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Biomedical subjects

M Hensley

Publications and source records attributed to M Hensley.

14 recordsLinked to original sources
PubMed2000

Lung volume reduction surgery for diffuse emphysema.

BACKGROUND: Lung volume reduction surgery (LVRS) has been re-introduced for treating patients with severe diffuse emphysema. OBJECTIVES: To assemble evidence from randomised controlled trials for the effectiveness of LVRS, and identify optimal surgical techniques, those patients who benefit most and those for whom it should be avoided. SEARCH STRATEGY: Randomised controlled trials were identified using the Cochrane Airways Group COPD register using the terms: emphysema AND (emphysema surgery OR lung volume reduction surgery OR LVRS OR volume reduction surgery OR pneumectomy OR reduction pneumoplasty OR lung reduction surgery). The Cochrane Controlled Clinical Trials Register was also searched using these terms. SELECTION CRITERIA: Randomised controlled trials that studied the safety and efficacy of LVRS in patients with diffuse emphysema were included. Studies were excluded if they investigated giant or bullous emphysema. DATA COLLECTION AND ANALYSIS: Two independent reviewers assessed trials for inclusion and extracted data. MAIN RESULTS: Only one randomised trial of LVRS for diffuse emphysema was identified. This compared stapled unilateral thoracoscopic lung reduction coupled with bovine pericardium reinforcement with a unilateral neodymium:yttrium aluminium garnet laser contact reduction. A total of 72 patients were studied. Both arms included post-operative rehabilitation and appeared to be well matched at randomisation. Improvement in FEV1 & FVC at six months was significantly greater in the staple treated group (p < 0.01 & p < 0. 07 respectively), but absolute increases were small. Need for supplemental oxygen was reduced significantly more in the staple treated group; Peto Odds Ratio (OR) 4.05; 95% confidence interval (CI) 1.40, 11.71. Quality of life improved more in the staple treated group (OR 5.36; 95% CI 2.13,13.47). The rate of delayed pneumothorax in the laser treated group was significantly higher (OR 10.46; 95% CI 1.98, 55.30). REVIEWER'S CONCLUSIONS: There is no randomised controlled trial evidence concerning the efficacy of LVRS for diffuse emphysema compared to optimal conservative medical therapy. Stapling is more effective than laser resection and has a lower complication rate. LVRS should not be applied routinely until results of large trials currently underway become available.

Emphysema↗
PubMed1997

Opportunistic blood lead testing in a paediatric inpatient population.

We report a simple protocol which has potential to estimate community paediatric blood lead levels using opportunistic testing. Permission to use leftover blood for a lead assay was sought from parents or guardians of 397 children one month to 13 years of age who were admitted to general paediatric wards of John Hunter Hospital, Newcastle, between May and August 1993 and who had blood for a full blood count taken for any reason. Results were reviewed by a medical officer and returned to parents. Where a child's blood lead level was of concern according to National Health and Medical Research Council guidelines, the child was referred to a specialist paediatrician for clinical assessment. Written consent was received from the parents or guardians of 95.5 per cent of eligible children (n = 379); 93.4 per cent of responders (354 of 379) had blood suitable for testing, giving an overall result rate of 89.2 per cent (354 of 397). The mean blood lead level for the whole group was 5.3 micrograms/dL. The highest blood lead level for any age group was 6.4 micrograms/dL in the 36 to < 60 month age group. Stratification by geographical area showed a trend in increasing blood lead with increasing population density and areas where lead polluting industries exist. The approximate cost per result achieved was $40. This opportunistic survey method provides a promising technique for obtaining data on community blood lead levels. It may be a practical and resource-efficient alternative to large-scale community surveys. Further studies are under way to validate the method as a community surveillance tool.

Adolescent↗
PubMed1996

Phase II study of elsamitrucin (BMY-28090) for the treatment of patients with refractory/relapsed non-Hodgkin's lymphoma.

PURPOSE: To determine the response rate of patients with refractory/relapsed non-Hodgkin's lymphoma to treatment with elsamitrucin and to further characterize the toxic effects of elsamitrucin in this group of patients. PATIENTS AND METHODS: Eligibility required pathologically verified relapsed or refractory non-Hodgkin's lymphoma with no more than two prior chemotherapy regimens for patients with tumors classified by the International Working Formulation (IWF) as A-C and no more than one prior chemotherapy for those with IWF grades D-G. Patients were entered with either normal or impaired bone marrow function, but normal liver function tests were required unless clearly related to lymphomatous involvement of the liver. Elsamitrucin 25 mg/m2 was administered intravenously over 5-10 minutes weekly. RESULTS: Thirty-one patients entered the study and were treated for a median of six weeks (range 1-42). All patients were evaluable for toxicity and 30 for response. Mild nausea and/or vomiting and asthenia were the most frequently reported adverse events. Four (13%, 95% Cl 4.4-31.6%) partial responses were seen along with two (7%) minor responses while 9 (30%) patients had stable disease. CONCLUSION: Elsamitrucin showed modest activity in patients with relapsed or refractory non-Hodgkin's lymphoma. Toxicity was relatively mild, consisted mainly of asthenia, nausea and vomiting and did not include myelosuppression. The activity of elsamitrucin in this group of patients and its lack of myelosuppression suggest utility in this disease especially when combined with other proven agents.

Adult↗
PubMed1994

Accuracy of reported family history of heart disease: the impact of 'don't know' responses.

BACKGROUND: Usual 'Yes/No' definitions of a family history of heart disease do not allow for 'Don't know' responses. In some families, misclassification of family history may result if these are not considered. AIMS: To study the accuracy of family history reporting and the impact of 'Don't know' responses. METHODS: We compared reported family history of coronary heart disease (CHD) and cancer among 360 deceased relatives of 59 probands with 'gold standard' diagnoses recorded on official death certificates. RESULTS: For first degree relatives, sensitivity of reporting was 81% for CHD, 86% for any heart disease and 60% for cancer, while for second degree relatives, sensitivity was 73%, 69% and 90%, respectively. When 'Don't know' responses were classified as 'No', sensitivity in first degree relatives was not affected, but in second degree relatives, it fell to 49%, 41% and 60%, respectively. Specificities were unchanged. These data show that in families where information beyond first degree relatives is considered, failing to account for 'Don't know' responses is likely to lead to misclassification of family history of CHD.

Adult↗
PubMed1994

Efficacy of an influenza hemagglutinin-diphtheria toxoid conjugate vaccine in elderly nursing home subjects during an influenza outbreak.

OBJECTIVE: To compare the efficacy of an influenza hemagglutinin-diphtheria toxoid conjugate vaccine with the commercially available influenza hemagglutinin-subunit vaccine in preventing influenza in older adults living in a nursing home. DESIGN: A prospective, randomized, double-blind vaccine trial with 5 months of follow-up after vaccination. SETTING: Fourteen Wisconsin nursing homes. PARTICIPANTS: Nursing home residents at least 65 years old who were able to give informed consent and were free of malignancy and not receiving immunosuppressive therapy. INTERVENTIONS: Participants received, by intramuscular injection, 0.5 mL of a trivalent influenza vaccine containing 15 micrograms each of A/Leningrad/360/86 (H3N2), A/Taiwan/1/86 (H1N1), and B/Ann Arbor/1/86 (HA) or 0.5 mL of an influenza vaccine containing the same antigens conjugated to diphtheria toxoid (HA-D). MEASUREMENTS: Blood was obtained pre- and 1 month post-vaccination to assess for any vaccine-induced antibody titer change. Clinical surveillance for respiratory illness was performed twice weekly for 5 months. A record was kept of all signs and symptoms of new respiratory illness, and a viral culture and acute and convalescent sera were obtained. RESULTS: 204 participants received HA and 204 received HA-D. Both groups had similar baseline antibody levels to all influenza antigens. HA-D recipients seroconverted more frequently based on serum neutralizing activity (P < 0.05), had a greater increase in geometric mean titer (GMT), and sustained the increase in antibody titer longer than HA recipients. Vaccine hemagglutinin recall was greater in a subset of HA-D recipients as measured by lymphocyte proliferative assays (P < 0.05). During an outbreak of influenza A (H3N2 A/Shanghai/11/87-like and A/Victoria/7/87-like), fewer HA-D (29/195) than HA (43/204) recipients had laboratory-confirmed infection (P = 0.053), and, of these, fewer HA-D-treated subjects had lower respiratory tract involvement (5/29 HA-D and 17/43 HA) (P = 0.022). CONCLUSIONS: HA-D was more immunogenic in institutionalized elderly recipients and produced greater protection from influenza infection. Superior protection may be due to HA-D's ability to stimulate and recruit antigen-presenting cells, thus enabling the recipient to achieve and maintain functional antibody titers.

Aged↗
PubMed1991

Phase II study of 13-cis-retinoic acid in pediatric patients with acute nonlymphocytic leukemia--a Pediatric Oncology Group study.

Forty-one patients with refractory acute non-lymphocytic leukemia (ANLL) in relapse were treated with 13-cis-retinoic acid (cRA) as salvage therapy. The cRA was given as a single oral dose of 100 mg/m2/day for 4 weeks. One patient achieved a complete remission and two patients achieved a partial remission with reduction of the bone marrow blast count from 40 to 20% after the first course. We recommend further study of cRA in combination with other agents in the treatment of ANLL in children.

Adolescent↗
PubMed1989

Uvulopalatopharyngoplasty as a treatment for snoring.

Uvulopalatopharyngoplaty was performed in 18 consecutive patients (15 men and three women; mean +/- standard deviation [SD] age, 46.3 +/- 7.5 years) who presented for the treatment of heavy habitual snoring. No attempt was made to select patients who were ideal anatomically for palatal modification. The loudness of snoring was measured during sleep by integrating the output of a calibrated microphone. An assessment before operation showed that nine patients had obstructive sleep apnoea; four patients had an apnoea index of greater than or equal to 25 apnoeas per hour. The patients were overweight and consumed, on average, 38 g of alcohol per day, but these variables did not change after the operation. The postoperative assessment was performed 138 +/- 44 days after uvulopalatopharyngoplasty. Fourteen patients showed a reduction in the loudness of their snoring, although snoring was abolished in one patient only (average snoring loudness in arbitrary units/min of sleep, 2.8 +/- 2.1 before operation compared with 1.4 +/- 1.5 units/min of sleep after the operation; P less than 0.05. The loudest snore in arbitrary units measured 7.1 +/- 3.3 units compared with 4.8 +/- 3.3 units, respectively; P less than 0.05). The percentage of the sleep time that was spent at an arterial oxygen saturation of less than 90% was reduced after uvulopalatopharyngoplasty (28% +/- 32% of total sleep time compared with 17% +/- 24% of total sleep time, respectively; P less than 0.05). There was no change in the apnoea index. The diastolic blood pressure was lower at the postoperative assessment (94 +/- 11 mmHg compared with 87 +/- 8 mmHg; P less than 0.05); six of 10 subjects whose diastolic blood pressures were greater than or equal to 95 mmHg before the operation had a diastolic blood pressure of less than 95 mmHg after uvulopalatopharyngoplasty (P less than 0.02). Computed tomographic scans showed an increase in the upper airway cross-sectional area at 3 cm and 4 cm above the hyoid bone after uvulopalatopharyngoplasty (P less than 0.05). We conclude that uvulopalatopharyngoplasty is an effective treatment for habitual, heavy snoring in many patients, but it is not the treatment of choice for patients with clinically-significant obstructive sleep apnoea.

Adult↗
PubMed1985

Hyperparathyroidism associated with the enlargement of two or three parathyroid glands.

Eighty-five (23%) of 375 patients undergoing surgery for primary hyperparathyroidism were found to have enlargement (greater than 50 mg) of two or three parathyroid glands. Of 76 patients followed from 12 to 140 months after surgery, eight (10.5%) developed hypercalcemia at 1, 4, 45, 64, 74, 79, 84, and 133 months. In a comparison of pertinent preoperative biochemical and pathologic data between 55 patients with two- or three-gland hyperparathyroidism and 55 age- and sex-matched patients with single-gland hyperparathyroidism, only the preoperative serum phosphate differed significantly, being lower in the patients with single-gland disease (2.4 +/- 0.1 vs. 2.6 +/- 0.1; p less than 0.04). In the eight patients with two- or three-gland hyperparathyroidism who developed postoperative hypercalcemia, the preoperative concentrations of serum calcium were lower (10.8 +/- 0.2 vs. 11.5 +/- 0.2; p less than 0.019), the preoperative concentrations of serum phosphate were higher (3.1 +/- 0.2 vs. 2.5 +/- 0.1; p less than 0.020), and the weights of the excised parathyroid tissues were less (356 +/- 72 mg vs. 1354 +/- 215 mg; p less than 0.02) than those of patients with two- or three-gland disease who did not develop postoperative hypercalcemia, indicating a milder form of hyperparathyroidism. In the 68 patients without recurrent hypercalcemia, there was no tendency for the serum calcium concentration to increase with time. Patients with primary hyperparathyroidism associated with two or three enlarged parathyroid glands have an appreciable incidence of persistent or recurrent hypercalcemia, which may increase even further with longer observation.

Aged↗
PubMed1980

Evaluation of baboon antiserum to carcinoembryonic antigen.

The common baboon (Papio), immunized with carcinoembryonic antigen (CEA), was found to form specific-site antibodies for CEA. The baboon antiserum does not recognize colon carcinoma antigen-III, but does demonstrate similar ionic strength effects to those previously described for goat antisera to the CEA-specific site(s). Baboon specific-site antibody for CEA can be used for radioimmunoassay of CEA in plasma and gives similar results to the commercial (Roche) goat anti-CEA.

Animals↗
PubMedDate not supplied

Community action for health promotion: a review of methods and outcomes 1990-1995.

OBJECTIVE: Our objective was to explore the effectiveness of community action as a strategy for health promotion, through a critical review of five years of community action evaluation literature. METHODS: Community action was defined as a health promotion, program that involved the community in implementation and control of the process of the program. Criteria for scientific evaluation of programs were proposed for sampling and control procedures, reliability and validity of instruments, analysis techniques, and specification of details of the intervention. A critical review of the literature, located by an on-line and related reference search, was undertaken for community action aimed at reducing cancer and cardiovascular disease, between January 1990 and May 1995. RESULTS: None of seven community action studies (17 articles) that examined cancer risk factors fulfilled all the criteria for rigorous scientific evaluation. The most methodologically adequate cancer study, the COMMIT intervention, had only a moderate degree of success in reducing community smoking rates. Similarly, none of the six studies (25 articles) on cardiovascular disease fulfilled all the criteria. The results for the most methodologically adequate study, the Minnesota Heart Health Program, were disappointing, with strong secular trends preventing adequate assessment of the intervention effect. CONCLUSIONS: The finding that none of the reviewed studies met all evaluation criteria was due to several factors, including political considerations, feasibility, and the continued evolution of the science of evaluation in health promotion. Some important questions are posed for researchers by the failure of methodologically superior projects, such as COMMIT, to show major gains in reducing health risk behaviors.

Cardiovascular Diseases↗