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Biomedical subjects

M Donnellan

Publications and source records attributed to M Donnellan.

8 recordsLinked to original sources
PubMed2004

Infiltrating lobular carcinoma--a comparison of diagnosis, management and outcome with infiltrating duct carcinoma.

The treatment and outcomes for 182 patients with lobular carcinoma were compared with 1612 patients with infiltrating ductal carcinoma managed concurrently at The Strathfield Breast Centre. The lobular carcinomas were larger (P < 0.0001) but of lower grade (P < 0.0001). Diagnosis with mammography and FNA was less sensitive in ILC (mammography P = 0.0002, FNA P < 0.0001). Although similar numbers of patients underwent initial attempted conservation, patients with ILC were more likely to have positive margins at attempted breast conservation surgery and the final mastectomy rate was higher (58.2% ILC versus 47% IDC, P = 0.0041). Of the patients who had successful conservation, the local recurrence rates for ILC (3.9%) were equivalent to the patients with IDC (5.3%). There was no significant difference in overall survival (90% ILC, 87% IDC, median follow-up 3.6 years ILC, 4.3 years IDC) or disease free survival (87.9% ILC, 81.6% IDC). Although mastectomy is more likely to be necessary to obtain clear margins, breast conservation therapy is reasonable in patients with infiltrating lobular carcinoma where clear margins can be obtained.

Adult↗
PubMed1999

Clinical significance of intramammary lymph nodes.

Intramammary lymph nodes (IMLN) are present in up to 47% of breasts and may be involved in metastatic disease in up to 9.8 % of operable breast cancer cases. IMLN are likely to be increasingly recognized with wider acceptance of high quality screening mammography and the use of ultrasound assessment of breast disease. The aim of this study is to demonstrate how IMLN can have an impact on management of breast cancer patients by presenting a case series of three patients. We conclude that IMLN metastases from breast cancer alters the prognosis and hence the management of patients. This will need to be addressed more frequently as sentinel node biopsy is more widely utilized.

Journal Article↗
PubMed1998

Diagnosis of small sized invasive breast cancer by an Australian mammography screening service: surrogate end-points for mortality reduction.

BACKGROUND: The percentage of screen-detected infiltrating cancers that are small, the percentage that are node-negative and the percentage of those that are grade 3 and small, are surrogate end-points for the main object of breast screening, namely the reduction in mortality from breast cancer in the screened population. METHODS: This study reports these end-points; that is, the prognostic features of invasive cancers, as detected by the Central and Eastern Sydney Service of BreastScreen NSW. The data reported were collected by the Service on women who attended for screening between March 1988 and December 1994. RESULTS: Breast cancer detection rates for women aged 50-69 years were 78 per 10,000 for prevalent screens and 37 per 10,000 for incident screens with 36 and 37%, respectively, of the invasive cancers being < or = 10 mm in size and 64 and 70%, respectively, being < or = 15 mm in size. Seventeen per cent of invasive cancers were grade 3 and of these 45% were < or = 15 mm in size. Axillary nodal dissection was carried out in 86% of invasive cancers and 69% of these were node-negative, the rates of node negativity being higher for small-sized cancers. CONCLUSIONS: Breast cancer detection rates, small invasive cancer detection rates, the percentage of small grade 3 cancers and the node negativity rates indicate that the potential long-term mortality benefits of mammography screening should be achieved. These rates could be used to underpin a review of the Australian Accreditation Standards.

Adult↗
PubMed1997

MIC-1, a novel macrophage inhibitory cytokine, is a divergent member of the TGF-beta superfamily.

Macrophages play a key role in both normal and pathological processes involving immune and inflammatory responses, to a large extent through their capacity to secrete a wide range of biologically active molecules. To identify some of these as yet not characterized molecules, we have used a subtraction cloning approach designed to identify genes expressed in association with macrophage activation. One of these genes, designated macrophage inhibitory cytokine 1 (MIC-1), encodes a protein that bears the structural characteristics of a transforming growth factor beta (TGF-beta) superfamily cytokine. Although it belongs to this superfamily, it has no strong homology to existing families, indicating that it is a divergent member that may represent the first of a new family within this grouping. Expression of MIC-1 mRNA in monocytoid cells is up-regulated by a variety of stimuli associated with activation, including interleukin 1beta, tumor necrosis factor alpha (TNF-alpha), interleukin 2, and macrophage colony-stimulating factor but not interferon gamma, or lipopolysaccharide (LPS). Its expression is also increased by TGF-beta. Expression of MIC-1 in CHO cells results in the proteolytic cleavage of the propeptide and secretion of a cysteine-rich dimeric protein of Mr 25 kDa. Purified recombinant MIC-1 is able to inhibit lipopolysaccharide -induced macrophage TNF-alpha production, suggesting that MIC-1 acts in macrophages as an autocrine regulatory molecule. Its production in response to secreted proinflammatory cytokines and TGF-beta may serve to limit the later phases of macrophage activation.

Amino Acid Sequence↗
PubMed1997

Effects of exposure to electromagnetic radiation at 835 MHz on growth, morphology and secretory characteristics of a mast cell analogue, RBL-2H3.

A mast cell line, RBL-2H3, was exposed to 835 MHz for 20 minutes, three times per day for 7 days at a power density of 8.1 +/- 3 mW/cm2. From day 4 onwards, it was observed that the rate of DNA synthesis and cell replication increased, that actin distribution and cell morphology became altered, and the amount of beta-hexosaminidase (a marker of granule secretion) released in response to a calcium ionophore was significantly enhanced, in comparison to unexposed cultures. There were no effects seen on levels of cytoskeletal protein synthesis or of beta-actin mRNA. Morphological changes persisted following subculture for at least 7 days in the absence of further exposure. It is hypothesized that effects of exposure to an electromagnetic field at 835 MHz may be mediated via a signal transduction pathway.

Actins↗
PubMed1996

Nurse practitioners' reactions to persons with HIV/AIDS: the role of patient contact and education.

Attitudes about caring for patients with HIV/AIDS (PWAs) were investigated in a survey mailed to all nurse practitioners (NPs) in Georgia. There was a 53% response rate to the survey (286 of 539 questionnaires were returned). It was hypothesized that exposure to continuing education on HIV/AIDS and to HIV-positive patients would be associated with more positive attitudes and less extreme behavioral changes associated with fear of transmission. Factor analytic procedures were used to generate three scales: resentment of PWAs (RESENT), anxiety or fear about contact with PWAs (FEELINGS), and changes in personal life related to fear of transmission after contact with PWAs (CHANGE). Descriptive findings indicated that a significant minority of NPs were worried about risk, harbored some resentment toward PWAs, and had changed their behavior out of concern about the possible transmission of HIV. Differences of means and stepwise regression analyses (with several potentially confounding variables controlled) found exposure to continuing education associated with less fear and anxiety, less resentment, and less behavioral change. Exposure to HIV-positive patients was associated with less behavioral change, as predicted, but not with less fear/anxiety or resentment. The cross-sectional survey design limits the attribution of causality, but offers some support for the role of continuing education in improving attitudes toward PWAs.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Cytotoxic T lymphocyte precursor frequency does not correlate with either the incidence or severity of graft-versus-host disease after matched unrelated donor bone marrow transplantation.

BMT from matched unrelated donors or mismatched family members is associated with an increased risk of graft-versus-host disease (GVHD) compared with HLA-identical sibling donors. It has been suggested that the level of patient-specific CTL precursors (CTLp) present in matched unrelated donors correlates with the incidence and severity of GVHD after BMT. This study group consisted of 17 patients who all received unmanipulated bone marrow from an HLA-A,B,DR-matched unrelated donor. Patient-specific CTLp frequencies were estimated in the donor before transplant. The CTLp frequencies were then compared with the incidence and severity of GVHD experienced by the patient after transplantation. Statistical analysis revealed no correlation between donor precursor frequencies and the patient developing clinically significant acute GVHD after transplantation (X2 = 1.16). This study suggests that caution should be used before the inclusion of the CTLp frequency result in the clinical decision of selecting the most suitable matched unrelated donor for BMT. CTLp frequency does not correlate with either the incidence or severity of GVHD after matched unrelated donor BMT.

Bone Marrow Transplantation↗