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Biomedical subjects

B Barraclough

Publications and source records attributed to B Barraclough.

At least 19 recordsLinked to original sources
PubMed1995

Combined chemotherapy and radiotherapy for patients with breast cancer and extensive nodal involvement.

PURPOSE: This retrospective review examines local control, freedom from distant failure, and survival for patients with nonmetastatic breast cancer with extensive nodal disease (> 10 nodes, 45 patients; or > or = 70% involved nodes, if < 10 nodes found, 19 patients). All patients received chemotherapy and radiotherapy following mastectomy. PATIENTS AND METHODS: Sixty-four patients were treated between January 1980 and December 1988 at Westmead Hospital, Westmead, NSW Australia. The median follow-up duration for surviving patients was 91.5 months (range, 56 to 121). The median age was 51 years, and the median number of positive nodes was 11. Four successive protocols evolved, each with three phases, as follows: induction chemotherapy (doxorubicin or mitoxantrone, plus cyclophosphamide; three cycles), radiotherapy (50 Gy in 25 fractions to chest wall and regional nodes), then chemotherapy (cyclophosphamide, methotrexate, and fluorouracil [CMF]) of progressively shorter duration. Radiotherapy and chemotherapy were concurrent in the fourth regimen. RESULTS: One patient (1.5%) developed local recurrence before distant relapse, and seven patients (11%) developed local and/or regional recurrence simultaneously or after distant relapse. The 5-year actuarial freedom from distant relapse and overall survival rates were 45% and 65%, respectively. Overall survival did not vary significantly by menopausal status, nodal subgroup, or dose-intensity. There were no treatment-related deaths. CONCLUSION: Combined chemotherapy and radiotherapy in standard dosage is an acceptable approach following mastectomy for patients with extensive nodal involvement at high risk for local recurrence and distant relapse. This approach should be considered standard best therapy for any randomized trials that examine high-dose chemotherapy or bone marrow transplantation for this subgroup of patients.

Adult↗
PubMed1995

Suicide.

Explore the source record for details and available documents.

France↗
PubMed1994

Locally advanced breast cancer: defining an optimum treatment regimen.

PURPOSE: This retrospective review examines response, local control and freedom from distant failure for patients with locally advanced breast cancer treated by chemotherapy and radiotherapy without routine surgery. METHODS AND MATERIALS: 67 patients were treated between January 1980 and December 1988 at Westmead Hospital, NSW, Australia. Median follow-up for surviving patients was 56 months. Four successive protocols evolved, each with three phases induction chemotherapy (adriamycin or novantrone, cyclophosphamide) (three cycles), radiotherapy then chemotherapy (cyclophosphamide, methotrexate, 5-fluorouracil) of progressively shorter duration. Radiotherapy and chemotherapy were concurrent in the fourth regimen. RESULTS: Clinical complete response (disappearance of all known disease) after chemotherapy, radiotherapy and additional chemotherapy was 18%, 55% and 79% respectively. Seven additional patients subsequently underwent mastectomy (N = 2), local excision (N = 1) or a radiation boost (N = 4) for a total complete response rate of 90%. Twenty one patients (31%) failed to achieve a complete response (N = 7) or recurred locally (N = 14). The crude 2-year rate of local recurrence was 50% for tumors > 10 cm (N = 10) and 14% for smaller tumors (n = 57) and was not influenced by protocol. Two-year actuarial freedom from distant failure was 67% at 2 years. CONCLUSION: Local control can be achieved for patients with locally advanced breast cancer with a primary tumor < 10 cm using chemotherapy and radiotherapy without routine mastectomy.

Adult↗
PubMed1994

A necessary neologism: the origin and uses of suicide.

In English-speaking societies today the word suicide is the preferred term for self-inflicted death. But it has not always been so. Evidence recounted here suggests that suicide was devised by Sir Thomas Browne and first published in his book Religio Medici in 1643. Although little used at first, suicide had become established as noun and verb by the mid-18th century and was recognized by inclusion in Johnson's Dictionary. The modern world has seen an enormous increase in words and expressions derived from suicide, some of which are discussed here.

History, 17th Century↗
PubMed1992

Breast conservation: long-term Australian data.

Long-term data on the management of early breast cancer in Australia by conservative surgery and radiation therapy is limited. To examine this issue we reviewed our experience of 131 patients with Stage I or II breast cancer treated between November 1979 and December 1985. Ninety patients had a T1 tumor and 41 a T2 tumor. The extent of surgery varied from a local excision (LE), a wide local excision, to a quadrantectomy or partial mastectomy. Sixty-two per cent of patients also had an axillary dissection. One hundred and nineteen patients were treated using 6Mev photons to the whole breast (Median dose; 50 Gy) +/- regional nodes followed by a single plane Iridium-192 boost to the primary tumor site (median dose; 30 Gy). Ten patients did not receive a boost and two elderly patients were treated with an implant only. The median follow-up of surviving patients was 83 months (range, 51-133 months). Six other patients were lost to follow-up at a median of 48 months (range, 4-62). The pattern of first relapse is: breast alone, 7.0%; breast + distant, 0.75%; breast + nodes, 0.75%; regional nodes only, 0.75%; and distant disease, 18%. The extent of surgery did not influence the probability of a recurrence in the primary tumor region. The time to a breast recurrence ranged from 12 to 127 months (median, 61 months). The 5-year actuarial rate of a breast recurrence was 4.5%. The 5-year freedom from distant relapse was 80%. The complications of treatment were acceptable. These included rib fracture (5%), symptomatic pneumonitis (4%), fat necrosis or fibrosis requiring surgery (4.5%), severe arm edema (4.5%). The treatment of the axilla by both surgery plus radiation therapy was associated with a moderate or severe arm edema rate of 29% compared to 8% for surgery alone and 6% for radiation therapy alone. Our long-term data indicate that conservative surgery plus radiation therapy is associated with low rates of breast cancer recurrence which are independent of the extent of surgical resection. Complications were acceptably low provided that the axilla was treated by surgery or radiation therapy but not by both modalities.

Adult↗
PubMed1990

Violent death and mental illness. A study of a single catchment area over eight years.

The names of 412 residents of the catchment population of a district general hospital unit who died potentially self-inflicted deaths in the eight years 1974-81 were identified. They were classified as suicide (245), accidental death (126), and undetermined (41). In each group, over half had a lifetime history of psychiatric treatment and over a third were psychiatric patients at the time of their death. The relative risk of a violent death for those who died within a year of their last psychiatric contact was 27 times greater than that of residents with no recent psychiatric contact. The relative risk was highest for those aged 35-44 and lowest for those of 75 years and over.

Accidents↗
PubMed1989

Benefits and problems of routine laboratory investigations in adult psychiatric admissions.

A survey of laboratory investigations in the management of 1007 non-geriatric admissions to a district general hospital adult psychiatric unit showed a wide variation in the number of tests performed, and in the abnormal proportion between test types. Despite a policy of screening on admission, 40% of admissions had no tests. Physical illness attributable to mental illness was common, but rarely serious and usually apparent clinically. Mental illness attributable to physical illness detected by laboratory tests was rare: five cases of thyroid disease in women with affective disorder, and two cases of chest infection with raised white cell count in sustained mania. The findings show that tests are frequently used in circumstances where the result is of no apparent value. Test use might be improved by restricting screening to thyroid function and laboratory urine analysis, each in women. There are particular indications for white cell count in sustained or unexplained relapse of mental illness, and for syphilis serology when disinhibition may have exposed the patient to infection.

Adolescent↗
PubMed1988

Localization of a susceptibility locus for schizophrenia on chromosome 5.

Schizophrenia is a common disorder with a life time prevalence of approximately 1 per cent. The illness often develops in young adults, who were previously normal, and is characterized by a constellation of symptoms including hallucinations and delusions (psychotic symptoms) and symptoms such as severely inappropriate emotional responses, a disorder of thinking and concentration, erratic behaviour as well as social and occupational deterioration. A considerable proportion of the variance in the liability to develop schizophrenia may be genetic, but segregation analysis, to establish a mode of transmission, has not produced a consistent result. One of these studies was carried out in Iceland and made use of the large family size and extensive geneaological information present in that country. Here we demonstrate genetic linkage of two DNA polymorphisms on the long arm of human chromosome 5 to schizophrenia in seven British and Icelandic families with multiple affected members. The results indicate the existence of a gene locus with a dominant schizophrenia-susceptibility allele. Inheritance of the allele in the families studied suggests that it may also predispose to psychiatric conditions such as schizophrenia spectrum disorders and a variety of other disorders. This report provides the first strong evidence for the involvement of a single gene in the causation of schizophrenia.

Chromosomes, Human, Pair 5↗
PubMed1988

Thyroid disease and mental illness: a study of thyroid disease in psychiatric admissions.

The notes of 1007 consecutive admissions to a District General Hospital adult psychiatry unit were examined retrospectively to establish the role of the thyroid disease detected in routine management. Thyroid function tests were performed on 300 admissions, leaving 707 untested. Ten had abnormal results (3.3% of admissions tested), accounted for by nine patients with affective disorder. Two of the nine settled spontaneously, but seven cases (2.3%) had sustained abnormality. Five of the seven had a known history of thyroid disease, leaving two new findings of hypothyroidism who presented with no clinical signs other than their mental illness (0.7% of admissions tested). In five cases, which included the two new findings, the thyroid disease had been judged to precipitate the mental illness. All cases except one transitory abnormality occurred in females. When the results of this and other surveys are compared with the figures for thyroid disease in the general population, the value of screening psychiatric patients seems questionable. However, diagnosis is important in a few cases where thyroid disease apparently contributes to the mental illness. For psychiatric patients aged up to 65, elimination of unnecessary thyroid function tests without sacrificing detection may be possible by restricting use to female patients with affective disorder, patients with a past or family history of thyroid disease or with presenile dementia. Abnormal results obtained during the acute phase of the illness may be transitory and require confirmation.

Adult↗
PubMed1988

Fat necrosis of the breast following lumpectomy and radiation therapy for early breast cancer.

Between January 1980 and December 1985, 121 patients with early breast cancer were treated in the Department of Radiation Oncology at Westmead Hospital by external beam irradiation and an iridium wire boost following "lumpectomy". After a median follow-up of 26 months, 14 patients have developed recurrent masses in the treated breast. In four, recurrent carcinoma was strongly suspected and subsequently confirmed by fine needle aspiration biopsy, but in only two was a subsequent salvage mastectomy possible. The remaining 10 patients developed a nodule which was usually tender. With three exceptions, the nodule was at the primary tumour site and developed 4-43 months after treatment. In seven, tumour recurrence was suspected but not confirmed by biopsy and the other three were accepted as having post-treatment "radiation fibrosis". Excision biopsy was undertaken in eight of the 10 patients. Another patient underwent partial mastectomy for presumed local recurrence. The histological appearance in all cases was similar, with areas of fat necrosis and fibrosis with atypical stromal fibroblasts. Suture material was present microscopically in eight patients and was noted macroscopically (that is, by mammogram) in the one patient who did not undergo surgery. This complication is most likely caused by a combination of surgical and radiation factors. The difficulty in management is differentiation between tumour recurrence and a benign condition.

Brachytherapy↗
PubMed1988

Early breast cancer: cosmetic and functional results after treatment by conservative techniques.

Between January 1980 and December 1985, 121 patients with early breast cancer were referred to the Department of Radiation Oncology at Westmead Hospital for radiation therapy following initial tumour excision. After a median follow-up of 26 months, five patients developed a loco-regional recurrence (4%) and nine developed metastatic disease but with local control. There were 105 eligible patients who were sent a letter/questionnaire which included: a request to attend a clinic, to allow an objective assessment of the cosmetic result of the treated breast by two clinicians, questions regarding breast function as it affected quality of life, and a request that they undertake a self-assessment of the treated breast from a cosmetic point of view. Seventy-six patients attended for assessment of the following factors: whether surgery was optimal as determined by predefined criteria, measurement of breast oedema, arm oedema, breast retraction and telangiectasia, and an overall cosmetic assessment performed independently by both a radiation oncologist and surgeon. A physician not involved in management undertook a cosmetic assessment using standard photographs. Approximately 20% of patients replied that their choice of clothing had been affected by treatment, 10% were embarrassed and 70% experienced some continuing tenderness or discomfort in their treated breast. The extent of surgery was judged to be suboptimal in 22% but that proportion increased to 34% of cases referred from external clinics. The overall incidence of moderate or severe breast oedema was 9%, breast retraction 50%, telangiectasia 16% and arm oedema 21%. Those patients with longer follow-up (i.e., greater than 36 months) had a higher incidence of breast retraction (67%), telangiectasia (30%) and arm oedema (33%) but less breast oedema (7%). As expected, the patients rated the appearance of their breast more favourably than did clinicians. Overall, the result was rated as good or excellent by 75% of patients compared with 55% when the assessment was made by a surgeon or radiation oncologist. The main factor identified as contributing to a poor cosmetic result was the area of the iridium implant. The area of implant was larger when suboptimal surgery had been carried out, the main component of which was excessive length of scar.

Breast↗
PubMed1985

Depression among men made involuntarily redundant.

Ninety-eight men aged 25-50, who were unemployed because of involuntary redundancy and out of work for 2-18 months, completed the Beck Depression Inventory (BDI) and the General Health Questionnaire (GHQ-30). Their scores were compared with those of a group of employed men matched for age and social class. The mean GHQ score for the redundant men was 13.0, compared with 4.0 for the employed group. The mean BDI score was 11.1 for the redundant group and 5.6 for the employed group. Eighteen per cent of the redundant men, compared with 6% of the employed group, scored 18 or more which are scores corresponding to those in depressive illness. We conclude that the prevalence of depressive illness may be increased among redundant men.

Adult↗
PubMed1985

Why teetotallers abstain.

Drinking practices and attitudes to alcohol among the members of a Southampton church were investigated by questionnaire (602 subjects) and by interviews (126 subjects). Teetotallers were older than drinkers, and included a higher proportion of women. They perceived their childhood upbringing and the teaching of the Bible as the main factors influencing them to abstain. Both teetotallism and alcoholism were more common among relatives of teetotallers than among relatives of social drinkers.

Alcohol Drinking↗