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J R Farndon

Publications and source records attributed to J R Farndon.

At least 19 recordsLinked to original sources
PubMed1992

Diagnostic and therapeutic aspects of fine-wire localization biopsy for impalpable breast cancer.

During the first 2 years (July 1989 to July 1991) of the Avon Breast Screening Service, fine-wire localization biopsy was indicated in 213 impalpable breast lesions. A total of 144 lesions were benign and 69 malignant. Only four of 213 lesions (1.9 per cent) were not excised at the first localization. Factors influencing reoperation in the 69 patients with malignant impalpable lesions were examined. There was a significant association (P < 0.001) between parenchymal disturbances on mammography and invasive carcinoma, and between non-invasive carcinoma and microcalcification (P < 0.001). In 31 patients the localization biopsy was the only surgical procedure. Thirty-eight patients required further surgery: 12 underwent further local excision and 26 mastectomy. Reoperation was more frequent in patients with calcification than in those with parenchymal disturbance (P < 0.001). The most frequent indications for mastectomy were inadequate excision of widespread comedo ductal carcinoma in situ or invasive ductal carcinoma combined with extensive ductal carcinoma in situ. Fine-wire localization biopsy was a combined therapeutic and diagnostic procedure in 31 of 69 women with impalpable screen-detected lesions. The majority of patients required further surgery because radiological abnormalities underestimated the extent of disease.

Biopsy, Needle↗
PubMed1992

Fat-suppression magnetic resonance imaging in the preoperative localization of parathyroid adenomas.

Prospective localization of parathyroid adenomas was attempted in 16 patients with hyperparathyroidism prior to surgery. All patients had magnetic resonance imaging (MRI) using T1-weighted spin-echo (SE) sequences and a fat-suppression sequence, the short-tau inversion recovery (STIR) sequence. Correlation with the results of surgery yielded an overall sensitivity of 71% and a specificity of 94%. Performance was good in patients with previous surgery and with ectopic tumours. We believe that fat-suppression MRI is a valuable technique in the preoperative localization of parathyroid adenomas in patients with hyperparathyroidism.

Adenoma↗
PubMed1991

pNR-2/pS2 immunohistochemical staining in breast cancer: correlation with prognostic factors and endocrine response.

Expression of the oestrogen-regulated pNR-2/pS2 protein has been studied in paraffin sections of a series of 172 primary breast cancers using an immunohistochemical technique. Positive staining of tumour cells was found in 117 tumours (68%): most of these tumours contained only a small proportion of positive cells. pNR-2 immunohistochemical staining correlated positively and significantly with the presence of oestrogen receptor. Mean percentages of pNR-2 positive cells were lower in tumours from postmenopausal women. Smaller, better differentiated tumours were significantly more likely to stain positively for pNR-2. The percentages of pNR-2 positive tumour cells in primary tumours and synchronously excised lymph node metastases were very similar. pNR-2 expression showed an unexpected positive association with lymph node metastasis. We were unable to find any significant association between pNR-2 immunohistochemical staining and either time to relapse or overall survival. There was a significant association between pNR-2 expression in primary tumours and response to endocrine therapy on relapse: positive pNR-2 immunohistochemical staining in primary tumours is predictive of response to hormonal therapy on relapse.

Aminoglutethimide↗
PubMed1991

Epidermal growth factor receptor (EGFr); results of a 6 year follow-up study in operable breast cancer with emphasis on the node negative subgroup.

More accurate criteria are required for the selection of patients with node-negative breast cancer for systemic adjuvant therapy. Expression of epidermal growth factor receptor (EGFr) has been shown previously to be inversely related to oestrogen receptor (ER) in patients with operable breast cancer and to be associated with a poorer prognosis. Analysis of EGFr and ER was performed on tumour samples from 231 patients with operable breast cancer followed for up to 6 years after surgery. The median duration of follow-up in patients still alive at the time of analysis was 45 months. Thirty-five percent of patients (82) had tumours with greater than 10 fmol mg-1 I125-EGF binding (EGFr+) and 47% (109) and cystolic ER concentrations greater than 5 fmol mg-1 (ER+), with a marked inverse relationship between EGFr and ER (P less than 0.00001). In a univariate analysis EGFr was second only to axillary node status as a prognostic marker for all patients both in terms of relapse-free and overall survival (P less than 0.001, log rank). For patients with histologically negative axillary nodes EGFr was superior to ER in predicting relapse and survival (P less than 0.01 and P less than 0.005 respectively compared to P less than 0.1 and P less than 0.1, log rank). In a multivariate (Cox model) analysis only EGFr, out of EGFr, ER, size and grade, was predictive for either relapse-free or overall survival for patients with node-negative disease (P = 0.05 and P = 0.026 respectively). EGFr has been shown to be a marker of poor prognosis for patients with node-negative breast cancer. Since patients with EGFr+ tumours are unlikely to respond to hormone therapy it may be possible to select them for trials of systemic adjuvant chemotherapy.

Breast Neoplasms↗
PubMed1991

The varicose vein waiting list: results of a validation exercise.

A lengthening waiting list for treatment of varicose veins in a busy teaching hospital prompted a careful review. Patients were sent a detailed questionnaire which addressed current symptoms, progression of the complaint and the desire for surgical treatment. Of 519 patients on the waiting list, replies were received from 471 (91%). Forty-eight patients could not be traced after two questionnaires had been sent and enquiries made with their last known local GP. A further 87 (17%) patients were removed from the waiting list because they no longer desired treatment or had had treatment in the private sector. The remaining 384 patients were sent appointments for specially organised Saturday morning assessment clinics attended by consultants and senior registrars. Eighty patients failed to attend without giving a reason and were removed from the waiting list. Of 304 patients reviewed, surgical treatment was considered necessary for 219, of whom 182 were suitable for day-case surgery, leaving only 37 patients of the original 519 who required inpatient surgical care. This study has shown how careful assessment and the increased provision of day-case facilities can relieve pressure on inpatient care.

Adult↗
PubMed1991

Familial breast cancer.

The genetic inheritance of familial breast cancer is complex and heterogeneous, i.e. it cannot be explained by one major susceptibility gene. It is likely that the chromosomal abnormalities and genetic lesions detected in the inherited syndromes will be implicated in the development of the more common sporadic breast tumours. Study of this important subgroup is essential to advance our understanding of the tumour biology of breast cancer and to develop adequate screening programmes for high risk young women.

Adult↗
PubMed1990

Epidermal growth factor receptor (EGFr) as a marker for poor prognosis in node-negative breast cancer patients: neu and tamoxifen failure.

Analysis of EGFr and ER was performed on tumour samples from 231 patients with operable breast cancer followed for up to 6 yr after surgery. The median duration of follow-up in patients still alive at the time of analysis was 45 months. Thirty-five percent of patients (82) had tumours greater than 10 fmol/mg 125I-EGF binding (EGFr+) and 47% (109) had cystolic ER concentration greater than 5 fmol/mg (ER+), with a marked inverse relationship between EGFr and ER (P less than 0.00001). EGFr was second only to axillary node status as a prognostic marker for all patients both in terms of relapse-free and overall survival (P less than 0.001, logrank EGFr+ vs EGFr-). For patients with histologically negative axillary nodes EGFr was superior to ER in predicting relapse and survival (P less than 0.01 and P less than 0.005, respectively, compared to P less than 0.1 and P less than 0.1, logrank). In a multivariate (Cox model) analysis only EGFr, out of EGFr, ER, size and grade, was predictive for either relapse-free or overall survival for patients with node-negative disease (P = 0.052 and P = 0.026, respectively). The correlation of neu expression with response to tamoxifen in patients with recurrent disease was assessed immunochemically. Response rate was reduced in the presence of neu from 50 to 17% for ER+ cases and from 26 to 0% for ER- cases.

Biomarkers, Tumor↗
PubMed1990

Thallium isotope scintigraphy and ultrasonography: comparative studies of localization techniques in primary hyperparathyroidism.

Controversy exists about whether preoperative localization procedures are indicated in patients with primary hyperparathyroidism before first neck exploration. Currently, thallium subtraction scintigraphy and ultrasonography are the techniques used most frequently. This paper examines prospectively the accuracy and value of these techniques in a group of 71 patients with primary hyperparathyroidism. When considering all glands, thallium scanning produced a sensitivity of 46.6 per cent with a specificity of 91.5 per cent, compared with a sensitivity of only 21.4 per cent and specificity of 94.5 per cent for ultrasonography. Accuracy rates, for all glands, were 80 per cent and 75.7 per cent respectively. Both localization procedures were consistently ineffective in localizing adenomas weighing less than 500 mg, over 80 per cent of which went undetected by both scanning modalities. While both scans produced satisfactory results in localizing adenomas weighing more than 1 g, these adenomas should not represent a challenge to an experienced endocrine surgeon and, therefore, neither localization is recommended before first neck exploration.

Adenoma↗
PubMed1990

Thallous chloride uptake and DNA profile in parathyroid adenomas.

Thallium isotope scintigraphy is used to localize parathyroid adenomas but the mechanism underlying the technique is poorly understood. While larger adenomas are reliably localized the results are less certain for small tumours. This study explores the relationship between cellular DNA profile and thallium uptake (localization accuracy) in 24 parathyroid adenomas. The DNA profile was assessed using flow cytometry and standard subtraction thallium scintigraphy was performed before surgery. Fifteen of the 24 adenomas demonstrated excessive mitotic activity and 13 of these glands were accurately localized. Of the remaining nine glands, only five were localized accurately (P less than 0.01, chi 2 test including Yates' correction). This difference in thallium uptake could not be accounted for on the basis of gland weight. Thallium localization of parathyroid adenomas is related to mitotic activity. This may explain some of the limitations of this technique.

Adenoma↗
PubMed1990

Parathyroidectomy in chronic renal failure: a nine-year follow-up study.

Seventy-three patients with chronic renal failure who underwent parathyroidectomy between March 1978 and April 1987 were reviewed. Thirty-four patients had undergone sub-total parathyroidectomy, and 39 patients had undergone total parathyroidectomy with parathyroid autograft into the forearm. Eight patients showed persistent hyperparathyroidism requiring a second surgical procedure. In all other patients there was highly statistical improvement in parathyroid hormone, total calcium, ionized calcium, alkaline phosphatase and a significant reduction in calcium x phosphate product. Histological evidence of osteitis fibrosa was present in 21 of 22 patients before surgery. Postoperatively, four showed complete resolution and improvement. Three patients developed histological evidence of osteomalacia during the study period. Only four of the 39 patients who underwent total parathyroidectomy with autograft had true recurrent hyperparathyroidism and only two of the 34 patients who underwent sub-total parathyroidectomy had recurrent disease, indicating that there is little to choose between the two techniques in the control of secondary hyperparathyroidism and its subsequent recurrence. In one patient with recurrence of hyperparathyroidism from a forearm parathyroid graft the histological picture was different from that of normal hyperplastic parathyroid tissue. Although it is probable that abnormal parathyroid tissue had been implanted there was no evidence of invasive growth into the forearm muscle. The most striking feature of long term follow-up was the difference in calcium x phosphate product in patients in whom vascular calcification increased compared to those patients with no change or regression of calcification. Mean calcium phosphate product in those patients with progressive vascular calcification was 4.93 for small and medium size vessels and 5.38 for large vessels compared to 4.10 for small and medium vessels and 4.09 for large vessels. In the former case the serum phosphate was 2.00 and 2.17 as compared to 1.75 or 1.73, suggesting that the aim in patients with end stage renal failure maintained by dialysis should be to control the serum phosphate concentration to 1.8 mmol or less and the calcium x phosphate product to less than 4.2.

Adult↗
PubMed1989

Expression of epidermal growth factor receptors associated with lack of response to endocrine therapy in recurrent breast cancer.

Epidermal growth factor receptors (EGFR) and oestrogen receptors (ER) were analysed in 221 patients with primary operable breast cancer by means of radioligand assays. After median follow-up of 24 months (range 3-60 months), there had been recurrences in 99 patients, of whom 72 (median age 56 years, range 32-77 years) received tamoxifen alone as first-line treatment for recurrence. 20 patients (28%) showed a response to this therapy and 52 (72%) did not. Of 32 ER-positive tumours, 12 (37.5%) showed an objective response to tamoxifen compared with only 2 of 40 (5%) ER-negative tumours (p less than 0.005). Of 35 EGFR-positive tumours, 3 (8.5%) achieved an objective response compared with 11 of 37 (30%) EGFR-negative tumours (p less than 0.05). Only 1 of 28 EGFR-positive, ER-negative tumours achieved an objective response. Including patients whose disease remained stable for more than 6 months with the responders, however, EGFR status was a better predictor of response to tamoxifen; 15 of 37 EGFR-negative patients and 5 of 35 EGFR-positive patients responded (p less than 0.01), compared with 13 of 32 ER-positive and 7 of 40 ER-negative patients (not significant). EGFR expression is a highly significant marker of poor prognosis in patients with breast cancer; it appears to be as good a predictor as ER for objective response and better for overall response to endocrine therapy on relapse.

Adult↗
PubMed1989

Prior renal transplantation does not facilitate subsequent canine islet allograft survival.

Successful islet allografts can be established in rats bearing long surviving renal allografts, without additional immunosuppression, when kidney and islet donor animals are of the same strain. The applicability of such a scheme to clinical practice has been investigated in a large animal model of diabetes: the pancreatectomized dog. Eight dogs with previously established renal allografts and immunosuppressed with cyclosporin A received islet allografts from their respective original kidney donors. The median islet graft functional survival was only 10.5 days, significantly less than for six similarly immunosuppressed dogs receiving islet allografts alone (48.5 days, P less than 0.05). Three of the sequentially transplanted dogs had had no renal graft rejection episodes before islet transplantation, yet their islet grafts were all rejected within 19 days. In the pancreatectomized dog, prior donor specific renal transplantation has an adverse effect upon subsequent islet graft survival.

Animals↗
PubMed1989

Diurnal insulin and glucose profiles following transplantation of fresh and cryopreserved canine pancreatic islets.

Dispersed islet autotransplants (fresh and cryopreserved) can produce normal fasting insulin and glucose concentrations. Following an intravenous glucose challenge, however, the insulin response is impaired and glucose clearance delayed. This study examines the diurnal insulin and glucose response to feeding in recipients of fresh islet autografts (n = 6), recipients of cryopreserved islet autografts (n = 3), normal unoperated controls (n = 10) and insulin treated pancreatectomized diabetic dogs (n = 7). Mean fasting insulin and glucose levels were similar in all groups. After feeding, insulin profiles in both transplant groups were near normal while significant hyperinsulinaemia occurred in insulin treated diabetic dogs. Mild postprandial carbohydrate intolerance was observed in transplant recipients but glycosylated haemoglobin levels were similar (mean(s.d.] to normals (6.88(0.86) per cent, 6.86(0.5) per cent respectively). Dispersed islet autotransplantation with portal insulin delivery produces near normal insulin and glucose profiles suggesting that this may represent a suitable treatment for insulin dependent diabetes.

Animals↗
PubMed1989

Failure of canine islet allotransplantation after kidney transplantation.

Eight dogs with previously established kidney allografts, immunosuppressed with cyclosporin A, received islet allografts from their respective original kidney donors. The median islet-graft functional survival was only 10.5 days, significantly less than for six similarly immunosuppressed dogs receiving only islet allografts (48.5 days, P less than .05). Three of the eight dogs that received sequential kidney and islet allografts had experienced no kidney-graft rejection episodes before islet transplantation, but their islet grafts were all rejected within 19 days. In the pancreatectomized dog, prior donor-specific kidney transplantation has an adverse effect on subsequent islet-graft survival.

Animals↗