bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neoadjuvant chemotherapy in locally advanced cervical cancer: two randomised studies
Authors: Kumar L. , Grover R. , Pokharel Y. H. , Chander S. , Kumar S. , Singh R. , Rath G. K. , Kochupillai V. 
Published: March 2008

AbstractBetween August 1990 and January 1992, 184 patients with squamous cell carcinoma of the cervix, FIGO stage IIBIV A were randomised (study 1) to receive either two cycles of bleomycin, ifosfamide‐mesna and cisplatin (BIP) chemotherapy (CT) followed by radiotherapy (RT) ‘CT‐RT Group’ a=94 or RT alone, RT Group n=90. In the ‘CT‐RT Group’, of evaluable 89 patients, 64 responded: complete response (CR) four (4.5%) and partial response (PR) 60 (67.5%). Of the remaining 25 patients 23 had stable disease and two progressed. Eighty of 89 patients completed RT as planned. Following RT 56 (70%) achieved CR, 19 (23.7%) had residual disease and five (6.3%) had progressed. Patients aged>45 and those with Hb >10 gm/dL had significantly better response to CT. Further, CT responders had a better response to RT; 83% (49/59) vs 33.3% (seven/21), p<0.01. In the ‘RT Group’ 88 patients were evaluable; 61 (69.3%) patients achieved CR, 25 had residual disease and two progressed. The estimated overall survival at 48 months in the ‘CT‐RT Group’ and the ‘RT Group’ is 38%+2.01 (SE) and 36%+1.85 (SE), p=0.59 respectively.In a subsequent randomised study (study 2) 36 patients with stage III B cervical cancer received three cycles of BIP (as above) followed by RT vs 36 patients who received RT alone. In the ‘CT RT Group’ 29 patients responded; CR‐8 (22.2%>), PR‐21 (58.3%). Six patients had no response to CT and one patient died of CT toxicity. Following RT ‐ 24 of 35 (68.6%) patients achieved CR, eight had residual disease and three patients progressed while on RT. In the ‘RT Group’ ‐ 21 of 36 (58.4%) achieved CR, 12 had residual disease and three progressed. Estimated survival was 71%> in the ‘CT‐RT Group’ and 69% in the ‘RT Group’, p=ns.Nausea/vomiting, alopecia, grade I‐II myelosuppression, diarrhoea and mucositis were the major side effects of CT. Three patients died of CT toxicity ‐ two in study 1 and one in study 2. Cystitis, proctitis and local skin reaction after RT occurred equally in the two groups in both the studies.BIP CT prior to RT in patients with locally advanced cervical cancer results in a high response rate. Response to CT predicts response to RT. There is no increase in the toxicity to subsequent RT. Our studies have failed to demonstrate any significant difference in overall and disease‐free survival when neoadjuvant CT is added prior to the standard RT regimen.
Lung cancer and quality of life
Authors: Thongprasert S. 
Published: March 2008

AbstractQuality of life (QOL) is frequently used as an endpoint of measurement in cancer treatment. Compared to other cancers, there are only a few reports of QOL in the treatment of lung cancer. Several QOL instruments have been developed and this paper reports experience with the functional Living‐Index‐Cancer and Quality of Life Index tools in Lung Cancer treatment, in a randomised controlled trial of chemotherapy.
NSAIDs and faecal blood loss in elderly patients with osteoarthritis: is plasma half‐life relevant?
Authors: Scharf S. , Kwiatek R. , Ugoni A. , Christophidis N. 
Published: March 2008

Abstract Background: Nonsteroidal anti‐inflammatory drugs (NSAIDs) vary in their degree of gastrointestinal (GI) toxicity. NSAIDs with longer half‐lives are of particular concern as they may be more toxic in the elderly. Aim: To compare the GI toxicity, by measurement of faecal blood loss, of short, intermediate and long half‐life NSAID treatments compared with control in elderly patients with osteoarthritis. Methods: Twenty‐three patients, mean age 69 years, with osteoarthritis requiring NSAID treatment, received treatment with diclofenac 100 mg/day, naproxen 750 mg/day and piroxicam 20 mg/day, representing a short, medium and long half‐life NSAID respectively, in a double‐blind, randomised, three way, cross‐over block design. In each case, a three week washout control phase was followed by active treatment phases of two weeks each with three week washout between treatment phases. Results: Faecal blood loss, collected over 72 hours at the end of each treatment phase, was measured by 51Cr‐labelled erythrocyte method. Comparison was made of mean 24 hour faecal blood loss with each treatment compared with control using repeated measures analysis of variance. Eighteen patients completed all phases of the study. Three patients were withdrawn due to GI bleeding; two during diclofenac treatment and one during treatment with piroxicam. Mean 24 hour faecal blood loss with diclofenac (0.53 mL±0.21) was not significantly different from control (0.28 mL±0.06), whereas it was significantly increased with naproxen (2.76 mL±2.22) and piroxicam (1.16 mL±0.62), p= 0.0013. Conclusion: A short half‐life NSAID was associated with lower GI toxicity than a medium and long half‐life NSAID, as measured by faecal blood loss.
Continuous and intermittent infusion of coagulation factor concentrates in patients undergoing surgery: a single centre Australian experience
Authors: Campbell P. J. , Rickard K. A. 
Published: March 2008

Abstract Background: Haemophilia patients require large doses of coagulation factor concentrates to optimise haemostasis at the time of surgery. The superior pharmacokinetic profile of continuous infusion over intermittent bolus administration may be more advantageous. Aims: We report our experience using coagulation factor concentrates delivered by continuous infusion in patients undergoing surgery. Methods: A retrospective case notes review of all patients treated by continuous infusion at Royal Prince Alfred Hospital (RPAH) over a two year period and a comparison of two cohorts of patients undergoing orthopaedic surgery using either continuous infusion or bolus factor VIII (FVIII) replacement therapy. Patients received a pre‐operative bolus of factor concentrate (AHF, Immunine or Recombinate) followed by a continuous infusion calculated according to weight, clearance and target plasma concentration. Results: Twenty‐one (19 M, two F) with haemophilia or von Willebrand's disease underwent 26 surgical procedures between July 1995 and July 1997. The mean total consumption of concentrate per patient was 36,676 units (range 6750–82,000) infused over a mean period of 7.6 days (range one‐16). One patient experienced minor surgical bleeding on treatment and one patient developed severe bleeding into the replaced joint off infusion requiring additional boluses of treatment. In a separate analysis, ten of these patients who underwent major orthopaedic surgery were compared to a historic cohort (n=8) of patients who received bolus injections for similar types of operations. Conclusions: Coagulation factor concentrates delivered by continuous infusion have major clinical and economic advantages in the surgical management of patients with haemophilia.
Heparin management in acute myocardial infarction (AMI)
Authors: Granger Christopher B. 
Published: March 2008

AbstractAntithrombotic agents have been shown to be beneficial in the setting of acute coronary syndromes, and as an adjunct to thrombolysis for acute myocardial infarction (AMI). The optimal type and dosing of antithrombotic drug, however, remains elusive. Heparin, the agent most commonly used, has several limitations, the most important of which may be its inability to inhibit clot‐bound thrombin. Newer, direct thrombin inhibitors (such as hirudin) provide potent and predictable thrombin inhibition and are able to inhibit clot‐bound thrombin. Both heparin and hirudin can carry a substantial risk of haemorrhage, however, and thrombin activity is likely to rebound after discontinuation of either agent. Further, the relationships of antithrombotic/thrombolytic dosing, measures of anticoagulation (such as APTT), and clinical outcomes are not always clear. Nonetheless, from the data available from large, randomised trials, intravenous heparin should remain a standard adjunct to thrombolytic therapy for AMI.
Oral cyclosporin in refractory inflammatory bowel disease
Authors: Taylor A. C. F. , Connell W. R. , Elliott R. , D'Apice A. J. F. 
Published: March 2008

Abstract Background: The role of cyclosporin in patients with severe, refractory inflammatory bowel disease is unclear. Methods: A seven year retrospective review of patients treated with oral cyclosporin for inflammatory bowel disease refractory to conventional medical therapy was undertaken. Results: Twenty‐eight patients (13 ulcerative colitis and 15 Crohn's disease) received oral cyclosporin for a mean of nine months (range 0.25–27 months). Within four weeks of starting cyclosporin, a complete clinical response occurred in 15 patients (nine with ulcerative colitis and six with Crohn's colitis), in whom conventional maintenance treatment was instituted concurrently. The clinical response was sustained during cyclosporin treatment in ten, but maintained after cyclosporin withdrawal in only five patients (18% of entire study group). Four of the five patients who relapsed after cyclosporin withdrawal had failed previously to respond to azathioprine. None of the five patients with continuing remission after cyclosporin withdrawal had received azathioprine in the past. There were three clinically significant infections and 14 cases of impaired renal function during treatment. Conclusions: Oral cyclosporin induces remission in some patients with severe ulcerative colitis or Crohn's colitis, but its benefits in cases refractory to azathioprine are overshadowed by a high frequency of relapse after drug withdrawal. (Aust NZ J Med 1998; 28: 179–183.)
Comparison of thallium‐201 and gallium‐67 scintigraphy in the evaluation of non‐Hodgkin's lymphoma
Authors: Roach P. J. , Arthur C. K. , Cooper R. A. , Ravich R. B. 
Published: March 2008

Abstract: Background: Gallium‐67 (Ga‐67) is widely used in the assessment of patients with lymphoma. Although highly sensitive in Hodgkin's disease and high grade non‐Hodgkin's lymphoma (NHL), its sensitivity is reported to be reduced in lower grades of NHL. Several series have suggested that thallium‐201 (Tl‐201) may be more useful than Ga‐67 in the evaluation of low and possibly intermediate grade NHL. Aim: To compare the sensitivity and relative avidities (uptakes) of Tl‐201 and Ga‐67 in patients with NHL. Methods: A total of 36 pairs of studies were performed in 33 patients (14 male: 19 female; age range 16–84 years, mean 55 years). All had whole body Ga‐67 (400 MBq) and Tl‐201 (100–200 MBq) studies (interval 0‐three days) which were read by two experienced nuclear medicine physicians blinded to clinical history and results of other investigations. Results: Tl‐201 had a higher sensitivity and avidity than Ga‐67 in patients with low grade NHL. In contrast, Ga‐67 was slightly more sensitive and had a higher avidity in patients with both intermediate and high grade NHL. Conclusions: We conclude that Tl‐201 is more sensitive and avid for low grade NHL than Ga‐67 and that consideration should be given to its use in this condition in conjunction with Ga‐67 as it may provide complementary information. Routine use in intermediate grade NHL is less convincing as Ga‐67 was superior in most cases. Ga‐67 is more sensitive than Tl‐201 in assessment of high grade NHL.
Shared rheumatoid epitope as a risk factor in determining outcome in rheumatoid arthritis
Authors: Hedger S. C. , Macardle P. , Bond M. J. , Ahern M. J. , Smith M. D. , Roberts‐Thomson P. J. 
Published: March 2008

AbstractBackground: A genetic component is thought to contribute to 30–40% of the expression of rheumatoid arthritis (RA) with the HLA‐DR4, w4 (B1*0401), w14 (B1* 0404) genes (and associated shared rheumatoid epitope) constituting a substantial portion of this risk.Aim: Our objective was to determine the presence of these risk factors in a group of patients with RA and to correlate presence with disease outcome.Method: Forty‐three RA patients who had been regularly assessed up to a ten year period since their initial entry into two gold treatment trials were studied. DR4, w4, w14 and shared rheumatoid epitope were determined on peripheral blood lymphocytes using flow cytometry and specific monoclonal antibodies. Disease outcome was measured by Health Assessment Questionnaire (HAQ) score and C‐Reactive Protein (CRP) as a serological measure of joint inflammation.Results: To confirm accuracy of the flow cytometric technique, DR typing and epitope status was compared with results obtained by genotyping in a subset of 14 patients. There was complete concordance between these two techniques for the rheumatoid epitope. However, concordance was not complete (both false positives and false negatives) for DR4, w4 and w14. Hence the presence of rheumatoid epitope was only evaluated further in the larger group. The presence of the shared rheumatoid epitope correlated positively with poorer outcome on serological assessment (p<0.05). No significant correlation between HAQ score and rheumatoid epitope status was observed although a weak trend was noted.Conclusion: These studies suggest that determination of rheumatoid epitope status by flow cytometry may provide useful data concerning the long term outcome of patients with RA.
‘Mini‐allografts’ for haematological malignancies: an alternative to conventional myeloablative marrow transplantation
Authors: Grigg A. , Seymour J. F. , Roberts A. , Szer J. 
Published: March 2008

Abstract Background: Considerable morbidity and mortality are consequences of the myeloablative chemoradiotherapy utilised in conventional allogeneic marrow transplantation. This has generally restricted such potentially curative treatment to patients <50–55 years with normal organ function. Recent studies suggest that purine‐analogue based non‐myeloablative regimens are sufficiently immunosuppressive to facilitate allogeneic donor cell engraftment. Aim: To review the outcome of HLA‐compatible sibling allogeneic peripheral blood progenitor cell (PBPC) transplants using fludarabine‐based conditioning in patients ineligible for a conventional transplant, with emphasis on engraftment, graft vs host disease (GVHD) and graft vs tumour effects. Methods: Eleven patients (nine 47 years age) with advanced haematological malignancies received one of three different fludarabine‐based chemotherapy followed by infusion of granulocyte colony‐stimulating factor mobilised PBPC. Cyclosporin‐methotrexate was used as GVHD prophylaxis. Results: Two patients died early; minimal non‐haematological toxicity apart from mucositis occurred in the other nine. Eight of the nine evaluable patients had evidence of durable donor cell engraftment in preference to recipient cells. Acute GVHD (grade 2) occurred in seven of eight patients with donor engraftment who survived beyond two months. Four patients are alive in complete remission 8–28 months post‐transplant; another is alive in probable remission at four months. Conclusions: Fludarabine‐based non myeloablative chemotherapy facilitates rapid engraftment of allogeneic donor cells, which produce powerful GVHD and graft vs tumour effects. This approach has the potential to extend the applicability of allogeneic stem cell transplants to patients traditionally regarded as too old or sick for conventional marrow transplants.
Cerebrovascular disease as a general medicine discharge diagnosis: assessment of diagnostic agreement on case note review
Authors: Lunt H. , Beard M. E. J. , Wilson M. A. , Kendall D. , Frampton C. M. 
Published: March 2008

Abstract Background: Accurate clerical coding of discharge diagnoses is important partly because results may be used to derive a recommended costing for hospital length of stays (LOS). Some authors think that discharge coding undertaken by clinicians will result in less diagnostic misclassification than clerical coding. This presupposes a high degree of between‐observer diagnostic agreement between clinicians. Aims: To compare discharge coding undertaken by two general physicians, for patients receiving a clerical discharge code of cerebrovascular disease. The recommended LOS was then calculated from each observer's discharge codes using the Physicians Diagnosis Related Group Working Guidebook. Results: Eighty‐two cases were coded as stroke by the clerical coder. Both medical coders agreed with this diagnosis in 68 (83%) of these cases. The corresponding figure for cases coded by the clerical coder as transient cerebral ischaemia was 47% (32/68) agreement between all three observers. Correcting for chance agreement between medical observers using the kappa statistic, a value of 0.64 was obtained for the combined stroke and transient cerebral ischaemia discharges, suggesting moderate diagnostic agreement. Using the clerical coder's results, the mean recommended LOS for all cases of cerebrovascular disease over the study period was calculated at 6.68 days. The corresponding values for the two medical coders were 6.68 days and 6.75 days. Conclusions: Diagnostic agreement between clinicians was moderate. Consideration of alternative diagnostic possibilities and the difficulty in determining the duration of neurological deficit were the main reasons for diagnostic disagreement. The mean recommended LOS was similar, however, when comparing results from all three observers.
Antithrombins and the importance of good control
Authors: Tideman P. A. 
Published: March 2008

AbstractThe generation of thrombin and the formation of platelet rich intra‐coronary thrombus in response to atherosclerotic plaque rupture is pathognomonic of acute coronary syndromes. An understanding of the process of thrombin generation and the unique relationship between the structure and function of thrombin is essential to developing more effective anti‐thrombotic strategies than the use of standard unfractionated heparin in the acute coronary syndromes. The mechanisms of action of heparin, low molecular weight heparins (LMWHs) and the newer direct anti‐thrombins, recombinant hirudin and Hirulog, are reviewed. Evidence from the currently available phase 2 and 3 trials of these drugs regarding their efficacy in the acute coronary syndromes is also reviewed.
Non‐rheumatic atrial fibrillation and stroke
Authors: Tonkin A. 
Published: March 2008

AbstractThe risk of systemic embolism and stroke in patients with non‐rheumatic atrial fibrillation (NRAF) should not be underestimated. The annual embolic rate is approximately 5% and in those with left atrial enlargement and/or left ventricular (LV) dysfunction, or who have already had systemic embolism, this rate may be as high as 20%. Decisions on patient management and the prophylaxis of stroke must always be individualised. The risk of bleeding related to warfarin is almost certainly greater than that encountered in the previous randomised trials. Also, clinical and echocardiographic features can further define absolute risk in an individual patient with NRAF. Clinical markers of increased risk of embolism in patients with NRAF include older age, previous cerebral embolism, recent congestive heart failure, hypertension and diabetes mellitus. Transthoracic echocardiography improves risk stratification and should be performed in the vast majority of patients. Embolic risk is greatest in those with increasing left atrial dilation, atrial dysfunction and LV dysfunction. Transoesophageal echocardiography sharpens the risk profile in selected patients.Overall randomised trials show greater benefit with warfarin than aspirin. In general, increasing age is associated with a greater incidence of structural heart disease and probably implies greater potential benefit with warfarin. Increasing age per se may not increase the risk of warfarin‐related bleeding. When the decision is made to warfarinise patients, at the present time data suggest that the target INR should be in the range of 2.0–3.0.
Oestrogen and vascular disease
Authors: Harvey P. 
Published: March 2008

AbstractCardiovascular disease (CVD) is the leading cause of morbidity and mortality in postmenopausal women. Epidemiological studies consistently suggest that oestrogen administered to postmenopausal women confers an estimated 30–50% reduction in risk of development and progression of CVD. The long term effect on the cardiovascular system of the addition of a progestogen to the replacement regimen is currently unknown. In addition, it may be argued that it remains to be proven whether the magnitude of the oestrogen‐induced cardioprotective effect demonstrated in these observational studies is a real biological phenonumon. No prospective, randomised, controlled studies examining the effect of oestrogen on primary and secondary prevention of CVD have been completed. However, a large number of biologically plausible mechanisms have been identified which provide evidence to support the proposed oestrogen‐induced cardioprotection. These include oestrogen mediated favourable changes in metabolic profile, in particular changes in lipid metabolism, insulin resistance and the fibrinolytic system. In addition, recent data have shown that oestrogen may affect vascular structure and function by a variety of mechanisms. It has been shown that oestrogen may induce acute and chronic coronary and cerebral vasodilation through both direct (vascular smooth muscle) and indirect (endothelium dependent) mechanisms. Oestrogen also has recently been shown to have complex anti‐atherogenic and antioxidant properties. Much less is known of the vascular effects of progestogens. Progestogens currently in clinical use have androgenic properties and may attenuate the beneficial effects of oestrogen by neutralising or opposing the lipid lowering, vasodilatory and anti‐atherogenic actions of oestrogen. Thus further studies are required to elucidate the effects on arterial physiology and CVD outcome of the oestrogens and progestogens of different types, doses and routes of administration which are collectively referred to as postmenopausal ‘hormone replacement therapy’.