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Biomedical subjects

G Needham

Publications and source records attributed to G Needham.

At least 37 records · Page 2Linked to original sources
PubMed1996

Choice of contrast enhancement index for dynamic magnetic resonance mammography.

Indices are often used in dynamic MRI of the breast to quantitate signal enhancement within suspicious lesions. Two indices are commonly used: one calculates the difference in pre- and postcontrast signal intensity, normalised to a base-line signal intensity such as that of fat (which does not enhance) whilst the other calculates the ratio of pre- to postcontrast signal intensity. The results of a computational simulation are presented which demonstrate the superiority of the normalised signal difference index, based on the criterion that the best index is that which is least influenced by initial tissue T1. This hypothesis was tested by comparing the two indices in a group of patients with clinical or mammographic suspicion of recurrent breast carcinoma. Of 37 patient examinations using Gadolinium enhanced MRI of the breast, 11 patients showed 13 lesions with some degree of enhancement, which were subsequently diagnosed histologically as either benign or malignant. The normalised signal difference index showed no overlap between the benign and malignant groups, whereas some overlap was observed with the signal ratio index. The clinical findings are therefore consistent with the results of the computational simulation.

Adult↗
PubMed1996

Measurement of spin-lattice relaxation times with FLASH for dynamic MRI of the breast.

Using a variable flip angle gradient refocused imaging technique, dynamic quantitative T1 relaxation maps acquired before and after the administration of a gadolinium contrast bolus enable the concentration-time curve of the paramagnetic agent in breast tissue to be calculated. This imaging technique has the aim of improving the diagnostic accuracy of MR mammography. Measurements with phantoms of calibrated T1 values have been carried out to investigate the accuracy of the method, with particular reference to errors caused by incomplete spoiling of residual transverse magnetization and inaccurate radio frequency (RF) flip-angle settings. A clinical example is presented. The method has potential use for any patient study which necessitates rapid quantitation of changing in vivo T1 values as a result of contrast agent injection.

Breast Neoplasms↗
PubMed1996

Dynamic magnetic resonance mammography of both breasts following local excision and radiotherapy for breast carcinoma.

The purpose of this study was to evaluate a dynamic gadolinium-diethylene-triaminepentacetate (Gd-DTPA) enhanced magnetic resonance mammography (MRM) protocol, incorporating image subtraction and using a dedicated double breast coil, in patients with treated breast cancer. 36 patients who had undergone breast conserving surgery and radiotherapy, with clinical or mammographic suspicion of locally recurrent breast carcinoma, were examined. 3D rapid volume imaging of both breasts was performed before and repeated three times, at 1, 2 and 3 min, following Gd-DTPA enhancement. Image subtraction allowed identification of enhancing lesions and quantitative analysis of these was performed. Five patients had six lesions demonstrating rapid enhancement in the first minute, all of which were histologically confirmed recurrent or second primary tumours. Slower enhancement was seen in six benign lesions and diffuse enhancement was seen in one patient within 6 months of treatment. The dynamic protocol used allowed sufficient temporal resolution for distinguishing malignant from benign lesions at the site of previous surgery and ensured that both breasts were imaged in their entirety, thus enabling the diagnosis of multifocal and second primary tumours.

Adult↗
PubMed1996

MRI as an aid to the fitting of tracheo-oesophageal Blom-Singer valves post-laryngectomy.

The Blom-Singer valve is a device for facilitating speech in patients who have undergone total laryngectomy. The valve is inserted into a surgically created tracheo-oesophageal fistula. Fitting the valve and determining the correct length and direction of the fistula, although usually straightforward, can be difficult. We describe two patients in whom MR imaging of the fistula tract has aided valve fitting.

Adult↗
PubMed1996

Public empowerment through accessible health information.

The Public Library Association (PLA) is developing plans for cooperative consumer health information services. Foremost for developing this program is the need for partnerships with health agencies and mechanisms to attract grant funding. The proposed project will expand the role of public librarians to address the health information queries they receive effectively. The project plans include the use of new technologies for delivery of health information, and the provision of tools, training, and resources.

Cooperative Behavior↗
PubMed1996

A novel diagnostic index for use in the breast clinic.

The diagnostic accuracy of clinical examination, mammography, ultrasonography and fine needle aspiration (FNA) cytology in discriminating between benign and malignant breast lesions has been retrospectively assessed in 603 patients who attended the Professorial Breast Clinic and then underwent surgical biopsy, in Aberdeen Royal Infirmary, between January 1989 and September 1992. In this series of patients, FNA cytology gave the highest overall prediction of malignancy (92.6%) with a sensitivity of 87% and a specificity of 98%, whilst ultrasonography gave the lowest correct overall prediction (75.6%), with a sensitivity of 70% and a specificity of 79%. Using all the available findings (clinical examination, mammography, ultrasonography, FNA) as well as the patients' age, a stepwise logistic discriminant analysis was used to derive a mathematical equation for use as a novel diagnostic index. Weighted scores, derived from each variable, were used in the discriminant equation to predict the likelihood of malignancy in patients of different ages (>90%). For young patients (<35 years) the discriminant analysis predicted the diagnosis in 98% of women correctly. Quadruple assessment provides an opportunity for establishing the likely diagnosis in most patients the same day they visit the Breast Clinic. The diagnostic index, currently being evaluated prospectively in our breast clinic, may be a further aid to establishing a correct diagnosis.

Adult↗
PubMed1995

Positron emission tomography: 2-deoxy-2-[18F]-fluoro-D-glucose uptake in locally advanced breast cancers.

Fifteen patients with locally advanced breast cancers were studied using the radiopharmaceutical 2-deoxy-2-[18F]-fluoro-D-glucose (FDG) with positron emission tomography (PET). Five patients were sequentially imaged before and after two pulses of chemotherapy. In 14 of 15 tumours increased uptake of FDG was observed which correlated with the clinical site of the tumour. The PET images were compared with the mammographic and ultrasonomammographic appearances of the tumours in selected patients. In two patients with normal mammograms PET imaging detected the tumour and in a further four patients, with suspicious but not conclusively malignant mammographic changes, a well-defined area of increased FDG uptake was demonstrated by PET. In all five sequentially imaged tumours, following chemotherapy, there was a decrease of the FDG tumour: normal breast uptake ratio. In four patients who completed a full chemotherapeutic course this change preceded a pathological response of their tumours. These findings suggest that this technique may be of benefit in imaging carcinomas in the breasts of pre-menopausal women which may appear dense on mammography and moreover, that sequential imaging may have a role in the prediction, at an early stage, of the response of locally advanced carcinomas to chemotherapy.

Adult↗
PubMed1995

Identification of women at high genetic risk of breast cancer through the National Health Service Breast Screening Programme (NHSBSP).

Breast cancer is a multifactorial disease with an inherited predisposition being implicated in around 5% of all cases. Using previous epidemiological data assessing risks for the relatives of women with breast cancer, we have identified 154 women (from a screened population of 35,505) and 289 of their relatives between 50 and 64 years who have more than twice the age related risk of developing breast cancer. This constitutes 1.24% of the breast screening population attending the North East Scotland NHSBSP. For each woman identified to be at high risk, we have found 1.87 female relatives between 50 and 64 years and 1.85 relatives under 50 years also to be at high risk. Around 78% of the women identified with a significant family history of breast or other cancer have attended for counselling about their risks. The breast screening programme can be used to identify women at high risk of breast cancer in order to offer them (and their relatives) access to genetic counselling and appropriate screening.

Adenocarcinoma↗
PubMed1994

Dietary supplementation with L-arginine in patients with breast cancer (> 4 cm) receiving multimodality treatment: report of a feasibility study.

L-Arginine has been shown, in human breast cancers, to increase protein synthesis and the number of cells in the growth phase of the cell cycle. L-Arginine, therefore, may potentiate the response of breast cancers to cell cycle-specific cytotoxic agents. This phase II pilot study assessed the clinical, radiological and pathological responses in 44 patients with breast cancers > 4 cm in diameter (46 tumours: T2, n = 6; T3, n = 22; T4, n = 19), who received oral L-arginine 30 g day-1 for 3 days prior to each cycle of CHOP chemotherapy, followed after 4-6 cycles by radiotherapy. Following this treatment, 95% of patients had a clinical response: complete response in 30% and partial response in 65%. Imaging, ultrasound and mammography revealed response rates of 91% and 76% respectively. Surgery was performed in 43 patients. Histological examination revealed that in 18% of cases there was no residual evidence of tumour. Furthermore, if residual tumour was identified, the degree of destruction was graded as 'severe' in 36% and 'moderate' in 30% of cases. Further studies are now required to evaluate the potential beneficial use of nutritional pharmacology in combination with existing treatment regimens.

Adult↗
PubMed1994

A GRiPPing yarn--getting research into practice: a case study.

This article describes the GRiPP initiative in the (old) Oxford Region which set out to explore the potential role of purchasers or commissioners of health care in putting the findings of research into the practice of healthcare. A short account of the background to GRiPP is followed by a more detailed description of the GRiPP project carried out in Buckinghamshire and some of the lessons which may be useful to other health authorities. The final section of the article considers the role of the healthcare librarian in the context of 'Getting Research into Practice and Purchasing'.

Adult↗
PubMed1993

The role of intravenous cholangiography in pre-operative assessment for laparoscopic cholecystectomy.

With the advent of laparoscopic cholecystectomy, pre-operative identification of calculi in the common bile duct has become increasingly important. In patients without clinical or biochemical evidence of common bile duct calculi, debate continues as to the value of intravenous cholangiography (IVC) as a screening modality for the detection of unsuspected choledocholithiasis. In a prospective series of 180 patients, IVC was used to assess the common bile duct in 113 patients at low risk of choledocholithiasis, 51 patients at high risk underwent endoscopic retrograde cholangiography (ERC) and sphincterotomy if indicated, and in 16 patients, for a variety of reasons, no pre-operative cholangiography was performed. 31% of those who had ERC and two (1.8%) of those who had IVC had duct calculi. These data do not support the routine use of IVC in patients with no evidence of common bile duct calculi and its routine use has been discontinued.

Adolescent↗
PubMed1988

Relationships between oestrogen receptor,epidermal growth factor receptor, ER-D5, and P24 oestrogen regulated protein in human breast cancer.

Proteins regulated by or related to the oestrogen receptor (ER) may prove to be more reliable indicators of prognosis and hormone sensitivity then expression of the receptor itself. It has been shown recently that expression of epidermal growth factor receptor (EGFR) is associated with a poor prognosis in breast cancer. In a series of 60 breast cancers, we have studied relationships between ER, ER-D5 oestrogen receptor related protein, P24 oestrogen regulated protein, and EGFR using an immunohistochemical technique employing monoclonal antibodies in each case. In addition, radioligand binding assays for ER and EGFR were carried out and tumour histological grade was determined. Seventy-one per cent and forty-three per cent of tumours stained for ER-D5 and P24, respectively, but there was no relationship between staining for these and ER or EGFR status. There was a significant correlation between staining for ER and EGFR, and the respective biochemical assays. Relating ER to EGFR, very few ER-positive cases expressed EGFR, but this relationship fell short of significance. The prognostic significance of expression of the epitopes recognized by the ERD5 and P24 antibodies must await assessment of clinical outcome.

Antibodies, Monoclonal↗