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Biomedical subjects

C D Collins

Publications and source records attributed to C D Collins.

At least 73 records · Page 4Linked to original sources
PubMed1991

Radical external beam radiotherapy for localised carcinoma of the prostate using a hypofractionation technique.

The survival of 232 patients with apparently localized carcinoma of the prostate is reported, who were treated between October 1964 and October 1984 by a radical course of external beam radiotherapy using a hypofractionation technique. Assessment was made in a retrospective analysis, noting influence of age, stage of disease at presentation, initial histology, dose of radiotherapy given and any subsequent treatment required, recorded up to October 1986. From this it will be seen that the development of a six fraction regime, given over a period of three weeks leads to comparable results to other reported series, whether assessed as a local response or by survival curves, and to the economical use of scarce resources, but even more important, is less wearing for patients than daily fractionation, with early and late morbidity being within acceptable limits.

Aged↗
PubMed1990

Caseload or workload?

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Diagnosis-Related Groups↗
PubMed1990

Caseload or workload? Scoring complexity of operative procedures as a means of analysing workload.

OBJECTIVE: To present a more realistic assessment of surgical workload than that provided by a case count. DESIGN: Prospective study of all the operative procedures performed in one year, classified according to the British United Provident Association's schedule of procedures and scored by the "intermediate equivalent" value (taking the recommended fee value of an intermediate operation as 1.0) compared with the number of operations performed. SETTING: General surgical unit of Taunton and Somerset Hospital, comparing four consultant surgeons and their teams. PATIENTS: Inpatients and day patients admitted under the care of general surgeons during 1989. MAIN OUTCOME MEASURE: Difference between the apparent workload represented by simple case counting (caseload) and the actual workload represented by calculation of the total "intermediate equivalent" value. RESULTS: The workload assessed in terms of intermediate equivalent values was greater than that suggested by case counting for complex operations (12% v 4%), operations at the district hospital (82% v 74%), and operations performed by consultants (53% v 35%) and was lower for minor operations (20% v 42%), operations at the community hospitals (18% v 26%), and operations performed by surgeons in training grades and clinical assistants (47% v 66%). CONCLUSIONS: The use of the intermediate equivalent values as an indicator of complexity allows a more realistic assessment of the operative workload than a simple case count of the number of different operations and is recommended for comparing workload in different hospitals and departments.

England↗
PubMed1990

Carcinoma of prostate treated by radical external beam radiotherapy using hypofractionation. Twenty-two years' experience (1962-1984).

The survival of 209 patients with apparently localized carcinoma of the prostate treated by radical external beam radiotherapy is reported, noting the influence of age, stage of the disease at presentation, initial histology, previous surgery, and dose of radiotherapy given. From this it is seen that the development of a six-fraction regimen given over a period of three weeks leads to excellent results whether assessed as a local response or by survival curves and to the economical use of scarce resources, but, even more important, is less wearing for patients than conventional daily fractionation and with no major early or late morbidity recorded up to October 1986.

Aged↗
PubMed1990

The role of discography in lumbar disc disease: a comparative study of magnetic resonance imaging and discography.

This study reviews prospectively a series of 29 patients who were examined by magnetic resonance imaging (MRI) and discography for degenerative disc disease. All had persistent low-back pain and non-diagnostic initial investigations, including plain films, myelography and/or computed tomography (CT). The imaging characteristics for degenerative disc disease correlated in 65 out of 73 intervertebral levels. All symptomatic discs were degenerate on both MRI and discography. Features of degenerative disc disease on MRI were assessed retrospectively, with a view to identifying the symptomatic level as defined by discography. MRI could not reliably detect this level, particularly in those with multi-level degenerative disc disease. Positive reproduction of symptoms at discography was the criteria used for surgery. All 12 patients in this group had posterior spinal fusion performed. Nine improved and three were unchanged. Of the ancillary features associated with disc degeneration, only a bulging annulus fibrosis proved to be of any value on MRI. Nonetheless, MRI should be used as the primary investigation in this patient group as it can lead to a marked reduction in the number of disc levels requiring injection.

Adult↗
PubMed1990

Model workload agreement for DGH general surgeon: discussion paper.

A guideline programme for a Consultant General Surgeon includes three operating lists, and two outpatient sessions per week. A General Surgical Consultant working with a 'standard' surgical team should expect to see approximately 1,000 new patients per year, and undertake an elective operative workload of 15 'hernia equivalent' procedures per week. A model workload such as this might assist surgical service planners to estimate the need for surgical staff in their Districts.

England↗
PubMed1989

Treatment of acromegaly by external irradiation.

Despite the place of hypophysectomy as the primary treatment in acromegaly, external radiotherapy maintains a role as a relatively slow but effective therapy for inadequately treated patients or those unsuitable for operation. Over the last 25 years our radiotherapy regimen has differed from the published series in that we give a larger dose per fraction, with fewer treatments. We have analysed the efficacy and side-effects of this regimen in 27 subjects with acromegaly. Growth hormone levels have fallen by, on average, 27% per year in the first five years, 83% of subjects achieving a basal growth hormone of less than 10 mU/l. The acute and chronic side-effects of irradiation are discussed, including the relevance of estimates of biological potency, for example the Time Dose Fraction (TDF). One patient suffered visual loss that was most likely to be secondary to the radiotherapy. We also report the histological appearances of the pituitary fossa in five subjects previously treated with radiotherapy.

Acromegaly↗
PubMed1985

Assay of anti-cancer drugs in tissue culture: relationship of relapse free interval (RFI) and in vitro chemosensitivity in patients with malignant cerebral glioma.

One hundred and seventeen patients with cerebral glioma (Kernohan grades III and IV) were treated with adjuvant chemotherapy using procarbazine (PCB), CCNU and vincristine (VCR) following whole head irradiation. Cell cultures were prepared from 40 patients in this series and their sensitivity to each cytotoxic drug was assessed in a mictotitration assay with 35 S-methionine incorporation as the end point. Twenty-two of forty (55%) patients responded to PCB and/or CCNU in vitro, and sensitivity to these drugs was linked with increased RFI, whilst sensitivity to VCR was not. The RFI of patients who had responded to PCB or CCNU in vitro was significantly longer than the RFI of patients whose tumours failed to respond in vitro or patients who had not been tested. There was no difference in sex ratio, extent of operation, radiation dose and degree of steroid cover between responders, non-responders and untested groups. Grade III tumours tended to be more sensitive in vitro than grade IV tumours. The age of patients also influenced in vitro chemosensitivity. Patients with chemosensitive tumours in vitro tended to be younger than patients with insensitive tumours in vitro. Further statistical analysis, taking into account these prognostic factors, indicated an association between chemosensitivity in vitro and RFI.

Adult↗
PubMed1984

Attitudes to follow-up after uncomplicated surgery--hospital out-patients or general practitioner?

The attitude of 216 patients, 10 hospital doctors and 80 general practitioners (GPs) to hospital follow-up after uncomplicated surgery for non-malignant disease was assessed. Hospital doctors felt that most patients (86%) could have been satisfactorily followed-up by their GP and in most cases (89%), the GP was willing to provide the service. However, 183 patients (85%) found their visit to hospital out-patients worthwhile and only 41 patients (19%) would have preferred to have visited their GP instead. In fact, 157 patients (73%) had already seen their GP before their return to surgical out-patients. In most cases, hospital follow-up appears to be unnecessary. In this series, if suitable post-operative patients were followed-up by their GP, there would be a reduction of 20% in the number of old patients returning to out-patients.

Continuity of Patient Care↗
PubMed1983

Abdominal drainage following cholecystectomy: high, low, or no suction?

A prospective trial to assess the effect of suction in an abdominal drain following cholecystectomy was carried out. Three types of closed drainage system were compared: a simple tube drain, a low negative pressure drain, and a high negative pressure drain: 120 consecutive patients undergoing cholecystectomy were randomly allocated to one of the three drainage groups. There was no significant difference in postoperative pyrexia, wound infection, chest infection, or hospital stay. This study failed to demonstrate any clinically useful difference between high negative pressure, low negative pressure, and static drainage system were compared: a simple tube drain, a low negative used, suction is not necessary and a simple tube drain (greater than 6 mm internal diameter) is the most effective form of drainage.

Adult↗
PubMed1982

Ecological Consequences of Long-Term Exposure of Anabaena variabilis (Cyanophyceae) to Shifts in Environmental Factors.

Cultures of Anabaena variabilis were exposed to different light intensities, and the time course of photoadaptation was measured by photosynthetic rate and changes in pigmentation. A shift down in intensity of 284 muEin . m . sec caused a temporary decrease in the photosynthetic response followed by gradual adaptation to the new conditions. Final chlorophyll a and carotenoid concentrations were reached after 1 day, although other physiological indicators showed that adaptation required 4 days. The parameter I(k) was shown to be the best indicator of photoadaptation. A shift up in light intensity of the same magnitude also required 4 days for complete photoadaptation by the culture, although chlorophyll and carotenoid concentrations stabilized within 1 day. A shift down in light intensity of 392 muEin . m . sec resulted in a temporary attempt to adapt followed by collapse of the population. This demonstrates an apparent threshold in the magnitude of the shift in light intensity which will permit successful adaptation. Simultaneous changes in light intensity and temperature also adversely affected culture populations. Our observations present a possible cause for the decline or prevention of an algal bloom under a fluctuating light regime and suggest that it may be possible to predict this decline as a result of synoptic weather patterns or hydrodynamic influences.

Journal Article↗
PubMed1981

In vitro activity of N-formimidoyl thienamycin, moxalactam, and other new beta-lactam agents against Bacteroides fragilis: contribution of beta-lactamase to resistance.

N-Formimidoyl thienamycin (N-F-thienamycin) and moxalactam were compared with other currently available and investigational antibiotics against 100 clinical isolates of Bacteroides fragilis by an agar dilution method. N-F-thienamycin was the most active among the beta-lactam agents tested, with a minimal inhibitory concentration for 90% of isolates (MIC90) of 0.25 micrograms/ml. Moxalactam was next in activity, with an MIC90 of 4 micrograms/ml. N-F-thienamycin was somewhat more active, and moxalactam was slightly less active, than metronidazole and clindamycin. An increase in inoculum size caused an increase in the MIC of N-F-thienamycin, cefoperazone, and cefotaxime. This inoculum effect could influence the usefulness of these drugs in certain clinical conditions. The minimal bactericidal concentration was less than two times the MIC for most agents and less than four times the MIC for all beta-lactam agents at each inoculum size tested. Investigation of the mechanism of resistance to beta-lactam agents demonstrated a correlation between the level of resistance and beta-lactamase activity in each strain tested. N-F-thienamycin and cefoxitin were not hydrolyzed, and moxalactam was less susceptible to hydrolysis than the other beta-lactam antibiotics. Moxalactam and N-F-thienamycin may prove to be useful against infections with B. fragilis.

Anti-Bacterial Agents↗
PubMed1981

Is bone scanning of value in patients with breast cancer?

Over the last decade, bone scans have played an increasingly important role in the management of patients with breast carcinoma; by detecting both occult and symptomatic bony metastases. 234 bone scans carried out in this hospital in 1978/79 on patients with breast cancer, at considerable cost to the NHS, are reviewed.

Bone Neoplasms↗