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Biomedical subjects

N Acheson

Publications and source records attributed to N Acheson.

5 recordsLinked to original sources
PubMed2005

A systematic review of the accuracy of diagnostic tests for inguinal lymph node status in vulvar cancer.

OBJECTIVE: To determine the accuracy of minimally and non-invasive tests to assess the groin node status in squamous cell vulvar cancer. METHODS: A systematic review of published research from 1979 to 2004 that compares the results of tests to determine groin node status with histology at inguinofemoral lymphadenectomy was made. Studies included in the review were those that compared the index test to the standard surgical intervention of inguinofemoral lymphadenectomy and allowed the construction of two-by-two tables. From these tables, sensitivity, specificity, and the likelihood ratios (with 95% confidence intervals) were reported and, where feasible, meta-analysis was used to pool results for each test separately. Sentinel node biopsy using technetium-99m-labelled nanocolloid ((99m)Tc) had a pooled sensitivity and negative LR of 97% (91-100 95% CI) and 0.12 (0.053-0.28 95% CI), respectively, and was the most accurate test reviewed. CONCLUSION: Five diagnostic tests were identified in a total of 29 studies (961 groins). Although the studies were small and the design often poor, this represents the best summary of the data to date. Sentinel node identification using (99m)Tc appeared to be the most promising test for accurately excluding lymph node metastases in squamous cell vulvar cancer and potentially reducing the radicality of surgery. Its efficacy as a tool in reducing the need for radical surgery and associated patient morbidity without reducing survival needs further assessment probably in a randomised control trial.

Female↗
PubMed2000

Folic acid targeting of protein conjugates into ascites tumour cells from ovarian cancer patients.

Despite a wealth of in vitro data describing the use of folic acid for drug and DNA delivery into ovarian cancer cell lines, there have been no reports describing the targeting of such compounds to freshly isolated tumour cells. We have carried out a study to determine the usefulness of folic acid as a targeting ligand for ovarian cancer by measuring the uptake of folic acid-BSA-FITC in tumour cells isolated from the ascitic fluid of ovarian cancer patients. In 7 out of 7 patients we have found folic acid mediated uptake of the fluorescently labelled albumin, with the accumulation (average cell fluorescence) and differential uptake (ratio between receptor mediated and fluid phase uptake) varying between patients. Accumulation of folic acid-albumin FITC occurs in ascites tumour cells expressing the epithelial cell marker EMA, with a significant proportion of EMA negative cells also accumulating the conjugate. There is no correlation between cell cycle and uptake of folic acid-BSA-FITC. These results suggest that folic acid-targeting of therapeutics is a promising approach for the treatment of ovarian cancer.

Ascites↗
PubMed1994

The role of microscopy in the diagnosis of sexually transmitted infections in women.

INTRODUCTION: Microscopy of genital secretions is routinely performed in female patients attending genitourinary medicine clinics. It diagnoses only 50-70% of gonorrhoea, 40-80% of trichomoniasis and has no value in the diagnosis of chlamydial infection. This study was therefore conducted to reassess the role of routine microscopy in female patients. SUBJECTS AND METHODS: One thousand consecutive women attending the genitourinary medicine clinic of the General Hospital, Birmingham, were studied prospectively. The first 500 women had routine microscopy performed. The second 500 women had microscopy performed only if they complained of symptoms, were known gonorrhoea contacts, or when an abnormal vaginal discharge was noted by the examining clinician. RESULTS: In the routine microscopy group, 46 (9.2%) women had gonorrhea; 30 of these were diagnosed by microscopy and subsequently confirmed on culture and 16 by culture alone; of these, two (4.3%) defaulted from follow-up and were not treated. In the selective microscopy group 139 women (28%) did not require microscopy. Thirty three women had positive culture for Neisseria gonorrhoeae. Of these, seven were diagnosed by microscopy, the rest by culture alone. All patients were successfully treated. No patients with trichomoniasis in the routine microscopy group and only two (4.3%) in the selective microscopy group were lost to follow-up. CONCLUSION: In this study, the selective policy in the second group led to a significant reduction in microscopy. Such a policy has the benefits of saving time for patients and staff, more efficient utilisation of manpower and resources. It did not lead to any significant delay in the diagnosis and treatment of patients with sexually transmitted infections.

Adolescent↗
PubMed1991

Haemoccult testing as an indicator of recurrent colorectal cancer: a 5-year prospective study.

A prospective study was conducted to assess the value of routine haemoccult testing as an indicator of early luminal recurrence of colorectal cancer. One hundred patients (mean age 72 years) undergoing radical resection (70% Dukes' B and 30% Dukes' C) for colorectal carcinoma were asked to provide 3-monthly haemoccult tests to a special follow-up clinic for a minimum of 5 years. Positive tests underwent further investigation with barium enema and colonoscopy. Patient compliance was 84%. Positive tests were obtained in 14 asymptomatic individuals, five of whom proved to have anastomotic recurrence. Recurrence was also identified in a further patient despite a negative haemoccult test. Three patients with anastomotic recurrence were able to undergo further radical surgery; two were still alive over 5 years after detection of recurrent disease. Haemoccult screening appears to detect increased numbers of patients with luminal recurrence (7.2%) when compared to historical controls (2.1%). Larger studies will be needed to determine if this increased detection rate results in improved long-term survival.

Aged↗