Biomedical subjects

John J Wilson

Publications and source records attributed to John J Wilson.

5 recordsLinked to original sources

PubMed2006

Practical management: vocal cord dysfunction in athletes.

Vocal cord dysfunction (VCD) is characterized by paradoxical adduction of the vocal folds during inhalation, and occasionally upon exhalation, resulting in extrathoracic airflow obstruction. Sports medicine professionals must have a high index of suspicion for VCD when acute respiratory symptoms occur so that prompt evaluation and use of appropriate specialists results in an accurate and timely diagnosis. Many factors have been implicated in the pathophysiology of VCD, including laryngeal irritants, psychogenic and neurogenic causes. The diagnosis and management of VCD involves a variety of specialties including pulmonology, otolaryngology, speech-language pathology, allergy and immunology, and psychologic management as appropriate. The mainstay of treatment remains behavioral management guided by a medical speech-language pathologist, as well as pharmacologic management for VCD triggers.

Airway Obstruction↗

PubMed2005

Common overuse tendon problems: A review and recommendations for treatment.

There is a common misconception that symptomatic tendon injuries are inflammatory; because of this, these injuries often are mislabeled as "tendonitis."' Acute inflammatory tendinopathies exist, but most patients seen in primary care will have chronic symptoms suggesting a degenerative condition that should be labeled as "tendinosus" or "tendinopathy." Accurate diagnosis requires physicians to recognize the historical features, anatomy, and useful physical examination maneuvers for these common tendon problems. The natural history is gradually increasing load-related localized pain coinciding with increased activity. The most common overuse tendinopathies involve the rotator cuff, medial and lateral elbow epicondyles, patellar tendon, and Achilles tendon. Examination should include thorough inspection to assess for swelling, asymmetry, and erythema of involved tendons; range-of-motion testing; palpation for tenderness; and examination maneuvers that simulate tendon loading and reproduce pain. Plain radiography, ultrasonography, and magnetic resonance imaging can be helpful if the diagnosis remains unclear. Most patients with overuse tendinopathies (about 80 percent) fully recover within three to six months, and outpatient treatment should consist of relative rest of the affected area, icing, and eccentric strengthening exercises. Although topical and systemic nonsteroidal anti-inflammatory drugs are effective for acute pain relief, these cannot be recommended in favor of other analgesics. Injected corticosteroids also can relieve pain, but these drugs should be used with caution. Ultrasonography, shock wave therapy, orthotics, massage, and technique modification are treatment options, but few data exist to support their use at this time. Surgery is an effective treatment that should be reserved for patients who have failed conservative therapy.

Adrenal Cortex Hormones↗

PubMed2004

Patterns of recurrence in patients treated with photodynamic therapy for intraperitoneal carcinomatosis and sarcomatosis.

The purpose of this study was to evaluate the patterns of recurrence in patients treated with Photofrin-mediated intraperitoneal photodynamic therapy (IP PDT). Sixty-six patients with gastrointestinal cancers, ovarian cancers, and sarcomas have been enrolled to date and 51 patients underwent IP PDT. Photofrin, 2.5 mg/kg, was administered intravenously 48 h prior to surgical debulking and intraoperative light treatment. Forty-five, and 49 patients were evaluable for response rates, and patterns of recurrence, respectively. Response to treatment was evaluated by CT or MRI scans of the abdomen and pelvis every 3 months. Patterns of recurrence were determined by evaluating the abdomen as a combination of different treatment regions. Of the 51 patients enrolled and treated with IP PDT two are alive without evidence of recurrence. Eleven of 45 patients showed no evidence of recurrence 3 months after treatment. No evidence of recurrence was noted in 7/17 sarcoma patients, 2 of 13 ovarian cancer patients, and 2 of 15 gastrointestinal cancer patients. The most common site of recurrence as determined by radiographs was the pelvis, which was noted in 19 of 49 (39%) patients. The presence of gross residual disease before light treatment (as determined by the attending surgeon) did not affect the site of recurrence. When studying those patients who had only locoregional recurrence, 9 of 33 evaluated radiographically and 10 of 24 evaluated operatively recurred only in peritoneal areas not previously involved with gross disease. The pelvis was the site with the highest rate of recurrence after IP PDT. A significant minority of patients recurred only in sites not previously involved with gross disease. Patients with gross residual disease before light therapy had similar recurrence rates to those without gross residual disease. Since sites involved with gross residual tumor often received boost doses of light, this could suggest a dose-response relationship for IP PDT.

Adult↗

PubMed2004

A 3-week gemcitabine-cisplatin regimen for metastatic urothelial cancer.

OBJECTIVE: To assess the efficacy and tolerability of a 3-week outpatient schedule of intravenous gemcitabine and cisplatin in patients with locally advanced unresectable or metastatic transitional cell carcinoma of the urothelial tract (TCC). PATIENTS AND METHODS: A two-stage phase II trial enrolled TCC patients with Karnofsky performance status > or = 60, measurable disease, and adequate organ function. Prior adjunctive chemotherapy was allowed provided it had been completed at least 1 year prior to study entry. Treatment consisted of gemcitabine 1250 mg/m2 iv days 1 and 8 plus cisplatin 70 mg/m2 day 1 iv repeated every 21 days. The primary outcome was the objective response rate. RESULTS: Thirty patients were enrolled at six Canadian centres. Three complete and 10 partial responses were observed in 29 eligible patients (overall response rate 45% [95%CI, 27-63%]). Three patients had stable disease and 13 had progressive disease. The relative dose-intensities of gemcitabine and cisplatin were 81% and 88%, respectively. Toxicity was primarily hematological, and 60% of patients experienced at least one episode of grade 3 or 4 toxicity. One patient died of neutropenic sepsis and two died of vascular events while on treatment. CONCLUSIONS: The efficacy and tolerability of this schedule are similar to that reported with the standard 4-week schedule of gemcitabine-cisplatin. In the absence of a large randomized trial, the similarity of these results supports the use of this 3-week program in typical TCC patients treated in both community and academic cancer clinic settings.

Adult↗

PubMedDate not supplied

Clinical trial resources on the internet must be designed to reach underrepresented minorities.

PURPOSE: Internet-based clinical trial information services are being developed to increase recruitment to studies. However, there are limited data that evaluate their ability to reach elderly and underrepresented minority populations. This study was designed to evaluate the ability of an established clinical trials registry to reach these populations based on expected Internet use. PATIENTS AND METHODS: This study compares general Internet users to participants who enrolled in an Internet based colorectal cancer clinical trials registry established by OncoLink (www.oncolink.org) and the National Colorectal Cancer Research Alliance. Observed rates of demographic groupings were compared to those established for general Internet users. RESULTS: Two thousand, four hundred and thirty-seven participants from the continental United States used the Internet to register for the database. New England, the Mid-Atlantic region, and the Southeast had the highest relative frequency of participation in the database, whereas the Upper Midwest, California, and the South had the lowest rates. Compared to general Internet users, there was an overrepresentation of women (73% vs. 50%) and participants over 55 years old (27% vs. 14%). However, there was an underrepresentation of minorities (10.3% vs. 22%), particularly African Americans (3.1% vs. 8%) and Hispanics (2.8% vs. 9%). DISCUSSION: The Internet is a growing medium for registry into clinical trials databases. However, even taking into account the selection bias of Internet accessibility, there are still widely disparate demographics between general Internet users and those registering for clinical trials, particularly the underrepresentation of minorities. Internet-based educational and recruitment services for clinical trials must be designed to reach these underrepresented minorities to avoid selection biases in future clinical trials.

Black or African American↗