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Biomedical subjects

G Higgins

Publications and source records attributed to G Higgins.

At least 55 records · Page 3Linked to original sources
PubMed1991

Productivity of needle localization to facilitate excision of nonpalpable, mammographically suspicious lesions.

The use of needle localization to aid excisional biopsy of nonpalpable breast lesions is now common, and the literature suggests that 13% to 33% of such lesions are malignant. During the 4 years from 1984 to 1988, all women who underwent fine-needle localization in preparation for biopsy were studied to identify factors that might facilitate the selection of those more likely to harbour a cancer, thus sparing patients with benign disease operative intervention. In all, 124 biopsies were performed on nonpalpable lesions that were suspicious on mammography; 51 lesions were malignant and 73 benign. The average age of the patients was 56 years (55 years for those with benign lesions and 61 for those with malignant lesions). The family history, history of breast disease, symptoms and calcification seen on mammography were not significantly different between the two groups. Only 25% of the malignant lesions were noninvasive. In 10% of the patients who had invasive lesions there was lymph-node involvement. The rate of malignancy in this patient population (41%) was slightly better than that reported in the literature, and a larger proportion of patients had noninvasive disease. The authors conclude that none of the above-mentioned risk factors could be used in the preoperative selection of patients for open biopsy.

Biopsy↗
PubMed1990

Can medication education improve the drug compliance of the elderly? Evaluation of an in hospital program.

We report the evaluation of a pharmacist-led medication education program for the elderly. The program consisted of a single group-based education session followed by individual pre-discharge counseling. Patients also received an individual medication record card. The study design was a nonrandomised trial. Patients in the control group received a "dummy" intervention conducted on alternate months to the medication program. Drug compliance was assessed by interviewer-administered questionnaire in the patients' homes at 1 and 3 months post-discharge. The main outcome factor of interest was severe noncompliance with essential medications. This meant taking 80% or less or conversely 120% or more of those medications prescribed for the control of the patient's medical condition. At 1 and 3 months post-discharge, no effect of the program was detected. However, among the sub-group of patients taking four drugs or more the effect of the program was evident at 3 months post-discharge. Among this group at 3 months post-discharge, 55% of control group patients were severely noncompliant with essential medications as compared to 32% of the education group (a difference of 23%, 95% confidence interval 4-42%). This effect was not accounted for by possible confounding factors such as age, sex, number of medications and the patient's living arrangements.

Aged↗
PubMed1990

Production and characterisation of a monoclonal antibody to human papillomavirus type 16 using recombinant vaccinia virus.

A monoclonal antibody was raised against the major capsid protein L1 of human papillomavirus type 16, using a recombinant vaccinia virus that expresses the L1 protein, as a target for screening. This antibody, designated CAMVIR-1, reacted with a 56 kilodalton protein in cells infected with L1-vaccinia virus, and the protein was present in a predominantly nuclear location. The antibody also detects the HPV-16 L1 antigen in formalin fixed, paraffin wax embedded biopsy specimens and on routine cervical smears. The antibody reacts strongly and consistently with biopsy specimens containing HPV-16 or HPV-33, but very weak reactions were occasionally observed with biopsy specimens or smears containing HPV-6 or HPV-11. The potential advantages of using a vaccinia recombinant are (i) the target protein is synthesised in a eukoryotic cell so that its "processing" and location are normal; (ii) cells infected with vaccinia recombinants can be subjected to various fixing procedures similar to those used for routine clinical material. This greatly increases the probability that an identified antibody will be useful in a clinical setting.

Animals↗
PubMed1986

Potential for cost saving by recycling of drugs in hospital.

To investigate the potential benefits of recycling of drugs in hospital two studies were conducted. In the main study, 219 consecutively admitted medical and surgical patients were asked to surrender their drugs on admission to hospital. fifty six per cent of patients complied with the request and 79% of the drugs they brought in were suitable for redistribution within the hospital. Patients were given one months supply for all discharge medications. The cost of reusable drugs surrendered on entry corresponded to 36% of discharge medication costs. In the second study, a telephone survey of a random sample of hospitals in NSW, it was revealed that 31% of metropolitan hospitals and 21% of country hospitals recycle medications. It was concluded that the extension of the practice of recycling to remaining hospitals may substantially offset discharge medication costs and reduce the total bill for pharmaceuticals in hospitals in NSW. However, further discussion of acceptable standards for recycling and further investigation of the cost benefit equation of drug recycling is urged.

Australia↗
PubMed1985

Reliability and sensitivity of frozen-section pancreatic biopsy.

A collaborative Veterans Administration and University of California, Davis Medical Center group of 586 patients with histologically proved pancreatic carcinoma was reviewed. During laparotomy, 159 patients underwent 251 frozen-section pancreatic biopsies with subsequent permanent section examination of the same tissue block. All 112 positive frozen-section diagnoses were corroborated on permanent sectioning. The 47 patients with false-negative biopsy specimens were equally divided between sampling and interpretation error. We conclude that in this group of 159 pancreatic cancer patients, 30% failed to be correctly diagnosed by intraoperative frozen-section biopsy. This failure was due to patient sampling and interpretation error in equal proportion. Interpretation error rates were not influenced by the type or number of biopsies. Patient sampling error is apparently reduced by repeated biopsy, and specimen sampling error occurred less frequently with wedge biopsy.

Biopsy↗
PubMed1985

Antibiotic-associated colitis due to Clostridium difficile: double-blind comparison of vancomycin with bacitracin.

A randomized double-blind study was carried out in patients with unresolving antibiotic-associated colitis due to Clostridium difficile, to compare the effect of bacitracin (80,000 U/day) with vancomycin (500 mg/day) on the resolution of symptoms, clearance of organism, and prevention of relapse. Forty-two patients with colitis, 9 of whom had a pseudomembrane, were randomized, 21 patients to each treatment group. The two groups were comparable in age, disease severity, and antibiotic exposure. For a 50% reduction in stool frequency the mean times (+/- SE) were 4.1 +/- 0.4 days for bacitracin and 4.2 +/- 0.4 days for vancomycin. Sixteen patients (76%) had symptom resolution after 7 days of treatment with bacitracin, compared with 18 patients (86%) given vancomycin. Patients who failed to respond were crossed over (blind) to the alternative antibiotic, but tended to be refractory to the alternative medication as well. Vancomycin-treated patients had negative toxin (83% vs. 53%, p = 0.04) and negative stool cultures (81% vs. 52%, p = 0.02) more frequently than did those patients given bacitracin. Similar numbers of patients in each group had symptomatic relapse during 1 mo of follow-up, but most of them relapsed yet again after blinded crossover therapy. Although bacitracin was significantly less effective than vancomycin in clearing C. difficile from the stools, both were of similar value in the control of symptoms in a group of patients with predominantly nonpseudomembranous colitis. In view of its low cost, bacitracin is a reasonable first-line alternative to vancomycin in the treatment of antibiotic-associated colitis.

Adult↗
PubMed1985

Gastric damage from ingested acid in children.

Acid ingestion occurs relatively rarely and produces a spectrum of injury that is markedly different from the more commonly encountered alkaline burns of the oropharynx and esophagus. Gastric damage results from pylorospasm with pooling of the ingested caustic in a dependent location. Symptoms may be delayed for days or weeks. Perforation and/or strictures may require extensive gastric surgery. Early fiberoptic endoscopy is essential.

Acids↗
PubMed1984

Evaluation of cyclocytidine in reinduction and maintenance therapy of children with acute nonlymphocytic leukemia previously treated with cytosine arabinoside: a report from Children's Cancer Study Group.

A study of children in relapse with acute nonlymphocytic leukemia (ANLL) previously maintained in remission with combination chemotherapy including cytosine arabinoside (Ara-C) was undertaken by Children's Cancer Study Group (CCSG) to assess the efficacy of cyclocytidine (Cyclo-C), a depot Ara-C, compared to parenteral Ara-C given every 12 hr. The reinduction protocol consisted of daunomycin combined with either Ara-C (Regimen 1) or Cyclo-C (Regimen 2). One-hundred thirty eligible patients were entered on the randomized study. Hematologic toxicity was significant in both regimens and resulted in four drug-related deaths. Cardiac toxicity was observed in five patients, manifested only by abnormal echocardiogram or electrocardiogram patterns in three and congestive heart failure in two patients. Seventy-seven of 112 evaluable patients achieved M-1 or M-2A marrow remissions (69%): 46 of 60 on Regimen 1 (75%), 30 of 52 on Regimen 2 (60%). The remission rate between the two regimens was not significantly different. There was no significant difference in the duration of remission comparing maintenance cyclophosphamide combined with Ara-C or with Cyclo-C. Addition of VP-16 and CCNU to the maintenance therapy did not prolong the duration of remission. This study indicates that patients with childhood ANLL previously treated with Ara-C and daunomycin can obtain a successful second remission. A single daily subcutaneous dose of Cyclo-C was found to be as efficacious as Ara-C given intravenously every 12 hr. The single dose schedule provides a convenient way to treat patients with relapsed ANLL in the outpatient setting.

Adolescent↗
PubMed1984

Antibiotic prophylaxis in hysterectomy--cefotaxime compared to ampicillin-tinidazole.

The role of prophylactic cefotaxime and a combination of ampicillin and tinidazole was assessed in 201 patients undergoing hysterectomy. One hundred and twenty-five patients were evaluated in the abdominal hysterectomy group and 46 patients completed the protocol after vaginal hysterectomy. Patients were allocated randomly to receive either (1) no prophylactic antibiotic, (2) cefotaxime peroperatively for 24 h or (3) ampicillin/tinidazole peroperatively for 24 h. Both cefotaxime and ampicillin/tinidazole reduced the septic complication rate in abdominal and vaginal hysterectomy. Efficacy was most evident in reducing early urinary infections after abdominal hysterectomy (0.001 less than P less than 0.01). Cefotaxime and ampicillin/tinidazole were equally effective and no significant side-effects were demonstrated. Cefotaxime is recommended as a safe and effective agent for hysterectomy prophylaxis.

Adult↗
PubMed1983

Gastric outlet obstruction after palliative surgery for cancer of head of pancreas.

Gastroenterostomy as part of the palliation of unresectable cancer of the head of the pancreas, in the absence of gastric outlet obstruction at the time of surgery, has been both rejected, and, more recently, advocated for all such patients. A study of 105 cases yielded four factors that correlated with the subsequent occurrence of gastric outlet obstruction: age, 60 years or younger; hemoglobin level, 11.5 g/dL or less; absence of liver metastases; and survival, three months or longer. A fifth factor, absence of clinical jaundice, may be an indicator of a poor prognosis with a small risk of obstruction. By combining factors, we identified a group with a risk of obstruction of at least 25% (those with two or more factors) and one with negligible risk.

Adult↗
PubMed1983

Gastrointestinal bleeding after operation for pancreatic cancer.

Gastrointestinal bleeding after surgery for cancer of the pancreas contributes significantly to patient morbidity and to patient mortality, if the bypass was performed for palliation. Bleeding after resection of the pancreatic tumor appears to be amenable to therapy, and unaltered by the addition of vagotomy at the time of surgery. Patients undergoing palliative surgery who are expected to live beyond the postoperative period may well benefit from measures to reduce the risk of gastrointestinal bleeding.

Adult↗
PubMed1983

Current status of the biology and treatment of acute non-lymphocytic leukemia in children (report from the ANLL strategy group of the Children's Cancer Study Group.

Major advances have been made in the past 10 yr in both the understanding of the biologic characteristics of acute nonlymphocytic leukemia and in the treatment of patients with this disease. Advances in the biologic characteristics include: a better understanding of the nature of leukemic cell proliferation and differentiation; a clearer description of the morphological, histochemical, and ultrastructural characteristics of leukemic cells; a recognition that a high percentage of patients may have specific cytogenetic abnormalities; and a recognition that biochemical differences exist between acute nonlymphocytic leukemia (ANLL) and acute lymphoblastic leukemia (ALL). Today, over 70% of children with ANLL can be induced into a complete remission and over 25% are remaining in a continuous remission for over 2 yr. In spite of these improved results, the best method of extending remissions is unknown. It is unlikely that better results of therapy will be achieved in the future by tailoring the treatment according to the biologic characteristics of the patient, since it appears that ANLL is a heterogeneous group of diseases.

Acute Disease↗
PubMed1982

Intergroup Hodgkin's disease in children study of stages I and II: a preliminary report.

The intergroup study of involved-field (IF) radiotherapy, IF radiotherapy plus MOPP chemotherapy, and extended-field (EF) radiotherapy for treatment of Hodgkin's disease in children has assessed 305 patients. Of these, 279 were "not ineligible" (no mediate cause for disqualification). Among 223 randomized patients, 144 were evaluable, 131 had documentation of complete or partial remission, 20 of the remitters relapsed, and two died. Among 62 nonrandomized patients with favorable presentations (unilateral upper neck, unilateral inguinal, or massive mediastinal disease), 29 had documented remission, two relapsed, and none died. Length of initial disease control (LIDC) was used to measure duration of response. LIDC was best in patients given IF plus MOPP, and 95% are disease free. EF was better than IF radiotherapy (P = 0.004). Of the disease characteristics prognostic for response (stage, histologic subtype, and presence of symptoms), only the last factor had a statistically significant effect on LIDC (P = 0.004). Ninety-six percent of the patients survive. Using criteria developed by the committee, 23% of the staging procedures reviewed were nonevaluable and 28% of the radiotherapy treatments were nonevaluable. The necessity for criteria for evaluation of staging and treatment is certain. Length of followup is too short for correlations of treatment with significant late effects and for relevant therapeutic recommendations.

Antineoplastic Agents↗
PubMed1981

Randomized study of 5-FU and CCNU in pancreatic cancer: report of the Veterans Administration Surgical Adjuvant Cancer Chemotherapy Study Group.

Between the years 1973-1977, 152 male patients from 28 participating Veterans Hospitals with histologically proven nonresectable cancer of the pancreas were randomized in a two-arm study. The treated group was to receive combination chemotherapy with 5-FU and CCNU, and the controls were to receive no chemotherapy. Both groups were comparable with respect to age, amount of weight loss, extent of histologically proved metastases, and operation performed. In the treatment group, drug therapy was begun between 10 and 60 days postoperatively. Intravenous 5-FU, 9 mg/kg, was administered on five consecutive days, and CCNU, 70 mg/m2, was given orally on the first day of each course. In the absence of toxicity, the course was repeated every six weeks for life; 146 drug courses were given. The incidence of toxicity was not great. One or more toxic reactions were reported for one-third of the drug courses administered, but for the most part, these were mild. The most frequent toxic reaction was vomiting in 17% of the courses, and hematologic toxicity-primarily leukopenia-in 15% of the drug courses. There was no evidence of a beneficial effect on survival from drug treatment in the group as a whole or in any subgroup analyzed. The median survival of the control group was 3.9 months, and of the drug-treated group, 3.0 months.

Adenocarcinoma↗
PubMed1981

Aplastic anemia in Down's syndrome.

A child with Down's syndrome was seen with pancytopenia and was found to have an aplastic bone marrow. None of the known contributing etiologies of aplastic anemia could be identified in this patient. This is the first reported case of the simultaneous appearance of these two disorders.

Anemia, Aplastic↗