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Biomedical subjects

G T Royle

Publications and source records attributed to G T Royle.

At least 55 records · Page 3Linked to original sources
PubMed1990

Demonstration of oestrogen receptor in symptomatic breast carcinoma, using fine needle aspiration cytology.

Oestrogen receptor immunocytochemical assay (ER-ICA) was used to determine oestrogen receptor (ER) content of cells in fine needle aspirate (FNA) specimens from 88 breast carcinomas. In 49 of these the radioligand binding assay for oestradiol was available for comparison. The predictive value of ER-ICA staining for a positive radioligand binding assay (greater than 10 fmol/mg protein) was 95%. Although the predictive value of negative staining was only 66%, 34 out of 37 ER-ICA negative tumours had radioligand binding assays below 60 fmol/mg protein. ER-ICA staining showed a strong positive correlation with age of the patient, positivity being rare before the menopause. There was a weak inverse correlation with tumour grade but none with tumour size or lymph node status. The assessment of ER by immunocytochemistry using FNA cytology is a rapid technique, which may easily be repeated and provides a pre-operative assessment of ER status. It allows confirmation that tumour cells are present in the sample and an assessment of tumour heterogeneity.

Adult↗
PubMed1990

Poor response of breast cancer to tamoxifen.

Fifty eight (58) patients with early breast cancer (mean age 78.3 years) and 37 patients with advanced breast cancer (mean age 65.9 years) were treated with tamoxifen orally 20 mg daily or twice daily. The mean follow-up time was 19.1 months in the early group and 18.4 months in the late group. The drug was extremely well tolerated. All patients had cytological or histological evidence of breast cancer. A complete or partial response was found in only 36% of the patients with early breast cancer and only 13% in the advanced group. We conclude that tamoxifen was disappointing as a primary therapy in our patients. Although because of its lack of toxicity it can be seen as initial therapy for patients with breast cancer, it may have to be supplanted rapidly by other forms of therapy in the substantial proportion of patients in whom a response will not occur.

Administration, Oral↗
PubMed1990

Varicose vein surgery using a pneumatic tourniquet: reduced blood loss and improved cosmesis.

A prospective controlled randomised study has been performed of 100 consecutive patients undergoing varicose vein surgery. One group underwent saphenofemoral flush ligation and multiple lower leg avulsions with the leg exsanguinated with a Rhys-Davies cuff, and ischaemia maintained with a pneumatic tourniquet. The other group underwent identical surgery but with a 30 degree head down tilt only. Blood loss was significantly less (13.5 +/- 12 ml vs 133 +/- 78 ml; P less than 0.01) and postoperative cosmesis was significantly improved in patients in the tourniquet group. Operating time was similar (27 +/- 11 min vs 30 +/- 13 min) in the two groups.

Esthetics↗
PubMed1990

The Southampton teaching triad: an audit of operative surgical instruction.

Clinical audit and regular morbidity and mortality meetings are required of all units involved in surgical training. Agreed standards of training are under discussion in the face of new examinations and have not at present been formally evaluated. In order to quantify the level of operative surgery instruction in this unit, a prospective 'Teaching Audit' has been undertaken, using an extension of the existing surgical audit. Results, which are presented as a standardised diagram, reflect the relationship between trainer and trainee. Problems, such as missed teaching opportunities, were identified. The method can be applied to any specialty, and may be useful in planning teaching resources and surgical training programmes.

Breast↗
PubMed1989

Clinical, radiological and cytological diagnosis of breast cancer in young women.

In women over the age of 35 years, an accurate diagnosis of breast cancer can be made in over 95 per cent of patients using a 'triple assessment' system collating information from clinical examination, mammography, sonomammography, and fine-needle aspiration cytology. These methods have not been specifically evaluated in women aged 35 years or less, hence a study was undertaken on 30 such patients. Clinical examination was unreliable in predicting malignancy with a sensitivity of only 37 per cent. Thirty per cent of patients presented with a lump which had the clinical features of a fibroadenoma. Radiological methods were less sensitive in detecting malignancy in this age group than in older patients. The sensitivity of aspiration cytology was 78 per cent which was higher than that for breast cancer at all ages. Histology showed that there were fewer low grade tumours and fewer scirrhous tumours in this age group than in a control group of women aged over 35 years. This study indicates that cytological confirmation of apparently benign focal breast lesions in young women is essential, especially when these are managed conservatively.

Adult↗
PubMed1989

Does hyperketonemia affect protein or glucose kinetics in postabsorptive or traumatized man?

Leucine and glucose turnover were measured using simultaneous infusions of [13C]leucine and [2H]glucose before and during an infusion of Na DL-hydroxybutyrate (Na DL-HB) in overnight-fasted patients the day before and 3 days after total hip replacement. The ketone body infusion before surgery resulted in a significant increase in plasma leucine concentration and leucine turnover, while glucose concentration and turnover decreased. Surgery increased leucine turnover. Ketone body infusion after surgery caused a further increased leucine turnover while turnover fell as before surgery. We suggest that exogenous ketone bodies decrease hepatic glucose production and probably stimulate a rise in protein synthesis above breakdown leading to a decreased nitrogen excretion as observed by other investigators. Despite the metabolic adaptation to trauma, this response was not affected by surgery.

Aged↗
PubMed1989

Radiological evidence for the polyp/cancer sequence in the colon.

Three cases of frank malignancy developing in pre-existing colonic polyps are presented. Although this sequence of events is well recognised, it is rarely demonstrated radiologically. The cases illustrate the importance of identifying and appropriately treating polypoid colonic lesions.

Adenocarcinoma↗
PubMed1989

Changes in the surgical management of early breast cancer in England.

A questionnaire survey of consultant surgeons in England indicates that there has been a considerable change in opinion over the past few years concerning the management of early breast cancer; only 39.1% would now perform mastectomy, whereas 64.4% would perform conservative surgery. The most common forms of management are simple mastectomy and axillary clearance (21.9%); wide excision, axillary clearance plus radiotherapy (20.1%); and wide excision plus radiotherapy alone (16.9%). The majority of the surgeons would offer patients a choice of surgery, but only 52% had access to a breast care nurse.

Attitude of Health Personnel↗
PubMed1989

Evaluation of a 'DIY' test for the detection of colorectal cancer.

A new type of faecal occult blood test, EZ-Detect, has been evaluated in 404 patients presenting with symptoms suggestive of colorectal disease. The test avoids handling of stools and gives a result which patients can read themselves--factors which may increase patient compliance. In comparison with the Haemoccult test, EZ-Detect has the same sensitivity for blood in laboratory conditions. In clinical use 98% of patients expressed a preference for EZ-Detect but it detected significantly fewer patients with cancer than did Haemoccult (P = less than 0.05). In its present form, this type of test would be unsuitable for population screening for colorectal cancer even if improved compliance is achieved.

Adolescent↗
PubMed1989

After surgery for breast cancer: which mode of surveillance?

Five hundred and ten women attending a specialized breast clinic for follow-up after surgery of early breast cancer (Stage I and II) have been studied. Recurrence was found most often (58%) in symptomatic women who returned to the clinic earlier than planned. Only 3% of asymptomatic patients had recurrent disease. It is concluded that counselling in symptoms of recurrent breast cancer would allow more efficient follow-up.

Breast Neoplasms↗
PubMed1989

Ultrasound detection of axillary lymph node metastases in breast cancer.

Presence or absence of lymph node metastases is the most accurate prognostic indicator in breast cancer. Clinical examination is unreliable in detecting involved nodes. Preoperative ultrasound scan of the axilla has been performed in 140 consecutive women with breast cancer. The sensitivity for involved nodes was 66% which was significantly higher than clinical examination (42%) (P = less than 0.01). However ultrasound gave more false positives than clinical examination and thus no overall improvement in prognostic information was achieved.

Adult↗
PubMed1988

Pre-operative or postoperative colonic examination for synchronous lesions in colorectal cancer.

A review of 130 consecutive large bowel examinations at which a cancer of the colon or rectum was diagnosed has been undertaken. Of 50 patients examined by colonoscopy, the whole colon was seen in only 21 (42 per cent) and almost half of these had a tumour in the caecum or ascending colon. In most cases, an incomplete examination was the result of narrowing of the lumen by the tumour preventing passage of the endoscope. Of 80 patients examined by double contrast barium enema, the entire length of the colon was visualized in 83 per cent but the quality of the examination was sufficient to confidently exclude synchronous neoplastic lesions in only 51 per cent. The incidence of synchronous cancer in this series was within the expected range, although two such cancers were not detected until laparotomy, but the incidence of synchronous adenomas was two-thirds of the expected number in colonoscopy patients and one-third in those examined by barium enema. It is concluded that, in patients with known colorectal cancer, preoperative investigation is unreliable for the detection of all synchronous neoplasia and that patients should have postoperative colonoscopy.

Adult↗
PubMed1988

Offering patients a choice of surgery for early breast cancer: a reduction in anxiety and depression in patients and their husbands.

Thirty patients with early breast cancer have been studied prospectively to assess whether being offered a choice of surgery (simple mastectomy or wide excision plus radiotherapy) influences levels of anxiety and depression pre- and post-operatively. A significantly higher percentage of the patients not offered a choice of surgery experienced clinical levels of anxiety and depression pre-operatively and up to 2 months post-operatively compared with patients offered a choice; the results were also similar for the husbands of these patients. At 6 months, differences between the 2 groups were not statistically significant, although the trend remained the same with more patients not offered a choice of treatment showing high levels of anxiety and depression. Patients offered a choice of surgery had similar pre-operative levels of anxiety and depression to patients with benign breast disease and patients undergoing surgery for non-cancerous conditions. This study indicates that with proper counselling patients and husbands suffer less stress if they are allowed to take an active part in the treatment of their cancer.

Adult↗
PubMed1988

Glucose kinetics in protein depletion--effect of glucose infusion in the fasted rat.

A primed constant infusion of [6-3H]glucose was used to determine glucose turnover in rats fasted for 48 h that had previously been pair-fed isoenergetic 4% and 14.4% protein diets for 6 wk. The protein-depleted rats had a low body weight and lower plasma glucose and plasma insulin concentrations compared with the 14.4% protein pair-fed control animals. The rate of appearance of glucose in plasma in the protein-depleted rats was significantly less than that in the pair-fed controls. During an intravenous infusion of unlabeled glucose (38.8 mumol.kg-1.min-1) plasma glucose concentrations and glucose appearance increased in both groups. Plasma insulin concentration remained lower in the 4% protein-fed group though the percentage of increase above basal was similar in both groups during glucose infusion. The clearance of glucose from the blood and suppression of endogenous glucose production during the exogenous glucose infusion were similar in both control and protein-depleted rats. Rats fed a 14.4% protein diet ad libitum consumed more diet than the pair-fed groups and their body weights were greater. However, fasting plasma glucose and insulin, concentrations were similar to the 14.4% protein pair-fed animals. This indicates that the observed changes in glucose metabolism in the 4% protein-fed animals were due to a reduced dietary ratio of protein to carbohydrate rather than reduced energy intake.

Animals↗
PubMed1988

Open access colonoscopy for suspected colonic neoplasia.

An open access endoscopy service for direct referral of patients suspected to have colonic neoplasia has been analysed. In the first year of the service 137 patients were referred by 52 general practitioners. The most common reason for referral was rectal bleeding (58%). Colonoscopy was done without outpatient consultation or barium enema examination in 130 patients: there were no complications. The diagnostic yield was 57%: 34 patients (25%) had neoplasia (cancer 14, adenoma 20), which was higher than the yield of neoplasia in patients referred for open access double contrast barium enema during the same period. Only nine patients (7%) needed further investigation because colonoscopy was incomplete and 21 (16%) were treated by polypectomy at the diagnostic colonoscopy.

Aged↗