PubMed Health⌕ Search

Biomedical subjects

F Cummings

Publications and source records attributed to F Cummings.

18 recordsLinked to original sources
PubMed1997

Integrated disease control initiatives: polio eradication and neonatal tetanus elimination in Egypt.

Accelerated disease control initiatives, such as polio eradication by the year 2000, may substantially benefit public health programs in general. In Egypt, the control of other vaccine-preventable diseases, most noticeably neonatal tetanus (NT), has been facilitated by the polio eradication initiative. Linking NT reporting with the acute flaccid paralysis (AFP) surveillance system, which had been established for polio eradication, markedly improved the capacity to identify NT high-risk areas and target supplementary immunization activities appropriately. While the close integration of surveillance activities was to the benefit of both programs, mass immunization activities were not conducted simultaneously because of differences in the objectives, target populations, and operational aspects of oral polio vaccine and tetanus toxoid campaigns. In addition to substantial progress toward polio eradication in Egypt since 1988, there has been an 80% reduction in annual NT cases, in part due to the integration of appropriate aspects of these two disease control initiatives.

Adolescent↗
PubMed1997

Weekly high-dose paclitaxel in metastatic and locally advanced breast cancer: a preliminary report.

The optimal dose and schedule for paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) in the treatment of patients with advanced breast cancer are not known. Based on our phase I study in non-small cell lung cancer, in which the dose intensity of paclitaxel was successfully escalated by using a weekly schedule, we initiated a phase II study of weekly paclitaxel in previously untreated patients with metastatic breast cancer (MBC) and locally advanced breast cancer (LABC). Treatment consists of weekly paclitaxel 175 mg/m2 intravenously over 3 hours for 6 weeks, followed by a 2-week break. Doses are modified for neutropenia (absolute neutrophil count < 1,500/microL), bilirubin levels greater than 1.5 times normal, or greater than grade 1 neuropathy. Patients with MBC continue treatment until disease progression. Patients with LABC receive one to two cycles before proceeding to surgery if resectable. Thus far, 15 patients, eight with MBC and seven with LABC, are assessable for response and/or toxicity. Most patients have required dose modification, with median delivery of 75% (cycle 1) and 50% (cycle 2) of the planned dose of paclitaxel. Neutropenia has been the most common cause of dose reductions, although only one patient required treatment for neutropenic fever. Six patients have developed grade 2/3 peripheral sensory neuropathy, but with dose reductions many have continued treatment with stable or improving neurologic symptoms. Objective responses have been seen in 12 of 14 assessable patients, including six with MBC (one complete response, five partial responses) and six with LABC (two complete responses, four partial responses), for an overall response rate of 86% (95% confidence interval, 66% to 96%). All responding LABC patients have been rendered free from disease at surgery. These preliminary results are very encouraging. Accrual to the study continues.

Adult↗
PubMed1996

Phase II study of 5-fluoruracil leucovorin and azidothymidine in patients with metastatic colorectal cancer.

The primary objective of this study was to determine the response rate of patients with metastatic colorectal cancer to combined therapy with 5-fluorouracil (5-FU), leucovorin, and intravenous azidothymidine (AZT), a thymidine nucleoside analog. By itself, AZT has limited antineoplastic efficacy. However, experimental studies indicate that 5-FU enhances the antitumor activity of AZT by inhibiting synthesis of normal thymidine nucleotides with which AZT competes for incorporation into nucleic acids. A phase I study defined the maximum tolerated dose of AZT as 7 g/m2 with hypotension during the infusion being the dose-limiting toxicity. A phase II study was performed with oral leucovorin (100 mg p.o. hourly for 4 h prior to 5-FU and 4 h and 8 h after 5-FU), bolus 5-FU (400 mg/m2) followed 1 h later by a 2-h infusion of AZT (7 g/m2). Treatment was given weekly for 4 weeks followed by a 1-week break, which constituted a cycle of therapy. Responses were evaluated after every two cycles. Patients continued on therapy as long as they tolerated treatment and did not have progressive disease. Of 15 evaluable patients who had received no chemotherapy there was 1 complete response and 4 partial responses (a 33% response rate), whereas only 1 of 6 patients who had received prior adjuvant chemotherapy had a partial response (17%). An additional 10 patients had stable disease lasting 2-14 months. Therapy was well tolerated with the only one instance each of grade 3 nausea and vomiting, diarrhea, anemia, and hypotension. Approximately 50% of treatments were accompanied by mild hypotension, which was easily corrected by increasing the rate of normal saline infusion. There was no difficulty administering this regimen in the outpatient setting. While the overall response rate (29%) is comparable to that seen with combinations of 5-FU and leucovorin alone, in most reported series a considerably higher dose of 5-FU was utilized than in this study. Since patients in the present study experienced relatively little 5-FU toxicity, increasing the dose of 5-FU in this regimen would appear to be feasible and might result in a higher response rate.

Adenocarcinoma↗
PubMed1995

Abnormal insulin treatment behaviour: a major cause of ketoacidosis in the young adult.

Diabetic ketoacidosis occurs more frequently in the young adult population than in any other age group. In a 3-year retrospective casenote review of all patients admitted with ketoacidosis to this hospital, we have defined the clinical characteristics of ketoacidosis in this age group. Young adults (< 25 years) had worse preceding glycaemic control (median HbA1 14.6 vs 10.1%, p = 0.0001) and more frequent episodes of ketoacidosis in the previous 5 years (3 vs 0, p = 0.0001) than older adults (> 25 years); on admission they had lower blood urea concentrations (p = 0.0001) and had a lower incidence of systolic hypotension (6% vs 32%, p = 0.007). There were fewer complications of ketoacidosis in the young adults, and the duration of hospital stay was less than that in the older age group (4 vs 8 days, p = 0.0003). Young adults were less likely to have a proven underlying infective or other organic precipitant for ketoacidosis, but were investigated and treated in a similar way to older adults. Insulin error or manipulation was identified in 42% of young adults; abnormal insulin treatment behaviour is likely to be the major cause of ketoacidosis in this age group.

Adolescent↗
PubMed1993

Combined modality therapy for stage IIIA non-small cell carcinoma of the lung.

53 patients with stage IIIA non-small cell carcinoma of the lung (NSCCL) were treated with multimodality therapy consisting of induction radiotherapy (55.8 Gy) and two cycles of concurrent chemotherapy with cisplatin, 25 mg/m2 for 4 days by continuous infusion and bolus etoposide, 100 mg/m2 on days 2 and 4 of each cycle followed by surgery and adjuvant chemotherapy. Of 53 evaluable patients, 47 achieved clinical responses (9 complete response, 38 partial response) after induction therapy for a response rate of 89%. 47 patients were resectable after induction therapy, but 8 patients refused surgery and 6 patients were not eligible for surgery based on poor pulmonary function (medical contraindications). 33 patients underwent thoracotomy and in 6 patients, resection was technically unfeasible. Thus complete surgical resection was accomplished in 27 patients. After all therapy, 28 patients achieved a complete response (53%) and 19 patients a partial response (36%). Toxicities were mild. At a maximum of 75 months (median, 28 months) of follow-up, the median survival of the entire group is 24 months. The median survival of resected patients has not been reached; their 6-year survival rate is 55%. Unresected patients survived for a median of 11 months. This multimodality regimen is well-tolerated, induces a high response and resectability rate and prolongs survival in resected patients.

Adult↗
PubMed1989

A phase I/II trial of 5-fluorouracil and etoposide in metastatic colorectal carcinoma.

Twenty-two patients with metastatic colorectal carcinoma were treated in a Phase I-II study of combination therapy with 5-fluorouracil (5-FU) and etoposide (VP-16). Treatment consisted of weekly intravenous VP-16, 100-120 mg/M2, followed by 5-FU, 400-480 mg/M2, in 28-day cycles. Myelosuppression was the dose-limiting toxicity with a mean nadir leukocyte count of 3,600/mm3 and a mean nadir thrombocyte count of 101,000/mm3. There were no episodes of sepsis or bleeding. The tolerable dose for this regimen is VP-16, 110 mg/M2, and 5-FU, 440 mg/M2, weekly. A total of 63 cycles of chemotherapy were given. Although 10 patients had stabilization of disease, no partial or complete responses were documented. We conclude that there is no clinical support for the in vitro synergy observed with this combination. Further trials of this combination using this schedule in colorectal carcinoma are not indicated.

Adenocarcinoma↗
PubMed1985

Adjuvant CMFP versus CMFP plus tamoxifen versus observation alone in postmenopausal, node-positive breast cancer patients: three-year results of an Eastern Cooperative Oncology Group study.

After mastectomy, 265 postmenopausal patients with node-positive breast cancer were stratified according to pathologic nodal status and estrogen-receptor (ER) status and randomized to receive either 12 cycles of cyclophosphamide, methotrexate, 5-fluorouracil, and prednisone (CMFP), or CMFP plus tamoxifen (CMFPT), or observation alone. Patients entered the study between March 1978 and July 1981. Cox regression analysis indicated that, compared to observation alone, chemotherapy (CMFP and CMFPT groups combined) led to a significant reduction in relapses by the end of the first year of study in every examined prognostic subgroup. However, after the first year the relapse-free survival curves of all treatment groups tended to merge, so that by three years 52% of the observation group and 51% of the chemotherapy groups remained disease free. Chemotherapy continued to show a significantly superior relapse-free survival rate for three years only in the subgroup of patients with ER-negative tumors (the subgroup with the largest relapse-free survival advantage at one year). The addition of tamoxifen produced no benefit or harm in any prognostic subcategory examined. ER status was prognostically important for predicting early relapse only in those patients not receiving chemotherapy, due to the greater effectiveness of this chemotherapy to prevent early relapse in the ER-negative subgroup. Treatment has had no early effect on survival. As breast cancer continues to recur even after ten or more years, later relapse patterns may alter these results.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1979

The role of communication aids in the rehabilitation of hearing impairment.

The primary emphasis in rehabilitating the hearing impaired has involved fitting a hearing aid. There are patients however, who can be helped by communication aids in addition to, or in place of hearing aids. Communication aids include any device, other than a conventional hearing aid, which assists the hearing impaired in maintaining contact wiht the normally hearing. In Scandinavian countries a sophisticated system for rehabilitating the hearing impaired has evolved and communication aids are recommended extensively. Similar aids exist in North America, but clinicians have not yet developed a full awareness of how these devices can benefit their patients. This paper represents the results of a two year survey undertaken to identify and evaluate various devices available in Toronto. The contribution these aids can offer in rehabilitating patients is discussed.

Amplifiers, Electronic↗
PubMed1977

The clinical utility of ipsilateral stapedius reflex tests.

Ipsilateral stapedius reflex testing has been evaluated in 166 patients. It proves of value in defining the state of an ear (1) opposite to a unilateral conductive loss; (2) the less hard-of-hearing ear in the presence of bilateral asymmetrical sensorineural hearing losses where the worse ear has sufficiently severe loss to prevent a contralateral reflex from being elicited; (3) in patients with absent contralateral acoustic reflexes at 500, 1000, and 2000 Hz; and (4) in suspected central lesions. The test is still bedevilled by artifacts which are produced in the ear rather than the machine; atypical results must be evaluated with extreme caution.

Acoustic Impedance Tests↗
PubMed1975

Problems in the clinical use of the microcytotoxicity assay for measuring cell-mediated immunity to tumor cells.

Lymphocytes from control donors and from cancer patients have been tested for antitumor, cell-mediated immunity against various melanoma and breast cancer target cell cultures with a microcytotoxicity assay. Control lymphocytes inhibited growth of target cells with high frequency, particularly with cell line, as opposed to short-term, cultures. Inhibition was not found for all target cells tested at a given time with a single preparation of lymphocytes. Sequential studies over a 2-year period with lymphocytes from the same control donors showed fluctuations of inhibition against the same target cells. With serial passage, the target cells also changed in their susceptibility to destruction by control lymphocytes. Lymphocytes from melanoma patients were more inhibitory than control lymphocytes for one melanoma target cell culture but not for two other melanoma cultures. Significant inhibition by lymphocytes from melanoma patients was not seen against two cultures derived from breast cancer patients. Lymphocytes from breast cancer patients were more inhibitory than control lymphocytes for 4 of 5 breast cancer cultures and they did not inhibit two melanoma cultures. Significantly specific inhibition was seen with short-term, but not cell line, breast cultures. The over-all data show specificity for target cells of the appropriate histological type. However, the high and inconstant reactivity of control lymphocytes in this assay suggests that nonspecific inhibition of tumor target cells by patient lymphocytes is found in many experiments. It is concluded that the microcytotoxicity assay is not suitable for clinical studies, since sequential data obtained in individual patients are difficult to interpret.

Adult↗
PubMedDate not supplied

Puretone threshold estimation from acoustic reflex thresholds--a myth?

There have been repeated claims in the literature that hearing thresholds can be estimated by means of acoustic reflex threshold (ART) measurements. We have evaluated this thesis in depth by examining the statistical relationships between conventional puretone thresholds and ARTs for tonal and broadband stimuli in a large sample (1207) of adult patients with sensorineural hearing loss; they were compensation claimants for noise-induced loss. All relevant data were stored in a computer database, and analysed using the Statistical Package for the Social Sciences (SPSS). The relationships were examined from two distinct standpoints; dependency of ART's upon puretone thresholds, and prediction of audiogram features using ARTs. The average tonal ART is constant up to 70 dB average loss, and thereafter increases rapidly. The broadband noise ART increases steadily for average losses of 10 to 85 dB. The convergence principle is therefore valid up to 70 dB in this population. The predictor suggested by Niemeyer & Sesterhenn does not fit the data. The single ART which best predicts average loss is that for white noise, but a multiple regression prediction using the white noise and 500 Hz ARTs is preferable. Predictive accuracy is dependent upon audiogram slope, but the latter cannot be predicted usefully from the ART measures used. None of the predictors studied is adequate for medico-legal assessment and the method is probably not sufficiently accurate for clinical use in adults.

Adult↗