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Biomedical subjects

I Taylor

Publications and source records attributed to I Taylor.

At least 127 records · Page 7Linked to original sources
PubMed1995

Patterns of clinical metastasis in breast cancer: an analysis of 100 patients.

Many patients diagnosed with breast cancer will develop metastases and these have diverse presentations. We have reviewed 100 consecutive patients who have died with metastatic breast cancer, to determine the frequency, sites and mode of presentation of recurrent disease. The commonest site of failure was loco-regional (n = 61), this usually presented with a mass, but a minority of patients also complained of pain. Bone metastases developed in 60 patients and produced bone pain, pathological fracture (n = 6) or cord compression (n = 5). Pulmonary metastases producing shortness of breath were diagnosed in 34 patients and were asymptomatic in a further 10. Intra-abdominal metastases were found at some time in 23 patients, most commonly in the liver (n = 20) and the majority complained of epigastric pain (n = 17). Brain metastases occurred in 23 patients and produced a wide range of symptoms including those of a space-occupying lesion (n = 10), cranial nerve palsy (n = 7), diabetes insipidus (n = 3), focal limb weakness (n = 2) and meningitis (n = 1). Three patients had choroid metastases producing reduced visual acuity. Recurrent breast carcinoma can present in a variety of ways, therefore any new symptom or sign should be considered to represent recurrence until proved otherwise.

Adult↗
PubMed1995

Phase I clinical and pharmacokinetic study of leucovorin and infusional hepatic arterial fluorouracil.

PURPOSE: A phase I and pharmacokinetic trial was performed between October 1993 and June 1994 to determine the maximum-tolerated dose of hepatic arterial infusion (HAI) of fluorouracil (5-FU) and intravenous (IV) leucovorin (folinic acid; FA) in patients with hepatic metastases from colorectal cancer. PATIENTS AND METHODS: Forty-three patients received 310 courses of HAI chemotherapy administered over 48 hours every 2 weeks. The regimen consisted of FA 200 mg/m2 by IV infusion over 2 hours, followed by a loading dose of 5-FU 400 mg/m2 by HAI over 15 minutes, followed by a 22-hour infusion of 5-FU at doses ranging from 0.8 to 1.84 g/m2, with identical chemotherapy on day 2. Pharmacokinetic studies were performed to determine peak and steady-state plasma concentrations (Css) of 5-FU. RESULTS: Severe diarrhea and cardiac and neurologic toxicity were dose-limiting at 1.84 g/m2. The recommended dose for the 22-hour component of the schedule was 1.6 g/m2 and was associated with tolerable toxicity. A Css of 2.2 +/- 0.8 mumol/L for 5-FU was achieved on the recommended schedule, which compares favorably with conventional IV 5-FU regimens. Among 30 patients assessable for response, there were four complete responses and seven partial responses, and 12 patients with stable disease and seven with progressive disease, reported after 3 months (ie, six cycles) of therapy. CONCLUSION: A regimen that combines 5-FU and FA has been identified for regional chemotherapy in patients with hepatic metastases from colorectal cancer. The systemic levels of 5-FU achieved are similar to the conventional IV de Gramont regimen using an identical schedule of 5-FU and FA, which implies that this chemotherapy has the best of both worlds, ie, a regional advantage in delivering high drug concentrations to the target organ with adequate systemic cover for extrahepatic micrometastases.

Adult↗
PubMed1995

Cystic carcinoma of the breast: a trap for the unwary.

Cystic breast masses are a common presentation to breast clinics. While the majority of cysts can be managed by simple aspiration, a small proportion are malignant. Histology records for a 10-year period have been examined to identify patients with cystic breast carcinomas. In all, 31 patients were identified. Of these, 18 had cystic degeneration of high-grade tumours, while 13 had intracystic papillary carcinoma. Both of these tumour types were diagnosed by a combination of cyst fluid cytology and breast imaging. The prognosis of high-grade tumours was poor, while that of intracystic papillary carcinomas was excellent. After cyst aspiration, bloodstained fluid should be sent for cytology and breast imaging arranged in all patients. Patients in whom a cyst refills within 2 week of aspiration require a careful re-evaluation. Cysts in postmenopausal women should be viewed with suspicion. Excision should be performed in patients with positive cytology or imaging.

Adult↗
PubMed1995

Management of fibroadenoma of the breast.

Fibroadenoma is a common cause of discrete breast lumps in young women. There is agreement that fibroadenomas can be diagnosed preoperatively with a high degree of confidence and that some of the lesions thus diagnosed will resolve, possibly obviating the need for excision. There is, however, wide disagreement over the proportion of fibroadenomas that resolve spontaneously and therefore the benefit that accrues from an expectant policy. The aim of this study was to audit the management of fibroadenomas on one unit and clarify their natural history over a 5-year period. A cohort of 70 women with 87 fibroadenomas diagnosed using a triple assessment of clinical examination, cytology and imaging (sonomammography) have been followed for a minimum of 5 years. In all, 53 of the 'fibroadenomas' have been excised. In four cases the histology revealed benign disease other than fibroadenoma; there were no neoplasms. The sensitivity of cytology and sonomammography for the diagnosis of fibroadenoma were 84% and 98% respectively. Thirty-four fibroadenomas have not been excised. Of 25 fibroadenomas that have been reassessed after at least 5 years of follow-up, 13 (52%) have reduced in size, 4 (16%) are unchanged in size and 8 (32%) have grown. No patient has developed a carcinoma at the site of the presumed fibroadenoma. This study confirms that an expectant management policy of fibroadenomas has not resulted in misdiagnosis of carcinomas. Further, since a significant proportion of fibroadenomas remain static or reduce in size over a 5-year period many women can avoid excision.

Adolescent↗
PubMed1994

Helix pomatia agglutinin binding is a useful prognostic indicator in colorectal carcinoma.

BACKGROUND: Most deaths from colorectal carcinoma are due to metastases. A relatively reliable prognostic indicator at surgery to date is the Dukes' stage, but this is a morphologic approach that does not elucidate biochemical changes to explain why cells became metastatic. The binding sites for the lectin from the Roman snail Helix pomatia (HPA) were shown to be good prognostic indicators in breast and gastric cancer, and accordingly, this study was performed to evaluate the use of HPA binding sites as prognostic markers in colorectal carcinoma. METHODS: The histochemically detected expression of HPA binding sites in colorectal carcinomas (n = 130) was increased. The results of the histochemical findings were correlated with patient survival and tumor recurrence. RESULTS: The results indicated that the prognosis for the groups of patients whose colorectal cancer cells binded to HPA in tissue sections was almost as bad as those with Dukes' Stage C disease. CONCLUSION: Because HPA binds to N-acetylgalactosamine, the authors' results indicate that this sugar residue is at least partly involved in the process of human colorectal carcinoma cells metastasizing to regional lymph nodes and possibly also to distant sites.

Acetylgalactosamine↗
PubMed1994

Randomized comparison of fine-needle aspiration cytology and Biopty-Cut needle biopsy after unsatisfactory initial cytology of discrete breast lesions.

In a minority of patients with a discrete breast lump the initial cytological assessment is either unsatisfactory or at variance with the results of other methods of diagnosis. A randomized comparison of repeat cytology and needle-core biopsy provided clinically useful information in 14 of 31 patients receiving repeat cytology and in 26 of 29 randomized to core biopsy. Nineteen patients had carcinoma: ten who received repeat cytology, which indicated malignancy in only three (diagnostic of malignancy in one, suspicious in two), while all nine patients who underwent core biopsy had a correct diagnosis (only suspicious of malignancy in one). The sensitivity for the definitive diagnosis of carcinoma on repeat cytology and core biopsy was 10 and 89 per cent respectively. Patients with a discrete breast lump and unclear cytology results require needle-core biopsy. This has more diagnostic value than repeat cytology.

Adult↗
PubMed1994

Dosimetric assessment of radiolabelled lipiodol as a potential therapeutic agent in colorectal liver metastases using combined CT and SPECT.

Lipiodol has previously been used as an agent for targeted radiotherapy by selective retention in primary hepatic tumours following direct hepatic arterial infusion. We have considered the potential dosimetry of 131I-labelled lipiodol in treating colorectal liver metastases. Fifteen patients with multiple colorectal liver metastases underwent selective hepatic angiography when 5 ml lipiodol labelled with 40 MBq 131I were infused. All patients underwent planar scintigraphy of the abdomen and thorax, single photon emission computed tomography (SPECT) of the liver and whole body counting on at least two occasions following lipiodol injection. Computed tomographic (CT) images of the liver were also taken typically 7 days postinjection. The lipiodol was found to deposit on the periphery of metastases of less than 10 cm diameter. In one patient a metastasis of diameter greater than 15 cm failed to infuse. In two patients the lobe of the liver containing metastases was not successfully infused. Overlay of CT and SPECT images confirmed concentration in metastases. Quantification of SPECT images indicated that between 55 and 100% (median 86%) of the injected activity was retained in the liver following injection, and tumour to liver ratios of dose delivered ranged from 1.21:1 to 4.7:1 (median 3.1:1). Tumour does ranged from 11.8 to 43.3 mGy MBq-1 injected. Dose to the lungs ranged from 0 to 46% of the liver dose (median 16%). Lipiodol has potential for treatment of colorectal liver metastases in targeted radiotherapy.

Colonic Neoplasms↗
PubMed1994

The health needs of gay men: a discussion of the literature and implications for nursing.

Although there is a general dearth of nursing literature on health issues specific to gay (homosexual) men, the literature reviewed shows that gay men have particular concerns related to anti-homosexual feelings anticipated and experienced from health professionals. The effects of homophobia in wider society may cause high levels of emotional distress in some gay men, which is associated with a higher incidence of substance misuse, parasuicide, bipolar psychiatric disorders and depression. Gay men also have specific needs with regard to general medical problems, including hepatitis, HIV infection and some other sexually transmitted diseases. Gay men may also present to health services for a wide range of general medical, surgical and mental health problems. Some specific health needs are discussed: general health, sexual health and bereavement counselling. These issues may affect individuals differently through various stages in the lifespan, and nurses should be cognizant of them during their assessment of client needs. Minimum counselling skills, together with appropriate training about gay issues, are required if nurses are to deal effectively with clients' needs.

Adolescent↗
PubMed1994

The timing of breast cancer surgery within the menstrual cycle.

The effects of the timing of surgery, fine needle aspiration cytology (FNAC) and mammography within the menstrual cycle were investigated retrospectively in 211 premenopausal breast cancer patients. The day of surgery within the menstrual cycle was known for 157 women whose menstrual cycles were regular. Recurrence and survival were closely similar whether surgery was performed during days 3-12 or at other times (days 0-2 or 13-32) in the cycle. Outcome was also unrelated to the timing of mammography which was known in 101 cases. There were no significant differences in recurrence or survival associated with the timing of FNAC when all patients were considered. In the subset of lymph node negative patients (n = 32), however, FNAC outside days 3-12 was associated with a significantly decreased rate of relapse (RR = 0.25, 95% CI = 0.07-0.9) and death (RR = 0.10, 95% CI = 0.02-0.9). These patients, however, also had significantly smaller tumours (median = 2 cm, interquartile range = 2-3 cm) than patients having FNAC on days 3-12 of the cycle (median = 3, interquartile range = 2-4) (Mann-Whitney: z = 2.11, P = 0.04). We have not confirmed that surgery or FNAC during days 3-12 of the cycle is associated with a poorer outcome than interventions during other parts of the cycle.

Adult↗
PubMed1994

The impact of the first 3 years of breast cancer screening on the overall presentation of breast cancer.

We have assessed the effect of the first round of the Breast Cancer Screening Programme on the presentation of breast cancer in the Southampton Health District with respect to number of cases and pathological characteristics. A retrospective comparative survey of the presentation of breast cancer in the 3 years prior to breast cancer screening (1985-1988) with the presentation of breast cancer during the prevalent round of breast cancer screening (1988-1991) was performed. During the period of study 1536 cases of breast cancer presented. Six hundred and sixty presented in the years prior to screening and 864 during the first round of screening. All patients lived within the Southampton Health District. The study was designed to assess the changes in breast cancer presentation with regard to age, pathological characteristics, and treatment. Even allowing for the increases in the local population there was a significant increase in the number of cases of breast cancer diagnosed (chi 2 = 23.7, df = 1, P < 0.001). The majority of this increase was in the 50-64 age group. There was also a significant shift towards an earlier stage at diagnosis and a significant reduction in tumour size when all cases were included (mean 26 mm versus 34 mm P < 0.001). Screening also created the opportunity for less invasive treatment. Consequently there was a rise in the number of excisions by localization biopsy from 1% to 13% during the screening period. In conclusion, the National Breast Cancer Screening Programme (NBCSP) has had a significant impact on the presentation of breast cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Prospective study of outcome in women presenting with nipple discharge.

In this study, 56 women who presented to the breast clinic with nipple discharge have been reviewed. Patients were selected for surgery by a triple assessment of clinical examination, discharge cytology and breast imaging. Surgical intervention was required in 17 women. Significant pathology was found in 11 cases including five with carcinoma (in situ or invasive). Those women who did not have carcinoma detected at their initial presentation have been reviewed after a minimum of 5 years. None has gone on to develop breast cancer. We conclude that women with nipple discharge, but no positive findings on triple assessment, are not at an increased risk of the development of carcinoma. In addition, nipple discharge spontaneously resolves in 73% of women over a 5 year period.

Adolescent↗
PubMed1994

Is the binding of mistletoe lectins I and III a useful prognostic indicator in colorectal carcinoma?

A retrospective study on 127 patients with colorectal carcinoma was performed to evaluate the use of mistletoe lectins I and III as possible prognostic indicators. Tissue sections were stained by a histochemical technique using these lectins and the staining results correlated with survival. No correlation between survival and the presence of lectin binding or non-binding was found. A lectin with the same monosaccharide specificity as ML-III, Helix pomatia agglutinin, which was of prognostic significance in the same patient cohort in another study showed on Western blot analysis a slightly different lectin binding pattern towards glycoproteins than the MLs. The results of this study indicate that even subtle differences in the carbohydrate composition of glycoconjugates which can be differentiated by lectins are of biological significance in terms of the metastatic spread of tumours.

Blotting, Western↗
PubMed1993

Peripheral peptide YY induces c-fos-like immunoreactivity in the rat brain.

The influence of peripheral injection of peptide YY (PYY) on neuronal activity in the rat brain was examined by immunohistochemical detection of c-fos protein. Numerous c-fos-immunoreactive nuclei were found in the area postrema, nucleus tractus solitarius (commissural and medial subnuclei), central amygdala and thalamus (periventricular and medial) of rats injected i.p. with PYY at a dose of 300 micrograms/kg. c-fos-like immunoreactivity was found to be less when lower doses of PYY (50-200 micrograms/kg, i.p.) were injected. Either no or few cells were detected after i.p. injection of the vehicle alone. These data provide anatomical support for the centrally mediated actions of peripheral PYY on gut function.

Amygdala↗
PubMed1993

Substrate recognition and selectivity in the type IC DNA modification methylase M.EcoR124I.

The type I DNA modification methylase M.EcoR124I binds sequence specifically to DNA and protects a 25bp fragment containing its cognate recognition sequence from digestion by exonuclease III. Using modified synthetic oligonucleotide duplexes we have investigated the catalytic properties of the methylase, and have established that a specific adenine on each strand of DNA is the site of methylation. We show that the rate of methylation of each adenine is increased at least 100 fold by prior methylation at the other site. However, this is accompanied by a significant decrease in the affinity of the methylase for these substrates according to competitive gel retardation assays. In contrast, methylation of an adenine in the recognition site which is not a target for the enzyme results in only a small decrease in both DNA binding affinity and rate of methylation by the enzyme.

Base Sequence↗