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M D Staunton

Publications and source records attributed to M D Staunton.

At least 19 recordsLinked to original sources
PubMed2000

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History, 19th Century↗
PubMed1994

Thyroid cancer: a multivariate analysis on influence of treatment on long-term survival.

Contemporary management of patients with follicular pattern thyroid cancer remains uncertain. This retrospective multivariate analysis studied 410 such patients treated in a cancer hospital in the years 1932-72 and providing a follow-up of 20 years. In papillary carcinoma thyroxine administration (P < 0.005) and surgery (P < 0.001) improved survival together with youth (P < 0.001) and being female (P < 0.05). In follicular carcinoma, thyroxine therapy (P < 0.001) increased survival as did surgery but it failed to reach significance (P = 0.19); increasing age (P < 0.001), stage M1 (P < 0.05) and 'complete' radiotherapy (P < 0.05) decreased survival. In anaplastic carcinoma survival was improved by thyroxine therapy (P < 0.001), a new finding, but decreased by stages T3 (P < 0.001) and M1 (P < 0.05); however, radiotherapy, the mainstay in control of local disease, did not increase survival. Overall, total thyroidectomy reduced local recurrence with an increase in complications and no operation gained a significant increase in survival. Radio-iodine achieved no benefit in survival which raises the possibility of confounding. Thyroxine therapy is indicated as initial treatment of follicular cell thyroid cancer.

Adenocarcinoma, Follicular↗
PubMed1993

A 25-year prospective study of modified radical mastectomy (Patey) in 193 patients.

The results of a prospective study over 20 years of 193 patients with breast carcinoma treated by Patey mastectomy are presented together with details of the operative technique employed. One hundred and twenty-eight cases (66%) were stage 1 (T1/T2 N0), 46 (24%) were stage 2 (T1/T2 N1), 18 (9%) were stage 3 (T3 N0/N1), and one was stage 4 (M1). The probability of survival together with 95% confidence intervals for stage 1 (T1/T2 N0) at 10 years was 79% (71-88); and at 15 years 74% (61-87). For stage 2 (T1/T2 N1), the probability of survival at 10 years was 64% (48-79), and at 15 years 60% (44-76). For stage 3 (T3 N0/N1), the probability of survival at 10 years was 70% (45-95) and nobody survived at 15 years. These differences between the clinical stages lacked significance [Log-rank test: chi 2 = 3.44 df = 2 P = 0.18]. There were nine patients (5%) who developed local recurrence without systemic metastases. There was no postoperative mortality, and morbidity was low. Axillary node metastases depressed survival with probability of survival at 10 years 43% (29-57) in contrast to those without it 90% (84-96) [log-rank test: chi 2 = 39.42 df = 1 P < 0.0001]. Patey mastectomy should be considered for patients with T1 or T2 tumours who choose mastectomy rather than breast conservation. It is an effective local treatment which is of particular relevance in countries where radiotherapy is not available.

Breast↗
PubMed1993

Thyroid cancer in the 1980s--a decade of change.

Changes in the 1980s in thyroid cancer included an increased incidence of papillary carcinoma and a decrease in anaplastic carcinoma in the UK; the establishment of cytology as the prime agent in diagnosis; and total thyroidectomy became the operation of choice in many centres and block dissections gave way to local node removal. Thyroxine was shown to give significant improvement in survival. Histological type remained the prime factor in prognosis with papillary carcinoma showing excellent long-term survival rates compared to follicular carcinoma, while anaplastic carcinoma had few survivors over two years (log rank X2 = 304.57, p < 0.005). In the totality of thyroid tumours, excluding consideration of the histology, we found that increasing age, progression of stage T1 and T3 and stage M1 all contributed to reduce survival and that females outlived males. We contrasted technical aspects in total and sub total lobectomy and showed that the more radical procedures reduced local recurrence at the price of increased parathyroid and nerve damage without evidence of improved long-term survival. We found that the critical factor in surgical results was whether the operation cleared all cancer from the neck and suggested near total thyroidectomy as the standard procedure in follicular cell tumours, reserving total thyroidectomy for gross bilateral spread.

Adult↗
PubMed1993

The modified radical mastectomy of Patey: technique and experience.

We report our experience from 193 patients with breast cancer treated by Modified Radical Mastectomy of Patey and describe the technique used, amplified by illustrations. We achieved a low morbidity viz symptomatic lymphoedema five cases, chronic shoulder stiffness one case, skin grafting two cases, and all cases of chest wall pain cleared by four years. Cancer recurred, to date, local in nine cases (4.6%), local and systemic in 17 cases (8.9%) and systemic in 27 cases (13.9%). We compile, for the first time, all references by Patey and Richard Handley to the procedure. We recommend the operation as achieving complete primary clearance with safe and full axillary node removal. Histological state of the nodes allows rational decisions on adjuvant therapy with hormones and chemotherapy.

Breast Neoplasms↗
PubMed1992

Malignant thyroid tumours 1932 to 1972: the outcome in 492 patients.

We report on 492 patients treated for thyroid cancer at the Royal Marsden Hospital between 1932 and 1972: 380 of the patients are now dead. Eighty-three per cent (n = 410) are tumours of follicular cell origin. We found the crude 20-year probability of survival to be 54% in papillary carcinoma, 29% in follicular carcinoma and 1% in anaplastic carcinoma. Considering solely cancer deaths, the survival in papillary cases was 68%. Age, histology (tumour type), extent of primary tumour (T stage), haematogenous metastases (M1 stage) and, to a lesser extent, sex exercised a significant influence on survival. We support the use of these five factors to produce a prognostic index for estimating the level of risk for tumours of follicular cell origin. We add our experience in the non-follicular cell tumours of medullary carcinoma (3%), lymphoma (7%) and fibrosarcoma (1%).

Actuarial Analysis↗
PubMed1991

Sclerosing lymphocytic lobulitis of the breast--evidence for an autoimmune pathogenesis.

We describe 13 cases of inflammatory lesion of breast lobules in young and middle-aged women, presenting as breast lumps, with, in five cases, associated breast pain. The patient with the most florid bilateral disease subsequently developed Hashimoto's thyroiditis. This prompted us to consider an autoimmune pathogenesis for all the breast lesions. We confirm a previously documented association of such breast lesions with diabetes mellitus and review the evidence for a possible HLA association. Increased HLA-DR expression by breast epithelial cells was observed in cases available for study. Of the seven patients screened for circulating autoantibodies, three had none, one had smooth muscle antibodies, one parietal cell, one parietal cell and thyroid microsomal, and the seventh had the thyroid autoantibodies expected in Hashimoto's disease. Five of seven patients whose HLA-status was determined were HLA-DR3, 4 or 5 positive, either singly or in combination. Immunophenotypic analysis of the mammary lymphoid infiltrate showed that the majority of infiltrating lymphocytes were B-cells.

Autoantibodies↗
PubMed1991

Brachial plexopathy in breast carcinoma--an unsolved problem.

Brachial plexus involvement from carcinoma of the breast produces a severe disability which presents difficulties in diagnosis and treatment. Five patients who suffered this complication are described and the problems they present are discussed.

Adult↗
PubMed1987

Stab injury--the experience of an East London Hospital 1978-1983.

A retrospective review of 201 patients with stab wounds admitted to an East London Hospital over a period of six years was performed. There was no striking increase in the annual incidence of these injuries over the period reviewed. The majority of patients were young males who arrived at the Accident and Emergency Department after 1800 h on a Friday, Saturday, or Sunday and had consumed alcohol prior to admission. There were 47 abdominal injuries (23%), 69 thoracic (34%), 51 limb injuries (25%) and 34 injuries involving the head and neck (17%). Forty patients (20%) had injuries involving more than one site. Abdominal stabbings were managed by a selective approach resulting in 28 laparotomies of which only 2 (7%) were negative. Evisceration of small bowel or omentum was always associated with significant intraperitoneal injury.

Abdominal Injuries↗
PubMed1981

Thyroid cancer - a surgeon's view.

Thyroid cancer comprises a family of rare and differing tumours. Radiation and iodine play a part in causation. Ultra sound and needle cytology should improve diagnosis. Sub-total thyroidectomy promises the safest method of primary excision for cure. Radio-iodine and Beam radiation and thyroid supplements play supporting roles. Tumour type, stage and age largely determine the outcome. Thus treatment should carry a low morbidity.

Age Factors↗
PubMed1976

Treatment of thyroid cancer in 293 patients.

Two hundred and ninety-three patients with thyroid cancer were treated at The Royal Marsden Hospital, London, between 1931 and 1963. Thirty-six per cent of the tumours were papillary, 21 per cent follicular, 1 per cent medullary and 42 per cent anaplastic. Surgery combined with radiotherapy formed the commonest treatment regime. Thirty-six per cent of the patients with papillary carcinoma survived for 20 years, 20 per cent with follicular tumour and 4 per cent with anaplastic carcinoma. The present series indicates that treatment influences the survival time, confirms the prognostic value of histology and age and shows that papillary node metastases do not prejudice survival.

Adenocarcinoma↗