Randomised trial of memory training in the over-60s.
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Biomedical subjects
Publications and source records attributed to L Israel.
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Sweat gland carcinoma is a rare malignant tumor considered to be radio- and chemo-resistant. A case affecting a labium majorum recurred after surgical resection and was accompanied by bone and visceral metastases. After four cycles of combination chemotherapy consisting of doxorubicin, mitomycin C, vincristine and cisplatin, complete remission lasting 16 months and prolonged survival (50 months) were obtained. A review of the literature also is presented.
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The training is realised through exercises carried out during courses and at home. The effectiveness of this training is assessed by psychometric tests (before/after) and a questionnaire for self evaluation (after). An equal number of subjects to be trained and controls are selected among 100 or so voluntary participants.
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Definition and magnitude of the disability problem and the level of affected activities in daily living (ADL) are discussed on the basis of findings from several epidemiological studies. Prevalence of various disabilities for ADL and functional ability level by age and sex in the light of various aspects of health and satisfaction with life are summarised. Such disabilities have an important effect on consequences in daily living and might or might not be associated with loss of autonomy and with further development of dependency in the process of ageing. Inter-relation of various conditions of health and activities of daily living in the light of several coping abilities which compensate various disabilities on the individual level, are underlined.
Twenty-four patients with histologically proven metastatic malignant melanoma were included in a Phase II trial of human DNA recombinant interferon (rDNA IFN alpha 2). They were given 10 X 10(6) IU of IFN alpha 2 subcutaneously three times a week until progression of disease or major intolerance developed. Twenty-two patients were evaluable for toxicity and response. General manifestations of intolerance were seen in all the patients. Hematologic toxicity was seen in six patients and therapy had to be interrupted in one patient. Mild liver toxicity was seen in most patients after 2 weeks of treatment. These manifestations disappeared within 2 weeks after treatment was discontinued. A partial response was seen in four cases lasting 2, 4, 4, and 5 months, respectively. There were two complete responses (one skin, one lymph node metastasis) lasting 20 and 6 weeks, respectively. These results indicate a potential role for rDNA IFN alpha 2 in treating patients with metastatic malignant melanoma. However, further trials are required to determine the optimal dose and schedule of administration and modalities of combination.
A cis-platin + bleomycin combination, sometimes associated with a third cytostatic drug, was administered for prolonged periods to 1062 cancer patients previously subjected to a wide variety of treatments. The objective response rate was about 70% in localized squamous cell and anaplastic bronchial carcinoma and 40% in bronchial adenocarcinoma and metastatic squamous cell carcinoma. Cancers of the head and neck responded in 70% of the cases before irradiation and in 30% after irradiation. Other epidermoid tumours responded objectively in the proportion of 45%, as did 58% of metastatic and refractory breast cancers. These results were not clearly improved by any of the other cytostatic drugs used concomitantly, and the combination alone was less toxic. The high response rate obtained is attributed to a synergistic effect of cis-platin and bleomycin administered for prolonged periods.
Kidneys from an Rh-negative cadaver donor were transplanted to two Rh-positive patients. The donor's serum contained anti-Rho (D). In both patients, anti-Rho (D) was detected in their serum and on their red cells 3.5 weeks after transplantation. One patient had hemolysis. The antibodies persisted for nearly six months, despite graft rejection and nephrectomy in one case. These antibodies presumably arose from passenger B lymphocytes in the grafts from the Rh-immunized donor.
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A group of 70 adults with end-stage liver disease received 87 homologous liver transplants from 7/11/81 and 7/11/83. The recipients fell into the following diagnostic categories: postnecrotic cirrhosis (PNC) in 22, primary biliary cirrhosis (PBC) in 18, cancer or neoplasia (CA) in 11, sclerosing cholangitis (SC) in 8 and miscellaneous (MISC) in 11. Survival for six months or longer was 46%: survival by group was PBC = 67%, CA = 55%, PNC = 45%, SC = 25%, and MISC = 18%. Preoperative coagulation profiles were evaluated on 64 of the 70 first transplant patients by assigning a score derived from one point per abnormality in each of 8 tests. Mean coagulation abnormality scores (CAS) were strikingly elevated in the PNC and MISC groups. Mean intraoperative blood product usage was 43 units of RBCs, 40 units of fresh frozen plasma (FFP), 21 units of platelets, and 9 bags of cryoprecipitate. Direct correlations were found between CAS and RBC usage (+0.454, P = less than .001), CAS, and survival of 6 months or longer (-0.281, P = less than .02), and RBC usage and survival (-0.408, P = less than .001). These findings indicate that the degree of coagulation abnormality and the type of liver disease may be predictive of intraoperative blood usage and survival in liver transplantation in adults.
A group A1 diabetic received a pancreas-spleen transplant from a group 0 donor. Severe immune hemolysis due to anti-A ensued, requiring graft splenectomy. The transplanted spleen can be a potent source of blood group antibody.
Palliative chemotherapy in cases of epidermoid bronchogenic carcinoma, initially judged to be inoperable, made it possible to perform operative resection in 50 cases. An association of cis-platinum and bleomycin was used, this combination having previously been considered synergistic. In certain cases the tumour seemed to have disappeared on macroscopic examination of the resected specimen, and in some instances no tumoral cells could be found on histological examination. This series brought out several positive features: chemotherapy made it possible to operate on patients previously judged to be inoperable; it ensured maximum local efficiency of drugs because of the absence of abnormal vascularity; and it made it possible to anticipate the cure of occult metastases. However, three negative aspects were also present: modification of postoperative TNM classification making it difficult to establish a prognosis; difficulty in determining therapeutic strategy for pNo; and inadequate long-term follow-up. On the whole the positive points appeared to outweigh the negative aspects, but a randomized study is necessary to confirm this.
It is postulated that some hormones may regulate proliferation of cancer cells in the same way as growth factors produced by cellular oncogenes. The gene coding for the hormone's specific receptor would also act as a cellular oncogene. Normal adult breast cells show few if any oestrogen receptors. In the model put forward the oestrogen receptors in breast cancer cells should not be regarded as a marker of differentiation but as a survival advantage for the tumour when oestrogens are present. Prolactin and somatomedin may also behave as growth factors. In relation to the antitumour effects of hormone antagonists such as tamoxifen, it is postulated that cancer cells are immortalised and prevented from full differentiation by the presence of growth factors and their receptors. If receptor genes are re-expressed through the process of neoplastic transformation, their presence in cancers from unresponsive normal tissues should be regarded as a common event.