PubMed Health⌕ Search

Biomedical subjects

R Milroy

Publications and source records attributed to R Milroy.

At least 37 records · Page 2Linked to original sources
PubMed1996

Interviewing cancer patients in a research setting: the role of effective communication.

A case-control study of quality of life in patients with lung cancer was carried out. The investigation was conducted by means of a series of interviewer-administered instruments. As part of the study, patients' attitudes towards the interviewer-administered questionnaires were studied. Previously we reported that a high proportion of the patients found being interviewed acceptable. The present study firstly examines why patients found being interviewed acceptable and secondly investigates whether there is an association between gender, age, diagnosis, place of interview, patients' overall health status, global quality of life and patients' feelings. Two hundred and thirty-two patients attending an outpatient clinic with either lung cancer or chronic respiratory disease were interviewed by means of a short questionnaire. They were asked to indicate their feelings about interviews, and to explain the reasons why they had their particular feelings. We documented issues on communication between interviewers and patients. These include observations on interviewing cancer patients, interviewing at home, and interviewing in the clinic. Nearly all the patients (96%) indicated that they found being interviewed acceptable. A content analysis of data showed that patients' feelings can be attributed to four major themes: the interview was not disturbing, they felt relaxed and at ease, they liked to talk, and the interview was conversational. There were no significant association between gender, age, diagnosis (cases and controls), place of interview, patients' overall health status and global quality of life and the reasons expressed. Practical experience from interviewing patients at home or in the clinic reveals several issues on communication between interviewer and patients. The study results suggest that apart from communication factors, other parameters such as age, gender, diagnosis, overall health status and quality of life and interview setting do not have significant role in patients' feelings about interviews. If data on quality of life studies are to be collected by interviewers, then proper communication is essential. How to achieve this remains a major question.

Adult↗
PubMed1996

Quality of life: perception of lung cancer patients.

An investigation was carried out to examine what quality of life means to lung cancer patients. 200 patients with either lung cancer (108) or chronic respiratory disease (92) were interviewed using a short open-ended questionnaire. They were asked to define quality of life in general, identify what they considered to be a good quality of life for themselves and to rank the relative importance attached to each nominated item. A content analysis was carried out and patients' responses were categorised into eight items. These were: ability to do what one wants to do/work, enjoyment of life, family life, financial security, happiness, health, living longer and social life/leisure activities. Of these, health (42%), enjoyment of life (25%) and family life (24%) were the three most nominated items as definition of quality of life in general. Patients perceived a good quality of life for themselves differently. Family life (58%), health (51%) and social life (43%) were found to be the most nominated components of a good quality of life for the patients. Overall, patients ranked family life and health as the first or second most important factors. There were no significant differences between cases and controls. The study results are challenging and serve to remind us that the term quality of life is misused in many studies. Most existing measures do not encompass the wider aspects of quality of life identified here, but rather concentrate on the "health-related" aspects of quality of life. To achieve this, the research into the best ways of measuring and assessing quality of life must continue to seek individual values and preferences and how these can be applied in a simple way in clinical studies.

Adult↗
PubMed1996

The relationship between weight loss and interleukin 6 in non-small-cell lung cancer.

Markers of the inflammatory response, interleukin 6, C-reactive protein, albumin and full blood count, were measured in non-small-cell lung cancer (NSCLC) patients (n = 21) with and without weight loss ( > 5%). There were significant increases in circulating C-reactive protein (P < 0.001), interleukin 6 (P < 0.01) and platelets (P < 0.01) in the weight-losing group. Moreover, there was a statistically significant correlation (r = 0.785, P < 0.001) between interleukin 6 and C-reactive protein concentrations. These results are consistent with interleukin 6 and the acute phase response promoting weight loss in NSCLC.

Acute-Phase Reaction↗
PubMed1995

Actinomycosis presenting as carcinoma.

Actinomycosis is rare compared to carcinoma, but the two conditions can present with very similar clinical pictures. Two cases of actinomycosis are reported, one thoracic and one pelvic-abdominal which presented as carcinoma and proceeded to surgery without a histological diagnosis having been established.

Actinomycosis↗
PubMed1995

Clinical and in vitro effects of recombinant human erythropoietin in patients receiving intensive chemotherapy for small-cell lung cancer.

PURPOSE: Recombinant human erythropoietin (r-Hu-EPO) is known to be effective in untreated cancer patients. Here we assess the possibility that r-Hu-EPO may also prevent or reduce anemia in patients who receive cytotoxic chemotherapy. METHODS: Thirty-six patients with small-cell lung carcinoma (SCLC) were enrolled onto a three-arm, randomized trial to investigate the effect of r-Hu-EPO on hemoglobin (Hb) levels and RBC and platelet (Plt) transfusions during chemotherapy. Bone marrow progenitors were studied before and after treatment. Two groups of patients received r-Hu-EPO at a dose of either 150 IU/kg (group 150) or 300 IU/kg (group 300) three times per week for the duration of chemotherapy. A control group did not receive r-Hu-EPO (group O). A maximum of six cycles of a chemotherapy regimen that consisted of vincristine, ifosfamide, carboplatin, and etoposide (VICE) were given to all patients. Hematologic parameters were measured weekly, and RBC or Plt transfusions were given for Hb levels less than 9 g/dL and Plt counts less than 20 x 10(9)/L. RESULTS: Hb levels decreased in all patients, but onset of anemia was delayed in groups that received r-Hu-EPO (P = .002). A total of 116 U RBC were transfused in group 0, 54 in group 150, and 52 in group 300 (P = .017). In addition, there was a nonsignificant trend toward higher Plt counts and fewer Plt transfusions in patients who received r-Hu-EPO. CONCLUSION: r-Hu-EPO at a dose of either 150 or 300 IU/kg three times weekly delays the onset of anemia and reduces RBC transfusion requirements in patients who undergo intensive chemotherapy for SCLC. A possible effect of r-Hu-EPO on platelet numbers deserves further study.

Adult↗
PubMed1994

Relative importance of DT-diaphorase and hypoxia in the bioactivation of EO9 by human lung tumor cell lines.

PURPOSE: Although a number of bioreductive agents are substrates for purified DT-diaphorase the role of this enzyme in either activation or detoxification of these agents in the whole cell is unclear. The aim of this study was to determine the role of DT-diaphorase in the metabolic activation of EO9 under both aerobic and hypoxic conditions. METHODS AND MATERIALS: A panel of lung cancer cell lines was used and drug sensitivity was determined by clonogenic or tetrazolium-dye-based assays. Activities of DT-diaphorase, cytochrome P450 and cytochrome b5 reductase were determined spectrophotometrically by following the reduction of cytochrome c. RESULTS: Small-cell lung cancer cell lines showed a 600-fold range in DT-diaphorase activities but levels were much higher in three of the four non-small-cell lines. Activities of cytochromes P450 and b5 reductase were much lower than those of DT-diaphorase and showed much less variation between cell lines. There was no relationship between the activities of any of the enzymes and aerobic sensitivity to SR 4233, BCNU and cis-platin. Under aerobic conditions there was a clear correlation between DT-diaphorase activity and sensitivity to EO9. The small-cell lines were much more resistant to EO9 than the DT-diaphorase rich non-small-cell lines. A doxorubicin resistant variant of one of the small-cell lines (H69LX10) did not show cross resistance to EO9 but did show a small degree (3-fold) of cross resistance to SR 4233. Under hypoxic conditions, cell lines with high levels of DT-diaphorase showed only a small increase in sensitivity to EO9 (1.5-7 fold); cell lines with low levels of activity showed a 10-37-fold increase in sensitivity. CONCLUSION: These results suggest that under hypoxic conditions, EO9 is metabolized by 1-electron reducing enzymes to a toxic species. This reduction product is oxygen sensitive but a similar degree of activation is obtained under aerobic conditions in cell lines with high levels of 2-electron reducing DT-diaphorase.

Antineoplastic Agents↗
PubMed1994

Effects of priming and suppression of worry.

High and low worriers were primed by a short period of worry, suppression of worry, or the same period of non-worrying thought. Analysis of thoughts during the period following showed that worriers had more than twice as many unpleasant thoughts as did controls, across all prior conditions. Priming condition had little effect on this difference, although worry suppression was associated with a slight increase in the frequency of neutral or pleasant thoughts in high worriers, and a slight decrease in controls. These results are taken as evidence against the hypothesis that suppression of upsetting thoughts increases their intrusive quality, and thereby contributes to anxiety disorders.

Adult↗
PubMed1993

A randomised clinical study of verapamil in addition to combination chemotherapy in small cell lung cancer. West of Scotland Lung Cancer Research Group, and the Aberdeen Oncology Group.

Proliferation of drug resistant tumour following chemotherapy is the principal cause of treatment failure in small cell lung cancer (SCLC). Verapamil has been shown to partially restore drug sensitivity in tumour cells rendered resistant in vitro. The results of the first large-scale randomised study of a resistance modifying drug given in conjunction with chemotherapy in cancer patients are reported. Two hundred and twenty-six patients have been entered. All patients received four cycles of cyclophosphamide (750 mg m-2), doxorubicin (40 mg m-2) and vincristine (1.4 mg m-2) on Day 1 and etoposide (75 mg m-2) on Days 1, 2 and 3, repeated at 21 day intervals. Those patients randomised to the verapamil arm received oral verapamil 120 mg qid for 5 days with each course of chemotherapy. Similar numbers of cycles of protocol treatment were given in both arms with over 75% of patients completing all four cycles. There were no significant differences in general toxicities between the two arms, except for more severe alopecia in the verapamil treatment group (P = 0.045). There was no significant difference in cardiovascular or haematological toxicity, although the median nadir white cell count after Cycle 1 chemotherapy was lower in the verapamil arm (P = 0.065) and there were significantly more dose reductions after Cycle 1 in the verapamil arm (P = 0.031). No statistically significant differences in response (P = 0.582) or survival (P = 0.290) data were seen. The absence of a significant improvement in response or survival using verapamil may relate to the low blood levels of verapamil seen in the clinic (0.8 microM), in contrast to those known to be maximally active in vitro (> 6 microM) or to the presence of other cellular mechanisms by which drug resistance develops.

Adult↗
PubMed1992

Preliminary observations concerning treatment of visual discomfort and associated perceptual distortion.

A system for therapeutic precision tinting is described. Some individuals who are subject to perceptual distortion of text no longer perceive the distortion when the text has a particular colour. A simple colorimeter enables an observer to illuminate text with light of a particular chromaticity, varying first CIE 1976 hue angle (huv), then saturation (suv), and then luminance, to obtain a setting that maximizes visual comfort and reduces any perceptual distortion. The colorimeter setting is then matched by a combination of tinted trial lenses. The combination uses only two dyes at a time from a selection of seven, unless a dark lens is required, when a third neutral (grey) dye is added. The subject observes both text and a normal scene when wearing tinted trial lenses. A variety of trial lenses are compared including those that match the colorimeter setting and others with similar hue angle. Spectacle lenses are then tinted so as to have a spectral transmission identical to that of the chosen combination of trial lenses. Certain patients with reading disorders, eye-strain, headaches or photosensitivity epilepsy report benefit when wearing spectacles tinted according to the above techniques. The physiological basis for the therapeutic effects is uncertain, but may involve a selective impairment of luminance or colour-difference channels.

Adolescent↗
PubMed1992

Extrapulmonary small cell carcinoma of bone.

Small cell carcinoma has been reported to arise in many extrathoracic sites. However, such tumours arising from bone have not been previously described. We report what we believe is the first reported case of extrapulmonary small cell carcinoma of bone. The tumour arose from the fifth dorsal vertebra in a 60 year old woman. The patient was treated with local radiotherapy and combination chemotherapy and remains in remission, 18 months after diagnosis. As such extrathoracic small cell tumours are rare, there seem to be no clear-cut guidelines for treating them, but combination chemotherapy is recommended.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

1990 Mary J. Nielubowicz Award winner. Observations on stress reactions as seen in Naval Reserve Fleet Hospital training evolutions.

Intense field medical exercises, survival and weapons training are of vital importance to the Naval Reserve Fleet Hospital. This training is, of necessity, stressful and chaotic in order to simulate combat conditions. It must be planned that way to be realistic. We must do this to test our ability to function in abnormal situations. Yet, we must be sensitive to the needs of our shipmates. We need to provide support and understanding so that all can successfully carry the burdens placed upon them. Education, stress debriefings, and leadership skills may answer this need.

Adaptation, Psychological↗
PubMed1990

The activity of verapamil as a resistance modifier in vitro in drug resistant human tumour cell lines is not stereospecific.

The L-isomer of verapamil is a more potent calcium antagonist than the D-isomer. We have examined the two stereoisomers of verapamil for their ability to increase the chemosensitivity in vitro of three drug resistant cell lines (2780AD, MCF7/AdrR and H69LX10). Neither racemic verapamil nor its individual isomers had any effect on the drug sensitivity of the parent cell lines (A2780, MCF7 and NCI-H69). Verapamil (6.6 microM) increased the sensitivity of all three resistant cell lines to Adriamycin by 10-12-fold. This activity was concentration dependent and was maximal at 6-7 microM. The increase in sensitivity was only 2-3-fold at 2 microM, the maximum plasma concentration achieved in patients. Both the D- and L-isomers of verapamil alone at 6.6 microM were as effective as racemic verapamil and the D-isomer demonstrated the same concentration dependent activity as racemic verapamil. The total cellular Adriamycin concentration of both 2780AD and MCF7/AdrR was increased by two-fold in the presence of verapamil (6.6 microM). Both D- and L-verapamil alone increased the amount of drug accumulated to the same extent as racemic verapamil. These results indicate that the resistance modification activity of verapamil is not stereospecific. Use of D-verapamil alone in patients could increase the maximum tolerated plasma concentrations of verapamil and thus D-verapamil may be a more effective resistance modifier in vivo than racemic verapamil.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1990

High dose epirubicin chemotherapy in untreated poorer prognosis small cell lung cancer.

A single agent chemotherapy regimen, comprising epirubicin 120 mg m-2 iv at 21-day intervals for a maximum of six cycles was administered to 26 patients with intermediate or poor prognosis small cell lung cancer. Staging consisted of both conventional disease extent and prognostic guidelines based on laboratory parameters. The overall response rate was 57% which predominantly occurred among the intermediate prognosis group (14 of 17 patients), compared with only 1 of 9 patients in the poor prognosis category. Seven patients survived for at least 12 months, including one 3-year survivor (remains disease free). Chemotherapy toxicity was easily managed and chemoresponse was generally accompanied by an improvement in perceived performance rating. The study confirms the activity of epirubicin against small cell lung cancer and emphasizes the importance of patient selection within the spectrum of small cell lung cancer.

Adult↗
PubMed1990

201Tl scintigraphy in the staging of lung cancer, breast cancer and lymphoma.

To evaluate 201Tl in the detection of the primary tumour, lymph node involvement and mediastinal spread we have studied a total of 188 patients with histologically proven lung cancer, breast cancer or malignant lymphoma. Ten patients with benign lung disease were also examined. Static images were performed 20 min after intravenous injection of 75 MBq of thallous (201Tl) chloride. The results were compared with those of standard staging procedures including CT scanning and mediastinal exploration. Thallium-201 imaging was highly sensitive in detecting the primary tumour (lung cancer 86%, breast carcinoma 100%, lymphoma 85%), but showed low sensitivity in detecting mediastinal spread or lymph node involvement. Thallium-201 uptake was also observed in active sarcoidosis (one case) and active TB (two cases). We conclude that 201Tl imaging is unlikely to have a clinically useful role in the diagnosis or staging of lung cancer, breast cancer or lymphoma.

Adenocarcinoma↗