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Biomedical subjects

H M Shaw

Publications and source records attributed to H M Shaw.

At least 19 recordsLinked to original sources
PubMed1995

Prediction of potential metastatic sites in cutaneous head and neck melanoma using lymphoscintigraphy.

BACKGROUND: The technique of lymphoscintigraphy may allow a more selective approach to the management of clinically negative neck nodes among patients with cutaneous head and neck melanoma. PATIENTS AND METHODS: A group of 97 patients with cutaneous head and neck melanoma had preoperative lymphoscintigraphy using intradermal injections of technetium 99m antimony trisulfide colloid to identify sentinel nodes. Fifty-one patients were eligible for clinical analysis after initial definitive treatment by wide excision only (n = 11), wide excision and elective dissection of the neck (n = 19) or axilla (n = 1), or wide excision and a sentinel node biopsy procedure (n = 20). RESULTS: Sentinel nodes were identified in 95 of 97 lymphoscintigrams, and 85% of patients had multiple sentinel nodes. In 21 patients (22%), sentinel nodes were identified outside the parotid region and the 5 main neck levels, mostly in postauricular nodes (n = 13). Lymphoscintigrams were discordant with clinical predictions in 33 patients (34%). Lymph nodes were positive in 4 elective dissections and 4 sentinel node biopsies. Among 16 patients evaluable after wide excision and a negative sentinel node biopsy, 4 patients subsequently developed metastatic nodes; however, confident identification of all nodes marked as sentinel nodes on lymphoscintigraphy was not achieved at the original biopsy procedure in 3 of these patients. CONCLUSIONS: Lymphoscintigraphy and sentinel node biopsy are more difficult to perform in the head and neck than in other parts of the body. The reliability of sentinel node biopsy based on lymphoscintigraphy may be improved by identifying and marking all nodes that are considered to receive direct lymphatic drainage from the primary melanoma, and by use of a gamma probe intraoperatively.

Adolescent↗
PubMed1995

Lymphatic drainage from peri-umbilical skin to internal mammary nodes.

While performing lymphoscintigraphy to define draining lymph node groups and sentinel nodes in patients with melanoma, the authors have discovered a new lymphatic channel in two patients with tumors in the peri-umbilical area. This channel passes over the right costal margin to an interval node before passing toward the midline, where it passes through the chest wall to reach the internal mammary lymph node chain. Appreciating the possible presence of this channel in patients with periumbilical lesions has important implications for the surgical management and follow-up of these patients.

Antimony↗
PubMed1995

Elective lymph node dissection in patients with primary melanoma of the trunk and limbs treated at the Sydney Melanoma unit from 1960 to 1991.

BACKGROUND: The value of elective lymph node dissection (ELND) in melanoma remains controversial. Published prospective and retrospective studies can be criticized, and results from two ongoing randomized trials are not yet available. A previous retrospective review from the Sydney Melanoma Unit (SMU) showed apparent survival benefit from ELND, especially in tumors of intermediate thickness. STUDY DESIGN: We undertook a retrospective analysis of all patients treated at the SMU since 1960 for melanoma of the trunk or limbs measuring 1.5 mm or more in thickness, without clinical lymph node metastases, whose definitive wide excision (WE) with or without ELND was performed at the SMU within 60 days of initial diagnosis. RESULTS: There were 1,278 patients who fulfilled these criteria. Of these, 845 (66 percent) were treated with ELND and the remaining 34 percent were treated with WE alone. The median follow-up period was 58 months. Patients with thicker tumors and younger age more commonly underwent ELND. Among patients with thinner tumors, males underwent ELND more commonly than females. A multivariate proportional hazard model of melanoma-specific survival stratified by tumor thickness was chosen to allow for the imbalances between the two groups. With or without allowance for covariates, no benefit from ELND was found in the whole group or any subset. In contrast to previous studies from the SMU, we deliberately excluded from the present study patients referred only after WE with or without ELND elsewhere, because these might have been a selectively biased poor prognostic group. CONCLUSIONS: This study does not indicate a benefit from ELND for melanomas of the trunk or limbs measuring over 1.5 mm in thickness.

Female↗
PubMed1995

Tumor thickness.

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Humans↗
PubMed1994

Tissue vitamin E status is compromised by dietary protein insufficiency in young growing rats.

In vitro erythrocyte hemolysis previously has been found to be significantly elevated in rats fed a low protein diet. To investigate the effects of dietary protein insufficiency on tissue vitamin E status, four groups of male weanling Long-Evans rats were given free access to either an 8% (wt/wt) lactalbumin diet containing 50 (L50) or 500 (L500) mg/kg diet of all-rac-alpha-tocopheryl acetate, or a 20% (wt/wt) lactalbumin diet containing 50 (N50) or 500 (N500) mg/kg of all-rac-alpha-tocopheryl acetate for 6 wk. A fifth group (P50) was pair-fed to the L50 group with the N50 diet. The L50 and L500 groups showed signs of protein malnutrition such as growth retardation as well as lower hematocrit and plasma protein and albumin concentrations. The alpha-tocopherol concentrations of plasma, heart, lung, kidney and muscle were significantly lower in the L50 group compared with the N50 group. The L500 group showed significantly less alpha-tocopherol in heart, kidney, muscle, brain and adipose tissue compared with the N500 group. The alpha-tocopherol concentrations in liver, testis, spleen and adrenal gland did not significantly differ either between the L50 and N50 groups or between the L500 and N500 groups. Supplementation with 500 mg/kg diet of all-rac-alpha-tocopheryl acetate resulted in significantly higher tissue alpha-tocopherol concentration in all tissues except muscle. The tissue alpha-tocopherol concentrations of the P50 group were not significantly different from those of the N50 group. The results indicated that protein insufficiency resulted in significantly lower alpha-tocopherol concentrations in most tissues in young growing rats.

Animals↗
PubMed1994

Lymphoscintigraphy to identify sentinel lymph nodes in patients with melanoma.

Lymphoscintigraphy (LS) has been performed for 8 years in patients of the Sydney Melanoma Unit, to define lymphatic drainage patterns. Over the past 2 years, LS has also been used to locate the sentinel lymph node prior to surgery. Our technique for LS and subsequent sentinel node biopsy has an accuracy of 97%. All sentinel nodes must be marked to ensure the successful application of the sentinel biopsy technique. We have found that the axilla and groin average just over one sentinel node per draining node group for lesions on the trunk and upper limb, but have noted that drainage to the groin differed when lower limb lesions were studied. Because of the anastomosis of lymph vessels in the upper thigh, multiple sentinel nodes are identified in the groin in some patients. We have found an average of three sentinel nodes in the groin when lymph drainage from lower limb lesions was studied with LS. This difference demands a modification of the LS technique, with early imaging of the groin nodes to identify all sentinel nodes in each patient. The depth of the sentinel nodes can also be measured and the location of all interval nodes marked on the skin. This ensures that all sentinel nodes and interval nodes can be removed at the time of surgery.

Arm↗
PubMed1994

Cutaneous malignant melanoma in teenagers.

Of 57 reviewed cases of malignant melanoma in teenagers, 51 had a minimum follow-up of 5 years. The histological and some clinical features of the 51 cases were compared for diagnostic and prognostic significance with those of 19 Spitz naevi and 10 other benign naevi using the SPSS-X computer program. The overall crude survival was 71% (males 64%, females 81%). Five patients with regional metastases survived more than 5 years, three of these more than 10 years. The main statistically significant features associated with a poor prognosis were Breslow thickness, diameter of ulcer, abnormal mitoses, pushing dermal borders and marginal (deep) mitoses. In comparison with Spitz naevi, features favouring malignancy were Breslow thickness, fine dusty cytoplasmic melanin pigment, marginal or abnormal mitoses, epithelioid intra-epidermal melanocytes below parakeratosis, dermal nests larger than junctional nests and the mitotic rate in the papillary dermis. Features favouring a benign lesion were diffuse maturation, spindle cells, spindle nuclei and Kamino bodies, especially if numerous or clustered. In comparison with the atypical benign naevi, significant features favouring malignancy were marginal or abnormal mitoses, single cell epidermal invasion below parakeratosis, large nuclei and irregular nuclei.

Adolescent↗
PubMed1992

Small-diameter malignant melanoma: a common diagnosis in New South Wales, Australia.

BACKGROUND: The "ABCDE" guide developed at the New York University Medical Center and Harvard Medical School has proved useful in the detection of early malignant melanomas. This guide stipulates that melanomas usually are more than 6 mm in maximal diameter and are elevated. OBJECTIVE: Our purpose was to determine whether these size criteria applied in Australia. METHODS: The records of 1150 melanoma patients at the Sydney Melanoma Unit between June 1989 and September 1991 were reviewed. RESULTS: Almost one third of the 1150 melanomas (358) were 6 mm or less in maximal diameter, and the median thickness of these 358 melanomas was 0.8 mm. CONCLUSION: The "ABCDE" guide to the signs of early melanoma may have to be modified to include smaller diameter, clinically impalpable melanomas. There appears to be a close correlation between patient age at diagnosis and both lesion diameter and thickness. Because increases in diameter occurred more rapidly than increases in thickness, subtle increases in lesion diameter may provide a better clue to earlier diagnosis.

Adult↗
PubMed1991

Hereditary melanoma in Australia. Variable association with dysplastic nevi and absence of genetic linkage to chromosome 1p.

Hereditary cutaneous malignant melanoma in association with the presence of multiple precursor lesions termed the dysplastic nevus syndrome (DNS) has been reported to display autosomal dominant inheritance with high penetrance. The gene for this disease was recently assigned to the distal short arm of chromosome 1 on chromosomal band 1p36, 7.6 centimorgans distal to the locus for the pronatrodilatin (PND) gene. We assessed 119 family members of eight newly described Australian families, 30 of whom had cutaneous malignant melanoma. Only eight of these affected individuals also had dysplastic nevi (DN). An additional 15 family members had DN alone. Pedigrees fell into three groups: 1) hereditary melanoma alone with no associated DN, 2) hereditary melanoma with occasional DN-affected individuals, and 3) hereditary melanoma with DN. All families displayed an autosomal dominant pattern of inheritance. An analysis of the cosegregation of the cutaneous malignant melanoma/DN trait with eight polymorphic DNA markers on the short arm of chromosome 1, including the distally located DNA markers D1S47 and PND yielded a strongly negative probability of linkage. The putative gene for susceptibility to melanoma in these families was effectively excluded from this region of the short arm of chromosome 1. No evidence for linkage was found at any of the other chromosome 1 markers examined. These findings suggest that hereditary melanoma is heterogeneous in relation to the genetic basis and its association with the DNS.

Adolescent↗
PubMed1991

Patients with thick melanomas surviving at least 10 years: histological, cytometric and HLA analyses.

Survival for melanoma patients with thick primary tumours is notoriously short. A small number of patients with tumours greater than 5.5 mm thick do, however, have protracted survival intervals. Attempts were made to account for this phenomenon by means of histological, cytometric and HLA serotyping analyses. Patients with thick lesions surviving more than 10 years were matched--by sex, age, anatomical site of primary lesion, stage of disease and, whenever possible, by initial surgical therapy--to patients dying of their disease within 5 years. This case-control study on 13 long-term survivors and 13 short-term survivors did not show that any of the following attributes of the primary lesion were useful in predicting survival: Clark's level of invasion, ulceration, mitotic rate, host inflammatory response, tumour regression, tumour necrosis, vascular invasion, satellitosis, radial or vertical growth phase, predominant cell type, histogenetic type, borders, DNA quantification and cytomorphometry. HLA serotyping of long-term survivors showed an excess of antigen DQw1 compared with the general population, although this excess was not statistically significant.

Adult↗