Biomedical subjects

M N Harris

Publications and source records attributed to M N Harris.

At least 55 records · Page 3Linked to original sources

PubMed1990

Opisthotonus and other unusual neurological sequelae after outpatient anaesthesia.

Four patients who developed unusual neurological sequelae after outpatient anaesthesia are described. Propofol is strongly implicated as the cause. All four patients were female with no previous history of psychiatric disorder or neurological disease, unpremedicated, and had procedures of duration less than 20 minutes. Hyperreflexia and hypertonicity were present postoperatively and the reactions appeared to be triggered by an external stimulus. Three patients were examined by a neurologist and had a normal electroencephalograph. Two patients were on the same operating list; quality control was carried out on the anaesthetic agents used, and blood samples sent for toxicology showed no abnormalities. Mechanisms underlying these reactions are discussed.

Adult↗

PubMed1990

Invasive papillary carcinoma of the breast: mammographic appearance.

The mammographic findings in 18 patients with invasive papillary carcinoma were studied retrospectively. The mammograms of 10 patients showed a multinodular pattern, and seven patients had solitary nodules. One patient had an irregular, ill-defined mass in the retroareolar region. Two patients were found to have carcinoma in the contralateral breast, and two patients had intraductal carcinoma adjacent to the invasive papillary carcinoma. The varied mammographic features that may occur with this rare breast malignancy are discussed.

Aged↗

PubMed1990

Thoracotomy for metastatic malignant melanoma of the lung.

The outcome of 29 patients who underwent lung resection for treatment of metastatic malignant melanoma from January 1976 to November 1988 was studied. Twenty-two patients underwent total resection for cure of all apparent metastatic disease, whereas seven patients did not undergo total resection. Of the 22 patients who underwent curative resection, the median survival was 11 months, with a 2-year survival of 13.6% and a 5-year survival of 4.5%. Four patients who underwent curative resection are currently alive and free of disease, with one patient surviving more than 10 years. The patients who underwent palliative resection had a median survival of 5 months, only one patient living longer than 10 months. The difference in survival of the patients who underwent curative resection compared with palliative resection was statistically significant. The thickness of the primary cutaneous malignant melanoma, the presence of regional lymph node metastases, the disease-free interval from primary diagnosis to metastatic pulmonary disease, and whether one or two metastatic nodules were removed during curative lung resection were not statistically significant in altering survival. These results demonstrate that although prolonged survival for metastatic melanoma is rare, lung resection in selected patients may be associated with long-term survival.

Adult↗

PubMed1990

Calcifications of the breast after reduction mammoplasty.

Mammograms of 152 patients after mammoplasty were studied and 37 patients were noted to have calcifications. The pattern of these calcifications was studied to determine if specific characteristics could be identified. The calcifications were found to occur within the skin of the breast, mainly at a periareolar location. The ability to identify these benign calcifications further aids in reliably monitoring patients by mammography after reduction mammoplasty.

Adult↗

PubMed1989

Minitracheotomy--a life-threatening complication.

A 55-year-old patient developed profuse haemorrhage immediately after insertion of a minitracheotomy tube. Measured blood loss was 1.1 litres, and the bleeding required to be controlled surgically. The cause was a subglottic granuloma which had developed after prolonged tracheal intubation and which was incised during insertion of the minitracheotomy.

Female↗

PubMed1989

Circumscribed intraductal carcinoma of the breast.

In a retrospective evaluation of 350 cases of proved intraductal carcinoma detected over a 3-year period, 13 had mammographic features similar to those of benign tumors. The carcinomas were sharply circumscribed, round or oval lesions that contained microcalcifications. These calcifications were smaller and more likely to be asymmetrically located within the nodule than those of the fibroadenomas that they mimicked. While the carcinomas appeared circumscribed on mammograms, microinvasion of surrounding tissue was proved histologically in five of 13 cases, and in another case biopsy revealed metastasis to an axillary lymph node. Although these carcinomas are relatively rare, mammographic detection is important as none were palpable at the time of diagnosis.

Breast Neoplasms↗

PubMed1989

Differentiation of radial scar from scirrhous carcinoma of the breast: mammographic-pathologic correlation.

Radial scar, a sclerosing ductal breast lesion characterized by an irregular stellate pattern of epithelial proliferation around a central fibroelastic core, may be confused histologically with scirrhous carcinoma of the breast. Mammographic features used to distinguish these two entities were found unreliable in a retrospective review of 255 consecutive stellate lesions. Of 73 nonpalpable carcinomas, fourteen (19%) had radiographic features of radial scar. Only the presence of microcalcifications in 11 of those patients helped the authors distinguish carcinoma from radial scars. Four of nine biopsy-proved radial scars had a dense central region, simulating the appearance of scirrhous carcinoma. Stellate lesions with radiolucent centers should be considered suggestive of carcinoma, particularly if associated with microcalcifications.

Adenocarcinoma, Scirrhous↗

PubMed1989

Mammographic detection of carcinoma of the breast in patients with augmentation prostheses.

Evaluation of 85 patients who had augmentation mammaplasty with low-dose mammography detected microcalcifications in two patients. Both patients had biopsies that confirmed a diagnosis of intraductal carcinoma. A third patient with microcalcifications and a positive family history for carcinoma of the breast was found to have sclerosing adenosis. A fibroadenoma was visualized by mammography in a group of ten patients who were referred for the presence of palpable nodules of the breast. The remainder of the nodules were found to be related to the augmentation procedure.

Adult↗

PubMed1988

Immunogenicity of a polyvalent melanoma antigen vaccine in humans.

Fifty-five patients with Stage II (36 patients) or Stage III (19 patients) malignant melanoma confirmed histologically received adjuvant immunotherapy with a polyvalent melanoma antigen vaccine to evaluate toxicity and immunogenicity. There was no toxicity. Antibody and/or cellular immune responses to melanoma were induced more frequently in Stage II (36 patients [69%]) than Stage III (19 patients [53%]) disease. The ability of different immunization schedules, alum, or pretreatment with low-dose cyclophosphamide to potentiate immunogenicity was compared after 2 months of immunization. Immunization biweekly with a fixed intermediate dose of vaccine was more immunogenic than immunization weekly with escalating vaccine doses. Alum increased the intensity of cellular responses slightly, whereas pretreatment with cyclophosphamide augmented both the incidence and intensity of cellular immune responses slightly. However, these changes did not reach statistical significance. There was a reciprocal relationship between the induction of humoral and cellular immune responses. These results show that (1) active immunotherapy with a polyvalent melanoma vaccine is safe in patients with minimal disease, (2) the vaccine augments immunity to melanoma in many, but not all, patients, and (3) several immunization strategies failed to potentiate immunogenicity significantly.

Adult↗

PubMed1988

Magnesium and coronary revascularization.

Twenty patients, who underwent coronary revascularization without cardioplegic arrest, were given (during cardiopulmonary bypass) either magnesium chloride 16 mmol in 10 ml of water (magnesium group) or 10 ml of water alone (control group). Plasma and urinary magnesium concentrations were measured for 24 h after operation. ECG was recorded continuously during this period. QT intervals corrected for heart rate (QTcorr) were calculated from periodic full lead ECG. The mean plasma magnesium concentrations in the control group were less than normal throughout the study, while hypomagnesaemia did not occur in the magnesium group. Urinary magnesium excretion was higher in the magnesium group, with 58% of the administered magnesium excreted in the first 24 h. The observed incidence of frequent or ventricular arrhythmias was 22% in the magnesium group compared with 63% in the control group. No significant differences in QTcorr intervals were observed between the groups.

Arrhythmias, Cardiac↗

PubMed1988

Differentiation of postsurgical changes from carcinoma of the breast.

Evaluation of 486 consecutive mammograms with biopsy and excision scars revealed 25 with spiculated radiodensities on mammography. Of these 25 patients, 17 were diagnosed as having benign scars, based upon the appearance of a central lucency, representing fat in the central portion of the spiculated radiodensity. Seven patients were diagnosed as having carcinoma by the absence of lucency in the radiodensity at a biopsy or excision site.

Adult↗

PubMed1986

Influence of anatomic location on prognosis of malignant melanoma: attempt to verify the BANS model.

Stage I cutaneous malignant melanomas between 0.76 and 1.69 mm thick (Breslow measurement) in BANS (upper part of the back, posterior aspects of the arms, posterior and lateral aspects of the neck, posterior aspect of the scalp) areas have been reported to portend a relatively poor prognosis compared to non-BANS sites. We were unable to confirm the 15% poorer survival for BANS area lesions (84% BANS, 99% non-BANS) originally reported. In this report of 211 patients, malignant melanomas in BANS sites had a 4.6% poorer 5-year cumulative survival rate (88.9% BANS, 93.5% non-BANS; p = 0.35). Although many more patients need to be studied, we believe this small difference in survival is insufficient to influence therapeutic management strategies.

Adult↗

PubMed1986

Surgical treatment of dermatofibrosarcoma protuberans.

The clinical course and histopathologic factors of 50 consecutive patients treated for dermatofibrosarcoma protuberans were reviewed. Forty-eight patients were observed until the present time or death. No patient had distant metastases develop, although 16 patients had 18 recurrences of the dermatofibrosarcoma protuberans at the site of initial therapy. There was no correlation between the diameter of the primary lesion and the incidence of recurrence. There was no correlation between the histologic pattern of invasion and recurrence. However, a trend toward decreasing recurrence was noted with increasing minimal margins of resections (41 per cent less than 2 centimeters versus 24 per cent greater than or equal to 2 centimeters). The lowest incidence of recurrence (20 per cent) was noted with minimal margins of resection greater than or equal to 3 centimeters. Five year recurrence free survival rates increased with increasing margins of resection--59 per cent less than 1 centimeter; 66 per cent greater than or equal to 1 centimeter; 70 per cent greater than or equal to 2 centimeters, and 80 per cent greater than or equal to 3 centimeters. No patient had distant metastases and no change in histologic pattern was noted with progressive local recurrence.

Adolescent↗

PubMed1985

Anaesthesia for translumbar aortography.

Fifty patients presenting for elective translumbar aortography were randomly allocated to one of two groups receiving either enflurane or isoflurane. Premedication was with oral lorazepam. The patients' tracheas were intubated and they were allowed to breathe spontaneously in the prone position during the procedure. There was no significant difference in heart rate during the investigation but there was a statistically significant fall in the blood pressure from its pre-induction level. Arterial oxygenation was adequate throughout the procedure. Arterial carbon dioxide tension was significantly lower in the isoflurane group at the beginning and at end of the procedure (p less than 0.01), but there was no significant change in carbon dioxide tension within the groups during the procedure. Spontaneous ventilation with enflurane or isoflurane is a satisfactory anaesthetic technique for translumbar aortography.

Anesthesia, Inhalation↗

PubMed1985

Surgery for primary cutaneous malignant melanoma.

In summary, we believe that in the following situations elective regional lymph node dissection should not usually be performed: Patients whose primary malignant melanomas are in situ or have a maximal thickness of less than 1.0 mm. The incidence of regional node metastases in the latter group is so low that regional lymph node dissection is not justified. Patients whose primary malignant melanomas are in the midline of the head and neck or the trunk. Bilateral nodal dissections in these two regions of the body in the absence of a clearly demonstrable therapeutic advantage are not justified. Whether radioisotopic localizing studies will add greater definition to this group remains to be seen. Elderly patients or those with serious intercurrent disease. They should not undergo elective nodal dissection unless the primary malignant melanoma is very thick and lies directly over its nodal group. Patients with systemic metastases. For all remaining patients, the therapeutic or at very least prognostic advantages of elective regional lymph node dissections have been outlined. Conversely, an adverse effect on the course of the disease has never been demonstrated. We adhere to a policy that includes these procedures as primary therapy, provided they are performed with minimal morbidity. Should a surgeon elect not to perform such a procedure in the absence of clinically suspicious lymphadenopathy, careful clinical evaluation at 2-month intervals for the first 2 to 3 years following primary excision, with more prolonged intervals thereafter, would appear prudent. Until such time as effective means of eradicating systemic metastatic malignant melanoma exist, surgery remains the treatment of choice for this potentially fatal neoplasm. Efforts to develop effective adjuvant treatment based on the precise means of delineating prognosis that have thus far been developed has eluded investigators. A reasoned surgical approach is still required in our judgment until the identification and treatment of premalignant precursor lesions are universal or effective systemic therapy is available.

Head and Neck Neoplasms↗

PubMed1985

Prognosis of patients with pathologic stage II cutaneous malignant melanoma.

The prognostic relevance of the extent of nodal metastases, lesion thickness, level of invasion, site of lesion, satellitosis, age, sex, and year of diagnosis and treatment were assessed in 213 consecutive patients with pathologic Stage II malignant melanoma (157 with clinical Stage I disease and 56 with clinical Stage II disease). Of these factors, only three were significant: 1) clinical status of the lymph nodes (p less than 0.0001); 2) thickness of the primary lesion in the ranges of less than 2.0 mm, 2.0 to 4.9 mm, and 5.0 mm or greater (p = 0.002); and 3) level of invasion (p = 0.0002). The extent of nodal metastases in those patients with clinical Stage I disease was not significant. The difference in survival between patients with clinically negative/histologically positive nodes (clinical Stage I) and clinically positive/histologically positive nodes (clinical Stage II) was apparent throughout the follow-up period. The 5- and 10-year survival rates for the clinical Stage I patients were 44% and 28%, respectively, and for the clinical Stage II patients 21% and 12%, respectively (p less than 0.0001). A 5-year cumulative survival rate of 65% was achieved for clinical Stage I patients having primary lesions of less than 2.0 mm in thickness, while it was 19% for patients having primary lesions of 5.0 mm or more in thickness. For pathologic Stage II malignant melanoma patients, prognosis is most dependent on the clinical status of the lymph nodes, not on the number of lymph nodes with micrometastases.

Actuarial Analysis↗

PubMed1984

"Microscopic satellites" are more highly associated with regional lymph node metastases than is primary melanoma thickness.

A multivariate analysis was performed on 20 clinical and histologic variables from 327 Stage I prospectively studied melanoma patients who underwent elective regional lymph node dissection (ERLD). Primary tumor thickness, microscopic satellites, and the elapsed interval between diagnosis and ERLD, were selected as the combination of variables that were most highly associated with clinically occult regional lymph node metastases (P = 10(-15), model chi-square). Microscopic satellites were defined as tumor nests, greater than 0.05 mm in diameter, in the reticular dermis, panniculus, or vessels beneath the principal invasive tumor mass but separated from it by normal tissue on the section in which the Breslow measurement was taken. The probability of finding nodal metastases for melanomas less than 0.75 mm thick was 0% (0/41 patients); for those 0.76-1.50 mm, 4% (4/108); 1.51-3.0 mm, 14% (14/102); and greater than 3.0 mm, 39.5% (30/76). Primary melanomas greater than 1.50 mm thick with microscopic satellites were more often associated with nodal metastases than those of similar thickness without satellites (30/57 (53%) versus 14/121 (12%), P = 0.01). Some satellites probably represent intraspecimen metastases, while others do not. Any predictive model for occult regional lymph node metastases based on data from ERLD done less than 50 days after diagnosis may underestimate the prevalence of metastases.

Adult↗

PubMed1984

Cardiac arrhythmias during anaesthesia for laparoscopy.

Fifty-six patients undergoing elective laparoscopy were allocated randomly to two groups. Group H received alcuronium and were ventilated artificially using 0.5% halothane and nitrous oxide in oxygen. Group E breathed spontaneously a mixture of enflurane and nitrous oxide in oxygen. Arterial pressure, heart rate, tidal volume, respiratory rate and end-tidal carbon dioxide tension (PECO2) were monitored. The electrocardiogram (ECG) was recorded continuously using magnetic tape, from before induction until the patient left the recovery area. The incidence of arrhythmias was similar in the two groups. No arrhythmias occurred after the insufflated carbon dioxide had been removed from the abdomen. Spontaneous ventilation with enflurane anaesthesia is a simple and safe, technique for routine laparoscopy, providing the intra-abdominal pressure does not exceed 25 mm Hg.

Adolescent↗