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Biomedical subjects

W G Jones

Publications and source records attributed to W G Jones.

At least 73 records · Page 4Linked to original sources
PubMed1989

Penis cancer: a review by the Joint Radiotherapy Committee of the European Organisation for Research and Treatment of Cancer (EORTC) Genitourinary and Radiotherapy Groups.

A review of the literature on penis cancer has been undertaken. The disease is rare and most of the cumulative experience is reported in retrospective series. Multi-institutional international collaboration will be needed to study prospectively facets of this disease where controversy presently exists. Suggested areas of research are in the treatment of early invasive tumours, the diagnosis and treatment of inguinal metastases, the improvement of radiotherapy techniques, and the development of effective chemotherapy and effective combinations of therapies. This will potentially lead to a greater degree of organ sparing. Studies of palliation, and aspects of quality of life, are also needed. Public education about the condition and genital hygiene, including the necessity for the early treatment of phimosis, may further reduce the incidence of penis cancer.

Aged↗
PubMed1989

Hepatocellular membrane function during chronic burn injury.

Hepatocellular membrane dysfunction, as indicated by depolarization of the membrane potential, occurs after acute injury and early bacteremia. To determine whether hepatocellular membrane dysfunction occurs in the setting of ongoing thermal injury and infection, Wistar rats were divided into four groups: (1) sham-burned, freely fed controls (FF); (2) rats sustaining approximately 30% total body surface area dorsal full-thickness scald burn (Burn); (3) rats sustaining burns as in group 2 followed by immediate inoculation of 1 x 10(8) CFU Pseudomonas aeruginosa (Burn/Inf); and (4) sham-burned rats pair-fed to the food intake of the Burn/Inf group (PF). On the third and seventh days postburn, body and liver weights were determined. In vivo hepatocellular transmembrane potentials were measured and hepatic ATP, RNA, DNA, and protein contents were assayed. By Day 7, despite greater weight loss in the Burn/Inf group than due to starvation alone (P less than 0.01 Burn/Inf vs FF and PF), hepatic mass was conserved. This was associated with hyperpolarization of the hepatic transmembrane potential (-46.6 +/- 1.5 vs -32.1 +/- 0.6 mV, Burn/Inf vs FF, P less than 0.01) and increases in RNA (141 +/- 9 vs 91 +/- 4 mg/liver, Burn/Inf vs FF, P less than 0.01) and DNA (37 +/- 5 vs 22 +/- 2 mg/liver, Burn/Inf vs FF, P less than 0.05) contents, with no change in ATP or hepatic protein contents. There was a significant hypercorticosteronemia observed in the Burn/Inf group (43 +/- 9 vs 2.8 +/- 0.7 micrograms/dl, Burn/Inf vs FF, P less than 0.01). This hepatic membrane hyperpolarization and augmented RNA content were not secondary to burn or starvation alone as the response in these groups was significantly less than that of the Burn/Inf group. It is suggested that this hepatic membrane hyperpolarization is one mechanism by which hepatic function is maintained during ongoing burn infection in the rat.

Adenosine Triphosphate↗
PubMed1989

Effective palliation of advanced breast cancer with weekly low dose epirubicin.

A single institution Phase II study of weekly low dose epirubicin was performed on patients with advanced breast cancer. They received epirubicin in doses approximating to 12 mg/m2 i.v. each week. Most patients had received prior hormone therapy and five had previous chemotherapy; all were post-menopausal. Only patients with bidimensionally measurable visceral or soft tissue metastatic lesions were eligible for objective assessment of response according to WHO criteria. Forty-two patients were evaluable for response and 46 were evaluable for toxicity. An objective response rate of 43% was observed (95% CI = 27.9-57.8%) confirming that epirubicin is an active single agent in breast cancer. Remarkably little toxicity was seen; 35% of patients reported no toxicity at all. Since this low dose weekly approach was so well tolerated, and yet was effective, useful palliation was achieved in this group of patients.

Adult↗
PubMed1989

Computed tomographic appearances of treated metastatic testicular tumours.

Recent therapeutic advances have considerably improved survival rates in patients with testicular tumours. Computed tomography (CT) permits accurate staging and follow-up monitoring of these patients, and it is important, therefore, to be familiar with the evolution of abnormalities on CT after treatment. This study was undertaken to evaluate these appearances and consider their impact on management. Eighty-three patients with metastatic testicular neoplasms had serial CT scans as part of their management. The average age was 34 years (range 19-66 years) with a mean follow-up period of 30 months (range 3-97 months). Seventy-three patients had nodal disease at some stage: 44% reverted to normal on treatment, with no recurrence, while 30% regressed but did not clear completely. Thirty-six patients had lung lesions: although most responded to treatment persistent abnormality was observed in 39% of cases. Nine patients had extranodal disease. A variable response to treatment is reflected by CT findings that contribute to the development of a follow-up strategy whereby successful therapy may be recognised and residual or recurrent disease confirmed.

Adult↗
PubMed1989

Drug-induced toxic epidermal necrolysis in children.

Nine pediatric patients with drug-induced toxic epidermal necrolysis were treated with a regimen of basic burn care and without the use of steroids or topical or systemic antimicrobial agents. Although septic complications continue to occur frequently, infections are better tolerated when potential iatrogenic sources of decreased host resistance, such as steroids, are eliminated. Neutropenia, gram-negative sepsis, and mortality were all greatly reduced with this regimen, while healing was neither impaired nor prolonged. Thus, steroids and sulfa-containing topical agents should be avoided in the treatment of this disorder.

Adolescent↗
PubMed1989

Tracheostomies in burn patients.

The use of tracheostomies in burned patients with inhalation injuries is now reserved for specific indications rather than as prophylactic airway management. A 5-year burn center experience with tracheostomies used in this fashion is presented. Ninety-nine tracheostomies were performed in 3246 patients who had indications of prolonged respiratory failure or acute loss of airway. Although colonization of the sputum was universal, neither rates of pulmonary sepsis nor mortality were significantly increased in patients who underwent tracheostomies. Twenty-eight patients developed late upper airway sequelae, including tracheal stenosis (TS), tracheoesophageal fistula (TEF), and tracheoarterial fistula (TAF). Duration of intubation correlated only with development of TAF, whereas patients in whom TEF developed were significantly older and more likely to have evidence of tracheal necrosis at the time of tracheostomy. The pathogenesis of upper airway sequelae in these patients as divergent responses to the combined insults of inhalation injury, infection, and intubation is considered.

Burns↗
PubMed1989

Clostridial sepsis and malignant disease.

To address the significance of clostridial bacteremia in surgical patients, the bacteriologic records of the New York Hospital from an eight year period were reviewed. Of 1,708 patients who underwent surgical treatment with positive blood cultures, 23 (1.3 per cent) with clostridial bacteremia were identified. Twenty-one of the 23 patients manifested clinical signs of sepsis at the time of clostridial bacteremia consisting of fever, leukocytosis or hypotension. Fourteen patients had intra-abdominal sources of bacteremia and eight of these had either a diverticular abscess or colorectal perforation. The over-all mortality rate was 43 per cent, with all deaths resulting from uncontrolled sepsis. An association between clostridial bacteremias and malignant disease has been described. Thirteen malignant diseases were identified in 12 of the 23 patients reported herein. Carcinoma of the colon and rectum was the most frequently associated malignant condition, but a wide variety of other malignant diseases were also identified. The diagnosis of underlying malignant disease was known prior to the clostridial bacteremia in ten patients and unknown in two. None of the patients were receiving chemotherapy or radiation therapy at the time of bacteremia. Three different Clostridium species were isolated in patients with underlying malignant disease, supporting an association between malignant conditions and other Clostridium species as well as Clostridium septicum. The identification of clostridial bacteremia in surgical patients warrants both aggressive treatment of the septic state and a thorough search for associated malignant lesions.

Adolescent↗
PubMed1988

Urological manifestations of acute appendicitis.

The diagnosis of appendicitis may be difficult to establish even for the experienced surgeon. Considerable variability in presenting symptoms and signs, resulting in part from the numerous locations in which the appendix may be found, contributes to diagnostic insecurity. Appendicitis that mimics acute disorders of the genitourinary tract is a rare cause of diagnostic confusion. The association of appendicitis with abnormal urinary sediment or ureteral obstruction has been reported previously. We report 3 cases of proved appendicitis that presented with other symptoms suggestive of acute urological disorders (gross hematuria, acute prostatis and acute pyelonephritis). While gross hematuria caused by appendicitis has been reported previously, cases of appendicitis mimicking acute prostatitis or rupture of a renal calix with extravasation of urine following ureteral obstruction have not been described. Recognition of unusual manifestations of appendicitis is essential in current surgical practice. Appendicitis should be included in the differential diagnosis of acute urological disorders.

Acute Disease↗
PubMed1988

Is there a place for chemotherapy in advanced prostatic cancer?

The cure of adult solid tumors with chemotherapy remains illusive. However, useful palliation and survival prolongation are possible in a number of cancers. Chemotherapy can have major side effects, and a balance must be struck between the likely benefits and expected toxic effects and inconveniences of the therapy to the patient. The biology of prostate cancer is extremely variable, ranging from a condition causing little or no inconvenience, to a progressive, debilitating, rapidly fatal illness. For this latter group of patients, particularly those resistant or unresponsive to hormone therapy, chemotherapy is a therapeutic modality with potential for halting or reversing the disease process. Considerable effort has been expended in the last 15 years searching for useful drugs. The patterns of metastatic disease in prostate cancer make the assessment of response exceedingly difficult, and the results of different studies, showing widely divergent results, difficult to interpret. When strictly objective criteria are employed, very few drugs show worthwhile activity, with only mitomycin-C, doxorubicin, and cis-platinum exhibiting 20% plus response rates. Further effort is needed to identify useful drugs, but consideration must also be given to the effect of therapy on the patient's quality, as well as duration, of survival.

Adult↗
PubMed1987

Histopathology in the prediction of relapse of patients with stage I testicular teratoma treated by orchidectomy alone.

259 patients with stage I non-seminomatous germ-cell testicular teratoma who were treated by orchidectomy alone and monitored at one often centres in the United Kingdom were followed for a median of 30 months. 62 of the 70 relapses occurred in the first 18 months after orchidectomy. The 2-year relapse-free rate was 74%, falling to 68% at 4 years. Histological sections from 233 of the orchidectomy specimens were reviewed centrally. Four features independently predicted relapses: invasion of testicular veins, invasion of testicular lymphatics, absence of yolk-sac elements, and presence of undifferentiated tumour. An index, based on the number of these features observed, identified a high-risk subgroup of 55 patients who had a 42% relapse-free rate at 2 years.

Follow-Up Studies↗
PubMed1987

Multivariate analysis of prognostic factors in patients with disseminated nonseminomatous testicular cancer: results from a European Organization for Research on Treatment of Cancer Multiinstitutional Phase III Study.

Univariate and multivariate linear logistic regression analyses of potential prognostic variables have been performed for 163 patients with disseminated nonseminomatous testicular cancer, treated with cisplatin, vinblastine, and bleomycin in a multicenter study of the European Organization for Research on Treatment of Cancer Genito-Urinary Tract Cancer Cooperative Group. With a multivariate analysis, four prognostic groups with complete responder rates of 100, 89, 41, and 18%, respectively, were identified based on three prognostic factors: trophoblastic elements in the primary tumor, serum concentration of alpha-fetoprotein, and lung metastases by size and number. However, with a univariate analysis the logarithm of the beta subunit of human chorionic gonadotrophin (BHCG) was the single most important factor. This model aids the physician in selecting prospectively good risk patients who are candidates for low toxicity chemotherapy and poor risk patients with whom innovative treatment should be attempted.

Analysis of Variance↗