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Biomedical subjects

D J Webster

Publications and source records attributed to D J Webster.

At least 55 records · Page 3Linked to original sources
PubMed1989

The predictive value of T-lymphocyte counts in breast cancer patients treated by endocrine manipulation.

Endocrine manipulation has a valuable role in the management of advanced breast cancer. However, it is only effective in some cases and at least 12 weeks is required before efficacy can be ascertained. In an attempt to achieve earlier assessment of response, changes in lymphocyte counts have been studied in patients receiving endocrine therapy. Absolute lymphocytes were not significantly changed by 6 weeks in any patients but there was a significant increase (P less than 0.05) in absolute T counts by 6 weeks in patients who achieved partial remission when compared with those whose disease continued to progress. Percentage T counts increased significantly from pretreatment values (P less than 0.002) in patients in whom disease progression was stopped by endocrine manipulation and this rise was maintained during clinical benefit. Fall in percentage T counts to pretreatment values predated objective evidence of recurrence by as much as 2 months. There was no increase in percentage T counts in patients in whom disease progression continued despite treatment, indicating that the rise in percentage T counts is a secondary phenomenon to tumour response. T-lymphocyte counts may permit earlier evaluation of the patient during treatment, allowing earlier selection of alternative treatment modalities.

Adrenalectomy↗
PubMed1988

Role of Doppler ultrasound flowmetry in the diagnosis of breast lumps.

One hundred and five patients with discrete breast lumps were examined with a 10 MHz Doppler ultrasonic flowmeter. Doppler flow signals were analysed on an Angioscan spectrum analyser. Recordings from the opposite normal breast were taken as controls and signals from the two sides compared. In 23 patients signals from the normal breast could not be recorded and therefore results of the remaining 82 patients are reported. These included 39 patients with carcinoma, 20 with fibroadenoma, 12 with cyclical nodularity and 11 with cysts. Malignant lumps exhibited significantly higher peak systolic (S) and minimum diastolic frequencies (D) in comparison to the control breast. Fibroadenoma also had a higher S and D than those of the opposite normal breast. Signals over cysts and cyclical nodularity showed no significant difference from the recordings over the control side. Despite significantly higher systolic and diastolic frequencies in the cancer group in comparison to benign lumps and normal breast, considerable overlap in the values was seen between cancer and other groups. Therefore the patterns on 10 MHz Doppler sonography are not sufficiently specific to discriminate benign from malignant breast lumps.

Adenofibroma↗
PubMed1988

Ferritin-bearing T-lymphocytes and serum ferritin in patients with breast cancer.

Flow cytometric studies of T-lymphocytes in breast cancer patients show that the number of cells bearing ferritin on their surface is significantly greater than normal. The number of ferritin-bearing T-cells does not appear to be related to the clinical stage of the disease nor to the serum ferritin concentration, though this is higher in cancer patients than in normal women. There is no difference in the number of T-cells positive for interleukin 2 or transferrin receptors nor in the absolute number of T-cells, T-helper cells and B-cells between normal women and those with breast cancer or benign breast disease. However, there is a significant increase in the level of HLA DR-positive T-cells and T-suppressor cells in breast cancer patients. While the significance of ferritin-bearing T-cells is not known an increase in their number appears to be associated with cancer.

Adult↗
PubMed1987

Aberrations of normal development and involution (ANDI): a new perspective on pathogenesis and nomenclature of benign breast disorders.

A framework for understanding and management of benign breast disorders is presented, based on the notion that most breast complaints can be explained as minor aberrations of the normal processes of development, cyclical change, and involution. The generic term ANDI (aberrations of normal development and involution) is introduced to allow breast problems to be placed within an overall framework of pathogenesis; this concept also permits more detailed individual assessment with respect to normality and disease. Fibrocystic disease and its synonyms are discarded in favour of terms that are strictly descriptive of the clinical and/or histological picture.

Adenofibroma↗
PubMed1987

Changes in Wolfe mammographic patterns with aging.

Mammograms of 212 women were examined at a mean interval of 15 (range 11-17) years, to determine whether there was any change in Wolfe mammographic pattern with age. The mean age of the patients at repeat mammography was 52 (range 32-75) years. The DY pattern tended to change to P2 or P1 with age. Those in whom the DY pattern remained tended to be younger (mean age 47 years) than those who changed to P2 (57 years), or P1 (55 years). Women whose pattern changed from DY to N1 had a mean age of 42 years. These findings support the hypothesis that the perilobular connective-tissue elements are the structures responsible for the dense appearance of the DY breast, as these elements would be most active between 15 and 45 years (peak reproductive period) and tend to regress later.

Adult↗
PubMed1987

In-situ breakage of an implantable venous access system.

A totally implantable system for venous access (Port-A-Cath, Pharmacia, Nu-tech) has now entered clinical use. This system consists of a silastic catheter secured to a stainless steel reservoir with a locking ring. The system has been shown to have several advantages when compared with earlier venous access systems. However, the advantages of total implantation have also disposed the system to new complications. Two cases are presented of patients who had this system placed and developed in-situ separation of the catheter from the reservoir. The catheter was removed surgically from the subcutaneous tissues in one patient and with a Dormain basket in the second because complete migration of the catheter into the central venous system had occurred. In neither patient could the precise cause for the separation be ascertained. However, it can be appreciated that if chemotherapeutic agents were infused in these patients the results would have been disastrous. It is recommended that if blood cannot be easily aspirated after gentle to and fro flushes with a 10 ml syringe, a chest radiograph be obtained prior to the infusion of any substance to check for continuity in the system. Any breaks in the system should be immediately repaired since migration of the catheter into the venous system can occur.

Adult↗
PubMed1987

Alteration in monocyte function in patients with breast cancer.

Migration, phagocytosis and lysozyme production of peripheral monocytes from 36 patients with breast carcinoma was compared with a group of 36 healthy controls. A significant reduction in monocyte random migration and migration towards a chemotactic agent (P less than 0.001) was observed in patients with breast cancer. Furthermore monocyte phagocytic activity was also significantly decreased (P less than 0.001) in breast cancer patients compared to the controls. In contrast lysozyme production by peripheral monocytes was significantly increased in patients with breast cancer compared to controls (P less than 0.001). The changes in monocyte function in patients with breast carcinoma were not due to abnormal blood biochemistry or to direct continuous serum inhibitors, suggesting that the defect may be intrinsic. This defect in monocyte function may play an important role in the control of malignancies by cellular immune processes.

Adult↗
PubMed1987

Multicenter study of trilostane: a new hormonal agent in advanced postmenopausal breast cancer.

Trilostane, an inhibitor of the production of adrenal estrogens, was administered, together with dexamethasone, to 97 eligible postmenopausal women with advanced breast cancer. Seventy-four patients who had either received trilostane for a minimum of 10 weeks or whose disease had progressed while on trilostane before this period were assessed for tumour response. Eighteen patients (25%) had objective responses (two complete, 16 partial); a further 21 patients had stable disease. The response rate among all 97 patients, including those not treated for a minimum 10-week period, was 19%. Thirty-two of 97 patients reported adverse reactions which were attributed to trilostane and/or dexamethasone. Therapy was stopped for 15 patients, and the dose of trilostane was reduced for ten. Diarrhea was the commonest side effect, being reported in 16 patients, of whom nine stopped treatment. Trilostane, given with a corticosteroid, is an effective alternative hormonal agent acting by adrenal blockade for postmenopausal women with advanced breast cancer.

Breast Neoplasms↗
PubMed1986

Cosmetic results of immediate breast reconstruction post-mastectomy: a follow-up study.

We reviewed 95 patients who underwent immediate breast reconstruction at the time of mastectomy at least one year after operation for assessment of cosmetic results and complications. There were 45 rectus abdominis and 38 latissimus dorsi myocutaneous flaps used for reconstruction. Twelve patients had subpectoral implants without a flap. The results show a remarkable concordance of assessment by patient and surgeon: both found simple subpectoral prosthesis insertion to be inferior to flap reconstruction. Flap reconstruction gave satisfactory results in the majority of patients; latissimus dorsi and rectus abdominis flaps gave similar cosmetic results. However rectus abdominis flaps showed a higher complication rate of flap necrosis and incisional hernia of the abdominal wound. Psychological assessment showed no differences between the three types of reconstruction. We conclude that immediate breast reconstruction can give excellent cosmetic results, and provides an acceptable and safe means of ameliorating the effects of mastectomy. The number of grossly unsatisfactory results decreased notably as the series progressed. Experience and meticulous attention to detail are necessary, since many patients are unwilling to have revisionary procedures if the initial result is unsatisfactory.

Breast↗
PubMed1986

Abdominal aortic aneurysm causing duodenal and ureteric obstruction.

We report a unique case of an abdominal aortic aneurysm complicated by both duodenal and ureteric obstruction and review the literature on these conditions. Duodenal obstruction is a consequence of compression of the duodenum in its fixed retroperitoneal course between the aneurysmal aorta and the superior mesenteric artery. Treatment should be based on replacement of the aneurysm as gastrointestinal bypass alone does not resolve the risk of aneurysm rupture. Ureteric obstruction is related to encasement of the ureters in an inflammatory perianeurysmal fibrosis of unresolved etiology rather than secondary to aneurysm compression. Although urinary tract symptoms are often seen with aortic aneurysms, they tend to be nonspecific and are often overlooked. As many as 71% of patients with abdominal aortic aneurysms may have radiologic evidence of ureteric involvement. Although aneurysm replacement alone may resolve the perianeurysmal fibrosis with resultant relief of ureteric obstruction, most authors advise simultaneous ureterolysis. Aortic aneurysm should be considered as a possible cause of duodenal or ureteral obstruction in the elderly, especially in the presence of a pulsatile abdominal mass.

Aged↗
PubMed1986

Length of follow-up in teratomas--results of a modification of Einhorn's regime in testicular teratomas.

A modification of Einhorn's original chemotherapy schedule was used to treat 40 patients with metastatic testicular teratomas. Each cycle of chemotherapy consisted of cisplatin (100 mg/m2), bleomycin (30 mg X 3) and vinblastine (5 mg/m2 X 2). Four patients failed to achieve a complete response and died with advanced disease. There was one treatment death. Only two of 14 patients who had residual masses resected still had active tumour. The 2-year actuarial disease free survival for patients in first remission was 85%, but this fell to 77% at 5 years as 3 patients relapsed (34, 36, 37 months). The results are comparable with other series but are associated with less toxicity. The need for continued follow-up is demonstrated in view of relapses occurring after 2 years.

Aged↗
PubMed1985

Coherent-Compton scattering for the assessment of bone mineral content using heavily filtered x-ray beams.

The feasibility of using heavily filtered x-ray beams to assess trabecular bone mineral content has been investigated by measuring the ratio of coherent to incoherent scattered x-rays with a high purity Ge detector. The technique uses the strong dependence of coherent scattering on the effective atomic number of the scattering medium. With an x-ray beam filtered with a high-atomic-number filter, a spectrum characterised by a sharp discontinuity at the K-absorption edge is produced. Analysis of the spectral shape after scattering allows the coherent to Compton scattering ratio to be obtained. Theoretical and experimental results from phantom studies are presented and a comparison made between the results obtained with x-ray beams and radionuclide sources respectively. The influence of overlying tissue thickness on the sensitivity of the measurements is demonstrated.

Biophysical Phenomena↗