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Biomedical subjects

R D James

Publications and source records attributed to R D James.

52 records · Page 3Linked to original sources
PubMed1987

Quantitative magnetic resonance imaging in rectal carcinoma.

T1 and T2 relaxation times have been calculated in 30 patients with rectal carcinoma and seven patients with a fibrotic pelvic mass. The relaxation times were calculated using a multipoint iterative method with data from seven total saturation recovery and six spin-echo sequences. The results show that the calculated T1 relaxation value is a useful discriminant between carcinoma and pelvic fibrosis and should improve the detection of early tumour recurrence.

Adenocarcinoma↗
PubMed1985

Three months' treatment with cyclophosphamide, VP-16-213 followed by methotrexate and thoracic radiotherapy for small cell lung cancer.

One hundred eleven patients with inoperable but limited-stage small cell lung cancer were treated with three courses of cyclophosphamide (1.5, 2.5, and 3.5 g/m2, respectively) and VP-16-213 followed by methotrexate and thoracic radiotherapy. The total duration of treatment was 3 months. Patients were included who had pleural effusions, contralateral neck nodes, and bone marrow infiltration. The complete response (CR) rate was 56%, the majority confirmed by repeat bronchoscopy, with an 81% overall response rate. The minimum follow-up was 14 months. Median survival for all 111 patients was 11 months and 14 months (1-34+) for complete responders; the median survival was also 11 months for the 91 patients with conventional limited-stage disease, although 15 of the 19 patients alive at 14 months or more were from this subpopulation. There was no significant difference in the survival of those CR patients whose response was confirmed bronchoscopically and patients whose CR was assessed only radiologically and clinically. Forty-four patients with leukopenia (less than 1000 cells/microliter) received intravenous antibiotics for malaise and suspected infection. Close monitoring between treatments and direct access of patients to the hospital was encouraged. The majority of patients improved symptomatically as assessed by Karnofsky and Respiratory scores. These results support the view that short but intensive treatment without long-term or maintenance chemotherapy is beneficial.

Adult↗
PubMed1985

Resection of 'inoperable' rectal cancer following radiotherapy.

Forty-two patients with fixed inoperable adenocarcinoma of the rectum due to local extension in the pelvis have been treated using high dose radiotherapy followed by surgery when possible. Inoperability was determined initially by laparotomy in 15 patients and in the remainder by examination under anaesthetic. Twenty-nine patients underwent laparotomy following radiotherapy and resection was performed in 18. In three of these cases there was no residual tumour in the operation specimen. The median survival of the resected group was 28 months compared with 7 months for the unresected group. Treatment related mortality in the resected group was confined to five patients, two postoperative deaths and three small bowel fistulae which developed as late complications. Analysis of prognostic factors indicates that patients most likely to benefit from this approach are those with no evidence of distant metastases or of urinary obstruction at presentation. Patients who have a good clinical response to radiotherapy are more likely to achieve resection and subsequent long-term survival.

Adenocarcinoma↗
PubMed1985

Local radiotherapy in the management of squamous carcinoma of the anus.

This paper describes the results of treating 74 patients with squamous cell carcinoma of the anal canal and perianal skin using interstitial radiotherapy as primary treatment. This technique does not involve irradiation of regional lymph nodes. The local control rate for patients with tumours smaller than 5 cm and with negative inguinal nodes was significantly better than for the remaining patients (64 versus 23 per cent). Only 3 of 41 patients with tumours less than 5 cm diameter had clinically significant nodes at presentation, while in 33 patients with tumours larger than 5 cm there were 6 with involved nodes at presentation. Local treatment using interstitial radiotherapy is suggested as useful primary treatment for small, node-negative carcinomas, with surgery held in reserve for failures.

Aged↗
PubMed1985

Upper abdominal lymphadenopathy as first presentation of relapse, identified by ultrasonography, in patients treated for small cell (oat cell) bronchogenic carcinoma.

Ten patients treated for 'limited' stage small cell lung cancer presented during follow-up with epigastric or back pain together with nausea and/or vomiting. Upper abdominal lymphadenopathy was shown to be the first symptomatic site of relapse. A single fraction of radiotherapy provided a convenient, effective form of palliation. Ultrasound scanning proved an accurate, readily available technique for the diagnosis of this form of intra-abdominal disease.

Abdomen↗
PubMed1984

A randomised study of adjuvant chemotherapy after mantle radiotherapy in supradiaphragmatic Hodgkin's disease PS IA-IIB: a report from the Manchester lymphoma group.

One hundred and fourteen untreated patients with pathological stage (PS) IA-IIB supradiaphragmatic Hodgkin's Disease were randomised to mantle radiotherapy alone (55) or mantle radiotherapy followed by 6 courses of adjuvant chemotherapy with mustine, vinblastine, prednisolone and procarbazine- MVPP (59). Patients excluded were those outside the age range 16-65 years and those with massive mediastinal disease precluding laparotomy. Bulk disease was defined as a mass of lymph nodes measuring five centimetres or more in any axis. Mediastinal bulk was present if the ratio of the maximum width of mediastinal disease to the maximal chest diameter was more than one third. All patients achieved a complete remission. Median duration of follow-up was 62 months (range 16-97). The relapse free survival (RFS) was 81%; 69% for radiotherapy alone and 93% for adjuvant chemotherapy (P = 0.002). RFS was also shown to be adversely affected by B symptoms (P = 0.0003), bulk disease (P = 0.018), abnormal CXR (P = 0.037), and increasing stage (P = 0.039). Age, sex, histology, and number of sites involved had no significant effect upon RFS. A Cox multivariate analysis showed that only three variables had a significant adverse effect on RFS - radiotherapy alone, the presence of bulk disease, and B symptoms. The overall 5 year survival was 93% with no statistically significant difference between the two treatment groups (P = 0.54). Survival was adversely affected by three variables - B symptoms (P = 0.02), the presence of bulk disease (P = 0.002), and pathological stage (P = 0.05). High risk groups for relapse are those with bulk and B symptoms. This analysis has shown that RFS was significantly improved by adjuvant chemotherapy, but that overall survival was not.

Adolescent↗
PubMed1984

Ovarian cancer antigen CA125: a prospective clinical assessment of its role as a tumour marker.

Serum CA 125, quantified by an immunoradiometric assay employing the monoclonal antibody 0C125 was found to be elevated in 48/58 (83%) of patients with established ovarian cancer. All histological types of carcinoma were antigen positive and there was a positive correlation between the frequency and level of serum CA125 and body burden of tumour. Twenty patients undergoing chemotherapy had serial CA125 estimations following a prospective protocol. Variation in CA125 level reflected disease progression or regression in 21/23 instances. Three of 9 patients tested showed an acute elevation of CA125 in the first week following chemotherapy and this effect predicted a good response to treatment. The natural half-life of CA125 in serum was estimated at approximately 4.8 days, sufficiently short to allow changes in tumour volume to be rapidly reflected by a change in circulating antigen level. Although none of 15 patients with non-Hodgkin lymphoma demonstrated antigen levels outside the normal range, 11/27 patients with non-ovarian adenocarcinoma showed elevated CA125 levels, a specificity of 58% for this latter group. The value of CA125 in the management of ovarian malignancy is discussed.

Antigens, Neoplasm↗
PubMed1984

Computed tomographic scanning in rectal carcinoma.

Computed tomographic (CT) scanning has been used to assess the extent of local spread in 85 patients with rectal carcinoma. In 37 patients with carcinoma of the rectum who were scanned before surgery, good correlation was found between the extent of local invasion, as assessed by scanning, and that demonstrated at operation by histological assessment. Scanning is not a reliable method for assessing regional lymph node involvement. Forty-eight patients presented with recurrent rectal carcinoma after previous rectal excision (30 patients after abdominoperineal and 18 patients after anterior resection). CT scanning was shown to be a valuable tool in establishing the diagnosis of recurrent tumour. Most of these patients have spread which precludes further curative surgery. CT may identify those patients who have a resectable recurrence, but is especially valuable in planning radiotherapy which may be used for palliation.

Aged↗
PubMed1983

Prognostic factors in locally recurrent rectal carcinoma treated by radiotherapy.

An analysis has been made of the symptomatic response and survival of 143 patients following radiotherapy for locally recurrent rectal cancer. Computerized tomography (CAT) was performed on 45 patients. Of 119 evaluable patients, 54 had a good response to radiotherapy, 29 a moderate response and 36 no apparent response. Median response was 9 and 3 months respectively in the good and moderate groups. Median survival was 15, 9 and 5 months for the three groups. Latent interval between surgery and radiotherapy appeared to be of prognostic importance. When this exceeded 2 yr median survival was 12 months compared with 7 months for patients with a latent interval of less than 2 yr. Tumour volume measured by computed tomography may have prognostic importance. Radiotherapy should be considered for most patients with symptomatic recurrence. Surgery might be combined with radiotherapy for selected groups of patients with good prognosis.

Female↗
PubMed1982

Retinopathy in adolescents and young adults with onset of insulin-dependent diabetes in childhood.

Retinal studies were done in 181 postpubescent, insulin-dependent diabetic patients who developed diabetes before the age of 20. Retinal studies included serial direct ophthalmoscopic examinations, stereoscopic fundus photography and fluorescein angiography. At the time of retinal studies, muscle biopsies also were done to measure capillary basement membrane thickness (CBMT) as an index of early microvascular changes in skeletal muscles. Assessment of clinical metabolic control, interpretation of retinal findings, and CBMT were done independently. No retinopathy was detected in patients observed continuously and known to have been in higher degrees of metabolic control. Twenty-five patients in lower degrees of control for extended periods had retinopathy. CBMT was found to be labile and to progress or regress within a year depending on the degree of control. All patients in lower degrees of control with retinopathy had increased CBMT, but if they subsequently attained and maintained a high degree of control for a year, then CBMT diminished and there was no progression of retinopathy. Our study demonstrates that a high degree of metabolic control delays, and may prevent, microvascular changes, and confirms other studies indicating that most postpubescent, insulin-dependent diabetic patients will develop retinopathy within 15 years unless a relatively high degree of control is maintained.

Adolescent↗
PubMed1979

When should radiotherapy be given for rectal cancer?

There are a number of reasons why radiotherapy is better given before rather than after radical surgery for rectal cancer. When this policy is adopted, however, two related problems arise. First, how are patients requiring radiotherapy to be selected? Second, how are irradiated patients to be compared with unirradiated patients stage by stage in clinical trails? It is suggested that the Dukes' staging system in inappropriate for both, and that a clinical staging system for rectal cancer is urgently required to solve both these problems. The way in which such a staging system might be developed is indicated. In the meantime trials of adjuvant radiotherapy for carcinoma of the rectum should be interpreted with caution for two reasons. First, a reduction in local recurrence may not necessarily be reflected in a reduction in death rates. Second, since the origin of local recurrence is obscure, the radiation dose to the regional lymph nodes should be recorded carefully.

Humans↗
PubMedDate not supplied

Recombinant human erythropoietin and platinum-based chemotherapy in advanced ovarian cancer.

PURPOSE: Patients with ovarian cancer often experience dose-limiting myelotoxicity, nephrotoxicity and anemia following treatment with platinum-based chemotherapy. PATIENTS AND METHODS: To investigate the ability of recombinant human erythropoietin (epoetin alfa) to prevent the development of anemia, 30 patients with advanced ovarian carcinoma receiving cisplatin or carboplatin were randomly assigned to treatment with subcutaneous epoetin alfa 300 IU/kg three times a week in addition to conventional supportive treatment, or conventional supportive treatment alone, for up to six chemotherapy cycles. The dose of epoetin alfa was reduced if hemoglobin concentration exceeded 15 g/dL. RESULTS: A highly significant difference in mean hemoglobin concentrations was observed between the two groups during the first cycle of chemotherapy due to a significant decrease in mean hemoglobin concentration in the control group. A maximal difference of 3.4 g/dL was achieved during cycle three. Fewer patients required blood or platelet transfusions in the epoetin alfa-treated group, although the difference was not significant compared to the control group. Epoetin alfa was well tolerated. CONCLUSION: Epoetin alfa appears to be effective and well tolerated in preventing hemoglobin decline in patients undergoing aggressive cyclic platinum-based chemotherapy for advanced ovarian carcinoma.

Adolescent↗