Biomedical subjects

K Gilyon

Publications and source records attributed to K Gilyon.

4 recordsLinked to original sources

PubMed1991

Cutaneous T-cell lymphoma.

Cutaneous T-cell lymphoma (CTCL) represents a spectrum of the non-Hodgkin's lymphomas, including mycosis fungoides (MFs) and Sezary syndrome. Although an uncommon malignancy, the number of new cases per year in the United States is increasing at a constant rate. This paper provides an overview of CTCL, including pathophysiology, information on the various treatment modalities, and practical clinical approaches needed by oncology nurses to assist individuals experiencing treatment-related toxicities. Psychosocial issues, an aspect of disease in which oncology nurses can provide support and understanding, also are addressed.

Administration, Topical↗

PubMed1990

Interferon alfa-2a combined with phototherapy in the treatment of cutaneous T-cell lymphoma.

Escalating doses of recombinant interferon alfa-2a (Roferon-A), administered intramuscularly three times weekly, combined with psoralen plus ultraviolet light irradiation (PUVA), were tested in a phase I trial for the therapy of patients with cutaneous T-cell lymphomas (CTCL). Interferon doses were escalated in groups of three patients from 6 million to 30 million IUs three times weekly. Disease stages ranged from IB to IVB. Eighty percent of the patients entered in this trial had failed at least one prior therapy. Complete remissions were obtained in 12 of 15 patients, and partial responses were seen in two of 15 patients, for an overall response rate of 93%. The median duration of response exceeded 13 months (range, 3-15+). All patients who responded have been maintained on therapy. The dose-limiting toxic effects were constitutional symptoms such as fevers and malaise (93.3%), leukopenias (40.0%), mental status changes consisting of depression and confusion (33.3%), and photosensitivity (26.6%). These side effects were reversible with a decrement in dose or discontinuation of the interferon. No patient tolerated 30 million IU of the interferon for extended periods; the maximally tolerated dose was 18 million IU. Interferon plus PUVA appears to be a highly effective regimen for the treatment of patients with CTCL. Phase II studies investigating this combination, using 18 million IU of interferon alfa-2a three times weekly, should be undertaken to expand these findings, and to attempt to reduce the toxic effects associated with this therapy.

Combined Modality Therapy↗

PubMed1990

Photochemotherapy alone or combined with interferon alpha-2a in the treatment of cutaneous T-cell lymphoma.

Eighty-two patients with either mycosis fungoides (MF) or parapsoriasis en plaques were treated with psoralens ultraviolet A light (PUVA). Clinical and histologic parameters were followed for a period from 6 months to 10 years. Complete clinical clearing of lesions was observed in 51 patients (62%) and most of them were in limited-plaque MF group or parapsoriasis en plaque. The mean total dose of PUVA for complete clearing was less for early MF. Thirty-one patients (38%) relapsed and responded to additional PUVA. Patients in early stages of the disease remained clear for up to 68 months after the first course of PUVA. Post-treatment skin biopsies with early MF showed histologic clearing. A new combination therapy for MF is presented in 15 patients. Recombinant interferon alpha-2a (Roferon-A), administered intramuscularly combined with PUVA were tested in a phase I trial. Interferon doses were from 6-30 million units three times weekly. Disease stages ranged from I-B to IV-B. Complete responses were obtained in 12 of 15 patients, and partial responses seen in 2 of 15 patients, for an overall response rate of 93%. The median duration of response exceeded 23 months (range, 3 to 25 months). All responding patients have been maintained on therapy. The dose-limiting toxicities were constitutional symptoms such as fevers and malaise (93.3%), leukopenias (40.0%), mental status changes consisting of depression and confusion (33.3%), and photosensitivity (26.6%). Interferon plus PUVA appear to be highly effective regimens for the treatment of patients with cutaneous T-cell lymphomas.

Adult↗

PubMed1987

A cancer screening skills laboratory for medical students.

At St. Louis University School of Medicine a 15-hour Integrated Oncology Module is part of the required second-year Introduction to Medicine course. In place of a one-hour lecture in the module, a required one-hour laboratory was introduced to teach cancer screening as a means of secondary cancer prevention. This activity follows completion of the Introduction to Physical Diagnosis course. The laboratory utilized anatomically correct models to instruct students in fundamental screening procedures for cervical, breast, prostate, and colorectal cancer. Emphasis was placed on a professional interaction with the patient. The Cancer Prevention Laboratory sessions were conducted by registered nurses with specialized training in cancer screening. The Socratic method was employed by the instructors as each of 157 students moved through a series of stations screening appropriate models. The student described the procedure as it was performed, and answered questions pertinent to the activity. The instructors assessed performance using a checklist developed for this purpose. Questions relative to secondary cancer prevention and proper physical detection of cancer appeared on the final exam of the Integrated Oncology Module. One hundred fifty-seven students completed the screening laboratory. Four nurse instructors were employed at each session. Thirty-nine hours were required for all students to complete the lab. Student critique of the activity was overwhelmingly positive, particularly in the acceptance of the registered nurse instructors. Eighty-six percent of the 157 students reported that the teaching methodologies used by the nurses were excellent. The nurses were also perceived as knowledgeable and nonthreatening.

Education, Medical, Undergraduate↗