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Biomedical subjects

C Fisher

Publications and source records attributed to C Fisher.

At least 307 records · Page 17Linked to original sources
PubMed1993

Asymptomatic carotid artery bifurcation disease in patients with claudication.

A study was undertaken to determine the prevalence of asymptomatic atherosclerotic carotid artery bifurcation disease in patients presenting with claudication; thus 263 consecutive patients with intermittent claudication, but without recent or old cerebrovascular symptoms were studied by routine carotid duplex scanning. Of the 263 patients, 124 (47.1%) had a C, D, D+ or E lesion in some vessels of the carotid bifurcation and 54 (20.5%) had a D, D+ or E lesion of the common or internal carotid arteries. Women had a higher prevalence of significant carotid stenosis (29.6% v. 18.2% in men) as did patients over the age of 70 years (28.6% v. 16.3% if below 70 years). It is concluded that the prevalence of clinically significant carotid bifurcation disease (greater than 50% stenosis in the common or internal carotid arteries) in patients with claudication is high (20.5%). The presence of an asymptomatic high-grade stenosis (D+ or E) in 11.8% of patients with claudication should alert the clinician that he is treating a patient who is at a high risk of developing cerebrovascular ischaemic complications.

Aged↗
PubMed1993

A potential role for N-cadherin in mediating endothelial cell-smooth muscle cell interactions in the rat vasculature.

BACKGROUND: The cadherins are a family of calcium-dependent cell adhesion molecules that play a critical role in morphogenetic cell interactions in the embryo. N-cadherin has been identified in neural and non-neural tissues, including developing muscle; however, there are few reports of N-cadherin expression in adult mammals. We attempted to identify N-cadherin in the rat vasculature and to ask whether it has a role in mediating vascular cell interactions. EXPERIMENTAL DESIGN: Vascular tissues were isolated from Fischer rats and analyzed immunohistochemically and by Western blotting using pan-cadherin and N-cadherin antibodies. Anti-N-cadherin antibodies were used in an in vitro cell adhesion assay to determine if N-cadherin mediates interactions between smooth muscle cells (SMC) and endothelial cells (EC). RESULTS: Western blot analysis of vascular tissues reveals a 135 kilodalton (kd) band that is recognized by anti-N-cadherin antibodies. N-cadherin localizes in the rat aorta to the endothelium and to the smooth muscle cell layer beneath the internal elastic membrane. A cell adhesion assay demonstrates that rat SMCs and ECs adhere to each other in a Ca(2+)-dependent manner, and an anti-N-cadherin antibody inhibits approximately 25% of this adhesion. CONCLUSIONS: Our data indicate that N-cadherin is expressed in large vessels of the rat and is capable of mediating EC-SMC adhesion in vitro. It is noteworthy that N-cadherin localizes to a population of SMCs in the rat aorta adjacent to ECs suggesting that N-cadherin may mediate EC-SMC interactions in vivo.

Animals↗
PubMed1993

Screening asymptomatic subjects with subclinical arteriosclerotic lesions with arterial ultrasonic biopsy. The P.A.P. study.

Ultrasound Biopsy is a an effective screening method for detecting early, subclinical arteriosclerotic lesions. Carotid and femoral artery wall lesions are important markers of generalized cardiovascular disease. The evaluation of 4 arterial sites (both carotid and femoral arteries) gives a clue of the status of the whole cardiovascular system. In 27.9% of all patients the femoral lesions are present earlier or in a more advanced stage than carotid lesions. Different age groups have a different UB class distribution and score due to the progression with age of the disease. Early arterial lesions and small plaques are important indicators of silent coronary ischemia and cardiovascular events. The method has also an impact on patients' compliance. Subjects with early plaques shown by high resolution ultrasound are more impressed by this finding than by laboratory results.

Adolescent↗
PubMed1993

HPV-16 E7 or adenovirus E1A can overcome the growth arrest of cells immortalized with a temperature-sensitive p53.

Rat embryo fibroblasts immortalized with a temperature-sensitive p53 mutant and ras rapidly stop proliferating at 33 degrees C. Expression of the viral oncoproteins human papillomavirus type 16 (HPV-16) E7 or adenovirus E1A efficiently overcame this growth arrest, although cells rescued by E7 or E1A displayed no detectable changes in p53 expression. Co-transfection of HPV-16 E6, which binds and directs the degradation of human p53, affected neither growth of the cells at 33 degrees C nor the amount or conformation of the p53 protein, possibly reflecting an inability of E6 to interact with mouse p53 in rodent cells. Our results suggest either that the temperature-sensitive p53 failed to regain full wild-type suppressor activity at 33 degrees C or that E7 and E1A can modulate wild-type p53 growth-suppressor activity without altering the conformation or stability of the protein.

Adenovirus E1A Proteins↗
PubMed1993

Breaking down the barriers--midwives turn east.

Three-and-a-half years ago the barriers to communication between East and West Europe began to break down. Some of the news that first came through, particularly regarding the health care and living conditions of babies and children, was deeply disturbing and appeals were immediately launched for money, food, medical supplies and professional help. Later, equally tragic news was received about the plight of refugees and victims of the war in Bosnia. Midwives and nurses from the UK were among those who have responded by travelling to the worst affected areas and offering their care and support to mothers and children.

Bosnia and Herzegovina↗
PubMed1992

Detection of premature atherosclerosis by high-resolution ultrasonography in symptom-free hypopituitary adults.

Retrospective analysis suggests that there is increased mortality from vascular disease in hypopituitary adults, but vascular status before death is unknown. High resolution B-mode ultrasonic imaging of both carotid and femoral arteries was therefore done in 34 adult hypopituitary patients on routine replacement therapy and was compared with that in 39 matched controls. Changes were related to risk factors for vascular disease. Carotid intima-media thickness was greater in patients than in controls (mean [SD] 0.74 [0.16] vs 0.65 [0.13] mm, p < 0.02). This difference was seen in middle-aged and elderly patients. More patients than controls had one or more atheromatous plaques (65% vs 41%, p < 0.05). The percentage of individual arteries with a plaque was also higher in patients (32% vs 18%, p < 0.005). In multiple regression analysis, patients' age was the dominant factor determining carotid intima-media thickness. Symptom-free adults with hypopituitarism show an increased prevalence of atherosclerosis.

Adult↗
PubMed1992

Ifosfamide is an active drug for chemotherapy of metastatic cystosarcoma phyllodes.

Metastases from cystosarcoma phyllodes are rare, and treatment generally is ineffective. Four patients were treated with ifosfamide (alone in three and combined with doxorubicin in one). Two patients had complete remissions that lasted 26 and 61+ months. One other patient had a partial response that lasted 13 months. The complete responders were both treated as soon as metastases appeared, when they had only a small volume of disease. This appears to represent a significant improvement on other described regimens for this condition, and further trials of ifosfamide are warranted. Close follow-up of patients at high risk for metastases is suggested.

Adult↗
PubMed1992

The clinical and histologic criteria that predict metastases from cystosarcoma phyllodes.

A retrospective study of 33 patients with cystosarcoma phyllodes was done. Eight of these patients had metastases, and the clinical and histologic criteria predicting the development of metastases were examined. The most reliable predictor was the presence of stromal overgrowth; this appears to be necessary for metastasis to occur. Other useful indicators of clinical behavior were the degree of mitotic activity, nuclear pleomorphism, and infiltrating margins. Based on these data and a literature review, the authors suggest close follow-up of patients whose primary tumors contain areas of stromal overgrowth because, in all series combined, the risk of metastatic spread in such patients was 72% within 5 years. Among these high-risk patients, local recurrence is another indication that metastasis is likely.

Adolescent↗
PubMed1992

Carcinoma in episiotomy scars.

The finding of primary or metastatic carcinoma in an episiotomy scar is a rare event; we report three cases. The first patient presented with an abnormal cervical smear and was found to have a primary squamous cell carcinoma of the vulva in an old, healed episiotomy scar. A second patient, diagnosed as having cervical carcinoma 6 months postpartum, was found to have a metastatic deposit in the episiotomy scar during the staging of her disease. The third patient developed adenocarcinoma metastatic from an endocervical primary in an episiotomy scar that presented as a small nodule at the introitus. These cases exemplify the need for careful inspection and biopsy of any nodular lesions in episiotomy scars as part of the initial assessment and follow-up of patients with premalignant or malignant lesions of the lower genital tract.

Adult↗
PubMed1992

Benign mimics of soft tissue sarcomas.

We reviewed all new patients referred for treatment to the Sarcoma Unit at the Royal Marsden Hospital with a clinical diagnosis of soft tissue sarcoma (STS) during the course of 1 year (1989-1990). Of 118 patients, 65 (55.1%) had primary STS, 26 (22.0%) had recurrent STS, 19 (16.1%) had benign soft tissue tumours and eight (6.8%) had malignant tumours other than STS involving soft tissues and presenting clinically as soft tissue tumours. All patients underwent CT scanning which was used to assist diagnosis, assess operability or for radiotherapy planning. The CT findings of the benign lesions, all clinically suspicious of sarcoma, are discussed. The role of CT in the identification and management of these cases is emphasized.

Arteriovenous Malformations↗
PubMed1992

Preoperative radiotherapy for initially inoperable extremity soft tissue sarcomas.

The results and complications of a combination of preoperative radiotherapy and surgery in the treatment of 70 patients with large or fixed extremity soft tissue sarcomas are reported. Sixty-one patients were referred with a primary tumour and 9 had recurrences. Thirty-three patients had tumours in the thigh and 38 tumours were fixed to neighbouring structures. The mean preoperative dose was 53 Gy (range 21-75). Eleven patients received a postoperative boost to tumour site. Four patients received preoperative intra-arterial Adriamycin. Overall, 42 patients (60%) responded to the radiotherapy, 4 with complete tumour resolution. Eighty per cent of those receiving greater than or equal to 60 Gy responded and a significant correlation between 2 Gy equivalent dose and response was demonstrated (P less than 0.005). The degree of tumour necrosis was increased in 23 of 52 evaluable patients following radiotherapy, although there was no correlation with dose or clinical response. There have been eight local recurrences and 17 deaths after a median follow-up of 2 years. Tumour size less than 10 cm was the only significant factor in the development of local recurrence (P = 0.04). Thirty-six patients developed immediate postoperative complications: 9 major (13%), 13 moderate (19%) and 14 minor (20%). Increasing patient age was the only significant independent factor for the development of complications (P = 0.015). Preoperative radiotherapy will usually permit limb conservation of extremity sarcomas which otherwise would be inoperable or require amputation. However, the increased incidence of wound complications in older patients demands meticulous technique.

Adolescent↗
PubMed1992

Popliteal vein entrapment in the normal population.

The aim of this study was to determine the incidence and severity of popliteal vein compression by full knee extension in the normal population. The popliteal veins in 100 healthy volunteers (200 limbs) with no history of previous deep vein thrombosis (DVT) or venous obstruction were examined using duplex scanning with the knee slightly flexed and then fully extended. Knee extension produced complete obstruction in 17 subjects and severe obstruction (< 50% decrease in diameter) in a further 10 subjects. Thirteen subjects had unilateral compression and 14 bilateral. The 27 subjects were tested for functional venous outflow obstruction with air plethysmography. In flexion, the outflow fraction was normal (> 40%) in all subjects. With the knee fully extended, severe or complete venous obstruction (outflow fraction < 10%) was found in eight subjects. Moderate obstruction (outflow fraction 10-40%) was found in all the remaining 19 subjects. When digital compression of the long saphenous vein was performed, these subjects also demonstrated severe outflow obstruction. Although the incidence of symptoms of functional venous obstruction is rare in the general population, these findings have important implications for venous stasis for patients on the operating table and in those having prolonged bed rest. Studies investigating the association between popliteal vein compression and postoperative deep venous thrombosis are needed.

Adult↗
PubMed1992

The role of electron microscopy in the diagnosis of tumours of the head and neck.

A four-year study was undertaken to determine the value of electron microscopy in the diagnosis of head and neck tumours. During this period 80 samples were submitted for examination, of which 69 contained assessable tumour. Electron microscopy made a major contribution to the diagnosis in 25 cases (36 per cent). Areas in which ultrastructural examination was of diagnostic significance included the precise categorization of apparently undifferentiated carcinoma and the identification of melanomas. Little diagnostic benefit was gained from electron microscopic examination of thyroid, lymphoid or salivary gland neoplasms. The value of electron microscopy in relation to immunohistochemistry is discussed.

Carcinoma, Squamous Cell↗
PubMed1992

Surveillance following orchidectomy for stage I testicular seminoma.

An analysis of the primary tumour histopathology was performed on 103 patients managed by orchidectomy and surveillance for stage I seminoma. Patients have been followed for 14-141 months (median 62 months) after orchidectomy. Seventeen patients relapsed, the probability of remaining relapse free at 5 years being 82% (95% confidence intervals, 74%-88%). No patients died of progressive germ cell tumours. The only significant histological factor predicting relapse was the presence of lymphatic and vascular invasion. Four of 42 patients with neither lymphatic or vascular invasion recurred, nine of 53 patients with either lymphatic or vascular invasion recurred and three of eight cases with both lymphatic and vascular invasion recurred (P = 0.05-trend). Though initial recurrence was usually of moderate volume and confined to para-aortic nodes, eight patients were treated with chemotherapy either because of the extent of their initial relapse (four cases), or because of subsequent relapse (four cases). In view of the difficulties of identifying patients at risk and of detecting early relapse, surveillance for stage I seminoma should remain a research protocol.

Adult↗
PubMed1992

Angiomyofibroblastoma of the vulva. A benign neoplasm distinct from aggressive angiomyxoma.

Aggressive angiomyxoma of pelvic soft parts is a rare lesion with a high risk of recurrence. We report 10 cases of angiomyofibroblastoma, a hitherto uncharacterized benign tumor of the vulva histologically mimicking aggressive angiomyxoma. All patients had a vulval mass, often clinically diagnosed as a Bartholin's cyst. There was no recurrence after excision. The tumors were well circumscribed, measuring 0.5-12 cm in maximum dimension. They were characterized by alternating hypercellular and hypocellular edematous zones in which abundant blood vessels (predominantly of the capillary type) were irregularly distributed. Spindled, plump spindled, and oval stromal cells were aggregated around the blood vessels, sometimes forming solid compact foci, or were loosely dispersed in the hypocellular areas. Their nuclei were bland, but rare ones were enlarged and hyperchromatic in four cases. Some cells had abundant eosinophilic hyaline cytoplasm and eccentrically placed nuclei. Mitotic figures were absent or very sparse. Scattered throughout were thin, wavy strands or thick bundles of collagen. Mast cells were readily seen in eight cases. Immunohistochemically, the stromal cells were reactive for vimentin and desmin, but not cytokeratin, muscle-specific actin, alpha-smooth muscle actin, or S-100 protein. Ultrastructural studies showed well-developed rough endoplasmic reticulum, Golgi apparatus, abundant intermediate filaments, and pinocytotic vesicles in the stromal cells. Angiomyofibroblastoma can be distinguished from aggressive angiomyxoma by its circumscribed borders, much higher cellularity, more numerous blood vessels (which lack prominent hyalinization), frequent presence of plump stromal cells, minimal stromal mucin, and rarity of erythrocyte extravasation.

Adult↗