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Biomedical subjects

J D Nash

Publications and source records attributed to J D Nash.

5 recordsLinked to original sources
PubMed1991

Gynecologic malignancies.

The combination of cisplatin and cyclophosphamide remains the preferred regimen for the primary treatment of advanced stage epithelial ovarian cancer. Maximal dose intensity, particularly that of cisplatin, is generally accepted as critical for optimal results, but the concept has not yet been rigorously validated by prospective, randomized trials. Since higher doses of cisplatin are associated with renal and neurologic toxicity, the accumulating evidence of equivalent response rates with the less toxic platinum analogue, carboplatin, is encouraging. Salvage chemotherapy remains unsatisfactory, although the remarkable responses observed this year in heavily pre-treated and platinum-resistant patients with the novel new agent taxol is promising. Further trials with this unique drug in combination with other agents in previously untreated patients, as well as in salvage settings, is eagerly anticipated. Although experience with intraperitoneal therapy is rapidly accumulating, the precise role for this route of delivery has yet to be demonstrated in prospective trials. The management of early stage ovarian cancer has become increasingly clarified. Several trials have now demonstrated that a subgroup of patients at low risk for recurrence do well with surgery alone, while a high-risk subgroup clearly benefits from adjuvant therapy. The identification of optimal regimens awaits further trials. In cervical carcinoma, trials utilizing a variety of radiation-sensitizing agents have failed to demonstrate superiority over that of hydroxyurea, which has been shown to improve survival in advanced disease. Preliminary experience with neo-adjuvant regimens administered prior to surgery or radiation therapy is promising, but survival advantages utilizing this approach have yet to be demonstrated. In endometrial cancer, cisplatin was shown to achieve response rates similar to those attainable with single agent doxorubicin, and in uterine mixed mesodermal tumors, ifosfamide was found to have significant activity.

Antineoplastic Agents↗
PubMed1991

The postmenopausal palpable ovary syndrome. A retrospective review with histopathologic correlates.

Since its introduction in 1971 and based on experience with three patients, the postmenopausal palpable ovary (PMPO) syndrome has been widely accepted as appropriate justification for exploratory celiotomy to rule out ovarian malignancy. However, reports on only two small series have been published that address the incidence of malignancy in these patients. From March 1982 to June 1986, 20 patients underwent surgical exploration at the Naval Hospital, Bethesda, to evaluate an asymptomatic PMPO. Thirteen patients (60%) were found to have an ovarian neoplastic process. Three of the neoplasms were malignant or of borderline malignant potential, resulting in an overall malignancy rate of 15% for the PMPO syndrome. In comparing the PMPO groups, patients in the malignancy group had a statistically significant lower mean parity and greater mean number of postmenopausal years (P = .02 and .03, respectively). When the PMPO group was compared to patients with adnexal masses larger than 5 cm, there were no significant differences in the malignancy rates (15% versus 25%, P = .26), but the power was low. The data suggest that the PMPO syndrome may be clinically important. Additional studies to compare ultrasound, CA-125 and pelvic examination are indicated.

Aged↗
PubMed1977

Community education for cardiovascular health.

To determine whether community health education can reduce the risk of cardiovascular disease, a field experiment was conducted in three northern California towns. In two of these communities there were extensive mass-media campaigns over a 2-year period, and in one of these, face-to-face counselling was also provided for a small subset of high-risk people. The third community served as a control. People from each community were interviewed and examined before the campaigns began and one and two years afterwards to assess knowledge and behaviour related to cardiovascular disease (e.g., diet and smoking) and also to measure physiological indicators of risk (e.g., blood-pressure, relative weight, and plasma-cholesterol). In the control community the risk of cardiovascular disease increased over the two years but in the treatment communities there was a substantial and sustained decrease in risk. In the community in which there was some face-to-face counselling the initial improvement was greater and health education was more successful in reducing cigarette smoking, but at the end of the second year the decrease in risk was similar in both treatment communities. These results strongly suggest that mass-media education campaigns directed at entire communities may be very effective in reducing the risk of cardiovascular disease.

Adult↗