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Biomedical subjects

I Taylor

Publications and source records attributed to I Taylor.

At least 109 records · Page 6Linked to original sources
PubMed1997

Staging of symptomatic primary breast cancer with MR imaging.

OBJECTIVE: This study was designed to investigate the accuracy of contrast-enhanced MR imaging in the locoregional staging of symptomatic primary breast cancer and to determine the impact of contrast-enhanced MR imaging in planning surgical management. MATERIALS AND METHODS: Ninety patients with primary breast cancer (including two bilateral cancers) diagnosed and treated on the basis of conventional triple assessment (clinical, cytologic, and mammographic examination) underwent MR imaging at 1.0 T using a three-dimensional fast low-angle shot T1-weighted pulse sequence before and after contrast enhancement. A short inversion time inversion recovery sequence was also obtained to evaluate the axilla of each patient. After resection, tumors were histopathologically mapped in detail and correlated with the extent of contrast enhancement on MR imaging. RESULTS: On the basis of triple assessment, 53 cancers were treated by wide local excision, of which 17 (32%) had positive margins at excision. Residual disease at reexcision was detected in eight of these 17 patients, a finding that correlated accurately with the extent of contrast enhancement on MR imaging. MR imaging was more accurate than mammography in determining invasive tumor size (r2 = .93 versus r2 = .59), in depicting multifocality and extensive intraductal component (sensitivity, 81% versus 62%), and in assessing nipple-retroareolar complex. MR imaging-histopathologic correlation was possible in 75 axillae. Sensitivity and specificity for axillary node metastases were 90% and 82%, respectively. CONCLUSION: MR imaging of the breast has value in the preoperative locoregional staging of symptomatic primary breast cancer and is useful in planning a single definitive surgical resection in patients with breast cancer.

Adult↗
PubMed1997

Benchmarking in home care.

Recognizing that continuous quality improvement will be imperative for success in the future, six visiting nurse associations of northwestern Pennsylvania used benchmarking as a tool to improve their respective agencies' performance. The agencies benchmarked three areas: continuity of care, patient rehospitalization, and nosocomial infection rate.

Continuity of Patient Care↗
PubMed1997

Comparison of magnetic resonance imaging and conventional triple assessment in locally recurrent breast cancer.

BACKGROUND: Magnetic resonance imaging (MRI) was compared with triple assessment (clinical examination, cytology and mammography) in the differentiation of post-treatment changes from local recurrence of breast carcinoma. METHODS: Thirty patients treated previously by breast conservation surgery and radiotherapy with clinical suspicion of local recurrence were evaluated prospectively by triple assessment and MRI. Breast MRI was performed on a 1-tesla scanner using a T1-weighted three-dimensional fast low angle shot pulse sequence before and after contrast enhancement. RESULTS: Local recurrence was confirmed histologically in 14 patients. Of these, mammography identified seven (sensitivity 50 per cent), cytology 11 (sensitivity 79 per cent) and breast MRI 13 (sensitivity 93 per cent). Compared with histological measurement, breast MRI allowed an accurate estimation of the extent of local recurrence (r2 = 0.98). Morphologically abnormal areas without contrast enhancement correlated with postradiation changes. False-positive contrast enhancement was seen in two patients (specificity 88 per cent) in whom histology confirmed inflammatory changes only. CONCLUSION: Breast MRI is useful in the evaluation of patients with a high clinical suspicion of local recurrence within the irradiated conserved breast.

Adult↗
PubMed1996

Growth enhancement of implanted human colorectal cancer cells by the addition of fibroblasts in vivo.

The effect of fibroblasts on the growth of HT29 human colorectal cancer cells was used to study stromal modulation of tumour growth dynamics. Fibroblasts were isolated from rat livers, 1, 2.5 and 4 days after two-thirds partial hepatectomy and from normal livers. Cells harvested 2.5 and 4 days after hepatectomy ('fast' fibroblasts) had a significantly faster growth rate in vitro than those harvested on day 1 or those from normal livers (P < 0.02). The fibroblasts were inoculated with HT29 colorectal cancer cells into nude mice. Controls received cancer cells with or without a fibroblast cell line (C3H10T 1/2). At 3 weeks both tumour take and growth (size) were significantly greater in the group inoculated with cancer cells and 'fast' fibroblasts than in the other groups (tumour take 100 versus 42-75 per cent, P < 0.03; median tumour size 3.5 versus 0.3-0.4 g, P < 0.02). In conclusion, tumour growth is enhanced by fibroblasts, especially by those derived from actively regenerating liver. It is suggested that the stimulation is not only mechanical but may also involve a humoral mechanism.

Animals↗
PubMed1996

Liver metastases from colorectal cancer: lessons from past and present clinical studies.

In patients with primary colorectal cancer the development of liver metastases has traditionally been equated with imminent demise. This metastatic event is remarkably common; indeed, liver metastases are present in some 25 per cent of patients at the time of initial colorectal resection and over 50 per cent of patients will eventually develop them. Some 90 per cent of patients who die from colorectal cancer have liver metastases. There are few cancers in which the metastatic pattern has such a high degree of predictability. Information from past and present clinical studies should, therefore, provide a basis for logical approaches to prevention and treatment.

Clinical Trials as Topic↗
PubMed1996

Breast surgery after neoadjuvant treatment. Is it necessary?

The optimum management of women with advanced loco-regional breast cancer (T3-4, N1-2) is controversial. Neoadjuvant therapy in the form of chemotherapy and or radiotherapy is popular and results in an encouraging local response in over 70% of patients. However, should subsequent surgery (either mastectomy or breast conservation treatment) be undertaken in women who respond? We present a prospective evaluation of 15 patients with T3-4, N1-2 tumours (including 1 bilateral cancer) who underwent mastectomy after achieving a complete clinical response to neoadjuvant treatment. All patients had 6 cycles of chemotherapy and 10 also received 50 Gy radiotherapy. In addition to clinical examination, the response to neoadjuvant treatment was assessed by mammography (in all cases) and by magnetic resonance imaging (MR) (in eight patients). Careful histopathological assessment of the breast was undertaken to determine the extent of residual disease. In all patients histological malignancy was recognized within the breast. The size varied from 0.6 to 6.5 cm in maximum diameter with three grade I, eight grade II and five grade III tumours. Axillary lymph nodes were positive in seven patients. In conclusion, surgery is indicated for control of residual disease in locally advanced breast cancer regardless of the response to neoadjuvant treatment. Our preliminary observations suggest a potential role for breast MR in defining the extent of residual disease which may aid in the planning of surgery.

Adult↗
PubMed1996

The absence of autonomic perivascular nerves in human colorectal liver metastases.

The peptidergic/aminergic innervation of normal liver and tumour blood vessels was investigated in order to determine vascular control with a view to improving the efficacy of hepatic arterial cytotoxic infusion in the treatment of colorectal liver metastases. Selected areas of liver metastases and macroscopically normal liver from resection specimens (n = 13) were studied using light microscope immunohistochemistry for the presence of protein gene product 9.5 (PGP), vasoactive intestinal polypeptide (VIP), neuropeptide Y (NPY), calcitonin gene-related peptide (CGRP), substance P (SP) and tyrosine hydroxylase (TH). The ultrastructure of blood vessels supplying liver metastases and their perivascular innervation were also examined by transmission electron microscopy. In the normal liver, perivascular immunoreactive nerve fibres containing PGP, NPY and TH were observed around the interlobular blood vessels and along the sinusoids and the central vein of the hepatic lobule. The greatest density of immunoreactive nerve fibres was seen for PGP, followed (in decreasing order) by NPY and TH. VIP, SP and CGRP immunoreactivity was observed only in nerve bundles associated with the large interlobular blood vessels. In contrast, no perivascular immunoreactive nerves were observed in colorectal liver metastases. Electron microscopy confirmed the absence of perivascular nerves in liver metastases. In addition, it showed that the walls of these blood vessels were composed of a layer of endothelial cells surrounded by an incomplete or, very rarely in the periphery of the tumour, a complete, layer of synthetic phenotype of smooth muscle-like cells. These results imply that the blood vessels supplying liver metastases are bereft of normal neuronal regulation; whether there is a role for endothelial cell control of blood flow in these vessels is not yet known.

Adenocarcinoma↗
PubMed1996

Fine needle aspiration (FNA) cytology of the breast: the influence of unsatisfactory samples on patient management.

FNA continues to play an important role in the management of patients with breast lesions. However, the reliability and efficiency of the FNA service depends heavily on the quality of the specimens. We have audited the rate of "inadequate FNAs' at intervals over the last 5 years and related our findings to the clinical expertise of the aspirator. We have also correlated the rate of inadequate FNAs with the percentage of patients who had an FNA preceding a definitive diagnosis of cancer. We report trends in the rate of inadequate samples, and subsequent diagnosis of cancer, over a 5-year period. The percentage of breast FNA samples reported as inadequate was 46.8% in 1988-89, falling to 20% in 1991-92 with the introduction of an FNA clinic, and rising to 30.6% in 1993. The rates of cancer following inadequate FNA were 15.7%, 16.1% and 4.2%, respectively, and the percentage of patients with cancer having a preceding inadequate FNA were 37.5%, 13.2% and 7.1%. Possible explanations for the apparent paradox between increasing numbers of inadequate FNA specimens and a falling breast cancer rate are discussed.

Biopsy, Needle↗
PubMed1996

Laser therapy for breast cancer: MR imaging and histopathologic correlation.

PURPOSE: To investigate magnetic resonance (MR) imaging guidance of interstitial laser photocoagulation to treat primary breast cancer. MATERIALS AND METHODS: Twenty female patients with symptomatic breast cancers diagnosed at cytologic examination underwent interstitial laser photocoagulation by means of a single fiber prior to surgical excision. Gadolinium-enhanced T1-weighted three-dimensional fast low-angle shot (FLASH) MR imaging was performed before and after laser therapy (median, 48 hours; range, 24-96 hours). Following resection, tumors were mapped in detail histopathologically. The extent of disease, size of laser burn, and extent of residual tumor were correlated with MR findings. RESULTS: Twenty-seven tumors were detected at histopathologic examination in the 20 patients. Five patients had more than one invasive mass. Twenty-five of the 27 tumors were identified as discrete enhancing masses at MR. The two missed invasive foci were obscured on MR images by diffuse patchy enhancement that correlated with the presence of an associated extensive intraductal component. Early (4-hour) follow-up images failed to depict the laser effect. Later (24-96 hours) follow-up images depicted the laser-induced necrosis as a zone of nonenhancement within the residual enhancing tumor. The correlation coefficients (MR vs histopathologic analysis) for the laser-burn diameter and residual tumor were 0.80 and 0.86, respectively. CONCLUSION: Delayed gadolinium-enhanced MR images can help define the extent of laser-induced necrosis and residual tumor after interstitial laser photocoagulation therapy in breast cancer.

Adult↗
PubMed1996

Randomized trial assessing the addition of interferon alpha-2a to fluorouracil and leucovorin in advanced colorectal cancer. Colorectal Cancer Working Party of the United Kingdom Medical Research Council.

PURPOSE: To determine the effects of interferon alpha-2a (IFN alpha) on the efficacy and toxicity of fluorouracil (FUra) and leucovorin (LV) in patients with advanced colorectal cancer. PATIENTS AND METHODS: Two hundred sixty chemotherapy-naive patients were randomized to FUra/LV alone or FUra/LV plus IFN alpha. All patients received: LV 200 mg/m2 intravenous (IV) infusion over 2 hours, then FUra 400 mg/m2 i.v. bolus plus 400 mg/m2 i.v. infusion over 22 hours, all repeated on day 2. Treatment was every 2 weeks for up to 12 cycles. Patients randomized to IFN alpha received 6 x 10(6) IU subcutaneously every 48 hours throughout. Objective response (OR) and toxicity were assessed conventionally; in addition, palliative benefit and adverse effects were assessed using quality-of-life (QoL) questionnaires. RESULTS: There were no differences in OR rate, progression-free survival, or overall survival. OR rates in assessable patients were as follows: FUra/LV alone (n = 104), complete or partial response (OR) = 27%, no change (NC) = 34%; FUra/LV/IFN alpha (n = 101), OR = 28%, NC = 30%. Median survival was 10 months in both arms. Dose-limiting FUra toxicities were not significantly increased by co-administration of IFN alpha, and the delivered FUra dose-intensity was not significantly reduced. However, QoL was adversely affected: patients on IFN alpha were less likely to report improvement in pretreatment physical and psychologic symptoms, and more likely to report new or worsening symptoms. CONCLUSION: IFN alpha, at a dose that impaired QoL, did not improve the efficacy of FUra/LV. The power of this trial is sufficient to exclude with 95% confidence a benefit of 15% in OR or 10 weeks in median survival. Accordingly, we cannot recommend the use of IFN alpha as a clinical modulator of FUra/LV in the treatment of advanced colorectal cancer.

Adult↗
PubMed1996

Research in the training of general surgeons: results of a survey.

By means of a postal questionnaire to all members of the Association of Surgeons of Great Britain and Ireland, attitudes to the importance, timing, and assessment of research activity in surgical training were obtained. There was a 71% response rate. Most believe that a period of research is desirable, highly desirable or essential, irrespective of whether a University/Teaching or DGH consultant. The implications of incorporation of research into training programmes are discussed.

Attitude of Health Personnel↗
PubMed1996

Myocardial perfusion scintigraphy in patients undergoing major non-vascular abdominal surgery.

The prognostic value of myocardial perfusion scintigraphy is beginning to be recognised in patients undergoing cardiovascular surgery. The aim of this prospective study was to assess the predictive value of scintigraphy in elderly patients undergoing major non-vascular abdominal surgery. Adenosine stress thallium-201 (201Tl) single-photon emission tomography (SPET) was employed for imaging using a standard protocol. Patients over the age of 60 years (n = 55) with an intermediate to high likelihood of coronary artery disease were evaluated prospectively. The clinical outcome variables analysed were cardiac mortality and major cardiac morbidity occurring within 30 days of surgery. Cardiac events were cardiac death (n = 5), angina pectoris (n = 5), nonfatal mycardial infarction (n = 1), acute left ventricular failure (n = 2) and arrhythmias requiring treatment (n = 4). All cardiac events occurred in the first 10 postoperative days except one cardiac death which happened on the 29th postoperative day. Patients with an abnormal 201Tl SPET scan had a higher risk of postoperative death (4 vs 1) or any postoperative cardiac event (13 patients vs 4 patients; P < 0.0001) when compared with those with a normal scan. The sensitivity, specificity and positive predictive value of 201Tl imaging for perioperative ischaemia and adverse outcomes were 76%, 82% and 65%, respectively. The occurrence of an intraoperative event (P < 0.02) and the length of surgery (P < 0.01) were also predictors of a postoperative cardiac event. Clinical risk variables and an abnormal electrocardiogram in isolation were poor predictors. In conclusion, preoperative myocardial perfusion scintigraphy is a valuable technique for identifying elderly patients with a high risk for cardiac events when undergoing major non-vascular abdominal surgery.

Abdomen↗
PubMed1996

Localization of anthracycline accumulation in sensitive and resistant urothelial tumor cell lines.

Emergence of resistance to chemotherapy is a serious clinical problem. Our aim was to investigate anthracycline uptake in sensitive and resistant urothelial cancer cell lines and to manipulate uptake by resistant cells. Anthracyclines exhibit natural fluorescence; therefore, the techniques used for detection were high-resolution fluorescence image analysis and confocal microscopy. Different patterns of intracellular drug distribution were observed in the two cell lines. Sensitive cells showed predominantly nuclear drug localization, while in resistant cells there was nuclear and cytoplasmic fluorescence. Manipulation of drug uptake by resistant cells was achieved using an essential fatty acid, gammalinolenic acid, and the calcium channel blocker, verapamil. Both substances increased drug uptake in resistant cells, with verapamil producing patterns of intracellular drug distribution in resistant cells similar to those of sensitive cells.

Antibiotics, Antineoplastic↗
PubMed1995

Liver resection for colorectal liver metastases.

The management of patients with colorectal liver metastases is still controversial. Recent evidence suggests benefit for resection of localized metastases within a single lobe of the liver. A series of 49 patients undergoing liver resection for localized liver metastases is presented. Resection involved right hepatectomy (23), left hepatectomy (8) and segmental excision (18). The median age was 62 (range 40-77). Patients have been followed for a period of up to seven years. The overall median survival was 24 months. The actuarial 3-year survival was 57.9%. There was no significant correlation of survival with the degree of differentiation or Dukes staging of the primary tumour. This series adds further weight to the evidence supporting resection in selected patients with colorectal liver metastases.

Adult↗