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Biomedical subjects

O Harris

Publications and source records attributed to O Harris.

At least 19 recordsLinked to original sources
PubMed2005

Tumour localisation with a metal coil before the administration of neo-adjuvant chemotherapy.

Complete clinical response (CR) with tumour disappearance is not uncommon after neo-adjuvant chemotherapy (NAC) for locally advanced breast cancer, avoiding 25% mastectomies by facilitating breast-conserving procedures. We reviewed our series to understand the feasibility and utility of marking the cancer site before administering NAC. In total, 23 women (median age 47 years) with T2-4, N0-1, M0 tumours were considered unsuitable for breast conserving surgery between January 2002 and November 2003, thus received NAC following a coil placement at the core of tumour. All patients had the coil successfully inserted and no migration or infection was recorded. Eight patients (35%) had a radiological CR (rCR) including 3 (13%) with pathological CR (pCR). In total, 87% patients were managed conservatively. The insertion of a metal coil is a simple mean to provide a landmark for localisation and excision when the breast lump becomes impalpable and radiologically undetectable after the administration of NAC.

Adult↗
PubMed2005

Occult breast lesions: A comparison between radioguided occult lesion localisation (ROLL) vs. wire-guided lumpectomy (WGL).

Mammographic screening increases the number of impalpable breast cancers requiring surgical excision. It is important to optimise the localisation technique to remove the smallest amount of tissue, still adequately excising the lesion. The last 65 wire-guided lumpectomies (WGLs) were compared vs. the first 65 radioguided occult lesion localisations (ROLLs) performed for impalpable breast cancers. Data collection included patient's age, radiological abnormality, pre-operative core biopsy, type of primary surgery, length of localisation and excision, hospital stay, cancer size, weight and volume of the excised specimen, clearance margins. All patients were successfully localised with ROLL and WGL. Localisation time was reduced with ROLL (P<0.001). Clear margins were achieved in 83% ROLLs and 57% WGLs (P=0.001). Pathological cancer size and specimen weight were similar in both groups, although the specimen volume was slightly smaller for ROLL. A total of 74% ROLLs had excellent cosmetic outcomes and 26% good, vs. 55% excellent and 45% good in WGLs. A larger amount of normal breast tissue was excised with WGL, without achieving any better cancer clearance. ROLL provides a feasible alternative to WGL. This quick and simple technique achieves an improved rate of clear margins.

Adult↗
PubMed2005

Radio-guided localization of clinically occult breast lesions (ROLL): a DGH experience.

AIM: Wire-guided localization (WGL) of clinically occult breast lesions is a well established technique. The aim of this study was to evaluate radio-guided localization (ROLL) within the breast screening service of a district general hospital. METHOD: The study group comprised 70 women who underwent ROLL under US and stereotaxis. This required an injection of Technetium-labelled colloidal albumen into the impalpable breast lesion. The women then proceeded to theatre, where localization was achieved with the use of a gamma probe. The lesion was identified by the presence of a high signal, caused by the injected isotope. The results of 70 consecutive cases in which a breast lesion was localized using ROLL were compared with the results of the latest 70 WGLs. RESULTS: All 140 lesions were successfully localized. However, the change in technique from WGL to ROLL offered significant benefits to patients. CONCLUSION: Our study demonstrated that ROLL is a practical and reliable localization technique. It can be implemented in hospital units without using valuable gamma camera time. The cost compares well with WGL. There is an improved cosmetic outcome for patients, and the very small quantity of radioactivity used is safe for both patients and staff.

Adult↗
PubMed2001

Post-discharge surgical wound infection surveillance in a provincial hospital: follow-up rates, validity of data and review of the literature.

BACKGROUND: Numerous studies suggest that many surgical site infections (SSI) come to light only after discharge from hospital. With increasing trends towards shorter length of stay and ambulatory day surgery, post-discharge surveillance may become necessary for all infection control programs, but the methodology has yet to be validated and standardized. The overall aim of the present study was to examine the impact of effective post-discharge SSI follow up on the overall SSI rate. METHODS: A prospective targeted surveillance programme of 1291 surgical procedures was conducted at St John of God Health Care Geelong using the standardized National Nosocomial Infections Surveillance (NNIS) METHOD: Questionnaires were sent to surgeons and the results rigorously chased up. Factors giving rise to high follow-up rates and the relationship between follow up, attrition bias and validity of data were explored using a literature search. RESULTS: A post-discharge follow-up rate of 98.7% was achieved. When the post-discharge data were included, the overall SSI rate (6.0% (95% CI: 4.7-7.4)) was more than double that in hospital (2.7% (95% CI: 1.9-3.8)). CONCLUSIONS: An effective post-discharge follow-up programme significantly increased the SSI rate. From the authors' experience and a literature survey, possible ways to achieve high follow-up rates were suggested. It was also recommended that professional and regulating bodies in Australia be encouraged to standardize methodology and set minimum follow-up rates for post-discharge SSI surveillance. Increasing use of computerized hospital database systems for automated data gathering and processing should make this more practicable.

Aftercare↗
PubMed1995

A simple CT method for location of auditory brain stem implant electrodes.

A method for locating auditory brain stem implant electrodes that have been placed in the lateral recess of the fourth ventricle is described. CT bone window images are "inverted" to black on white, then manually superimposed onto soft-tissue window images to enable identification of electrodes in relation to soft-tissue structures.

Brain Stem↗
PubMed1994

Effects of Borrelia burgdorferi organisms on the functional characteristics and membrane integrity of the canine spermatozoa.

Two experiments were conducted to study the effect(s) of Borrelia burgdorferi and its metabolites (toxicants?) on canine spermatozoa, using B burgdorferi type strain B-31 and ejaculates from 5 sexually mature dogs. In Experiment 1 the spirochetes were cocultured with semen and incubated under various conditions, and in Experiment 2 the spirochetes were sonicated to release the metabolites/toxicants. The sonicate was then cultured with the semen. The parameters investigated were kinematics and percentage of sperm motility, morphology, and sperm response to the hypoosmotic swelling test and acrosome reaction. There were no visible physical interaction between either dead or motile spirochetes and viable or dead spermatozoa. Neither the spirochetes per se nor their metabolites/toxicants had any significant adverse effect on the functional and morphological characteristics of the canine spermatozoa. It is possible that the exposure times for incubation were not long enough for metabolites or toxicants in the sonicate to significantly affect sperm characteristics. Some investigators have reported that B burgdorferi contain biologically active LPS-like endotoxins. It is also likely that storage denatures B burgdorferi metabolites and other intracellular products in the sonicate and, thus, negates any effects the medium or the sonicate might have on the spermatozoa. The apparent lack of effect suggests that either peripheral metabolism or action on other organ(s) may be required for deleterious action of the spirochetes and/or their toxicants on spermatozoa. It was concluded that B burgdorferi and/or metabolites/toxicants do not have any significant deleterious effects on the functional and morphological characteristics of the postspermatogenic spermatozoa. Interaction of the spirochetes with in vivo conditions may be needed to adversely affect spermatozoa.

Animals↗
PubMed1990

Flucloxacillin induced delayed cholestatic hepatitis.

We report four cases of severe delayed cholestatic hepatitis induced by flucloxacillin. All patients presented with deep jaundice and pruritus which developed soon after ceasing flucloxacillin. Liver function tests were abnormal in all patients with markedly elevated serum bilirubin concentration, alkaline phosphatase and aspartate transaminase levels. Extrahepatic biliary obstruction and infective hepatitis were excluded in all cases. Liver biopsies showed centrilobular cholestasis with portal and lobular inflammation and eosinophil infiltration. Although symptoms resolved within six weeks in all patients, cholestatic liver function tests have persisted in two patients for more than six months. With the increasing usage of this drug and the delayed presentation of cholestasis, flucloxacillin needs to be considered in the differential diagnosis of all patients presenting with cholestatic jaundice.

Aged↗
PubMed1988

Transjugular liver biopsy--an Australian experience.

During the four year period 1983-87 transjugular liver biopsy was performed on 67 patients (M43, F24) aged 17-79 yr (mean 45.6 yr). Standard percutaneous biopsy was contraindicated by coagulation disorders (95%) often with ascites (17%). Biopsies were taken using a specially modified Ross trans-septal needle passed into hepatic veins under fluoroscopic guidance. Hepatic tissue samples were obtained from the initial biopsy in 62 (93%) patients. In 30 consecutive transjugular biopsies a mean area of 38.2 mm2 per section (0.9-100 mm2) was available for histology compared with an area of 15.9 mm2 (9.3-48.8 mm2) in 50 consecutive percutaneous biopsies. Improved techniques of sample washing, sieving and fixation optimised separation of hepatic tissue from blood clot and fibrin. Four patients experienced significant complications but no deaths occurred. Individual diagnoses were changed in 17 patients as a result of biopsy findings. This study confirms the efficacy and relative safety of the transjugular approach in obtaining liver biopsies from patients with contraindications to standard percutaneous techniques.

Adolescent↗
PubMed1986

The role of serum isoamylase and lipase determinations in clinical practice.

To determine the clinical utility of routine determination of serum isoamylase (pancreatic/salivary) and/or lipase activity, sera were tested from 109 consecutive patients with elevated total serum amylase. Without knowledge of the isoamylase and lipase results, an assessment was made of the confidence with which the attending medical staff had made or excluded a diagnosis of acute pancreatitis. The attending staff had considered acute pancreatitis to be probable in 78, possible in 12 and unlikely in 19 patients. The confidence of the clinical diagnosis of acute pancreatitis was directly related to the degree of elevation of the serum total amylase: (mean IU/l +/- s.e.m.) probable pancreatitis 1807 +/- 313, possible pancreatitis 680 +/- 74, pancreatitis unlikely 493 +/- 50. Pancreatic isoamylase was elevated in 97% of patients with probable pancreatitis, 92% with possible pancreatitis and 68% in whom pancreatitis had been considered unlikely. Lipase elevations generally parallelled these results. Although gall-stones were usually sought among patients with probable pancreatitis, they were rarely sought in patients in the other categories. In conclusion, amylase isoenzyme or lipase determinations add little information in cases of clinically suspected acute pancreatitis with marked hyperamylasemia. The tests may have a role in the evaluation of patients with clinically unexplained hyperamylasemia by defining more precisely the origin of the amylase.

Acute Disease↗
PubMed1985

Difficulties in the endoscopic diagnosis of gastric and oesophageal cancer.

A study was made of 116 patients with gastric or oesophageal cancer, in whom endoscopy was negative, or biopsy was negative or not performed. The most common problems were the presence of pyloric or oesophageal stricture (sometimes with excessive luminal content) and difficulty in obtaining diagnostic biopsy material in linitis plastica, early gastric cancer, lymphoma and sarcoma. Problems also occurred from failure to biopsy apparently benign conditions and from delay in a second endoscopy. Some cancers were regarded as benign ulcers and treated as such by drugs or surgery because more reliance was placed on endoscopic biopsy than on the endoscopist's opinion of the macroscopic appearance. In 17 of the 16 patients there was delay, incorrect management or further difficulty in diagnosis.

Diagnostic Errors↗
PubMed1984

Congenital hepatic fibrosis associated with Mallory bodies and copper retention.

New observations are described in a case of congenital hepatic fibrosis. Histochemical stains of liver tissue for copper (rhodanine) and copper associated protein (orcein) were positive and hepatic copper concentration, measured by atomic absorption spectroscopy, was markedly elevated being 550 micrograms/g dry weight (NR less than 30 micrograms/g dry weight). Mallory bodies were observed in several areas in liver sections. These observations have not been previously recorded in congenital hepatic fibrosis. Increased hepatic copper concentration in this case may have contributed to the production of liver damage. Hepatic copper concentration should be specifically measured in other patients with congenital hepatic fibrosis.

Adult↗
PubMed1979

Coeliac disease. Haematological features, and delay in diagnosis.

Seventy patients consecutively diagnosed as having coeliac disease were studied with regard to the clinical and laboratory features of related blood disorders and the delays that occurred in making the eventual correct diagnosis. Eighty-four percent of these patients had some readily demonstrable haematological abnormality. Thrombocytosis was present in 44% of the patients appropriately studied and hyposplenism was diagnosed in 21% of the total group. The importance of associating these conditions with coeliac disease has been stressed. The average delay from the time of initial presentation with relevant symptoms to correct diagnosis was 73 months.

Adolescent↗
PubMed1977

A prospective study of gastric and oesophageal carcinoma.

A prospective study of carcinoma of the stomach and oesophagus has been carried out for 2 1/2 years. Seventy-three cases of carcinoma of the stomach, and 16 cases of carcinoma of the oesophagus have been documented. For carcinoma of the stomach, operability rate was 72-6% and resectability rate was 41-9%; overall survival was poor, 20-9% at 12 months. For those who underwent resection, survival at 12 months was 45-5%. No cases of early gastric cancer are among those studied. For carcinoma of the oesophagus, four patients had a resection, and only one has survived for more than 12 months. In the clinical sphere there is a need for early endoscopic as well as radiological investigation of dyspeptic symptoms. In the research field there is a need for studies of chemotherapy in combination with surgery in the initial treatment of gastric carcinoma.

Adult↗