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Biomedical subjects

M Palmer

Publications and source records attributed to M Palmer.

11 recordsLinked to original sources
PubMed1992

The utility of squamous cell carcinoma antigen for the follow-up of patients with squamous cell carcinoma of the anal canal.

BACKGROUND: Thirty-three patients with histologic documentation of squamous cell carcinoma (SCC) of the anal canal underwent prospective serial collection of 234 serum samples for radioimmunoassay of SCC tumor-associated antigen. METHODS: There were 23 female and 10 male patients, with a median age of 55 years. Twenty-two of the 33 patients had multimodality therapy with radiation therapy and chemotherapy as initial treatment. RESULTS: The median follow-up was 22 months (range, 4-52 months), with a median of 13 serum specimens per patient (range, 1-23 specimens). Twenty-eight patients currently have no evidence of disease, 4 patients are alive with disease, and 1 patient died with disease. CONCLUSION: In these 33 patients, the sensitivity of the SCC tumor-associated antigen was 76%, specificity 86%, and positive predictive value 62%.

Adult↗
PubMed1992

Quality-of-life assessment: patient compliance with questionnaire completion.

BACKGROUND: Previous investigators have found that compliance with quality-of-life data collection on cancer clinical trials is poor. There is general belief that collecting complete quality-of-life data is at present an unachievable goal. PURPOSE: We assessed the completeness of quality-of-life data collection on trials instituted by the National Cancer Institute of Canada Clinical Trials Group (NCIC CTG), since incorporation of quality-of-life outcomes into trials became mandatory for the group. METHODS: Data from three NCIC CTG trials in which quality of life was a study end point were examined to determine the extent to which protocol specifications were met with respect to questionnaire completion. Two of the studies examined adjuvant therapies, and one examined anti-emetics. In two trials, the quality-of-life questionnaire of the European Organization for Research and Treatment of Cancer was used; in the other, the Breast Cancer Chemotherapy Questionnaire. RESULTS: Patient compliance with questionnaire completion was unexpectedly high: More than 95% of the scheduled questionnaires were returned, and more than 99% of the questions were answered. CONCLUSIONS: We attribute this success to a comprehensive set of measures taken to enhance compliance on these studies. Which of these measures was most contributory requires further investigation, as does the issue of whether similar results can be obtained in other circumstances. IMPLICATIONS: It seems that the commonly held belief that quality-of-life data cannot be successfully collected in multicenter cancer trials is incorrect.

Clinical Trials as Topic↗
PubMed1992

Decision tree for the management of substance-abusing psychiatric patients.

This paper describes a short-term approach developed at a time of numerous drug-related incidents occurring at a large VA Hospital to help staff manage psychiatric patients abusing alcohol or drugs during hospitalization. This was accomplished through the development of a decision tree designed to improve the clinical problem-solving process by identifying key decision points. Prior to this, staff responded emotionally either by prematurely discharging patients or by not recognizing the problem at all. Decision Trees have widespread applicability for resolving complex clinical problems.

Adult↗
PubMed1992

The chemiluminescent detection of leptospiral antigen.

The aim of this study was to investigate the feasibility of using enhanced chemiluminescence for the rapid detection of leptospiral antigen (L. interrogans serovar hardjo) in biological fluids, and to assess the suitability of such an assay for the early diagnosis of human leptospiral infections. The limit of detection for homologous antigen in phosphate buffered saline was 9 x 10(4) leptospires/ml. In human blood the sensitivity remained unchanged throughout the sampling time, (1.8 x 10(5) leptospires/ml), but decreased with time in human urine. The assay did not cross-react with other members of the Leptospira interrogans species, was unaffected by the presence of biological fluids but the sensitivity was reduced by contaminating bacteria. The assay was both rapid and sensitive, when compared with current cultural techniques, and offers a potentially valuable aid to the early diagnosis of leptospirosis.

Antigens, Bacterial↗
PubMed1992

Does gallium uptake in the pulmonary hila predict involvement by non-Hodgkin's lymphoma?

67Ga imaging of non-Hodgkin's lymphoma is useful for evaluating the presence of viable tumour in a residual mass after treatment. However, we have frequently seen gallium uptake in the pulmonary hila without other evidence of lymphoma. To study the significance of this finding, 79 patients with intermediate grade non-Hodgkin's lymphoma were reviewed. Thirty-seven (47%) had abnormal hilar gallium uptake. Twenty-three of these could be fully evaluated, and only five (22%) had hilar lymphoma. A pattern of bilateral, symmetric hilar uptake was seen in 19 patients, but only one had evidence of lymphoma. In 15 cases, this pattern was seen only on single photon emission computed tomography (SPECT). The aetiology of this uptake remains unknown. It is not treatment related, as 12 patients had hilar gallium uptake prior to chemotherapy. Unless confirmed by other methods, hilar gallium uptake should not be attributed to lymphoma, and should not influence patient management.

Alberta↗
PubMed1979

Spinal-cord compression in myeloma.

Clinical records of 47 patients in whom spinal-cord compression was the presenting feature of plasma-cell myeloma were analysed retrospectively. Patients were referred during 1954-78. Median survival was 30 months and prognosis was best for those in whom the site of cord compression was the thoracic region. Early laminectomy and decompression followed by adequate radiotherapy resulted in complete or good partial response in over a third of patients who presented with complete paraplegia. Improvements in supportive care and more effective chemotherapy allow spinal-cord compression in myeloma to be treated promptly and vigorously, thus improving duration and quality of survival in a substantial proportion of patients.

Female↗
PubMed1979

A prospective randomized trial of vagotomy in chronic duodenal ulceration.

In a prospective, randomized trial, 76 patients with duodenal ulceration treated by truncal vagotomy and pyloroplasty were compared with 77 patients who underwent highly selective vagotomy. A total of 149 patients was followed up for from 1 to 4 years, the average follow-up period being 2.6 years. There was no operative mortality and no significant difference in postoperative morbidity between the two groups. The incidence of recurrent ulceration was greater after highly selective vagotomy, but this difference was not statistically significant. The clinical results were comparable in each group, and although the incidence of diarrhoea and dumping was greater after vagotomy and pyloroplasty, this difference was not statistically significant.

Adult↗
PubMed1978

Management of congenital adrenal hyperplasia. Urinary steroid estimations--review of their value.

A retrospective study was made of 16 children with 21-hydroxylase-deficient congenital adrenal hyperplasia of the salt-losing variety, who were treated with fludrocortisone and prednisone and were in good health during the period under review. The height velocity of the children was subnormal, height achievement was poor, and their bone ages retarded. Urinary 17-oxosteroid and pregnanetriol excretion were used to monitor the therapy of the children and these data have been related to growth velocities. In spite of urinary steroid figures in excess of those published as desirable for monitoring therapy, the children failed to grow properly, probably as a result of glucocorticoid overdosage. Published urinary steroid criteria are considered too strict and in order to achieve them one would need to give unnecessarily high doses of steroid. Regular measurement of height velocity and skeletal maturation rate are better indicators of therapeutic control and should lead to more satisfactory growth and ultimate height.

17-Ketosteroids↗
PubMed1976

Distribution of survival times of 12,000 head and neck cancer patients who died with their disease.

The lognormal parametric statistical model can provide, for groups of carcinoma cervix patients, good estimates of long-term survival fractions several years earlier than would otherwise be possible. The present paper extends this model work to head and neck cancer by using a minimum chi-squared test for goodness of fit (P greater than 0-05), to study the distribution of survival times of patients who died with their cancer present. Some 12,000 case histories were available from 7 hospital registries, 4 regional cancer registries and one national registry (the OPCS). All histories were followed up for at least 10 years subsequent to treatment and could be grouped into one of 8 cancer sites: antrum, floor of mouth, larynx, nasopharynx, pyriform fossa, post cricoid, tonsil and tongue. The theoretical distributions investigated were the lognormal, negative exponential and skew exponential. The results showed that the lognormal provided the best overall fit to the data, although the range of optimum values for the lognormal parameter, S, differed with cancer site. The optimum range did, however, usually include the value S=0-45. These results will now permit the second stage of validation of the lognormal model to proceed for head and neck cancers.

England↗