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Biomedical subjects

P McCormack

Publications and source records attributed to P McCormack.

At least 37 records · Page 2Linked to original sources
PubMed1997

Magnetic resonance imaging of the postpneumonectomy chest: normal and abnormal findings.

To determine the normal findings at magnetic resonance imaging (MRI) of the postpneumonectomy space (PPS), and to evaluate the utility of MRI in detection of recurrent tumor in the postpneumonectomy chest, 32 MRI scans were performed in 31 patients at varying time intervals after pneumonectomy. Eleven patients also had 12 computed tomography (CT) scans performed at the same time to evaluate possible tumor recurrence. Of the 32 scans, 5 demonstrated complete obliteration of the fluid containing PPS, and 4 showed gas in the PPS; the remainder (n = 23) demonstrated persistence of fluid-filled spaces of varying size. The presence of a fibrotic rim of tissue was constant. In 11 patients with clinically suspected tumor recurrences, both CT and MRI were obtained: the two modalities performed with similar accuracy in diagnosing tumor recurrence at 16 sites; CT detected opposite-lung metastatic nodules not seen on MRI in one patient, and a rib metastasis described as "indeterminate" on MRI in a second patient. MRI detected a focus of recurrence in the PPS that was indeterminate on CT. There is considerable variability in the amount of fluid seen in the PPS on MRI. CT remains the procedure of choice for routine follow-up or in suspected tumor recurrence in the postpneumonectomy patient; MRI can be helpful if the CT scan is nondiagnostic or equivocal.

Adult↗
PubMed1996

Dissemination of malignant tumors after video-assisted thoracic surgery: a report of twenty-one cases. The Video-Assisted Thoracic Surgery Study Group.

Video-assisted thoracic surgical techniques are widely used for biopsy and resection of thoracic tumors, but studies of long-term outcomes have not been reported. Dissemination of tumor by these techniques is a potential hazard. Therefore we surveyed the surgical members of the Video-Assisted Thoracic Surgery Study Group to determine whether tumor implants thought to be directly related to video-assisted techniques had occurred. Surgeons reported 21 cases. The sites of recurrence were the incision (n = 14), pulmonary staple line (n = 2), pleura (n = 2), both staple line and incision (n = 1), both pleura and incision (n = 1), and both pleura and staple line (n = 1). Review of these cases illustrates the pitfalls of present video-assisted techniques for malignant tumors of the thorax.

Adult↗
PubMed1995

Incidence of local recurrence and second primary tumors in resected stage I lung cancer.

From 1973 to 1985, 598 patients underwent resection for stage I non-small-cell lung cancer. There were 291 T1 lesions and 307 T2 lesions. The male/female ratio was 1.9:1. The histologic type was squamous carcinoma in 233 and nonsquamous carcinoma in 365. Lobectomy was performed in 511 patients (85%), pneumonectomy in 25 (4%), and wedge resection or segmentectomy in 62 (11%). A mediastinal lymph node dissection was carried out in 560 patients (94%) and no lymph node dissection in 38 (6%). Fourteen postoperative deaths occurred (2.3%). Ninety-nine percent of the patients were observed for a minimum of 5 years or until death with an overall median follow-up of 91 months. The overall 5- and 10-year survivals (Kaplan-Meier) were 75% and 67%, respectively. Survival in patients with T1 N0 tumors was 82% at 5 years and 74% at 10 years compared with 68% at 5 years and 60% at 10 years for patients with T2 tumors (p < 0.0004). The overall incidence of recurrence was 27% (local or regional 7%, systemic 20%) and was not influenced by histologic type. Second primary cancers developed in 206 patients (34%). Of these, 70 (34%) were second primary lung cancers. Despite complete resection, 31 of 62 patients (50%) who had wedge resection or segmentectomy had recurrence. Five- and 10-year survivals after wedge resection or segmentectomy were 59% and 35%, respectively, significantly less than survivals of those undergoing lobectomy (5 years, 77%; 10 years, 70%). The 5- and 10-year survivals in the 38 patients who had no lymph node dissection were reduced to 59% and 32%, respectively. Apart from the favorable prognosis observed in this group of patients, three facts emerge as significant: (1) Systematic lymph node dissection is necessary to ensure that the disease is accurately staged; (2) lesser resections (wedge/segment) result in high recurrence rates and reduced survival regardless of histologic type; and (3) second primary lung cancers are prevalent in long-term survivors.

Adenocarcinoma↗
PubMed1995

The spontaneous reporting of adverse drug reactions by nurses.

In an attempt to improve the low reporting rate of adverse drug reactions (ADR) we examined the potential for hospital nurses to report ADRs through a spontaneous 'yellow card' system. Over 14 months 100 cards were received (compared with 28 cards from doctors). Although reports from doctors for the same period were of a more substantial nature, nurses nevertheless reported many life threatening (17%) or moderately severe (76%) reactions. Nurses identified uncertainty concerning their role and deficient in-service education on drug therapy as major constraints in their participation. Given their unique position in drug administration and recording observations on patients, we believe that nurses could contribute significantly and in a complementary fashion to the spontaneous reporting of adverse reactions.

Adverse Drug Reaction Reporting Systems↗
PubMed1994

Is surgery for proliferative vitreoretinopathy justifiable?

Surgery for proliferative vitreoretinopathy (PVR) may require prolonged procedures often with limited improvement in visual function. Forty-seven consecutive patients who had PVR surgery in one eye had a case note review to assess anatomical re-attachment rate and improvement in visual acuity. All patients had at least 3 clock-hours of grade C PVR membrane. Surgery comprised vitrectomy and membrane peel in all cases. There was a mean follow-up period of 9 months (range 3-23 months). Thirty-two eyes (68%) had an attached retina with the mean visual acuity being 0.089 (where 6/60 = 0.10). A mean of 2.15 PVR operations were performed per eye. Seventeen patients chosen at random were contacted by telephone and standardised questions were asked regarding their surgery. Eleven (65%) patients stated that, with the benefit of hindsight, they would still have had surgery and 8 (47%) patients stated that the peripheral vision gained was of benefit.

Eye Diseases↗
PubMed1994

A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma.

PURPOSE: This study investigated the feasibility of a novel approach to the treatment of malignant pleural mesothelioma by combining surgical resection with immediate postoperative intrapleural chemotherapy and subsequent systemic chemotherapy. PATIENTS AND METHODS: Patients with biopsy-proven, resectable malignant pleural mesothelioma underwent pleurectomy/decortication immediately followed by intrapleural chemotherapy with cisplatin 100 mg/m2 and mitomycin 8 mg/m2. Systemic chemotherapy was started 3 to 5 weeks postoperatively and included cisplatin 50 mg/m2 on days 1, 8, 15, 22, 36, 43, 50, and 57, and mitomycin 8 mg/m2 on days 1 and 36. Patients were then monitored by serial chest and abdominal computed tomographic (CT) scans every 3 months until death or for a minimum of 18 months, whichever occurred first. RESULTS: Of 36 patients entered onto the study, 28 had pleurectomy/decortication and intrapleural chemotherapy. There was one postoperative death, and two episodes of grade 4 renal toxicity after intrapleural chemotherapy. The 23 patients who also had systemic chemotherapy received a median of 80% and 87% of the planned total cisplatin and mitomycin doses, respectively. No grade 3 or 4 toxicities were observed. The overall survival rate of the 27 patients who were originally candidates for systemic chemotherapy was 68% at 1 year and 40% at 2 years, with a median survival duration of 17 months. Locoregional disease was the most common form of relapse (16 of 20 patients). CONCLUSION: This short but aggressive combined modality regimen was generally well tolerated, but should not be used outside of a protocol setting because of the potential for serious toxicity. Overall survival was as good or better than with previously reported multimodality approaches, but other strategies are needed to improve local control.

Aged↗
PubMed1994

Biological study of R24 mouse monoclonal antibody in patients undergoing thoracotomy for pulmonary metastases from soft tissue sarcoma.

The disialoganglioside GD3 is expressed on the surface of soft tissue sarcoma, malignant melanoma, and other malignant cells and is, therefore, a potential target for therapeutic monoclonal antibodies. Intravenously administered R24, a murine IgG3 monoclonal antibody to GD3, induces inflammation and tumor regression at sites of metastatic malignant melanoma. R24 5 mg/m2 was given intravenously every other day for six doses to 10 patients with pulmonary metastases from a primary soft tissue sarcoma of the extremity for whom thoracotomy was planned. Resected tissue was available from 7 patients. All metastases expressed GD3; however, expression was heterogeneous within tumors, and in no tumor were more than 80% of the cells GD3 positive. A mild to moderate infiltrate consisting of mononuclear cells with T-cell markers was identified around or within pulmonary metastases in 6 patients. Tolerable acute allergic reactions occurred in all patients, but 3 patients had severe chest tightness and bronchospasm that limited the planned therapy. The setting of thoracotomy for metastatic disease provides an ideal system for studies on the pharmacology and biological effects of monoclonal antibodies that target soft tissue sarcoma antigens.

Adult↗
PubMed1994

Evaluation of an intervention program: relation between children's phonology and parents' communicative behavior.

Parents of 9 preschoolers with Down syndrome participated in a training program focusing on phonological skills. Three of the children were producing multiword utterances, but their speech was characterized by jargon and/or inconsistent errors. The remaining 6 children had very few spoken words or were mute; some relied on a Makaton sign vocabulary. Parents attended twelve 3-hour training sessions. Videotapes of parent-child interactions (made before, during, and after the program) were analyzed for number and type of children's phonological errors and rating of parents' therapeutic skills. Results showed that measures of the children's phonological abilities were correlated with their parents' interactional communication skills.

Child↗
PubMed1993

Management of the anticoagulated patient for ophthalmic surgery.

The outcome of 50 surgical procedures in 41 patients who were anticoagulated at the time of surgery were reviewed to determine whether anticoagulation was associated with an increase in ophthalmic morbidity. Twenty-seven patients were receiving warfarin and 14 patients nicoumalone. The International Normalised Ratio (INR) was determined immediately prior to surgery and ranged from 1.1 to 4.9. Thirty-nine operations were performed under local anaesthetic and 11 under general anaesthetic. Thirty-three patients had extracapsular cataract extractions with posterior chamber lens implantation. No major haemorrhagic complications were associated with the local anaesthetic or the surgical procedure. Patients on anticoagulation therapy are at risk of life-threatening complications if their anticoagulation is stopped or reduced. This study demonstrates that most ophthalmic surgical procedures can be safely performed whilst the patient is therapeutically anticoagulated.

Acenocoumarol↗
PubMed1993

NR-LU-10 monoclonal antibody scanning. A helpful new adjunct to computed tomography in evaluating non-small-cell lung cancer.

UNLABELLED: Computed tomographic scanning has improved the noninvasive staging of lung cancer but has the deficiency of not distinguishing benign from malignant lesions. This prospective trial evaluated the usefulness of a new radiolabeled monoclonal antibody, NR-LU-10, as an adjunct to computed tomography by assessing its clinical applicability and accuracy in detecting malignancy in primary lung tumors and mediastinal nodes. NR-LU-10 is a technetium 99m-labeled Fab fragment of a murine immunoglobulin G2b monoclonal antibody that recognizes a 40 kD glycoprotein expressed in lung and other epithelial cancers. METHODS: (1) Patients with potentially resectable non-small-cell lung cancer were eligible; (2) all patients had computed tomographic scans of the chest; (3) whole body and single photon emission computed tomographic imaging were performed 14 to 17 hours after intravenous infusion of 20 to 30 mCi of NR-LU-10; (4) subsequent mediastinoscopy or thoracotomy with complete mediastinal nodal mapping provided pathologic correlation. RESULTS: Twenty-four patients were entered, 14 men and 10 women. No allergic reactions or other adverse effects were seen. Interference from a prior ventilation-perfusion scan precluded adequate imaging in 1 patient, but high-quality images were obtained in the other 23 patients. The 22 primary malignant tumors all had uptake and there was no uptake in 1 lung nodule found to be benign. In 21 patients who had surgical correlation of mediastinal nodal involvement, NR-LU-10 was false-positive in 5 and false-negative in 1; results of computed tomography were false-positive in 6 and false-negative in 1. In this preliminary study, NR-LU-10 antibody scanning was safe and easily performed, it produced high-quality images of the lung and mediastinum, and it was accurate in detecting primary non-small-cell lung cancers. Further evaluation of its value in staging the mediastinum is needed, in particular, its role as an adjunct to computed tomography to help distinguish benign from malignant lesions.

Antibodies, Monoclonal↗
PubMed1992

The effect of in vitro aging on human lung fibroblast beta-adrenergic receptor density, coupling and response.

Age-related changes in regulation of receptor response have been observed in several tissues and include regulation of beta-adrenergic receptor (beta-receptor) responses. The role of cellular aging in age-related changes in receptor response is not clear. We have examined the effect of aging in vitro on human fibroblast beta-receptor function. MRC-5 (embryonic lung) fibroblasts were aged by replication to produce cells of early, middle and late stages corresponding to the following cumulative population doublings: 15-20, 35-45 and greater than 50, respectively. Fibroblast membrane beta-receptor responses to isoproterenol (ISO, 0.1 mM) did not differ between the three stages. Adenylate cyclase responses to prostaglandin E1 (PGE1, 1 microM), guanosine triphosphate (GTP, 0.1 mM) and 5'-guanylimidodiphosphate (Gpp(NH)p, 0.1 mM) were also similar between the stages. Beta-receptor density (Bmax) was unaffected by in vitro aging. Beta-receptor agonist affinity, an indication of the capacity for beta-receptor coupling to the nucleotide binding protein (NS), was also unaffected by cell aging. These findings suggest that cellular aging in fibroblasts alone is not accompanied by changes in beta-receptor function.

Adenylyl Cyclases↗
PubMed1992

Ear lobe crease and coronary heart disease.

Two hundred and forty seven consecutive patients admitted to an acute general hospital were studied. The presence of an association between the ear lobe crease (ELC) and ischaemic heart disease, hypertension, hypercholesterolaemia, peripheral vascular disease, cerebrovascular disease and smoking was investigated. The association between an ELC and coronary heart disease was found to be significant. There was no significant difference between the prevalence of ear lobe creases in males versus females and no correlation between ear lobe creases and smoking, hypercholesterolaemia, hypertension, peripheral vascular disease or stroke was found. Despite having a low sensitivity the specificity of an ear lobe crease is 94% which suggests that it should be used as a physical sign predictive of the presence of coronary heart disease rather than a diagnostic test.

Aged↗