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Biomedical subjects

E Hayward

Publications and source records attributed to E Hayward.

At least 19 recordsLinked to original sources
PubMed1992

The ethical responsibility of the hospital to the environment.

The ethical responsibility of the hospital to the environment is a relatively new concept. It is complex and ever changing as the whole field of medicine continues to evolve. The recent dilemmas of medical waste washing up on beaches and waste-laden barges not finding an accepting port should convince us that this issue is becoming more serious. Responsible change in this area calls for creative and imaginative leadership. It is a terrible contradiction when an institution committed to the health and wholeness of those whom it serves is not also committed to the health and wholeness of the environment.

Alabama↗
PubMed1987

Endocrine therapy for advanced carcinoma of the breast: effect of tumor heterogeneity and site of biopsy on the predictive value of progesterone receptor estimations.

This study was carried out to assess the influence of site of biopsy and tumor heterogeneity upon the value of progesterone receptor (PR) measurements for prediction of response of patients with advanced carcinoma of the breast to tamoxifen or ovarian ablation. One hundred eighty-one assessable patients were studied. Sixty-nine % of responders and 31% of nonresponders were PR positive. The times to progression and survival were not significantly different for responders whether they were receptor positive or receptor negative. PR was measured on operable primary tumors (97), inoperable primary tumors (59), and secondary deposits (69). The proportion of responders who had PR-positive biopsies from these sites was 59%, 88%, and 61%, respectively, and the proportion of PR-positive nonresponders was 30%, 27%, and 42%, respectively. Ten to 12 separate PR measurements were made on seven tumors, and in four of them, there were PR-positive and PR-negative areas which could account for false positive and false negative results. We conclude that the optimum prediction of response was seen when the biopsy was performed on inoperable primary tumors. Errors in prediction of response at this site were, in part, explained by within-tumor heterogeneity of PR; the greater errors in prediction when measurements were made on operable primary tumors or on secondary deposits are presumed to be related to the additional effects of change in receptor status with time and between-tumor-site heterogeneity, respectively.

Biopsy↗
PubMed1987

Endocrine therapy for advanced carcinoma of the breast: relationship between the effect of tamoxifen upon concentrations of progesterone receptor and subsequent response to treatment.

In some cell lines and tumors of mammary origin, tamoxifen causes an increase of progesterone receptor (PR) as a result of its partial estrogen agonist activity. In this study we have assessed the effect of tamoxifen on PR in patients with advanced carcinoma of the breast in order to test if those with a rise in PR are more likely to respond to endocrine therapy. PR was measured before and a median of 13 days after treatment with tamoxifen in a group of 52 patients with either locally advanced (n = 28) or recurrent (n = 24) carcinoma of the breast. Controls were a group of patients with operable disease who had two biopsies with no intervening tamoxifen (n = 51) or with intervening tamoxifen (n = 58). In the test group PR was higher in the second biopsy than the first in 21 patients, and 19 of these responded to continued endocrine therapy (90%). In the remaining 31 patients PR was either lower in the second biopsy (n = 19) or was negative in both biopsies (n = 12), and 11 of the total of 31 patients (35%) responded to continued endocrine therapy. The prediction of response and time to progression was better when both biopsies were taken into account than either the first or the second alone. The prediction of survival was similar for the group selected by an increase in the second biopsy and the group with PR present in the second biopsy. The controls without tamoxifen showed a marked variation in the level of PR in the first and second biopsies, suggesting heterogeneity of PR across the tumors studied. However, the PR level was significantly higher in the second biopsy in the controls given tamoxifen and in the test group compared with those with no intervening treatment (p = 0.031). This study indicates that some effect of tamoxifen upon PR can be demonstrated in human mammary tumors in vivo and that, by taking a second biopsy for PR estimation during treatment with tamoxifen, a more precise indication of subsequent response is obtained. The value of a single estimation of PR before treatment on secondary deposits is limited, and if one biopsy only is performed, it is of greater predictive value if taken after a few days treatment with tamoxifen.

Aged↗
PubMed1985

Alpha 1-adrenergic blockade raises epinephrine-arrhythmia threshold in halothane-anesthetized dogs in a dose-dependent fashion.

The authors determined whether increasing alpha 1-adrenergic blockade resulted in progressively less arrhythmic activity in the canine halothane-epinephrine arrhythmia model. Dogs (n = 7) were anesthetized with halothane (1.5%) in oxygen. Stepwise increases in steady-state plasma levels of either of two alpha 1-adrenoceptor antagonists (droperidol, doxazosin) were produced by applying Wagnerian principles to the known pharmacokinetic parameters of these drugs. At each steady state plasma level of these antagonists, the extent of the alpha 1-adrenergic blockade produced was assessed by defining a phenylephrine (PE) dose pressor response curve. The degree of alpha 1-blockade produced was quantitated as the dose of PE that caused a 25-mmHg increase in mean arterial pressure (ED25) as derived by polynomial regression analysis. By analysis of variance (ANOVA) the ED25 increased significantly for each targeted steady state plasma level of either droperidol (P less than 0.001) or doxazosin (P less than 0.001). For an assessment of the antiarrhythmic activity of these alpha 1-antagonists, the arrhythmogenic dose of epinephrine (ADE) was determined at each of the states of alpha 1-adrenergic blockade previously defined. By ANOVA there was a significant increase in the ADE over the range of alpha blockade produced for either droperidol (P less than 0.001) or doxazosin (P less than 0.001). A close correlation (r2) existed between the ED25 and the ADE for the target steady state levels that were achieved for either droperidol (0.99) or doxazosin (0.74).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Antagonists↗
PubMed1984

Steroid receptors in human meningioma.

It is well recognised that there is an increased frequency of meningioma in women compared with men and that rapid progression of the disease may occur during pregnancy. Recent studies have demonstrated steroid receptors in human meningioma. In this study we have looked for the presence of nuclear and cytoplasmic estrogen receptor (ER) and cytoplasmic progesterone receptor (PR) in 22 cases of meningioma. Radioreceptor assays using a six-point dextran-coated charcoal procedure failed to demonstrate specific ER, but 17 of 22 meningiomas did have specific PR (range 11-314 fmol/mg cytosol protein). Flat-bed isoelectric focusing in agarose gel was used to confirm the results in a few of these cases. We were not able to correlate the presence of receptor with age or sex of patient, or the site of tumour with receptor content. Of the five PR-negative tumors, one was a poor specimen when the histology was examined and two belonged to the angioblastic group (haemangiopericytic variety), a particularly aggressive tumour with a tendency to be more necrotic. The presence of PR in many of these tumours suggests a possible role for hormone therapy where total resection is not possible.

Adolescent↗
PubMed1983

Progesterone receptor measurement by isoelectric focusing: a potential microassay.

Sixty-two selected breast cancers were used to compare the conventional dextran-coated charcoal (DCC) assay with a new method of separating progesterone receptor by isoelectric focusing in flat beds of agarose gel. Ninety assays were performed. Isoelectric focusing indicated correctly the presence of receptor in 92% and the absence of receptor in 86% of assays, when compared with the DCC assay. The relationship between the results of the two methods was linear. Isoelectric focusing underestimated receptor to a variable extent, finding relatively less receptor at higher absolute levels of binding than at lower levels. The lower limit of sensitivity of isoelectric focusing was 30 fmol/ml cytosol. The protein concentrations of cytosols prepared from 46 needle biopsy samples (mean weight 25 mg) ranged from 0.5 to 30 g/l (median 4 g/l, 10th percentile 0.75 g/l). Isoelectric focusing is a satisfactory method of progesterone receptor measurement and can be applied to samples too small for conventional techniques.

Biopsy, Needle↗
PubMed1980

Metastasis to the central nervous system from colorectal cancer.

Eighteen of 78 patients (23%) with metastatic colorectal cancer developed clinically significant metastases to the central nervous system (CNR). The patients developing CNS metastases had a decreased likelihood of associated liver metastases compared to the patients without CNS metastases (22% versus 80%). Pulmonary metastases were present in 55% of patients with CNS lesions and in 25% of those without CNS lesions. Overall survival from diagnosis of the primary tumor was comparable (median, 28 months) for patients with or without CNS lesions. The incidence of CNS metastases was comparable irrespective of Duke stage at presentation. For early lesions (Duke B or C), CNS metastases were associated with a shorter survival (31 versus 42 months). For advanced disease (Duke D lesions) at presentation, the overall survival of the group with CNS metastases was longer (24 versus nine months). Therefore, the longer survivorship of patients with advanced disease may contribute to a greater likelihood of CNS metastases.

Adult↗
PubMed1980

Glycoprotein hormone alpha subunit secretion by pituitary adenomas: influence of external irradiation.

In ninety-nine patients with pituitary adenomas, forty-six with acromegaly, the serum level of the glycoprotein hormone alpha subunit was elevated in eighteen cases. Thirteen of these were acromegalic and one had an FSH-producing tumour. Alpha levels varied little during the day, from one day to the next and over a 6 month period. In twenty-five patients with a variety of other hypothalamic-pituitary disorders examined, one patient with a craniopharyngioma had a mildly elevated alpha level. External pituitary irradiation was followed by an acute and often transient fall in alpha level in several of these patients. Of the fifty-four patients with pituitary adenomas who had received external irradiation before testing, only five had elevated alpha subunit levels compared with thirteen patients of the forty-five who had not been irradiated. This difference in incidence of elevated alpha level was statistically significant (P less than 0.025). We conclude that external irradiation may reduce alpha subunit level chronically in many patients with pituitary adenoma.

Acromegaly↗