Biomedical subjects

C D Collins

Publications and source records attributed to C D Collins.

At least 37 records · Page 2Linked to original sources

PubMed1999

The diagnostic value of positron emission tomography (PET) with radiolabelled fluorodeoxyglucose (18F-FDG) in head and neck cancer.

Positron emission tomography (PET) scanning has recently been introduced into clinical practice but its usefulness in the management of head and neck cancer is not well defined. The aim of this prospective preliminary study was to examine the clinical value of fluorodeoxyglucose (FDG)--PET in patients with head and neck cancer treated by radiotherapy with surgery in reserve by (i) relating quantitative uptake of isotope to tumour type and histological grade and (ii) comparing the imaging findings of PET and magnetic resonance imaging (MRI) in post-radiotherapy assessment of tumour response. Twenty-one patients had pre-treatment PET and MRI scans and these were repeated four and eight months after treatment if there was no clinical relapse. Pre-treatment uptake of FDG using tumour to cerebellar ratio parameters was significantly related to the histological grade of squamous cancer (p = 0.04) but not to tumour type. Discordance of post-treatment PET/MRI findings in one case indicates a possible role for PET in the early detection of tumour recurrence. Other potential uses of PET scanning in the management of head and neck cancer are discussed.

Adult↗

PubMed1998

Randomized comparison of progenitor-cell mobilization using chemotherapy, stem-cell factor, and filgrastim or chemotherapy plus filgrastim alone in patients with ovarian cancer.

PURPOSE: This was the first randomized study to investigate the efficacy of peripheral-blood progenitor cell (PBPC) mobilization using stem-cell factor (SCF) in combination with filgrastim (G-CSF) following chemotherapy compared with filgrastim alone following chemotherapy. PATIENTS AND METHODS: Forty-eight patients with ovarian cancer were treated with cyclophosphamide and randomized to receive filgrastim 5 microg/kg alone or filgrastim 5 microg/kg plus SCF. The dose of SCF was cohort-dependent (5, 10, 15, and 20 microg/kg), with 12 patients in each cohort, nine of whom received SCF plus filgrastim and the remaining three patients who received filgrastim alone. On recovery from the WBC nadir, patients underwent a single apheresis. RESULTS: SCF in combination with filgrastim following chemotherapy enhanced the mobilization of progenitor cells compared with that produced by filgrastim alone following chemotherapy. This enhancement was dose-dependent for colony-forming unit-granulocyte-macrophage (CFU-GM), burst-forming unit-erythrocyte (BFU-E), and CD34+ cells in both the peripheral blood and apheresis product. In the apheresis product, threefold to fivefold increases in median CD34+ and progenitor cell yields were obtained in patients treated with SCF 20 microg/kg plus filgrastim compared with yields obtained in patients treated with filgrastim alone. Peripheral blood values of CFU-GM, BFU-E, and CD34+ cells per milliliter remained above defined threshold levels longer with higher doses of SCF. The higher doses of SCF offer a greater window of opportunity in which to perform the apheresis to achieve high yields. CONCLUSION: SCF (15 or 20 microg/kg) in combination with filgrastim following chemotherapy is an effective way of increasing progenitor cell yields compared with filgrastim alone following chemotherapy.

Adult↗

PubMed1997

Relapse of intracranial germinoma 23 years postirradiation in a patient given growth hormone replacement.

There is no clear evidence that growth hormone replacement therapy for treatment-related growth hormone deficiency in patients with childhood intracranial malignancies has a role in tumour relapse or second malignancy. A 16-year-old girl with an intracranial germinoma was treated with local radiotherapy and subsequently received growth hormone replacement therapy as an adult. Three years after starting growth hormone therapy, 23 years after her radiotherapy treatment, the patient's tumour recurred. Surveillance requirements for patients receiving growth hormone in this setting are discussed.

Adolescent↗

PubMed1997

What is the value of the lateral chest radiograph in the follow-up thoracic lymphoma?

Lateral chest radiography in the investigation of thoracic lymphoma remains a feature of the current literature. This study assessed what information the lateral chest radiograph (CXR) adds in the follow-up of such patients. Eighty-eight patients with known lymphoma who had a CXR and thoracic CT within the same 4-week period were assessed. Five radiologists scored eight mediastinal and hilar nodal groups and eight extramediastinal regions on the frontal CXR as normal, equivocal or definitely abnormal (denoted 0, 1 and 2, respectively). This was repeated 1 week later with a combination of frontal and lateral films. Results were compared with the findings on CT which were scored similarly using accepted criteria for the presence of lymphadenopathy. Where the lateral CXR caused a change in score at any site, this change was compared with CT to determine the effect on diagnostic accuracy. For four of the five observers, the lateral film made no significant difference in diagnostic accuracy in the assessment of mediastinal lymph nodes. A fifth observer derived a small benefit from the addition of the lateral film, although almost 30 % of this was accounted for by changing from a wrong to an equivocal diagnosis. The lateral film did cause a small increase in the detection of pleuro-parenchymal lung lesions, although none of these were clinically significant. We conclude that routine lateral chest radiography is unhelpful in the follow-up of patients with lymphoma.

Adult↗

PubMed1997

Hypofractionated radiotherapy for invasive bladder cancer.

BACKGROUND AND PURPOSE: The policy of the Radiotherapy Department of St. Thomas' Hospital in London for patients with invasive bladder cancer, used to be treatment with hypofractionated radiotherapy. The advantages of this fractionation scheme included reduction of the number of treatment sessions and better use of limited resources. Our results after hypofractionation were compared to series with more conventional radiotherapy. MATERIAL AND METHODS: Between 1975 and 1985, 123 patients with a T2-T3 transitional cell carcinoma of the bladder were treated by a radical course of hypofractionated radiotherapy. Local control, survival and morbidity rates were analysed retrospectively. RESULTS: The actuarial local control rates at 5 and 10 years were 31 and 29%, respectively. The actuarial cancer-specific 5- and 10-year survival rates were 48 and 39%, respectively. Acute side effects were observed in 87% of patients. The actuarial overall and severe late complication rates at 5 years were 33 and 9%, respectively. The local control, survival and early side effect rates we found, were in the same range as those reported in literature. Late radiation side effects however, were more common after hypofractionated radiotherapy compared to conventional radiotherapy schedules. CONCLUSIONS: We conclude that the potential advantage of a reduced number of treatment sessions may be lost in the long term, because of the higher incidence of late morbidity after hypofractionated radiotherapy. Hypofractionation however, remains a valuable technique for palliation and deserves further investigation for radical treatment where access to equipment is difficult or resources are limited.

Aged↗

PubMed1997

Prognostic factors for disease progression in advanced Hodgkin's disease: an analysis of patients aged under 60 years showing no progression in the first 6 months after starting primary chemotherapy.

The aim of this study was to determine whether a very high-risk group based on presenting characteristics could be identified in patients with advanced Hodgkin's disease who may benefit from high-dose chemotherapy (HDCT). Between 1975 and 1992, 453 previously untreated patients aged under 60 years who did not progress in the first 6 months after the start of standard chemotherapy had their hospital notes reviewed. The outcomes analysed were early disease progression (in the 6- to 18-month window following the start of chemotherapy) and disease progression in the whole of the follow-up period. A Cox regression analysis was used to investigate the combined effects of a number of presenting characteristics on these outcomes. Despite the presence of factors with significant effects on the relative rate of progression, the absolute effects in a group identified as having the poorest prognosis were not especially poor. No group could be defined with a freedom from progression rate of less than 70% over 6-18 months, and the worst prognostic group, which included only 53 patients, had an overall freedom from progression rate of 57% at 5 years. Four other reported prognostic indices were evaluated using our data set, but none of the indices was more successful in identifying a very high-risk group. It has not been possible to define a sufficiently high-risk group of patients with Hodgkin's disease based on presenting characteristics for whom HDCT could be advised as part of primary treatment. The search for more discriminating prognostic factors identifying vulnerable patients with a high risk of relapse must continue before a role can be found for HDCT following conventional chemotherapy in patients without disease progression.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1996

A study of ovarian cancer patients treated with dose-intensive chemotherapy supported with peripheral blood progenitor cells mobilised by filgrastim and cyclophosphamide.

We have shown that large numbers of haemopoietic progenitor cells are mobilised into the blood after filgrastim [granulocyte colony-stimulating factor (G-CSF)] alone and filgrastim following cyclophosphamide chemotherapy in previously untreated patients with ovarian cancer. These cells may be used to provide safe and effective haemopoietic rescue following dose-intensive chemotherapy. Using filgrastim alone (10 micrograms kg-1), the apheresis harvest contained a median CFU-GM count of 45 x 10(4) kg-1 and 2 x 10(6) kg-1 CD34+ cells. Treatment with filgrastim (5 micrograms kg-1) following cyclophosphamide (3 g m-2) resulted in a harvest containing 66 x 10(4) kg-1 CFU-GM and 2.4 x 10(6) kg-1 CD34+ cells. There was no statistically significant difference between these two mobilising regimens. We have also demonstrated that dose-intensive carboplatin and cyclophosphamide chemotherapy can be delivered safely to patients with ovarian cancer when supported by peripheral blood progenitor cells and filgrastim. Carboplatin (AUC 7.5) and cyclophosphamide (900 mg m-2) given at 3 weekly intervals with progenitor cell and growth factor support was well tolerated in terms of haematological and systemic side-effects. Double the dose intensity of chemotherapy was delivered compared with our standard dose regimen when the treatment was given at 3 weekly intervals. Median dose intensity could be further escalated to 2.33 compared with our standard regimen by decreasing the interval between treatment cycles to 2 weeks. However, at this dose intensity less than a third of patients received their planned treatment on time. All the delays were due to thrombocytopenia.

Adult↗

PubMed1996

A randomised trial investigating the dose intensity of primary chemotherapy in patients with ovarian carcinoma: a comparison of chemotherapy given every four weeks with the same chemotherapy given at three week intervals.

BACKGROUND: The dose intensity of chemotherapy for patients with ovarian carcinoma remains a controversial issue. Few randomised trials have been conducted examining dose intensity using the same total dose of chemotherapy. This study was designed to investigate two schedules of chemotherapy using standard and higher dose intensity with both groups receiving the same total dose. PATIENTS AND METHODS: Patients with FIGO stage IC, II, III and IV epithelial ovarian carcinoma were randomised to receive cycles of cyclophosphamide (600 mg/m2) and carboplatin (300 mg/m2) alternating with doxorubicin (50 mg/ m2) and ifosfamide (5 g/m2) at either four-weekly (n = 47) or three-weekly (n = 97) intervals (1:2 randomisation). At randomisation patients were stratified according to histological grade and amount of post operative residual tumour (greater or less than 2 cm). The two arms of the study were well balanced in terms of the major prognostic features. RESULTS: There was no difference in either progression free survival or overall survival between the two arms. The median overall survival was 730 days for the three-weekly treatment and 740 days in the four-weekly arm (progression-free survival was 500 days and 483 days, respectively). The combined overall response rate (complete and partial response) in the 114 assessable patients was 65.7% (66.7% for the three-weekly treatment and 64% for the four-weekly treatment). These differences were not statistically different. CONCLUSIONS: A modest increase in the dose intensity of chemotherapy (1:3 fold) failed to improve the response rate, progression-free survival and overall survival in patients with ovarian carcinoma.

Adult↗

PubMed1995

Health service accreditation: report of a pilot programme for community hospitals.

Voluntary accreditation in the United Kingdom is being used by health care providers to improve and market their services and by commissioners to define and monitor service contracts. In a three year pilot scheme in the south west of England, 43 out of 57 eligible community hospitals volunteered to be surveyed; 37 of them were ultimately accredited for up to two years by the hospital accreditation programme. The main causes for non-accreditation related to safety, clinical records, and medical organisation. Follow up visits in 10 hospitals showed that, overall, 69% of recommendations were implemented. An independent survey of participating hospitals showed the perceived benefits to include team building, review of operational policies, improvement of data systems, and the generation of local prestige. Purchasers are increasingly influenced by accreditation status but are mostly unwilling to finance the process directly. None the less, the concept may become an important factor moderating the quality of service in the new NHS.

Accreditation↗

PubMed1995

Computed tomography in the assessment of response to limb compression in unilateral lymphoedema.

In this prospective study computed tomography (CT) was used to monitor the response of compression therapy in 27 patients with chronic unilateral lymphoedema over a 12 week period. Computed tomography examination of abnormal and normal limbs (proximal and distal portions) was performed in the first, third and 12th weeks of treatment. Changes in cross-sectional area (CSA) and average densities of the different compartments within the proximal and distal portions of the abnormal limb were compared with the normal side. The most significant decrease in CSA occurred within the subcutaneous compartment of the distal portion (P = 0.002); the decrease in CSA of the proximal portion was also significant (P = 0.02) but changes in muscle and bone compartments were not significant. Significant differences in average density measurements of the subcutaneous and muscle compartments remained between normal and abnormal limbs following the conclusion of the study (P = 0.001 and P = 0.01, respectively). This study demonstrates that CT is a useful method for monitoring therapeutic response to compression therapy.

Adult↗

PubMed1995

Pelvic arterial embolization following hysterectomy and bilateral internal iliac artery ligation for intractable primary post partum haemorrhage.

A case of successful arterial embolization following hysterectomy and bilateral internal iliac artery ligation for intractable primary post partum haemorrhage is described. The selected artery was a branch of the inferior epigastric artery. Little has been written to date in the radiological literature about embolization via pelvic collateral vessels following arterial ligation. Although there is a good argument for postponing surgery until transcatheter embolization has been attempted, this case demonstrates that embolization can still be successful even when performed following surgery.

Adult↗

PubMed1995

Outpatients revisited: subjective views and clinical decisions in the management of general surgical outpatients in south west England.

STUDY OBJECTIVE: To assess the scope for reducing unnecessary outpatient reattendances, using a benchmark an acute specialty at a site recognised to have an especially low ratio of repeat to new attendances. DESIGN: This was a survey of the re-attendance workload at general surgery outpatient clinics over a three month period. Patient re-booking and discharge rates for different grades of staff; clinicians' perception of the ability of the GP to have managed the patient; perception of the value of individual re-attendances; reason given for discharging/re-booking; and outcome of attendance for patients in relation to diagnostic category were determined. SETTING: General surgery outpatients clinics with re-attendance rates that were 50% below average, in Taunton and Somerset Hospital, a non-teaching district general hospital. PATIENTS: Altogether 454 patients who made 470 second or subsequent visits (re-attendances) within the same episode of outpatient care. MAIN RESULTS: Thirty eight percent (178/470) of visits were perceived as manageable by the GP, 45% (79, 17% of total re-attendances) of which were also thought to have been of marginal or little value. A substantial group of patients was being followed up largely for reasons of convention and traditional policy. Re-booking rates were higher among junior staff. Subjective views of the value of attendance at the hospital outpatient clinic and the ability of the GP to have seen the patient varied systematically between consultants and junior staff. Judgements varied to some extent according to the diagnostic group. CONCLUSION: The numbers of patients being followed up equivocally at most general surgical outpatient departments will be 50% more an average than those in this benchmark department. A department seeing 2000 new patients per annum will have 3600 reattendances, 25.5% (918) of which may be avoidable on the basis of these results. A variety of approaches can be used to increase the proportion of patients seen appropriately by GPs. In some cases this might be achieved without the intensive commitment required to plan and develop shared care protocols or new formal discharge guidelines, but by encouraging GPs to manage some patients, increasing of hospital clinicians' access to knowledge of local general practices, and internal clinic review of 'routine' follow up policies as shown in this study. This type of review of outpatient practice can also help prioritise conditions likely to repay the effort of developing and implementing clinical management guidelines and local protocols.

Delivery of Health Care↗

PubMed1995

Case report: diffuse fatty infiltration of the renal parenchyma secondary to bilateral angiomyolipomas--features on ultrasound and computed tomography.

A case is described where ultrasound demonstrated diffusely increased echogenicity in massively enlarged kidneys. Computed tomography confirmed fatty replacement of the renal parenchyma, allowing a confident diagnosis of multiple bilateral angiomyolipomas in a clinical setting of tuberous sclerosis. This is the first ultrasound demonstration of such diffusely echogenic kidneys in angiomyolipoma.

Adult↗

PubMed1995

Computerized axial tomographic scan measurements as prognostic indicators in patients with cervical carcinoma.

This retrospective study of 56 patients with carcinoma of the uterine cervix treated with radical radiotherapy at the Royal Marsden Hospital, London, examined whether simple measurements of maximum tumour dimension from computerized axial tomographic (CT) scans have any prognostic significance. Our results indicate that tumour depth (i.e. maximum antero-posterior dimension) of 4 cm or more is associated with a statistically significant increased relative risk of death of 2.4 (95% CI 1.1-5.5; p = 0.045), as compared with tumours with a depth of less than 4 cm. In addition, there was a clear correlation between tumour depth and lymph node involvement (r = 0.36; p < 0.01), and tumour depth and width (r = 0.70; p < 0.005). We suggest that a measurement of maximum tumour depth from the staging CT scan in these patients provides valuable additional information about likely occult lymph node metastases and prognosis, over and above that suggested by the FIGO staging system alone.

Adult↗

PubMed1995

Quantification of pneumothorax size on chest radiographs using interpleural distances: regression analysis based on volume measurements from helical CT.

OBJECTIVE: The aim of this study was to define the relationship between interpleural distance measurements on an erect posteroanterior chest radiograph and pneumothorax size as measured by helical CT in a series of patients. SUBJECTS AND METHODS: Twenty pneumothoraces from 19 patients (10 males, nine females) were analyzed. Most pneumothoraces were on the right side (n = 16). The etiology was spontaneous in seven patients and iatrogenic in thirteen. All patients underwent an erect inspiratory posteroanterior radiograph and a helical CT scan of the thorax on the same visit to the radiology department. The interpleural distance was measured at three locations and the figures added together. Following helical CT of the thorax, the percentage pneumothorax size was calculated by drawing regions of interest around the relevant hemithorax and lung on 10-mm reconstructed slices. A scattergram of the sum of interpleural distances in centimeters versus percentage pneumothorax size was plotted. RESULTS: Analysis of results showed that percentage pneumothorax size could be calculated by the formula Y = 4.2 + [4.7 x (A + B + C)], r = .98, p < .0001. CONCLUSION: This study identified a formula for accurately calculating percentage pneumothorax size as determined by helical CT from an erect posteroanterior radiograph. Using this formula with the clinical status of the patient should more easily identify patients requiring active intervention.

Adolescent↗

PubMed1994

International transfers of National Health Service reforms: problems and issues.

Recent market-style reforms in the UK National Health Service (NHS) have attracted the attention of health care professionals, managers, and policy-makers from many developing and central and eastern European countries. This article asks how NHS managers and health professionals should react to such international interest. Six key issues have to be considered when introducing market-style reforms into developing and eastern European countries. First, health sector reform should be formulated on the basis of sound research and evidence. We should also take particular care in understanding how efficiency contributes to health policy objectives and the extent to which private management practices are appropriate to the public sector. We should also question the value of international technology transfer and evaluate the experiences of health sector reform in other countries. Last we should look at the way in which health sector reform is formulated and implemented. Here we highlight important questions about the suitability of replicating the UK experience in other countries.

Europe↗

PubMed1994

Reversible findings of methylene diphosphonate bone scintigraphy in Raynaud's phenomenon: case report and review of the literature.

A 53-year-old woman with carcinoma of the right breast, spinal metastases and right arm lymphoedema was referred for bone scintigraphy prior to commencement of chemotherapy. The patient arrived in the department complaining of pain in the left hand, which appeared red and slightly swollen. Bone scintigraphy revealed increased tracer uptake in the first four metacarpal and all the carpal bones of the left hand. A repeat three-phase bone scintigram, performed 1 week later when the patient was asymptomatic, showed equal blood flow to both hands with normal blood pool and uptake in bone images. The case demonstrates a state of reversibly increased bone uptake in a patient injected at the time of an episode of Raynaud's phenomenon and the possible implications for scan interpretation.

Bone Neoplasms↗

PubMed1994

Observer variation in pattern type and extent of disease in fibrosing alveolitis on thin section computed tomography and chest radiography.

In fibrosing alveolitis the pattern type on thin section computed tomography (CT) predicts histological appearances at open lung biopsy and the likelihood of response to treatment. To test the level of inter- and intra-observer variability on CT and chest radiography (CXR), the pattern type and extent of disease were assessed by four observers (two experienced, two inexperienced). A total of 126 CT examinations and 108 concurrent postero-anterior chest radiographs were scored on two occasions, at least 8 weeks apart. A confidence rating was assigned to each observation. Three out of four observers agreed on pattern type in 81% of cases on CT compared with 54% on CXR (kappa coefficient 0.48 and 0.16 for CT and CXR, respectively). Inter-observer variability in categorizing pattern type on CT was lowest in patients with the highest confidence scores (kappa = 0.63). Confident observations were associated with extensive or moderately extensive disease (P < 0.001), and with a predominantly reticular pattern (P < 0.0001). Intra-observer variability for pattern type on CT was less for the experienced observers (kappa = 0.78 and 0.70) than for the inexperienced group (kappa = 0.50 and 0.37). Inter-observer variability for extent of disease was significantly less on CT than on CXR (standard deviations 7.8% and 9.2% respectively, P < 0.001). This study shows that observer variability using a clinical grading system is lower with CT than with chest radiography in fibrosing alveolitis.

Attitude of Health Personnel↗