Tamoxifen as initial sole treatment of localised breast cancer in elderly women: a pilot study.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
C R Mackie
Publications and source records attributed to C R Mackie.
Milk 99Tcm-EHIDA test for enterogastric bile reflux.
The study and clinical assessment of enterogastric bile reflux has been restricted for want of a simple non-invasive test for its detection and quantification. This paper describes such a test in which biliary excretion scintigraphy has been combined and a mild meal provocation. Two of 10 healthy volunteers studied showed probable reflux of approximately 5 per cent of total initial abdominal field activity. Among 73 patients studied, 37 patients showed definite reflux of up to 47 per cent. Reflux occurred in 19 of 22 post-gastric surgery patients and in 7 of 22 patients with peptic ulcer disease, gastritis or gastro-oesophageal reflux. None of 7 patients with 'non-specific' abdominal pain showed any reflux, but 11 of 22 patients with gallstone disease or previous cholecystectomy showed reflux of up to 35 per cent, including 9 of 11 patients with loss of gallbladder reservoir function.
Adult↗
Exogenous gastrin in rhesus monkeys. The effect of 50% distal small-bowel resection on its rate of disappearance.
The rate of disappearance from the circulation of exogenous heptadecapeptide gastrin was studied before and after 50% distal small-bowel resection in four rhesus monkeys. For each study, venous blood samples were drawn during, and at frequent intervals after, a one-hour peripheral venous infusion of synthetic human gastrin 1 given at a constant rate within the range of 0.4 to 2.4 microgram/hr/kg of body weight. The rate of disappearance of infused gastrin was not affected by small-bowel resection (mean half-time before operation, 2.50 minutes; mean half-time after operation, 2.47 minutes). These data indicate that in the rhesus monkey, the rate of catabolism of exogenous gastrin is not decreased after distal small-bowel resection, and indicate that other mechanisms are responsible for the hypergastrinemia and gastric acid hypersecretion observed in this animal model.
Animals↗
Hemorrhage from ileal varices after total proctocolectomy.
We report two cases of hemorrhage from ileal varices developing after total proctocolectomy for chronic ulcerative colitis. Intermittent peristomal bleeding preceded life-threatening hemorrhage from tru ileal varices proximal to the stoma. Management by portacaval shunting was effective and has not resulted in encephalopathy.
Adult↗
The effect of isoperistaltic jejunal interposition upon gastric emptying.
Ten patients with severe postgastrectomy-postvagotomy symptoms, all of whom had the features of vasomotor dumping, underwent gastric emptying studies, using a 300 milliliter meal of 15 per cent dextrose labeled with 99mTc-sulphur colloid. Studies were repeated two to 11 months following remedial operative treatment, using a 12.5 to 15.0 centimeter isoperistaltic jejunal interposition. Preoperatively, all patients had rapid gastric emptying with a typical biphasic pattern. Following isoperistaltic interposition, the rate of gastric emptying was similar to that found in control patients. Gastric emptying reverted to a more normal pattern but, as in the preoperative studies, was best described by a double exponential function, consisting of slow and fast components. Analysis of these particular functions suggests the manner in which isoperistaltic interposition modified the underlying disorder of gastric motility.
Adult↗
Prospective evaluation of some candidate tumor markers in the diagnosis of pancreatic cancer.
As part of a prospective diagnostic protocol, patients suspected of having pancreatic cancer had systemic and portal venous blood samples assayed, in coded batches, for peptide hormones and enzymes thought to be of potential value as tumor markers. An average of 111 patients were tested for each candidate marker. Results were analyzed by dividing patients into three groups according to the definitive diagnoses. These were pancreatic cancer (32% of patients), other cancers (27%), and benign diseases (41%). Although elevated mean levels of fasting plasma glucose and serum alkaline phosphatase were found in the pancreatic cancer group, there were no significant differences in the mean levels of any of the candidate markers studied in the three groups. The diagnostic values of normal and elevated levels of each candidate marker studied have been calculated. None has proven to be as useful as the serum level of pancreatic oncofetal antigen, fasting plasma glucose, or serum alkaline phosphatase in the diagnosis or exclusion of pancreatic cancer.
Alkaline Phosphatase↗
Effect of 50 percent distal small bowel bypass on gastric secretory function in rhesus monkeys.
Six rhesus monkeys had basal acid output and histamine-stimulated maximal acid output measured before and at 10 weeks and 6 months after 50 percent distal small bowel bypass. At each stage fasting serum gastrin was measured in all animals and fasting serum gastric inhibitory polypeptide in two animals. No change in basal or maximal acid output occurred after a sham operation carried out in two of the animals. The mean preoperative basal acid output (0.17 +/- 0.02) increased to 0.49 +/- 0.04 at 10 weeks after bypass (p less than 0.001) and then decreased significantly to 0.33 +/- 0.03 mEq/kg/hour at 6 months (p less than 0.001). Preoperative maximal acid output (0.43 +/- 0.06) increased to 0.76 +/- 0.10 mEq/kg/hour at 10 weeks (p less than 0.001) and remained at that level at 6 months. Small bowel biopsy specimens at 6 months showed characteristic changes in both proximal and distal small bowel segments. Fasting gastrin and gastric inhibitory polypeptide levels did not change significantly during the study. A comparison of these results with those obtained after 50 percent distal small bowel resection in a previous study revealed a similar proportional increase in maximal acid output in both early (resection, 78 +/- 20 percent; bypass, 77 +/- 23 percent) and late postoperative studies (resection, 57 +/- 14 percent; bypass, 74 +/- 19 percent). However, the early increase in basal acid output after resection (370 +/- 50 percent) was sustained and was significantly greater (p less than 0.005) than the early ill-sustained increase (188 +/- 24 percent) after bypass.
Animals↗
Value of new diagnostic aids in relation to the disease process in pancreatic cancer.
An assessment was made of the diagnostic value of six tests done on 28 patients who proved to have resectable and 45 patients who had non-resectable pancreatic cancer. Ultrasonography and endoscopic retrograde cholangiopancreatography (ERCP) were the most sensitive tests for the diagnosis of resectable tumours. Ultrasonography was slightly, and cytology definitely, better for the diagnosis of resectable tumours than for the diagnosis of non-resectable tumours. Computerised tomography, angiography, and scintigraphy were not effective means of diagnosing resectable tumours. The differences in diagnostic sensitivities of the tests for resectable and non-resectable disease are probably due to variations in pathological features which influence not only the stage of presentation, but also the detectability of the tumour. As long as investigation is limited to patients with symptoms, a large proportion of tumours will not be diagnosed at a resectable stage. However, the results of this study suggest that the resectability rate may be maximised by the early use of ultrasonography in patients with symptoms suggesting cancer in the region of the head of the pancreas, and in patients with vague, non-specific complaints. A combination of ERCP and direct ductal aspiration for cytology is the best means of diagnosing resectable tumours.
Angiography↗
Ultrasonography and tumor-associated antigens. The concept of combining noninvasive tests in the screening for pancreatic cancer.
A total of 134 patients suspected of having pancreatic cancer were given preoperative ultrasonic examinations. A total of 54 cases had a final diagnosis of pancreatic cancer histologically confirmed. The diagnostic sensitivity and specificity of the ultrasonographies were 76% and 91% or 87% and 74%, depending on whether doubtful results were called abnormal or normal. "Doubtful" results were defined as those that stated that pancreatic cancer was "possible" or "could not be excluded." When these results were divided into abnormal and normal groups on the basis of the patients' preoperative serum carcinoembryonic antigen and pancreatic oncofetal antigen levels, the sensitivity and specificity of the combined tests may prove to be a more accurate means of screening patients for pancreatic cancer than ultrasonography alone.
Adenocarcinoma↗
A reappraisal of the value of carcinoembryonic antigen in the management of patients with various neoplasms.
Eight hundred and eight patients with histologically proved malignant disease had carcinoembryonic antigen (CEA) estimations performed at the time of tissue diagnosis. An elevated level was found in 384 of 518 patients with gastrointestinal neoplasms (74 per cent) and in 162 of 290 patients with other neoplasms (56 per cent). No correlation was found between CEA elevations and tumour differentiation. There was a good correlation between tumour staging and CEA levels for patients with colorectal cancer; the more advanced the tumour, the higher the CEA. Several illustrative cases are presented and the role of CEA assay in the diagnosis and management of neoplasia is discussed. CEA assay is a poor screening test for neoplastic disease, but serial CEA monitoring is valuable in the detection of residual or recurrent cancer.
Adult↗
Prospective evaluation of angiography in the diagnosis and management of patients suspected of having pancreatic cancer.
One hundred three patients suspected of having pancreatic cancer underwent celiac and superior mesenteric arteriography which was reported 'blind.' Final diagnosis, operative findings, and resectability of pancreatic cancers were correlated with angiography reports. Forty patients had pancreatic cancer. Thirty-seven of these underwent laparotomy, and 14 (37%) had resectable lesions. Sensitivity and specificity of arteriogrphy for pancreatic cancer were 72% (29/40) and 71% (45/63) respectively. Resectability was unrelated to the angiographic diagnosis. Nonresectability was related to an angiographic finding of definite tumor vessel (4/4), large-vessel encasement (14/7), and major venous pathology (8/11). Only the first of these was unique to pancreatic cancer. Hepatic metastases were detected in only six of 13 patients. Small-artery encasement, arterial occlusion, vessel displacement, and gallbladder distention were not indicators of diagnosis or extent of disease. Major anatomic anomaly of foregut vasulature was revealed in 25% of angiographic studies. Prior knowledge of such anomalies has important bearing on the operative approach to pancreatic resection. We conclude that angiography should be performed prior to laparotomy whenever a resectable pancreatic cancer is suspected from other investigations. When used prospectively, angiography is not a reliable diagnostic or prognostic tool for pancreatic cancer.
Adolescent↗
Non-operative differentiation between pancreatic cancer and chronic pancreatitis.
Eighty-five of 186 patients investigated for suspected pancreatic cancer had an unequivocal final diagnosis of either pancreatic cancer (58 patients) or chronic pancreatitis (27 patients). They had been studied prospectively using ultrasonography, computerized tomography, radionuclide scanning, endoscopic retrograde cholangiopancreatography (ERCP), selective celiac and superior mesenteric angiography, duodenal drainage studies, cytologic studies, serum carcinoembryonic antigen assay, and pancreatic oncofetal antigen assay, The results were compared to determine which test would most frequently and reliably differentiate between pancreatic cancer and pancreatitis in a patient believed to have one or other disease. Criteria for interpreting results, first for highest rate of correct diagnoses, and second for highest accuracy were derived. Applying these criteria, ultrasonography achieved the highest rate of correct diagnoses (97% of patients diagnosed with 84% accuracy). ERCP, duodenal drainage studies, and cytology were the most accurate tests ((86% accuracy each test) but, with this accuracy, ERCP most frequently gave a diagnosis (diagnosis rate: ERCP--70%, duodenal drainage--32%, cytology--35%). The results suggest that ultrasonography is the best noninvasive test, and that a combination of ERCP, pancreatic juice assay and cytology in a single procedure may prove to be the best discriminating investigation.
Adult↗
Surgical treatment of pancreatic cancer.
The problems encountered in the surgical treatment of pancreatic cancer are outlined on the basis of a review of the literature published in the last 15 years and the authors' experience with 157 patients over the period 1970 to 1977. The overwhelming evidence favors resection as opposed to any palliative procedure. Although the number of patients eligible for 5-year follow-up is small, the data suggest that total pancreatectomy with regional lymphadenectomy may be the most appropriate operation.
Biopsy, Needle↗
Prospective evaluation of gray scale ultrasonography in the diagnosis of pancreas cancer.
One hundred thirty-four patients suspected of having pancreas cancer successfully underwent gray scale ultrasound examination of the pancreas. The prospective ultrasound findings were correlated with the final diagnoses, laparotomy findings, and pathology findings. Fifty-four patients had pancreas cancer, confirmed by resection or biopsy in all cases. On ultrasonography, the pancreas was correctly reported to have abnormalities in sixty-one of seventy-eight patients (78 per cent) and correctly reported to have no abnornalities in thirty-eight of fifty-six patients (68 per cent). A correct ultrasound diagnosis of pancreas cancer was made for forty-four of fifty-six patients (81 per cent), and there were thirteen false-positive reports. Ninety-four percent of cancers confined to the head of the pancreas and 70 per cent of cancers at other locations within the gland were detected by ultrasound examination. The correct ultrasound diagnosis was given for fifteen of seventeen patients with resectable pancreas cancer, the degree of associated pancreatitis ranging from minimal to severe. Analysis of the predictive values of positive and negative ultrasound examinations suggests that this test could be used to screen a population of patients with symptoms mildly suggestive of pancreas cancer. The importance of preselecting the level of confidence of a positive test result, a,ove which further investigation is indicated, is emphasized.
Diagnosis, Differential↗
Porto-systemic gradient of immunoreactive parathyroid hormone in man.
Explore the source record for details and available documents.
APUD Cells↗