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Biomedical subjects

C Stannard

Publications and source records attributed to C Stannard.

14 recordsLinked to original sources
PubMed2001

Localized whole eye radiotherapy for retinoblastoma using a (125)I applicator, "claws".

PURPOSE: To treat children with retinoblastoma, who require whole eye radiotherapy, with a specially designed (125)I applicator that irradiates the eye while sparing the surrounding tissues. METHODS AND MATERIALS: Under general anesthesia, a pericorneal ring is attached to the 4 extraocular muscles, and 4 appendages, each loaded with (125)I seeds, are inserted beneath the conjunctiva in-between each pair of muscles and attached anteriorly to the ring. Twenty-nine eyes were treated. Eighteen received a median dose of 28 Gy during 91 hours and 11 received 40 Gy during 122 hours, when the relative biologic effectiveness was taken as 1 instead of 1.5. Six had received prior chemotherapy. RESULTS: Twenty-four eyes were followed up for 2-157 months (median 29). Although 22 eyes responded, local control was achieved in 13 patients, 3 of whom required additional treatment for new tumors; a further 3 required additional treatment for tumor recurrence as well as new tumors. One of these eyes was enucleated for neovascular glaucoma. All 6 Group I-III eyes and 6 of 18 Group V eyes were retained for 2-157 months (median 39), with good vision in 10 eyes. Three developed cataracts 7, 8, and 12 years later, 1 of which has been removed. CONCLUSIONS: This is a new way of irradiating the whole eye with a minimal dose to the surrounding tissues. The treatment time is only 5 days. It is effective in Groups I-III, but only 33% of Group V eyes retained vision. No late cosmetic defects occurred.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2001

Worry and chronic pain patients: a description and analysis of individual differences.

Patients with chronic pain often report negative and aversive rumination about pain and its consequences. Little is known about how and why patients with chronic pain worry. This study provides a description of worrying by chronic pain patients. Eighteen female and 16 male chronic pain patients reported, over a 7-day period, their experience of pain-related and non-pain-related worry. Results indicated that, in comparison with non-pain related worry, worry about chronic pain is experienced as more difficult to dismiss, more distracting, more attention grabbing, more intrusive, more distressing and less pleasant. Further analyses suggest that these characteristics of worry about chronic pain do not arise from a general disposition to worry or from a general disposition to anxiety. Worry is, however, related to awareness of somatic sensations. These results are discussed within an attentional model in which worry functions to maintain vigilance to threat.

Adult↗
PubMed1997

Attention and somatic awareness in chronic pain.

Empirical methods are used to explore the relationship between chronic pain, somatic awareness and attention. Using a primary task paradigm, 46 chronic pain patients performed an attentionally demanding task. Patients were classified according to self reported pain intensity and the extent of their reporting of the perception of bodily sensations (somatic awareness). Results showed that, as predicted, disruption of attentional performance was most pronounced in those who reported high pain intensity and high somatic awareness. Further analysis revealed that these patients also reported high negative affect. These findings are discussed in terms of their theoretical implications for the concept of hypervigilance and their clinical implications for chronic pain control.

Adult↗
PubMed1992

Improved iodine-125 plaque design in the treatment of choroidal malignant melanoma.

The use and development of iodine-125 plaque therapy for choroidal malignant melanoma are described. Since 1975 experience has led to changes in plaque design and insertion techniques. Twenty-one patients were irradiated with local episcleral iodine-125 plaques. Three patients required a second plaque for tumour recurrence. Four eyes were enucleated because of continued tumour growth and a further eye was removed because of glaucoma secondary to radiation retinopathy. Two patients (9.5%) died of metastases. The remaining 19 patients are alive and clinically clear of metastases, with a mean follow up time of 73.1 months (range 43-142 months).

Adult↗
PubMed1989

Cavernous haemangioma of the head and neck in the adult.

This paper reviews a personal experience of 51 cases seen over a 30 year period. Patients were treated in either a combined Head and Neck clinic or a Combined Ophthalmology clinic and a balanced view is thus represented. A method of grading the severity of the disease is described as well as a method of assessing response. This approach has not been proposed hitherto. It is generally concluded that the preferred treatment for small lesions is excisional surgery and for larger lesions carefully planned and highly localized radiation.

Adolescent↗
PubMed1987

The use of iodine-125 plaques in the treatment of retinoblastoma.

125I has an energy of 27-35 keV which permits highly effective screening and makes it eminently suitable for treating ophthalmic tumours. It was first used for this in 1974 (Sealy et al., 1976), and since then a flexible system has been developed to treat a variety of such tumours including localized retinoblastoma. A gold foil backed plaque is custom built to cover the tumour(s). The turned edges reduce the dose and thus protect vital adjacent structures such as the optic nerve and lens. The iodine seeds are sealed in the plaque in a predetermined position to give the required dose. A range of doses and times have been used but the authors now aim to give a TDF of 100 to the apex of the tumour in two to three days. Ten tumours in the remaining eye of seven patients with bilateral retinoblastoma were treated. The size ranged from 3 X 3 X 2 to 10 X 10 X 6 mm. There were nine complete responses from 17-90 months and a partial response in one patient who died of metastases at ten months. Vision was maintained in all. Eight recurrent tumours in seven patients were also treated together with a subsequent new tumour in one of the patients. There were three complete responses at 28-39 months and six tumours persisted. Vision was maintained in three of seven patients. The only complication was a vitreous haemorrhage which was mild in two patients, moderate in one patient and severe in three previously treated patients. These latter three patients subsequently had the eye enucleated and were found to have recurrent tumour.

Brachytherapy↗
PubMed1987

Improved cosmesis in retinoblastoma patients treated with iodine-125 orbital irradiation.

Patients who are at risk for developing an orbital recurrence after enucleation of the eye for retinoblastoma are those with full thickness choroidal invasion or further extension into the sclera or extension into the optic nerve beyond the lamina cribrosa. The authors have treated these patients routinely with external irradiation to the orbit but this usually resulted in a dry contracted socket that often would not accept a prosthesis. An orbital implant was designed with 125I seeds in an attempt to improve the cosmetic result. It consisted of seven rows of 125I seeds, six of which were partially screened and implanted around the periphery of the orbit so that the contents were irradiated whilst reducing the dose to the bony orbit. The seventh central row was unscreened. A metal disc, with 125I seeds sealed to the posterior surface, was sutured beneath the eyelids thus protecting them and the accessory lacrimal glands. A TDF of 90-100 over two to three days was given. Thirteen patients have been treated, nine prophylactically and four therapeutically. Three of the latter patients have died of metastases but no local recurrences have been seen. All 13 patients were left with a moist socket that accepted a prosthesis.

Brachytherapy↗
PubMed1985

Pineal malignant neoplasm in association with hereditary retinoblastoma.

A patient with unilateral hereditary retinoblastoma who was successfully treated at the age of 7 weeks developed a tumour in the pineal region two and a half years later. The initial response to radiation treatment of the latter lesion was not maintained. Subsequent necropsy findings are described. Clinically and pathologically this case represents an example of the recently described trilateral retinoblastoma. The response to treatment after early recognition was disappointing.

Brain↗
PubMed1980

Progress in the use of iodine therapy for tumours of the eye.

Developments in a new system of brachytherapy for tumours of the eye are reported. This involves the use of 125I sources with special screens and filters to avoid irradiation of vital structures and to produce a homogeneous radiation field. Methods for the treatment of tumours of the lids, conjunctiva, retina, choroid and lachrymal gland have been developed. Sixteen out of 20 treatments appear to have been successful. This system would seem to be a material advance on those previously reported.

Brachytherapy↗
PubMed1979

Retinoblastoma: correlation of invasion of the optic nerve and choroid with prognosis and metastases.

The histological sections of 74 retinoblastoma patients were reviewed. The extent of optic nerve invasion was correlated with choroidal/scleral extension. Choroidal invasion carries 100% survival provided that the sclera, iris, and whole optic nerve are not also involved. Invasion of the optic nerve beyond the lamina cribrosa also carries 100% survival provided that the resection line is free and that invasion does not involve the sclera or iris. Plentiful rosettes were usually found in those tumours that had not extended beyond the choroid or as far as the resection line of the optic nerve and were therefore associated with a good prognosis. The absence of rosettes did not necessarily indicate a poor prognosis. The site of metastases was related to optic nerve and scleral/extrascleral extension. The various systems of staging retinoblastoma are compared, and a new system is proposed to cover the whole spectrum of the disease and to offer a reliable guide to prognosis and treatment.

Choroid↗
PubMedDate not supplied

Ciliary body malignant melanoma in a black child.

Uveal malignant melanoma is uncommon both in children and in black patients. There has been only one previous report of this type of tumor occurring in a black child. This paper presents the case history of a 5-year-old black girl who presented with a mass arising from the ciliary body and choroid. This was found to be a malignant melanoma on histological examination. The difficulties in diagnosis are discussed and the histological features presented.

Black People↗