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Biomedical subjects

L C Ward

Publications and source records attributed to L C Ward.

At least 73 records · Page 4Linked to original sources
PubMed1995

Pathological prognostic factors in the second British Stomach Cancer Group trial of adjuvant therapy in resectable gastric cancer.

The second British Stomach Cancer Group trial was a prospective randomised controlled trial of adjuvant radiotherapy or cytotoxic chemotherapy after gastrectomy for adenocarcinoma. It recruited between 1981 and 1986. No survival advantage has been demonstrated for the patients receiving either type of adjuvant therapy compared with those undergoing surgery alone. We report on 436 patients randomised into the trial together with 203 patients, who did not fulfil the trial criteria, referred to the trial. A univariate (log-rank) analysis of pathological factors obtained from the local referring centres showed that tumour size, macroscopic type, number os sites involved, depth of invasion, involvement of resection lines and lymph nodes and histological grade were significant determinants of survival. Histological review by two experienced histopathologists found that the Lauren classification and histological grade, but not the Ming classification, were significant prognostic factors. The degree of lymphocytic and eosinophilic infiltration and presence of dysplasia assessed by one of the pathologists showed a significant correlation with survival. However, inter-observer correlation for these histological parameters and grade was poor. Multivariate analysis identified only depth of invasion, resection line and nodal involvement as significant independent pathological variables influencing survival. This study confirms the need for expert preparation of the resected specimen to obtain the important information on depth of invasion and nodal status and also reveals some variation in histological assessment, particularly grading, in gastric carcinoma.

Adenocarcinoma↗
PubMed1995

Correspondence of the MMPI-2 and MCMI-II in male substance abusers.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and the Millon Clinical Multiaxial Inventory-II (MCMI-II; Millon, 1987) were given to 306 men with substance use disorders, and scores on 45 MMPI-2 scales and 25 MCMI-II scales were analyzed separately into seven and five principal components. The first two components from both tests accounted for a majority of the explained variance and were well correlated across tests. They were labeled Emotional Maladjustment and Antisocial Traits for both tests.

Adaptation, Psychological↗
PubMed1995

Psychosocial benefits of postmastectomy lymphedema therapy.

The effect of a comprehensive lymphedema management program was assessed in 25 patients in whom moderate to severe lymphedema had developed after surgery and/or radiotherapy for carcinoma of the breast. Intensive treatment (4 weeks) involved massage, compression bandaging, and sequential pneumatic compression, with an adjunct program of education to provide skills in exercise, massage, bandage, and containment garment use. The intensive treatment phase was followed by a self-management phase based on the skills that had been acquired. A significant reduction in limb circumference and volume, with continuing improvement over 12 months of self-management, was observed. There was a decrease in need for physical assistance. Quality of life generally remained high and stable throughout the 12 months. Quality of life specific to lymphedema, however, declined during the intensive phase of treatment, but recovered and surpassed pretreatment levels during the self-management phase of treatment. Perceived comfort and strength in the lymphedematous limb improved, and perceived size decreased. The study confirmed that the combination of multimodal physical therapy and education for self-management reduces lymphedema and its adverse subjective consequences and maintains the improvement thus achieved.

Adult↗
PubMed1994

Post-mastectomy lymphoedema treatment and measurement.

OBJECTIVE: To evaluate multimodal treatment (massage, pneumatic compression, bandaging and education) of post-mastectomy lymphoedema and to review methods of measurement of lymphoedema. DESIGN: Prospective cohort study with 12 months' follow-up. PATIENTS: Twenty-five consecutive women referred for lymphoedema examination after mastectomy to a private day-patient clinic attached to a tertiary referral hospital. INTERVENTION: Patients received multimodal therapy, including education on self-management techniques, for four weeks. MAIN OUTCOME MEASURES: Changes in body weight, limb circumference and volume, and patient reports of self-management (exercise, massage, bandaging and sleeve wearing). RESULTS: Excess limb volume decreased by approximately 40% immediately after treatment and by over 50% at 6 months' follow-up, remaining stable to 12 months' follow-up. Self-management that required assistance (massage and bandage wearing) declined more after treatment than did exercise or compression sleeve wearing. Correlations between body mass and limb volume and self-management and limb volume reduction were non-significant. CONCLUSION: Multimodal therapy reduced lymphoedematous limb volume by at least half in 18 of 25 patients. Patients can maintain these reductions independently through exercise and sleeve wearing and without further treatment. We used a replicable method of measuring lymphoedema, which we recommend for adoption by researchers in this field.

Arm↗
PubMed1994

The second British Stomach Cancer Group trial of adjuvant radiotherapy or chemotherapy in resectable gastric cancer: five-year follow-up.

The overall survival in patients with gastric cancer is low, even among those undergoing resection. It has been hoped that the development of adjuvant therapy might improve survival in patients following surgery when tumour burden was minimal and both chemotherapy and radiotherapy have been proposed as suitable for use in gastric cancer. Their value has been evaluated by the British Stomach Cancer Group Second adjuvant therapy trial. 436 patients entered a prospective, randomised, controlled trial of adjuvant radiotherapy or cytotoxic chemotherapy with mitomycin, doxorubicin, and fluorouracil after gastrectomy for adenocarcinoma. After at least 5 years, there have been 372 deaths of which 7 were due to surgical complications and 327 from recurrent cancer. Following stratified randomisation, 145 patients were allocated to surgery alone, 153 to receive adjuvant radiotherapy, and 138 to adjuvant combination chemotherapy. The overall 2-year and 5-year survival were 33% (95% confidence interval 31-35%) and 17% (13-21%). No survival advantage has been shown for those patients receiving either adjuvant therapy compared to those undergoing surgery alone. The 5-year survival for surgery alone was 20%, for surgery plus radiotherapy 12%, and for surgery plus chemotherapy 19%. Surgery, therefore, remains the standard treatment for this condition and the use of adjuvant treatments should be restricted to controlled trials.

Adolescent↗
PubMed1993

Improved prediction of extracellular and total body water using impedance loci generated by multiple frequency bioelectrical impedance analysis.

Bioelectrical impedance analysis (BIA) using a frequency of 50 kHz is an established method of predicting total body water (TBW). However, very little research has been performed to determine whether 50 kHz is the optimum frequency for the prediction of TBW from impedance measurements. This paper analyses a mathematical expression describing the equivalent electrical circuit for biological tissue, and derives a graphical representation of the resistive and reactive components. The nature of the resulting impedance locus was used in the analysis of measured whole-body impedance of 42 rats over a range of frequencies to determine the impedance at the characteristic frequency, Zc, and also the impedance at zero frequency, R0. The standard error associated with the prediction of TBW (determined by isotope dilution) using Zc was 5.9% compared with a standard error of prediction of 10.1% using the established BIA method at 50 kHz on the same data. Predictions of extracellular water (ECW) using the impedance at zero frequency, R0, yielded a standard error of 3.2% compared with standard errors of 4.8% and 4.2% using single frequency BIA measurements at 5 kHz and 1 kHz, respectively. These results demonstrate a significant (P < 0.01) improvement in the prediction of TBW and ECW using multiple frequency bioelectrical impedance analysis (MFBIA).

Animals↗
PubMed1992

Fluorimetric detection of serum corticosterone using high-performance liquid chromatography.

A simple, sensitive, specific and reproducible method for the determination of corticosterone concentrations in rat serum using high-performance liquid chromatography (HPLC) with fluorimetric detection is described. Corticosterone is detectable down to 0.1 ng injected onto the HPLC column. Cortisol is used as an internal standard. Ethyl acetate was used for both initial serum corticosteroid extraction and the subsequent fluorophore extraction after sulfuric acid hydrolysis; thus sulfuric acid does not enter the HPLC system. The resultant fluorophores for both corticosterone and cortisol are stable for at least two weeks at ambient temperature not requiring storage at -20 degrees C. The procedure is highly suitable for use with HPLC systems utilising automatic sample injectors. The method is specific for corticosterone; dexamethasone, cortisone and gonadal steroids are not detectable and do not interfere in this assay.

Animals↗
PubMed1992

Use of a spreadsheet program for Deming's linear regression analysis.

A spreadsheet program for Deming's linear regression analysis suitable for use with popular software packages such as Lotus 1-2-3 or Quattro is described. The program is controlled by an autoexecuting simple menu of operations allowing use by those with only limited experience of spreadsheet operation. Regression coefficients, identification of suspect outlying data values and confidence limits and graphical displays of fitted regression lines are provided.

Confidence Intervals↗
PubMed1992

The selection of cases for randomised trials: a registry survey of concurrent trial and non-trial patients. The British Stomach Cancer Group.

A randomised trial of adjuvant chemotherapy vs placebo in operable stomach cancer recruited 249 patients from the West Midlands Region between 1976-1980. A Cancer Registry survey identified a further 1261 suitable concurrent cases. Trial patients were compared with the 960 non-trial cases from participating Districts. Only 493 (51%) non-trial cases passed all of the prospective trial selection criteria for entry. Stage and fitness caused the majority of exclusions and were also highly prognostic. A univariate analysis comparing eligible patients with the trial showed the two groups to be balanced for the significant independent prognostic factors of the trial. However, differences in patient age and the surgery performed indicate that recruitment may have been influenced by unknown selection factors. This survey highlights the difficulty of retrospective selection and confirms the need for randomised controls. Data available from specialist Registries may be used to help develop new protocols and to verify and extend trial results.

Adolescent↗
PubMed1992

Multi-frequency bioelectrical impedance augments the diagnosis and management of lymphoedema in post-mastectomy patients.

The value of multiple frequency bioelectric impedence analysis (MFBIA) in the monitoring and management of post-mastectomy lymphoedema of the arm was evaluated in 15 patients and controls. The technique was found to produce quantitative agreement with a clinical diagnosis of lymphoedema and with the currently-used measure (limb volume calculated from circumferential measurements) of limb size. The significance of this finding lies in MFBIA being diagnostically informative: it indicates when an observed change in limb volume is directly, albeit theoretically, attributable to accumulation of extracellular fluid. MFBIA potentially offers the means for earlier definitive diagnosis and more-accurate monitoring of extracellular fluid changes during and after treatment.

Adult↗
PubMed1992

Benzodiazepine metabolism in ethanol-treated male rats: use of pair-fed and age-matched controls.

The effects of chronic moderate (15%) ethanol consumption and ageing on rat hepatic cytochrome P450 monooxygenase activities were examined using diazepam, nordazepam, d-benzphetamine, erythromycin, ethylmorphine and nitrosodimethylamine (NDMA) as substrates. In addition, the effects of moderate ethanol alone on the oxidation of metoprolol, morphine and temazepam were examined. Cytochrome P450 specific content increased significantly only in the 6-week ethanol-treated rats, and no changes in percentage liver to body weights were apparent in any of the ethanol-treated animals compared with pair-fed controls. Only cytochrome P450IIIA enzyme activities displayed age-related decreases, these being identified in the pair-fed animals. C3-hydroxylation of diazepam and nordazepam (36% of controls) and N-demethylation of erythromycin and ethylmorphine (58% and 64% of controls) were decreased in 6-week ethanol-treated animals, these effects being less pronounced in the 12, 24 and 48-week ethanol-treated groups. The decrease seen for diazepam and d-benzphetamine N-demethylation caused by ethanol consumption was approximately 80% of control groups for the duration of the treatment. NDMA and morphine N-demethylations were increased to 120% of control activities and metoprolol alpha-hydroxylase was increased to 140% of control activities at 6 weeks, whilst metoprolol O-demethylase activity remained unaltered. NDMA N-demethylase activity showed a two-fold induction at 24 and 48 weeks of ethanol treatment, compared with corresponding pair-fed control groups. These results support previous findings from this laboratory showing that the same or similar P450IIIA family isozymes are involved in the C3-hydroxylation of diazepam and nordazepam.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1991

The measurement of denial and rationalization in male alcoholics.

Two hundred male alcoholics were given 94 true-false items constructed to characterize alcoholic defensiveness, and a factor analysis revealed two strong factors. The first factor (Denial) was correlated with items that asserted an ability to control one's drinking, denied being an alcoholic or needing treatment, or minimized the consequences of alcohol abuse. Items that loaded the other factor (Rationalization) gave reasons, justifications, and excuses for drinking. Two derived scales were examined in a replication sample of 66 male alcoholics, and alpha coefficients (.84 and .85) from the first sample did not show undue shrinkage in the second (.86 and .77).

Adult↗
PubMed1990

Prediction of verbal, performance, and full scale IQs from seven subtests of the WAIS-R.

The Wechsler Adult Intelligence Scale-Revised (Wechsler, 1981) was given to 70 male VA patients, and IQs were estimated from seven subtests that require about half the administration time of the full test. Estimates correlated well with Verbal, Performance, and Full Scale IQs, and mean estimated IQs differed by less than 1 IQ point from actual means. Error sizes in predicting Full Scale IQs were small (M = 1.96) and exceeded 4 IQ points in only 3 cases. In comparison, error sizes for the Doppelt (1956) abbreviation (M = 3.71) were significantly larger and were greater than 4 IQ points in 20 cases.

Adult↗
PubMed1990

Sex differences in voluntary locomotor activity of food-restricted and ad libitum-fed rats. Implications for the maintenance of a body weight set-point.

1. Male and female Wistar-strain rats were studied under either ad libitum or 23-hour food restriction conditions both with and without access to a running wheel. 2. Daily measures were taken of body weight, food consumption and wheel revolutions. 3. It was observed that food restriction was associated with decreased food consumption and body weight but increased wheel revolutions. 4. Irrespective of feeding regime, females exhibited higher running rates than males.

Animals↗