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Biomedical subjects

S B Sutcliffe

Publications and source records attributed to S B Sutcliffe.

At least 73 records · Page 4Linked to original sources
PubMed1981

Protection of ovarian function by oral contraceptives in women receiving chemotherapy for Hodgkin's disease.

It has been reported by us and by others that after chemotherapy for Hodgkin's disease the ovary contains fewer than 5 primordial and primary follicles per 5 x 5 mm biopsy section. In young women this is associated with premature menopause. We report here that before treatment the tissue contains 18--55 such follicles per biopsy section. When women took combination oral contraceptives throughout the course of MVPP therapy, the posttreatment ovarian biopsy tissue had more than 20 follicles per histologic section. Normal menses were established in the five women who discontinued oral contraceptives at the end of MVPP therapy, and one of them is now pregnant.

Adolescent↗
PubMed1980

Computerised tomographic (CT) abdominal scanning in Hodgkin's disease.

Thirty-nine patients with Hodgkin's disease (HD) with little or no clinical evidence of abdominal disease were investigated by abdominal CT scanning. The results were compared with those of bipedal lymphography and laparotomy and splenectomy. In the assessment of para-aortic lymph nodes, CT scanning and lymphography were of equal efficacy in determining the presence or absence of disease (87 and 79% respectively). Although CT scan could occasionally demonstrate disease in nodes in areas other than the retroperitoneum, its value was limited by its inability to detect involvement of nodes which were not significantly enlarged. CT assessment of splenic HD was unreliable, focal deposits being detected in only one of the 11 spleens involved. In this selected group of patients, CT scan had little advantage over lymphography in the description of disease extent. However, CT scan would appear to be the investigation of choice in patients with suspected abdominal relapse because of the more frequent presence of disease in sites not seen on lymphography. When treatment decisions are dependent on accurate knowledge of distribution of disease, CT scanning cannot yet effectively replace staging laparotomy and splenectomy as the means of achieving this information.

Hodgkin Disease↗
PubMed1980

The effects of dialyzable products from human leukocyte extracts on cutaneous delayed-hypersensitivity response.

Fractions from human whole leukocyte lysates were prepared by sequential double dialysis against membranes with cut-offs of m.w. 12,000 and 3500, and by elution chromatography on Sephadex G-10. The effect of localized intracutaneous implantation of fractions with m.w. less than 3500 was studied. Two types of response were obtained: 1) the amplification of response to antigen to which the donor had preexisting immunity, and 2) the induction of inflammatory response histologically resembling delayed hypersensitivity in the absence of added antigen. The substances mediating these responses could be separated into unique components by use of a long (1 x 150 cm) G-10 column, or by hydroxylapatite chromatography. The active principles were derived from leukocyte extracts (as demonstrated by their absence from autologous RBC extracts prepared by identical methodology), and the histopathologic appearances after intracutaneous implantation were compatible with those of a delayed-hypersensitivity response. No evidence of transfer of antigen-specific information from a sensitive donor to a nonsensitive recipient was obtained under the conditions of study.

Antigens↗
PubMed1979

Cytotoxic-induced ovarian failure in women with Hodgkin's disease. I. Hormone function.

Forty-one women with advanced Hodgkin's disease were studied to determine the effect of combination chemotherapy on fertility and ovarian function. Histories and pretreatment ovarian biopsy specimens indicated normal fertility before therapy, thus implying no adverse effect of Hodgkin's diseases on female gonadal function. Ovarian activity was assessed after therapy by menstrual history, serial basal body temperatures, and hormonal levels. Each case was assigned to one of three categories: primary ovarian failure (failed ovary), irregular ovarian activity (failing ovary), and normal cyclic ovarian activity (functioning ovary). After therapy, 20 of 41 patients (49%) were categorized as failed, 14 (34%) as failing, and only 7 (17%) as functioning. In 16 months of further observation, progressive loss of ovarian function occurred that was clearly age related but not statistically dose related. Induction of premature, irreversible menopause presents a need for effective hormonal replacement and patient counseling.

Adult↗
PubMed1979

Cytotoxic chemotherapy and gonadal function in patients with Hodgkin's disease. Facts and thoughts.

Castration commonly appears to be the price of "cure" in patients treated with chemotheraphy for Hodgkin's disease. Awareness and anticipation by the physician, with appropriate counseling of the patient on the profound psychological and emotional changes occasioned by chemotherapeutic treatment, may provide benefit both in terms of acceptance of therapy and in adjustment of changes in interpersonal relationships. From this point, attention should be directed to (1) replacement of evident hormonal deficiency, (2) artificial preservation of viable germ cells, and (3) means of avoidance of germ cell damage by chemotherapy.

Antineoplastic Agents↗
PubMed1979

Cyclical combination chemotherapy and gonadal function. Retrospective study in males.

The effect of cyclical chemotherapy on fertility and gonadal function was investigated in seventy-four male patients who had been treated for advanced Hodgkin's disease. All patients were azoospermic after therapy, and, with a median follow-up period of 27 months (range 1--62 months), only four patients have regained spermatogenesis. Testicular biopsy showed an absence of germinal epithelium without other gross architectural changes. Despite this high degree of infertility, 60% of patients were practising contraception. A decline in libido and sexual performance with frequent long periods of sexual inactivity was noted by most men during therapy. Although some recovery was apparent once therapy was stopped, this was incomplete in approximately half of the patients. Follicle-stimulating-hormone levels were consistently raised after therapy at all periods of study. Median luteinising-hormone levels were at, or just above, the upper limit of normal, and median testosterone levels were normal. Increased prolactin levels were noted in 42% of patients, of whom about a half had an identifiable cause for hyperprolactinaemia. Return of spermatogenesis could not be predicted by serial hormone assessment. Because of the guaranteed infertility and the low frequency and unpredictability of recovery of spermatogenesis, sperm storage should be available for male patients undergoing cytotoxic therapy, since most of these patients may enjoy prolonged survival. Hormone-replacement therapy will usually be unnecessary. However, the probability of major changes in libido and sexual performance should be discussed with patients so that additional stress can be avoided. Contraceptive advice should be available to those who require it.

Adolescent↗
PubMed1979

Adriamycin, bleomycin, vinblastine and imidazole carboxamide (ABVD) therapy for advanced Hodgkin's disease resistant to mustine, vinblastine, procarbazine and prednisolone (MVPP).

Forty-one previously treated patients with advanced Hodgkin's disease were treated with a combination chemotherapy regimen -- ABVD (adriamycin, bleomycin, velbe/vincristine, imidazole carboxamide). Complete remission was achieved in three patients (7%), partial remission in 23 (56%), and no response in 15 patients (37%). The median survival of the group was 12 months from the start of therapy. Survival correlated with response to treatment. No apparent benefit resulted from giving more than six courses of therapy (3 months' treatment time). There was no serious haematological toxicity in patients without bone marrow disease, and bleomycin and adriamycin toxicity was not apparent clinically or at autopsy in the dosages employed in the regime. Alopoecia was very frequent. The role for ABVD, other than as a primary induction regimen, appears to be in conjunction with other regimens in the induction of patients with adverse features at presentation or during induction; or in the salvage and palliation of patients who demonstrate a response but fail to achieve remission, either initially or at relapse, with MOPP (mustine, vincristine rpocarbazine, and prednisolone) or MVPP (mustine, vinblastine, procarbazine and prednisolone.

Adolescent↗
PubMed1978

Post-treatment laparotomy in the management of Hodgkin's disease.

Tissues obtained by laparotomy and splenectomy from patients with Hodgkin's disease who had received either supradiaphragmatic irradiation for localised disease or combination chemotherapy for advanced disease were examined histologically. 4 of 19 patients considered to be free of abdominal disease after chemotherapy showed residual active Hodgkin's disease; the spleen was the commonest site showing active disease. 2 patients thought to have intra-abdominal disease showed no histological evidence of active disease in the tissue excised. The finding of residual active abdominal disease in patients considered to be in "clinical" remission indicates that the interpretation of the result of treatment depends on the definition of response. A proportion of "relapses" may, in fact, be patients who never achieve genuine remission of disease, whereas the prognosis for those who do achieve complete remission may be even better than currently accepted, and may even amount to "cure". This study shows that histological changes of lymphoreticular tissue can be defined after treatment and may help in determining more accurately the need for further therapy.

Evaluation Studies as Topic↗
PubMed1978

Radiotherapy in the treatment of Hodgkin's disease.

Eighty-seven untreated patients with localised Hodgkin's disease seen from 1969 to 1975 were treated by megavoltage radiotherapy. All were followed for at least 33 months. Thirty-three patients were staged clinically and 54 underwent more extensive investigation by lapaortomy and splenectomy. The projected five-year disease-free survival figures for patients staged surgically were 100% for the 17 with stage IA disease, 70% for the 19 with stage IIA disease, and 73% for the 15 with stage IIIA disease. These results were consistently better than those obtained in clinically staged patients. Five patients died, one of them without evidence of Hodgkin's disease. As irradiation seems to produce excellent disease-free survival in most patients who are staged accurately at diagnosis, caution should be exercised in the routine use of adjuvant chemotherapy until the full risks of such treatment are clear. Combined modality therapy may be appropriate for patients with unfavourable features at presentation.

Adolescent↗
PubMed1978

MVPP chemotherapy regimen for advanced Hodgkin's disease.

During January 1968 to December 1972, 133 patients with advanced Hodgkin's disease (HD) were admitted to hospital for combination chemotherapy with mustine, vinblastine, procarbazine, and prednisolone (MVPP regimen). Remission rates were 76% among 49 untreated patients and 90% among 42 patients who had relapsed after radiotherapy. The corresponding five-year survival rates were 65% and 86% respectively. Provided the observed yearly mortality (6%) remains unchanged 75% of patients who had previously received no treatment or irradiation and achieved remission are expected to continue in first remission after five years. Forty-two patients had received prior chemotherapy. They had lower remission and five-year survival rates (40% and 33% respectively), and fewer than half of those achieving remission were still in first remission after five years. There were several reasons for the poor prognosis in this group, including advanced-stage disease (stage IVB), age over 40, and achievement of remission.Chemotherapy was administered on an outpatient basis. Haematological toxicity and immediate drug-related side effects were similar to those of other regimens but there was no appreciable neurotoxicity. Most deaths were due to either HD itself or complications of advanced disease. Five malignancies other than HD occurred in patients who had received both single-agent chemotherapy and radiotherapy before MVPP chemotherapy. Two patients developed osteonecrosis of the femoral heads.Combination chemotherapy has a profound effect on the prognosis of advanced HD. The MVPP regimen yields results comparable to those of other regimens but with perhaps less toxicity.

Adolescent↗
PubMed1978

Comparison of combined and single-agent chemotherapy in non-Hodgkin's lymphoma of favourable histological type.

Sixty-six untreated patients with advanced non-Hodgkin's lymphoma of favourable histological type were allocated alternately to initial treatment with cyclophosphamide, vincristine, and prednisolone or with chlorambucil. The complete remission rate was higher in the group receiving combination chemotherapy, but the overall response rate was the same for both groups. The mean duration of complete remission was the same as that of good partial remission, and was the same for both treatments. The duration of remission was influenced by histological type and extent of disease at presentation, but not age. Those who responded to the initial treatment (whether with complete or with good partial remission) survived significantly longer than did non-responders. It is concluded that neither treatment is satisfactory and that new treatment programmes are needed for patients with a favourable prognosis, especially young patients with extensive disease.

Adult↗