Platelet size and venous disease.
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Blood Platelets↗
Biomedical subjects
P R Thomas
Publications and source records attributed to P R Thomas.
Trauma deaths in the south west Thames region.
This is an epidemiological study based on Coroners' records analysing mode of injury and place and cause of death. The aim of the study is to provide data on the incidence and patterns of death from trauma and to assess the need for changes in trauma management. All traumatic deaths occurring in the South West Thames Region during 1988 were studied. We analysed 434 of these deaths (mean age 52 years) in some detail. Of the deaths, 59 per cent occurred before arrival at hospital. Road traffic accidents are the commonest cause of death from trauma, being most prevalent in the areas containing major trunk roads. The majority of deaths due to chest injury (79 per cent) and multiple injuries (70 per cent) occurred before arrival at a hospital, whereas the majority of deaths due to head injury (63 per cent) occurred after admission. The majority of deaths from trauma occur before arrival at a hospital, particularly in the semi-rural areas. Improvements in hospital trauma care could have only a limited effect on the death rate in existing circumstances. If important reductions in deaths from severe injury are to be made then prevention and prehospital care need to be improved.
Accidental Falls↗
Vibration white finger and Dupuytren's contracture: are they related?
Between 1988 and 1990, 500 claimants were assessed and considered to have vibration white finger (VWF). Of these, 137 were under 45 years of age and none had Dupuytren's contracture of the remaining 363, 311 were aged 50-85 years, and of these 62 (19.9 per cent) had Dupuytren's contracture. Statistically, this prevalence was significantly higher than that in a control group of 150 men of similar age distribution (10.7 per cent). As far as can be ascertained, this is the first study to indicate that there may be a causal relationship between VWF and Dupuytren's contracture, and the possible theoretical reasons for this are discussed. It is suggested that further studies are required to confirm or refute the findings.
Adult↗
Serving up nutrition instead of guilt.
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Diet↗
Prognostic implications of hepatic adhesion, invasion, and metastases at diagnosis of Wilms' tumor. The National Wilms' Tumor Study Group.
In the Third National Wilms' Tumor Study, (NWTS-3), 190 patients with Favorable Histology (FH) Wilms' tumor (WT) were identified as having tumor adherent to, directly invading, or metastatic to the liver at diagnosis. Analyses of the 3-year relapse-free survival and survival of these patients show that adhesion to the liver surface, direct invasion of the liver, and liver metastases have no additional detrimental effect on prognosis stage-for-stage. The authors conclude that hepatic involvement, when present at the time of diagnosis, should not be regarded as different from other patterns of the disease. Treatment policies should follow those appropriate for stage.
Adhesiveness↗
Results of two radiation therapy randomizations in the third National Wilms' Tumor Study.
In the third National Wilms' Tumor Study (NWTS-3), patients with Stage II favorable histologic type (FH) or Stage III FH Wilms' tumor were randomized according to a factorial design for both radiation therapy (RT) and chemotherapy to be given after nephrectomy. Patients with Stage II FH disease were randomized between 2000 cGy and no postoperative RT; patients with Stage III FH disease were randomized between 2000 and 1000 cGy. No significant differences in survival were noticed. Although there were no significant differences in the rate of intraabdominal relapses, those patients with Stage III disease who received 1000 cGy and dactinomycin and vincristine (seven patients) experienced a relapse in the abdomen more frequently than those who received 2000 cGy and dactinomycin and vincristine (three patients), 1000 cGy and dactinomycin, vincristine, and doxorubicin (three patients), or 2000 cGy and dactinomycin, vincristine, and doxorubicin (two patients). This would suggest that doxorubicin might be a good substitute for the second 1000 cGy of RT. Boost doses of RT, although allowed, were rarely given and no assessment of the value of supplemental RT can be made. The dismal prognosis of abdominal relapse after RT is confirmed and delay of initiation of treatment beyond 10 days after surgery was a significant adverse factor as in NWTS-1 and NWTS-2.
Antineoplastic Combined Chemotherapy Protocols↗
Hepatocellular carcinoma as second malignant neoplasms in successfully treated Wilms' tumor patients. A National Wilms' Tumor Study report.
Although rare, second malignant neoplasms (SMN) after treatment for Wilms' tumor are deadly. A recent National Wilms' Tumor Study (NWTS) report identified 15 patients with second malignancies discovered over 14,381 person-years of observation. This report described four patients with secondary hepatocellular carcinoma in greater detail. These patients were strikingly similar in that all had right-sided tumors and each one had received right upper-quadrant irradiation. All patients died shortly after diagnosis of the SMN.
Adult↗
Remission induction and continuation therapy in children with their first relapse of acute lymphoid leukemia. A Pediatric Oncology Group study.
Between January 1979 and April 1983, 113 children undergoing their first relapse of acute lymphoid leukemia (ALL) at any site were registered in Pediatric Oncology Group study 7834; 98 were eligible and evaluable. In addition to radiotherapy administered to sites of local relapse, induction consisted of vincristine, doxorubicin, and prednisone (VAP) chemotherapy. Continuation therapy consisted of triple-drug intrathecal therapy and regimens of 6-thioguanine and cytarabine alternating with vincristine, prednisone, cyclophosphamide, and cytarabine. Randomization in continuation was between VAP pulses or no pulse, regardless of the site of relapse. This report provides long-term follow-up of these patients. Thirty-two of 39 children with bone marrow involvement achieved a complete response (CR). Only one of these is alive in an unmaintained remission, a child who did not have an initial CR. Thirty-four of 36 evaluable children with central nervous system involvement as the site of relapse achieved CR. Of these ten are alive; eight are in continuing CR. Nineteen of 20 boys with testicular relapse achieved CR. Of these, 14 are still alive and not receiving therapy, although only one half received treatment in compliance with the protocol described. These results illustrate the possibility of cure of patients who have relapsed with ALL when it is (1) confined to a meningeal or gonadal site and (2) treated vigorously with radiotherapy and a new regimen of systemic chemotherapy. The results reconfirm the need to prevent an initial relapse at any site.
Antineoplastic Combined Chemotherapy Protocols↗
Light reflection rheography: an effective non-invasive technique for screening patients with suspected deep venous thrombosis.
Light reflection rheography is a simple non-invasive technique for assessing venous function in the leg. One hundred and twenty-four patients referred for venography with a clinically suspected deep venous thrombosis were investigated by light reflection rheography to determine the accuracy of the technique in diagnosing acute thrombosis. In half of the patients venography confirmed a deep venous thrombosis. Light reflection rheography had a sensitivity of 92 per cent and a specificity of 84 per cent in detecting acute thrombosis. The technique had a negative predictive value of 92 per cent in selecting those patients with no thrombosis. Light reflection rheography can be performed at the bedside or in the radiography department which makes it a suitable technique for screening patients with suspected deep venous thrombosis.
Female↗
Therapeutic aspects of white blood cell rheology in severe ischaemia of the leg.
In order to investigate the involvement of white blood cells (WBC) in ischaemia, we have used micropore filtration techniques to measure the flow properties of cells from patients with severe leg ischaemia, before and after therapy (amputation or pharmacological). Compared to age-matched controls, WBC from patients had impaired ability to flow through 8 microns and 5 microns pore filters. This applied to fractionated granulocytes and mononuclear cells, as well as to unfractionated mixed WBC. WBC from blood drawn from the ischaemic leg had worse filterability than those from arm blood of the same patients. Judging from WBC morphology, the percentage of active WBC was higher in samples drawn from ischaemic patients compared to controls. After amputation of the ischaemic leg, significant improvement was observed, so that the WBC were no longer significantly different from controls. The flow abnormalities may reflect activation of WBC by factors released in the ischaemic tissue. A cycle of WBC trapping, activation, tissue damage and further activation and trapping could contribute to the worsening of tissue ischaemia. Pharmacological intervention in this degenerative cycle might be possible, and our preliminary data show that Trental infusion (600 mg over 6 hours) improves the filterability of granulocytes from severely ischaemic patients.
Arterial Occlusive Diseases↗
Increased white cell trapping in the dependent legs of patients with chronic venous insufficiency.
Interest in white cell (WBC) rheology has largely been directed towards hypotensive conditions. However, as capillary flow is dependent on the relative arteriovenous pressure gradient, we investigated the dynamics of WBC flow in patients with venous hypertension. Three groups of matched subjects were studied: normal controls, patients with primary varicose veins, and patients with deep venous insufficiency confirmed by foot volumetry and Doppler studies. A venous cannula inserted at the level of the medial malleolus allowed blood samples to be taken at time 0 (supine) and then at 15, 30, 45, and 60 minutes after sitting up. Further samples were taken after subjects resumed a supine position. After 60 minutes sitting the haematocrit of blood leaving the foot increased by 9.6% in controls and 25.6% in patients with venous insufficiency. The difference in the behaviour of WBC was more marked. Controls showed a 5.0% decrease in the relative number of WBC after 60 minutes sitting compared to 28% decrease in patients with venous insufficiency. On resuming a supine position there was a significant increase in the number of WBC leaving the foot and this "wash-out" appeared to be delayed in the two patient groups. Platelets showed a corresponding fall when the foot was dependent but there appeared to be no washout after elevation.
Chronic Disease↗
Hyperfractionated radiation and chemotherapy for unresectable localized adenocarcinoma of the pancreas. The Gastrointestinal Tumor Study Group experience.
Eighteen patients with unresectable localized adenocarcinoma of the pancreas were treated by a combination of chemotherapy plus hyperfractionated radiation therapy to the pancreas for 4080 cGy with an additional 960 cGy to the pancreatic tumor and a surrounding margin. One hundred and twenty cGy were given twice daily 4 to 6 hours apart. High-energy photon or electron beams were used with treatment planning based on computed tomographic (CT) scans. Patients were given chemotherapy in the form of 5-fluorouracil (5-FU) at 350 mg/m2 on the first 3 and last 3 days of radiation therapy. On day 53, chemotherapy was given that included 600 mg/m2 IV of 5-FU, 1 gm/m2 of streptozotocin, and 10 mg/m2 IV of mitomycin C. The 5-FU and streptozotocin were repeated on days 60, 81, and 88, and the stretozotocin and mitomycin (SMF) cycles were repeated every 8 weeks until progression. Radiation toxicity was generally tolerable with one of 18 evaluable patients having severe nausea and vomiting and two of 18 patients having severe diarrhea. One patient had total liver failure and died 3 months after initiation of therapy. Six patients had severe hematopoietic toxicity during chemotherapy. Overall, the severe toxicity rate was higher (67%) than in previous studies. Median survival was 35 weeks, the 1-year survival rate was 39%, and the patient who survived the longest died at 68 months. Although this schedule of hyperfractionated radiation and chemotherapy was disappointing, combined experimental radiation approaches plus chemotherapy for localized unresectable adenocarcinoma of the pancreas deserve additional research.
Adenocarcinoma↗
The optimization of radiation therapy and chemotherapy: the price of success.
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Child↗
Radiation therapy for gliomas of the optic nerve and chiasm.
Thirty-three patients with optic glioma seen over a 30-year period were reviewed. Five patients (15%) had tumor confined to the optic nerve, 8 patients (24%) had optic nerve and chiasmal involvement, and the remaining 20 patients (61%) had invasion of contiguous structures as well as chiasmal involvement. Eleven patients (33%) had a history of neurofibromatosis. Two-thirds of the patients had either a biopsy or a partial resection of the tumor, with the remaining one-third being clinically diagnosed. All patients received irradiation to local fields. The median dose was 5040 cGy in 160 cGy fractions. Of patients alive at last follow-up, the median time of follow-up was 12.3 years. The 5-, 10-, and 15-year overall actuarial survivals were 94, 81, and 74%, respectively. Univariate and multivariate analysis were performed on the following clinical variables: extent of primary tumor, extent of surgery, dose of radiation, gender, race, age, and presence or absence of neurofibromatosis. Extension of the primary lesion to the optic chiasm and age less than or equal to 15 years were the only two variables to have statistically significantly inferior 15-year progression free survivals by multivariate analysis. Eighteen (55%) patients had treatment related complications with most involving the pituitary gland. We conclude that postoperative radiotherapy is beneficial in patients with chiasmal involvement and those with incomplete resections. A minimum tumor dose of 4000 cGy is recommended.
Adolescent↗
Caval thrombectomy in a ruptured aortic aneurysm associated with aorto-caval fistula.
Aorto-caval fistula is a rare but recognized complication of an aortic aneurysm. The association of pulmonary emboli has also been described and is attributed to paradoxical embolisation of the atheromatous contents of the aneurysm sac. This report describes a unique case of a fistula associated with a ruptured aneurysm in which a large intracaval thrombus was removed at the time of operation.
Aged↗
Multivariate analysis of prognostic factors in pediatric and adult thalamic and brainstem tumors.
A multivariate analysis of prognostic variables was performed on a retrospective review of 136 patients with presumed or histologically proven primary lesions of the thalamus and brainstem treated by combined surgery and post-operative irradiation or by irradiation alone from January 1950 through December 1983. Overall survival for all patients at 5 and 10 years was 34.4 and 27.8%, respectively. Follow-up of 33 living patients ranged from 3 to 22 years. Prognostic variables analyzed by univariate analysis and found to be of significance (p less than 0.05) were race, duration of symptoms, extent of surgery (i.e. subtotal excision), and dose of irradiation. Further evaluation by Cox regression analysis revealed these same factors to be of prognostic significance (p less than 0.05). It is of importance to note that age and tumor site were not significant prognostic variables in the multivariate analysis but were significant by univariate analysis. The 5-year overall survival for patients with thalamic tumors was 59.5 and 20.9% for children and adults, respectively (p = 0.006). The 5-year overall survival for patients with pontine lesions was 46.6 and 16.0% for adults and children, respectively (p = 0.01). Only one patient was known to have expired due to a complication of therapy. Neurologic deficits and functional ability was normal or mild in 57.6% of the surviving patients.
Adolescent↗
White blood cells and venous ulceration.
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Humans↗