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Biomedical subjects

P Kaye

Publications and source records attributed to P Kaye.

At least 19 recordsLinked to original sources
PubMed2006

Acetic acid-enhanced magnification endoscopy in the diagnosis of specialized intestinal metaplasia, dysplasia and early cancer in Barrett's oesophagus.

BACKGROUND: Barrett's surveillance is prone to sampling error. Aim To determine whether enhanced magnification endoscopy using acetic acid instillation improves diagnostic accuracy of specialized intestinal metaplasia/dysplasia in Barrett's oesophagus. METHODS: We examined the detection rate of the specialized intestinal metaplasia/dysplasia in 64 consecutive patients with Barrett's oesophagus using acetic acid to enhance mucosal pit patterns. Histology was compared with the previous findings at recent conventional surveillance in 62 patients. We also examined the inter-/intra-observer agreement in the assessment of the enhanced magnification endoscopy pit pattern findings. RESULTS: Histology revealed columnar-lined oesophagus in six (9%) patients, specialized intestinal metaplasia in 49 (77%), low-grade dysplasia in five (8%), high-grade dysplasia in one (2%), and adenocarcinoma in three (5%). There was discordance between the histologic findings from conventional surveillance with random biopsy. Fifteen patients (24%) had a histological upgrade with enhanced magnification endoscopy. There was a high detection rate of specialized intestinal metaplasia even in short segment Barrett's oesophagus (74%), and additionally, there were two cancers, one with 2-cm Barrett's oesophagus and one ultra-short (1 cm). The mean kappa values for inter- and intra-observer agreement in assessing the pit patterns were 0.571 (0.041) and 0.709 (0.038), respectively. CONCLUSIONS: Enhanced magnification endoscopy allows clear visualization of the epithelial pit patterns within Barrett's oesophagus, and targeted biopsy results in a high yield of specialized intestinal metaplasia and dysplasia.

Acetic Acid↗
PubMed2006

Routine elastic staining assists detection of vascular invasion in colorectal cancer.

AIM: To determine the value of routine staining of colorectal cancer (CRC) specimens with elastic stains. METHODS AND RESULTS: Four hundred and ninety-eight cases of CRC were included. In 208 cases, vascular invasion (VI) was assessed using elastic stains [Elastic van Gieson or Elastin haematoxylin and eosin (H&E)] that were introduced as routine staining in CRC in our hospital. As a control, 290 cases in which VI was assessed solely on H&E staining were included. The site, stage and presence of vascular invasion were determined in both groups. The cost, time and workload resulting from the addition of these stains were also taken into account. The sensitivity of detection of VI in CRC was significantly improved after the introduction of these elastic stains in our routine practice (46.2% compared with 35.5% in the control group; P = 0.014). Particular improvement was noted in Dukes' stage A and B. We also noted that the net benefits gained from the introduction of these special stains outweighed the small extra cost and effort and, in addition, saved time for the reporting pathologists. CONCLUSION: Routine elastic stains are very useful and practical in evaluation of VI status in CRC and we recommend implementing these stains in routine pathological practice to improve patient care.

Adenocarcinoma↗
PubMed2006

Barrett's esophagus specialist clinic: what difference can it make?

A 'Barrett's specialist clinic' was set up in our institution consisting of a specialist nurse, research fellow, and a consultant gastroenterologist. The aim of our study was to examine the impact of this clinic in the management of patients with Barrett's esophagus (BE). Patients with the diagnosis of BE seen in the outpatient departments or in the endoscopy unit were referred to this clinic. Guidelines were introduced modelling the American College of Gastroenterology recommendation. Patients were assessed based on their comorbidity and willingness to undergo surveillance. Reflux symptom control and acid suppression was addressed. All patients were invited to undergo high-resolution enhanced magnification endoscopy (EME) and targeted biopsy to confirm the diagnosis and to form a management plan. During the appointment in the clinic, patients were given an option to fill a questionnaire that inquired about the information given to them regarding BE. One hundred and forty-three patients (92 men, mean age: 62 years) with a diagnosis of BE were seen in the specialist clinic. In 16 patients surveillance was stopped. In 25 patients treatment was changed due to poor control of reflux symptoms. Sixty-five patients (51%) answered the questionnaire. Seventy-five patients (58%) underwent high resolution EME. Twelve patients, had a histological upgrade after EME, in spite of a short mean screening interval (5.5 months). The 'Barrett's specialist clinic' introduced a more structured approach in our institution and changed the way these patients were managed. Our results indicate the need for local guidelines and Barrett's specialist clinics in the UK, and perhaps in the rest of the Western world, wherein the burden of this condition is increasing.

Adult↗
PubMed2005

Early prediction of individual outcome following cardiopulmonary resuscitation: systematic review.

Following resuscitation from cardiorespiratory arrest 80% of patients are comatose. Of these patients, 20% will survive and regain consciousness. Is it possible to predict an individual's long term outcome at presentation and alter management accordingly? This review examines the current medical literature and demonstrates it is impossible to predict immediately outcome from hypoxic-ischaemic coma except in a small subgroup of patients with poor premorbid factors. As individual prognosis cannot be determined in the emergency department all patients who do not have significant premorbid features should proceed to a period of supportive care in the intensive care unit. Therapeutic hypothermia should be considered for these patients.

Age Factors↗
PubMed2002

Myocardial contusion: emergency investigation and diagnosis.

Cardiac contusion is an infrequent but occasionally serious complication of deceleration injury. According to ATLS teaching, the true diagnosis of contusion can only be established by direct inspection of the myocardium. The clinically important sequelae of myocardial contusion are hypotension and arrhythmia. Despite recent advances in investigative techniques, myocardial trauma remains an important diagnostic and management challenge. This paper presents an evidence-based review of the topic.

Contusions↗
PubMed2002

The role of magnesium in the emergency department.

Magnesium has been advocated for the treatment of a variety of conditions seen in emergency medicine. The authors present a systematic review and advice on appropriate indications for its use. Evidence supports its use in severe asthma, eclampsia, and torsade de pointes. There is insufficient evidence to justify its routine use in other emergencies.

Arrhythmias, Cardiac↗
PubMed2001

BTS asthma guide.

Explore the source record for details and available documents.

Acute Disease↗
PubMed1999

The significance of Erb-b2 immunostaining in cervical cancer.

OBJECTIVE: The aim of this study was to assess the relationship between survival and erb-b2 immunohistochemical staining in patients with early stage cervical carcinoma. METHODS: Archival specimens for 126 patients with stage IB/IIA cervical carcinoma treated with radical hysterectomy and bilateral pelvic node dissection (RH-BPND) were retrieved and submitted to immunohistochemistry for ERBB2 expression. The association between positive results and poor survival was assessed in a multivariate analysis. RESULTS: Erb-b2 immunostaining was significantly associated with poor survival (P = 0.0284) but less so than parametrial extension (P = 0.0014) and nodal disease (P = 0.0106). Tumor type (squamous/adenosquamous/adenocarcinoma) and the status of surgical margins were not significantly associated with survival. CONCLUSIONS: These results supported further investigations of ERBB2 expression as a marker of high-risk disease in patients treated with RH-BPND.

Adenocarcinoma↗
PubMed1999

The role of dendritic cells in the induction and regulation of immunity to microbial infection.

Dendritic cells (DCs) play a critical role in the initiation and regulation of immune responses. Recent advances have begun to uncover the nature and diversity of DC-pathogen interactions and the modulation of DC function by microbial stimuli. Antigen pulsed DCs have also been shown in several infection models to induce high levels of protective immunity and to display immunotherapeutic potential. The study of the function of DCs in the response to infection is thus an exciting and rapidly expanding field with important implications for both fundamental and clinical immunology.

Animals↗
PubMed1999

Factors leading to local recurrence or death after surgical resection of phyllodes tumours of the breast.

BACKGROUND: Local recurrence and death from metastases are occasional, but consistent, themes in reports of patients with phyllodes tumours. Factors that might contribute to these outcomes were sought. METHODS: Data from 38 patients with a phyllodes breast tumour were reviewed retrospectively, reclassifying the pathological material using the Pietruszka and Barnes criteria. RESULTS: At a median of 12 months, nine patients had developed a local recurrence and four had died from metastases. Following local excision in 24 patients (for diagnosis in 13, for 'fibroadenoma' in nine and for phyllodes tumour in two patients), 13 had no further surgery and five had local recurrence (three of eight benign tumours, two of two malignant tumours). Wide local excision or mastectomy in 18 patients was followed by four recurrences (one of eight borderline tumours, three of ten malignant tumours). All patients with recurrence had margin involvement on histological examination, but not all patients with margin involvement developed recurrence. Lack of statistical correlation between local recurrence and age, delay, size, grade or type of surgery was confounded by selection bias for more extensive surgery for malignant tumours. Death correlated with size (P = 0.05) and grade (P = 0.03) of tumour. CONCLUSION: Inadequate preoperative diagnosis ('fibroadenoma' or failure of triple assessment) frequently led to local excision with positive margins. Without revision this often resulted in local recurrence. Local recurrence of any grade was usually followed by further recurrence. Death was related to tumour size and histological grade, confirming these as prognostic factors.

Adolescent↗
PubMed1995

[Effects of cytokine-activated macrophages on intracellular leishmania].

The effects of activated macrophages on Leishmania donovani amastigotes and nitrite (NO2-) release were determined by in vitro inducement of macrophage activation with recombinant IFN-r, TNF-alpha, and rIL-3. The results indicated that rIFN-r or rTNF-alpha at 40,000U/L was able to induce a significant but modest level of macrophage activity, and synergistic effect of rIFN-r and rTNF-alpha was apparent in the induction of macrophage activation. 48 hours after macrophages were induced with both rIFN-r and rTNF-alpha, the percentage of the macrophages infected by Leishmania donovani was 16%, and the mean number of the parasite per infected macrophage was 1.2 +/- 0.04. There was a strikingly significant difference in comparison with the control group, in which the infection rate of macrophages was 62% and the mean number of the parasite per infected macrophage was 6.8 +/- 0.10. However, no significant difference was noted between rIL-3 at 1/100 concentration, alone or combined with rIFN-r, and the control in leishmanicidal activity of macrophages. An increase of NO2- in the culture supernatants was paralleled by the ability of various cytokine-activated macrophages to kill the intracellular parasites.

Animals↗
PubMed1984

Tracing foundations' pattern of giving for health care construction.

The philanthropic contributions of foundations have long been recognized as an important source of low-cost capital for hospitals. But to what extent do foundations contribute to hospitals' capital needs for construction and equipment? The authors discuss the findings of an HHS study that queried foundations to discover the extent to which they are providing such funds, what purposes the grants serve, and the criteria that institutions must meet.

Capital Expenditures↗