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Biomedical subjects

R I Swift

Publications and source records attributed to R I Swift.

At least 19 recordsLinked to original sources
PubMed2006

Predictive poor prognostic factors in colonic carcinoma.

INTRODUCTION: Five-year survival in rectal cancer has been steadily improving since the introduction of neoadjuvant chemoradiation and total mesorectal excision surgery. In contrast, 5-year survival rates and management of colonic carcinoma remain relatively unchanged. This study aims to identify poor prognostic factors in colonic cancer patients that could potentially be predicted pre-operatively to identify a subset of patients amenable to neoadjuvant treatment strategies. METHODS: Database compilation of all operable rectal and colonic cancer patients presenting to a single district general hospital over 5 years. Data were documented on presentation and site of tumour, TNM staging, differentiation and extramural venous invasion. RESULTS: There was no significant difference in 4-year survival between rectal (57.5%) and right (57%) or left sided (52.5%) colonic cancers (p=0.4689). On multivariate analysis, N2-stage, T4-stage and emergency presentation were identified as independent prognostic factors. On univariate analysis, in addition to the above factors, presence of venous invasion (p=0.001) and poor differentiation (p=0.0003) of tumour also predicted for poor 5-year survival. CONCLUSION: T4-stage and N2-stage and extramural venous invasion are poor prognostic factors that could be identified pre-operatively with suitably accurate imaging. Such patients could then be considered for a pre-operative treatment strategy.

Adult↗
PubMed2004

Hyperplastic polyps and serrated adenomas: colonoscopic surveillance?

Hyperplastic polyps are not thought to carry a malignant potential. They are, therefore, not regularly screened by the majority of clinicians. We present two case reports of serrated adenomas that add to a small but expanding body of clinical and histological evidence that suggests a hyperplastic to neoplastic pathway. Regular colonoscopic surveillance may be indicated in at least some cases of hyperplastic polyposis

Adenocarcinoma, Mucinous↗
PubMed2002

Plasma basic fibroblast growth factor levels in colorectal cancer: a clinically useful assay?

Angiogenic cytokines in the plasma and serum of cancer patients may serve as 'surrogate' markers of tumour neoangiogenesis. Serum VEGF correlates with disease stage in colorectal cancer (CRC), but the role of bFGF in CRC is uncertain. This study aimed to assess plasma bFGF levels in CRC patients before treatment, during chemoradiotherapy and at one-year follow-up. Plasma samples were taken from 124 CRC patients, 26 polyp patients and 55 controls, and bFGF levels were measured by ELISA. 19 patients underwent pre-operative chemoradiotherapy. One-year follow-up samples were available from 48 disease-free patients and 18 patients with progressive disease. There were no detectable differences between plasma bFGF levels in polyp, Dukes' A or B patients (4.55, 5.77, 4.25 pg/ml, respectively), but there was a significant increase in metastatic CRC patients [Dukes' C and D (7.42 and 6.6 pg/ml; P = 0.004 and 0.048, respectively)], relative to median control levels of 4.14 pg/ml. At follow-up, there was a significant fall in plasma bFGF levels in disease-free patients (pre-op 6.09 and follow-up 3.45 pg/ml, P = 0.0004), but a non-significant rise in 18 patients with progressive disease (pre-treatment 5.90 and follow-up 9.99 pg/ml, P = 0.33). Pre-treatment plasma bFGF in patients receiving chemo-radiotherapy was similar in those with responsive and non-responsive tumours. There were no detectable changes in plasma bFGF through the adenoma-carcinoma sequence or patient groups with non-metastatic cancers. Elevated plasma bFGF was, however, associated with metastatic spread. The significant fall in bFGF in disease-free patients following therapy suggests that bFGF may be useful in clinical practice.

Biomarkers, Tumor↗
PubMed2001

Non-invasive methods of assessing angiogenesis and their value in predicting response to treatment in colorectal cancer.

BACKGROUND: Tumour neoangiogenesis can be assessed non-invasively by measuring angiogenic cytokine concentrations in peripheral circulation and by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). The aim of this study was to assess whether these methods can predict and monitor response to treatment in patients with rectal cancer treated with preoperative chemoradiotherapy. METHODS: Serum and plasma vascular endothelial growth factor levels were measured in 31 patients with T3/T4 rectal cancers before quantitating tumour permeability (ln Ktrans) by DCE-MRI. Sixteen patients receiving preoperative chemoradiotherapy had serial vascular endothelial growth factor (VEGF) and DCE-MRI measurements. Response to treatment was assessed using World Health Organization criteria. RESULTS: Serum VEGF and ln Ktrans correlated before treatment (r = 0.48, P = 0.01). Responsive tumours (n = 8) had higher pretreatment permeability values than non-responsive tumours (n = 8) (mean ln Ktrans - 0.46 and - 0.72 respectively; P = 0.03). Compared with pretreatment values, responsive tumours showed a marked reduction in permeability at the end of treatment (mean ln Ktrans - 0.46 and - 0.86 respectively; P = 0.04). Pretreatment serum VEGF levels were not statistically different between the two groups. CONCLUSION: Rectal tumours with higher permeability at presentation appear to respond better to chemoradiotherapy than those of lower permeability. This may allow preselection of appropriate tumours for these regimens, with patients with low-permeability tumours being considered for alternative therapies.

Colorectal Neoplasms↗
PubMed2000

Correlation of plasma and serum vascular endothelial growth factor levels with platelet count in colorectal cancer: clinical evidence of platelet scavenging?

Most studies measuring circulating vascular endothelial growth factor (VEGF) have sampled serum rather than plasma. There has been much debate whether the collection of sera (which causes the activation of platelets and VEGF release) is a true reflection of tumor angiogenic activity or whether platelets act as scavengers of VEGF. Addressing this issue, we measured serum and plasma VEGF, before and after colorectal resection, with reference to platelet counts. Serum and plasma samples were collected from 116 colorectal cancer (CRC) and 116 control patients. Ninety CRC and 32 benign resections were performed. Both plasma and serum VEGF were significantly higher in CRC patients (18.5 and 327 pg/ml, respectively) compared with controls (9.0 and 151.5 pg/ml, respectively; P < 0.0001). Paired serum and plasma VEGF measurements correlated in both CRC (r = 0.56) and control patients (r = 0.73; P < 0.0001). Serum and plasma VEGF levels correlated with platelet count in CRC patients (r = 0.58 and 0.44, respectively) but not in controls. Plasma and serum VEGF levels, and VEGF concentration per platelet, increased with advancing disease stage. The correlation of serum and plasma VEGF with platelet counts in CRC but not in benign disease may be attributable to the scavenging of VEGF from the tumor source by platelets, with plasma levels reflecting free circulating VEGF in equilibrium with platelet levels. VEGF levels in citrated plasma are low and lie close to the limits of ELISA sensitivity. We recommend that a standardized measurement of serum VEGF--normalized by the patient's platelet count to give a value of serum VEGF per platelet--be adopted.

Adult↗
PubMed1998

A prospective audit of the usefulness of evacuating proctography.

Fifty-nine evacuating proctograms were performed over a 4 month period. We sought to identify how useful this technique is in diagnosing the cause of various anorectal symptoms and indicating which treatment option may be beneficial to the patient. The main reasons for referral were faecal soiling (60%) and obstructed defaecation (47%). Of the proctograms, 90% revealed some pathology. The most common abnormalities detected were rectocele (56%), rectal intussusception (39%), enterocele (19%) and rectal prolapse (12%). Of the patients, 45% were treated with an operation specific to the pathology detected on the proctogram; 29% did not require any active treatment and the remainder were managed with biofeedback conditioning or injection sclerotherapy. Evacuating proctography is of value in providing a diagnosis in patients with anorectal symptoms and thereby allowing specific treatment, operative or nonoperative, to be directed to the underlying pathology.

Adult↗
PubMed1998

The use of rectosigmoid stents in the management of acute large bowel obstruction.

The management of the acutely obstructed colon is controversial. Initial decompression of the bowel is still favoured by many surgeons, but the resulting colostomy has significant morbidity and mortality. Instead, stenting of the obstruction would permit defunctioning of the bowel, without the need for surgery and stoma formation. In this study we present our experience of the use of stents in the initial management of six patients with acute and sub-acute large bowel obstruction.

Acute Disease↗
PubMed1997

Can serum interleukin-6 levels predict the outcome of patients with right iliac fossa pain?

In patients with right iliac fossa (RIF) pain it can be difficult to distinguish between appendicitis and nonspecific abdominal pain (NSAP). In this study we sought to determine whether serum interleukin-6 (IL-6) levels, an early marker of acute inflammation, taken at the time of admission could predict the outcome of patients admitted with RIF pain. Data were collected in a prospective manner on 53 consecutive patients (23 male, 30 female), mean age 22.1 years (range 10-79 years). Nineteen (36%) patients underwent surgery, of whom 16 had appendicitis (histologically proven). The mean (SEM) IL-6 levels (pg/ml) in patients undergoing operation vs those receiving non-operative management were 270.8 (106.3) vs 265.0 (80.4) (P = NS). The mean white blood cell (WBC) counts (x10(9)/l) in these patients were 14.28 (0.81) vs 9.66 (0.67), respectively (P = 0.0002). When patients with a confirmed diagnosis of appendicitis were compared with patients with a diagnosis of NSAP, the IL-6 levels were 149.4 (69.1) vs 363.6 (113.2), respectively (P = NS). In the same groups of patients, the WBC counts were 14.21 (0.81) vs 9.51 (0.68) (P = 0.004). We conclude that IL-6 levels taken at the time of admission are not useful in predicting the outcome of RIF pain.

Abdominal Pain↗
PubMed1995

Percutaneous endovascular covered stenting of a distal superficial femoral artery occlusion.

Peripheral vascular disease is a common problem in the elderly population. This is commonly treated nowadays by percutaneous transluminal angioplasty (PTA). When PTA is used in the treatment of superficial femoral artery (SFA) occlusions 35% reocclude within 1 year. Endovascular stents (uncovered) have been used to try to overcome this problem; however, results have been disappointing with reocclusion rates similar to PTA. In order to try to reduce this problem covered endovascular stents have been developed. We report the first known case in the UK of one of these stents being used in the treatment of SFA disease.

Aged↗
PubMed1994

Effect of cardiopulmonary bypass on gastrointestinal perfusion and function.

Gastric mucosal tonometry was used to determine the adequacy of gastrointestinal perfusion in 10 patients undergoing elective myocardial revascularization. Patients were prospectively randomized to receive either pulsatile or nonpulsatile flow during cardiopulmonary bypass. All patients showed a reduction in gastric mucosal perfusion during bypass, manifested by a reduction in the gastric mucosal pH, which occurred independently of variations in the arterial pH. In the group of patients receiving nonpulsatile flow, this reduction was significantly greater (p < 0.05). Cardiopulmonary bypass using nonpulsatile flow is associated with the development of a gastric mucosal acidosis, which may have implications for the development of postoperative complications.

Acidosis↗
PubMed1992

A new regime in the management of gastroschisis.

In this review of 24 patients with gastroschisis, we illustrate a regime of management with a low morbidity and no mortality. The essence of the technique relies on antenatal diagnosis, intrauterine transfer, and a planned cesarean section with immediate repair performed at 37 to 38 weeks' gestation. Although the operation may be technically easier at lower gestational ages, we believe the concomitant increase in complications such as respiratory distress syndrome outweigh the advantage of easier surgery. The results of this series compare favorably with other published results.

Abdominal Muscles↗
PubMed1992

Cardiac denervation in the calf using cryoablation: functional evidence and regional tissue catecholamine content.

Twenty-six calves were subjected to a technique of cryoablation in order to establish an animal model of complete cardiac denervation. All 26 survived the procedure, and 20 were alive to be re-evaluated 2-4 weeks later. Mean heart rate in the denervated animals rose from 77 +/- 7.8 beats/min to 102 +/- 16.4 (P less than 0.01). Cryoablation abolished the heart rate responses to electrical stimulation of the vagus nerve and thoracic sympathetic trunk. The reduction in myocardial noradrenaline concentrations averaged 99% in the right atrium, 90% in the left atrium, 85% in the right ventricle and 90% in the left ventricle, when compared with tissue obtained from control animals. Cryoablation is a relatively simple means of accomplishing complete functional cardiac denervation in the calf. On the basis of the observed change in heart rate, the calf model appears to be more comparable with human heart transplant recipients than the dog.

Animals↗
PubMed1992

Alveolar rhabdomyosarcoma: a case presentation.

We present a case report of an unusual tumour, presenting as a mass on the forearm. We have used this case to review the current literature and histological classification of rhabdomyosarcoma.

Child↗
PubMed1992

In vitro sensitized autologous tumorocidal lymphocytes to colonic adenocarcinoma.

We report a method of developing a population of tumorocidal lymphocytes by culturing peripheral blood mononuclear cells (PBMC) with live isogenic colorectal tumour cells in a mixed cell culture. When the proportion of PBMC to tumour cells is 100:1, eradication of the tumour cell population results. The proportion of activated lymphocytes in culture increases with cytotoxic activity as demonstrated by the presence of the cytotoxic enzyme serine esterase in the lymphocyte granules.

Adenocarcinoma↗
PubMed1991

Imaging of metastatic colorectal cancer with tumour-activated killer lymphocytes.

Adoptive immunotherapy may be useful for treating or visualising metastatic cancer. Lymphocytes were taken from 6 patients with metastatic colorectal cancer and cultured with cells from the patients primary tumour to produce tumour-activated killer (TAK) lymphocytes. We re-injected each patient with IIIIn-labelled TAK cells in order to visualise metastases. Images were taken with a gamma-camera for up to 48 h after injection. Metastases were revealed as early as 4 h in the lung and as late as 48 h in the abdomen. Liver images produced "cold" spots corresponding to metastatic lesions. Lymph nodes were not visualised. Re-injection of TAK cells raised against autologous colorectal tumours reveals the sites of metastases.

Abdominal Neoplasms↗
PubMed1990

Bilateral, spontaneous, concurrent patellar tendon rupture.

Bilateral rupture of the infrapatellar tendon is extremely rare. When it occurs, it is almost always associated with connective tissue disease. We present a case of bilateral concurrent rupture of the patella tendon in a patient without any apparent systemic disease.

Adult↗