Role advancement for the experienced clinical nurse specialist.
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Biomedical subjects
Publications and source records attributed to P Boyd.
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Nonpalpable, low-density, noncalcified lesions sometimes can be difficult to see on an initial specimen radiograph. In 57 consecutive wire localizations, 37 patients had obvious microcalcifications and did not require a second specimen radiograph. Twenty-six patients had nonpalpable, noncalcified lesions, and a second specimen radiograph was obtained in 24 of these. In four of these cases the initial specimen radiograph failed to show the suspected lesion, and a second specimen radiograph orthogonal to the original plane of orientation of the specimen showed the lesion to be contained within the biopsied material. Although it is seldom necessary to use this technique, it may obviate a second biopsy specimen as well as reduce operative time. We found that a second orthogonal specimen radiograph provided important information in 7% of cases.
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Catalase is known to map at chromosome 11p13. It is one of the closest known markers to the WAGR locus. Restriction fragment length polymorphisms (RFLP) of the catalase gene may be invaluable for studying rearrangements in somatic tumours, linkage in cases of familial Wilms tumour, and the relationship between sporadic and familial aniridia. We describe a catalase RFLP with two different enzymes and use these polymorphisms to exclude deletion of the catalase gene in patients with sporadic aniridia, including one who is known to have a deletion and another suspected of having a deletion.
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The usefulness of hepatobiliary echography was assessed prospectively in 32 patients with cholestatic jaundice. The predictive reliability of the method for detecting major bile duct obstruction was 93% and for excluding this possibility was 88%. Echography altered diagnostic thinking significantly in 22 patients (69%). Correct management decisions were made promptly in all but 1 patient who underwent unnecessary laparotomy for acute hepatitis. Laparotomy was correctly avoided in 2 patients and invasive investigations were not required in a further 12. It is concluded that hepatobiliary echography is a useful and cost-effective method in the diagnosis and management of the jaundiced patient.
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A survey of the first year's referral of heroin-addicted adolescents was undertaken exactly two years after the opening of a special treatment unit. Out of 130 patients presenting 78 were selected for treatment and were followed up. The drug-taking pattern of this group is reported. At the time of the survey 27% were assessed as off all addictive drugs.
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The association between exposure to environmental tobacco smoke and lung cancer in female lifetime nonsmokers was evaluated using data collected during the first 3 years of an ongoing case-control study. This large, multicenter, population-based study was designed to minimize some of the methodological problems which have been of concern in previous studies of environmental tobacco smoke and lung cancer. Both a cancer control group and a population control group were selected in order to evaluate recall bias. A uniform histopathological review of diagnostic material was conducted for case confirmation and detailed classification. Biochemical determination of current exposure to tobacco and screening of multiple sources of information to determine lifetime nonuse were utilized to minimize misclassification of smokers as nonsmokers. A 30% increased risk of lung cancer was associated with exposure to environmental tobacco smoke from a spouse, and a 50% increase was observed for adenocarcinoma of the lung. A statistically significant positive trend in risk was observed as pack-years of exposure from a spouse increased, reaching a relative risk of 1.7 for pulmonary adenocarcinoma with exposures of 80 or more pack-years. The predominant cell type of the reviewed, eligible lung cancer cases was adenocarcinoma (78%). Results were very similar when cases were compared to each control group and when separate analyses were conducted for surrogate and personal respondents. Other adult-life exposures in household, occupational, and social settings were each associated with a 40-60% increased risk of adenocarcinoma of the lung. No association was found between risk of any type of lung cancer and childhood exposures from a father, mother, or other household members.