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Biomedical subjects

I R Gough

Publications and source records attributed to I R Gough.

17 recordsLinked to original sources

What value is given to quality of life assessment by health professionals considering response to palliative chemotherapy for advanced cancer?

A study was designed to obtain information on the importance of quality of life assessment (QL) during palliative chemotherapy. A questionnaire was answered by 542 health professionals (392 general practitioners, 20 specialist oncologists, and 130 oncology nurses). In both simulated patient situations and multiple-choice questions, all groups rated QL higher than other standard methods of assessment. General practitioners and oncologists appeared to weight the assessment criteria more equally than nurses who gave strong emphasis to QL. In the simulated patient situation, there was a small degree of interaction between QL and other assessment criteria. However, the analysis showed that QL was regarded as an independent variable and was considered to be the most important objective of palliative chemotherapy for advanced cancer.

Aged

Metastatic carcinoid tumour: stability throughout pregnancy.

A patient with asymptomatic histologically proven extensive hepatic metastases of carcinoid tumour had no progression of disease for over 4 years without specific treatment. Throughout a normal pregnancy the hepatic metastases remained stable by clinical, computerized tomography and biochemical criteria.

Adult

Aetiology of branchial cysts.

The aetiology of branchial cysts is unknown. It is possible that they arise by more than one mechanism. The major theories are that they originate either from the branchial apparatus or from lymphoid tissues. A retrospective review was conducted of 61 cases occurring over a recent 14-year period. Eighty-five percent were diagnosed after the age of 10 years, 80% occurred in the 'classical' position, 80% had a squamous epithelial lining and 87% had lymphoid tissue in the wall. The clinical and histological features strongly support the lymphoid aetiology theory for the majority of branchial cysts.

Adolescent

Long-term follow-up of patients with benign thyroid fine-needle aspiration cytologic diagnoses.

Reliance on fine-needle aspiration (FNA) of the thyroid as the key determinant whether to observe only or proceed surgically is predicated on achieving a minimal false-negative error rate (the incidence of malignant disease in nodules diagnosed benign by means of FNA). To provide convincing data that malignant disease has not been overlooked requires extended follow-up on a large number of patients with cytologically benign lesions. The intent of our study was to assess the long-term accuracy of thyroid FNA-based diagnoses--particularly with respect to false-negative errors. From our total experience of more than 8000 patients, we reviewed the cases of 680 patients who underwent FNA in 1980, the first year we used it clinically. Follow-up information was obtained on 641 (94%) of the patients with a mean time since FNA of 6.1 years. Benign cytologic findings were reported on 439 (68%) of these patients, and only three (0.7%) had false-negative diagnoses. The false-positive rate was 0% for the 24 (4%) patients with positive aspirates. FNA is a safe, reliable, effective means of accurately discriminating benign from malignant thyroid lesions.

Biopsy, Needle

Diagnostic pneumoperitoneum in traumatic rupture of the right diaphragm.

The diagnosis of diaphragmatic rupture following blunt trauma is difficult and often delayed. Introduced pneumoperitoneum can provide important diagnostic information. Its use is illustrated in a case of massive rupture of the right diaphragm where diagnostic pneumoperitoneum was valuable in distinguishing recent rupture from preexisting pathology.

Aged

Transplantation of organ cultured rat parathyroids.

The hypothesis that tissue culture alters the immunogenicity of grafts by removal or inactivation of passenger leucocytes has been investigated in an inbred rat parathyroid allograft model. DA rat (Ag-B4) parathyroid glands cultured for up to three weeks in Eagle's minimal essential medium (MEM) alone, or MEM with added donor-specific antilymphocyte serum, did not survive longer than fresh glands when allografted into Lewis rat (Ag-B1) recipients. Subsequent in vitro comparisons of three different culture media established that RPMI 1640 was superior to MEM and Medium 199 for rat parathyroids. However, further series of transplants after culture in RPMI 1640 alone also failed to produce prolongation of allograft survival.

Animals

Abdominal apoplexy.

Seven patients with abdominal apoplexy have been treated between 1975 and 1977 and their clinical features and management are reviewed. Accurate preoperative diagnosis is difficult but the condition should be considered in patients with abdominal pain and vomiting or diarrhoea who have signs of shock, peritonism or a falling haemoglobin level. Urgent laparotomy to identify and ligate the bleeding artery offers the best chance of survival.

Abdomen

Strangulating adhesive small bowel obstruction with normal radiographs.

A review of patients having laparotomy for adhesive small bowel obstruction has revealed that many patients have normal radiographs on admission and that this group of patients, who are predominantly women, have delayed laparotomies and are at a significantly increased risk of developing strangulating obstruction while in hospital. The clinical and laboratory data which may distinguish strangulating from non-strangulating obstruction were examined and found to be non-discriminatory in this series.

Adolescent

Chemoimmunotherapy in disseminated melanoma and colorectal carcinoma.

Non-specific immunotherapy with monthly intramuscular injection of Corynebacterium parvum has been investigated by randomized clinical trials in patients with advanced cancer. Thirty-six patients with disseminated melanoma were treated with either imidazole carboxamide (DTIC) alone or DTIC plus C.parvum. A 19% objective response rate was observed. The mean survival time was similar for both groups. Thirty-three patients with disseminated colorectal cancer were treated with either 5-fluorouracil (5FU) alone or 5FU plus C.parvum. No objective responses were observed. The mean survival time was similar for both groups. No advantage has been demonstrated in either tumour group by adding C.parvum to standard chemotherapy.

Bacterial Vaccines

Bilateral renal artery aneurysms: in-situ and extracorporeal repair.

Renal artery aneurysms are uncommon, but when they do occur they are frequently associated with hypertension which may be amenable to surgery. Complex arterial abnormalities which formerly would have been treated by nephrectomy may now be reconstructed with preservation of the kidney. This is illustrated by a patient with renovascular hypertension and bilateral renal artery aneurysms, in whom arteriography and renal vein renin ratios were used as a guide to surgery performed in two stages. An in-situ repair was performed on one side. On the other side, where the aneurysm involved the three main branches of the renal artery, an extracorporeal repair was performed using continuous cold perfusion, substitution of the pathological segment with the patient's internal iliac artery, and autotransplantation to the iliac fossa. Both kidneys were retained and the hypertension was cured.

Adult

A trial of 5-fluorouracil and Corynebacterium parvum in advanced colorectal carcinoma.

This study has confirmed that patients who have advanced colorectal carcinoma have impaired responsiveness to delayed-hypersensitivity skin testing, and also have elevated levels of serum IgM. Serial observations of delayed-hypersensitivity skin tests, total lymphocyte counts, T-lymphocyte counts, B-lymphocyte counts, and serum immunoglobulin levels failed to reveal any consistent pattern of responses in patients treated with either chemotherapy alone or chemoimmunotherapy. In 33 patients chosen at random to receive either 5-FU alone or 5-FU in combination with intramuscularly administered C. parvum, there was no evidence of objective response or influence on survival. Intramuscularly administered C. parvum, in the dose and schedule used, produced no evident immunologic or therapeutic effect.

Antibodies, Bacterial

Chylous ascites in cirrhosis: a case report and review of the literature.

Chylous ascites is an uncommon clinical entity which results from the accumulation of fat, predominantly chylomicrons, in the ascitic fluid. Conventional treatment methods are unsatisfactory. A patient is reported with chylous ascites associated with cirrhosis and portal hypertension in whom the ascites, the renal insufficiency and the fluid and electrolyte disturbances were corrected by the insertion of a Denver peritoneovenous shunt.

Chylous Ascites