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Biomedical subjects

M Tattersall

Publications and source records attributed to M Tattersall.

11 recordsLinked to original sources
PubMed1992

Pleural effusions.

Pleural effusions are a common development in patients with cancer. The optimal means of control are not defined, but systemic treatment is often effective in patients with drug-sensitive tumors. Local treatments advocated in the management of malignant pleural effusions differ in the means of drainage, the length of time pleural tubes are left in situ, and the type of intrapleural therapy administered. Randomized trials published in the past few months have suggested that bleomycin sulfate may be superior to tetracycline as a sclerosant and that mitoxantrone does not add to control of effusions compared with large-bore pleural tube alone placed at time of thoracoscopy.

Algorithms↗
PubMed1991

Percutaneous urinary diversion in gynecologic oncology.

During the 10-year period after 1979, percutaneous urinary diversion (PCUD) was performed on 35 patients whose mean age was 53.5 years (30-80 years). Twenty-one patients (60%) had Stage IIB-IV cervical cancer, 11 (31%) Stage IB-IIA cervical cancer, 2 (6%) Stage IB-II endometrial cancer, and 1 (3%) Stage IB vaginal cancer. All had radiological evidence of ureteric obstruction and 8 patients also had urinary tract fistulae. Serum creatinine levels were elevated in 24. Following diversion there was a significant fall in mean pretreatment creatinine levels from 482 mumol/liter (range, 70-1703 mumol/liter) to 131 mumol/liter (range, 60-290 mumol/liter; P less than 0.0001); those patients with normal creatinine levels prior to diversion also had a reduction in their levels. A significant fall in mean serum urea levels from 22.0 mmol/liter pre- to 11.9 mmol/liter post-PCUD (P less than 0.001) was also noted. Minor complications occurred and included hemorrhage, replacement/reinsertion, infection, and blockage. Median survival of the 35 patients after PCUD was 6 months (mean, 16.5 months). For the 11 with normal pretreatment renal function median survival was 16 months (mean, 41 months) compared to 2.5 months (mean, 5.1 months) for those with elevated pretreatment serum creatinine levels. Median survival with untreated malignancy was 7 months (mean, 19.6 months) and 6 months (mean, 12.3 months) in patients with previously treated cancer. PCUD is indicated in previously untreated patients with gynecologic cancer so that primary therapy can be instituted. The role of urinary diversion in patients with previously treated cancer must be individualized. Palliative diversion is appropriate in selected patients where additional therapy is expected to prolong life, where symptom control is needed, or to allow the patient to return home for a significant proportion of the remainder of life.

Adult↗
PubMed1991

Women's perceptions of screening mammography.

A random sample of women in Sydney were interviewed by telephone to determine their knowledge about and attitudes to mammography. A response rate of 56 per cent (628 women) was obtained. While the majority of women had had some experience with breast cancer, knowledge about which age groups were most at risk and treatment alternatives was limited. Only about half of the sample had heard about screening mammography before the survey. However, when a simple explanation was given, 79 per cent expressed a favourable attitude toward it. Only 22 per cent of women thought of themselves as being personally susceptible to breast cancer; the proportion was lower in women over 60 than in those in their 40s. Morbid concern about breast cancer was rare. About a quarter of the sample expressed concern about mammographically induced exposure to radiation. Attitudes and perceptions of personal susceptibility were not associated with knowledge about risks of breast cancer. However, having a favourable attitude and a lack of concern about radiation were associated with previously having heard about screening mammography. Women speaking a language other than English at home and from households where the main income earner was in an unskilled occupation were least likely to have heard of screening mammography. Suggestions for data-based recruitment strategies are discussed.

Attitude to Health↗
PubMed1990

Effective salvage chemotherapy with etoposide, dactinomycin, and methotrexate in refractory germ cell cancer. Australasian Germ Cell Trial Group.

Fifty-one patients with advanced germ cell malignancy who had either failed to achieve complete remission with initial cisplatin, vinblastine, and bleomycin chemotherapy or who had relapsed after complete response (CR) to this therapy and then proven refractory on retreatment, were treated with etoposide (75 mg/m2 for 3 days), dactinomycin (1 mg/m2 day 1), and methotrexate (30 mg/m2 day 1) (EAM) every 3 weeks. Courses were continued until maximum response without empirical limit, and if complete remission was achieved, two courses of consolidation therapy were given before cessation of treatment. Thirteen patients (25%) were complete responders with residual masses containing fibrosis or benign teratoma being subsequently resected in seven patients. Two patients had persisting viable carcinoma within residual masses that were completely resected, leaving no evidence of disease (NED); the combined CR plus NED rate was 29%. The only pretreatment factor significantly influencing this response rate was tumor volume. Toxicities were moderate, with leukopenia being observed in 28% of patients, but it was severe in only 2%. There was one death from septicemia. Severe nausea and vomiting occurred in only 9% of patients and treatment-related stomatitis was observed in 42%. All patients achieving CR plus NED have been followed for a minimum of 5 years and no relapses have occurred, suggesting that these patients are cured. Unlike other regimens of salvage chemotherapy, this treatment program did not contain cisplatin and it is contended that a completely noncrossresistant drug regimen based on etoposide provides the opportunity to further improve the curability of patients with advanced germ cell cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Encouraging attendance at screening mammography: knowledge, attitudes and intentions of general practitioners.

We surveyed a random sample of 200 general practitioners from the Sydney metropolitan area about their attitudes to and knowledge of screening mammography. General practitioners' knowledge about some aspects of screening mammography was found to be limited; only 25% of the sample knew that the risk of breast cancer increases with age and only 30% of the sample knew that the evidence for a reduction in mortality as a result of mammographic screening is weakest for women of less than 50 years of age. Ninety-five per cent of general practitioners were of the opinion that breast self-examination and clinical examination were important for asymptomatic women of more than 45 years of age compared with the 75% of respondents who viewed mammography in the same way. Scores on a scale that was constructed to measure attitudes to mammographic screening showed that 20% of general practitioners had a "very favourable" attitude, and that a further 67% of general practitioners had a "favourable" attitude. No general practitioners had a "very unfavourable" attitude. Eighty-four per cent of general practitioners indicated that they would recommend that their patients attend a free screening-mammography service. Willingness to recommend mammographic screening was predicted by a general practitioner's attitude score. The strongest component of this prediction was a belief that the benefits of screening mammography outweighed the radiation risks. General practitioners need to be supplied with correct information about target groups for screening, so that women in the appropriate age-groups are encouraged to attend screening programmes.

Age Factors↗
PubMed1989

Dose intensity and outcome with combination chemotherapy for germ cell carcinoma. Australasian Germ Cell Trial Group.

Two hundred and fifty-three patients with advanced stage germ cell carcinoma received induction chemotherapy with vinblastine, bleomycin and cisplatin, sometimes with subsequent surgical resection of residual masses. Overall, 191 patients (76%) achieved complete remission or no evidence of disease after surgery (CR + NED). With 64 months median follow-up only 24 patients have relapsed (13%) and 68% of all patients treated are long-term survivors and 84% of patients entering CR + NED are alive. Toxicity with this chemotherapy was considerable, including seven deaths from leukopenia and septicaemia and eight deaths from bleomycin lung toxicity. Dose reductions or omissions of the drug from the treatment programme was necessary with cisplatin in 8% of patients, with vinblastine in 37% and with bleomycin in 35% of patients. Analysis of these alterations in dose intensity for each drug revealed that initial treatment response and subsequent survival were not compromised by reductions in intended doses of drug administered for either vinblastine or bleomycin. Too few patients had dose reductions of cisplatin for meaningful analysis. This apparent lack of major dose-response effect for either vinblastine or bleomycin in the present treatment programme for germ cell carcinoma has prompted the initiation of a randomized study to determine whether deletion of bleomycin from treatment for patients with good prognostic pretreatment characteristics improves the therapeutic index of this very successful therapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

A comparative study of proliferating (borderline) and invasive epithelial ovarian tumours in young women.

A series of 18 patients with proliferating or borderline ovarian tumours and 18 with invasive ovarian tumours is discussed. Proliferating tumours occurred at a younger mean age than invasive disease, and presented at an earlier stage, both contributing factors to their more favourable outlook. Histopathological assessment revealed that the majority of both proliferating and invasive tumours were of serous origin. Mucinous cell type occurred less often as did the endometrioid and clear cell types. The management of the proliferating tumours involved 'radical' surgical procedures in 11 of 18 (61.6%) patients. Only 7 patients (38.8%) had conservative surgical procedures performed. Six patients (33%) had adjuvant chemotherapy while 2 (11%) also underwent abdominopelvic irradiation. All patients with invasive disease had radical surgery and adjuvant chemotherapy and 2 also received abdominopelvic irradiation. The fact that epithelial malignancies of the ovary do occur in younger women needs to be remembered by gynaecologists contemplating surgical procedures on younger patients with adnexal masses. Proliferating or borderline tumours tend to occur more frequently in the younger age groups, and contrary to the implication of their name, they are associated with significant morbidity and mortality.

Adolescent↗
PubMed1988

A prospective study of cisplatin-based combination chemotherapy in advanced germ cell malignancy: role of maintenance and long-term follow-up.

Two hundred fifty-three patients with advanced germ cell malignancy received initial chemotherapy with cisplatin, vinblastine, and bleomycin followed by surgical resection of residual masses if possible. Patients achieving complete remission (CR) were prospectively randomized to receive 6 months maintenance therapy with vinblastine or no further treatment. CR was achieved in 183 patients (72%) and a further eight patients (4%) had complete resection of residual viable malignancy (no evidence of disease [NED]). Pretreatment factors having a significant adverse influence on response by univariate analysis included extragonadal origin of the tumor, poor performance status, advanced lung or lung and abdominal disease, and elevated serum levels of human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) greater than 1,000 ng/mL. Multivariate regression analysis indicated the independent prognostic factors of significance were advanced lung or advanced lung and abdominal disease, total tumor diameter greater than 10 cm, and a serum level of HCG greater than 1,000 ng/mL. Of the toxicities encountered, myelosuppression was significant, being exacerbated by radiotherapy, and seven deaths occurred from septicemia. Bleomycin pulmonary toxicity occurred in 46% of patients and was severe in 4%, resulting in eight deaths. With a median follow-up of 64 months, relapses have occurred in 25 patients with no significant difference between those patients receiving or not receiving maintenance vinblastine. Eight of these relapses occurred beyond 1 year and four beyond 2 years of follow-up. Presently, 68% of the total patient population is alive and disease-free, with 84% of the CR and NED patients alive and 81% alive and disease-free. It is concluded that with prolonged follow-up, vinblastine maintenance therapy does not improve treatment outcome. Moreover, late relapses occur, cautioning against premature pronouncements of cure.

Adolescent↗
PubMed1987

Phase I study of epirubicin given on a weekly schedule.

Epirubicin was studied in a phase I setting to find the maximum tolerated dose when given weekly for 3 of 4 weeks. Forty-one evaluable patients were treated in groups at doses increasing from 20 to 45 mg/m2. The highest dose level produced the maximum degree of myelosuppression (lowest neutrophil count, 1.9 X 10(9)/L; range, 0-3.7) recorded on Day 22. This was well-tolerated in this group of mainly pretreated patients. Nonhematologic side effects were minimal. This dose schedule allows a greater dose per unit time to be administered than other recommended schedules for epirubicin.

Adult↗