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Biomedical subjects

D J Webster

Publications and source records attributed to D J Webster.

At least 37 records · Page 2Linked to original sources
PubMed1995

The immunosuppressant leflunomide inhibits lymphocyte proliferation by inhibiting pyrimidine biosynthesis.

Leflunomide is a novel immunosuppressive compound that is effective in the treatment of animal models of autoimmune disease and human rheumatoid arthritis. The mechanism of action is unknown. Here we show that leflunomide blocked 1) increases in nucleolar size and number, 2) upregulation of the nuclear protein antigens (PCNA and Ki-67), 3) increases in uridine incorporation and total RNA and DNA content, 4) cell cycle progression and 5) proliferation in mitogen-stimulated rat spleen mononuclear cells and human peripheral blood mononuclear cells (HPBMC). Exogenous uridine reversed the leflunomide-dependent inhibition of the normal increase in total RNA and DNA content in mitogen-stimulated HPBMC and rat spleen cells. Uridine reversed the leflunomide-dependent inhibition of cell cycle progression in stimulated rat cell cultures. Either uridine or cytidine, which can be converted to uridine by cytidine deaminase, reversed the antiproliferative effect of leflunomide in HPBMC. Dihydroorotate accumulated in leflunomide-treated human T-lymphoblastoid cells, suggesting that the compound inhibited the fourth enzyme in the pyrimidine biosynthetic pathway, dihydroorotate dehydrogenase. The results support the hypothesis that the in vitro effects of leflunomide on T-lymphocytes are due to inhibition of de novo pyrimidine synthesis.

Animals↗
PubMed1994

Portfolio learning: a proposal for undergraduate cancer teaching.

This paper describes a randomized study to evaluate a longitudinal approach to undergraduate education using cancer patients and cancer medicine as a model. Medical students were randomized to the study or control group. Those in the study were allocated to tutors (general practitioners or consultants) in groups of three. Each student was allocated three consenting patients with cancer to follow longitudinally. They compiled a portfolio to record events, interactions, relevant articles, etc. based around the patients' case histories. The students received tutorials to provide direction, discussion and support bimonthly during the course. Evaluation was by central review of the portfolios, appraisal in the clinical competence examination and hidden questions in the standard MCQ examinations. The aim was to provide the learner with a personal experience of cancer patients at all stages of the disease, an understanding of the natural history of cancer and an insight into the impact of the disease and its treatment on the patient and family. The study evaluates whether these aims were achieved to a greater extent in those students receiving the portfolio teaching compared with a control group receiving the standard curriculum teaching only.

Curriculum↗
PubMed1993

Management of synergistic bacterial gangrene in severely immunocompromised patients. Report of four cases.

We present four cases of perianal synergistic gangrene in severely immunocompromised patients. In all patients, gangrene was controlled by radical surgery, including defunctioning colostomy in three patients, backed up by appropriate antibiotic therapy. Three of the patients survived and left the hospital; the fourth died in the intensive care unit of overwhelming sepsis from an unidentified source other than the anus. We review the literature and conclude that such infections in these patients are not inevitably fatal and that radical surgery can result in a cure.

Adult↗
PubMed1993

Student selection: are the school-leaving A-level grades in biology and chemistry important?

This study determined the relationships of grades in A-level biology and chemistry with examination success or failure during the medical course. By inspection of medical student records, A-level grades at entry to medical school and examination performance were obtained for 128 (91%) of the students who sat their final MBBCh examination at the University of Wales College of Medicine in June 1988. The majority, 92 (72%), completed their medical school careers with no professional examination failures; 15 failed examinations just in the period up to 2nd MB; 11 failed examinations in the clinical period only and 10 failed examinations in both periods. Whereas grade achieved in A-level chemistry was not associated with undergraduate examination performance, students with a grade A or B in A-level biology were less likely to have problems than the others (21% compared with 47%; the difference of 26% has a 95% confidence interval of 7% to 44%). Specifically, there appears to be a strong relationship between a low grade in biology and difficulties in the preclinical examinations. Moreover, for those who have difficulties at this stage, this association continues later in the course.

Educational Measurement↗
PubMed1993

Preclinical progress in relation to personality and academic profiles.

One hundred and forty-six (93%) of the University of Wales College of Medicine intake of new students completed a personality questionnaire (Cattell 16PF) on registration in October 1988. The students were divided into four groups depending on their academic progress up to and including 2nd MB BCh. Whereas the majority (73%) encountered no major examination problems, 40 (27%) did experience such difficulties, nine of them serious enough to delay graduation. Fourteen students had left the course, nine of them voluntarily. Academic progress was not significantly related to any of Cattell's personality factors, either primary or second order. Further analyses of established clusters of factors which have previously been associated with problems among students were also shown to be unrelated to the medical students' progress. A profile at entry involving previous degrees, points obtained and number of attempts at A-levels proved to be a much better predictor of success during the preclinical period.

Adult↗
PubMed1993

Is immediate postmastectomy reconstruction safe in the long-term?

A prospective case-control study of 81 patients has been carried out over 10 years comparing mastectomy with immediate reconstruction to mastectomy alone. The patients were matched for age (within 5 years), TNM stage, pathologic nodal status and operative procedure. After complete 10-year follow-up we have failed to demonstrate any long term difference in tumour behaviour. We conclude that immediate reconstruction is widely applicable and technically feasible without any long term effect on the development of local recurrence or metastatic disease.

Adult↗
PubMed1993

Complications of rectus abdominis myocutaneous flaps in breast surgery.

One-hundred-and-twenty-two rectus abdominis myocutaneous flaps used for reconstruction, post mastectomy (106) and after salvage surgery (16), were reviewed. The minimum period of follow up was 24 months. Simple vertical flaps were raised in 88 patients; in addition seven Drevers, four trans-umbilical, 19 lower transverse and four combined (vertical and transverse flaps) were raised. Early complications (within 2 weeks of surgery) were seen in 30% (37/122) patients. Late complications occurred in 5% of patients (6/122) and 8% had both early and late complications. Flap necrosis was seen in 25% (21/122) of patients. This comprised complete flap loss in two patients. Partial skin and fat necrosis was observed in 14 patients and partial skin loss only in 15. In the group with simple vertical flaps the incidence of partial flap necrosis was 12.5%. Late complications included incisional hernia in 5% of patients. Reoperation for complications were required in 18% of patients. We conclude that while minor morbidity is common with rectus flaps, major complications are few. The more important considerations relate to cigarette smoking and overuse of the peripheral segment of the transverse rectus abdominis flap. While the transverse flaps have now largely replaced other breast flaps, in our practice vertical and higher transverse flaps were useful alternatives. Lessons learned during the development of these flaps have led to greatly improved results in the latter part of the series and it is regarded as a versatile and useful flap in this situation.

Abdominal Muscles↗
PubMed1992

Plasma fatty acid profiles in benign breast disorders.

Breast pain (mastalgia) and macroscopic breast cysts present commonly. Mastalgia may be improved by dietary manipulation to reduce saturated fat or supplement essential fatty acid intake. Fatty acid profiles were measured in women with mastalgia and breast cysts, before and during treatment with evening primrose oil, a rich source of essential fatty acids. The fatty acid profiles of both groups of patients were abnormal, with increased proportions of saturated fatty acids and reduced proportions of essential fatty acids. Treatment with evening primrose oil improved the fatty acid profiles towards normal, but this was not necessarily associated with a clinical response.

Breast Diseases↗
PubMed1991

Case report: gastroduodenal intussusception--an unusual cause of pancreatitis.

Gastroduodenal intussusception is a rare complication of polypoidal gastric tumours, and it has not previously been described as a cause of acute pancreatitis. We report a case of an endoscopically, radiologically and histologically proven intussuscepting gastric leiomyoma presenting with biochemical evidence of acute pancreatitis. The radiological appearance is illustrated and possible mechanisms for the pancreatitis are discussed.

Acute Disease↗
PubMed1991

An assessment of academic performance and personality.

This study examines whether personality profiles, using personality factors, or clusters of personality factors, are associated with academic success. One hundred and forty medical students of the University of Wales College of Medicine were invited to complete a personality questionnaire (Cattell 16 PF) as they sat their final examinations in June 1988. A total of 129 usable forms were obtained. The students were divided into four groups dependent on their academic performance, which had been monitored throughout the course. The majority (62%) had no academic problems, but 16 (12%) students had serious difficulties, which entailed delaying qualification by at least 6 months. There was no relationship between the scores obtained for the students' first attempt at A-level and their subsequent medical school academic performance. However, students who obtained a degree either before or during their medical course were significantly less likely to have academic problems. Academic success was not associated with any of Cattell's personality factors. This was true of previously reported groups of factors associated with the poor student performance, and regardless of first or second order factors. We conclude that this personality profile is unlikely to be helpful in selecting future intakes of medical students, although a prospective study would be required for a definite answer to this question.

Cattell Personality Factor Questionnaire↗
PubMed1991

Management of mammillary fistulae.

Mammillary fistulae develop between the lactiferous ducts of the breast and areolar skin. Over a 14-year period 41 fistulae were treated in 36 patients (34 women, 2 men). In 24 women at least one subareolar abscess (mean 2.5) had been incised and drained previously. Fourteen fistulae developed after discharge of an inflammatory mass and three after surgical biopsy. Twelve women underwent 13 fistulectomies, two of which required reoperation. The remaining 24 patients with complicated fistulae (n = 28) had previously undergone multiple surgical procedures; 12 patients had 13 fistulae treated by total duct excision and primary closure without antibiotic cover and six fistulae required reoperation. Fifteen fistulae in 12 women were treated by duct excision with either primary closure under antibiotic cover (n = 7) or packing with healing by granulation (n = 8) and only one recurred (P less than 0.05). Operations for mammillary fistulae should be treated as contaminated procedures. In simple cases where no previous surgery has taken place, fistulectomy is appropriate. In complicated cases, treatment should be duct excision with the wound either closed primarily under antibiotic cover or left open to heal by secondary intention.

Adolescent↗
PubMed1990

How good are case notes in the audit of radiological investigations?

Audit based on the use of case notes completed in the ordinary course of patient care has not been widely used because of concern about the completeness and adequacy of such records. This paper describes the results of a study carried out to assess whether information contained in case notes was sufficiently reliable to enable clinical effectiveness to be measured. The study examines the extent to which a radiologist and an epidemiologist agree with two experienced clinicians in making retrospective judgements on whether out-of-hours radiological investigations are worthwhile. There was a high measure of agreement; only a relatively small amount of information in the case notes is needed to make valid judgements on clinical performance. The method described here may be applicable to other diagnostic investigations and the results of the study have wide implications for more effective and efficient management of resources within the NHS.

Clinical Competence↗
PubMed1990

A randomized trial of dietary intervention with essential fatty acids in patients with categorized cysts.

Two hundred women with breast cysts proven by aspiration were entered into a randomized double-blind trial of Efamol (evening primrose oil) at a dose of 6 capsules daily or equivalent placebo dose for a year. Cysts were categorized by initial electrolyte composition, and follow-up continued for 1 year posttherapy. Recurrent cyst formation in the first year was slightly (but not significantly) lower in the Efamol group compared with the placebo-treated group. The Efamol treatment was well tolerated as the dropout rate was only 7% and equal in both the active and placebo groups. The initial electrolyte composition did not predict for cyst recurrence.

Adult↗
PubMed1989

Salvage surgery for advanced local recurrence of breast cancer.

The development of myocutaneous flaps and other reconstructive procedures has made it possible to offer surgical palliation to many patients with advanced local recurrence of breast cancer who previously would have been regarded as untreatable. We present the results of excision of such recurrences in 42 patients treated from 1982 to 1986 after non-surgical measures had failed. Good palliation was achieved in all of the patients with acceptable morbidity. There was one death. Further local recurrences developed in 12 (29 per cent) patients, though none was painful or offensive. Thirteen patients remain alive and free from local disease; 17 patients remained free from local disease until they died.

Adult↗
PubMed1989

Drug acetylation in breast cancer.

The acetylator phenotype was determined in 100 patients with breast cancer and 100 control female subjects using isoniazid. The proportion of fast acetylators in the breast cancer patients (43%) was not significantly different from the control group (43%). We conclude that acetylator phenotype is unlikely to be an important determinant of the risk of developing breast cancer.

Acetylation↗
PubMed1989

The male breast.

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Adolescent↗