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Biomedical subjects

M G O'Rourke

Publications and source records attributed to M G O'Rourke.

At least 19 recordsLinked to original sources
PubMed1997

A case report: immune responses and clinical course of the first human use of granulocyte/macrophage-colony-stimulating-factor-transduced autologous melanoma cells for immunotherapy.

The first use of granulocyte/macrophage-colony-stimulating-factor-transduced, lethally irradiated, autologous melanoma cells as a therapeutic vaccine in a patient, with rapidly progressive, widely disseminated malignant melanoma resulted in the generation of a novel antitumour immune response associated with partial, albeit temporary, clinical benefit. An initially negative reaction to non-transduced, autologous melanoma cells was converted to a delayed-type hypersensitivity (DTH) reaction of increasing magnitude following successive vaccinations. While intradermal vaccine sites showed prominent dendritic cell accrual, DTH sites revealed a striking influx of eosinophils in addition to activated/memory T lymphocytes and macrophages, recalling the histology of challenge tumour cell rejection in immune mice. Cytotoxic T lymphocytes (CTL) reactive with autologous melanoma cells were detectable at high frequency after vaccination, not only in limiting-dilution analysis, but also in bulk culture without added cytokines. Clonal analysis of CTL showed a conversion from a purely CD8+ response to a high proportion of CD4+ clones following vaccination. A prominent acute-phase response manifested by a five- to tenfold increase in C-reactive protein was observed, as was a systemic eosinophila. Vaccination resulted in the regression of axillary lymphatic metastases, stabilisation of pulmonary metastases, and a dramatic, reversible increase in cerebral oedema associated with multiple central nervous system metastases: however, lesions in the adrenal glands, pancreas and spleen proved refractory. The antitumour effects and immune response were not detectable 2 months following the last vaccination. Irradiation of the extensive cerebral metastases resulted in rapid deterioration and death of the patient.

Autopsy↗
PubMed1993

Melanoma recurrence after excision. Is a wide margin justified?

Through retrospective analysis of patient records for 187 patients with melanoma seen between 1975 and 1989, the aim of this study was to determine whether outcome varied according to degrees of surgical intervention in the primary treatment of stage I disease for thin, intermediate, and thick lesions. There were no significant differences in recurrence rate associated with an excision margin of 15 mm or less compared with wider excision margins; with initial excision compared with wider re-excision after excision biopsy; or for primary closure as compared with closure with a graft. There was, however, a significant difference in wound complication rate between wounds closed primarily (6%) and those closed by grafting (31%) (p < 0.01). The authors advocate the more conservative excision margin of 1.00 cm to 1.50 cm in the treatment of stage I melanoma with primary closure of the wound where possible.

Adolescent↗
PubMed1990

The diagnosis of breast cancer: a clinical and mammographic comparison.

The early and accurate diagnosis of breast cancer is of paramount importance in the symptomatic patient. In this study, the sensitivity and false negative rates of clinical assessment and community mammographic imaging are measured and compared. One hundred and sixty-nine histologically proven breast cancers, derived from one surgeon's practice, were clinically assessed. Of these, 108 were additionally assessed by mammography. Eighty-seven per cent of the patients with breast cancer presented with a lump. In 82.8% of cases the patient or her partner found the lump, while 12.3% of lumps were found by the family practitioner. The false negative rate for clinical diagnosis was 19%, and for mammographic diagnosis it was 29%. Premenopausal mammographic diagnosis had a significantly higher false negative rate (54%) than postmenopausal diagnosis (14%). Mammographic examination had a particularly high false negative rate (65%) when cancer was thought clinically to be of "low index of suspicion". The clinical evaluation of and the indications for biopsy of the symptomatic breast remain the essential step in the diagnosis of breast cancer.

Adult↗
PubMed1988

Management of Merkel cell tumour.

The records of 13 patients suffering from Merkel cell tumour of the skin have been reviewed and the treatment analysed. Pending further experience of this uncommon tumour, a recommendation is made for wide excision of the primary site with elective postoperative radiation to both the primary site, the in-transit zone where practicable, and regional nodes. If malignant nodes occur, block dissection with postoperative radiotherapy is indicated. If widespread metastases develop, cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy may give a response. The prognosis is poor.

Adult↗
PubMed1987

Merkel-cell tumour of the skin.

The case histories of four patients with a Merkel-cell tumour of the skin are presented and the findings are compared with other reports in the literature. An association with other skin tumours is noted and ultraviolet light may be implicated in the causation of Merkel-cell tumours. The Merkel-cell tumours in this series occurred initially on the face. The difficulty of diagnosis is stressed. It is recommended that wide excision of the tumour be followed by radiotherapy to the excision site plus a large margin, in an attempt to prevent local recurrences that are brought about by lymphatic permeation.

Adenocarcinoma↗
PubMed1986

Gallstone pancreatitis.

Gallstone pancreatitis is a disease of high mortality (11%) and significant morbidity (42%). An analysis of 66 patients with this disease revealed the importance of an early aetiological diagnosis; 66% of our patients had evidence of previous biliary disease. Most patients were elderly and the severity of their disease could be predicted using Ranson's predictive indices. Surgery was immediate (within 48 hours) in 11 (17%) patients, early (two-14 days) in 16 (24%) and delayed in 27 (41%) patients. Some patients refused surgery. Our study suggests that very ill patients require immediate surgery--often cholecystostomy alone--and that although in the majority symptoms should settle on conservative treatment, definitive surgery should be carried out at the time of the initial admission. Further delay increases morbidity, mortality and expense.

Aged↗
PubMed1986

Carcinoid of the small intestine.

Carcinoid tumour was the most common small bowel tumour found in this series of 179 patients. It occurred in 24% of patients. Forty-six percent of patients were asymptomatic during life, the tumours being found either at autopsy or during other surgical procedures. Of those that were symptomatic, half presented with intestinal obstruction and the rest with long-standing symptoms. An abdominal mass, which occurred in 14% of cases, is an uncommon physical finding since the majority present as small submucosal tumors. Fifty-eight per cent overall and 72% of those having surgery had evidence of regional spread, either by local invasion or in the form of regional nodal involvement. Seven per cent of patients have died of their disease. Excisional surgery should be performed for all cases where feasible, and repeated for recurrent symptoms.

Adult↗
PubMed1986

The operating room diagnosis of small bowel tumours.

A scheme is proposed whereby a surgeon in the operating room may identify macroscopically, with accuracy, the nature of a small intestinal tumour. This will help the surgeon to make a correct decision regarding the immediate operative management of the tumour.

Adenocarcinoma↗
PubMed1986

Lymphoma of the small intestine.

In a group of 179 patients with small bowel tumours presenting over a 10 year period, lymphomas (20%) were the second most common group. The tumour was usually a white mass and was usually resectable. Eighty-one per cent of patients had regional invasion or metastasis at the time of surgery. Treatment was by surgery and radiotherapy for regional disease. If patients survived 2 years they were usually cured. The overall survival rate was 57%. Fresh tissue for expert histology is essential. Histological review by an experienced panel revealed many tumours previously classified as undifferentiated and several anaplastic carcinomata to be lymphoma. It has been recommended that the criteria for intestinal lymphoma be revised.

Adolescent↗
PubMed1985

Cutaneous malignant melanoma in association with other skin cancers.

A case-control study of 232 cases of cutaneous malignant melanoma and 232 matched controls was performed to assess the association of the disease with nonmelanotic skin tumors--basal cell carcinomas, squamous cell carcinomas, and solar keratoses. There was a fourfold increase in risk of melanoma of all types when actinic tumors were present on the face. The risk was not restricted to the lentigo malignant melanoma class as might be expected but was significantly raised for superficial spreading melanoma and nodular melanoma as well (relative risk, 2.8; 95% confidence interval, 1.1-7.2). This relationship with lesions known to be associated with high-dose solar UV irradiation was supported by quantitative evidence that heavy sun exposure was associated with an increased risk of malignant melanoma.

Adolescent↗
PubMed1984

Prophylactic antibiotics in appendicectomy: a prospective double blind randomized study.

Our double blind prospective randomized trial comparing intravenous cefoxitin with rectal metronidazole in appendicectomy reveals both groups to be similar regarding basic data, with no significant difference in the results between the two drugs. Nearly all the wound infections occurred after the patient went home. Most were minor infections and the overall infection rate was 6%. The intravenous route was the more certain but the more expensive. Bacteriology suggests that the same flora were present in the appendiceal wall of normal and acute non-perforated appendices. This would suggest bacteriologically that the same risks exist with non-inflamed appendicectomy as occurs with inflamed non-perforated appendices. These findings support the use of short course prophylaxis in appendicectomy.

Adolescent↗
PubMed1982

Metastases in malignant melanoma.

A study has been made of 76 cases of metastatic melanoma presenting over a ten year period. Of this group, 64.5 per cent developed clinical metastases within 12 months of presentation with the primary disease while 80 per cent had developed metastases by three years. Fifty per cent of our patients had ulcerated lesions, and most patients had thick lesions on histological examination. The site of the first metastasis occurred in the regional lymph nodes in 65 per cent and in viscera in 22 per cent. Subsequent clinical metastases were widespread and their distribution is recorded. Of those patients with nodal involvement, 75 per cent had only one node involved in histological examination. Only 14 of the 76 patients are alive and of these nine are alive without disease. The surviving patients had regional node, intransit or local metastases present. Disease beyond these areas was fatal. We have recorded the therapeutic modalities used without attempting to study them objectively.

Adolescent↗
PubMed1982

Angiosarcoma of skin.

We report two patients with angiosarcoma of the skin, a rare tumour in Queensland. Both presented on the face of elderly people; both were misdiagnosed as the more common skin cancers: basal cell carcinoma in one instance, and squamous cell carcinoma in the other. Frozen section histological examination diagnosis presented difficulty in both patients. Both tumours invaded very deeply requiring wide resection and reconstruction. One metastasized to the lungs, the other to the regional nodes.

Aged↗