Search PubMed⌕ Search

Biomedical subjects

S Kay

Publications and source records attributed to S Kay.

At least 91 records · Page 5Linked to original sources
PubMed1988

Late presentation of ulcerative colitis in ex-smokers.

Details of the smoking history were obtained from 288 patients with ulcerative colitis who were more than 15 years of age when colitis developed. Men who had previously smoked presented with colitis at a later age than lifelong non-smokers (mean age difference 15.2 years). The proportion of ex-smokers in this group of patients with colitis was more than twice that expected in the general population. The interval between cessation of smoking and subsequent onset of colitis in ex-smokers was found to be relatively short and in two-thirds of patients occurred within seven years. A tentative model to explain the association between smoking and subsequent colitis is proposed. We suggest that whilst current smokers may have a lower incidence of colitis, ex-smokers appear to be at increased risk of developing the disease. An alternative explanation is that smoking may act in a manner analogous to sulphasalazine.

Adult↗
PubMed1988

Principles in the management of pediatric intestinal leiomyosarcomas.

Primary intestinal leiomyosarcomas in children are unusual tumors with little known about their natural history. Two patients (aged 9 and 10 years) with leiomyosarcoma of the jejunum treated at our institution are reported and added to the 20 other patients reported in the literature. The first patient had a grade 1 leiomyosarcoma completely resected, received no additional therapy, and remains alive with no evidence of disease 14 years later. The second patient presented with a perforated grade 2 leiomyosarcoma which was incompletely resected; he received combination chemotherapy with an initial good response, but eventually died from sarcomatosis 7 years after initial diagnosis. The 22 cases of pediatric intestinal leiomyosarcoma presented more commonly with obstruction or perforation, were able to be completely resected more often, and appear to have a better prognosis than in adults. Thus, intestinal leiomyosarcomas in children appear to have a natural history different from that of the same tumor arising in adults.

Child↗
PubMed1988

Endometrial carcinoma arising in a large polypoid adenomyoma of the uterus.

A case of endometrial carcinoma arising in a large adenomyomatous polyp is described in a 75-year-old woman. The malignant element appeared to be a mixed adenosquamous carcinoma that was embedded in diffuse adenomyomatous infiltration. The lesion was entirely intramural, and the surface endometrium was atrophic and not neoplastic. The absence of endometrial involvement led to a 6-year delay before hysterectomy was carried out. Pathologic study of the radically excised uterus showed evidence of metastasis to one paraaortic lymph node. Since this appears to be the first example of such an event, the English literature was reviewed for the associated findings of adenomyosis and carcinoma in an intramural setting with noninvolvement of the surface endometrium.

Adenocarcinoma↗
PubMed1987

Gastrointestinal sarcomas. Analysis of prognostic factors.

Clinical and pathologic data from 51 patients with primary sarcomas of the gastrointestinal tract treated from 1951 through 1984 were reviewed to determine clinical presentation, histologic features, treatment, and prognostic factors. The most common signs and symptoms were abdominal pain (62%), gastrointestinal bleeding (40%), and/or abdominal mass (38%). The primary site was stomach in 50%, small bowel in 30%, colorectum in 15%, and esophagus in 5%. Virtually all the sarcomas were leiomyosarcomas. Distribution was uniform among the three histologic grades; although 88% of Grade 1 tumors could be completely excised, only 35% of Grade 3 tumors could be completely resected. The 5-year survival rate was 75% for Grade 1 tumors, 16% for Grade 2 tumors, and 28% for Grade 3 tumors (p = 0.0013, Grade 1 vs. 2 and 3). Thirty of the 51 patients (59%) had curative resection with an operative morbidity rate of 24% and an operative mortality rate of 12%; at 5 years the disease-free survival rate was 58% and the overall survival rate was 63% (48% at 10 years). Eleven patients (42%) had recurrent disease develop at a median interval of 2 years after complete tumor excision. Twenty-one patients (41%) had partial excision or biopsy only of their tumors with an operative morbidity rate of 28%, operative mortality rate of 8%, and median survival of only 9 months. Overall, patients whose tumors were confined to the site of origin had a 58% 5-year survival rate compared with 20% for those whose tumors had invaded adjacent organs (p less than 0.05). If the tumor was less than 10 cm in size, the 5-year survival rate was 78%, significantly better than the 38% for tumors greater than 10 cm (p = 0.03). These data suggest that histologic grade, local invasiveness, size, and extent of resection are the most important prognostic factors for patients with primary gastrointestinal sarcomas. Patients who have resection of all gross tumor, especially if it is well differentiated and localized, have a good prognosis.

Adolescent↗
PubMed1986

Trial of strategy for reducing the use of laboratory tests.

Clinical guidelines and a weekly review of medical records were introduced into a medical unit in a teaching hospital to promote a more discriminating use of laboratory tests. This strategy resulted in an immediate reduction in the average number of requests each week from 74 to 27 haematological tests (64%) and 158 to 58 biochemical tests (64%). During a period of 10 weeks after the strategy was introduced (the intervention period) the mean number of haematological tests for each person decreased from 2.0 during the baseline period to 1.1 (45% reduction; p less than 0.01) and the mean number of biochemical tests decreased from 4.4 to 2.7 (39%; p less than 0.0001). The decrease in the number of repeat requests was greater than that for new requests and accounted for half the reduction in use. There was no significant change in the number of tests requested from an adjacent medical unit that was not exposed to the interventions. This strategy is worthy of trial in other specialties and hospitals, but attention will have to be paid to possible difficulties in sustaining reductions in use over long periods of time.

Clinical Laboratory Techniques↗
PubMed1986

The effect of a novel thromboxane synthetase inhibitor dazmegrel (UK38485) on random pattern skin flaps in the rat.

In the light of work (Emerson and Sykes, 1981) suggesting a protective effect of prostacyclin on the random pattern dorsal skin flap of the rat, the ability of dazmegrel, a novel thromboxane synthetase inhibitor, to protect against ischaemic necrosis in similar flaps has been assessed. No such protective effect could be demonstrated and a possible explanation of the earlier observations is offered.

Animals↗
PubMed1986

Microtubular aggregates within rough endoplasmic reticulum: an unusual ultrastructural feature of extraskeletal myxoid chondrosarcoma.

Two extraskeletal myxoid chondrosarcomas were examined by electron microscopy. In addition to the well-described ultrastructural features indicative of chondroblastic origin, both of these chondrosarcomas had unusual parallel microtubules packed within rough endoplasmic reticulum. This paper reviews the differential diagnosis of extraskeletal myxoid chondrosarcoma and discusses ultrastructural examination as a valuable adjunct in the diagnosis of this uncommon soft tissue tumor.

Chondrosarcoma↗
PubMed1986

Localized primary (AL) amyloid tumor of the breast. Cytologic, histologic, immunocytochemical and ultrastructural observations.

Two examples of localized primary amyloid tumor of the breast are presented, including one patient with metachronous bilateral lesions. Our findings and review of the literature indicate that this rare lesion occurs predominantly in elderly females and can be mammographically and clinically confused with carcinoma. Fine-needle aspiration biopsy can be a useful procedure to make a preliminary diagnosis. Congo red staining with prior potassium permanganate incubation confirmed the AL type of amyloid in our two cases; this might be the predominant type in the localized form involving the breast. Immunofluorescence studies demonstrated IgA, with kappa and lambda light-chain deposition within the amyloid foci in one case, and intracytoplasmic IgG with both light chains within plasma cells and amyloid deposits of the second case. Ultrastructural examination of one of the cases showed characteristic findings of straight, nonbranching fibrils of 4-9 nm, diagnostic of amyloid. From our findings and a review of the literature, we conclude that amyloid tumors of the breast can occur in three separate settings: secondary amyloidosis, systemic or multiple myeloma associated amyloidosis, and as a localized primary type having a benign course.

Age Factors↗
PubMed1985

Prognosis of level V malignant melanoma.

Level V melanomas have been reported to have a poor prognosis, but in-depth analyses of prognostic factors and treatment have not been reported. From 1952 through 1982, 41 patients presented with primary Clark's Level V melanomas. There were 23 patients who presented with clinical Stage I disease and 18 with Stage II. Among Stage I patients, 9 were treated by wide excision alone and 13 underwent wide excision plus prophylactic regional lymph node dissection (RLND); 8 of 13 patients had histologically positive nodes. Twelve Stage II patients were treated by wide excision and RLND (including three hemipelvectomies), and four refused surgery. The 5-year survival was 52%. For Stage I patients, survival was 62% and disease-free survival (DFS) 28% at 5 years; 6 of 10 recurrences were local or regional only. Prophylactic RLND reduced the incidence of recurrence but did not appear to influence survival rates. Among 14 evaluable Stage II patients, overall survival was 60% and DFS 42% at 3 years; of 4 patients who subsequently had a recurrence, 3 had distant metastases. All seven patients with distant metastases at the time of first recurrence died of disease within 14 months (median, 4 months) of detection of metastatic disease. Primary melanomas of the foot (11 patients) and trunk (4 patients) appeared to have a worse prognosis than other sites. Ulceration (seen in 21 patients) did not appear to significantly influence outcome. These data suggest that most patients with Level V melanoma present with clinically localized disease. Prophylactic RLND did not significantly affect overall survival. The invasiveness of these deep tumors appears to reduce the influence of other factors, including primary site, sex, race, and ulceration. The prognosis of patients with Level V melanoma, even with clinically or histologically positive lymph nodes, is not hopeless, and these patients should be treated aggressively.

Actuarial Analysis↗
PubMed1985

Syndrome of inappropriate secretion of antidiuretic hormone after severe head injury.

This study is based on 109 patients with severe head injury who had a Glasgow coma score equal to or less than 7 and a Liège coma score equal to or less than 12 in the first 24 hours. The syndrome of inappropriate secretion of antidiuretic hormone seems to us to be a frequent complication of severe craniocerebral trauma. It has been discovered in 33% of our patients. On the other hand, diabetes insipidus was rarely diagnosed (2.8%). We propose, in cranial trauma, to subdivide the syndrome of inappropriate secretion of antidiuretic hormone into two clinical forms: an early syndrome (5%) that becomes apparent towards the second day and is significantly associated with lesions at the base of the skull; and a delayed syndrome that occurs at the end of the first week and is related to different factors inherent in intensive care procedures. Surgical intervention, in the case of acute craniocerebral trauma, does not result in a higher frequency of inappropriate secretion of antidiuretic hormone.

Adolescent↗
PubMed1985

Venous occlusion plethysmography in patients with cold related symptoms after digital salvage procedures.

Fourteen patients who had undergone microsurgical salvage of one or more digits were interviewed and examined. An assessment of sensitivity to cold is defined as cold intolerance and correlated with nerve function and arterial inflow measured by venous occlusion plethysmography. No relationship between arterial inflow and cold intolerance nor nerve function was found. There was, however a tendency for worsening cold intolerance to be associated with poorer nerve function. Half the salvaged digits had arterial inflow greater than the contralateral control digit.

Adolescent↗
PubMed1985

Electrical injuries due to railway high tension cables.

We have noted a large number of young boys being admitted to our Unit with burns due to railway high tension cables. On review of these cases we have noted: most of the burns were due to arcing, there is a high level of ignorance among the population at risk. We propose some ways of preventing these injuries.

Adolescent↗
PubMed1985

Flow cytometric determinations of ploidy and proliferation patterns of adrenal neoplasms: an adjunct to histological classification.

Flow cytometric deoxyribonucleic acid measurements were performed with propidium iodide on 7 adrenal neoplasms and 4 normal adrenal glands to determine how useful this technique would be in defining malignancy. The 4 cases classified histologically as carcinoma all had aneuploid stemlines of 2.7, 3.3, 3.4 and 3.6c respectively, whereas the 4 normal glands and an aldosteronoma had only a small percentage (less than 10 per cent) of hyperdiploid cells (greater than 2c) at the tetraploid level (4c). A pheochromocytoma and benign adenoma had significant tetraploid populations of 30 and 18 per cent, respectively, with no evidence of aneuploid cells. Flow cytometry determination of deoxyribonucleic acid ploidy values is an accurate, objective, quantitative mean to identify adrenal malignancy and should have a role in the pathological evaluation of adrenal neoplasms.

Adenoma↗
PubMed1985

Microglandular adenosis of the female mammary gland: study of a case with ultrastructural observations.

A case of microglandular adenosis of the breast in a 75-year-old woman is presented, with emphasis on the ultrastructural features. While the tumor was histologically similar to those reported previously in the literature, certain microscopic aspects suggested malignant change. Ultrastructurally, the characteristic findings were villus interdigitation between epithelial cells, thick basement membranes around individual tubules, and abundant apical lysosomal granules.

Aged↗