Biomedical subjects

P S Dale

Publications and source records attributed to P S Dale.

At least 19 recordsLinked to original sources

PubMed1996

Nipple-areolar preservation during breast-conserving therapy for subareolar breast carcinomas.

OBJECTIVE: To determine if women with subareolar breast carcinoma can be successfully treated by breast-conserving therapy consisting of segmental mastectomy that preserves the nipple-areolar complex, axillary lymph node dissection, and postoperative irradiation. DESIGN: Prospective study. SETTING: Tertiary care cancer center. PATIENTS: Twenty-five patients; median age, 56 years; median tumor diameter, 1.4 cm; and median follow-up, 48 months. INTERVENTION: Breast-conserving therapy for subareolar primary breast carcinoma. RESULTS: Two patients had positive surgical margins of resection, and another patient underwent simple mastectomy after developing a local recurrence. Nipple-areolar distortion was the most common cosmetic deformity after breast-conserving therapy, but overall cosmesis was good. At the most recent follow-up, all patients were free of disease. CONCLUSION: Patients who have small subareolar primary breast carcinomas without evidence of nipple involvement are candidates for breast-conserving therapy with nipple-areolar preservation.

Adult↗

PubMed1996

Improved survival in cervical cancer cases in a rural Indian population.

In the first Rural Cancer Registry in India, 194 cervical cancer cases were registered during 1988-91. The 3 year survival was significantly higher in cases registered in 1990-91 (40.0%), than in those registered in the earlier years (26.6%). This improvement was due to the cancer education activities undertaken by the Registry.

Female↗

PubMed1995

Improved stage at diagnosis of cervical cancer with increased cancer awareness in a rural Indian population.

As part of its strategy to identify cancer cases in a rural population, the cancer registry of Barshi, India, has developed a methodology which includes education of the population about likely symptoms of cancer, and motivation of symptomatic individuals to undergo medical investigation. Patients with cervical cancer from the registry area who attended Barshi Cancer Hospital (84% of the total) showed a significant improvement in stage at diagnosis between 1988-1989 (38% in stages I and II) and 1990-1992 (51% in stages I and II). No change was observed in those attending the same hospital from a control area (38% vs. 34%). Among a random sample of the population of the registry area, 76% of women were aware of the symptoms of cervical cancer, compared with 25% of the population of control areas. It is suggested that action to raise awareness of symptoms of cancer, and to encourage medical consultation, should form an important initial component of cervical-cancer control programmes.

Female↗

PubMed1995

Resection of the inferior vena cava for recurrent Wilms' tumor.

Wilms' tumor is one of the most common solid tumors of childhood. Approximately 500 cases occur annually in the United States, and the overall incidence is 0.8 per 100,000 children per year. Direct involvement of the inferior vena cava occurs in 5% to 10% of cases. The National Wilms' Tumor Study (NWTS), an intergroup cooperative clinical trial, indicates that aggressive primary surgical management combined with chemo-radiation therapy improves (with respect to both survival and recurrence) the long-term prognosis for children who have extrarenal involvement. In addition, aggressive surgical resection may further improve the survival rate for patients with recurrent Wilms' tumor after initial multimodal therapy.

Child↗

PubMed1995

Resection and adjuvant immunotherapy for melanoma metastatic to the lung and thorax.

Although melanoma that metastasizes to distant sites is generally associated with a median survival of only 6 to 8 months, certain metastatic sites including the lung may carry a better prognosis than others. Surgical therapy for pulmonary metastases remains controversial because of the variable survival rates reported for previous small series. To determine the prognosis and optimal management of patients with melanoma with pulmonary metastases, we reviewed our 22-year melanoma database of over 6100 patients. Of 984 patients with metastatic melanoma involving the lung or thorax, 106 underwent resection by posterior lateral thoracotomy or median sternotomy. There were no operative deaths, and the median follow-up period for surgical patients was 55 months. The remaining 878 patients were treated without operation with immunotherapy, chemotherapy, radiation therapy, or a combination. In both treatment groups the male/female ratio was approximately 2:1. The primary lesion's Clark level of invasion and Breslow thickness and the patient's age at diagnosis of metastatic disease were not significantly different between the two groups. The 1-year, 3-year, and 5-year survival rates for surgical patients were 77%, 37%, and 27%, respectively, compared with 32%, 7%, and 3% for nonsurgical patients; these differences were highly significant (p = 0.0001). The highest 5-year survival rate (39%) occurred in those patients with a single metastatic lesion. Sixty-three percent of the surgical patients received some form of immunotherapy, compared with 34% of the nonsurgical patients. Multivariate analysis showed that resection and immunotherapy with a melanoma cell vaccine were both independent predictors of survival (p < 0.0001). These results indicate that the prognosis associated with metastatic melanoma may be less dismal than previously thought when distant metastases involve thoracic sites. We believe that surgical resection is the treatment of choice for patients with melanoma with pulmonary metastases; when combined with immunotherapy, this regimen offers the best chance for long-term survival.

Cancer Vaccines↗

PubMed1995

Desmoid tumor occurring after reconstruction mammaplasty for breast carcinoma.

We present a case of desmoid tumor associated with prior alloplastic breast reconstruction. Wide local excision that includes chest wall resection, if necessary, is the primary treatment of choice. Patients with extensive nonresectable or recurrent disease may benefit from radiation therapy. Systemic therapy is a possibility in certain cases, but its toxicity generally precludes its use with this nonmetastatic tumor. Although this is the fourth reported case of desmoid tumor arising after implantation of a silicone prosthesis, we cannot claim a causal relationship. Careful follow-up consisting of yearly physical and mammagraphic examinations may facilitate early diagnosis and treatment of locally aggressive desmoid tumors but is not warranted, except in the context of routine screening for breast carcinoma.

Aged↗

PubMed1995

Improved axillary staging of breast cancer with sentinel lymphadenectomy.

OBJECTIVE: The authors evaluated the effect of intraoperative lymphatic mapping and sentinel lymphadenectomy (SLND) on the axillary staging of patients with carcinoma of the breast. SUMMARY BACKGROUND DATA: The accurate staging of patients with breast cancer is essential to guide management and determine prognosis. The authors previously reported the feasibility and accuracy of SLND in breast carcinoma. Sentinel lymphadenectomy identifies the first ("sentinel") axillary lymph node draining the site of a primary tumor; because this node is the most likely site of axillary metastasis, histopathologic examination of the sentinel node correlates well with examination of the entire axillary contents. The current study compares SLND with standard axillary lymphadenectomy (ALND) for the staging of breast carcinoma. METHODS: The incidence of axillary node metastasis and micrometastasis in SLND and ALND specimens from patients undergoing operative treatment of a primary breast carcinoma was compared prospectively. Multiple sections of each sentinel lymph node in SLND specimens were examined by hematoxylin and eosin (H&E) staining and by immunohistochemical techniques using antibodies to cytokeratin. One or two sections of each nonsentinel lymph node in ALND specimens were examined by routine H&E staining. RESULTS: One hundred thirty-four patients underwent ALND (ALND group), and 162 underwent successful SLND followed by completion ALND (SLND group). Both groups were similar with respect to age (median, 55 and 54 years, respectively), palpable primary tumors (54.5% and 59.3%, respectively), palpable axillary nodes (5.2% and 7.4%, respectively), size of primary tumor (median, 1.5 cm in each group), and total number of axillary lymph nodes examined (median, 19 and 21, respectively). The number of patients with axillary metastasis was 39 (29.1%) in the ALND group and 68 (42.0%) in the SLND group (p < 0.03). Of these, 4 of 39 (10.3%) ALND patients (3.0% of all ALND patients) and 26 of 68 (38.2%) SLND patients (16.0% of all SLND patients) had micrometastasis (< or = 2 mm), a highly significant difference (p < 0.0005) CONCLUSIONS: Sentinel lymphadenectomy with multiple sectioning and immunohistochemical staining of sentinel nodes increases the accuracy of axillary staging in breast cancer and can identify significantly more patients with lymph nodes metastases, especially micrometastases, than can ALND with routine histopathologic processing of lymph nodes.

Adult↗

PubMed1995

Detection of occult melanoma cells in blood with a multiple-marker polymerase chain reaction assay.

PURPOSE: The objective of the study was to develop a sensitive multimarker polymerase chain reaction (PCR) assay to detect circulating melanoma cells in patient blood. The rationale was that malignant melanoma is heterogeneous in regards to antigen expression. PATIENTS AND METHODS: A PCR assay that uses four melanoma-associated gene markers (tyrosinase, p97, MUC18, and MAGE-3) was developed. Sensitivity and specificity of the PCR assay for individual markers were assessed using 10 melanoma cell lines and peripheral-blood lymphocytes (PBL) from 39 normal volunteers as controls. The assay's sensitivity and specificity were improved using nested primers and Southern blot analysis. Patients (N = 119) with American Joint Committee on Cancer (AJCC) stages I to IV disease were evaluated for circulating melanoma cells using the four gene markers under optimal conditions. RESULTS: All melanoma-associated gene markers were expressed in at least 80% of the melanoma lines, whereas 37 of 39 normal PBL tested negative for all markers; the remaining two PBL were positive for MUC18. Using four markers in the PCR assay was significantly better than using tyrosinase alone. There was a significant correlation between the number of positive PCR markers, AJCC stage of disease, and progression of disease. In all AJCC stages, there were more PCR-positive patients with disease than without disease. CONCLUSION: A multimarker PCR assay is more reliable and sensitive than a single-marker assay for detection of melanoma cells in blood of patients. This assay can provide important insight into tumor progression kinetics without major surgical or conventional radiologic diagnostic procedures.

Antigens, Neoplasm↗

PubMed1994

Variability in early communicative development.

Data from parent reports on 1,803 children--derived from a normative study of the MacArthur Communicative Development Inventories (CDIs)--are used to describe the typical course and the extent of variability in major features of communicative development between 8 and 30 months of age. The two instruments, one designed for 8-16-month-old infants, the other for 16-30-month-old toddlers, are both reliable and valid, confirming the value of parent reports that are based on contemporary behavior and a recognition format. Growth trends are described for children scoring at the 10th-, 25th-, 50th-, 75th-, and 90th-percentile levels on receptive and expressive vocabulary, actions and gestures, and a number of aspects of morphology and syntax. Extensive variability exists in the rate of lexical, gestural, and grammatical development. The wide variability across children in the time of onset and course of acquisition of these skills challenges the meaningfulness of the concept of the modal child. At the same time, moderate to high intercorrelations are found among the different skills both concurrently and predictively (across a 6-month period). Sex differences consistently favor females; however, these are very small, typically accounting for 1%-2% of the variance. The effects of SES and birth order are even smaller within this age range. The inventories offer objective criteria for defining typicality and exceptionality, and their cost effectiveness facilitates the aggregation of large data sets needed to address many issues of contemporary theoretical interest. The present data also offer unusually detailed information on the course of development of individual lexical, gestural, and grammatical items and features. Adaptations of the CDIs to other languages have opened new possibilities for cross-linguistic explorations of sequence, rate, and variability of communicative development.

Birth Order↗

PubMed1994

Early diagnosis of cervical cancers. Our experience at the Rural Cancer Registry, Barshi, India.

In the cervical cancer cases registered at the Cancer Hospital at Barshi, India during 1988-90, 99 of the 105 cases were clinically staged (Total number of cases registered: 136). The annual number of cases were too few for a comparison of stage distribution between the registry years. However, comparison of the proportions of early cases (FIGO Ib, IIa & IIb) in each year, with the corresponding proportion in a large series at the Tata Memorial Hospital (TMH) in Bombay in 1988, showed that the proportions of early cases in 1988 & 1989 (0.31 and 0.35 respectively) were similar to that (0.30) in TMH but in 1990, it (0.50) was significantly higher (P < 0.01). The shift to early stages observed three years after the inception of the Registry is most likely due to the registry activity which involved inter-personal contact with the community and motivation of the symptomatics to undergo a medical investigation. These activities were designed to overcome the adverse conditions for cancer registration prevailing in the rural population. It is suggested that to achieve early diagnosis similar activities be incorporated in the initial phase of a cervical cancer control programme in the country, where cervical cancer is not only the predominant cancer in women but also the cases generally present themselves in advanced stages.

Adult↗

PubMed1994

Experience in screening for cervical cancer in rural areas of Barsi Tehsil (Maharashtra).

The organization of cancer detection camps is gaining popularity in our country and it is therefore necessary to evaluate the effectiveness of this approach in the early diagnosis and treatment of cancer. This to our knowledge has not been done. This report analyses an experience in screening for cervical cancer in rural areas of Barsi Tehsil (Maharashtra). The Barsi Tehsil consists of 134 villages with a population of 34,080 women above the age of 30 years (1982-1987). Of these 2,846 were screened through a series of cancer detection camps between 1982 and 1987. The results of the cytological screening in these women have been presented. An evaluation of the camp approach was carried out by the Population based Cancer Registry set up under the National Cancer Registry Programme (Indian Council of Medical Research) in Barsi, Paranda and Bhum tehsils. It was shown that acceptance of cytological screening was poor, thereby indicating that the mere holding of camps was not in itself sufficient to motivate the people, to subject themselves to the Pap smear. Certain suggestions which would appreciably increase the acceptance of cytological screening have been put forward.

Adult↗

PubMed1993

Pronoun reversals: who, when, and why?

Seventeen of a sample of 30 precocious talkers aged 1;8 produced at least one pronoun reversal (I/you) during unstructured play. This finding led to an examination of the role of cognitive and linguistic individual differences as well as contextual factors and processing complexity as determinants of pronoun reversal. Contrary to predictions derived from previous hypotheses, there were few differences between reversers and non-reversers, other than higher use of second person forms by reversers. Reversals were more likely to occur in certain contexts: semantically reversible predicates with two noun phrases, and in imitations (though the rate of imitation was lower overall in reversers). We propose that pronoun reversals commonly result from a failure to perform a deictic shift, which is especially likely when children's psycholinguistic processing resources are taxed. Children who did not produce any pronoun reversals tended to avoid pronoun use, especially second person forms. Overt reversal may thus reflect a risk-taking approach to language acquisition, which may be particularly characteristic of precocious children.

Child Development↗

PubMed1992

Stability of the intelligence quotient-language quotient relation: is discrepancy modeling based on a myth?

Diagnostic and service eligibility decisions are often made on the basis of the relation between assessments of cognitive ability and assessments of language ability. A discrepancy between cognitive and language performance, with cognition being higher, is thought to be a positive predictor of ability to benefit from intervention. This triage model assumes reasonable stability of cognitive and language measures over time. We evaluated the stability, over 1- and 2-year periods, of the relation between a cognitive measure and two language measures. We examined whether the cognitive-language relation for these measures changed significantly over time and whether children remained in the same service eligibility category, based on the discrepancy model, over time. Results indicated substantial changes in the cognitive-language relation over time. Children's eligibility for service, based on the discrepancy model, also fluctuated greatly over time. We conclude that a discrepancy model of triage based on broad cognitive and language measures is not an effective means of determining who should receive service. Alternative triage methods were presented.

Child↗

PubMed1991

The validity of a parent report measure of vocabulary and syntax at 24 months.

Parent report can provide valuable information on early child language development for clinical and research purposes. Previous research has documented the validity of parent report as an overall assessment of child language and as a measure of expressive vocabulary. In this project, a newly revised questionnaire for the assessment of vocabulary and syntactic development, the MacArthur Communicative Development Inventory: Toddlers, is evaluated. Twenty-four children at 24 months were seen for a laboratory assessment including the Expressive One-Word Picture Vocabulary Test, the Memory for Sentences subtest of the Stanford-Binet Intelligence Scale: Fourth Edition, and selected items of the Sequenced Inventory of Communicative Development. In addition, a language sample was recorded, from which mean length of utterance and other measures were derived. Concurrent validity correlations demonstrate high validity for parent report in both domains (r = .73-.79), and some ability to differentially assess the two.

Child, Preschool↗

PubMed1991

Effect of preschool integration for children with disabilities.

This study examined the effects of integration and segregation in a special education preschool program for children with mild to moderate disabilities to determine whether initial level of development differentially influenced gains achieved. No main-effect differences between the two groups appeared on several pretest and posttest measures. Aptitude-by-Treatment analyses revealed than higher performing students gained more from integrated classes, whereas lower performing students gained more from segregated classes. The data suggest careful monitoring of lower functioning students to ensure appropriate academic and social stimulation.

Child↗

PubMed1990

Real-time microcomputer-based analysis of spontaneous and augmented labor.

In an attempt to develop a reproducible, objective measure of adequate uterine activity in labor, real-time measurements of intrauterine pressure amplitude and contraction frequency, interval, duration, and integral were made in 54 patients, 11 of whom received oxytocin augmentation. We determined the active pressure integral required per centimeter of cervical dilatation, expressed in kPa seconds, and the mean active pressure, expressed in kPa. The augmented group had a significantly higher mean active pressure integral per centimeter than those in normal labor (P less than .01). There was a trend, which did not reach statistical significance, for subjects who required oxytocin augmentation of labor to develop a higher mean active pressure than those in normal labor. However, the correlation of any uterine contractility index (Montevideo units, Alexandria units, mean active pressure) with progress in labor was poor. We conclude that women with dysfunctional labor require more uterine activity for progress in labor than women with normally progressing labor, and that the computer-derived "area under the curve" is not a better predictor of labor progress than Montevideo units.

Adult↗

PubMed1990

Transuterine ion movement and electrical potential difference in pregnant guinea pigs.

An investigation of the site and mechanism responsible for the maternal-fetal electrical potential difference (PD) was done in 11 anesthetized guinea pigs at 54-56 days gestation. We removed the most distal fetus and placenta from one uterine horn and secured a catheter, thermistor, and Ag-AgCl electrode in the resulting pouch. The pouch was filled with Earle's solution. We placed another thermistor and electrode in the maternal abdomen. The PD between electrodes was monitored continuously; periodic samples of maternal blood and intrauterine fluid were taken. Thirty minutes after the uterus was filled, the PD (uterine cavity negative) averaged 29.6 +/- 4.5 (95% confidence interval of the mean) mV. Over 4 h, intrauterine K+ concentration [( K+]) decreased from 4.9 to 2.6 +/- 0.5 meq/l, against a chemical and electrical gradient. In eight animals, we measured bidirectional Na+ flux using 22Na and 24Na. The flux ratio was not distinguishable from unity despite a significant PD. Our data indicate that the maternal-fetal PD is probably generated by the endometrial epithelium and that Na+ and K+ both move across the epithelium by active transport or cotransport rather than simple diffusion.

Animals↗

PubMed1989

The validity of a parent report instrument of child language at twenty months.

When carefully assessed and analysed, parent report can provide a valuable overall evaluation of children's language at 20 months. Norming information and validity coefficients are presented here for a vocabulary checklist assessment included in the Early Language Inventory. Normative data are provided for fullterm, preterm, and precocious samples, including selected vocabulatory subsets that are indicative of early language learning style. The vocabulary checklist has substantial validity as indexed by correlations with the Bayley Scales of Infant Development and particularly with a language subscale derived from that test.

Child Language↗