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Biomedical subjects

M R Lane

Publications and source records attributed to M R Lane.

At least 19 recordsLinked to original sources
PubMed1999

Long-term follow-up of the management of benign oesophageal strictures at Auckland Hospital 1990-1994.

AIMS: To audit the success of endoscopic dilatation treatment for oesophageal stricture, to determine any predictive factors for multiple dilatations and to compare data with a previous series from the same department. METHODS: The endoscopy records of 121 consecutive patients with benign oesophageal strictures undergoing endoscopic dilatation were reviewed at Auckland Hospital from 1990 to 1994. RESULTS: Two hundred and thirty-eight procedures were performed with no recorded technical failures and minimal morbidity. The follow-up period from presentation ranged from 18 to 77 months (median 47 months) and the symptom-free period after the last dilatation ranged from 6 to 77 months (median 47 months). One hundred and nineteen patients had been followed for 12 months or more since their last dilatation. Sixty-three patients (52%) required only one dilatation, 44 (36%) patients required two to three dilatations and 14 (12%) patients required more than three dilatations. There was a trend for patients treated with omeprazole to require fewer dilatations than patients treated with H2-receptor antagonists (p = 0.07). Patients with tight strictures (< 11 mm) and Barrett's oesophagus required more dilatations. CONCLUSIONS: Oesophageal dilatation for benign peptic strictures is a safe and effective procedure.

Adult↗
PubMed1998

Upper gastrointestinal endoscopy: are preparatory interventions effective?

BACKGROUND: This study was designed to examine the effects of preparatory cognitive and behavioral information on self-confidence, anxiety, and negative affect elicited by an impending upper gastrointestinal endoscopy. METHODS: Forty-eight male and female out-patients, between 18 and 65 years of age, scheduled for a first-time, non-emergency, endoscopic examination were randomly assigned to receive one of four experimental interventions: cognitive, behavioral, combination, or attention-control. Measures of self-reported anxiety and self-reported self-confidence were obtained. RESULTS: Cognitive and combination intervention subjects were statistically younger than behavioral and attention-control subjects. A credibility assessment revealed that subjects who were taught visualization used it during their procedure. Results indicated that subjects in the cognitive and combination interventions experienced significant reduction in anxiety and increase in self-confidence from pre- to post-intervention. Self-confidence did not increase for subjects receiving the behavioral-only or the attention-control interventions. CONCLUSION: The results of this study show that preparatory information in general is effective in reducing anxiety and in increasing self-confidence before an upper gastrointestinal endoscopy. Results suggest that teaching subjects visualization before a procedure increases their use of visualization during a procedure.

Adaptation, Psychological↗
PubMed1997

Failure to detect colonic mucosal hyperproliferation in mutation positive members of a family with hereditary non-polyposis colorectal cancer.

Mucosal proliferation was studied in biopsies obtained from the ascending colon from four mutation positive members of a hereditary non-polyposis colorectal cancer family (group I) and compared to subjects with some positive family history of colorectal cancer but lacking the clinical and pathological features of hereditary non-polyposis colorectal cancer (group II). Labelling indices were derived through immunohistochemical staining of the cell cycle associated nuclear proteins proliferating cell nuclear antigen (PCNA) and Ki-67. Only perfectly longitudinally sectioned crypts were assessed and good intra- and interobserver reproducibility was demonstrated. The labelling indices and proliferative compartment locations were similar in both groups. The mean Ki-67 derived labelling indices (group I 18.0% and group II 17.5%) were similar to values obtained for normal subjects in other studies. PCNA derived labelling indices (group I 58.5% and group II 57.0%) were high, but probably reflect optimization of staining through methacarn fixation. The negative findings do not fit with most published data but critical appraisal of the literature indicates that they are likely to be correct.

Adult↗
PubMed1997

Can earning prompt-payment discounts really save money?

Healthcare financial managers should determine whether to take advantage of the discounts vendors offer for prompt payment of invoices. Prompt-payment discounts offered by vendors can result in substantial savings, but this benefit may be offset by the costs of acquiring the funds necessary for faster payment. The best results are achieved when the cost of funds is less than the discount savings that can be achieved, vendor discounts are available for a high percentage of the provider's purchase base, the provider is able to negotiate with vendors to increase discount levels, and the provider has an efficient system for processing invoices.

Accounts Payable and Receivable↗
PubMed1996

Percutaneous endoscopic gastronomy feeding tubes: a retrospective review at Auckland Hospital 1993-4.

AIMS: A retrospective review of patients being treated by percutaneous endoscopic gastrostomy (PEG) at Auckland Hospital from 1993-4 was undertaken in order to determine patient characteristics, clinical outcome and to compare these results with published series. METHODS: The case notes of all patients having PEGs performed in the Auckland Hospital gastroenterology unit during the defined period were reviewed. Demographic details, indications, morbidity and mortality data were obtained. Data were supplemented with information obtained from the general practitioner. RESULTS: Fifty procedures (18 in 1993, 32 in 1994) were performed on 41 patients (29 male 12 female), with a mean age of 61 years. Neurological disorders represented the most common clinical indication (25) followed by head and neck malignancy (9). Three patients (7) died within 30 days of the procedure and 13 (32) had early complications (less than 30 days) with four (10) having late complications. Significant pain requiring narcotics occurred in 18. CONCLUSIONS: Results were in general comparable to published series apart from a higher early complication rate (32% vs 16%). Pain may be significant post procedure and should be anticipated. The increasing use of this procedure in our hospital reflects its acceptability to patients, relatives and staff as a means of providing nutritional support to the patient with disorders of swallowing.

Adolescent↗
PubMed1996

Colorectal neoplasms detected colonoscopically in at-risk members of colorectal cancer families stratified by the demonstration of DNA microsatellite instability.

This study compared colonoscopic findings in families meeting the Amsterdam criteria (A) for hereditary non-polyposis colorectal cancer (HNPCC) but stratified according to whether the familial cancers showed DNA microsatellite instability. DNA was extracted from paired samples of normal and cancer, and microsatellite instability was analysed at up to six loci. Families were termed replication error positive (RER+) when at least 50% of tumours tested per family were positive. Of 26 families studied 17 were RER+ and 9 were RER-. Cancers in the A/RER- families showed no right-sided predilection (P < 0.001). Colonoscopies have been performed on 182 at-risk members of A/RER+ families and 60 members of A/RER- families. More of the at-risk members of A/RER-families were found to have adenomas at colonoscopy (P = 0.095), but these were smaller than those of A/RER+ families (P = 0.19). The adenoma:carcinoma ratio was twice as high in A/RER- families (13:1) as in A/RER+ families (7:1). One of the A/RER- families had hyperplastic polyposis. The others do not appear to have attenuated familial adenomatous polyposis and are similar to the adenoma families or late-onset colorectal cancer families described by others. This study illustrates the importance of molecular technology in separating HNPCC from syndromes with overlapping phenotypes.

Adenoma↗
PubMed1994

Hereditary non-polyposis colorectal cancer--morphologies, genes and mutations.

Mutations in a human homologue of the yeast DNA mismatch repair gene MSH2 (equivalent to bacterial MutS) cause the condition hereditary non-polyposis colorectal cancer (HNPCC). Cancers in HNPCC originate within benign neoplastic polyps termed adenomas. Adenomas are clonal and each may serve as a marker of a single initiating mutation. The progression of adenomas is marked by increasing size, dysplasia and villosity. These characteristics can be taken as the morphological counterparts of the stepwise accumulation of mutations implicating oncogenes and tumour suppressor genes. The aim of this study was to link the morphogenesis of hereditary colorectal cancer with recent insights into the role of DNA mismatch repair genes. The frequency and anatomical distribution of adenomas in at-risk members of HNPCC families was the same as in an autopsy population. This suggests that the HNPCC gene does not initiate the process of neoplastic transformation. On the other hand, adenomas in at-risk members of HNPCC families were more likely to show villosity (p < 0.001), high grade dysplasia (p = 0.002) and probably increased size (p = 0.15). These findings are consistent with the observation that the HNPCC gene causes DNA replication errors to develop and accumulate within neoplastic but not normal tissues. The effect of the HNPCC gene is to accelerate the progression of adenoma to carcinoma, but not to initiate adenoma development.

Adenoma↗
PubMed1994

Dolichos biflorus agglutinin binding in hereditary bowel cancer.

Dolichos biflorus agglutinin (DBA) binds specifically to N-acetylgalactosamine (GalNAc), one of the 5 sugars contributing to the oligosaccharide component of human colorectal goblet cell mucin. DBA binds to goblet cells of the upper crypt and surface epithelium within the proximal colon and to the majority of goblet cells of the distal large bowel. DBA therefore serves as a marker of colorectal goblet cell differentiation with a distinct proximal to distal gradient effect. Previous reports indicate significant loss of DBA reactivity within morphologically normal colorectal mucosa derived from at-risk members of hereditary non-polyposis colorectal cancer (HNPCC) families. This finding could not be confirmed in the present study. Reduced binding was a relatively consistent finding in transitional mucosa, hyperplastic polyps and carcinoma, with adenomas displaying a more varied pattern of loss. Reduced binding by DBA may be explained by several mechanisms and may not necessarily reflect loss of GalNAc. The concept that lectins can be used to identify stepwise changes that occur during neoplastic evolution should not be accepted uncritically.

Adenomatous Polyposis Coli↗
PubMed1994

Direct mutational analysis in a family with hereditary non-polyposis colorectal cancer.

BACKGROUND: It is now known that a proportion of cases of hereditary non-polyposis colorectal cancer (HNPCC) is caused by mutations in the human homologue of the yeast DNA mismatch repair gene MSH2. A proline to leucine change due to a C to T transition in codon 622 of hMSH2 has been identified in a large HNPCC family of over 240 individuals. AIM: To develop an assay to detect the family-specific mutation and apply the findings to genetic screening. METHODS: The C to T change in codon 622 creates a new Mae I site (CTAG) allowing a simple, non-radioactive assay to be developed in order to detect this mutation. The assay was applied to affected members of the family and their first degree relatives (siblings and offspring) between the ages of 17 and 77 years, a total of 75 subjects within two generations (IV and V). RESULTS: 13/13 (100%) subjects with cancer were mutation positive, 7/7 (100%) elderly subjects from generation IV and with no evidence of cancer were mutation negative, 23/57 (40%) subjects from generation V were mutation positive and 0/50 (100%) unrelated subjects were mutation negative. Following the demonstration of perfect segregation of the disease with the mutation, family members were invited to receive the results of the test. Sixty-three (84%) responded within six weeks of receiving the invitation. Genetic screening and counselling members of HNPCC families was perceived as beneficial overall, allowing non-carriers of the mutant gene (as well as their descendants) to be removed from a programme of colonoscopic surveillance.

Adolescent↗
PubMed1993

Palliation of biliary obstruction in patients with advanced breast cancer using endoscopic stents.

Endoscopic insertion of a biliary endoprosthesis was successful in eight patients with extrahepatic biliary obstruction caused by breast cancer metastases. The serum bilirubin level was significantly reduced in seven patients and in four this was accompanied by marked symptomatic improvement. Endoprostheses required replacement after a median of 8 (range 3-127) weeks. Two patients responding to systemic anticancer therapy survived 27 and 43 months. Endoscopically placed stents offer effective palliation of extrahepatic biliary obstruction caused by metastatic breast cancer and long-term survival may be possible.

Adult↗
PubMed1993

Ulex europaeus agglutinin-1 binding in hereditary bowel cancer.

Ulex europaeus agglutinin-1 (UEA-1) binds specifically to alpha-L-fucose, the terminal sugar of blood group substances H2 and Ley the expression of which is confined mainly to the proximal colon. The aim of the study was to determine whether there is neo-expression of alpha-L-fucose in the normal appearing mucosa of the distal bowel in subjects with or at risk of hereditary bowel cancer. UEA-1 binding was investigated by means of a direct lectin-peroxidase technique in tissues derived from patients with familial adenomatous polyposis (9) and affected (16) or at risk of (14) hereditary non-polyposis colorectal cancer. Control tissues were obtained from normal subjects and patients with sporadic bowel cancer and no family history of the condition. There was increased expression of alpha-L-fucose in some adenomas (mosaic pattern), in most carcinomas (diffuse), in hyperplastic polyps (crypt base), but not in normal appearing mucosa or transitional mucosa (adjacent to carcinoma) in any of the groups of patients examined. In view of the negative findings for normal-appearing mucosa, the suggestion that there is a pre-neoplastic field change in subjects at risk of hereditary bowel cancer may be unfounded.

Adenoma↗
PubMed1992

Upper gastrointestinal endoscopy in patients with human immunodeficiency virus infection: is it worthwhile?

AIM: To determine the diagnostic accuracy of upper gastrointestinal endoscopy in a selected group of patients with HIV infection, who had severe symptoms unresponsive to empirical treatment. METHOD: We reviewed all patients with HIV infection, who had undergone upper gastrointestinal endoscopy at Auckland Hospital. Specific diagnoses were based on the endoscopic appearances and on the histological and microbiological examination of endoscopic biopsies taken from the oesophagus, stomach and duodenum. RESULTS: A definitive diagnosis was reached in 16 of the 21 patients endoscoped, of whom 13 had a good clinical response to treatment. The median survival was three months. The most common diagnosis was oesophageal candidiasis seen in six patients, all of whom responded to treatment with a median survival of six months. Invasive cytomegalovirus gastrointestinal disease was seen in three patients, none of whom had positive blood cultures for cytomegalovirus. All responded to intravenous ganciclovir. Three patients with severe diarrhoea had opportunistic infection of the small bowel. All three had advanced AIDS with a median survival of less than one month. CONCLUSION: Upper gastrointestinal endoscopy has a high diagnostic yield in patients with HIV infection with oesophageal symptoms which fail to respond to antifungal therapy, or with severe weight loss and diarrhoea and it should be considered in these patients because excellent palliation may be possible.

AIDS-Related Opportunistic Infections↗
PubMed1992

Colonoscopy in unexplained lower gastrointestinal bleeding.

Two hundred and forty patient with unexplained gastrointestinal blood loss underwent colonoscopy. Significant lesions which were thought to be likely causes of bleeding were identified in 98 patients, ie, 41% of total, which included active colitis in 9%, large polyps in 10% and colorectal cancer in 12% of patients. Of the cancers found at colonoscopy, 64% were Dukes A or B. This study confirms the role of colonoscopy in the investigation of unexplained chronic lower gastrointestinal bleeding.

Adult↗
PubMed1992

Fulminant hepatic failure in a young mother.

We report the case of a mother who developed fulminant hepatic failure with hypoglycaemia, coagulopathy, Grade III hepatic encephalopathy, two days after the delivery of her fourth child. She had complained of pruritus for the final two weeks of pregnancy. She received supportive medical management within a critical care unit, and the hepatic failure resolved completely within 48 hours. Liver biopsy confirmed the diagnosis of acute fatty liver of pregnancy. This case is unusual in that this patient deteriorated markedly following delivery, at a time when spontaneous recovery is normally expected.

Adult↗
PubMed1991

Endoscopic management of bile duct stones at Auckland Hospital in 1988 and 1989.

OBJECTS: to define the role of endoscopic management of bile duct calculi in a tertiary referral institution. METHODS: an unselected series of 466 patients presenting for ERCP over a two year period were reviewed and 103 patients with bile duct calculi identified. The results of endoscopic management of these patients is reviewed. RESULTS: endoscopic sphincterotomy was successful in 98% of patients, and resulted in clearance of calculi from the bile duct in 75%, and in a further 8% symptoms were successfully controlled by sphincterotomy with or without endoprostheses, despite residual calculi. Seventy-nine percent of the patients with choledocholithiasis were successfully managed endoscopically, minor complications occurring in 16% which were significant in only 4%, with no procedure related mortality. CONCLUSIONS: endoscopic sphincterotomy provides a safe and effective means of managing bile duct calculi, even if stone extraction cannot be completed.

Adult↗