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Biomedical subjects

R A Cochrane

Publications and source records attributed to R A Cochrane.

7 recordsLinked to original sources
PubMed1999

The immunohistochemical expression of desmoplakin and its role in vivo in the progression and metastasis of breast cancer.

Desmoplakin (DP) is a protein located at the inner plaque of desmosomes where it associates with the desmosomal cadherins to form a cell adhesion complex. Reduced expression of DP has been correlated with the progression of several cancers, but its role in in vivo breast cancer is yet to be established. The aim of this present paper was to determine the immunohistochemical (IHC) expression of DP in breast cancer specimens (n = 75) in comparison with ductal carcinoma in situ (DCIS) (n = 26), tumour associated normal (n = 29) and normal breast tissue (n = 7). DP expression was correlated with that of desmosomal cadherin, Desmoglein 2 (Dsg2) and other clinical and IHC prognostic markers. DP staining occurred at the sub-plasma membrane level. There was no significant correlation between the level of DP (as assessed by the H-score) and that of Dsg. Significantly stronger staining was demonstrated in normal breast tissue and well differentiated tumours compared with more moderately or poorly differentiated tumours (P = 0.04). A significant inverse correlation was seen between DP staining and tumour size (P = 0.01). In a limited series of 8 cases, primary tumours demonstrated significantly stronger staining than the matched metastatic lymph nodes (P = 0.046). Of all the IHC markers examined, only Ki-67 showed a significant inverse relationship with DP staining (P = 0.01). In summary, the data suggest that loss of DP may be of potential importance in progression of breast cancer in vivo from normal, DCIS, well differentiated through to poorly differentiated, large tumours. In addition, this loss may be associated with metastasis.

Breast Neoplasms↗
PubMed1999

The National Breast Referral Guidelines have cut down inappropriate referrals in the under 50s.

AIMS: When the National Breast Referral Guidelines were applied to our local GPs letters immediately prior to their release in January 1996, it was shown that on the basis of the GPs own conclusions that 29% of symptomatic women could have been managed initially by their own GP without missing any carcinomas. We conducted this study at the Rapid Access Breast Clinic at the University Hospital of Wales to determine if the breast referral practices of local GPs have altered due to the breast referral guidelines. METHODS: We studied 2332 referrals from the inception of the Rapid Access Clinic in May 1995 to the issue of the guidelines, and 2421 referrals from May 1996 to the end of the year. Random samples of 600 patients were drawn from each year and the referral letters were scored as within or outside the guidelines. Family history patients were excluded. RESULTS: There was an 11% fall in referrals outside the guidelines in the under 50s (chi-squared=<0.001) but the 7% fall in the over 50s was not significant. CONCLUSIONS: The Breast Referral Guidelines seem to have been effective in reducing the higher level of inappropriate referrals in younger patients at less risk of carcinoma.

Age Factors↗
PubMed1998

Senior surgeons and radiologists should assess emergency patients on presentation: a prospective randomized controlled trial.

The objective of this study was to determine whether abdominal ultrasound and plain film radiography (evaluated by senior radiologists) substantially enhances senior surgical assessment in reducing surgical admissions. A randomized controlled trial was carried out in a teaching hospital; ninety-five emergency referrals to general surgery (mean age 51 years, 37% males), presenting with intrabdominal disturbances not requiring immediate surgery, were selected for study. The major outcome measure was the number of patients not admitted as in-patients. Thirty per cent of the intervention group and 10% of the controls did not need admission (95% confidence interval on this 29% difference, 12-38%). There were no important differences in the mean waiting time in casualty (26 min vs. 25 min), length of admission (4.1-5.9 days), surgical intervention (seven vs. 11 patients), readmission with similar pathology within 3 months (seven vs. three patients), and mortality as an in-patient or within 3 months of discharge. Abdominal ultrasound and plain film radiography, assessed by senior radiologists, enhances senior surgical assessment in reducing unnecessary surgical admissions.

Abdomen↗
PubMed1997

Evaluation of general practitioner referrals to a specialist breast clinic according to the UK national guidelines.

The recently published national guidelines to general practitioners for the referral of patients with breast problems were retrospectively applied to letters of all patients attending the Rapid Access Breast Clinic at the University Hospital of Wales. The patients have all had diagnostic investigations performed at the initial visit with a multidisciplinary review of results and provision of a management plan prior to the subsequent visit. Since its inception in May 1995 until the end of the year when the guidelines were published, 2332 new patients had been seen. Overall, 29% of patients with benign breast disease would not have been referred if the guidelines had been strictly followed. Of the 147 symptomatic carcinomas diagnosed from general practitioner referrals (6.3% of total referrals), no invasive cancers would have been missed. One patient with incidental detection of ductal carcinoma in situ (DCIS) in the asymptomatic contralateral breast would not have been referred. Referral for pain without a discrete lump constituted 63% of the patients with a benign diagnosis who fell outside the guidelines. The guidelines also include comprehensive algorithms for the initial management of benign breast symptoms that do not require immediate referral by the general practitioners. Our general practitioners were significantly better at referring patients over 50 years old but the proportion of appropriate referrals were not related to the number referred by each practice. The present guidelines adequately cover referral for the diagnosis of malignant breast disease to a specialist, and may reduce the benign workload of breast clinics.

Ambulatory Care Facilities↗
PubMed1992

Changes in drug treatment after discharge from hospital in geriatric patients.

OBJECTIVES: To ascertain changes in drug treatment of elderly patients after discharge from hospital and to identify areas of communication which may require improvement. DESIGN: Follow up of patients six to 14 days after discharge, when the drugs supplied by the hospital should have run out and a further supply obtained from the general practitioner. Patients were also asked about information supplied to them by health care professionals during their hospital stay. SUBJECTS: 50 elderly patients discharged from five geriatric wards (mean age 76.9 years). SETTING: Sunderland District Health Authority. MAIN OUTCOME MEASURE: Drugs taken after discharge from hospital. RESULTS: After returning home the drug regimen of 45 patients differed from that prescribed on discharge from hospital, with 11 patients taking a different dose, 10 having stopped drugs, and 20 taking new drugs. Possible influencing factors included an incomplete drug history, the continuation of drugs taken before hospital admission, and changes in the prescription not attributable to a conscious clinical decision. Lack of information also contributed; 46 patients could not recall being told when to take drugs before discharge. CONCLUSION: Closer communication is needed between hospital and community health care professionals to ensure that patients are informed about their discharge prescription and continuation of treatment.

Aged↗
PubMed1984

The role of androgens in the effect of diabetes mellitus on hepatic drug metabolism in the male rat.

Diabetes mellitus exerts a sex-dependent effect on hepatic drug metabolism in the rat and it has been suggested that this is due to a reduction in serum androgen levels. This study shows that the effect of diabetes is only seen in the presence of androgen and that testosterone can reverse the effect of diabetes on drug metabolism. Diabetes, however, does not consistently cause a reduction in serum testosterone. Diabetes and androgens, therefore, are postulated to interact in their effects on drug metabolism by action on a common mediator. It is suggested that this mediator is growth hormone, which is known to be affected by the androgens and insulin and to be involved in sex differences in drug metabolism in the rat.

Animals↗