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Biomedical subjects

W Duncan

Publications and source records attributed to W Duncan.

At least 109 records · Page 6Linked to original sources
PubMed1984

Subsequent malignancies in patients irradiated for testicular tumours.

897 patients received radiotherapy in Scotland for tumours of the testis between 1950-1969. 299 patients who died within two years of treatment, and a further 51 patients with inadequate follow-up data, were excluded from a survey of the incidence of second tumours. 547 patients with a mean follow-up of 15.4 years were included in the study. Fifty-one second and six third malignancies were found. The observed incidence is significantly higher than expected (ratio 1.87; p less than 0.001), both in the irradiated sites (ratio 1.94; p less than 0.05) and in unirradiated sites (ratio 1.99; p less than 0.01). These patients have a higher incidence of second testicular tumours (ratio 23.1; p less than 0.001). Analysis of the incidence of new malignancies in successive quinquennia after irradiation shows a significantly higher incidence in two periods. Within five years the greater incidence (p less than 0.05) is due mainly to the occurrence of second testicular tumours. In the period 15-19 years after irradiation the higher incidence (p less than 0.01) is accounted for by tumours arising in the urinary and gastro-intestinal tracts. The increased risk of developing a second cancer is low and there was no observed increase in radiation-related leukaemia.

Adolescent↗
PubMed1983

Extragonadal presentations of germ cell tumours.

This study reviews our experience over the past 25 years with unusual presentations of germ cell tumours and emphasises the need to consider the diagnosis of germ cell malignancy in any male patient who presents under the age of 60 years with a retroperitoneal or mediastinal tumour reported to be an "undifferentiated carcinoma" of apparently unknown origin.

Adult↗
PubMed1983

Circadian rhythm disturbances in manic-depressive illness.

Clinical features of manic-depressive illness, such as diurnal variation in mood, early morning awakening, and cyclicity and seasonality of recurrences, have led to speculation that the circadian system may be involved in its pathophysiology. At least three types of circadian rhythm abnormalities have been described in such patients: blunting of circadian rhythms' amplitudes, advanced position (or even nonentrainment) of circadian rhythms' phases, and doubling of the length of the sleep-wake cycle from 24 to 48 h. Several types of experiments indicate that alterations in the timing of sleep and wakefulness relative to other circadian rhythms (i.e., changes in internal phase relationships) may trigger the onset or offset of episodes of depression and mania. Whether drugs used to treat manic-depressive illness act through their effects on the circadian system is currently being investigated. Direct manipulations of the circadian system are also being investigated as new approaches to treatment.

Bipolar Disorder↗
PubMed1982

Results of radical radiotherapy of squamous cell carcinoma of the oesophagus.

A retrospective study was undertaken of 444 patients who were referred with squamous cell carcinoma of the oesophagus during the period January 1956 to December 1974 and who were treated by radical radiotherapy. The overall crude survival rate at 5 years was 9.0% which is similar to the results of most series reported from other centres and compares favourably with the results of radical surgery. The crude 5 year survival rate was 5.7% for males and 11.6% for females, a significant difference (P less than 0.05). Survival is analysed in terms of sex, site, size and histological grade. Patients (males and females) with the best 5-year survival rates had tumours no more than 5.0 cm in length (11.9%) or confined to the cervical oesophagus (18.9%). Histological grade appeared to have no influence on prognosis. The principal morbidity associated with radical radiotherapy is fibrous stricture formation. This occurred in 43.7% of the patients but was usually effectively managed by bouginage.

Adult↗
PubMed1982

The effects of radiotherapy on the integrity of the ureteroileal segment following cystectomy.

Thirty-nine patients treated by cystectomy and ileal loop diversion for carcinoma of bladder were divided into 3 groups: A. cystectomy alone, B. cystectomy combined with pre-operative irradiation, C. Salvage cystectomy following radical radiotherapy. The post-operative complications and subsequent function of the ureteroileal segment of the urinary diversion were compared in the 3 groups. Those having primary cystectomy had the fewest complications and best long-term function, whilst those having surgery within 12 months of radical radiotherapy had the highest incidence of ureteroileal obstruction. The possible aetiology is discussed.

Female↗
PubMed1980

Bipedal lymphography in the management of bladder cancer.

Bipedal lymphography was performed in 91 patients with transitional cell carcinoma of the bladder. Equivocal reports were submitted in 18 (19.8%) examinations. In this series 18 (19.8%) of the patients died within one year of first treatment by radical radiotherapy. The prognosis was poorer in patients with more locally advanced tumours, in whom there was a higher proportion of abnormal lymphograms. An abnormal lymphogram was also related to a poorer prognosis than if the lymphogram was normal. This difference was greater when associated with a poorly differentiated cancer. The implications for management are discussed.

Carcinoma, Transitional Cell↗
PubMed1980

1978 Gordon Richards memorial lecture. Assessment and management of bladder cancer.

The importance of radiology in the assessment of patients with bladder cancer is discussed. Particular mention is made of the contribution of excretory urography, lymphography and sonography. The result of treating 222 patients with transitional cell cancer of the bladder by megavoltage irradiation is reported. A case is made for a re-evaluation of primary radiotherapy, particularly for deeply invasive (T3a) and extra-vesical cancers (T3b) without fixation or spread to other organs. Radiotherapy alone may produce results as good as surgery for well-differentiated grades of tumor. Patients with locally advanced, poorly-differentiated (Grade III) cancers require systemic chemotherapy in addition to local radiotherapy, because of the high probability of latent disseminated disease.

Aged↗
PubMed1979

Phase advance of the circadian sleep-wake cycle as an antidepressant.

Sleep in depressed patients resembles sleep in normal subjects whose circadian rhythms of temperature and rapid-eye-movement sleep are phase-advanced (shifted earlier) relative to their sleep schedules. If this analogy is relevant to the pathophysiology of depressive illness, advancing the time of sleep and awakening should temporarily compensate for the abnormal timing of depressed patients' circadian rhythms. Four of seven manic-depressive patients studied longitudinally spontaneously advanced their times of awakening (activity onset) as they emerged from the depressive phase of their illness. In a phase-shift experiment, a depressed manic-depressive woman was twice brought out of depression for 2 weeks by advancing her sleep period so that she went to sleep and arose 6 hours earlier than usual. The antidepressant effect of the procedure was temporary and similar in duration to circadian desynchronization induced by jet lag in healthy subjects. This result supports the hypothesis that abnormalities of sleep patterns in some types of depression are due to abnormal internal phase relationships of circadian rhythms.

Bipolar Disorder↗
PubMed1979

Successful separation of depressed, normal, and insomniac subjects by EEG sleep data.

Data from all-night EEG sleep studies were used to distinguish normal subjects, primary depressed patients, and primary insomniac patients. In part 1, we compared 41 normal subjects, 56 depressed patients, and 18 insomniacs. In a univariate comparison with normal subjects, depressed patients showed less total sleep, longer sleep latency, more early morning awake time, more intermittent awake time, less delta sleep, less sleep efficiency, and shorter rapid eye movement (REM) latencies; compared with insomniacs, depressed patients showed greater early morning awake time, shorter REM latency, greater REM index, and greater REM density. Using multivariate discriminant analysis, 82% of the sample were correctly classified by diagnosis: 100% of the normal subjects, 72% of the depressed patients, and 77% of the insomniacs. Eight variables contributed to the multivariate separation of depressed individuals from insomniacs and normals: total sleep time, total recording period, sleep efficiency, sleep latency, early morning awake time, awake time, REM time and REM%. When the discriminant functions were applied to a second group of 18 primary depressed patients, 82% were correctly classified as depressed. These results suggest that primary depressed patients and primary insomniac patients may show relatively characteristic patterns of sleep abnormality.

Adult↗