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Biomedical subjects

H Nunnerley

Publications and source records attributed to H Nunnerley.

14 recordsLinked to original sources
PubMed1996

Anxiety in women "at risk' of developing breast cancer.

Do family history clinics offering counselling, surveillance and preventative programmes alleviate or exacerbate anxiety in women at a high risk of developing breast cancer? In this study risk perceptions and anxiety of 99 'at risk' women participating in the Tamoxifen Prevention Trial were compared with those of 87 'at risk' women not attending any specialist clinic who were recruited from the National Breast Screening Programme (NBSP). Most anxiety was found in NBSP women with a family history. Women attending the family history clinic and participating in the trial had anxiety scores comparable with 86 women recruited from the NBSP who did not have a family history. We conclude that such specialist clinics do not see a selected group of the most anxious 'at risk' women nor does participation in tamoxifen prevention programmes appear to increase anxiety.

Analysis of Variance↗
PubMed1995

Adverse life events and breast cancer: case-control study.

OBJECTIVE: To investigate the strength of association between past life events and the development of breast cancer. DESIGN: Case-control study. A standardised life events interview and rating was administered before a definitive diagnosis. SETTING: Breast Cancer Screening Assessment Unit and surgical outpatient clinics at King's College Hospital, London. SUBJECTS: 119 consecutive women aged 20-70 who were referred for biopsy of a suspicious breast lesion. MAIN OUTCOME MEASURES: Odds ratio of the risk of developing breast cancer after life events in the preceding five years after adjustment for confounders. RESULTS: 41 women were diagnosed as having malignant disease while the remainder had benign conditions. Severe life events increased the risk of breast cancer. The crude odds ratio was 3.2 (95% confidence interval 1.35 to 7.6). After adjustment for age and the menopause and other potential confounders this rose to 11.6 (3.1 to 43.7). Multiple logistic regression analysis showed that all severe events and coping with the stress of adverse events by confronting them and focusing on the problems significantly predicted a diagnosis of breast cancer. Non-severe life events and long term difficulties had no significant association. CONCLUSION: These findings suggest an aetiological association between life stress and breast cancer.

Adaptation, Psychological↗
PubMed1989

Adoptive immunotherapy administered via the hepatic artery and intralesional interleukin-2 in hepatocellular carcinoma.

We assessed the feasibility of using lymphokine-activated killer cells (adoptive immunotherapy) with infusions of interleukin-2 when given regionally in three patients with unresectable primary hepatocellular carcinoma (PHC). In 2 patients, 2 cycles, which included a bolus of LAK (10(7) to 10(8) cells followed by a 4-hourly infusion of IL-2 were administered via selective arterial catheterization of the hepatic artery. One further patient received 3 cycles of IL-2 alone by direct intralesional and perilesional injections. Minimal toxicity was observed and side effects such as fever were comparable to those observed with systemic infusions of IL-2 alone. Serial alpha-fetoprotein (AFP) levels initially fell but subsequently rose within 2 to 4 weeks of therapy. AFP levels had not reached pre-treatment values at 4 months in 2 patients, 1 of whom was alive and well at 15 months follow-up.

Carcinoma, Hepatocellular↗
PubMed1989

Lipiodol enhanced CT scanning in assessment of hepatocellular carcinoma.

We studied 20 patients with computed tomography (CT) following the intra-arterial injection of Lipiodol. Comparison with conventional CT, angiography and plain abdominal radiographs revealed additional satellite tumours in four patients. Technical difficulties occurred in selective hepatic arterial catheterisation and in satisfactory delivery of Lipiodol to all segments of the liver in a third of our patients. Plain abdominal radiographs following Lipiodol injection are inadequate in our experience in assessing tumour mass and distribution; we failed to demonstrate retention of Lipiodol by tumour tissue for longer than a few weeks in any case. The pattern of Lipiodol uptake within the tumour is not related to histology but to the vascular supply and size of the tumour. Our findings do not accord with the Japanese experience and this small study suggests that Lipiodol enhanced CT should be reserved for patients with small tumours in non-cirrhotic livers who are being considered for resection of their tumour. Such patients are likely to be encountered rarely in UK practice.

Adult↗
PubMed1985

Internal biliary drainage and local radiotherapy with iridium-192 wire in treatment of hilar cholangiocarcinoma.

Curative surgery is not possible in the vast majority of patients who present with hilar cholangiocarcinoma. Palliative therapy to relieve jaundice, either at laparotomy or percutaneously, is therefore necessary. The mean survival of these patients is of the order of 8.5 months (Wheeler et al., 1981). We report a significant increase in mean survival to 16.8 months in patients treated with internal biliary drainage when combined with local irradiation to the tumour with iridium-192.

Adenoma, Bile Duct↗
PubMed1983

Treatment of hilar carcinoma by bile drainage combined with internal radiotherapy using 192iridium wire.

Eighteen patients with a cholangiocarcinoma involving the hilum of the liver, and one patient with a carcinoma of the gall bladder causing obstruction of the common hepatic duct, have been treated with bile drainage using a U-tube (8 patients) or a percutaneous transhepatic catheter (11 patients) followed by internal radiotherapy with 192iridium wire. The median survival is 11 months, and 9 patients (47 per cent) have survived for 12 months or longer. The addition of internal radiotherapy may be beneficial to patients with hilar cholangiocarcinoma causing biliary obstruction in whom bile drainage can be established.

Adenoma, Bile Duct↗
PubMed1981

Newer techniques in the diagnosis and treatment of proximal bile duct carcinoma--an analysis of 41 consecutive patients.

The clinical course of 41 consecutive patients with primary bile duct carcinoma at or near the liver hilum was analysed to determine whether the outcome was improved by newer techniques of diagnosis and treatment. The age range was wide, with one third under 50 years. The only aetiological factor identified was long-standing ulcerative colitis (present in 9.8 per cent of patients). In one third of patients initial symptoms were misleading. The tumour had been missed in 11 (61 per cent) of 18 patients undergoing an exploratory laparotomy at other hospitals, despite operative cholangiography. None had pre-operative percutaneous cholangiography which was shown to be the best investigatory technique, giving the correct diagnosis in all cases in whom it was performed. Greyscale ultrasonography was useful and endoscopic retrograde cholangiography less so. Median survival in those treated by surgical T- or U-tube drainage (21 patients) or bypass (three) was nine months from diagnosis, as opposed to three months in the 36.5 per cent of patients in whom biliary drainage was not obtained. Radiotherapy, including insertion of a radioactive iridium wire through the tumour via a T- or U-tube, or percutaneously, was performed in nine patients and improved the duration of survival compared with tube drainage alone. The new percutaneous techniques offer a useful alternative to surgery for palliative drainage and radiotherapy.

Adult↗
PubMed1980

The use of therapeutic embolisation at the time of hepatic arteriography in the management of primary tumours of the liver.

In 10 of 14 patients with primary hepatic tumours the technique of selective arterial embolisation with gelatin foam was successful in inducing necrosis of the tumour tissue. In the patients with histologically proven hepatocellular carcinoma there was ultrasonographic evidence that this was produced, as was also shown by a rapid initial fall in serum alpha-foetoprotein concentration. Treatment was continued with a course of doxorubicin (Adriamycin) and the patients remained well and symptom-free for a median of 10 months, the longest survival being 19 months. In two patients with localised and highly vascular contraceptive pill-associated hepatic tumours, embolisation was followed by complete disappearance of the tumour mass in one and resolution of obstructive jaundice in the other. In one other the response was equivocal.

Adenoma↗
PubMed1979

Non-operative arterial embolisation in primary liver tumours.

Three patients with primary hepatic tumours were treated by selective arterial embolisation with gelatin-foam fragments to induce necrosis. In the two with histologically proved hepatocellular carcinoma ultrasonography suggested that necrosis had been induced, as did the rapid initial falls in serum alpha-fetoprotein concentration by 95 and 81% of the original values respectively. Treatment was continued with a course of adriamycin, and both patients remained well and symptom free at 10 and 12 months. In the third patient, who had an expanding and highly vascular benign hepatic adenoma associated with use of a contraceptive pill, embolisation obliterated the tumour mass. Tumour embolisation should be regarded as only the first step in managing hepatocellular carcinoma and as a means of reducing appreciably the viable tumour mass before chemotherapy. It may be used as the primary and definitive treatment in patients with benign liver tumours.

Adenoma↗
PubMed1977

Detection and grading of oesophageal varices by fibre-optic endoscopy and barium swallow with and without Buscopan.

Detection of oesophageal varices is important in the diagnosis of portal hypertension. We have, therefore, compared the results of fibre-optic endoscopy and barium swallow in 56 patients with chronic liver disease. Oesophageal varices were graded as small, moderate or gross by independent observers for each technique. In 12 patients varices were not detected by either method, and in six cases varices were detected by endoscopy when the barium swallow was negative. In 15 of the remaining 38 patients varices were found to be one grade larger at endoscopy than on barium swallow. Since it is possible that varices appear larger at endoscopy because of the Buscopan (hyoscine N-butyl bromide) used as a relaxant, we carried out barium examinations after Buscopan 20 mg i.v. in 23 of the patients. In eight cases varices were one grade larger after Buscopan than on the standard barium swallow, and in two were only detected after Buscopan had been given. Eight cases negative after Buscopan were also negative at endoscopy. Although emergency endoscopy has particular value in locating the site of bleeding in patients with portal hypertension and acute gastrointestinal haemorrhage, the results of the present study suggest that a barium meal with Buscopan is as accurate as endoscopy in the detection of oesophageal varices.

Butylscopolammonium Bromide↗
PubMed1974

Emergency endoscopy after gastrointestinal haemorrhage in 50 patients with portal hypertension.

Endoscopy was carried out in 50 patients with oesophageal varices within 24 hours of a major haematemesis or melaena. Sources of bleeding were identified in 42 of the cases and in only 19 patients was bleeding due to oesophageal varices. Bleeding from gastric varices was present in 11 patients, and a variety of acute and chronic lesions made up the remainder. In contrast with previous series haemorrhage from erosive gastric lesions was seen in only five patients and was no more common in 23 patients with alcoholic cirrhosis than in the group as a whole.

Adolescent↗
PubMed1974

Hyperthermia as a teratogenic agent.

The common cotton-eared marmoset, a nonhuman primate with a narrow zone of thermoneutrality, was used in an experiment to assess the effects of hyperthermia as a teratogenic agent. Mild heat stress conditions were used. The results of this preliminary study justify further investigation of the effect of hyperthermia on the primate embryo during morphogenesis.

Animals↗