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S Ashley

Publications and source records attributed to S Ashley.

At least 145 records · Page 8Linked to original sources
PubMed1993

The long-term efficacy of conservative surgery and radiotherapy in the control of pituitary adenomas.

OBJECTIVES: We assessed the long-term efficacy and toxicity of conservative surgery and radiotherapy in the control of pituitary adenomas. DESIGN: Retrospective study of patients treated at the Royal Marsden Hospital. PATIENTS: Four hundred and eleven patients with pituitary adenomas treated with conventional external beam radiotherapy at the Royal Marsden Hospital between 1962 and 1986. Two hundred and fifty-two patients had clinically non-functioning pituitary adenomas, 131 had hormone secreting tumours and in 28 patients the secretory status was not known. Three hundred and thirty-eight patients had surgical intervention of whom only 11 had complete tumour excision. All patients received conventional fractionated external beam radiotherapy to a dose of 45-50Gy in 25-30 fractions. MEASUREMENTS: Actuarial progression free survival and overall survival and assessment of toxicity, particularly in terms of vision, requirement for hormone replacement therapy and incidence of second tumours. RESULTS: The actuarial progression free survival was 94% at 10 years and 88% at 20 years for all patients and 97% at 10 years and 92% at 20 years for patients with clinically non-functioning adenomas. Only secretory status was an independent prognostic factor for disease control. The 10 and 20-year survivals for all patients were 77 and 58% respectively. When compared with the normal population the relative risk of death was 1.76 (P < 0.001) and no prognostic factors for survival were identified. The morbidity of radiotherapy was low. Visual deterioration, assumed to be radiation induced, occurred in 1.5% of patients and the risk of second brain tumour was 1.9% at 20 years. Fifty per cent of patients received hormone replacement therapy by 19 years. CONCLUSION: Conventional external beam radiotherapy as described here combined with conservative surgery is safe and effective in the control of pituitary adenomas. These results should form a baseline for comparison with new treatment strategies.

Adenoma↗
PubMed1993

CVM versus ACE in the treatment of small cell lung cancer.

In an attempt to achieve adequate palliation in patients with small cell lung cancer (SCLC) while keeping toxicity to a minimum, we compared CVM (carboplatin/vinblastine/methotrexate) and standard therapy with ACE (doxorubicin/cyclophosphamide/etoposide). None of the 104 SCLC patients with limited or extensive disease who participated had received previous treatment. After stratification according to disease extent, patients were randomized to receive either CVM or ACE. The maximum number of chemotherapy courses was six. When response rates were compared, ACE was found to be somewhat superior to CVM in terms of objective response [CVM 67%, 95% confidence interval (CI) 54-79%; ACE 88%, 95% CI 80-97%; p = 0.06]; however, a significant difference was evident only among extensive-disease patients. Median response durations (CVM 6 months, 95% CI 5-8; ACE 5 months, 95% CI 3-6) and median survival times (CVM 8 months, 95% CI 7-10; ACE 7 months, 95% CI 4-9) were comparable. CVM met the goal of producing significantly less hematologic toxicity than occurred with ACE. Leukopenia affected 92% of ACE-treated patients and 48% of CVM-treated patients (p = 0.005), and was severe in 80% of the ACE group and 20% of the CVM group. Alopecia occurred much more frequently among those treated with ACE (91 vs. 24%; p < 0.001), as did infection (59 vs. 24%; p < 0.001). The selection of a specific chemotherapy regimen must be individualized. CVM may be appropriate for patients in whom intensive chemotherapy is contraindicated due to performance status, age, concomitant medical disease, or patient refusal.

Adult↗
PubMed1993

Double-blind controlled trial of oral clodronate in patients with bone metastases from breast cancer.

PURPOSE: Osteolytic metastases often give rise to hypercalcemia, fracture, and bone pain, and occur commonly in patients with recurrent breast cancer. We assessed the bisphosphonate, clodronate, which has proven to be a useful treatment for hypercalcemia and may be a potent inhibitor of tumor-induced osteolysis, for its effect on reducing the osseous complications of metastatic breast cancer. PATIENTS AND METHODS: We studied 173 patients with bone metastases due to breast cancer in a randomized, double-blind, placebo-controlled trial of oral clodronate 1,600 mg/d (85 patients) compared with an identical placebo (88 patients). RESULTS: The patients in each wing were comparable in their clinical, radiologic, and biochemical characteristics at trial entry. In patients who received clodronate, there was a significant reduction compared with placebo in the total number of hypercalcemic episodes (28 v 52; P < .01), in the number of terminal hypercalcemic episodes (seven v 17; P < .05), in the incidence of vertebral fractures (84 v 124 per 100 patient-years; P < .025), and in the rate of vertebral deformity (168 v 252 per 100 patient-years; P < .001). The combined rate of all morbid skeletal events was significantly reduced (218.6 v 304.8 per 100 patient-years; P < .001). Trends were seen in favor of clodronate for nonvertebral fracture rates and radiotherapy requirements for bone pain (particularly spinal pain). No significant survival differences and no significant differences in side effects were observed between the two groups. CONCLUSIONS: These findings indicate that oral clodronate has a beneficial effect on the skeletal morbidity associated with breast cancer and should be considered as antiosteolytic therapy in affected patients. It deserves further investigation as an adjuvant therapy in operable breast cancer and in patients with nonosseous recurrence who are at high risk for bone metastases.

Administration, Oral↗
PubMed1993

Adequacy of general anesthesia for cesarean section.

To assess the adequacy of the general anesthesia commonly employed for Cesarean section, we used isolated forearm technique to study 30 parturients (physical status ASA I/II, aged 17-35 yr) scheduled for nonemergent abdominal delivery. Anesthesia was induced with intravenous thiopental (3 mg/kg, 250 mg maximum) and succinylcholine (1.5 mg/kg), and then proceeded with a mixture of 50% N2O, 50% O2, and 0.5% halothane at a flow of 5 L/min and end-tidal CO2 at 40 mm Hg. Paralysis was maintained with a 0.1% succinylcholine infusion. When eyelash reflex disappeared, patients received taped instruction via headphones at 1-min intervals for 10 min. The tapes instructed patients to flex fingers if they were able to hear, to make a fist or squeeze the investigator's hand if they felt pain, to remember six target words, and to respond with specific physical signals during later interviews. Three sets of tapes assigned at random were used in the study. For signs of inadequate anesthesia, other variables such as eye centering, pupil size, sweating, and lacrimation were concomitantly monitored at the time of induction, laryngoscopy/intubation, and skin incision, and then at 1-min intervals for 10 min. Brain activity was also monitored by means of computerized aperiodic analysis of electroencephalogram Lifescan). Patients were interviewed in the postanesthesia recovery room and again 24 h later. At the time of skin incision, 96.7% of patients (29/30) signaled awareness by flexing fingers, 86.7% (26/30) exhibited lacrimation, and 80% (24/30) made a fist or squeezed the investigator's hand, indicating pain perception.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Management of spinal astrocytoma with conservative surgery and radiotherapy.

Twenty-seven patients with histologically verified spinal astrocytoma were treated at the Royal Marsden Hospital with postoperative radiotherapy. All patients had previous surgery; 10 had partial resection and 17 biopsy alone. All patients received involved field radiotherapy to a median dose of 50 Gy in 33 fractions. Overall 5- and 10-year survival was 59 and 52%, and progression free survival was 38 and 26% at 5 and 10 years, respectively, at a median follow-up of 6.5 years. Following radiotherapy, eight patients showed functional improvement, 15 were unchanged and two deteriorated. Sixteen patients relapsed, eleven at the primary site and five elsewhere in the CNS. Low grade histology, female gender and the presence of intramedullary cysts were favourable prognostic factors for survival on univariate analysis. The extent of surgery was not a significant predictor of survival. It is not possible to define the precise role of radiotherapy. However, all patients had residual tumour prior to irradiation, and 53% of low grade and 33% of high grade gliomas remained controlled locally at 3 years with stabilization or improvement in neurological function in all but two patients. This suggests that radiotherapy may result in temporary disease control analogous to cerebral gliomas.

Adolescent↗
PubMed1992

Risk of second brain tumour after conservative surgery and radiotherapy for pituitary adenoma.

OBJECTIVE: To assess the risk of second brain tumour in patients with pituitary adenoma treated with conservative surgery and external beam radiotherapy. DESIGN: Long term follow up of a cohort of patients with pituitary adenoma and comparison of tumour occurrence with population incidence rates. SETTING: The Royal Marsden Hospital. SUBJECTS: 334 patients with pituitary adenoma treated with conservative surgery and radiotherapy (median dose 45 Gy) and followed up for 3760 person years. MAIN OUTCOME MEASURES: Second intracranial tumour and systemic malignancy. RESULTS: Five patients developed a second brain tumour: two had astrocytoma, two meningioma, and one meningeal sarcoma. The cumulative risk of developing a second brain tumour over the first 10 years after treatment was 1.3% (95% confidence interval 0.4% to 3.9%) and over 20 years 1.9% (0.7% to 5.0%). The relative risk of a second brain tumour compared with the incidence in the normal population was 9.38 (3.05 to 21.89). There was no excess risk of any other type of second primary malignancy. CONCLUSIONS: There is an increased risk of second intracranial tumour in patients with pituitary adenoma treated with surgery and radiotherapy. Although radiation is likely to be the most important factor contributing to the excess risk, further study is required in a cohort of similar patients not receiving radiation.

Adenoma↗
PubMed1992

Results of the first year of breast cancer screening in a district hospital.

The Humberside Breast Screening Service completed 1 year of screening by October 1990; 16,534 women were invited of whom 12,832 (77.6 per cent) attended. A group of 644 women (5.0 per cent) were called for further assessment and of these 134 underwent 135 primary surgical procedures. After assessment 25 were shown before operation to have cancer. One hundred and nine women had suspicious lesions and proceeded to surgical biopsy; 50 lesions proved malignant (benign: malignant biopsy ratio 1.2:1). The 75 malignant lesions represented a prevalence of 5.8 per 1000 of the screened population. Invasive cancer > 1 cm in diameter formed almost half of the malignant lesions. This service has cost 32 pounds per woman screened or 5533 pounds per cancer detected. The results are comparable to those of previous studies and suggest that a mammographic screening service can be successfully provided in a district hospital setting.

Biopsy, Needle↗
PubMed1992

Exogenous chromophores for the argon and Nd:YAG lasers: a potential application to laser-tissue interactions.

Chromophore dyes can be employed to modify laser-tissue interaction. A number of dyes have been investigated for their effect on the absorption and transmission of argon and Nd:YAG laser energy by vascular tissue in vitro. Three histological dyes have been assessed as potential chromophores for the argon laser and four infrared dyes for the Nd:YAG. Segments of porcine coronary artery to which dye had been applied were lased (1,064 nm, 2.5 W, 83 W/cm2, 60 s and 488/514 nm, 400 mW, 10.5 W/cm2, 60s) and the tissue temperature measured remotely using an infrared thermometer. In addition, energy transmission was measured with a photodiode and tissue morphological changes assessed histologically. All three argon dyes significantly increased energy absorption (typically 60 degrees C v. 20 degrees C at 60 s, P less than 0.001, 2-way ANOVA). Three of the four infrared dyes behaved similarly (40-70 degrees C v. 20 degrees C, P less than 0.001). All dyes significantly increased the initial rate of rise in tissue temperature during lasing. A reduction in energy transmission was observed for each of the Argon dyes but not for the Nd:YAG dyes. Histological evidence of thermal damage in control tissue first occurred for the argon and Nd:YAG lasers at 800 mW and 7.5 W without chromophore and at 400 mW and 2.5 W with the chromophore, respectively. A number of effective chromophores have therefore been identified at each wavelength.

Absorption↗
PubMed1992

Value of a radionuclide limb blood flow technique in the assessment of percutaneous balloon and dynamic angioplasty.

In a prospective study, a radionuclide technique was used to evaluate the limb blood flow (LBF) changes in 30 patients undergoing dynamic (n = 15) or balloon (n = 15) angioplasty for arterial occlusions or stenoses, respectively. The results were compared with Doppler Ankle Brachial Index (DABI) and treadmill exercise tests. Whilst LBF values (ml of blood flow per 100 ml of limb volume per min) were significantly lower in limbs with arterial occlusion than stenosis (4.5 +/- 0.46 and 6.4 +/- 0.74, respectively; P less than 0.05). DABI provided no discrimination. Immediately after balloon angioplasty, there was a fall in DABI, from 0.60 +/- 0.05 to 0.47 +/- 0.04 (P less than 0.05), which rose 24 h later to 0.73 +/- 0.02 (P less than 0.01). Following dynamic angioplasty, DABI improved from 0.60 +/- 0.05 to 0.66 +/- 0.02 (P less than 0.05). At 3 weeks, the LBF improved from 4.6 +/- 0.66 to 11.1 +/- 0.53 (P less than 0.001) following dynamic angioplasty and from 6.2 +/- 0.68 to 8.53 +/- 0.81 (P less than 0.001) following balloon angioplasty. "Normal" LBF (greater than 10 ml/100 ml per min) was achieved in 80% of patients who underwent successful dynamic angioplasty but in only 36% of the balloon group (P less than 0.05, chi 2-test). Reproducibility of repeated LBF measurements in control limbs was superior to that of DABI. This was indicated by a lower coefficient of variation, 13.8% compared with 25.2%, and a higher correlation coefficient, r = 0.79 compared with 0.27. Treadmill exercise tests were invalid or impossible in 30% of all occasions.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1992

Weight gain after primary surgery for breast cancer--effect of tamoxifen.

Changes in body weight have been studied in 92 consecutive patients with primary breast cancer from the time of initial diagnosis and treatment. Sixty patients receiving tamoxifen were compared with 32 controls receiving no hormone treatment. Weight gain was seen in both groups, but was greater in the group receiving tamoxifen. Premenopausal women receiving tamoxifen had greater weight gain than postmenopausal women on tamoxifen therapy.

Adult↗
PubMed1992

Effects of growth factors on proliferation on basal and luminal cells in human breast epithelial explants in serum-free culture.

A method of culturing human breast epithelium is described in which viable explants can be maintained in protein-free medium while retaining the capacity of responding to added hormones and growth factors for at least 7 days. Culture parameters were chosen to provide maximum sensitivity of detection of proliferative responses by autoradiography. Under basal conditions, the mean thymidine labeling index of the explants was 0.08%. After stimulation with insulin, hydrocortisone, and cholera toxin (I,H,CT), a combination known to stimulate proliferation in human breast epithelium in vitro, the mean labeling index was 15.7%. Stimulation of explants with epidermal growth factor (EGF) and transforming growth factor (TGF)-alpha resulted in mean labeling indices of 6.6 and 10.8%, respectively. Autoradiography at the ultrastructural level demonstrated that in I,H,CT-stimulated explants the majority of the labeled cells were luminal, with only 1.5% being basal cells. In contrast, after EGF and TGF-alpha basal cells accounted for 11.5 and 18.5% of the labeled population. These results indicate that this system provides an in vitro assay of proliferative activity in the normal human breast that enables comparisons to be made between both the luminal and the basal cells in the explants and their counterparts in monolayer culture prepared from flow sorted cells. Thus, growth responses dependent on cell-to-cell interactions or stromal modulation can be identified.

Breast↗
PubMed1992

Radiotherapy for the treatment of recurrent craniopharyngioma.

Twenty-five patients with craniopharyngioma received radiotherapy at the time of recurrence. The 10-year progression free survival and survival from the time of recurrence were 72% and 77% respectively. Nineteen patients underwent surgery prior to radiotherapy (6 partial excision, 4 decompression and 9 cyst aspiration). The extent of resection at the time of recurrence did not influence the outcome. Apart from pituitary failure there was no serious morbidity associated with this approach. The results of radiotherapy at recurrence are similar to those of conservative surgery and radiotherapy at the time of presentation. It suggests that radiotherapy remains an effective treatment modality at the time of recurrence of craniopharyngioma and it may therefore be delayed in situations where immediate radiation is not advisable. However, the high recurrence rate in incompletely excised craniopharyngioma, together with the potential risk of additional morbidity and mortality from undiagnosed progressive tumour and salvage surgery, would argue for a policy of radiotherapy as part of the initial treatment of incompletely excised craniopharyngioma.

Adolescent↗
PubMed1992

Salvage radiotherapy in recurrent Hodgkin's disease.

Forty-four patients with Hodgkin's disease (HD) which relapsed after chemotherapy were treated with salvage radiotherapy (S-RT) with curative intent. Patients were aged 7 to 80 years (median 32 years) at the time of S-RT and the median follow-up from S-RT was 5 years (1-15). Nine patients had recurrent HD following first-line chemotherapy and thirty five patients had refractory HD. Salvage therapy consisted of radiotherapy alone in 25 and combined chemotherapy and radiotherapy in 19 patients. The overall CR rate of salvage therapy was 66%. The overall median survival of 44 patients was 4.6 years from S-RT with 46% 5 year and 40% 10 year survivals. Age (greater than 40 years) and progression free interval (less than or equal to 1 year) were adverse independent prognostic factors for survival on multivariate analysis. The 5 and 10 year progression free survivals were 38% and 23% respectively. Adverse independent prognostic factors for progression-free survival were extranodal site of recurrence and short progression free interval (less than or equal to 1 year). We conclude that radiotherapy with or without chemotherapy has a role in the salvage of patients failing chemotherapy, particularly in those with nodal disease and progression-free interval greater than 1 year.

Adolescent↗
PubMed1991

24-hour survival of autotransfused red cells in elective aortic surgery: a comparison of two intraoperative autotransfusion systems.

Twelve patients undergoing elective aortic surgery had intraoperative autotransfusion using either the Haemonetics Cell Saver or the Solcotrans device. The 24-h post-transfusion survival of the patients' preoperative red cells, labelled with indium-111, was compared with the survival of salvaged red cells labelled with chromium-51. A correction coefficient for the instability of the indium-111 label was calculated from the study of red cell survival in six healthy volunteers. There was no significant difference in the volume of circulating red cells measured using each isotope, indicating that extensive early destruction of the autotransfused red cells does not occur. The percentage survival of autotransfused red cells at 24 h was similar to that of the red cells that had not undergone salvage. Both devices were comparable with respect to the effects of cell salvage on the 24-h survival rate of autotransfused red cells.

Aortic Diseases↗
PubMed1991

Isotope limb blood flow measurement in patients undergoing peripheral laser angioplasty.

A technique of isotope limb blood flow (ILBF) measurement employing Technetium-labelled human albumin and a gamma camera, was used to assess limb perfusion in 19 patients undergoing percutaneous laser angioplasty, both before and one month after treatment. Twenty-three limbs with femoro-popliteal occlusions ranging in length from 3-35 cm (median 8 cm) were recanalized using an Nd-YAG laser and sapphire tipped optical fibre. Primary angiographic success was achieved in 19 lesions of which 6 re-occluded within the first month, and 13 remained patent with relief of symptoms. Clinically successful procedures were associated with a large increase in ILBF. However, normal blood flow was restored in only 54% of limbs. There was a slight decrease in limb perfusion after failed laser angioplasty but this was not statistically significant in this small series. Furthermore, there was no clinically apparent circulatory compromise, or need for urgent surgical bypass in failed cases. We conclude that ILBF is a useful means of assessing patients undergoing laser angioplasty, particularly for detecting small flow changes in patients who are unable to complete a standard exercise test. Its use can be recommended for assessing blood flow changes following other forms of limb revascularization.

Aged↗
PubMed1991

Effective new low toxicity chemotherapy with carboplatin, vinblastine and methotrexate for small cell lung cancer: a randomised trial against doxorubicin, cyclophosphamide and etoposide.

Carboplatin has been incorporated into a new low toxicity combination chemotherapy regimen with methotrexate and vinblastine (CVM) against small cell lung cancer (SCLC). We have compared CVM (carboplatin 300 mg/m2, vinblastine 6 mg/m2, methotrexate 30 mg/m2, all intravenously every 4 weeks) with ACE (doxorubicin 40 mg/m2, cyclophosphamide 600 mg/m2, etoposide 100 mg/m2 all intravenously day 1-3, every 3 weeks) in a randomised trial. 36/54 evaluable patients treated with CVM achieved an objective response (67%) (95% confidence limits [CL] 54-79%) compared with 44/50 treated with ACE (88%) (95% CL 80-97%, P = 0.06). For patients with limited disease treated with CVM, 14/17 (83%) (95% CL 64-100%) had an objective response compared with 14/15 (93%) (95% CL 81-100%) treated with ACE (not significant). Overall median survival was 8 months for CVM and 7 months for ACE. Haematological toxicity was significantly lower for CVM than ACE and consequently dose reduction/delay and infection were less with CVM. Subjective toxicity was low and alopecia was significantly less for CVM than ACE. CVM is an active, well tolerated new chemotherapy regimen for SCLC.

Adult↗