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Biomedical subjects

R N MacDonald

Publications and source records attributed to R N MacDonald.

36 records · Page 2Linked to original sources
PubMed1987

Continuous sc infusion of narcotics using a portable disposable device in patients with advanced cancer.

Fifty-six patients with chronic pain due to advanced cancer were treated with an sc infusion of morphone (34 patients) or hydromorphone (22 patients) using a portable disposable infusor. The infusion was maintained for 26 +/- 14 days. Twenty-five patients (45%) were discharged to the home for a mean period of 18 days (range, 2-138). The mean daily increase in dose was 2.6% +/- 1.4% of the initial dose. The sc site needed to be changed every 8 days (range, 2-31). Local toxicity consisted of infection in two patients (3%), chemical irritation in three (5%), and bleeding in one (2%). After 48 hours of treatment, 54 of 56 patients (96%) preferred the sc infusion to their previous parenteral treatment. We conclude that this is a safe and simple method for the administration of narcotics to inpatients and outpatients.

Ambulatory Care↗
PubMed1987

Methylphenidate associated with narcotics for the treatment of cancer pain.

Thirty-two patients with chronic pain due to advanced cancer were treated with methylphenidate (10 mg with breakfast and 5 mg with lunch) for 3 days, versus placebo, in a randomized, double-blind, cross-over study designed to evaluate the capacity of methylphenidate to potentiate the analgesic effect of narcotics and/or to decrease sedation induced by narcotics. In 28 evaluable patients, the intensity of pain (visual analogue 0-100) and intake of extra doses of analgesics (number of doses/day) were 43 +/- 27 and 2.2 +/- 2.4 during methylphenidate, versus 55 +/- 24 (P less than 0.02) and 2.9 +/- 2.9 (P less than 0.002) during placebo, respectively. Activity and drowsiness (visual analogue 0-100) were 57 +/- 25 and 58 +/- 24 after methylphenidate, respectively, versus 41 +/- 26 (P less than 0.05) and 45 +/- 27 (P less than 0.02) after placebo. Upon completion of the study, the investigator and the patient chose methylphenidate blindly as a more useful drug in 23 cases (83%) and 20 cases (70%), respectively (P less than 0.02). No cases of severe toxicity were observed. We conclude that methylphenidate can increase the analgesic effect and decrease sedation of narcotics in this population.

Adult↗
PubMed1986

An electron-capture gas chromatographic method for analysis of urinary 3-methoxy-4-hydroxyphenylethylene glycol (MHPG).

A sensitive and convenient electron-capture gas chromatographic procedure for analysis of MHPG in small volumes of urine is described. The method involves acetylation under aqueous conditions, extraction with an organic solvent and reaction with trifluoroacetic anhydride under anhydrous conditions. The resultant derivative is separated and quantitated on a gas chromatograph equipped with a fused silica capillary column and an electron-capture detector.

Acetic Anhydrides↗
PubMed1982

Gynecomastia after cytotoxic therapy for metastatic testicular cancer.

Four men with metastatic nonseminomatous testicular cancer, who had received combination chemotherapy, experienced transient gynecomastia. Serum hormone levels were measured during and after the resolution of the gynecomastia. These levels indicated toxic effects on Leydig's cells and germinal epithelium concurrent with raised serum estradiol levels in the absence of tumor. The gynecomastia may have been caused by Leydig's cell dysfunction or refeeding after substantial weight loss. This benign form of gynecomastia must be recognized to avoid unnecessary investigation and treatment.

Adult↗
PubMed1981

Management of nonseminomatous testicular cancer--a total community experience.

Reports have been made in important advances in the therapy of nonseminomatous germ cell tumors from specialized cancer therapy centers that treat a selected referred patient population. We herein examine the impact of these improvements on the total community of a large geographic area. Using the facilities of a comprehensive cancer registry and standardizing the treatment of nonseminomatous germ cell tumors from 1976 to the present, we have shown that there has been a marked improvement in the over-all survival of patients with these tumors in northern Alberta. During the 4-year interval the survival rates were 100 per cent for patients with stage I, 93 per cent for those with stage II and 83 per cent for those with stage III tumor. The over-all survival rate for patients with nonseminomatous germ cell tumors in this community presently is comparable to that of patients with pure seminomas. We have shown that aggressive, multidisciplinary treatment, developed in specialized centers, can significantly improve the outlook for all patients with nonseminomatous germ call tumors in a defined community.

Adolescent↗
PubMed1979

The chemotherapy of plasma-cell myeloma and the incidence of acute leukemia.

Previously untreated patients with myeloma were randomized to initial treatment with melphalan and prednisone (and to cyclophosphamide or carmustine if relapse or progression occurred)(Group A, 125 patients), melphalan, cyclophosphamide, carmustine and prednisone in alternating (Group B, 123 patients) or concurrent (Group C, 116 patients) schedules. The groups were similar with respect to known prognostic factors. Response rates and survival were also similar. We were unable to identify a subgroup of patients who responded or survived better on melphalan-cyclophosphamide-carmustine and prednisone than on melphalan and prednisone. We conclude that the combination of the four drugs is not better than melphalen and prednisone for inducing responses or prolonging the survival of patients with myeloma. Myelomas producing only gamma chains have a poorer prognosis (P greater than 0.001) than IgG, IgA, or kappa myeloma. Acute leukemia has developed in 14 patients. The actuarial risk of developing acute leukemia, has increased rapidly to 17.4 per cent at 50 months.

Acute Disease↗