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N Rowell

Publications and source records attributed to N Rowell.

11 recordsLinked to original sources
PubMed2005

A randomised trial in malignant mesothelioma (M) of early (E) versus delayed (D) chemotherapy in symptomatically stable patients: the MED trial.

BACKGROUND: Prior phase II trials have demonstrated the therapeutic activity of cytotoxic chemotherapy in mesothelioma. Currently there are few randomised data assessing the role of chemotherapy versus best supportive care (BSC) in the management of patients with stable symptoms after control of any pleural effusion. A policy of observation is often adopted over initial use of chemotherapy. In this prospective randomised trial we assess the use of early versus delayed cytotoxic therapy. The study opened in 1998, and closed in view of a competing national study (MSO 1) in 2003. METHODS: Eligible patients had a performance status 3 months and had stable symptoms for at least 4 weeks prior to randomisation. Patients were randomised to receive immediate chemotherapy or initial BSC with the addition of chemotherapy at time of symptomatic progression. All patients received the same platinum-based chemotherapy regimen, MVP [mitomycin C 8 mg/m2 cycles 1, 2, 4 and 6, vinblastine 6 mg/m2, maximum 10 mg, and cisplatin 50 mg/m2 (or carboplatin AUC 5)], every 3 weeks for up to six cycles. RESULTS: A total of 43 patients were recruited, of which 21 were randomised to the early treatment group and 22 to the delayed treatment group. The median ages were 59 years (range 50-78) and 67 years (range 48-75), respectively (P=0.1); other baseline parameters were well matched between the two groups. All 21 patients in the early group received chemotherapy versus 17 patients in the delayed group. Median time to symptomatic progression was 25 weeks in the early group compared with 11 weeks for the delayed group (P=0.1). Median survival was 14 months (1-year survival 66%) for the early group compared with 10 months (1-year survival 36%) for the delayed group (P=0.1). Quality of life was in general better maintained for early treatment and the health resources use was similar in both arms. CONCLUSIONS: In this patient group, presenting with stable symptoms after control of pleural effusion, the early use of chemotherapy provided an extended period of symptom control, and in this small trial a trend to survival advantage.

Aged↗
PubMed1989

Reactive hyperemic responses in systemic sclerosis patients and healthy controls.

Hyperemic responses after arterial occlusion were investigated in patients with Raynaud's phenomenon due to systemic sclerosis (SSc) and in healthy controls. The hyperemia due to arterial occlusion for 2 min was measured by laser-Doppler flowmetry. If the hyperemic response was absent, the measurements were repeated after vasodilatation was induced by hand warming in warm water. Reactive hyperemia was absent in 12 patients when investigations were performed on the unwarmed hand, and these patients had very low resting blood flows. After vasodilatation was induced in these patients, and also in those patients whose resting blood flow was normal, hyperemic responses were comparable in magnitude with those in the controls. The slope of the hyperemic response was significantly less in the patients (1.11 +/- 0.02 V/s) than in the controls (1.28 +/- 0.03 V/s), and therefore, the time course of the hyperemia was lengthened in the patients with SSc, with a delay to achieving maximum blood flow of 2 min. Peak blood flow was directly related to the level of the initial blood flow. These findings support the view that reactive hyperemia is principally a mechanical phenomenon, and also that vessel wall reactivity is abnormal in SSc, producing delayed hyperemic responses. The magnitude of the hyperemia depends on initial flow rates, and the apparent lack of these responses in SSc is a result of their low, but reversible, resting blood flow.

Constriction↗
PubMed1987

Autoantibodies and immunogenetics in 30 patients with systemic sclerosis and their families.

Clinical and serological evidence of connective tissue disease was found in a high proportion of 132 family members of 30 patients with systemic sclerosis. In 20 probands with the milder CREST form of the disease, 10 had HLA-DR5 and 12 had null alleles at the C4 loci. None of 11 probands with more severe systemic sclerosis had HLA-DR5; all 11 had null alleles at the C4 loci. All but two of the probands had either HLA-DR5 or a C4 null allele, and this was also the case for the majority of the relatives with autoantibodies. Genetic markers of the major histocompatibility complex, including HLA-DR5 and C4 null alleles, appear to be closely associated with markers of disease in these probands and their families.

Antibodies, Antinuclear↗
PubMed1977

Digital ischaemia due to vascular anomalies.

Four patients presenting with painful persistent cyanosis or gangrene of the fingers were found to have anomalies of arterial circulation of the hands and fingers. Investigations for systemic disease were negative. It is postulated that variations in the normal arterial anatomy predispose to digital ischaemia and that trauma, the contraceptive pill or infection may precipitate small thromboses and give rise to clinical ischaemia. Angiography should be undertaken in all patients presenting with persistent ischaemia of the fingers and toes, when the peripheral pulses are present and systemic disease has been excluded.

Adult↗
PubMed1972

Urticaria.

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Angioedema↗