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Biomedical subjects

R G Wilson

Publications and source records attributed to R G Wilson.

At least 19 recordsLinked to original sources
PubMed2006

Retrospective review of laser therapy for palliation of colorectal tumours.

Patients with inoperable colorectal tumours will often require symptomatic relief due to the nature of extensive disease spread or existing co-morbidities. The use of laser treatment for palliation of tumours in the lower gastrointestinal tract has become an attractive treatment option for such patients. This paper presents the results of a retrospective review of 58 case notes in order to determine the effectiveness of laser therapy in palliating symptoms of colorectal tumours. In addition, the paper aims to identify which colorectal symptoms laser is best used to palliate. The study was conducted in a regional coloproctology unit at the Western General Hospital in Edinburgh. The main findings show that 52% (n=30) of patients had successful (complete/good) resolution of symptoms, 36% (n=21) had a poor response and 12% (n=7) had no resolution of symptoms from laser therapy. Of all documented symptoms, this study found that laser is most effective at palliating obstructive symptoms. It also has beneficial application in the palliation of bleeding and mucous discharge. It is less effective for the anal symptoms of tenesmus and pain and for stool related symptoms such as diarrhoea, constipation, frequency and incontinence.

Adult↗
PubMed2006

Variance of surgeons versus pathologists in staging of colorectal cancer.

AIM: Accurate staging of colorectal cancer depends on adequate retrieval and reporting of lymph nodes in the specimen. The presence of positive lymph nodes is an indication for adjuvant therapy. Both surgeons and pathologists influence the number of lymph nodes that are retrieved and reported in specimens. Although several recommendations exist in the literature regarding the minimum number of lymph nodes required for reliable staging, the relationship of examined to infiltrated lymph nodes has not been clarified. The aims of this study were to examine variance among surgeons and pathologists in the retrieval and reporting of lymph nodes in colorectal cancer specimens; to examine the relationship between retrieved/examined lymph nodes and infiltrated lymph nodes; to identify in our own series the minimum number of retrieved lymph nodes required to secure accurate staging. METHODS: Cross-sectional study of 284 patients with colorectal cancer followed in our hospital and retrospective analysis of histopathology reports. Correlation analysis, ANOVA, and survival analysis were performed on the data. RESULTS: There were 127 patients with cancer of the rectum and 157 patients with cancer of the colon under follow-up. The median number of lymph nodes per specimen was 8 (range 0-29). There was no difference in the number of retrieved lymph nodes among 9 surgeons. There were 2 outliers among pathologists, with one reporting a mean of 11.4 (9.8-12.9) 95% CI nodes per specimen and another reporting a mean 4.9 (3.6-6.2) 95% CI nodes per specimen. Dukes and T stage did not affect the number of nodes. Correlation analysis revealed a linear correlation between the total number of reported lymph nodes and the existence of positive lymph nodes. From the correlation equation we calculated that, in order to have one positive node, a minimum of 8.4 nodes was required in the specimen. Therefore, in our group of patients, a minimum of 8.4 nodes was required for accurate Dukes staging. However, survival analysis did not show any difference between patients with more and patients with less than 9 reported lymph nodes. CONCLUSIONS: Variance among pathologists exists and may be at least as important as variance among surgeons. Specialisation of pathologists similar to that of surgeons as well as employment of new techniques may be required . There is a linear correlation between the number of examined lymph nodes and the presence of positive nodes in a colorectal cancer specimen. This linear correlation makes the calculation of the minimum number of lymph nodes possible. In our series a minimum of nine nodes must be examined. However, we have not demonstrated an effect of inadequate nodes numbers on survival, possibly because survival in colorectal cancer is multifactorial.

Analysis of Variance↗
PubMed2004

Assessment of outcomes after colorectal cancer resection in the elderly as a rationale for screening and early detection.

BACKGROUND: Clinical, social and survival outcomes in elderly patients undergoing bowel cancer surgery were studied to explore the justification for the current upper age limit in colorectal cancer screening programmes. METHODS: Scottish national data were analysed to determine age-specific population survival following a diagnosis of colorectal cancer. Detailed analysis of outcome variables was undertaken in a cohort of 180 patients aged over 80 years who underwent resection of colorectal cancer. RESULTS: Population analysis revealed that the absolute risk of developing colorectal cancer was highest in those aged over 80 years, but relative survival was disproportionately poor. Of 180 patients in this age group, 30.0 per cent required an emergency procedure and only 4.6 per cent had Dukes' stage A tumours. Determinants of all-cause mortality were tumour stage (P < 0.001) and degree of co-morbidity (P = 0.004). Some 88.0 per cent of elderly patients returned to the same category of accommodation as that before admission. CONCLUSION: Colorectal cancer is increasingly common in people aged over 80 years and survival is disproportionately poor compared with that in other age groups. Elective management of early-stage cancer has a better outcome than emergency surgery. The majority of patients maintain social independence. These population and hospital data provide a rationale for early, and even presymptomatic, detection of colorectal cancer in the elderly.

Aged↗
PubMed2004

Paediatric resuscitation by phone: the call back.

OBJECTIVE: To assess whether the nationwide introduction of standardized paediatric resuscitation training has resulted in an increase in resuscitation knowledge from 1995 and whether this increase in knowledge is greater in those who have attended a resuscitation training course within the last year. METHODS: National telephone survey of paediatric residents. RESULTS: A total of 128 out of a possible 140 residents responded. The mean score in 2002 was significantly higher than in 1995. Those 2002 respondents who had attended a course scored significantly higher than both 1995 respondents, and those 2002 respondents who had not attended a course. There was no significant difference between those 2002 respondents who had not attended a course and the 1995 respondents. CONCLUSION: There has been a significant increase in resuscitation knowledge from 1995 to 2002. This improvement has occurred over a period coinciding with the nationwide introduction of standardized resuscitation training. The authors suggest that this improvement is, in part, due to the introduction of standardized paediatric resuscitation training.

Adult↗
PubMed2002

Unconventional carrier-mediated ferromagnetism above room temperature in ion-implanted (Ga, Mn)P:C.

Ion implantation of Mn ions into hole-doped GaP has been used to induce ferromagnetic behavior above room temperature for optimized Mn concentrations near 3 at. %. The magnetism is suppressed when the Mn dose is increased or decreased away from the 3 at. % value, or when n-type GaP substrates are used. At low temperatures the saturated moment is on the order of 1 Bohr magneton, and the spin wave stiffness inferred from the Bloch-law T(3/2) dependence of the magnetization provides an estimate T(c)=385 K of the Curie temperature that exceeds the experimental value, T(c)=270 K. The presence of ferromagnetic clusters and hysteresis to temperatures of at least 330 K is attributed to disorder and proximity to a metal-insulating transition.

Journal Article↗
PubMed2002

Chronic pain after laparoscopic and open mesh repair of groin hernia.

BACKGROUND: The aim of this study was to compare the incidence of chronic pain or discomfort after laparoscopic totally extraperitoneal (TEP) repair and open mesh repair of groin hernia, and to assess the impact of such pain on patients' physical activity. METHODS: A postal questionnaire was sent to patients who had TEP or open mesh repair of groin hernia between January 1998 and December 1999. The patients were asked about any persistent pain or discomfort in relation to the groin hernia repair and whether this pain or discomfort restricted their ability to undertake physical or sporting activity. RESULTS: Of the 560 available patients 454 (81.1 per cent) replied. Laparoscopic TEP repair was performed in 240 patients (52.9 per cent) and open mesh repair in 214 (47.1 per cent). Of the 454 patients, 136 (30.0 per cent) reported chronic groin pain or discomfort, which was significantly more common after open repair than after laparoscopic repair (38.3 versus 22.5 per cent; P < 0.01). Chronic groin pain or discomfort restricted daily physical or sporting activity in 18.1 per cent of the patients. The patients who had open repair complained of significantly more restriction of daily physical activity than patients who underwent laparoscopic repair (walking, P < 0.05; lifting a bag of groceries, P < 0.01). CONCLUSION: Chronic pain or discomfort was reported by 30.0 per cent of patients after groin hernia repair and was significantly more common after open mesh repair than after laparoscopic TEP repair. It restricted physical or sporting activities in 18.1 per cent of the patients and significantly more so after open mesh repair.

Adult↗
PubMed2002

The contemporary management of haemorrhoids.

BACKGROUND: New concepts in the management of haemorrhoidal disease have recently rekindled interest in this common pathology. General and subspecialist colorectal surgeons were surveyed to assess their impact on the current management of haemorrhoids. METHODS: A questionnaire was sent to all members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the Association of Surgeons of Great Britain and Ireland (ASGBI). Regarding indications for surgery, surgical techniques, day case haemorrhoidectomy (DCH) and postoperative treatment regimens. ASGBI members were asked to state their subspecialist interest and estimated time devoted to colorectal practice. RESULTS: There were 406 (71%) ACPGBI respondents and 483 (68%) ASGBI respondents. Eighty-four (12%) ASGBI respondents performed no elective colorectal surgery. One hundred and ninety-nine (35%) of ACPGBI respondents saw between 6 and 10 new haemorrhoid patients per week whereas three hundred (42%) of ASGBI respondents saw between 1 and 5 per week. Non-operative management included routine advice on fluid and diet by the majority of surgeons, with banding carried out in 79% (ACPGBI) and 75% (ASGBI) and injection sclerotherapy in 61% (ACPGBI) and 56% (ASGBI). The Milligan Morgan haemorrhoidectomy was performed in 265 (46%; ACPGBI) and 336 (47%; ASGBI). ACPGBI members used Submucosal diathermy (148, 26%vs 67, 9%; ASGBI (P < 0.01; chi2 test with Yates correction)) and stapled anoplasty (61, 11%vs 14, 2%; ASGBI (P < 0.01; chi2 test with Yates correction)) more often. DCH was performed in 117 (20%; ACPGBI) and in 48 (7%; ASGBI)(P < 0.01; chi2 test with Yates correction). CONCLUSIONS: In this sample of surgeons, operative management varies according to specialist interest. There was a trend towards day case haemorrhoidectomy. Whilst more surgeons have accepted the use of postoperative techniques to reduce pain, only a small minority have, as yet, adopted new surgical techniques such as stapling.

Journal Article↗
PubMed2001

The effects of hydrostatic pressure-induced changes on the cytoskeleton and on the regulation of gene expression in pheochromocytoma (PC-12) cells.

The purpose of this investigation was to determine the relationship of hydrostatic pressure-induced changes in the cytoarchitecture to regulation of gene expression in PC-12 cells. Hydrostatic pressure disrupts the cytoskeleton, decreases tubulin and actin mRNA levels and causes changes in the localization of tubulin and actin mRNA. Actin mRNA levels, at 6000 and 10,000 psi for 20 min, were reduced to 78% and 64%, respectively, in undifferentiated cells and to 81% and 72%, respectively, in 4-day differentiating cells, relative to untreated controls. Tubulin mRNA levels, at 6000 and 10,000 psi for 20 min, were reduced to 75% and 67%, respectively, in undifferentiated cells and to 84% and 74%, respectively, in 4-day differentiating cells. Changes in the localization of mRNA in the soluble and cytoskeletal fractions were determined by measuring the pressure level where the mRNA level in the cytoskeletal fraction equals the mRNA level in the soluble fraction. This measurement was designated the cytoskeletal/soluble fraction index (CSFI(50)). CSFI(50)measurements indicated that following hydrostatic pressure, actin mRNA cytoskeletal association was more stable than tubulin mRNA cytoskeletal association. The addition of chemicals which stabilize or destabilize microtubules and microfilaments to pressure treatment resulted in additional changes in the CSFI(50).

Actin Cytoskeleton↗
PubMed2001

Hydrostatic pressure induced changes in the cytoarchitecture of pheochromocytoma (PC-12) cells.

Confocal microscopy, in association with three-dimensional reconstruction, revealed that microtubules and microfilaments in differentiating PC-12 cells were disrupted in a dose-dependent manner following pressure treatment. Hydrostatic pressure caused cell rounding, microtubule and microfilament disorganization, neurite retraction and the formation of a microtubule ring adjacent to the cell surface. Volume analysis from computer-generated reconstructed cells, at atmospheric pressure, showed that the apparent volume of microtubules and microfilaments, normalized to 100 units, was 22 and 11 respectively. At 4000 and 8000 psi, the apparent microtubule volume was reduced to 16 and 12 units, respectively, and the apparent microfilament volume was reduced to 8 and 5 units, respectively. Thus, the apparent microtubule and microfilament volumes in PC-12 cells decreased as pressure increased. In the presence of taxol and phalloidin which stabilize the cytoarchitecture, cells resist the effects of hydrostatic pressure. In the presence of colchicine and cytochalasin D compounds which destabilize the cytoarchitecture, cells are more susceptible to the disrupting effects of hydrostatic pressure. The effects of hydrostatic pressure on cell morphology were reversible.

Actin Cytoskeleton↗
PubMed2001

High expression of the trefoil protein TFF1 in interval breast cancers.

Breast cancer screening is important for the early detection of breast cancer. Tumors that become symptomatic in the screening interval are known as interval cancers but the reasons for their rapid progression are unknown. Estrogen receptor expression is lower in interval cancers suggesting that they may have reduced hormonal responsiveness. To investigate this hypothesis we have measured the expression of the estrogen receptor and three estrogen-responsive genes (cathepsin D, progesterone receptor, and TFF1) in screen-detected and interval breast cancers. The expression of the protease cathepsin D was not associated with estrogen receptor in either group of tumor. Progesterone receptor expression was highly correlated with that of the estrogen receptor in both groups of tumors but it was not expressed at significantly different levels in the two groups of tumors. Expression of TFF1, a cellular motogen, was correlated with estrogen receptor in screen-detected but not interval cancers and was expressed at markedly higher levels in interval breast tumors, the group that expresses lower levels of estrogen receptor. Interval cancers are characterized by high levels of expression of TFF1 and/or Ki67 suggesting that cell migration and cell division play important roles in the rapid progression of interval cancers. The observation that TFF1 expression in interval cancers tends to be estrogen-independent and that interval cancers have reduced estrogen receptor expression suggests they may have a reduced response to hormone therapy.

Breast Neoplasms↗
PubMed2001

Aggressive local treatment for screen-detected DCIS results in very low rates of recurrence.

AIMS: To review our institution's practice of treatment of a mammographically detected population of ductal carcinoma in situ (DCIS) patients and to determine the outcome. METHODS: Between April 1989 and March 1994, 304 women with median age 59 years (range 51-65) with DCIS detected on screening mammogram, were treated in the Newcastle General and Royal Victoria Infirmary Hospitals, Newcastle-upon-Tyne, UK. More than half of the women (n=176, 57.8%) decided to have mastectomy. Other treatment options were wide local excision (WLE) with radiotherapy (n=97, 32%) and WLE alone (n=31, 10.2%). All except five received adjuvant hormone treatment. RESULTS: Predominant DCIS was comedo in 122 (42%), followed by cribriform in 87 (30%) and micropapillary in 44 (15%) cases. Grade I was found to be commonest grade (54%) followed by grade II (27%) and grade III (11%). With a median follow-up of 88 months, there were six (2%) recurrences, all of which were in women who were given breast conservation treatment, WLE with radiotherapy (n=1, 1%) and without radiotherapy (n=5, 16.6%). Mastectomy in this series was not associated with any recurrence at all. In three cases the recurrence was invasive, one of who also had distant metastasis. CONCLUSIONS: The findings of this study suggest that in women with DCIS suitable for breast conservation, WLE when combined with radiotherapy is associated with a very low recurrence rate.

Antineoplastic Agents, Hormonal↗
PubMed2001

Nanoscale magnetic regions formed in GaN implanted with Mn.

Platelet structures with diameters less than 250 A and hexagonal symmetry were formed in GaN by high dose Mn+ ion implantation and annealing at 700-1000 degrees C. Selected-area diffraction pattern analysis indicates that these regions are GaxMn1-xN with a different lattice constant to the host GaN. The presence of the GaMnN corresponds to ferromagnetic behavior of the samples with a Curie temperature of approximately 250 K.

Adsorption↗
PubMed2000

Utilisation of computerised clinical guidance in general practice consultations.

This paper reports on the results of a series of focus groups held during the Phase 1 pilot intervention period of a NHS decision-support system (Prodigy), which aims to offer contextual clinical guidance in general practice consultations. The aim of the focus groups was to collect qualitative data about users' interaction with the pilot system as part of a wider evaluation.

Attitude to Computers↗
PubMed1999

Growth dysregulation and p53 accumulation in human primary colorectal cancer.

p53 accumulation is common in colorectal cancer, but effects on growth homeostasis are unclear. In this study, DNA content, cell cycle phase fractions and DNA strand-breaks consistent with apoptosis were assessed by flow cytometry in 42 fresh primary colorectal tumours and matched normal mucosa. p53 accumulation was assessed in 37 fixed tumour sections, by immunohistochemistry. In normal mucosa, 10.3 +/- 6.6% (mean +/- s.d.) cells were in DNA synthesis phase while 28.7 +/- 17.9% showed apoptosis. A relationship suggestive of growth homeostasis, was observed between these parameters (r = 0.8; P < 0.05). In cancers, a greater number of cells were in DNA synthesis phase (15.6 +/- 12.9% tumour vs mucosa 10.3 +/- 6.6%; P < 0.02) while fewer showed apoptosis than normal mucosa (18.5 +/- 17.0% tumour vs mucosa 28.7 +/- 17.9%; P < 0.01). DNA synthesis and apoptosis fractions were unrelated in cancers, suggesting growth dysequilibrium. p53 accumulation was detected in 59% (22/37) tumours and was associated with reduced apoptosis compared to p53-negative tumours or mucosa (14.8 +/- 15% p53 accumulation vs 26.3 +/- 18% p53-negative; P < 0.05; vs 28.7 +/- 17.9% mucosa; P < 0.05). p53 accumulation was unrelated to DNA synthesis phase fractions. p53 accumulation is accompanied by reduced apoptosis which may accentuate growth dysequilibrium in colorectal cancer.

Aged↗
PubMed1999

Cyclin D3 expression, cell proliferation and pathological stage of human primary colorectal cancer.

Cyclin D3 promotes cell cycle progression but its expression and prognostic significance in human colorectal cancer is unknown. This study assayed cyclin D3 expression against cell cycle phase fraction and Duke's stage in 35 fresh human primary colorectal cancers. DNA content, cell cycle phase fraction and cyclin D3 expression were assessed by flow cytometry in disaggregated tumors. Cyclin D3 expression and S-phase fraction were independently related to Duke's stage. In Duke's stage C tumors, a higher proportion of cells expressed cyclin D3 (14.4 vs. 8.8%, mean; p < 0.05 by Mann-Whitney U test) and were in DNA synthesis (S) phase (21.1 vs. 9.7%, mean; p < 0.05 by Mann-Whitney U test). Neoplastic deregulation of cyclin D3 expression may provide a selective growth advantage which is related to stage in human colorectal cancer.

Aged↗