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Biomedical subjects

J W Denham

Publications and source records attributed to J W Denham.

At least 91 records · Page 5Linked to original sources
PubMed1987

Radiation therapy in hyperbaric oxygen for head and neck cancer at Royal Adelaide Hospital--1964 to 1980.

This report describes experience with radiation therapy in hyperbaric oxygen in 201 patients with squamous carcinoma arising in the mobile portion of tongue (anterior 2/3), oropharynx, hypopharynx, and supraglottic larynx, treated between the years 1964 and 1980. Although not statistically different, the overall 5-year determinate survival figures of 35% for all patients with tumors arising in the hypopharynx, 87.5% for Stage I and II, 55% for Stage III, and 27.1% for Stage IV supraglottic carcinoma were perceptibly better than those obtained in a contemporary but not randomly controlled series of patients treated in air at Royal Adelaide Hospital from 1970 to 1980. The results obtained for tumors arising in the oropharynx and mobile portion of tongue however were found to be very similar to those achieved in air. The results achieved in this series are discussed in the context of experience at other centers and the role of randomly controlled clinical studies in evaluating new treatment modalities is emphasized.

Carcinoma, Squamous Cell↗
PubMed1987

Merkel cell carcinoma: a review of behaviour patterns and management strategies.

Eleven patients with Merkel cell carcinoma of the skin were reviewed retrospectively. The aggressive nature of this tumour is reflected by the incidence of local recurrence, regional nodal metastases and systemic dissemination, which is 36%, 55%, and 18% respectively. This high frequency of local recurrence and metastases is confirmed in the literature. Management strategies should be planned accordingly, following accurate assessment of the extent of disease. Wide excision, with or without nodal dissection, together with adjuvant wide field irradiation is necessary for loco-regional control of this radiosensitive tumour. Radiotherapy alone may be appropriate treatment for extensive loco-regional tumours or in those that have already metastasized. Although the role of chemotherapy is unclear, there are an increasing number of reports of chemosensitivity and further investigation in this area is required.

Aged↗
PubMed1985

The computer analysis of interstitial implants in radiotherapy.

The use of computer techniques in the analysis of needle implants in Radiotherapy treatment is assessed from the point of view of the end user. The specification of a routine approach to the analysis is developed so that consistent assessments of implants will be possible to permit the accumulation of dosimetry data for correlation with clinical outcome. The protocol, in summary, consists of the identification of the plane in which the implant lies and of the presentation of dose rate information in the form of standardised isodose contours through three transverse slices at right angles to the "plane of lie". These transverse slices have been selected at the averaged centre of the sources (the "central plane" of Pierquin et al. [14] and at 5 mm distance from the averaged proximal and distal active ends of the sources. The isodose contours chosen for presentation include two "reference dose" contours representing 85 and 127% of the minimum dose rate found in the central plane for prescription calculation purposes and a limited set of standard contours for assessment of homogeneity of dose rate and for comparative purposes. A minimum number of subsidiary display planes may be used to characterise the implant when necessary, a lateral plane commonly proving useful. The position of the chosen sections may with value be shown on the X-ray films. A method of orientating the display with respect to anatomical structures by super-imposing on the isodose display a frame-like projection whose sides relate to anatomical landmarks is demonstrated. The future extension of the analysis to a fully automated approach is discussed.

Brachytherapy↗
PubMed1984

The management of primary carcinoma of the fallopian tube. Experience of 40 cases.

Forty patients with primary tubal cancer were treated at the Middlesex and Mount Vernon Hospitals between 1951 and 1981. Actuarial 5-year survival was seen in 68% of 10 Stage I cases, 39% of 17 Stage II cases, and 21% of 11 Stage III cases, and this experience is consistent with other reported postwar series. The disease was found to exhibit some similarity to ovarian cancer in terms of its mode of spread and response to radiation and cytotoxic agents. Transcoelomic spread was identified as the major cause of treatment failure, and management proposals have been structured around its detection and treatment.

Adult↗
PubMed1984

Recent experience in the radical irradiation of primary breast cancer at Mount Vernon Hospital.

In order to improve the long-term cosmetic results following the radical irradiation of primary breast cancer at Mount Vernon Hospital, dosage was reduced in the early 1970s. The clinical impression that local recurrence had become more frequent at the reduced dose level led to an early review of the results. This report details the results in 159 patients who formed the two largest groups of patients treated between 1968 and 1980. Sixty-five patients were treated between 1968 and 1973, using 6500 cGy to the whole breast in 25 daily fractions over 5 weeks, with alternate breast fields treated each day. Forty-two of these patients were with TNM stage I and II disease [TNM Classification of Malignant Tumours, Geneva, UICC, 1978] and had 5-yr actuarial survival and local recurrence figures of 59 and 10% respectively. The corresponding figures in 52 patients with stage I and II disease treated between 1974 and 1980 with 5500 cGy to the whole breast in 25 daily fractions over 5 weeks with both breast fields treated each day were 79 and 26.6%. In spite of the small numbers involved and the bias in favour of the latter group of patients, who had a greater proportion of T1,N0 lesions, the difference in local recurrence rate in favour of the former group (who received 6500 cGy) almost reached statistical significance at the 0.05 level. A difference was also observed when the two subgroups of stage I and II patients who had had their primaries excised prior to irradiation were compared. The 23 patients with TNM stage IIIa and b disease treated with 6500 cGy between 1968 and 1973 had similar local recurrence (49.7% at 18 months) and survival experience (32.5% at 5 yr) to the 42 similarly staged patients treated with 5500 cGy between 1974 and 1980 (48 and 36.4% respectively). It is possible that the addition of combination cytotoxic therapy to the primary management in 12 patients with stage IIIb disease in the latter group favourably influenced the local control data obtained. Cosmetic results were substantially better in the groups receiving 5500 cGy, with approximately 20% developing disfiguring retraction and skin changes. In contrast, these sequelae were almost inevitable in the patients who received 6500 cGy.

Breast Neoplasms↗
PubMed1984

Hyponatremia induced by thiazide-like diuretics in the elderly.

We have presented five episodes of hydrochlorothiazide-induced hyponatremia in three elderly nursing home patients. Fortunately all our patients survived. The common use of thiazide diuretics in this population and the nonspecific symptoms that follow toxicity make it imperative to monitor closely elderly patients who are taking thiazide diuretics.

Aged↗
PubMed1982

Interstitial radiation therapeutic techniques at Mount Vernon Hospital.

Retrospective analysis of 56 cases of carcinoma on the lateral border of the anterior two thirds of the tongue treated at Mount Vernon Hospital using radium needle implant alone yielded 5-year actuarial survivals of 75.3 per cent in 25 T1N0 cases and 81.8 per cent in 25 T2N0 cases. Five-year actuarial local recurrence of 17.5 per cent was recorded in the T1 group and 35 per cent in the T2 group. Local recurrences were attributed to failure of the implant to encompass extensions of the tumour along the lateral border or into the musculature of the tongue. Five-year actuarial local recurrence of 66.2 per cent was recorded in 18 patients with carcinoma of the breast treated by radium needle implant alone; 4 of these 9 local recurrences occurred at some distance from the treated area and could not be classed as marginal recurrences. A preliminary investigation carried out in 1981 indicated that significant improvements in source distribution, particularly at poorly accessible sites, could be achieved using afterloading techniques. In addition the use of 192Ir as a source could result in improvements in staff protection.

Adult↗
PubMed1981

Educational obstacles to learning diagnosis.

Formal teaching of the observational skills needed in diagnosing illness is a time honored part of medical education. The analytic skills which follow diagnostic observations, however, are often obscure and poorly taught. Much of this deficit may be due to the special character of the teaching context. The Flexnerian marriage of medical education to medical research and its substrate, the referral hospital, may have had consequences which confound the understanding and teaching of diagnosis. This paper explores four possibilities: inappropriate use of the inductive method; overemphasis on mechanistic paradigms; preoccupation with disease, the diagnostic end-point; and truncation of the analytic process occasioned by referral.

Diagnosis↗