Biomedical subjects
Publications and source records attributed to C M Furnival.
A case of acute obstruction of the inferior vena cava after partial hepatectomy for liver injury is described. The underlying haemodynamics and prevention of this complication are discussed.
Four methods of assessment of the quality of life were compared in 100 patients with advanced cancer. All showed highly significant correlations with each other. In particular, a single-item linear analogue self-assessment (LASA) which indicated the patients' general feeling of well-being showed a highly significant correlation with multiple item measures of the quality of life (interviewer-administered and self-administered versions of a 5-item quality of life index, and a 21-item LASA). The LASA indicating well-being was compared in a further 30 patients with a similar single-item LASA in which the term 'quality of life' was used. This comparison again showed a highly significant correlation. It is concluded that a single-item LASA asking the direct question "How would you rate your quality of life today?" is a valid and reliable indicator of the quality of life of patients with cancer.
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We describe sequential response to aminoglutethimide after eventual failure of treatment with tamoxifen in a patient with metastatic breast cancer. We suggest that aminoglutethimide is the next logical hormone therapy for such patients.
The results of a cytoplasmic oestrogen receptor assay in 134 cases of primary breast cancer are reported. Overall, 57% of primary cancers tested were oestrogen-receptor 'positive' (ER+) and attention is drawn to the need for careful initial handling of tumour tissue, to ensure an accurate assay result. ER+ tumours occurred more often and showed higher assay values in postmenopausal compared with premenopausal women and nine of 12 ER+ tumours responded to hormone manipulation when disease recurred. Follow-up of primary disease confirmed that women with ER+ tumours have a better prognosis with a lower risk of early recurrence than those with ER-tumours. It is suggested that clinical validation of the oestrogen receptor assay should precede routine clinical use.
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Nonspecific immunotherapy with monthly intramuscular (IM) injections of Corynebacterium parvum has been investigated in patients with disseminated melanoma. Forty-nine patients were randomized to receive either imidazole carboxamide (DTIC) alone or DTIC plus C parvum. A 24% overall objective response rate was observed, with no significant difference between the response rate or survival of the two treatment groups. Immunologic studies revealed no significant difference between the two groups. One patient undergoing chemoimmunotherapy demonstrated profound pancytopenia which responded to cessation of therapy, but toxic reactions were otherwise minimal. No advantage was obtained by adding IM injected C parvum to standard chemotherapy in the treatment of disseminated melanoma.
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Pathological features such as tumour type, tumour size and lymph node invasion have an important bearing on the prognosis of the patient with breast cancer. It is suggested that such prognostic factors should be considered in the selection of women for post-mastectomy breast reconstruction. The implications of pathological and other factors are reviewed and a summary of favourable prognostic factors is presented.
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Seventy-five women with clinical stage I or stage II carcinoma of the breast have had radionuclide bone scans at the time of presentation and at 6-monthly intervals during a mean follow-up period of 39 months. Patients with evidence of metastases on bone scan, either at the time of presentation or during follow-up, had significantly higher mortality and morbidity rates than those with persistently negative scans. Whatever the clinical stage, breast cancer patients with a positive bone scan have a very poor short term prognosis and local therapy to the breast is inadequate. A plan is outlined which incorporates the patient's bone scan status into the decision to introduce endocrine therapy or chemotherapy.
A study instigated by the British Breast Group and involving 3 centres (Edinburgh, Glasgow and Liverpool) was carried out to compare 3 methods for the estimation of urinary hydroxyproline. No significant difference between the first and the second 24 h urine collection was found for each measure of urinary hydroxyproline, within laboratories and within patient groups. Reliable hydroxyproline studies can, therefore, be performed on one 24 h urine collection. The Grant and Ellis/Goldberg methods gave comparable results and the excretion of hydroxyproline in the urine measured by either of these 2 methods could be used to distinguish cases of breast cancer with osseous involvement (as demonstrated by X-rays) from those without. The Hypronosticon Kit method was found to be unreliable as it has 29.4% false negatives in breast-cancer patients with X-ray demonstrable metastases. The incidence of elevated urinary hydroxyproline excretion in breast-cancer patients with negative X-rays was 11/14 (25%), 5/34 (15%) and 8/43 (19%) for the Ellis/Goldberg, Hypronosticon and Grant methods respectively. No conclusion can be drawn regarding the outcome of this group of patients because of the short period of follow-up.
The effect of prolonged normothermic ischaemia before partial hepatectomy was assessed in 10 dogs. During the period of ischaemia, portal decompression was maintained. The survival rate for animals undergoing 75 minutes of total liver ischaemia was 60 per cent and 2 of the dogs died as a result of hypoglycaemia. High levels of alkaline phosphatase and transaminases in the survivors indicated a severe degree of hepatocyte damage. However, complete restoration of liver mass was noted 6 weeks after partial hepatectomy and was not impaired by the prolonged ischaemia. This study confirms the resistance of the dog liver to ischaemia before partial hepatectomy. The critical period beyond which ischaemia is followed by an increasing number of deaths and severe metabolic upset is in the region of 1 hours.
The dissolving effect of four bile salt solutions (sodium cholate, sodium taurocholate, sodium deoxycholate and sodium chenodeoxycholate) upon gallstones was tested in an in-vitro preparation, using 226 stones from 38 patients. The effect of each solution was measured by recording weight loss in the gallstone at the end of a ten-day period of immersion in the bile salt solution. Sodium deoxycholate and sodium chenodeoxycholate produced the greatest average weight loss in the groups of stones tested with pure bile salt solutions, but the addition of heparin to solutions of sodium cholate and sodium deoxycholate produced a significant increase in weight loss in these solutions. This effect of heparin in the presence of bile salts, in comparison with the failure of heparinized saline to induce weight loss in gallstones, is discussed. Sodium chenodeoxycholate cannot be recommended for clinical use on the grounds of its toxicity, and in view of the possible toxicity of sodium deoxycholate it is concluded that a combination of sodium cholate with heparin is the optimum solution for the dissolution of retained intraduct calculi in vivo.