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Biomedical subjects

D Ingram

Publications and source records attributed to D Ingram.

At least 37 records · Page 2Linked to original sources
PubMed1999

Breath ethane as a marker of reactive oxygen species during manipulation of diet and oxygen tension in rats.

Breath ethane, O2 consumption, and CO2 production were analyzed in 24-mo-old female Fischer 344 rats that had been fed continuously ad libitum (AL) or restricted 30% of AL level (DR) diets since 6 wk of age. Rats were placed in a glass chamber that was first flushed with air, then with a gas mixture containing 12% O2. After equilibration, a sample of the outflow was collected in gas sampling bags for subsequent analyses of ethane and CO2. The O2 and CO2 levels were also directly monitored in the outflow of the chamber. O2 consumption and CO2 production increased for DR rats. Hypoxia decreased O2 consumption and CO2 production for the AL-fed and DR rats. These changes reflect changes in metabolic rate due to diet and PO2. A significant decrease in ethane generation was found in DR rats compared with AL-fed rats. Under normoxic conditions, breath ethane decreased from 2.20 to 1.61 pmol ethane/ml CO2. During hypoxia the levels of ethane generation increased, resulting in a DR-associated decrease in ethane from 2.60 to 1.90 pmol ethane/ml CO2. These results support the hypothesis that DR reduces the level of oxidative stress.

Aging↗
PubMed1999

Defensive mothering in HIV-positive mothers.

The grounded theory study discussed in this article provides an explanatory schema that illuminates the mothering experiences of women living with HIV infection. Eighteen HIV-positive mothers provided 24 in-depth interviews. The grounded theory method was used for data analysis. Defensive mothering was the basic social psychological process that these HIV-positive mothers used in response to their diagnosis and the inherent stigma. Their defensive posture afforded these mothers and their children some degree of psychological protection. Defensive mothering involved much mental work and included three subprocesses: preventing the spread of HIV, preparing the children for a motherless future, and protecting themselves through thought control.

Female↗
PubMed1998

A prospective study of microvascular free-flap surgery and outcome.

Over a 6-month period, 23 members of the International Microvascular Research Group participated in a prospective survey of their microvascular free-flap practice. Data were recorded with each case for 60 variables covering patient characteristics, surgical technique, pharmacologic treatment, and postoperative outcome. A total of 493 free flaps were reported with a representative demographic distribution for age, sex, indications for surgery, risk factors, flap type, surgical technique, and pharmacologic intervention. Mixed effects logistic regression modeling was used to determine predictors of flap failure and associated complications. The overall incidence of flap failure was 4.1 percent (20 of 493). Reconstruction of an irradiated recipient site and the use of a skin-grafted muscle flap were the only statistically significant predictors of flap failure, with increased odds of failure of 4.2 (p = 0.01) and 11.1 (p = 0.03), respectively. A postoperative thrombosis requiring re-exploration surgery occurred in 9.9 percent of the flaps. The incidence of this complication was significantly higher when the flap was transferred to a chronic wound and when vein grafts were needed, with increased odds of failure of 2.9 (p = 0.02) and 2.5 (p = 0.02), respectively. There was a lower incidence of postoperative thrombosis when rectus/transverse rectus abdominis muscle (TRAM) flaps were used, where odds of failure decreased by 0.36 (p = 0.04), and when subcutaneous heparin was administered in the postoperative period, where odds decreased by 0.27 (p = 0.04). There was an overall 69-percent salvage rate for flaps identified with a postoperative thrombosis. Intraoperative thrombosis occurred in 41 cases (8.3 percent) and was observed more frequently in myocutaneous flaps or when vein grafts were needed (5.5 and 5.0 greater odds, respectively; p < 0.001) but was not associated with higher flap failure (2 of 41 cases; 4.9-percent failure rate). The incidence of a hematoma and/or hemorrhage was increased in obese patients and when vein grafts were needed [2.7 (p = 0.02) and 2.6 (p = 0.03) greater odds, respectively], whereas this complication was significantly decreased in muscle flaps (myocutaneous or skin-grafted muscle), in tobacco users, when a heparinized solution was used for general wound irrigation, and when the attending surgeon performed the arterial anastomosis (in contrast to the resident or fellow on staff) (p < 0.05 for each factor). With the multivariable analysis, many factors were found not to have a significant effect on flap outcome, including the recipient site (e.g., head/neck, breast, lower limb, etc.); indications for surgery (trauma, cancer, etc.); flap transfer in extremes of age, smokers, or diabetics; arterial anastomosis with an end-to-end versus end-to-side technique; irrigation of the vessel without or with heparin added to the irrigation solution; and a wide spectrum of antithrombotic drug therapies. These results present a current baseline for free-flap surgery to which future advances and improvements in technique and practice may be compared.

Adolescent↗
PubMed1997

Case-control study of phyto-oestrogens and breast cancer.

BACKGROUND: Phyto-oestrogens are a group of naturally occurring chemicals derived from plants; they have a structure similar to oestrogen, and form part of our diet. They also have potentially anticarcinogenic biological activity. We did a case-control study to assess the association between phyto-oestrogen intake (as measured by urinary excretion) and the risk of breast cancer. METHODS: Women with newly diagnosed early breast cancer were interviewed by means of questionnaires, and a 72 h urine collection and blood sample were taken before any treatment started. Controls were randomly selected from the electoral roll after matching for age and area of residence. 144 pairs were included for analysis. The urine samples were assayed for the isoflavonic phyto-oestrogens daidzein, genistein, and equol, and the lignans enterodiol, enterolactone, and matairesinol. FINDINGS: After adjustment for age at menarche, parity, alcohol intake, and total fat intake, high excretion of both equol and enterolactone was associated with a substantial reduction in breast-cancer risk, with significant trends through the quartiles: equol odds ratios were 1.00, 0.45 (95% CI 0.20, 1.02), 0.52 (0.23, 1.17), and 0.27 (0.10, 0.69)--trend p = 0.009--and enterolactone odds ratios were 1.00, 0.91 (0.41, 1.98), 0.65 (0.29, 1.44), 0.36 (0.15, 0.86)--trend p = 0.013. For most other phytoestrogens there was a reduction in risk, but it did not reach significance. Difficulties with the genistein assay precluded analysis of that substance. INTERPRETATION: There is a substantial reduction in breast-cancer risk among women with a high intake (as measured by excretion) of phyto-oestrogens-particularly the isoflavonic phyto-oestrogen equol and the lignan enterolactone. These findings could be important in the prevention of breast cancer.

4-Butyrolactone↗
PubMed1997

An audit of 267 consecutively excised mammographically detected breast lesions 1989-1993.

Pathology reports and slides were reviewed from 267 mammographically detected impalpable breast lesions, excised after hookwire localisation. There were 182 benign and 85 malignant lesions (benign to malignant ratio of 2.1:1). The invasive cancers tended to be small (mean 13 mm; 50% < or = 10 mm), of low histologic grade (38% Grade I), with a low incidence of lymph node metastases (15%). A high proportion of pure duct carcinoma in situ (DCIS) lesions (21%) was found, and an unusually high proportion of invasive lobular carcinoma (17%). Preoperative fine needle aspiration (FNA) was performed in 95 (36%) cases, including 47 (18%) sampled using sterotactic guidance and 48 (18%) sampled by palpation. The absolute sensitivity of diagnosis of malignancy was 32% and 5% respectively. In 79% of carcinomas further operation was performed, for axillary clearance or re-excision of incompletely excised tumor; this high rate was largely a result of a decision not to use frozen section diagnosis for impalpable lesions and because of the early stages of the development of preoperative needle diagnosis. 58% of invasive cancers, including seven of eight (87.5%) carcinomas with an extensive intraduct component (EIC + ve), and 72% of DCIS were incompletely excised at the first operation. Residual tumor was found in the re-excisions in 26% of EIC - ve invasive carcinomas, 71% of the EIC + ve cases and 56% of DCIS lesions. The malignant lesions had highly favourable prognostic indices. The need for concentration of experience with pre-operative FNA was highlighted. Positive excision margins were a good predictor for residual malignancy, particularly for EIC + ve cases and for DCIS lesions.

Adult↗
PubMed1997

Opinions of physical therapy education program directors on essential functions.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the opinions of directors of physical therapy education programs concerning the essential functions physical therapist students must be able to complete, with or without reasonable accommodation. SUBJECTS: Fifty-eight physical therapy education program directors participated. METHODS: Participants completed surveys as part of a three-round Delphi technique. They had the opportunity to modify or make additions to the initial list in the first round and rate the items in the last two rounds using an ordinal scale. RESULTS: All participants rated communication skills and practicing in a safe, ethical, and legal manner as definitely essential functions. Nearly universal agreement (95%-99%) was present for determining physical therapy needs of patients with movement dysfunction and demonstrating the ability to apply universal precautions. Performance of treatment procedures and performance of assessment procedures were rated essential by 90% to 95% of the participants. The least agreement was found for participation in the process of scientific inquiry. CONCLUSION AND DISCUSSION: There is agreement among the physical therapy education program directors concerning the essential functions that should be required of students. The results of this study should serve as a reference for physical therapy education programs for developing the essential functions required of students.

Administrative Personnel↗
PubMed1996

Life events and the risk of breast cancer: a case-control study.

A case-control study was undertaken to investigate the possibility of an association between stressful life events and the development of breast cancer. Ninety-nine breast cancer cases, and 99 controls matched by age and area of residence, completed a life events inventory to measure life change and distress scores over a 2-year and a 10-year period. Study subjects were also interviewed to establish potential breast cancer risk factors; their height and weight were measured; they completed a food frequency questionnaire and provided a fasting blood sample for hormonal assay. After adjusting for potential confounders, women with a 10-year life change score greater than 210 (i.e. the highest quartile) had 4.67 times the risk of developing breast cancer, compared with those in the lowest quartile (P < 0.05).

Breast Neoplasms↗
PubMed1996

Stereotactic 14 gauge core-biopsy of the breast: results from 101 patients.

BACKGROUND: Along with fine needle aspiration (FNA) cytology, core-biopsy has become an integral part of the assessment of mammographically detected breast lesions. METHODS: A series of stereotactic large-core-biopsies of mammographically detected breast lesions was studied to assess the accuracy and limitations of the technique in diagnosing malignancy and in giving specific benign diagnoses, and its use in determining surgical management. RESULTS: Eighty per cent of carcinomas were diagnosed as malignant (absolute sensitivity). In 88.8% of the cancers, the core-biopsy was classified as malignant, suspicious or atypical/indeterminate (complete sensitivity), and in 72% of the invasive carcinomas, invasive tumour was present in the core. The technique was more successful for invasive carcinomas than for ductal carcinoma in situ (DCIS) (absolute sensitivity 86.1 and 55.5, respectively; P = 0.28) and for malignant mass lesions than for a mass with associated microcalcifications or for pure microcalcifications (absolute sensitivity 91, 71 and 66.6%, respectively; P = 0.19). In five of the 45 cancers (11.1%), no tumour tissue was present in the core, but all were excised after mammographic review and no delays in diagnosis have been experienced to date. The benign to malignant ratio for excised lesions was 0.11:1. Of the benign lesions, a specific diagnosis was given in 49% (calcifications in the core in a background of fibrocystic change, or postoperative scarring, or fibro-adenoma); the remainder showed non-specific benign findings. All patients where invasive carcinoma was diagnosed in the core underwent axillary clearance and wide local excision or mastectomy at their first operation. CONCLUSIONS: This technique can markedly reduce the number of benign lesions needing open biopsy, and provide information allowing definitive management of most carcinomas at the first operation. The accuracy of core-biopsy was lower in DCIS/microcalcification lesions; extra core samples or a combination of FNA and core-biopsy may be of value in these cases.

Biopsy↗
PubMed1995

The cultural basis of prosodic modifications to infants and children: a response to Fernald's universalist theory.

Fernald and her colleagues have argued for the universality of prosodic modifications in speech addressed to infants (e.g. Fernald, 1987; Fernald, Taeschner, Dunn, Papousek, de Boysson-Bardies & Fukui, 1989). An alternative proposal in Bernstein-Ratner & Pye (1984) and Pye (1986) argues that speech modifications to children are the result of a set of conventions that may vary from culture to culture. This note presents arguments against Fernald and in support of the cultural account of prosodic modifications to infants and children. First, in response to criticisms in Fernald et al., data are presented which defend the conclusion in Bernstein-Ratner & Pye that Quiché mothers show less prosodic modification to children than do mothers in other cultures studied to date. Second, data used to support the universal position in Fernald (1987) on adult identification of infant affective states are reinterpreted and shown to be equally interpretable as the result of a set of culturally transmitted rules.

Adult↗
PubMed1995

Using adverse events in health-care quality improvement: results from a British acute hospital.

Adverse event monitoring is a problem-oriented approach to clinical audit and health-care quality improvement, which was developed and has been widely used in the USA. Briefly explores the technique itself and its evolution. Presents experience gained from the widespread use of the approach in a British acute hospital, and results from one specialty--ophthalmology. Suggests that the study of adverse events in patient care can produce significant improvements in patients' care, that it is particularly suited to some specialties, and that it should be used alongside other techniques in hospital clinical audit programmes. Concludes that, as the demand for quality-monitoring information from purchasers and within providers grows, adverse event monitoring may become one of the key techniques for quality assessment and improvement.

Data Collection↗
PubMed1995

A portable communicative architecture for electronic healthcare records: the Good European Healthcare Record project (Aim project A2014).

The European Union is supporting research into medical informatics via its Advanced Informatics in Medicine (AIM) program. One of the current AIM projects is the Good European Healthcare Record (GEHR) project. Its objective is to devise an architecture for electronic healthcare records that will enable them to be comprehensive, communicative, and portable to different systems. The work was funded from January 1992 to December 1994. The project team consisted of over 50 personnel representing clinicians, computer scientists, and computer programmers in eight European countries. The partner organizations are Health Data Management Partners (Belgium), Croix Rouge Francaise (France), France Telecom, Association des Medecins et Medicins Dentistes (Luxembourg), Instituto Clinica Geral Zona Norte (Portugal), Medical College of St Bartholomew's Hospital (UK), and SmithKline Beecham (UK). The work of the project has been carried out by three subgroups covering clinical, architecture, and systems aspects. One of the strengths of the project has been that most of the work has been done as collaborations between members of different groups. This has meant that there has been very close contact between clinicians and computer experts. The GEHR project is providing important input into the standardization process in Europe via, for example, PT011 of Working Group 1 of CEN TC/251 (the developing standards for the architecture of healthcare records).

Computer Communication Networks↗
PubMed1994

The effect of hormone replacement therapy on prognostic indices in women with breast cancer.

OBJECTIVE: To examine the effect of hormone replacement therapy (HRT) on breast cancer biology. PATIENTS: Four hundred and sixty Western Australian women with breast cancer who were 40 years or over at the time of their breast cancer surgery. DESIGN AND SETTING: A questionnaire was sent to women seeking information on the use of HRT before breast cancer surgery. To qualify as HRT users, HRT had to have been used continuously for six months or more up to within two weeks of surgery. MAIN OUTCOME MEASURES: Biochemical indices of oestrogen receptor, progesterone receptor, cathepsin D and protein levels, and pathological indices of tumour size, tumour differentiation and lymph node involvement for users and nonusers of HRT. RESULTS: Eighty-seven per cent of questionnaires were recovered and 39 HRT users and 258 non-users were analysed. Twenty-five HRT users used a combination of oestrogen and progestogen and 14 used oestrogen only. Twenty-six had used HRT for more than two years and 13 for two years or less at the time of breast cancer diagnosis. There were no significant differences in the tumour indices between these two groups. The mean level of oestrogen receptors appeared to be lower in oestrogen-only users than in combination HRT users and non-users. The mean cathepsin D level was significantly higher in oestrogen-only users than in non-users. The percentage of all HRT users with involved lymph nodes (23%) was significantly lower than the percentage of non-users (44%). CONCLUSION: Oestrogen-only HRT may have a detrimental effect on tumour biology. The use of a progestogen in combination with oestrogen may offer some protection. On the other hand, HRT users had less lymph node involvement with tumour. This may reflect early detection with increased surveillance in women using HRT.

Adult↗
PubMed1994

The relative prognostic significance of total cathepsin D and HER-2/neu oncogene amplification in breast cancer. The South Australian Breast Cancer Study Group.

Total tumor cathepsin D (TCD) levels were determined prospectively by a radioimmunometric assay in tumor cytosol of 858 primary breast cancer patients diagnosed between 1989-1991. In 581 of these patients, tumor HER-2/neu oncogene amplification was simultaneously determined. In a "training-set" of 313 patients, "high" TCD was associated with significantly shorter disease-free survival (DFS). For the whole group, there was no correlation between TCD and pathologic stage, number of axillary nodes with tumor deposits, tumor size, histologic type and grade, or hormone receptor levels. In the node-positive group, high TCD level was associated with HER-2/neu amplification. After a median follow-up duration of 31 months, univariate analysis indicated that high TCD level was significantly associated with shorter DFS only in node-positive patients. The shorter DFS in association with high TCD levels was observed in both estrogen-receptor-positive and -negative patients. Cox multivariate analysis of DFS confirmed that high TCD level was predictive of shorter DFS in node-positive patients only. Because of the short duration of follow-up, the significance of TCD in overall survival was not determined. We conclude that high tumor TCD in node-positive patients is predictive of shorter DFS, and is often associated with HER-2/neu amplification. The possibility exists that high tumor TCD may act in combination with HER-2/neu amplification to promote dissemination of metastases.

Adult↗
PubMed1994

Diet and subsequent survival in women with breast cancer.

Our findings from a previous study, that increased consumption of beta-carotene and vitamin C is associated with favourable prognostic indices in patients with breast cancer, have been borne out by our current study of patient survival over a 6-year period. The results of the current study point to beta-carotene consumption as the dietary variable most significantly associated with improved survival. Only one death occurred in the group with the highest consumption of beta-carotene, while there were eight and 12 deaths in the intermediate and lowest groups of consumption respectively. The possible antiproliferative effects of beta-carotene have been recognised for some time, with investigations being focused more recently on its derivative, retinoic acid, which has been found to improve differentiation in many tissues, including cell lines derived from mammary carcinomas. Retinoids have been associated with significant clinical responses in a variety of tumours, and chemoprevention trials using beta-carotene have been undertaken for many malignancies. However, beta-carotene has not yet been used in clinical trials to evaluate its potential for the treatment of breast cancer. A large-scale clinical trial is necessary to determine the effectiveness of beta-carotene in reducing the chances of recurrence of breast cancer, and in preventing the development of new cancers.

Ascorbic Acid↗