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Biomedical subjects

A C Robinson

Publications and source records attributed to A C Robinson.

At least 19 recordsLinked to original sources
PubMed2004

A novel continuous infusional 5-fluorouracil-based chemotherapy regimen compared with conventional chemotherapy in the neo-adjuvant treatment of early breast cancer: 5 year results of the TOPIC trial.

BACKGROUND: To compare the efficacy of continuous infusional 5-fluorouracil (5-FU)-based chemotherapy against conventional bolus chemotherapy in the preoperative treatment of patients with large operable early breast cancer. PATIENTS AND METHODS: Four hundred and twenty-six women with histologically proven 3 cm invasive early breast cancer were randomised to receive pre-operative infusional 5-FU 200 mg/m(2) by daily 24 h continuous infusion via a Hickman line for 18 weeks with epirubicin 60 mg/m(2) intravenous (i.v.) bolus on day 1 and cisplatin 60 mg/m(2) i.v. bolus on day 1, both repeating 3-weekly (infusional ECisF), or conventional bolus doxorubicin 60 mg/m(2) i.v. on day 1 and cyclophosphamide 600 mg/m(2) i.v. on day 1, both repeating 3-weekly (AC), both schedules for six courses. Patients subsequently had local therapy (surgery or radiotherapy or both) and tamoxifen 20 mg orally daily as appropriate. RESULTS: The 5 year results for AC and infusional ECisF, respectively, were as follows: overall response, 75% and 77%; complete clinical remission, 31% and 34%; pathological complete remission (pathCR), 16% for both; and pathCR with residual ductal carcinoma in situ (DCIS), 25% and 24%. Mastectomy rates were 37% and 34%, respectively. Five-year overall survival was 74% for AC and 82% for infusional ECisF (hazard ratio 0.76, 95% confidence interval 0.51-1.13; P = 0.18). Both treatments were well tolerated. Grade III/IV lethargy, vomiting, alopecia and plantar-palmar erythema were significantly greater for infusional ECisF; grade III/IV leucopenia was significantly greater for AC. CONCLUSIONS: Preoperative continuous infusional 5-FU-based chemotherapy is no more active than conventional AC for early breast cancer; with a median 5 year follow-up, the infusion-based schedule shows a non-significant trend towards improved survival.

Adult↗
PubMed2004

Impacted cerumen: composition, production, epidemiology and management.

In the UK, some 2.3 million people suffer cerumen ('ear wax') problems serious enough to warrant management, with approximately 4 million ears syringed annually. Impacted cerumen is a major cause of primary care consultation, and a common comorbidity in ENT patients, the elderly, infirm and people with mental retardation. Despite this, the physiology, clinical significance and management implications of excessive and impacted cerumen remain poorly characterized. There are no well-designed, large, placebo-controlled, double-blind studies comparing treatments, and accordingly, the evidence surrounding the management of impacted cerumen is inconsistent, allowing few conclusions. The causes and management of impacted cerumen require further investigation. Physicians are supposed to follow the edicts and principles of evidence-based medicine and clinical governance. Currently, in patients with impacted cerumen, the lack of evidence makes this impossible.

Cerumen↗
PubMed2001

Audit of influenza and pneumococcal vaccination uptake in diabetic patients attending secondary care in the Northern Region.

AIMS: To document uptake of influenza and pneumococcal vaccination in diabetic patients attending secondary care in the Northern Region, and to explore influencing factors. METHODS: Diabetic patients attending out-patients in Middlesbrough, Gateshead and Newcastle were questioned from October 1999 to March 2000. Physicians inquired about influenza and pneumococcal vaccination status using a standardized questionnaire. Data collected included age, year of diagnosis, duration of diabetes, type of diabetes, and the presence of other recognized indications for vaccination. RESULTS: Two hundred and sixty-eight diabetic patients, 42% (113/268) with Type 1 diabetes, 34% (91/268) with ischaemic heart disease, 10% (26/268) with chronic pulmonary disease (CPD) and 10% (27/268) with chronic renal disease, were questioned. Thirty-five percent (93/268) of patients received both influenza and pneumococcal vaccines, 24% (64/268) received only influenza vaccine, and none received pneumococcus vaccine alone. Most vaccinees received advice about influenza and pneumococcal vaccination from their general practitioner (90% (142/157) and 87% (81/93), respectively). A large number of non-vaccinees were unaware of the need for influenza and pneumococcal vaccination (69% (76/111) and 91% (159/175), respectively). Using multiple logistic regression co-existing CPD increased the odds of receiving influenza (odds ratio (OR) (95% confidence interval (CI)) = 1.99 (1.07-14.12)) or pneumococcal (OR = 3.77 (1.69-21.76)) vaccination. Furthermore, each 1-year increase in age increased the chance of receiving influenza or pneumococcal vaccination by 22% (OR = 1.22 (1.09-1.67) and 29% (OR = 1.29 (1.07-1.72)), respectively. CONCLUSIONS: Vaccination rates in these diabetic patients are unsatisfactory. Secondary care health professionals might increase rates by raising the topic in consultations. Diabet. Med. 18, 599-603 (2001)

Adolescent↗
PubMed2000

Prevalence of renal artery stenosis in subjects with type 2 diabetes and coexistent hypertension.

OBJECTIVE: To assess the prevalence of renal artery stenosis (RAS) in subjects with type 2 diabetes and coexistent hypertension by using magnetic resonance angiography (MRA) of the renal arteries, to assess clinical and biochemical predictors of RAS, and to assess the hemodynamic significance of RAS, by using the captopril test (a measure of the response of plasma renin activity to a single oral dose of captopril). RESEARCH DESIGN AND METHODS: A total of 117 subjects with type 2 diabetes and coexistent hypertension between 40 and 70 years of age and with creatinine concentrations < 150 micromol/l were recruited from two inner-city general diabetes clinics. All subjects underwent MRA of the renal arteries. In a subgroup of 85 subjects, data concerning possible clinical and biochemical predictors of RAS were collected, and the captopril test was performed. For comparison of a continuous variable between subjects with a positive MRA and those with a negative MRA, the Mann-Whitney test was used. For comparison of a discrete variable between subjects with a positive MRA and those with a negative MRA, Fisher's exact test was used. RESULTS: The prevalence of RAS detected by using MRA in 117 hypertensive type 2 diabetic subjects was 17%; 19 subjects had unilateral RAS, and only 1 subject had bilateral RAS. A femoral bruit was significantly more common in subjects with a positive MRA versus subjects with a negative MRA (21 vs. 0%; Fisher's exact test P < 0.005); however, other clinical features of atherosclerotic disease were not statistically associated. Greater duration of hypertension and treatment with statins were features of subjects with RAS (P < 0.05). The captopril test was negative in all subjects, although the antihypertensive response to oral captopril was significantly greater in subjects with RAS detected by MRA. CONCLUSIONS: RAS is common in hypertensive type 2 diabetic subjects. The presence of a femoral bruit is a useful predictive clinical marker. The captopril test is not useful in predicting the hemodynamic significance of RAS in this patient group.

Aged↗
PubMed1998

The effects of metformin on glycemic control and serum lipids in insulin-treated NIDDM patients with suboptimal metabolic control.

OBJECTIVE: To test the hypothesis that metformin therapy, given as an adjunct to insulin therapy, improves metabolic control in insulin-treated NIDDM patients with suboptimal glycemic control. RESEARCH DESIGN AND METHODS: A total of 33 subjects with insulin-treated NIDDM were investigated; all had commenced insulin after secondary failure of antihyperglycemic agents. Two randomized double-blind placebo-controlled crossover studies were run. In study 1 (n = 19), insulin-treated subjects with suboptimal glycemic control received 12 weeks of metformin 1 g b.i.d. and 12 weeks of placebo. In study 2 (n = 14), subjects already established on adjunctive metformin/insulin therapy stopped the metformin component and received 12 weeks of metformin at their baseline dosage (range 1-2.5 g) and 12 weeks of equivalent placebo. Fasting plasma glucose, HbA1c, and serum lipids were measured at baseline and midway through and at the end of each treatment phase. The effect of 12 weeks of metformin treatment was compared with the effect of 12 weeks of placebo in each study and in both studies combined. RESULTS: In study 1, metformin treatment was associated with significant improvements in fasting plasma glucose (mean 12-week difference from placebo [95% CI]: 5.8 mmol/l [3.5-8.1], P < 0.001) and HbA1c (1.6% [0.9-2.4], P < 0.001). In study 2, metformin treatment was associated with significantly lower fasting plasma glucose (5.3 mmol/l [0.6-9.9], P = 0.029) and lower HbA1c (2.4% [1.0-3.8], P = 0.003) compared with those for placebo. Study 2 also showed metformin treatment to be associated with significantly lower total cholesterol than that for placebo (1.0 mmol/l [0.1-1.9], P = 0.032) and lower LDL cholesterol (1.0 mmol/l [0.1-1.9], P = 0.028). This significant difference in serum lipids seen in study 2 was not seen in study 1, but was present when both sets of data were combined (n = 33, mean total cholesterol difference at 12 weeks [95% CI]: 0.6 mmol/l [0.1-1.1], P = 0.015). Metformin had no significant effect on triglyceride, HDL cholesterol, weight, or blood pressure. Two subjects on metformin withdrew because of side effects. CONCLUSIONS: Metformin, when given as adjunctive therapy, was well tolerated and improved glycemic control and lipid concentrations in patients with insulin-treated NIDDM whose diabetes was poorly controlled. These improvements could be maintained over the long term.

Aged↗
PubMed1996

Heterotopic pleomorphic adenoma of the external nose.

Pleomorphic adenomas arising from sites other than the major or minor salivary glands are uncommon. We describe a case of pleomorphic adenoma in the subcutaneous tissue of the nasomaxillary crease. An identical tumour was previously excised from the right nasal cavity. The possible aetiology of these heterotopic salivary gland tumours is discussed.

Adenoma, Pleomorphic↗
PubMed1996

Does moderate aerobic activity have a stimulatory effect on 24 h resting energy expenditure: a direct calorimeter study.

This study was designed to establish whether moderate aerobic exercise (2 h at 30-35% VO2 max) in lean non-athletic male adults had a prolonged stimulatory effect on energy expenditure while at rest. Four weight maintaining male adults had their 24 h energy expenditure measured by direct calorimetry on four separate occasions. During the 24 h in the calorimeter each subject received a diet which in total supplied 35 kcal (146 kJ) per kg body weight. All studies in an individual were completed within four to six weeks during which time body weight remained stable. On two of these 24 h periods, individuals rested throughout while on the other two, they also performed the prescribed exercise. This consisted of cycling for two 1 h sessions; the first while they were fasting while the second period was approximately 45 min after consuming a 800 kcal (3.4 MJ) meal. Total 24 h energy expenditure was greater on exercise (8.3 +/- 1.8 MJ/day) than non-exercising days (6.3 +/- 1.4 MJ/day, P < 0.001) In contrast when the acute effects of the cycling where removed 24 h resting energy expenditure on the exercise day (6.8 +/- 1.7 MJ/day) was not significantly different from that of rest days (95% confidence intervals of the difference ranged from -0.36 to 1.27 MJ/day). This study did not demonstrate a prolonged stimulatory influence on non-exercising resting energy expenditure following physical activity likely to be achieved by non-athletes. These data provide no evidence that such exercise is associated with a greater energy deficit than that due to the activity itself.

Adult↗
PubMed1994

Characterisation of mutant alleles of the cell division protein FtsA, a regulator and structural component of the Escherichia coli septator.

Two alleles of ftsA, a gene that encodes an essential cell division protein in Escherichia coli, have-been mapped at the nucleotide level. The mutations are located inside domains that are conserved in an ATP-binding protein family. The ftsA2 mutation lies in the adenine-binding domain, and the ftsA3 in the ribose-binding domain. The defect in ampicillin binding to PBP3 described for allele ftsA3 is allele-specific. This supports the hypothesis of the existence of different domains in FtsA having different functions.

Alleles↗
PubMed1991

Massive metastasis from squamous carcinoma of the tonsil.

Squamous carcinomas of the oro-pharynx are associated with a high incidence of distant metastases at post-mortem. A case of a massive distant metastasis from a squamous cell carcinoma of the tonsil is presented. This occurred despite excellent local control. The pathology and the possible management implications are discussed.

Acetabulum↗
PubMed1991

Murine immune response to HIV-1 p24 core protein following subcutaneous, intraperitoneal and intravenous immunization.

The murine immune response to baculovirus-produced human immunodeficiency virus type-1 (HIV-1)p24 was examined after injection by three different routes: subcutaneously (s.c.), intraperitoneally (i.p.) and intravenously (i.v.). Both antigen-specific T-cell proliferation and serum antibody were induced by i.p. injection. In contrast, s.c. and i.v. injection of antigen resulted in specific antibody generation alone. Lympho-proliferative responses seen after i.p. injection were confined to splenocytes, and were greater after a low dose of antigen than after a high dose. p24-specific proliferation was not detected in lymph node cells. CD4:CD8 ratios were normal in lymph nodes and spleen at all times, irrespective of the dose or route of administration. p24-specific serum IgG antibodies were detected in all animals after the second injection of antigen. After s.c. and i.v. administration of high doses of antigen, the median antibody titres continued to rise after a third injection, but plateaued in animals injected by the i.p. route. In contrast, low doses of antigen given i.p. increased the median titre during and after the course of four injections. A low antigen dose given s.c. resulted in a plateau of median titre between the third and fourth injections. In i.v.-injected animals the median titre decreased between the third and fourth injections. IgG1 p24-specific antibodies were detected in all immunized mice, whereas IgM antibodies were detectable only following i.p. injection of antigen.

Animals↗
PubMed1991

The motility of keratinocytes in cholesteatoma: an ultrastructural approach to epithelial migration.

Eight cases of attico-antral cholesteatoma were studied by transmission electron microscopy concentrating on the mechanisms involved in intercellular adhesion. Desmosomes were found in large numbers throughout the epidermis and were arranged in various orientations around the keratinocytes. Those desmosomes found in the stratum corneum were significantly less dense than those in deeper layers and were associated with a large number of intercellular spaces, which would reduce the cohesive strength of this layer. The tortuous basement membrane features numerous hemidesmosomes along its length. The findings of this study were compared with previous ultrastructural observations made on the pars flaccida and pars tensa of the tympanic membrane and external canal skin. This revealed that the morphological characteristics of cholesteatoma resemble pars flaccida and external canal skin rather than pars tensa. The implications of these findings are discussed.

Cell Movement↗
PubMed1990

Percutaneous nephrostomy: its value in obstructive uropathy complicating carcinoma of cervix uterus.

Percutaneous nephrostomies (PCN) were performed in 25 patients with uterine cervical malignancy between November 1982 and December 1987 at the Christie Hospital and Holt Radium Institute. Group 1 consisted of eight patients with untreated disease; group 2 consisted of eight cases with recurrent tumour; and group 3 consisted of nine patients with obstructive uropathy related to previous treatment. Six patients in group 1 subsequently received radical radiotherapy, and two of them were alive and disease free (33%) ten months later. Further active treatment was only possible in two of the patients with recurrence and overall median survival was only 51 days. All patients in group 3 had normalization of their renal function post-nephrostomy and prior to definitive management of the obstruction. We conclude that the technique should be considered in patients who had no previous treatment and in patients with treatment-related complications. Its value in recurrent disease is limited.

Adult↗