Biomedical subjects
G Sutton
Publications and source records attributed to G Sutton.
Flow cytometric analysis of DNA content and RAS P21 oncoprotein expression in ovarian neoplasms.
Flow cytometric analysis of DNA content and ras p21 expression were studied in paraffin-embedded normal ovary (NO, n = 10), serous cystadenoma (SA, n = 11), serous tumors of low malignant potential (LMP, n = 13), and papillary serous cystadenocarcinoma (SCa, n = 7). Tissue for DNA analysis was processed via a modified Hedley technique; a separate aliquot of the same sample was stained with a monoclonal antibody directed to oncoprotein ras p21 (clone Y13259). NO (10/10) and SA (11/11) demonstrated diploid DNA stemlines; 4/12 LMP and 5/7 SCa were aneuploid. S-phase fraction varied with significant differences (p less than 0.001) for SA (mean = 4.4%), LMP (mean = 9.0%), and SCa (mean = 12.7%). When all cases were evaluated, p21 expression was relatively lower in NO and SA (mean = 4.2%) in contrast to LMP and SCa (mean = 13.0% and 8.1%). Diploid cases were examined separately, and lesions with high p21 expression were associated with a diagnosis of LMP/SCa (p less than 0.001), whereas diploid tissues with low p21 expression were associated with a nonmalignant diagnosis (NO/SA). This study suggests that aneuploidy or diploidy with high p21 expression (greater than 10%) may be associated with LMP or frankly malignant ovarian tumors.
Value of ambulatory ST segment monitoring in patients with chronic stable angina: does measurement of the "total ischaemic burden" assist with management?
OBJECTIVE: To assess the prognostic significance of transient ischaemic episodes during daily activities in patients with stable angina. PATIENTS AND METHODS: 172 patients with stable angina attending the cardiac outpatients departments of Hillingdon Hospital (n = 155) and the National Heart Hospital (n = 17) were prospectively studied by exercise testing and 48 hours of ambulatory ST segment monitoring, and followed for prognostic purposes for up to 39 months (mean 24.5 months). Patient inclusion depended on a clinical diagnosis of stable coronary artery disease which necessitated outpatient review (and antianginal treatment in 94% of patients). It was not dependent on objective evidence of reversible ischaemia. Events recorded during the follow up period included death, non-fatal myocardial infarction, unstable angina, and the requirement for revascularisation. RESULTS: 72 patients (42%) had transient ischaemic episodes during daily activities, and 104 patients (60.5%) had an ischaemic response to exercise. 63 patients (36%) had evidence of ischaemia on both investigations; with 59 (34%) having no documented ischaemia on either investigation. There were 27 patient events (15.7%) recorded over a mean 24.5 month follow up, including five deaths (2.9%) (three cardiac related (1.7%)), six non-fatal myocardial infarctions (3.5%), six admissions with unstable angina (3.5%), and 10 revascularisation procedures (5.8%). Of the nine "hard" or objective end points (cardiac death and non-fatal myocardial infarction), only two had evidence of transient ischaemia on ambulatory ST segment monitoring at initial investigation, with 10 of the 25 patients (38.5%) with any cardiac event having such episodes. CONCLUSIONS: The outcome in patients with chronic stable angina receiving standard medical treatment was good over a mean two year follow up period. For the purpose of assessing prognosis over this time scale, there was no advantage to performing ambulatory ST segment monitoring in such patients.
Abdominal wound closure using a running, looped monofilament polybutester suture: comparison to Smead-Jones closure in historic controls.
OBJECTIVE: To determine whether abdominal wound closure with a running, looped monofilament polybutester suture was as effective, inexpensive, and rapid as Smead-Jones closure using the same material. METHODS: Between April 19, 1990 and August 29, 1991, 154 patients undergoing major gynecologic surgery had wound closure using a running, looped monofilament polybutester suture. Controls were 154 patients undergoing similar surgical procedures in the 15 months immediately preceding the study period (January 5, 1989 to April 18, 1990) whose wounds were closed with 0 polybutester using the Smead-Jones technique. All patients received prophylactic cephalosporin antibiotic therapy and external pneumatic leg compression perioperatively. The subcutaneous tissues were not sutured after fascial closure, and the skin was closed with stainless-steel staples. There was no difference between the groups when compared by mean weight, mean ponderal index, number of previous abdominal operations, operative blood loss, or the use of chemotherapy or radiotherapy in the pre- or postoperative period. Both groups had similar rates of complicating medical conditions including insulin-dependent and non-insulin-dependent diabetes mellitus, hypertension, obstructive pulmonary disease, atherosclerotic coronary disease, or peripheral vascular disease. RESULTS: The use of a running closure with looped monofilament polybutester suture in the study patients resulted in a reduction in operating time when compared with controls. The rates of superficial separation and wound infection were similar in both groups. In the study group, there was one minor fascial separation and one wound dehiscence, which occurred when the running suture was inadvertently snipped during debridement of a superficial infection. CONCLUSION: Running closure with looped polybutester is an acceptable, inexpensive, and expeditious method of abdominal wound closure.
Double-blind randomised placebo-controlled dose-efficacy study of sustained release verapamil in chronic stable angina.
The efficacy and tolerability of sustained release verapamil (Securon SR) was investigated in twenty-four patients with chronic stable angina. Patients entered four randomised, double-blind treatment periods, each lasting one week of verapamil-SR 240 mg once daily, 360 mg once daily, 240 mg twice daily, and matching placebo. Four patients were withdrawn, but in one instance this was attributable to side effects from verapamil. Among the remaining twenty patients, mean frequency of angina fell from 4.25 episodes during the last five days of placebo to 2.35, 2.6 and 1.3 episodes during respective active treatments (all P less than 0.001). Compared with placebo the median percentage increase in time to 1 mV ST depression during treadmill exercise (12 hours post dose) was significant only with the regimen of verapamil-SR 240 mg given twice daily at +11% (P = 0.04). Total duration of exercise was also significantly longer and maximum ST depression significantly less only with the twice daily treatment (704 + 186 sec vs 648 + 203 sec; P = 0.03, and 1.75 + 0.73 mm vs 2.15 +/- 0.62 mm; P = 0.02). Side effects, predominantly constipation, breathlessness, and swollen ankles, occurred most frequently with verapamil-SR 360 mg. Thus, sustained release verapamil is well tolerated and effective in the treatment of angina. A regimen of 240 mg given twice daily emerges as superior to once daily treatments for 24-hour prophylaxis of angina.
Clean intermittent self-catheterisation for quadriplegic patients--a five year follow-up.
We present the findings of clean intermittent self-catheterisation (CISC) as a long term method of bladder management for 36 quadriplegic spinal cord injured patients, primarily at C6/C7 level, who were taught CISC between 1983 and 1987. Success in CISC was assessed by a mail survey, a telephone interview, and current sterile urine status. Twenty nine (81%) of 36 patients continued to use CISC after a mean discharge period of 2.9 years (p less than 0.001) with high levels of acceptance. Rao's V discriminant analysis showed success in CISC was affected by the interval between injury and initial self-catheterisation (Canonical Correlation Co-efficient = 1.34). Results of urinalysis for patients continuing CISC were obtained for 18 (62%) patients, 16 (88%) of whom had sterile urine. Implications of these and other findings along with reasons for cessation of CISC are discussed.
Surgical debate. We still have insufficient evidence to support perioperative heparin prophylaxis against venous thromboembolism.
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A new catheter to simplify portal vein cannulation for adjuvant cytotoxic liver perfusion following resection of rectal cancer.
Evidence from randomised clinical trials suggests that adjuvant cytotoxic liver perfusion with 5-fluorouracil following resection of colorectal carcinoma may improve survival in some patients. Various methods of cannulating the portal vein or a tributary at the time of surgery have been described. We describe a simple method of accessing the portal venous circulation via a tributary in the small bowel mesentery, employing a new type of polyurethane catheter. The technical details are discussed with reference to previous literature.
Hormonal aspects of endometrial cancer.
In summary, endometrial cancer is an estrogen-related neoplasm whose precursor lesion, endometrial hyperplasia, may be successfully treated with progestational agents. Trials of adjunctive progestin therapy have failed to demonstrate benefit, even though the malignancy is sensitive to palliative therapy with progestins as well as tamoxifen. Paradoxically, chronic tamoxifen exposure in postmenopausal women may increase the risk of endometrial cancer, and such women must be followed closely. Progesterone receptor may be measured using competitive binding assays or by immunohistochemical techniques. There is tumor heterogeneity with regard to progesterone receptor. Tissues surrounding the cancer may contain progesterone receptor and produce false-positive results in biochemical assays. Last, the presence of progesterone receptor not only predicts responsiveness to progestational therapy, but also confers a survival advantage in patients with endometrial cancer.
Metastatic choriocarcinoma complicated by term pregnancy.
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Phase II trial of cisplatin as first-line chemotherapy in patients with advanced or recurrent endometrial carcinoma: a Gynecologic Oncology Group Study.
Forty-nine evaluable patients with advanced or recurrent endometrial carcinoma who were no longer controllable with surgery, radiotherapy, and hormonal therapy and who had not received prior chemotherapy were treated with cisplatin 50 mg/m2 intravenously every 3 weeks. Two complete responses (4%) and eight partial responses (16%) were observed among the 49 patients. Twenty-two (45%) exhibited stable disease for at least 2 months, while 17 patients (35%) progressed less than 2 months after initiating chemotherapy. Adverse effects included mild leukopenia (31%), nausea and vomiting (72%), and mild azotemia (51%). Only 2 patients experienced life-threatening toxicity; one related to renal failure and the other to sepsis and shock. Cisplatin thus has definite activity when given at the dose and schedule tested to patients with endometrial carcinoma who have not received prior chemotherapy.
Treatment of heart failure with diuretics: body compartments, renal function and plasma hormones.
Body fluid compartments, renal function and plasma hormones were measured in 13 patients with severe chronic heart failure, when the referring physician considered the patient to be appropriately treated. Although renal function was substantially impaired and plasma noradrenaline, aldosterone and renin activity were elevated, fluid compartments were within the normal range. These results show that careful clinical assessment of patients by an experienced physician is a reliable method of assessing restoration of 'normal' body fluid volumes with diuretics.
Surgical staging of carcinoma of the ovaries.
One hundred and eighty-seven patients with stages I, II and III optimal (metastatic lesions of less than 3 centimeters) epithelial carcinoma of the ovaries were evaluated preoperatively and had standardized exploration and biopsy. The protocol called for examination and biopsy of the peritoneum, diaphragm, omentum, pelvic and para-aortic lymph nodes and aspiration of ascites or peritoneal washings for cytologic examination. Of those patients with metastases to the omentum, the clinical impression did not correlate with pathologic findings in 45 per cent. The findings were similar for diaphragmatic lymph nodes (50 per cent), pelvic lymph nodes (71 per cent) and para-aortic lymph nodes (96 per cent). Nine of 97 patients clinically thought to have stage I disease had the stage elevated to II and III based on pathologic findings. Similarly, 15 patients thought to have stage II were found to have stage III based on histopathologic findings. There were 74 complications in 54 patients, with 29 having at least one complication. Surgical exploration for early stage carcinoma of the ovary should include biopsy of the retroperitoneal pelvic and para-aortic lymph nodes, excision of the infracolic omentum, biopsies of pelvic and abdominal peritoneum, including the right diaphragm, and peritoneal cytologic studies.
Necrotizing fasciitis.
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Minimizing the risks of central venous catheterization.
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Ovarian carcinoma with extracellular mucin production: reassessment of "pseudomyxoma ovarii et peritonei".
Peritoneal implants of mucin and columnar epithelium with variable amounts of free peritoneal mucin complicated 11 mucinous ovarian neoplasms. Slides of the primary ovarian tumors were reviewed in eight cases. Although all contained areas of mucinous cystadenomatous tumor of low malignant potential, the neoplasms displayed additional features not well recognized as manifestations of invasive disease in the ovary. Irregular pools of mucin were present in the ovarian stroma and contained at least rare fragments of columnar epithelium in most cases. The epithelium was often more plentiful in the peritoneal mucin. Cytologic atypia was minimal in all except one case. Goblet cells were present in both the ovarian tumor epithelium and the peritoneal implants in most cases and may have a role in dissemination of the tumor. We propose the term "ovarian carcinoma with extracellular mucin production" for this form of mucinous carcinoma; this term is both descriptive of its histologic appearance and indicative of its malignant behavior. Eight of the 11 patients died of their disease from 8 months to 13.5 years after diagnosis. One additional patient died of chemotherapy-related leukemia. The mean survival was 4.2 years. The short-term prognosis is better than that for mucinous carcinoma in general, but most patients eventually die of their disease.
Untreated heart failure: clinical and neuroendocrine effects of introducing diuretics.
The clinical and neuroendocrine response to diuretic treatment was assessed at rest and on exercise in 12 patients with heart failure. Before treatment all patients were limited by breathlessness on exercise; one was oedematous. Plasma renin activity and aldosterone were normal but plasma noradrenaline was raised both at rest and on exercise. After one month's treatment with frusemide (40 mg) and amiloride (5 mg) weight was significantly reduced by a mean of 3.5 kg and exercise capacity had doubled. Plasma noradrenaline fell to normal at rest but remained abnormally raised on exercise. Plasma renin activity and aldosterone increased significantly both at rest and on exercise. Diuretics bring about a considerable clinical improvement in patients with chronic heart failure but they stimulate the renin-angiotensin system. Activation of the renin-angiotensin system in moderate heart failure occurs as a response to diuretic treatment rather than as a result of the disease process itself.
Does non-clinical decompression stress lead to brain damage in abalone divers?
Abalone divers are subject to considerable decompression stresses and could be at risk of progressive cognitive impairment. A sample of abalone divers was compared with a sample of fishermen, by means of a battery of neuropsychological tests. No evidence of cognitive impairment was found in the divers, in spite of evidence of their exposure to decompression stress. The implications for other professional divers and for recreational underwater divers who follow standard decompression protocols are reassuring.