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Biomedical subjects

Daniel Hayes

Publications and source records attributed to Daniel Hayes.

6 recordsLinked to original sources
PubMed2006

Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board.

BACKGROUND: The treatment of breast cancer requires a multidisciplinary approach, and patients are often referred to a multidisciplinary cancer clinic. The purpose of the current study was to evaluate the impact of this approach on the surgical management of breast cancer. METHODS: The medical records of 149 consecutive patients referred to a multidisciplinary breast cancer clinic over a 1-year period with a diagnosis of breast cancer were reviewed retrospectively for alterations in radiologic, pathologic, surgical, and medical interpretations and the effect that these alterations had on recommendations for surgical management. RESULTS: A review of the imaging studies resulted in changes in interpretations in 67 of the 149 patients studied (45%). This resulted in a change in surgical management in 11% of patients. Review of the pathology resulted in changes in the interpretation for 43 of the 149 patients (29%). Thirteen patients (9%) had surgical management changes made solely as a result of pathologic reinterpretation. In 51 patients (34%), a change in surgical management was recommended after discussion with the surgeons, medical oncologists, and radiation oncologists that was not based on reinterpretation of the radiologic or pathologic findings. Overall, a second evaluation of patients referred to a multidisciplinary tumor board led to changes in the recommendations for surgical management in 77 of 149 of those patients studied (52%). CONCLUSIONS: The changes in management stemmed from differences in mammographic interpretation, pathologic interpretation, and evaluation by medical and radiation oncologists and surgical breast specialists. Multidisciplinary review can provide patients with useful additional information when making difficult treatment decisions.

Breast Neoplasms↗
PubMed2006

Adjuvant aromatase inhibitors for early breast cancer after chemotherapy-induced amenorrhoea: caution and suggested guidelines.

PURPOSE: Aromatase inhibitors (AIs) are now established as adjuvant therapy for early hormone receptor-positive breast cancer in postmenopausal women. Their use is sometimes extended to younger women after chemotherapy-induced amenorrhoea; we have audited this in one institution's breast unit, and we propose guidelines for use in such circumstances. PATIENTS AND METHODS: The use of aromatase inhibitors as adjuvant therapy in younger women age > or = 40 with hormone receptor-positive early breast cancer and chemotherapy-induced amenorrhea has been audited clinically and biochemically. Results A total of 45 such women were identified in the audit, with a median age of 47 years (range, 39 to 52 years). Twelve women (27%) showed a return of ovarian function (10 renewed menses, one pregnancy, one biochemically premenopausal) after starting an AI. Median age at restart of ovarian function was 44 years (range, 40 to 50 years). CONCLUSION: AIs may promote recovery of ovarian function in some women with chemotherapy-induced amenorrhea and should be used with caution. Biochemical monitoring of ovarian function requires highly sensitive immunoassays. Guidelines for the selection and delivery of adjuvant endocrine therapy in such patients are proposed.

Adult↗
PubMed2006

Impact of estrogen receptor expression and other clinicopathologic features on tamoxifen use in ductal carcinoma in situ.

BACKGROUND: Recent data have demonstrated that benefit from adjuvant tamoxifen therapy for patients with ductal carcinoma in situ (DCIS) is limited to estrogen receptor (ER)-positive lesions. The objective of the current study was to correlate clinicopathologic features of DCIS with ER expression and the impact of this information on tamoxifen counseling. METHODS: Women with DCIS who were treated from 2001 to 2004 were evaluated. Routine ER staining was initiated in January 2003. RESULTS: Ninety-four women (mean age, 57.6 years) were analyzed. The mean DCIS size was 0.98 cm. ER-staining was performed in 55 lesions, and 76% were ER-positive. All Grade 1 and 2 DCIS lesions were ER-positive, compared with 54% of high-grade lesions (P<.001); no other clinicopathologic feature significantly predicted ER status. Overall, 58 patients (62%) were offered tamoxifen, and the rates were similar for the pre-ER and post-ER staining periods. In the pre-ER staining period, surgical treatment and grade were associated with offering tamoxifen (75% of patients who underwent breast conservation vs. 40% of patients who underwent mastectomy; P = .03; 78% of patients with Grade 1 or 2 lesions vs. 45% of patients with Grade 3 lesions; P = .04). In the post-ER staining period, however, only ER status was correlated significantly with offering tamoxifen (71% of patients with ER-positive lesions vs. 31% of patients with ER-negative lesions; P = .01). Approximately 66% of patients who were offered tamoxifen agreed to treatment (approximately 33% of the total DCIS study sample). No clinicopathologic features predicted for tamoxifen acceptance by patients in either the pre-ER or post-ER staining periods. CONCLUSIONS: Seventy-five percent of DCIS lesions were ER-positive. ER staining significantly influenced the likelihood that clinicians would offer tamoxifen to patients with DCIS, but it had no impact on whether patients accepted treatment.

Adult↗
PubMed2005

Microreactor microfluidic systems with human microsomes and hepatocytes for use in metabolite studies.

In the area of drug discovery, high-speed synthesis has increased the number of drug candidates produced. These potential drugs need to be evaluated for their adsorption, distribution, metabolism, elimination, and toxicology (ADMET) properties as early in the drug development stage as possible. Previously, a potential drug's ADMET properties have been found out by using monolayer cell cultures and live animals. These methods can be costly, time-intensive, and impractical for screening the large amount of potential drugs created by combinatorial chemistry. A quick, small, inexpensive, and highly parallel device would be desirable to determine a drug candidate's properties (i.e., metabolism of the drug). Here we fabricate a microfluidic device entrapping human microsomes within poly(ethylene) glycol hydrogels thereby generating an in situ microreactor to assess a drug candidate's metabolic properties that can be coupled to analysis equipment. We show that microsomes can be entrapped without the loss of enzymatic activity during photopolymerization. Additionally, a microreactor utilizing hepatocytes was also created for comparison with the microsome microreactor.

Biological Assay↗
PubMed2004

Recent developments in antidepressant therapy in special populations.

Major depressive disorder (MDD) in the elderly, children, and patients with unstable angina or acute myocardial infarction (MI) is a serious disorder. In elderly patients, where major depression is often overlooked and may have a significant impact on the quality of life, the goal of therapy is full remission. Selective serotonin reuptake inhibitors (SSRIs) have the most favorable combination of efficacy and side-effect profile for the elderly with MDD, regardless of the presence of medical comorbidities. Although the dual agent venlafaxine has been proposed as an alternative agent for older patients who are either nonresponders or partial responders to SSRIs, the frail elderly may be particularly vulnerable to its side effects. Most elderly patients have a relapse of depression when antidepressants are stopped; depression subsides when antidepressants are resumed. Because recent evidence suggests that the dosage of an antidepressant that achieves remission in the elderly does not always protect against recurrence, in addition to long-term maintenance, consideration should be given to increased dosage. Patients with major depression and either unstable angina or acute MI should be identified and considered for antidepressant treatment. Findings from the recent Sertraline Anti-Depressant Heart Attack Randomized Trial suggest that SSRIs may have antiplatelet and endothelium-protective properties that may benefit patients with depression and comorbid coronary artery disease and ischemic stroke. Concern regarding the safety of SSRIs in children has prompted new studies. Evidence suggests that the risks of SSRIs, except for fluoxetine, might outweigh benefits in the treatment of depression in children and adolescents.

Adolescent↗