patients who had lost more than 5% of body weight. During the 4 weeks of parenteral nutrition, body weight, total body fat, and total body potassium, but not total body nitrogen, increased significantly in the study group (p less than 0.001). However, after parenteral nutrition was stopped, body weight and potassium levels in the study group fell significantly and to the same extent as in the control group. Nitrogen levels showed an overall fall in the 32 weeks of observation for both groups. After the period of parenteral nutrition, the decrease in body fat was significantly greater in the control group than in the study group (p less than 0.05). Thus, parenteral nutrition increased body fat and total body potassium, but not total body nitrogen.

Adipose Tissue↗
PubMed1984

Effects of total parenteral nutrition and chemotherapy on the metabolic derangements in small cell lung cancer.

Changes in energy metabolism, substrate use, and hormone profiles were prospectively studied in 31 patients with small cell lung cancer receiving chemotherapy. Patients were randomized to receive either 4 weeks of total parenteral nutrition (n = 15) or to continue self-regulated p.o. diet (control group; n = 16). The initial actual resting energy expenditure measured by indirect calorimetry was 31% higher than the predicted resting energy expenditure determined by the Harris-Benedict formula. The p.o. calorie intake was inappropriately low for these hypermetabolic patients. Total parenteral nutrition resulted in a significant positive net energy balance, but in follow-up was associated with prolonged anorexia and a negative energy balance. Complete response to therapy reduced resting energy expenditure and increased calorie intake, whereas the contrary was true in nonresponders. Elevated plasma-free fatty acids (800 +/- 62 microM; S.E.) and a low respiratory quotient (0.74 +/- 0.02) indicate that the dominant energy source in patients with small cell lung cancer is fat, and that increased fat oxidation continues despite tumor response. Elevated fasting plasma catecholamines and insulin resistance may contribute to continued fat mobilization. Initially, there was a significant increase in blood lactate (1118 +/- 95 microM) suggesting either increased tumor or tumor-mediated glycolytic activity. Response to therapy was associated with a fall in blood lactate levels. The most effective way of improving the metabolic derangements in patients with small cell lung cancer was to achieve tumor response to therapy.

Adult↗
PubMed1984

Myasthenic syndrome and small cell cancer of the lung. Variable response to antineoplastic therapy.

Myasthenic syndrome secondary to small cell lung cancer has been studied in five patients who achieved complete remission with chemotherapy. The relationship between response or relapse of the neoplasm to therapy and the activity of the myasthenic syndrome is variable. This inconsistent clinical correlation between the cancer and its paraneoplastic syndrome is examined in view of current data on the immunologic basis of myasthenic syndrome.

Aged↗
PubMed1983

Intramedullary spinal cord metastases from small cell carcinoma of the lung.

Four patients with intramedullary spinal cord metastases from small cell carcinoma of the lung (SCCL) are described, with emphasis on clinical presentation and treatment. All patients developed the Brown-Séquard syndrome due to intramedullary tumor in the cervical spinal cord, three within 2 mo after combined modality treatment using chemotherapy and radiotherapy. One patient presented with a Brown-Séquard syndrome and an extradural spinal cord compression from tumor. The radiological and cerebrospinal fluid findings are presented and discussed. Radiation treatment was administered to the involved segments of spinal cord in each patient. All patients responded; two for 3 and 7 mo, two for 3 and 4 wk, respectively. There was significant improvement in the quality of life for three of the four patients.

Carcinoma, Small Cell↗
PubMed1983

Reduction in local recurrence and improved survival in surgically treated patients with small cell lung cancer.

To assess the role of operation in the treatment and prevention of local recurrence in limited small cell lung cancer, we analyzed retrospectively 35 patients undergoing surgical resection for small cell lung cancer between 1976 and 1982. Twenty-eight patients underwent resection for presumed non-small cell histology. Seven later patients had planned combined modality therapy consisting of chemotherapy and prophylactic cranial irradiation followed by surgical resection and irradiation to the primary site. Twenty-four patients received adjuvant postoperative chemotherapy and/or radiotherapy. All patients have been treated and followed up for a minimum of 1 year. There were 19 patients in Stage I and 16 in Stages II and III. In 15 patients, relapse has occurred. The commonest site of first relapse was brain (7/15). Five of these patients had received prophylactic cranial irradiation. In only two patients was there a relapse locally in the hemithorax and/or mediastinum--one with NO disease and one with N1 disease. No local recurrence was noted in six patients with N2 disease. Only two relapses have occurred beyond 1 year--both in brain. In those patients surviving more than 2 years, no relapses have occurred. The median survival time for patients with Stage I disease is 158 weeks and for those with Stages II and III, 92.4 weeks. The median survival time for the whole group is 92.4 weeks with a projected 5 year survival rate of 24%. It appears that surgical resection may help to prevent local recurrence in small cell lung cancer, even in N1 and N2 disease. In our series, projected 5 year survival rates are similar to those seen in the surgical treatment of patients with non-small cell lung cancer. The eventual role of operation in the prevention of local recurrence and improvement in overall survival of limited small cell lung cancer awaits prospective randomized trials.

Adult↗
PubMed1979

Clinical use of blood, blood components and blood products.

The goal of modern transfusion therapy is to provide appropriate replacement therapy with blood components as opposed to whole blood for patients with specific hematologic deficiencies. A prerequisite of component therapy is, therefore, correct identification of the deficiency. Appropriate use of components avoids many of the hazards associated with the use of whole blood, and at the same time makes maximal use of this valuable resource. Blood components separated from whole blood soon after collection and appropriately stored can, in combination, provide all the factors present in fresh whole blood. Red cell concentrates prepared from multiple packs have a hematocrit of approximately 70%. They may be stored for up to 3 weeks at 4 degrees C and are recommended for most situations requiring red cell transfusions. Platelet concentrates, which can be stored for up to 72 hours at 22 degrees C, may be used for thrombocytopenic patients. Fresh frozen plasma, stored plasma, cryoprecipitated factor VIII, factor VIII concentrate and factor IX complex concentrate are available for the proper treatment of patients with hemorrhagic disorders due to coagulation factor deficiencies. Similarly, albumin and immune serum globulin are available for their oncotic and antibody properties respectively. Thus, the availability and appropriate use of the various blood products allows not only optimal transfusion therapy for each patient, but also fuller utilization of national blood resources.

Albumins↗
PubMedDate not supplied

Lymphoproliferative disorders after liver transplantation: imaging features.

BACKGROUND: To define the imaging features of lymphoproliferative disorders that occur after liver transplantation. METHODS: A retrospective review of 605 liver transplantations between 1985 and 1998 showed 20 patients with posttransplantation lymphoproliferative disorders (PTLDs). All relevant clinical, imaging, and pathologic findings were reviewed. RESULTS: PTLDs occurred in 13 men and seven women (mean age = 43.3 years, age range = 18-68 years). The time to diagnosis of disease ranged from 1.5 to 51 months (mean = 14 months) posttransplantation. Cervical, thoracic, or abdominal lymphadenopathy was seen in 11 patients (55%). A complex portal mass in five patients (25%) was the second most common manifestation of PTLD, ranging in size from 5 to 12 cm. Other findings included gastrointestinal tract involvement in three patients (15%) seen as a duodenal mass and diffuse wall thickening in one patient and large bowel thickening in two patients with preexisting inflammatory bowel disease. CONCLUSION: There is a wide spectrum of findings in lymphoproliferative disorder after liver transplantation. The presence of lymphadenopathy, a portal mass, or bowel thickening indicates a need for further investigation to reach a pathologic diagnosis.

Adolescent↗
PubMedDate not supplied

Phase II trial of docetaxel with dexamethasone premedication in patients with advanced non-small cell lung cancer: the Canadian experience.

We performed a Phase II trial to evaluate the activity and tolerability of docetaxel as a single agent in the treatment of advanced non-small cell lung cancer (NSCLC). Forty-four patients with metastatic and/or locally advanced NSCLC received i.v. docetaxel 100 mg/m2 every 3 weeks for a median of 4 (range 1-11) cycles. All patients received premedication with oral dexamethasone 8 mg twice daily for 5 days starting the day before chemotherapy. Seven partial responses were observed among 35 evaluable patients, and the overall response rate was 20% (95% CI 8-37). The median response duration was 5 months, median survival time was 10 months and the estimated 1-year survival rate was 42%. Treatment was generally well tolerated. Febrile neutropenia occurred in 10 patients (23%); neutropenic infection occurred in 4 patients, and led to 2 toxic deaths (both patients had borderline exclusion criteria). The corticosteroid premedication effectively reduced the overall incidence (34%) and severity (4% severe) of fluid retention, and delayed the median time to onset from cycle 4 to cycle 7. This study shows the promising efficacy of docetaxel as monotherapy in advanced NSCLC, and combination chemotherapy regimens incorporating docetaxel are now being evaluated in this clinical setting.

Adult↗
PubMedDate not supplied

Sexual behaviour changes in a cohort of male sexual contacts of men with HIV disease: a three-year overview.

We describe the sexual behaviour reported by 240 seronegative and seropositive homosexual men over a 3-year period. Sexual partners of men with HIV disease were recruited into a prospective study between July 1984 and July 1985 and were monitored every 3 months thereafter. Data on sexual activities were collected through interviewer-administered questionnaires. The cohort experienced a reduction in both the number of sexual partners and the volume of sexual activity. Reductions in the number of partners were early and dramatic. Changes in sexual activities were gradual and consistent in trend. The greatest reduction occurred in high risk activities (receptive and insertive anal intercourse). After 3 years of follow-up, only 10% of the men continue to be exposed to semen through unprotected receptive anal intercourse and 18% through unprotected receptive oral-genital sex. The proportion of men engaging in oral-genital contact and masturbation remained stable over the 3 years. Once informed of their serostatus, both seropositive and seronegative men reduced their high risk behaviour. The decline in rates of STDs and seroconversion confirmed that this cohort had indeed reduced their high risk behaviour.

Cohort Studies↗