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Biomedical subjects

J R Bateman

Publications and source records attributed to J R Bateman.

At least 55 records · Page 3Linked to original sources
PubMed1981

Significance of relapse after adjuvant treatment with combination chemotherapy or 5-fluorouracil alone in high-risk breast cancer. A Western Cancer Study Group Project.

Beginning in 1974, patients undergoing mastectomy at high risk for recurrence (greater than or equal to 4 nodes positive; median, 9.4 positive; range, 4 to 28) were randomized after stratification for menopausal status and radiotherapy to receive either 5-fluorouracil (5-FU, 500 mg/sq m i.v. every week) or cyclophosphamide, 400 mg/sq m; methotrexate, 30 mg/sq m; and 5-FU, 500 mg/sq m (CMF; all given i.v. every 2 weeks) in a 12-month program. All 62 patients remain evaluable with median follow-up now exceeding 70 months (range, 60 to 80 months). CMF significantly prevented early disease recurrence (97% relapse free on CMF versus 75% on 5-FU at 12 months; p less than 0.05) and demonstrated survival advantage during the initial 40-month follow-up. This significance was subsequently lost, and the percentages of relapse free and overall survival after 70 months are: (formula, see text) The apparently paradoxical relationship between relapse and survival on the 5-FU arm was related to survival after recurrence. Survival after recurrence was significantly longer on the 5-FU compared to the CMF arm (median of greater than 38 versus 10 months, respectively; p less than 0.01). These results suggest (a) long-term survival in adjuvant trials cannot be accurately predicted by short-term differences in relapse frequency, (b) survival after relapse may be influenced by the antecedent adjuvant therapy received, and (c) disease relapse does not necessarily preclude long-term survival.

Breast Neoplasms↗
PubMed1981

Pulmonary disorders associated with Sjögren's syndrome.

Pulmonary disease is recognized to occur as a complication of Sjögren's syndrome and we have studied 17 patients, the majority middle-aged women, with this association. Eight had sicca syndrome alone and nine had Sjören's syndrome in association with a connective tissue disease. Various pulmonary disorders were found: 10 had diseases mainly affecting pulmonary parenchyma (recurrent pneumonia, granulomatous infiltration, pseudolymphoma and fibrosing alveolitis) and six had disorders of the airways (bronchitis, bronchiectasis and asthma). One patient presented with a mediastinal immunoblastic lymphoma. To test the hypothesis that physical factors such as the retention of viscid mucus may play a part in the development of lung disease in Sjögren's syndrome, we have measured mucociliary clearance in patients with Sjögren's syndrome using 99Tc-labelled polystyrene particles. The mucociliary clearance rate was found to be normal from central airways and the whole lung clearance rate was significantly increased in Sjögren's syndrome compared with normal controls. The latter was attributed to the failure of penetrance of the radioaerosol into the periphery of the lung consistent with obstruction of small airways in Sjögren's syndrome. The patients with Sjögen's syndrome and lung disease were characterized by a number of immunological markers irrespective of the presence or type of associated connective tissue disorder. The commonest found were speckled antinuclear antibody by indirect immunofluorescence, antibodies to the acidic nuclear antigen B by counterimmunoelectrophoresis, increased serum DNA binding, increased levels of circulating immunoglubulins, rheumatoid factor in high titre and circulating soluble immune complexes as detected by Clq binding assay.

Adult↗
PubMed1980

Treatment of advanced colon cancer with 5-fluorouracil (NSC19893) versus cyclophosphamide (NSC26271) plus 5-fluorouracil: prognostic aspects of the differential white blood cell count.

One hundred twenty-one patients with advanced measurable adenocarcinoma of the colon were randomized for treatment with intravenous 5-fluorouracil (IV 5-FU) alone, 15 mg/kg/week vs. cytoxan, 15 mg/kg/week IV, on day 1 and 5-FU, 15 mg/kg/week IV during weeks 2--5, repeated in a six-week cycle. Age, sex, performance status, and disease free intervals, were comparable in both arms. Response frequency was 11% for treatment with 5-FU alone and 10% for treatment with combination therapy. The median survival time was significantly greater in the 5-FU-alone arm (8.4 months vs. 5.6 months, P less than 0.05). In both arms, survival was correlated with the nadir white blood count (WBC) achieved during therapy (P less than 0.02). Fourteen patients had pretreatment WBC of greater than 12,000/mm3. None of them had fever, bone marrow involvement with tumor, or recognizable infection at study entry. The 14 patients had a median survival time of 2.3 months, significantly shorter than that of patients with normal pretreatment WBC (P less than 0.05). A pretreatment lymphocyte count was available for all patients. No association between this value and either response to chemotherapy or survival time was noted. These results support the superiority of 5-FU to the combination of 5-FU and cytoxan in the treatment of colon carcinoma, and point to the prognostic significance of the pretreatment WBC in this disease.

Adenocarcinoma↗
PubMed1980

Comparison of serial electrocardiographic and vectorcardiographic changes during recovery from status asthmaticus.

Serial electrocardiographs (ECG) and vectorcardiographs (VCG) have been performed on 10 patients admitted to hospital in status asthmaticus on 12 separate occasions. The VCG was more efficient than the ECG in the detection of right atrial and ventricular enlargement. Both investigations were equally reliable in recording changes in frontal plane P wave axis. The mean frontal plane P wave axis fell from +60 degrees (range +35 degrees to +90 degrees) on the day of admission to +43 degrees (range +30 degrees to +60 degrees) at the time of discharge. The mean FEV1 expressed as a percentage of predicted values increased from 48% (range 25% to 81%) to 87% (range 44% to 123%). In direct contrast to previous studies the presence of an abnormally vertical frontal plane P wave axis (> 60 degrees) was related to the severity of airway obstruction (p < 0.01).

Acute Disease↗
PubMed1980

Mucociliary clearance in patients with chronic autonomic failure.

Mucociliary clearance was measured in four patients with chronic autonomic failure and normal ventilatory function using a method of scanning the clearance of inhaled polystyrene particles tagged with 99mTc. Previous surgical and experimental evidence has suggested that autonomic denervation might be expected to impair clearance. However, the four patients in this study showed no significant difference in clearance rate compared to groups of sex-matched control subjects. A fifth patient was found to have impaired mucociliary clearance. However she had the symptoms and ventilatory function of smoking-related chronic obstructive bronchitis, a condition which has previously been shown to impair mucociliary clearance.

Adult↗
PubMed1980

Rotational therapy with a colchicine analog in chronic granulocytic leukemia.

9 patients with chronic granulocytic leukemia were treated sequentially with busulfan, 6-mercaptopurine, and trimethylcolchicinic acid methyl ether d-tartrate (TMCA; NSC-36354). Smoothness of control of the disease was similar with busulfan and 6-mercaptopurine, but it was significantly poorer with TMCA. Toxic effects of therapy and median survival were similar to those observed with conventional therapy.

Adolescent↗
PubMed1980

Clearance of lung secretions in patients with chronic bronchitis: effect of terbutaline and ipratropium bromide aerosols.

A placebo controlled, double-blind, cross-over study was carried out to examine both the bronchodilator properties and the effect on lung mucociliary clearance of terbutaline (Bricanyl), a beta agonist, and ipratropium (Atrovent), a synthetic anticholinergic drug. Both were given regularly (two puffs four times a day for 1 week) from pressurised metered dose inhalers to patients with chronic obstructive bronchitis. A total of 10 patients completed the terbutaline study and 12 patients the ipratropium study; of these, seven patients were common to both studies. Measurements of the pulmonary function indices, forced expiratory volume in 1 s, forced vital capacity (FVC), peak expiratory flow rate and the flow rate at 50% of FVC measured from maximal expiratory flow-volume curves, confirmed the bronchodilator action of both drugs in these patients. Clearance of lung secretions was measured by the non-invasive, radioaerosol technique. No evidence was found that either drug had any effect on the rate of mucociliary clearance. The radioaerosol tracer particles used for measuring lung clearance, although inhaled under strictly controlled conditions, were deposited significantly more towards the lung periphery after treatment with ipratropium only. This suggested that ipratropium reduced the resistance to the entry of inhaled aerosols in the small airways.

Aerosols↗
PubMed1980

Adriamycin given as a weekly schedule without a loading course: clinically effective with reduced incidence of cardiotoxicity.

Three hundred and thirty-six patients with a variety of tumors were treated with Adriamycin given weekly as an iv bolus of 1 mg/kg with subsequent doses adjusted for hematologic toxicity. This weekly schedule, not utilizing a loading course, resulted in only a 20% incidence of stomatitis. The number of evaluable patients and the percent with objective responses (respectively) according to tumor type were: lung (57 patients, 14%); sarcoma (62, 24%); breast (31, 35%); transitional cell carcinoma (17, 29%); non-Hodgkin's lymphoma (17, 29%); head and neck (16, 13%); colorectal (13, 0); ovarian (eight, 25%); and other (53, 11%). These response frequencies are comparable to those reported for every-3-week regimens using 60-75 mg/m2 of Adriamycin. Sixteen patients were given 450-550 mg/m2 of Adriamycin, five were given 550-600 mg/m2, and ten were given greater than 600 mg/m2. None of the study patients developed definite evidence of drug-induced congestive heart failure. Therefore, Adriamycin given as a weekly schedule provides a clinically effective alternative to the every-3-week schedule of administration. The weekly schedule is associated with tolerable toxicity and a decreased risk of developing drug-induced congestive heart failure.

Doxorubicin↗
PubMed1979

Regional lung clearance of excessive bronchial secretions during chest physiotherapy in patients with stable chronic airways obstruction.

Clearance of excessive bronchial secretions labelled with inhaled radioactive polystyrene particles has been directly measured with a gamma-camera linked to a computer. Chest physiotherapy significantly increased clearance from central, intermediate, and peripheral lung regions and sputum yield. These findings confirm the value of this form of treatment, which has hitherto been in doubt, in removing excessive bronchial secretions from all lung regions and in aiding their expectoration.

Aerosols↗
PubMed1979

Identifying the primary site in metastatic cancer of unknown origin. Inadequacy of roentgenographic procedures.

Two hundred sixty-six patients with metastatic nonsquamous carcinoma of unknown origin underwent upper and lower gastrointestinal series, intravenous pyelograms, and chest roentgenograms (CR) for location of a primary cancer site. Of 129 identified cancer sites, only 22 were verified antemortem, whereas necropsy disclosed 25 cases with false-positive examination results. The CR patterns thought typical for lung cancer (eg, single mass lesion and hilar or mediastinal adenopathy) were often shown (43%) to represent metastatic lesions. Because contrast roentgenographic studies are costly, uncomfortable, of low yield, and often misleading, they should be limited to cases with specific organ dysfunction.

Adenocarcinoma↗
PubMed1979

Sudden death in asthma.

Two deaths after sudden severe asthma attacks in young people are reported from a clinic set up to identify and manage "at risk" patients. These deaths occurred despite frequent visits at which recommendations made by previous studies were implemented. The risk factors and management of such episodes have been reviewed. Precautions taken proved inadequate due to the severe, abrupt nature of the attacks, failure of the patients' immediate treatment, and delay in reaching hospital. Consideration should be given to the self-administration of subcutaneous adrenaline or specific beta-agonists, the provision of a detailed medical card, and free access to the nearest hospital in such cases.

Adult↗
PubMed1979

Effect of ipratropium bromide on mucociliary clearance and pulmonary function in reversible airways obstruction.

The effects of (a) regular use for one week and (b) a single dose of a synthetic anticholinergic (ipratropium bromide) on lung mucociliary clearance and as a bronchodilator was ascertained in a controlled, double-blind, cross-over study in 12 patients with reversible airways obstruction (mean increase in FEV after isoprenaline: 17% range 10-50%). Two puffs from a metered dose inhaler of either placebo (propellants only) or drug (40 microgram) were administered four times a day for one week (regular use), and mucociliary clearance was measured, by radioaerosol tracer, at the end of each treatment period and after a control period in which no treatment was given. On the mornings of the measurements after the placebo and drug periods one final dose (single dose) of ipratropium (40 microgram) or placebo was given 2.5 hours before the start of the test. There was no statistically significant difference between the three mean mucociliary clearance curves (control, placebo, and drug) for the group; however, there was a significantly greater penetration towards the periphery of the lung of the tracer in the test after drug administration compared with the other two. This increased penetration was attributed to bronchodilatation caused by the drug. Ipratropium bromide does not appear to impair mucociliary clearance, and it acts an effective bronchodilator.

Aged↗
PubMed1979

Survival of patients with metastatic breast cancer treated with either combination or sequential chemotherapy.

One hundred twenty-one patients with metastatic adenocarcinoma of the breast were randomized to concurrent combination therapy or single-drug chemotherapy administered sequentially. Although response frequency and duration of response were significantly increased in patients receiving the combination regimen, survival was not significantly prolonged when compared to those receiving sequential treatment. For the 69 patients free of liver metastasis, median survival was comparable in both treatment arms (14.4 months sequential versus 12.8 months combination). These results indicate that a large subset of patients with metastatic breast cancer may benefit from less aggressive therapeutic regimens. Furthermore, these results illustrate that conclusions of chemotherapy trials in breast cancer based only on response frequency and duration of response represent preliminary results subject to change when final survival information becomes available.

Adenocarcinoma↗