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Biomedical subjects

I Taylor

Publications and source records attributed to I Taylor.

At least 217 records · Page 12Linked to original sources
PubMed1989

Major abdominal surgery in the over-eighties.

We report a prospective controlled trial looking at the outcome of major abdominal surgery judged on the ability of patients to return to their preoperative activity level. Eighty patients were included in the study. Forty of these were over 80 years old and the remainder in the age group 40-65 years. Fifty-four per cent of the over 80s demonstrated an increased level of dependance six months after surgery compared to 18% of the 40-65 year olds. The mortality rate at six months was 42% for the over 80 group. The poor prognosis of elderly surgical patients not only in their increased mortality rate but also in their dependency should be considered before they are subjected to major abdominal surgery.

Abdomen↗
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

A comparison of methods to measure the percentage hepatic replacement with colorectal metastases.

The percentage hepatic replacement (PHR) with liver metastases has been recognised as an important factor for patient management, prognosis, and clinical trial evaluation. The PHR can be assessed by various methods including ultrasound, radioisotope, or computed tomography (CT) imaging, or by inspection and palpation at laparotomy. We report a prospective study comparing these methods of PHR assessment in 56 consecutive patients with colorectal liver metastases. When all four methods were used complete agreement was achieved in only 35% of cases (9/26). The three imaging techniques agreed in only 37% of cases (14/38). Overall, the correlation between different methods was poor with a tendency for surgery to underestimate the PHR. However, CT and surgery agreed in 81% of cases (21/26), and CT gave a higher estimate than surgery in each of the other five patients. With such variability in the estimates of PHR derived from these different techniques, consideration must be given to which technique is used. It is concluded that CT is probably the most accurate for PHR assessment at present.

Colonic 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↗
PubMed1989

The role of chemotherapy in the treatment and prophylaxis of colorectal liver metastases.

Although colorectal liver metastases are a common occurrence, the role of chemotherapy in the management of this condition remains controversial. This article reviews the value of chemotherapy in the treatment and prevention of colorectal liver metastases. Systemic chemotherapy is of no proven benefit in terms of patient survival. Regional approaches to therapy are only a little more encouraging, although an objective view is difficult due to the lack of suitable randomized controlled trials and the difficulty in comparing results of different studies. More recent attempts to enhance regional therapy with degradable starch microspheres have theoretical advantages but need further clinical evaluation. Ultimately, more effective means of controlling overt or occult extrahepatic disease are also required when treating established liver metastases. The use of adjuvant intraportal chemotherapy for the prevention of liver metastases is more encouraging, however, and appears likely to have an important role.

Antineoplastic Agents↗
PubMed1989

Haemorrhagic effects of sodium heparin and calcium heparin prophylaxis in patients undergoing mastectomy.

In a double-blind prospective clinical trial 75 consecutive patients undergoing mastectomy were randomly allocated to one of three groups. Twenty-five patients received perioperative anti-thromboembolic therapy with sodium heparin and 25 with calcium heparin. The remaining 25 patients were given anti-embolism stockings but no heparin. The total postoperative blood loss and period of drainage did not differ between the two groups given heparin, but a total of 10 of these 50 patients suffered haemorrhagic complications in the form of severe bruising or haematoma postoperatively. Of the patients given no heparin, none suffered haemorrhagic complications and the blood loss following the first 24-hour postoperative period was significantly less than in the groups given heparin.

Adult↗
PubMed1988

Factor X-activating activity in normal and malignant colorectal tissue.

The factor X-activating activity (FXAA) of homogenates from human colorectal tumours and corresponding normal colonic mucosa from the same patients was assessed with a specific chromogenic substrate technique. FXAA was detected in all normal and tumour tissue tested, but was significantly higher in tumour tissue. The procoagulant activity was inhibited by DFP, but was unaffected by iodoacetamide and mercuric chloride. FXAA was largely abolished by prior incubation of both normal and tumour tissue homogenates with a rabbit anti-human factor VII serum, but was greatly enhanced by the addition of purified factor VII. FXAA was partially adsorbed on to aluminium hydroxide and almost completely abolished by treatment with barium citrate. It is concluded that the FXAA of both normal and malignant colorectal tissue is the result of tissue factor-factor VII interaction.

Adsorption↗
PubMed1988

Ultrasound mammography in the management of breast cancer.

In this centre, ultrasound mammography has been shown to be more accurate in elucidating the nature of palpable breast lesions than X-ray mammography. A prospective study was devised to determine whether this accuracy could be translated into improved management of patients with breast carcinoma. A total of 223 patients with palpable breast masses were assessed by clinical examination, imaging (X-ray and ultrasound mammography) and aspiration cytology. Each was scored on a five-point scale and treatment was planned according to the total score. According to the protocol, an adequate total score would permit definitive surgery avoiding frozen section. By using sonography rather than radiology, the number of correct diagnoses could be improved by 25 per cent. This was because the greater sensitivity of ultrasound (92.8 per cent) compared to X-ray mammography (82.5 per cent) was reflected in a higher total score, which was sufficient to allow definitive surgical treatment without prior histological confirmation of diagnosis.

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

Preferential growth of bloodborne cancer cells in colonic anastomoses.

Intracardiac injection, in hooded Lister rats, of syngeneic MC28 sarcoma cells never induced tumour growth in normal bowel. Tumour growth occurred at the site of a colonic anastomosis if surgery preceded tumour injection but not if it followed tumour injection, even by as little as 1 h. Maximum enhancement of tumour growth occurred when the healing process had progressed between 2 and 8 days, with a peak at 5 to 7 days. The enhancing effect was largely over by the time the healing had progressed 14 days. The syngeneic OES5 breast carcinoma also grew at colonic anastomoses when surgery preceded tumour injection by 5 days, but not in normal colon. The MC28 sarcoma also grew at ileal anastomoses but not in the normal ileum after intracardiac injection. By injecting radiolabelled sarcoma cells, an estimate of the probability of a single bloodborne tumour cell lodging at a colonic anastomosis and leading to a tumour deposit was calculated to be of the order of 1:43 whereas the probability of the cell lodging in normal colon and causing a deposit is less than 1:4 x 10(4).

Anastomosis, Surgical↗
PubMed1988

Mechanisms of organ selective tumour growth by bloodborne cancer cells.

The sites of tumour development for 6 rat tumours injected into syngeneic rats via different vascular routes was determined. Xenografts of human tumours were also injected intra-arterially (i.a.) into immunosuppressed rats. Following intravenous (i.v.) and intraportal (i.ptl.) injection of cells tumour colonies localized in lung and liver respectively due to tumour cell arrest. Arterially injected radiolabelled cells disseminated and arrested in a similar distribution to cardiac output and did not 'home' to any organs. Following arterial injection of unlabelled tumour cells colonies grew in many organs. While the pattern of growth for a particular tumour varied with the cell dose, the 'arterial patterns' for all of the tumours studied followed a similar pattern. Some organs (eg adrenals, ovaries and periodontal ligament) were consistently preferred, others (eg skin and skeletal muscle) only supported tumour growth following the delivery of large numbers of cells, while in some tissues (eg spleen and intestines) tumour never grew. Viable tumour cells could be demonstrated by bioassay in many organs for up to 24h after i.a. injection. However tumour growth only occurred in certain organs and the pattern of this growth was not related to the number of tumour cells arrested or their rate of autolysis. This site preference could be expressed quantitatively as the probability of an arrested cell developing into a tumour and was considered a 'soil effect'. Site preference was not directly related to organ vascularity. Organ colonisation was promoted by steroid treatment but the mechanism was unclear and was not secondary to T-cell immunosuppression or prostaglandin synthesis suppression. The adrenal glands were preferred sites of tumour growth but pharmacological manipulation of adrenal function did not alter tumour growth to this organ. Sites of injury and healing were preferred sites of tumour colonisation and this could not be accounted for by increased delivery of tumour cells to these regions. The possibility that the macrophage component of the inflammatory response promoted tumour growth was suggested from studies in which the interval between trauma and inoculation of tumour cells was varied as well as by promotion of intraperitoneal (i.p.) tumour growth by a macrophage infiltrate.

Animals↗
PubMed1988

Comparison of the detection of breast carcinoma metastases by routine histological diagnosis and by immunohistochemical staining.

The detection of metastases in 371 axillary lymph nodes by immunohistochemical staining and by routine histological examination was compared in the surgically removed tissue from 50 consecutive patients with breast carcinoma. The primary tumour and axillary lymph nodes were stained with three monoclonal antibodies directed against epitopes of the human milk fat globule (HMFG1; HMFG2; E29), and an anticytokeratin antibody (CAM 5.2), in a double-bridge immunoalkaline phosphatase staining technique. Metastases revealed by further sectioning through the tissue were identified before the immunohistological comparison. The use of immunohistochemical staining resulted in an increased detection of metastases in both infiltrating ductal carcinoma (13.1%) and infiltrating lobular carcinoma (37.5%), an overall increase of 17.3%. The follow-up data over a minimum period of 2 years is available for these patients.

Adenocarcinoma↗
PubMed1988

Use of ultrasound localization to improve results of fine needle aspiration cytology of breast masses.

A prospective randomized controlled trial of 116 patients with breast masses was conducted to compare the accuracy of 'blind' aspiration cytology performed in the clinic with aspiration cytology using ultrasound localization. The unsatisfactory aspiration cytology rate was significantly reduced by ultrasound localization (P = 0.028). This was mainly due to an improvement in the unsatisfactory rate for tumours less than 3 cm in diameter (P = 0.036). The results were influenced by the number of needle manoeuvres performed, less than 10 needle manoeuvres being associated with a 54% unsatisfactory aspiration rate compared with 25% when greater than 10 manoeuvres were performed (P = less than 0.02). One experienced aspirator in the clinic had results comparable to those achieved with ultrasound localization. It is concluded that experience and technique are the most important factors in obtaining a satisfactory aspirate from breast masses. Routine ultrasound localization prior to aspiration confers some benefit. Consideration should be given to the use of the ultrasound-assisted technique following a previous unsatisfactory aspiration, particularly if the tumour is less than 3 cm in diameter.

Biopsy, Needle↗
PubMed1988

Pre-operative scanning of the liver for colorectal liver metastases.

The comparative value of staging the extent of colorectal liver metastases by isotope, ultrasound and CT imaging has been assessed in 20 patients considered for inclusion into a randomized trial. Metastases were identified in all patients by CT, but failed in 4 by isotope and 2 by ultrasound scanning. There was often a discrepancy of 25% in estimating tumour replacement between the different modalities and surgical evaluation. As the extent of tumour is an important prognostic factor, initial evaluation should incorporate all three imaging techniques. Relative regional blood flow in tumour and normal liver regions was measured by dynamic liver scintigraphy, showing that 60% have a predominantly arterial blood supply.

Colorectal Neoplasms↗