Search PubMed⌕ Search

Biomedical subjects

J Buscombe

Publications and source records attributed to J Buscombe.

15 recordsLinked to original sources
PubMed2006

The cost effectiveness of treatment modalities for thyrotoxicosis in a U.K. center.

OBJECTIVE: This study determined the cost effectiveness of treating thyrotoxicosis using thionamide therapy, radioiodine or surgery in the United Kingdom. DESIGN: One hundred thirty-five patients diagnosed with thyrotoxicosis (62% Graves' disease, 7% nodular disease, 5% thyroiditis, and 27% unknown aetiology) referred in 12 months were offered a fully informed choice of treatment modality. Thirteen patients with transient thyrotoxicosis were subsequently excluded from the analysis. Seventy-four patients (61%) received an 18-month course of thionamide therapy, 43 received radioiodine therapy (35%), and 5 had a thyroidectomy (4%) within the first year of diagnosis as their primary treatment. A successful outcome ("cure") was defined as euthyroidism 12 months after thionamide therapy or euthyroidism or hypothyroidism on thyroxine replacement at 24 months following radioiodine or thyroidectomy. Costs were calculated for outpatient attendances, laboratory tests, and initial and subsequent treatments. MAIN OUTCOME: In the thionamide group 73% were "cured" at 30 months after initiating treatment compared to 95% in the radioiodine group and 100% treated by thyroidectomy at 24 months. Cost per "cure" was calculated to be 3,763 pounds (5,644 dollars) per patient who received thionamides, 1,375 pounds (2,063 dollars) per patient given radioiodine and 6,551 pounds (9,826 dollars) per patient who underwent thyroidectomy. CONCLUSION: The most cost-effective primary treatment modality for thyrotoxicosis is radioiodine.

Antithyroid Agents↗
PubMed2005

Assessment of osteoarthritis after reconstruction of the anterior cruciate ligament: a study using single-photon emission computed tomography at ten years.

We used single-photon emission computed tomography (SPECT) to determine the long-term risk of degenerative change after reconstruction of the anterior cruciate ligament (ACL). Our study population was a prospective series of 31 patients with a mean age at injury of 27.8 years (18 to 47) and a mean follow-up of ten years (9 to 13) after bone-patellar tendon-bone reconstruction of the ACL. The contralateral normal knee was used as a control. All knees were clinically stable with high clinical scores (mean Lysholm score, 93; mean Tegner activity score, 6). Fifteen patients had undergone a partial meniscectomy and ACL reconstruction at or before reconstruction of their ACL. In the group with an intact meniscus, clinical symptoms of osteoarthritis (OA) were found in only one patient (7%), who was also the only patient with marked isotope uptake on the SPECT scan compatible with OA. In the group which underwent a partial meniscectomy, clinical symptoms of OA were found in two patients (13%), who were among five (31%) with isotope uptake compatible with OA. Only one patient (7%) in this group had evidence of advanced OA on plain radiographs. The risk of developing OA after ACL reconstruction in this series is very low and lower than published figures for untreated ACL-deficient knees. There is a significant increase (p < 0.05) in degenerative change in patients who had a reconstruction of their ACL and a partial meniscectomy compared with those who had a reconstruction of their ACL alone.

Adolescent↗
PubMed2001

Radioguided sentinel lymph node biopsy in breast cancer surgery.

The concept of sentinel lymph node biopsy in breast cancer surgery relates to the fact that the tumor drains in a logical way through the lymphatic system, from the first to upper levels. Therefore, the first lymph node met (the sentinel node) will most likely be the first to be affected by metastasis, and a negative sentinel node makes it highly unlikely that other nodes are affected. Because axillary node dissection does not improve prognosis of patients with breast cancer (being important only to stage the axilla), sentinel lymph node biopsy might replace complete axillary dissection to stage the axilla in clinically N0 patients. Sentinel lymph node biopsy would represent a significant advantage as a minimally invasive procedure, considering that, after surgery, about 70% of patients are found to be free from metastatic disease, yet axillary node dissection can lead to significant morbidity. Furthermore, histologic sampling errors can be reduced if a single (sentinel) node is assessed extensively rather than few histologic sections in a high number of lymph nodes per patient. Although the pattern of lymph drainage from breast cancer can be variable, the mammary gland and the overlying skin can be considered as a biologic unit in which lymphatics tend to follow the vasculature. Therefore, considering that tumor lymphatics are disorganized and relatively ineffective, subdermal and peritumoral injection of small aliquots of radiotracer is preferred to intratumoral administration. (99m)Tc-labeled colloids with most of the particles in the 100- to 200-nm size range would be ideal for radioguided sentinel node biopsy in breast cancer. Lymphoscintigraphy is an essential part of radioguided sentinel lymph node biopsy because images are used to direct the surgeon to the site of the node. The sentinel lymph node should have a significantly higher count than that of background (at least 10:1 intraoperatively). After removal of the sentinel node, the axilla must be reexamined to ensure that all radioactive sites are identified and removed for analysis. The sentinel lymph node should be processed for intraoperative frozen section examination in its entirety, based on conventional histopathology and, when needed, immune staining with anticytokeratin antibody. The success rate of radioguidance in localizing the sentinel lymph node in breast cancer surgery is about 94%--97% in institutions where a high number of procedures are performed and approaches 99% when combined with the vital blue dye technique. At present, there is no definite evidence that negative sentinel lymph node biopsy is invariably correlated with negative axillary status, except perhaps for T1a-b breast cancers, with a size of < or =1 cm. Randomized clinical trials should elucidate the impact of avoiding axillary node dissection on patients with a negative sentinel lymph node on the long-term clinical outcome of patients.

Breast Neoplasms↗
PubMed2000

Nuclear medicine in the post-genomic era.

The underlying precepts by which medicine operates will be changed forever by the elucidation of the human genomic sequence. The possibility of using limited forms of genetic engineering are present and beset by ethical considerations. However the use of genetic material in both aiding diagnosing disease and helping our understanding of disease processes is being rapidly diffused into clinical medicine. As the only method available for the study of function in vivo, Nuclear Medicine is ideally suited to act as a bridge between the work in the biotechnology laboratory and the patient. This short review will look at some of the issues raised by the this new horizon in medicine and how it will impact on our practice

Journal Article↗
PubMed1998

Multimodality treatment for gastric carcinoid tumor with liver metastases.

Carcinoid tumors are the most common neuroendocrine tumors in the gastrointestinal tract, and between 10% and 30% of these tumors are gastric in origin. Three types of gastric carcinoid tumors are recognized: type I, associated with chronic atrophic gastritis type A; type II, associated with multiple endocrine neoplasia; and type III, sporadic and the most malignant. We present a patient with an aggressive, sporadic-type gastric carcinoid that metastasized to the liver. Her symptomatic treatment included the somatostatin analog octreotide. Octreotide scintigraphy demonstrated that this tumor avidly bound the peptide. The patient's gastric carcinoid (assessed by endoscopy and endoscopic ultrasound) regressed and she underwent hepatic artery embolization for her liver metastases. After initial partial CT resolution the tumor grew, compressing the inferior vena cava. The patient underwent orthotopic liver transplant with excellent recovery, although she was subsequently found to have two small lung metastases. She has responded well to adjuvant Indium-111 octreotide receptor targeted therapy. This case highlights the therapeutic options for metastatic neuroendocrine tumors, including liver transplantation and adjuvant receptor targeted therapy.

Adult↗
PubMed1996

Inter-observer agreement in the reporting of 99Tcm-DMSA renal studies.

The early identification of renal cortical scarring secondary to urinary reflux and/or renal infection is important in the management of patients with recurrent disease. Scintigraphic imaging of the renal cortex using 99Tcm-dimercaptosuccinic acid (DMSA) is often considered the standard method for the diagnosis of renal scars in both adults and children. Consistent reporting of 99Tcm-DMSA is nevertheless essential in ensuring that the clinician can act on the data reported. In this study, seven experienced observers were asked to report, independently, 99Tcm-DMSA data sets from 32 patients. The observers were asked to note the presence of a space occupying lesion or of a renal cortical scar(s) and to conclude if the kidney was normal or abnormal. There was marked variation in the number of renal cortical scars reported, the total number of scars seen and whether or not the kidney was normal or abnormal. After peer review of all data, consensus and referenced criteria were arrived at for a reanalysis of data. All scans were reread by the observers. There was some improvement in the concordant reporting of kidneys with renal scars (51 vs 61%) and whether or not the kidney was normal or abnormal (53 vs 63%). However, this was not statistically significant (at a level of P < 0.05). This study demonstrated significant inter-observer variation regarding the reporting of 99Tcm-DMSA studies. A consensus with agreed guidelines for data interpretation did not significantly affect this apparent lack of consistency of reporting.

Adolescent↗
PubMed1995

Radiolabelled human immunoglobulins.

Radiolabelled human immunoglobulins have been available for 5 years. Within that time there have been many publications on the use of these agents labelled with both technetium-99m (99Tcm) and indium-111 (111In). The results of these data appear contradictory and only now do we understand both some of the mechanisms of radiolabelled immunoglobulins and some of their limitations. While 111In-polyclonal immunoglobulin seems to have a wide range of clinical applications in infection and inflammation, the more readily available 99Tcm-labelled product is best suited to the localization of peripheral bone and joint disease. The ease of producing these agents from commercially available immunoglobulins will ensure continued interest and research into these new tracers.

Arthritis↗