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Biomedical subjects

E M Chisholm

Publications and source records attributed to E M Chisholm.

33 records · Page 2Linked to original sources
PubMed1987

The relationship between plasma pharmacokinetics and tissue metabolites of 5-fluorouracil (5-FU) in patients with colorectal cancer.

To assess the relationship between the plasma pharmacokinetics of 5-Fluorouracil (5-FU) and the levels of intracellular 5-FU metabolites, we have studied eight patients presenting with primary carcinomas of the colon and rectum. Serum 5-FU levels and fluorinated metabolites within normal and malignant tissue were estimated using chromatographic methods. An analysis of the total fluorinated products against plasma halflife, plasma clearance and maximum plasma concentration failed to demonstrate any significant correlation. Furthermore the differing levels of 5-FU metabolites in normal and malignant tissue could not be correlated with the pharmacokinetic parameters studied. It is concluded that the cellular levels of active 5-FU metabolites reflect local cellular activity rather than the handling of the drug in vivo.

Aged↗
PubMed1986

Post-mastectomy breast reconstruction using the inflatable tissue expander.

Breast reconstruction following mastectomy has previously relied on the insertion of a silicone gel implant or the use of a myocutaneous flap. We report the use of an innovation, the inflatable tissue expander, for both immediate and delayed breast reconstruction in 26 patients where soft tissue cover was inadequate to permit the use of the silicone implant. By serial inflation of the tissue expander with saline, sufficient tissue cover was achieved for a second operative placement of a silicone prosthesis of appropriate volume to match the normal breast. To date, 10 patients undergoing delayed reconstruction and 5 of 16 patients with immediate reconstruction have had their final prosthesis inserted, while 3 women are satisfied with the result of the expandable implant and desire no further surgery. Only two technical complications have arisen with loss of the expander in one patient who had had recent radiotherapy and in another the tissue expander was placed much too high on the chest wall. Mechanical failure occurred in three cases where disruption of the seam led to sudden deflation in two and a slow leak from the injection port developed in one. One patient also attempted self-inflation leading to deflation of the tissue expander. The cosmetic results were subjectively and objectively very good with capsular distortion present in only one case. We feel that the inflatable tissue expander is simple and safe to use, may be used for immediate reconstruction without compromising the ablative surgery and should be a choice available to general surgeons for providing safe and cosmetically acceptable reconstructive surgery.

Adult↗
PubMed1986

The role of a questionnaire and four biochemical markers to detect cancer risk in a symptomatic population.

The roles of a self-completed symptom questionnaire and four biochemical markers of disease were assessed to determine risk for gastric and colorectal cancer from within a hospital population and a random population. Eight-six patients with cancer, 168 subjects with benign conditions of the stomach and large bowel and 720 individuals from the community at large were investigated. Multivariate analyses of the questionnaire and biochemical data were performed individually and in combination using a data set comprising 54 cancer subjects, 80 patients with benign disease and 200 random individuals. The most favourable predictive equation derived was then applied to the remaining data set to determine its efficacy. In the primary analyses the questionnaire data identified 32 (60%) cancers successfully and using the biochemical markers alone 36 (67%) patients were also correctly classified as cancer bearing. However, the combination of the questionnaire and marker data improved the sensitivity for cancer to 50 cancers detected (92%) (P less than 0.02). Using the predictive equation from this combination of data to identify risk in the second data set 28/32 (88%) cancers were correctly identified with only an 11% false positive rate. An 18 month follow-up for the non-cancer group has to date revealed only one cancer (ca. pancreas). In this limited study, multivariate analysis of questionnaire and biochemical marker data does successfully identify individuals at "high risk' of harbouring gastric or colorectal cancer within a symptomatic population and may have a role in determining priority for investigation for a symptomatic individual.

Aged↗
PubMed1986

Incorporation of intermediary products of 5-FU anabolism into colorectal cancer.

In 18 patients intermediary anabolic metabolites of 5-FU were measured in normal colonic mucosa and colorectal cancer tissue of intravenous bolus injection or continuous infusion. Higher total concentrations of 5-FU products were found in the cancers when compared with normal colonic tissue. There appeared to be no evidence, however, that some patients had a selectively increased ability to incorporate 5-FU into their tumours. Overall higher concentrations of tumour incorporation of 5-FU were found after bolus injection rather than the infusion method, although this difference is statistically not significant.

Aged↗
PubMed1985

Validation of a self administered questionnaire to elicit gastrointestinal symptoms.

Self administered questionnaires are becoming popular investigative tools in medical research, yet few reports state the extent of methods used to validate these questionnaires before their general use. A pilot study was therefore carried out to validate a 41 item questionnaire for use in a population screening study for gastrointestinal disease. Participants in the study comprised 69 population controls, 40 patients with benign disease, and 35 patients with gastrointestinal cancer. Acceptability, ease of completion, reliability, and reproducibility of the questionnaire were all assessed. Only one subject refused to complete the questionnaire. Ninety six per cent of the questions were completed by each subject and only one response in 1440 was altered in the reproducibility study. The questionnaire disclosed symptoms similar to those elicited by a clinician and highlighted unreported gastrointestinal symptoms in the control group. Three questions were found to be unreliable and were altered before the questionnaire was put into general use. It is concluded that a pilot study to validate a new questionnaire is simple to perform and necessary to identify unreliable questions.

Gastrointestinal Neoplasms↗
PubMed1984

Priorities for computed tomography in the management of testicular seminoma.

A study to assess the role of computed tomography (CT) in the management of testicular seminoma showed that CT was of value in defining the extent of bulky abdominal disease at initial staging. After radiotherapy for Stage IIc disease, relapse by 1 year was common and predominantly extra-abdominal. Mediastinal relapse was detected by CT in the absence of raised serum tumour markers or changes on the chest radiograph. It was concluded that CT should be used at initial staging only to assess the volume of bulk disease shown by lymphangiography, that no benefit seemed to accrue from CT scanning of Stage I and IIa patients and that the follow-up of Stage IIb and IIc patients requires regular CT surveillance in the first year, irrespective of clinical status.

Combined Modality Therapy↗
PubMed1984

The impact of computed tomography on the management of testicular teratoma.

A comparison has been undertaken between conventional radiographic imaging and computed tomography (CT) in 35 patients with testicular teratoma as part of an audit of our investigative approach to staging and follow-up. The CT examination included alternate cuts from the carina of the trachea to the lung bases as the thoracic assessment as well as the standard examination of the abdomen. Lymphangiography appeared to detect Stage IIa lesions better than did CT; however, CT was able to define the volume of abdominal disease more accurately. During the follow-up of Stage I patients, CT detected progressive disease in the absence of tumour marker elevation. Such progressive disease presented within 4 months in the majority of cases. The selective thoracic CT scanning conferred no advantage over whole-lung tomography, only one additional lesion being detected in 123 examinations. It is recommended that CT should be reserved for examining the area above the renal hila, for cases where lymphangiography is equivocal or positive, and that CT scanning of the abdomen in Stage I patients not receiving therapy should be repeated every 3 months following orchidectomy for the first year, irrespective of clinical status.

Humans↗
PubMed1983

Cross-leg fasciocutaneous flaps.

Twelve patients with cross-leg fasciocutaneous flaps are reported. Of the 12 flaps, 11 healed without loss, with satisfactory cover of the recipient area, and without trouble in the donor area.

Adolescent↗
PubMedDate not supplied

Hypothesis testing in the polychotomous logistic model with an application to detecting gastrointestinal cancer.

We discuss the use of the trichotomous logistic model to discriminate between patients with gastrointestinal (GI) cancer, patients with benign GI disease and 'normal' subjects, using symptoms and the concentrations of some serum proteins that are potentially indicative of malignancy as covariates. A parsimonious model can be obtained by invoking an indistinguishability hypothesis which is appropriate when a covariate is considered to have no predictive value between categories. It is shown that the polychotomous model can be re-parameterised under the null hypothesis to give a 'reduced form', which can be fitted by maximum likelihood. The validity of the use of the same methods for retrospective sampling is discussed. The approach is illustrated by the development of a logistic model to identify symptomatic and asymptomatic subjects with a high risk of GI cancer.

C-Reactive Protein↗