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Biomedical subjects

J H Winstanley

Publications and source records attributed to J H Winstanley.

13 recordsLinked to original sources

Variant estrogen receptor alpha mRNAs in human breast cancer specimens.

A panel of human breast cancer specimens was examined for single base change mutations by DNA sequencing and for larger deletions using a PCR-based assay. In the cancer specimens examined, no sequencing variants were detected other than a previously characterized polymorphism. Although most of the specimens contained estrogen receptor (ER) variants at a low level, 2 of 118 specimens exhibited variants which, after amplification, constituted most of the amplified ER cDNA. One specimen contained a single variant form, and there was little evidence of the wild-type ER mRNA by PCR, Northern blotting or immunocytochemistry. The second specimen, despite the presence of a normal-sized mRNA by Northern blotting and normal immunocytochemical staining for ER, contained at least 5 different variant forms as well as the wild-type ER. All but 1 of the variant forms were processing variants, and 3 of these processing variants have not been described before. One variant, although lacking exons 2-4, has break points in exons 1 and 5 that do not correspond to intron-exon boundaries. This variant might reflect more widespread damage to the genome in this breast cancer specimen. The low level of occurrence of variants suggests that ER variant forms, at least in the coding region, do not contribute generally to the progression of breast cancer.

Blotting, Northern↗

Comparison of the metastasis-inducing protein S100A4 (p9ka) with other prognostic markers in human breast cancer.

Our aim was to compare the occurrence and prognostic significance over 14-20 years of immunocytochemically detected S100A4 and other tumour variables in primary tumours from 349 patients with operable breast cancer. For a cut-off of 1% staining of the malignant cells, the antibody to S100A4 stains positively 56% of the carcinomas. There was a significant association of staining for S100A4 with tumours fixed to the chest wall, staining for c-erbB-2, c-erbB-3, pS2, cathepsin D and, inversely, at borderline levels with staining for estrogen receptor. Using Wilcoxon statistics in univariate analyses, staining for S100A4, nodal status, tumour class, histological grade and staining for c-erbB-2, p53 were associated negatively and staining for estrogen receptor, progesterone receptor were associated positively with patient survival times. The survival times of patients with S100A4-negative carcinomas with or without one of the other tumour variables showed no significant differences, whilst those of patients with S100A4-positive carcinomas showed significant differences in a negative or a positive way. Multivariate regression analysis for 137 patients showed that staining for S100A4 is most highly correlated with patient deaths, but involved lymph nodes, fixed tumours, high histological grade and staining for progesterone receptor were also significant independent prognostic variables. Our results suggest that in this set of patients, the tumour variable most tightly correlated with patient death is S100A4.

Adult↗

Prognostic significance of the metastasis-inducing protein S100A4 (p9Ka) in human breast cancer.

The calcium-binding protein S100A4 is capable of inducing metastasis in rodent models for breast cancer. We now show that rabbit antibodies to recombinant rat S100A4 recognize specifically human S100A4 using Western blotting techniques and use them to assess the prognostic significance of S100A4 in primary tumors from a group of 349 patients treated between 1976 and 1982 for stage I and stage II breast cancer. The antibody stains normal breast tissue heterogeneously, but stains positively 41% of the carcinomas, leaving the remaining 59% as negatively stained. In addition to the carcinoma cells, some host stromal cells and lymphocytes are also stained, but these have been discounted in subsequent analyses. There is an association of staining of carcinomas for S100A4 with some tumor variables considered to be associated with poor prognosis for patients: tumor present in axillary lymph nodes (borderline P = 0.058), staining for c-erbB-3 (P = 0.002), cathepsin D (P = 0.024), and c-erbB-2 (P = 0.048). The association of staining for S100A4 with patient survival has been evaluated using life tables and analyzed using generalized Wilcoxon statistics. Eighty percent of the S100A4-negative patients but only 11% of the S100A4-positive patients are alive after 19 years of follow-up, and this association is highly significant (P < 0.0001); the former have a median survival of >228 months and the latter 47 months. The other tumor variables that show significant association with survival time are nodal status (P < 0.0001), tumor size (P = 0.0035), histological grade (P = 0.013), staining for c-erbB-2 (P = 0.0015), estrogen receptor (P = 0.028), and p53 (P = 0.032). Analysis of the association of patients with carcinomas staining for S100A4 and their survival in subgroups defined by these other tumor variables shows that in each subgroup, staining for S100A4 is associated with poorer survival. Patients whose tumors stain for S100A4 and possess involved lymph nodes (P < 0.0001), which are fixed to the chest wall (P = 0.015) or which stain for c-erbB-2 (P = 0.050), show a significant reduction in survival times over those with only S100A4-staining tumors. Patients with involved lymph nodes, or staining for c-erbB-2 in the S100A4-negative group fail to show any significant reduction in survival times. Multivariate regression analysis for 137 patients shows that staining for S100A4 is most highly correlated with patient deaths (P < 0.0001), but involved lymph nodes (P = 0.001), fixed tumors (P = 0.0002), and high histological grade (P = 0.022) are also significant independent prognostic variables. These results suggest that in this group of patients, the metastasis-inducing protein S100A4 is most tightly correlated with patient demise.

Adult↗

Anaesthesia for Conn's syndrome.

We describe the peri-operative management of two patients undergoing bilateral adrenalectomy for Conn's syndrome; one using an open surgical approach and the other a laparoscopic technique. The first patient, aged 64 years, died of a myocardial infarction 5 days postoperatively; the second, aged 29 years, had an uneventful recovery. The pre-operative preparation, peroperative management and postoperative care of these patients are detailed, and the pathophysiology and clinical management of Conn's syndrome are reviewed.

Adrenalectomy↗

Cytoplasmic staining of c-erbB-2 is not associated with the presence of detectable c-erbB-2 mRNA in breast cancer specimens.

The cell-surface receptor tyrosine kinase protein c-erbB-2 is immunocytochemically detected as membrane staining on the surface of cancer cells in 20-30% of cases of breast cancer, and its presence has been associated with poor prognosis for the patient. However, there have been numerous reports of immunocytochemical staining for c-erbB-2 solely in the cytoplasm of some normal and tumour specimens with frequently used anti-sera, and the presence of such staining has been difficult to interpret. It is not known for certain that cytoplasmic c-erbB-2 staining is an artefact of the immunocytochemical procedures used. Thus, mRNA for c-erbB-2 has been quantified in tumours exhibiting only cytoplasmic staining or varying levels of membrane staining using a sensitive, competitive PCR method. Whereas abundant levels of c-erbB-2 mRNA are found in tumours exhibiting membrane staining for c-erbB-2 and these levels correlate with the percentage of tumour cells showing membranous staining for c-erbB-2, the level of c-erbB-2 mRNA in tumours displaying only cytoplasmic staining is no higher than in c-erbB-2-negative specimens.

Breast Neoplasms↗

Variation in the staging of colorectal carcinomas: a survey of current practice.

Dukes' staging is the most common means of staging and grouping colorectal carcinomas and is also used to determine which patients will be offered adjuvant therapies or entered into clinical trials. This study was performed to assess the degree of variation in the staging of colorectal carcinomas in normal clinical practice. Seven consultant surgeons and two consultant pathologists returned questionnaires asking them to stage 14 carcinomas on the basis of their pathology reports alone. The results show agreement among all nine in only six out of the 14 cases. In two cases there was a close to 50:50 split in perceived stage. Between them, the nine consultants produced eight different sets of staging results. These results indicate difficulties in the application of Dukes' staging system for several possible reasons. There may be misinterpretation of the written report, misapplication of the staging system because of unfamiliarity or confusion between the various modifications of Dukes' system which have been published. A more precisely defined staging system based on a standard proforma may be more appropriate in modern clinical practice.

Clinical Competence↗

Impact of fine-needle aspiration cytology, ultrasonography and mammography on open biopsy rate in patients with benign breast disease.

The management of breast disease has been influenced by breast imaging and fine-needle aspiration cytology (FNAC) for preoperative diagnosis. To investigate the impact of introducing an in-clinic FNAC service on patient management, the pathology records of patients presenting before and after introduction of the service were studied. Four management changes emerged. The number of patients investigated by histology and/or cytology increased (from 266 to 503), as did specimen numbers (392 to 728). The use of pathological services changed, with more cytology specimens (39 to 554), fewer needle-core biopsies (62 to three) and fewer excision biopsies (245 to 118). The number of patients admitted for surgery fell, especially those with a benign histological diagnosis (174 to 49). These figures demonstrate a change in the management of benign breast disease, from surgery with histopathological diagnosis to cytological diagnosis with surgery only if indicated clinically or from imaging.

Adolescent↗

The value of guidelines in a breast screening service.

The use of agreed guidelines in the management of common surgical and medical conditions has received much attention and enjoys varying degrees of support. In May 1992 the UK Breast Screening Programme produced guidelines with the intention of providing criteria for all units to attempt to achieve. We have investigated these guidelines as a means of comparative audit and stimulus for change. Two units were compared, one in a teaching centre and the other in a district general hospital. Although both units performed for the most part within the guidelines, areas where improvement could be made were identified and measures to correct deficiencies taken. This resulted in improved performance in those areas. The study demonstrates that guidelines can have considerable benefit in helping to identify problems in the provision of care and introducing measures to improve the situation.

Breast Diseases↗

Comparative expression of fibroblast growth factor mRNAs in benign and malignant breast disease.

The messenger RNAs for the angiogenic acidic and basic fibroblast growth factors are expressed at a significantly higher level in samples of human benign neoplastic and hyperplastic tissue than in samples from breast cancers. However, approximately one in four malignant breast cancer samples contain basic fibroblast growth factor mRNA at the same level as in the benign lesions when basic fibroblast growth factor mRNA levels are corrected with respect to levels of expression of glyceraldehyde-3-phosphate dehydrogenase mRNA. A similar proportion of human malignant breast cancer cell lines express a high level of basic fibroblast growth factor mRNA. The results suggest that some malignant breast cancers and their constitutive carcinoma cells express abundant levels of basic fibroblast growth factor mRNA. The resultant production of basic fibroblast growth factor by breast cancer cells within some tumours may contribute to their development.

Adult↗

Prognostic significance of cathepsin-D in patients with breast cancer.

The expression of the protease cathepsin-D has been evaluated using an immunohistochemical technique with a polyclonal antibody in paraffin-embedded tissue from 359 patients treated between the years 1975-1981 for Stage I and II breast cancer. One hundred and twenty seven patients (35%) have strongly positive, granular staining, 138 (38%) are intermediately stained in the cytoplasm, and in 94 (26%) no staining is observed. There is a strong positive association between expression of cathepsin-D and the presence of tumour in axillary lymph nodes (P < 0.006). Expression of the protease is associated with significantly poorer survival of patients in univariate analysis (P = 0.025); however, this is not independent of other tumour variables.

Adult↗

The expression of basic fibroblast growth factor and its receptor in cell lines derived from normal human mammary gland and a benign mammary lesion.

mRNA for basic Fibroblast Growth Factor (bFGF) was expressed in a series of SV40-transformed human mammary cell lines as molecules of 7.1, 3.6, 2.0 and 1.2 kb. This expression was much weaker in those lines of epithelial morphology than in myoepithelial-like cell lines derived from them. It was confirmed, using northern hybridization to single-stranded RNA probes, that the multiple mRNAs were transcribed from the coding strand for bFGF. bFGF activity was detected in extracts of the cells and the relative amounts of activity corresponded in general to the amounts of mRNA found. Similar results were obtained from spontaneously transformed cell lines derived from a human benign breast lesion. The presence of bFGF protein in the extracts was confirmed by western blotting, which showed a band of 18-19 kDa, migrating in the same position as authentic bFGF; in addition, the myoepithelial-like cells showed prominent bands of bFGF at 24 and 26 kDa. No FGF receptor was detectable by the binding of 125I-bFGF to the SV40-transformed cell lines or to the epithelial cell lines from the benign breast lesion, but both high- and low-affinity receptors were found on myoepithelial-like cells derived from the latter. The results indicate that differentiation to the human myoepithelial-like phenotype in culture is associated with the enhanced expression of bFGF, and it is suggested that bFGF, immunocytochemically detected in the basement membrane of the human breast, may arise, at least in part, from the myoepithelial cells of the mammary parenchyma.

Breast↗

Audit--a cause for TMJ dysfunction.

The last few years have seen those of us in hospital practice confronted by clinical audit and unit budgeting. We have recently been advised, by our unit general manager, that in the next financial year we must make a 1% saving, followed by 2% the subsequent year. Of course, clinical budgeting is nothing new for our colleagues in general practice. They have been working within its confines almost since the inception of the Health Service, in the guise of item of service payment. However, for those of us in hospital practice who have hitherto been relatively cushioned from economic realities, this can come as quite a shock.

Costs and Cost Analysis↗