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Biomedical subjects

A I Skene

Publications and source records attributed to A I Skene.

12 recordsLinked to original sources
PubMed2001

Axillary lymph node scarring and the association with tumour response following neoadjuvant chemoendocrine therapy for breast cancer.

We observed that the axillary lymph nodes of some of our breast cancer patients who received neoadjuvant chemoendocrine therapy (NCT) showed evidence of scarring. The purpose of this study is to determine whether such scarring exists and, if so, whether it is confined to neoadjuvant patients and may be related to response to therapy of the primary tumour. We examined the axillary lymph nodes of a consecutive series of 255 breast cancer patients, all of whom had undergone radical axillary dissection. Fifty-three had received NCT; the remainder formed the control group. A scar was defined as an area of cellular fibrous tissue >0.25 mm in diameter and for each patient scar count, median size and score were recorded. Nodes with scars were stained immunohistochemically (IHC) with 2 epithelial markers for the presence of occult micrometastases. The nodes of 20.7% of patients who had received NCT contained scars compared with 13.4% of controls. The median scar size was significantly greater in neoadjuvant patients (P<0.001) and within this group scar count and score were significantly higher (P=0.026 and 0.020) in those with no or minimal evidence of residual primary tumour. Scars which were IHC-positive for micrometastases were almost exclusively confined to neoadjuvant patients. Our results suggest that axillary lymph node scarring does exist, but is not a common phenomenon. It is more significant in neoadjuvant patients and within this group is most marked in those with the greatest primary tumour response to therapy. We believe that scarring is likely to represent downstaging of axillary disease. A prospective study involving a larger group of patients receiving NCT is indicated, to confirm these preliminary findings and establish whether scarring has prognostic or predictive potential.

Journal Article↗
PubMed1998

Multimodality treatment in the control of deep musculoaponeurotic fibromatosis.

BACKGROUND: Deep musculoaponeurotic fibromatoses are rare soft tissue neoplasms with a propensity for local recurrence. METHODS: A retrospective analysis was carried out of the factors contributing to local disease control in 75 patients treated between 1963 and 1993. RESULTS: Multivariate analysis identified the type of surgical excision (P < 0.001) and involvement of pathological resection margins (P < 0.02) as significant factors contributing to local recurrence. After a median follow up of 47 months (range 24 months to 29 years) 31 (49 per cent) of the 63 patients who had an 'adequate' surgical resection developed local recurrence. The median time before development of local recurrence was 83.4 (range 8-129) months in patients with clear pathological resection margins. This was significantly shortened to 13.1 (range 2-35) months in those with positive margins (P < 0.001). CONCLUSION: Adequate surgical extirpation is the most important determinant in local disease control. Treatment of local recurrence ranged from observation during periods of disease stabilization to multimodality treatment for aggressive disease.

Adult↗
PubMed1994

Superficial parotidectomy in the treatment of cutaneous melanoma of the head and neck.

The preauricular lymph nodes are frequently the first site of metastatic disease from primary malignant melanoma of the upper two-thirds of the face or the anterior scalp. For these patients, or those with adjacent metastatic nodal disease, the prognosis is poor. The median survival of 13 such patients presented was 2 years, with two long-term survivors at 4 and 6 years. Palliative surgery can, however, prevent uncontrolled locoregional disease. Patients with palpable preauricular and cervical node disease should be treated by facial nerve-preserving parotidectomy and radical neck dissection. When no cervical nodes are palpable in patients with preauricular node metastasis, peroperative jugulodigastric node biopsy and frozen-section histopathological examination are useful to select patients for radical neck dissection.

Adolescent↗
PubMed1993

Adult type (nonembryonal) soft tissue sarcomas in childhood.

Nonembryonal soft tissue sarcomas are rare in childhood. We report our experience from a series of 28 patients treated at this centre, whose treatment was based on primary surgical resection. No patient required limb amputation. Anatomical distribution and histological subtypes differed from the adult sarcoma population. A total of 79 percent of the sarcomas were classified as high grade. Six patients (21%) developed local recurrence, and 6 patients (21%) developed distant recurrence, including 3 patients (11%) who developed both. Median follow-up was 57 months. Actuarial 5 years survival was 82%, which compares favorably with the 5 year survival of adults with high grade soft tissue sarcomas treated at this centre (63%) and with the survival of children with embryonal sarcomas treated by chemotherapy.

Adolescent↗
PubMed1993

Technical note: appearances on ultrasound of impalpable injection port in a double chamber breast prosthesis.

Breast reconstruction utilizing tissue expansion is being increasingly practised by both plastic and general surgeons. Our current experience for both immediate and delayed reconstruction is with the double chamber Becker prosthesis. The prosthesis with the resulting breast mound has on occasions rendered the injection port difficult to localize by palpation. We have found ultrasound useful in identifying impalpable ports and in facilitating needle insertion into the injection dome.

Female↗
PubMed1992

Venous leg ulcers: a prognostic index to predict time to healing.

OBJECTIVE: To evaluate the prognostic factors in uncomplicated venous leg ulcer healing. DESIGN: Randomised parallel group controlled trial with subjects stratified by initial ulcer diameter and four months' maximum duration of follow up. SETTING: Assessment at Northwick Park Hospital vascular unit with community based treatment. PATIENTS: 200 patients with clinical and objective evidence of uncomplicated venous leg ulceration and an initial ulcer diameter > 2 cm. MAIN OUTCOME MEASURE: Time to complete healing of the ulcer. RESULTS: In the presence of graduated compression healing occurred more rapidly in patients with a smaller initial ulcer area (relative risk of healing 1.92 associated with halving of ulcer area (95% confidence interval 1.58 to 2.33)), shorter duration of ulceration (relative risk 1.35 associated with halving duration (1.17 to 1.56)), younger age (relative risk 1.34 associated with 10 year decrease (1.12 to 1.59)), and no deep vein involvement (relative risk 1.8 (1.19 to 2.78)). CONCLUSION: These prognostic factors used in a simple scoring system predict time to healing.

Aged↗
PubMed1992

Metastasectomy.

The literature on metastasectomy abounds in anecdote and retrospective studies of non-randomized patients. In this paper, the published evidence concerning the efficacy of metastasectomy in the lung, liver, brain, gastrointestinal tract and omentum is reviewed to formulate practical recommendations for patient selection and treatment. At some sites metastasectomy can be recommended with little hesitation for more widespread application, but surgery for liver metastases should still be regarded with some reservation.

Adult↗
PubMed1990

Perineal, vulval and vaginoperineal reconstruction using the rectus abdominis myocutaneous flap.

Poor perineal healing is a major complication of total or partial pelvic exenteration especially when the pelvis and perineum have previously been irradiated. Perineal, vulval or vaginoperineal reconstruction was performed in five women using the inferiorly based rectus abdominis myocutaneous flap. Primary perineal wound healing occurred in all patients and no flap-related complications developed. Primary healing of abdominal wall wounds occurred in all patients without incisional hernia. Three of the patients had an anterior or total pelvic exenteration with continent urinary diversion by the Mitrofanoff technique. Two of the patients had complete vaginal reconstruction and one patient had after-loading catheters inserted for postoperative interstitial irradiation. The patients were in hospital for 42, 28, 21, 17 and 15 days respectively. The longest stays were associated with training for self-catheterization of the continent urinary diversion. Median follow-up was 9 months. One patient developed two perineal recurrences at 16 months which were resected, and she remains disease-free 6 months later.

Abdominal Muscles↗
PubMed1990

Hyperthermic isolated perfusion with melphalan in the treatment of advanced malignant melanoma of the lower limb.

A retrospective study of 91 patients with malignant melanoma treated by lower limb isolated hyperthermic regional perfusion was performed. Objective response in patients with evaluable disease was 78 per cent. The role of perfusion as primary treatment of large melanomas of the foot is confirmed and recommended. Control of locoregional disease and limb salvage remains a valuable and attainable therapeutic goal using this technique.

Chemotherapy, Cancer, Regional Perfusion↗
PubMed1990

Leukocyte antigen CD34 is expressed by a subset of cultured endothelial cells and on endothelial abluminal microprocesses in the tumor stroma.

It has been reported that the human haemopoietic progenitor cell antigen CD34 is also expressed by vascular structures. To investigate its precise vascular localization, we have studied the cellular and subcellular distribution of CD34 in normal tissues and pathologic tissues with neovascularization. In normal resting tissues, anti-CD34 antibodies, ICH3 and QBEND-10 predominantly stain the luminal endothelial membrane, whereas the abluminal membrane is negative or weakly positive. In contrast, a striking staining of endothelial abluminal microprocesses (EAM) was found in the tumor stroma. These structures, measuring up to 20 microns in length, could be observed in thick vibratome sections both at the tips of vascular sprouts and, also frequently, on fully formed microvessels. The number of vascular sprouts and EAM varied widely between different tumors. CD34-stained EAM were sparsely present in fetal tissue of 10 weeks gestation, but they could not be demonstrated in granulation tissue of wound healing. By immunoelectron microscopy, the EAM were continuous with the cytoplasm of endothelial cells showing an immature phenotype as seen in regeneration. In cultured human umbilical vein endothelium, CD34 was preferentially found on a small subset of cells with the morphologic appearance of migrating cells. These findings suggest that CD34 is an endothelial marker for EAM present during angiogenesis.

Antibodies, Monoclonal↗
PubMed1987

An outbreak of Serratia marcescens infection following urodynamic studies.

Serratia marcescens was isolated from the urine of five patients, two of whom subsequently developed septicaemia with other Gram-negative bacilli. Four of the five patients had undergone urodynamic investigation. An inadequately sterilized re-usable rectal balloon was identified as the source of infection.

Aged↗