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Biomedical subjects

R Stout

Publications and source records attributed to R Stout.

At least 55 records · Page 3Linked to original sources
PubMed1991

Intensive therapy for small-cell lung cancer using carboplatin alternating with cisplatin, ifosfamide, etoposide, mid-cycle vincristine, and radiotherapy.

Forty patients with small-cell lung cancer (31 patients with limited-stage [LS] disease, and nine patients with extensive-stage [ES] disease but of good performance status) have been treated with an intensive therapy composed of carboplatin alternating with cisplatin, ifosfamide, and etoposide with vincristine on day 14 of each carboplatin cycle. A maximum of six cycles were administered at 3 weekly intervals after the cisplatin combination and 4 weekly after the carboplatin combination. Prophylactic cranial irradiation was given with the first cycle of chemotherapy and thoracic irradiation with the third cycle. The median nadir for neutrophils was 0.47 x 10(9)/L and for platelets, 40 x 10(9)/L. Chemotherapy dosages were not reduced in response to myelosuppression, but treatment was delayed to allow blood count recovery. Sixty-eight percent of patients received all six cycles of chemotherapy, and there were four deaths associated with treatment-related neutropenia. Twenty-eight patients (70%) achieved a complete response (CR) when assessed 1 month after the end of treatment, and a further five patients (12.5%) had a partial response (PR). Median duration of CR was 16 months and of PR, 8 months. Cerebral metastases occurred in 20% of all patients and was the apparent sole site of relapse in 11% of the CR patients. The median survival of the total group was 14 months with an actual 2-year survival of 30% and a minimum follow-up of 28 months.

Adult↗
PubMed1990

Ifosfamide, doxorubicin and etoposide in small cell lung cancer patients with poor prognosis.

61 patients with small cell lung cancer in a poor prognosis group were treated with chemotherapy and with thoracic radiotherapy if they had 'limited stage' disease. No prophylactic cranial irradiation was given. Chemotherapy comprised doxorubicin 50 mg/m2 and ifosfamide 5 g/m2 with mesna on day 1, and etoposide 120 mg/m2 intravenously on days 1 and 2 and 240 mg/m2 orally on day 3. Treatment was repeated every 3 weeks for a maximum of six courses and no dosage reductions were allowed. Complete response rate in limited stage patients was 55% and 16% in extensive stage patients. The partial responses were 38% and 66% respectively. Overall median survival was 10.5 months with 2-year survival of 14%. The corresponding values for limited stage disease were 13 months and 16% and for extensive stage disease 8 months and 13%. Despite the addition of doxorubicin at a somewhat higher dosage than usual in this type of regimen and a policy of no dose reduction, toxicity was generally mild. There was, however, a 19% relapse rate in complete responders in the brain, apparently as the sole site of disease.

Adult↗
PubMed1990

Intraluminal irradiation for the palliation of lung cancer with the high dose rate micro-Selectron.

Fifty patients with inoperable, symptomatic endobronchial carcinoma were treated by a single exposure of intraluminal radiotherapy. A high dose rate afterloading system (the micro-Selectron-HDR) was used to minimise radiation exposure for staff. Haemoptysis was relieved in 24 of 28 patients, breathlessness in 21 of 33 patients, and cough in nine of 18 patients. Radiological collapse resolved in 11 of 24 patients. Treatment was given on an outpatient basis and was well tolerated. Intraluminal radiotherapy appears to offer an effective alternative to conventional fractionated external beam radiotherapy.

Adult↗
PubMed1989

Carcinoma of the oesophagus--a review of 108 cases treated by radical radiotherapy.

A retrospective survey was made of 108 patients accepted for radical radiotherapy over a 10-year period. The crude 5-year survival was 8.3% (9 of 108). Patients aged 65 years and over fared significantly better than patients aged less than 65 years (P = 0.04). Long-term survival was more likely with the following features: females, good general condition, tumour in the upper third of oesophagus and no more than 8 cm in length. The 5-year survival for upper third cases was 15.6% (7 of 45) so that for this site radiotherapy can reasonably be considered the treatment of choice. Hypothyroidism developed in three of the seven upper third long-term survivors.

Adult↗
PubMed1989

Radical radiotherapy for carcinoma of the bronchus: an equal alternative to radical surgery?

A retrospective study of 175 patients with T1-T3N0M0 carcinoma of the bronchus treated by radical radiotherapy at the Christie Hospital and Holt Radium Institute, Manchester between 1971 and 1980, is presented. Survival corrected for intercurrent death was 60.3% at 1 year and 19.6% at 5 years. Excluding T3 tumours which were all fatal by 5 years, corrected survival was 64.6% at 1 year and 26.0% at 5 years. A definition of the type of tumour suitable for radical radiotherapy is given.

Adult↗
PubMed1989

Carboplatin, ifosfamide and etoposide with mid-course vincristine and thoracic radiotherapy for 'limited' stage small cell carcinoma of the bronchus.

Forty-two patients with small cell lung cancer were treated with a combination of carboplatin, ifosfamide and etoposide. Vincristine was given on day 14 of each course, the courses being repeated every 28 days for a maximum of six. Thoracic radiotherapy was given 4 weeks after the last course of chemotherapy but no prophylactic cranial radiotherapy was administered. Thirty patients had clinically limited state disease, the remaining patients having contralateral neck lymphadenopathy and/or pleural effusions. Elevated enzyme levels (alkaline phosphatase, LDH, ALT, GGT) were noted in 69% of patients. Twenty-four patients (57%) achieved a complete response (CR) when assessed one month after the end of treatment. A further 21% of patients had a partial response (PR). Median duration of CR was 14 months and of PR 8 months. Cerebral metastases were the sole site of relapse in 13% of the CR patients. Myelosuppression was severe with a median nadir of neutropenia of 0.2 x 10(9) cells 1-1. However, 74% of the patient group received all six courses of chemotherapy and only 16 courses (7%) were delayed because of toxicity. There were three deaths associated with treatment-related neutropenia. The median survival of the total group was 14 months, with an actuarial 2 year survival of 37% and a minimum follow-up of 18 months. [A recent analysis, March 1989, demonstrated a 33%, 2 year actual survival.]

Adult↗
PubMed1989

A simple outpatient treatment with oral ifosfamide and oral etoposide for patients with small cell lung cancer (SCLC).

For the first time in a clinical study oral Ifosfamide was used: 65 elderly or unfit patients with small cell lung cancer (SCLC) were treated as outpatients with fractionated oral Ifosfamide and Etoposide. Forty patients (62%) had extensive stage (ED) disease. The median age of the patients was 66 years. In the 60 patients evaluable for response the objective response rate was 90% with a complete response (CR) rate of 32% and a partial response (PR) rate of 58%. The overall median survival of all 65 patients was 11 months (13 months for LD, 9.5 months for ED). In those patients with LD achieving a CR or a PR radiotherapy was given to the mediastinum. No prophylactic cranial irradiation was given. There was a rapid improvement in the responding patients' performance status and symptoms generally with the first treatment cycle. Overall haematological toxicity was mild, with intravenous antibiotics only being required in 4% of the courses and with only one treatment-related death from septicaemia. A higher than expected rate of CNS toxicity was seen (30%). This was generally mild and always fully reversible and consisted mainly of forgetfulness, occasionally hallucinations, nightmares and somnolence. In only one case did encephalopathy necessitate early termination of treatment. This raises the question of whether Ifosfamide metabolism differs quantitatively or qualitatively when given by the oral route as opposed to the usual intravenous route. We conclude that this simple outpatient based treatment gives a high response rate with rapid improvement in symptoms.

Administration, Oral↗
PubMed1988

Characterization of bronchoalveolar lavage cells and macrophage-derived chemoattractant activity in pancreatic elastase-induced emphysema in hamsters.

Bronchoalveolar lavage (BAL) was performed 30 days after endotracheal saline (C) or pancreatic elastase (E) administration to hamsters. E animals had twice as many cells as C animals (7.04 +/- 0.07 vs. 6.69 +/- 0.05 log10 cells, p less than 0.0001, paired t-test) and greater numbers of polymorphonuclear neutrophils (PMN) (6.61 +/- 0.05 vs. 5.27 +/- 0.04 log10 cells/animal, p less than 0.0001, t-test). On flow cytometric analysis and cell sorting, BAL cells from C animals showed a homogeneous population of cells with high light scatter and laser-excited intrinsic autofluorescence that were predominantly (greater than 99%) pulmonary alveolar macrophages (PAM). BAL cells from E animals had 80% PAM with characteristics similar to those of C animals; the remaining 20% of cells were smaller with lower forward and 90 degrees light scatter and four- to fivefold lower autofluorescence. These were found to be predominantly PMN on cytological examination of a sorted fraction. Fc receptors were expressed by greater than 95% of BAL cells from both C and E animals. To explain the altered cell population in E animals, PAM from both E and C animals were cultured in vitro, and the supernatants were assayed for neutrophil chemoattractant activity (NCA). In vitro PAM from E animals produced greater NCA than control PAM after 48 h in culture when stimulated with aggregated immunoglobulin or serum activates zymosan (p less than or equal to 0.003, ANOVA). Analyses of BAL supernatants 24 h after elastase administration indicated the presence of a heat-stable chemoattractant for PMN; such chemotactic activity, however, was not detectable 1 week or 4 weeks after the administration of elastase.

Animals↗
PubMed1987

Ifosfamide, etoposide, and thoracic irradiation therapy in 163 patients with unresectable small cell lung cancer.

One hundred sixty-three patients with small cell lung cancer were treated with six courses, at 3-week intervals, of ifosfamide (5 g/m2) with mesna and etoposide. Thoracic radiotherapy was delivered to the limited stage (LS) patients. The complete response rate (CR, determined clinically and radiologically) was 76% for the 78 LS patients with a further 14% partial response (PR). The majority of the CRs were confirmed on a follow-up bronchoscopy. The CR rate was 27% for extensive stage (ES) patients with another 38% undergoing a partial response. The median survival for LS patients was 11 months, (16 months for CR confirmed by rebronchoscopy) and 8 months for ES patients. The 2-year actuarial survival for LS patients is 27%, follow-up ranges from 12 months to 30 months with a median of 22 months. Toxicity was not severe for the patient population, of whom only 20% had a good performance status before chemotherapy. Parental antibiotics were required on 4% of all 844 chemotherapy courses and 12% of courses were delayed due to side effects. The majority of responses occurred within the first two courses of chemotherapy and there was a corresponding improvement in the patients' symptoms and performance status. The regimen produced rapid tumor response with corresponding improvement in symptoms without marked toxicity and allowed further treatment development.

Adult↗
PubMed1986

DSM-III and clinically identified problems as a guide to treatment.

Problems, DSM-III diagnoses, and treatment interventions were coded from the problem-oriented medical records of an acute psychiatric hospital. Problems and diagnoses were entered into separate stepwise multiple regression analyses to test their ability to predict 24 treatment interventions. Significant predictors were then included in a combined analysis. Both DSM-III diagnoses and problems were robust and significant indicators of medication treatments. Both were better predictors of medication than were problems and DSM-II diagnoses in an earlier study. With regard to psychosocial interventions, problems were better indicators than were DSM-III diagnoses, although neither was robust. Both were less useful as predictors of psychosocial interventions than in the earlier study. Overall, the combination of problems and diagnoses was generally superior in predictive power to either alone. These results suggest that problem nomenclature should include DSM-III diagnoses. Alternatively, DSM-III should be revised to accommodate some of the greater specificity and range of a problem nomenclature.

Hospitalization↗
PubMed1986

Malignant epithelial tumours of the thymus: survival after radiotherapy.

This study describes 26 patients with histologically proven malignant epithelial thymic tumours seen at one radiotherapy centre between 1965 and 1980. Twenty-three patients had mediastinal radiotherapy and the overall 5-year survival rate (corrected for intercurrent death) of this group was 35%. Those patients in which there was complete surgical removal of the tumour had a good prognosis. Where this was not achieved, the prognosis was poor.

Adolescent↗
PubMed1986

Results of intracavitary radium treatment for adenocarcinoma of the body of the uterus.

Between 1965 and 1970, 160 inoperable patients with adenocarcinoma of the endometrium were treated using intracavitary radium alone. Patients were given either two insertions (7500 cGy stated dose over 10 days), or one insertion (5000 cGy stated dose over 4 days) depending on their general condition. The FIGO stage and histological degree of differentiation had a significant influence on survival. Most patients had Stage 1 disease; 5-year and 10-year corrected survival for those having two insertions was 73% and 62% respectively, compared with 58% and 34% respectively for those having a single insertion (p less than 0.015). The primary tumour control rate was greater using two insertions (77%) than with a single insertion (67%). Treatment morbidity was low. In this selected group of patients, intracavitary radium using a central intrauterine line source and vaginal ovoids produced results comparable with other reported radiotherapy techniques.

Adenocarcinoma↗
PubMed1985

Three months treatment with chemotherapy and radiotherapy for small cell lung cancer.

Fifty-five patients with inoperable but limited stage small cell carcinoma of the bronchus and a further 15 patients with contra lateral neck nodes, pleural effusions and marrow involvement were entered into the study and treated. The 3 month treatment regimen comprised 3 courses of etoposide with cyclophosphamide at 2.5 gm-2 followed by methotrexate and radiotherapy, no maintenance treatment was given. The complete response rate in the total patient group was 54% and the partial response rate 21%. The median survival was 11 months for the 70 patients, 15 months for the complete responders, and those patients with a bronchoscopically confirmed complete response survived significantly longer. There was no significant difference between the patients with strictly limited stage disease and those in the broader category. Eight patients are tumour free and alive one year or more after the end of treatment. The median followup is 17 months. Twenty-four patients were delayed 1-2 weeks during treatment because of chemotherapy induced toxicity. Six patients died probably of infection associated with leucopaenia. The majority of the patients' Karnofsky performance improved with the treatment as did their breathlessness assessed on a respiratory score. The short intensive chemotherapy regimen of 3 months produced similar results to those following more prolonged treatment regimens.

Adult↗
PubMed1984

Stability of drinking prior to alcoholism treatment.

This study assessed how many months of pretreatment drinking data would represent a stable baseline. Fifty-one couples were interviewed using the time-line follow-back interviewing procedure to obtain 365 days of pretreatment drinking data. The pattern (binge, episodic, steady) and frequency of drinking did not differ when comparing 30 days prior to treatment with the rest of the year. However, there were significantly more abstinent days in the last 3 months than in the remainder of the pretreatment year. Implications for baseline data collection in alcoholism treatment research are discussed.

Adult↗
PubMed1984

Serum zinc levels in retinitis pigmentosa.

Serum zinc and copper levels were analyzed in 26 retinitis pigmentosa patients and compared with serum zinc levels of a control group. Serum zinc levels were documented to be decreased with a mean concentration of 0.735 +/- 0.167 micrograms/ml (p less than 0.001). Serum copper levels, on the other hand, were found to be increased in retinitis pigmentosa patients with a mean value of 1.261 +/- 0.348 micrograms/ml (p less than 0.001).

Adolescent↗
PubMed1984

Adherence in a behavioral alcohol treatment program.

This report examines the correlates of early treatment termination by patients being treated for alcohol abuse or dependence. All of the study subjects were participants in a controlled experimental investigation of the differences in clinical outcome and treatment cost of extended inpatient and partial hospital treatment. A large number of clinical variables demonstrated no difference between groups, except for the greater likelihood of a DSM III Axis I diagnosis of alcohol abuse or dependence in the treatment completers. In contrast, three of four system variables differentiated completers from noncompleters. Patients treated by hospital-employed psychiatrists, in contrast to private psychiatrists, were more likely to complete the program; 4 sequential months in the middle phase of the study were associated with noncompletion of treatment; and patients who were detoxified on the preferentially designated unit were more likely to receive some specialized alcohol treatment. The authors interpret these data to indicate that treatment adherence is influenced by factors affecting the cohesiveness of the treatment delivery system. The failure of patient characteristic variables to predict treatment adherence may well be a result of their comparative insignificance in relation to system variables.

Adult↗