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Biomedical subjects

I Carr

Publications and source records attributed to I Carr.

At least 19 recordsLinked to original sources
PubMed2003

Defining "early dementia" and monitoring intervention: what measures are useful in family caregiving?

Measures of cognition are often used to define and measure the progress of dementia and outcomes of intervention. This paper examines whether measures of psychosocial disability used with those of cognition are more useful than measures of cognition alone, particularly in early dementia. A measure of cognition and two instruments of caregiver burden, used as routine clinical outcome measures of three types of Old Age Psychiatry dementia services, were examined. All cases with dementia in a memory clinic (MC; n = 149), a community mental health service for older people (CMHT; n = 120) and a specialist dementia day hospital (DH; n = 118), in one NHS district were followed up at 12 months. Measures of cognition (MMSE), behaviour, caregiver coping (Problem Checklist; PC) and caregiver mood (Hospital Anxiety and Depression Scale; HAD) were taken at baseline (MC, n = 48; CMHT, n = 113; DH, n = 55) and at follow-up (MC, n = 35; CMHT, n = 34; DH, n = 23). At baseline, all three groups had an average MMSE score of "mild impairment" but measures of behaviour and caregiver burden showed subtle between-group differences. At the 12-month follow-up, cognition remained stable in all groups, but the frequency of day-to-day problems increased and caregiver mood deteriorated in families receiving DH support. The use of psychosocial measures of disability in conjunction with those of cognition, are important in the definition and longitudinal measurement of intervention and support in early dementia.

Adaptation, Psychological↗
PubMed2001

Is transcutaneous electrical nerve stimulation an effective analgesia during colonoscopy?

OBJECTIVES: To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) as analgesia during colonoscopy. DESIGN: In a randomised controlled trial, patients undergoing diagnostic colonoscopy were assigned to one of three groups: standard medication only (midazolam); active TENS plus standard medication; or non-functioning TENS and standard medication. Efficacy of TENS was determined using numerical rating scores for pain and the post-procedural evaluation questionnaire. SETTING: Patients undergoing diagnostic colonoscopy in a teaching hospital. MAIN OUTCOME: There was no statistically significant differences between the three groups. However in the active TENS group there was a greater variation in "physical discomfort" and "psychological distress", suggesting TENS may be effective in subgroup of patients.

Adult↗
PubMed2000

How much gin in the tonic? The problems of writing a provincial medical history,.

This paper describes the problems and resources involved in writing a Canadian provincial medical history, (Manitoba Medicine: A Brief History). The first decision was whether it should be a scholarly or a popular history; The authors' background, and the realities of publishing dictated the latter. Resources available were local and easily accessible: archives and records, the Manitoba medical journals, a series of local medical journals (almost continuous for a century), and the Manitoba medical biographies, books variable in length, and content, but relating to a wide variety of physicians. Such a paper leads to a question- "Is local history merely trivial?" The answer to such a question is "no."

Canada↗
PubMed1999

The effects of migration on ulcerative colitis: a three-year prospective study among Europeans and first- and second- generation South Asians in Leicester (1991-1994).

OBJECTIVE: Our aim was to measure prospectively the incidence of ulcerative colitis in Leicester City and to compare this with a previous retrospective study in the same area. We also sought to compare the incidence and disease extent in the European community with that of the South Asian community and to compare the disease extent between first- and second-generation South Asian migrants. METHODS: A 3-yr prospective study of ulcerative colitis in the city of Leicester took place from October 1, 1991 to September 30, 1994 and included all cases resident in Leicester City and diagnosed as having ulcerative colitis, regardless of the extent and severity of the disease. RESULTS: Extensive colitis was commoner in second-generation migrants than in the first generation (chi2 = 4.3, p = 0.04) and was comparable to the European community. The annual average incidence of ulcerative colitis was 9.1/10(5) population/yr (95% confidence interval [CI] 7.1-11.3), which is similar to the previous retrospective study. However, the annual average incidence of ulcerative colitis in the European population was 7.0/10(5) population/yr (95% CI 5-9.5), whereas that of the South Asian population was 17.2/10(5) population/yr (95% CI 11.8-24.3), confirming that the risk of ulcerative colitis in this particular community is exceptionally high. CONCLUSIONS: These early results suggest that the disease pattern follows that of the indigenous population after only one generation and requires monitoring over the next decade. The incidence of ulcerative colitis in the South Asian population is high and continuing to rise.

Adult↗
PubMed1998

Screening for osteoporosis in Crohn's disease. A detailed evaluation of calcaneal ultrasound.

OBJECTIVES: To compare calcaneal broadband ultrasonic attenuation (BUA) and velocity of sound (VOS) in patients with Crohn's disease with an age-matched control population. The validity of BUA as a screening tool for osteoporosis was evaluated and the relationship between BUA and previous fracture studied. DESIGN: Cross-sectional study. BACKGROUND: Since patients with Crohn's disease are at risk of osteoporosis and premature fracture, routine assessment of bone mineral density (BMD) is recommended. Quantitative ultrasound of the calcaneum is an inexpensive and radiation-free means of assessing bone density which also provides information on bone microstructure. METHODS: BUA (dB/MHz) and VOS (m/s) were measured at the calcaneum (CUBAclinical, McCue Ultrasonics, Winchester, UK) and compared with bone mineral density at the hip and lumbar spine measured by dual-energy X-ray absorptiometry (DEXA); 100 patients (42 men) with Crohn's disease and 52 age-matched healthy controls (23 men) were studied. RESULTS: BUA was significantly reduced in patients with Crohn's disease compared with age-matched controls [76.53 dB/MHz (+/-17.3) vs 87.29 dB/MHz (+/-17.9), difference in means = 10.76, 95% CI -16.67, -4.85, P = 0.0004] and was significantly associated with BMD at the spine (r = 0.49, 95% CI 0.32, 0.63, P< 0.0001) and femoral neck (r = 0.54, 95% CI 0.38, 0.67, P < 0.0001). In the diagnosis of osteoporosis (t score <-2.5) BUA had a sensitivity of 66.7% at the femoral neck, with a specificity of 85.6%; sensitivity of BUA at the spine was 75% with specificity 89%. CONCLUSION: Patients with Crohn's disease have reduced BUA compared with an age-matched control population. Calcaneal BUA is significantly associated with BMD at the hip and spine but the correlation is insufficient to recommend ultrasound as a screening tool for DEXA.

Absorptiometry, Photon↗
PubMed1993

Ability of aberrant crypt foci characteristics to predict colonic tumor incidence in rats fed cholic acid.

Aberrant crypt foci (ACF) are putative preneoplastic lesions of colon cancer which are being utilized currently as a biological end point to evaluate the induction and modulation of colon carcinogenesis. In several previous short-term studies, the unexpected reduction of ACF by the reported colonic tumor promoter cholic acid (CHA) emphasized the need for a systematic evaluation of the growth of ACF in response to a tumor promoter. The present study was conducted to determine if any characteristic(s) of ACF at various early stages of carcinogenesis would predict resulting tumor incidence in rats fed CHA. Male Sprague-Dawley rats received two injections of azoxymethane (20 mg/kg) and were fed either the AIN-76 diet or AIN-76 plus 0.2% CHA. The number, crypt multiplicity (number of crypts/focus), and size (area) of ACF were measured after 2, 8, 14, and 18 weeks in 5 rats/group. The number of ACF was lower (P < 0.033) in animals fed CHA at all time points. Average crypt multiplicity of ACF was greater (P = 0.045) from CHA-fed animals after 8 weeks compared to animals fed the AIN-76 diet. The average size of ACF was smaller in CHA-fed animals after 2 weeks and then tended to be larger than the sizes of the ACF from animals fed the AIN-76 diet. All remaining animals were killed after 18 weeks. Tumor incidence was higher (P < 0.001) in the CHA-fed group (63.2%) compared to the control diet group (29.4%). CHA-fed rats also had a higher number of tumors/tumor-bearing rat compared to control diet rats (1.96 versus 1.13). The main finding of this study is that the number of ACF at early time points did not predict tumor incidence. Crypt multiplicity was a consistent predictor of tumor outcome and should be measured in future studies using ACF as a biological end point. The CHA diet appears to provide a unique tumor-modulating environment that selectively enhances the growth of a smaller number of ACF leading to an increased number of tumors compared to a control diet. The mechanism(s) by which CHA mediates this effect warrants further investigation.

Animals↗
PubMed1992

Will a tumor metastasize? Quantitate, semi-quantitate or pseudo-quantitate? A brief review of the microscopic prediction of tumor metastasis.

This review examines ways in which histopathologists can attempt to predict whether a neoplasm will metastasize by microscopic examination of surgically removed samples of human neoplasms. These include qualitative description, semi-quantitative analysis of differentiation and proliferation, or of the nature of the edge of the neoplasm, and quantitative analysis of mitotic counts. More recently measurement of DNA content, analysis of DNA turnover, measurement of proliferation antigens, measurement of nucleolar organizing areas, counting nucleoli, morphometry of nuclei and identification of genetic change have become possible. There is no test capable of uniform accurate prediction of prognosis. In certain types of neoplasms in individual sites useful prognostic information can be obtained either by rigorous semi-quantitative microscopic analysis or by quantitative microscopical analysis. There is still doubt as to whether newer quantitative techniques will perform uniformly better than older semi-quantitative techniques. The simple subjective statement "high-grade malignancy, average malignancy, low malignancy" is better than elaborate non-reproducible pseudo-quantitation.

Data Interpretation, Statistical↗
PubMed1987

Lymphatic metastasis and its treatment.

The treatment of lymphatic metastasis depends on an understanding of its basic biology. We are still uncertain as to how human cancer cells enter lymphatic vessels and as to what reactions if any in the draining lymph node inhibit metastasis. We are uncertain as to whether lymphatic metastasis is an indicator or a governor of rapid dissemination, and poor prognosis. We are uncertain as to whether it is worth attempting to treat lymphatic metastases by means supplementary to those used in treating systemic tumour dissemination. It may be possible to obtain local cure of a local lesion by local lymphatic therapy and to concentrate therapy locally by intralymphatic infusion of a chemotherapeutic agent or encapsulation in liposomes. This is at best accessory to obtaining systemic cure of systemically disseminated neoplasm. Optimal results could be expected from appropriate combinations of local and systemic immunotherapy, chemotherapy and radiotherapy, after appropriate surgical reduction in tumour bulk.

Combined Modality Therapy↗
PubMed1986

Heterogeneity in a colonic carcinoid tumor.

This report describes a colonic carcinoid tumor in which three, and possibly four, distinct cell types are distinguishable on the basis of their ultrastructure and granule morphology. These cell types closely resemble the normal endocrine cells of the large bowel, both in appearances and in relative frequency. The mixed composition of this tumor may have arisen either by parallel differentiation of distinct cell types, or by sequential maturation of one cell type.

Carcinoid Tumor↗
PubMed1986

Primary lymphoma of the central nervous system: Manitoba experience and literature review.

We describe eight cases of primary cerebral lymphoma seen in Manitoba from 1980 to 1985. The clinical presentation is similar to other primary brain tumors. The diagnosis should be considered when single or multiple, often deep lesions, show dense enhancement on computerized tomographic (CT) scan, but are avascular at angiography. These tumors are histologically indistinguishable from non-Hodgkins lymphomas arising outside the CNS. The prognosis is poor. However, radiotherapy with or without surgery may offer significant palliation. Although there is no consensus on the value of chemotherapy, corticosteroids alone or multiagent chemotherapy have shown promise in a few cases. For these reasons, histologic diagnosis should be sought in all cases and surgery, radiotherapy, and chemotherapy should be considered, as prolonged survival is possible.

Aged↗
PubMed1986

Isolated granulocytic sarcoma: report of a case and review of the literature.

Granulocytic sarcoma (GS) is an extramedullary tumor composed of granulocytic precursor cells. The tumor usually develops during the course of myelogenous leukemia or myeloproliferative disorders and may represent the initial manifestation of leukemia. Rarely, GS is recognized as an isolated tumor without any evidence of leukemia. However, in such cases, leukemia generally develops within 1 to 2 years of the diagnosis of GS. We are reporting a case of a 45-year-old woman who was diagnosed as having an isolated GS of the right breast in August 1980. She was treated with a partial mastectomy followed by 1 year of combination chemotherapy as used in the cases of acute myeloblastic leukemia and has remained free of disease to the present time. That is, she has not developed leukemia or recurrence of GS for 64 months. Based on this experience and on the review of the literature, we recommend that all cases of GS be treated with combination chemotherapy as in cases of acute myeloblastic leukemias.

Adult↗
PubMed1983

Invasion and metastasis.

Malignant tumours cause sickness and death largely because they invade and metastasize. Such spread is made possible by many cellular properties, including the ability of neoplastic cells to move and to release degradative enzymes. These properties enable tumour cells to break free of the primary tumour, penetrate blood or lymphatic vessels and, after being transported to distant sites, pass out of the vessels to establish new tumours. Not all cells in a tumour, however, are able to metastasize, so the process tends to select for greater malignancy in the secondary tumour. The heterogeneity of tumours probably accounts for the difficulty of providing effective treatment, in that the various subpopulations of cells arising from each tumour vary in their responses to chemotherapeutic agents. We do not yet understand the process sufficiently to treat cancer patients by interfering selectively with the metastatic mechanisms.

Blood Vessels↗
PubMed1983

Lymphatic metastasis.

Lymphatic metastasis is an important mechanism in the spread of human cancer. During its course, tumor cells first penetrate the basement of membrane of the epithelium, in which they arise, and then the underlying connective tissue, carried partly by hydrostatic pressure. They enter the lymphatic partly by active movement, pass up the lymphatic trunk; they then settle and proliferate in the subcapsular sinus, penetrate its endothelium and proliferate and destroy the node. There are varied forms of immune response in the node and in human nodes often a complex fibrous and vascular response. The degree of lymphocytic response may be important for prognosis. The nodal reaction may be stimulated by release of antigens from the tumor. One of the most studied animal models of lymphatic metastasis is that which occurs in the politeal node after injection of tumor into the footpad. This model has been used to show that tumor cells enter lymphatics through gaps in endothelium, probably between endothelial cells, and that lymph nodes can destroy small numbers of tumor cells. Local immunotherapy and chemotherapy can sterilize a lymph node of tumor cells; the modes of treatment used have included intralymphatic injection and encapsulation of chemotherapeutic agents in liposomes. Prior radiotherapy may accelerate metastasis possibly by making tumor cells shed into lymphatic vessels. Lymph nodes are rather poor barriers to tumor cells. The prognostic significance of lymph node metastasis varies within tumor type; if hematogenous metastasis is early, then the presence of lymph node metastasis is of lesser prognostic significance. Lymph nodes can probably destroy only small numbers of tumor cells. Tumor cell heterogeneity is of importance in many aspects of metastasis; while clonal variation may be of importance in determining lymph node metastasis, it is not yet clear how important this is, nor whether specific clones metastasize specifically to lymph nodes. Lymphography is well established in diagnosis of lymphatic metastasis. A recent interesting development has been to inject antibodies labeled with a radioactive label, and image the label in lymph nodes with a gamma-camera. If anti-tumor antibodies are used in this way it may be possible to detect lymph node metastasis. Within the expanding field of tumor metastasis, lymphatic metastasis needs much more attention, particularly in relation to the diagnosis and treatment of the lymphatic spread of human cancer.

Animals↗
PubMed1983

Experimental lymphatic metastasis.

A model of lymphatic metastasis of cancer has been established by injecting tumour cells into the rat footpad and examining the draining popliteal lymph node. The node can probably destroy only a few tumour cells; thereafter metastasis is progressive and lethal. The tumour cells penetrate the lymphatic endothelium, in the footpad either by moving singly between intact endothelial cells, by destroying the endothelium, or by passing in clumps between the endothelial cells. Tumour cells may then be obtained from the lymph by cannulation of the lymphatic trunk. These experiments pose the question: is local lymphatic chemotherapy useful in treating lymphatic metastasis?

Animals↗
PubMed1983

Indomethacin treatment in small versus large premature infants with ductus arteriosus. Comparison of plasma indomethacin concentration and clinical response.

An analysis of clinical response and plasma indomethacin concentration was performed on 10 small (less than or equal to 1000 g) and 12 large (greater than 1000 g) premature infants who had symptomatic ductus arteriosus and required intravenous indomethacin therapy (0.3 mg/kg per day). The postnatal age, daily fluid intake, and cardiopulmonary status of the two groups at time of study were comparable, The small premature infants had a significantly lower peak plasma indomethacin concentration and lower concentration in the first four hours after infusion, and lower plasma concentration X time integral than that of the larger premature infants. There was a significant difference between the groups in proportion of response (2/10 vs 9/12) after one dose of indomethacin; this difference was not seen after two to three doses. The results of the study suggest that small premature infants do respond to indomethacin treatment, but compared to the larger infants may require repeated doses.

Birth Weight↗