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Biomedical subjects

R Warren

Publications and source records attributed to R Warren.

At least 37 records · Page 2Linked to original sources
PubMed2001

Screening with breast ultrasound in a population at moderate risk due to family history.

OBJECTIVE: To perform a pilot study to compare ultrasound and mammographic screening with particular respect to specificity, in a cohort of women at moderate family history risk of breast cancer. MATERIAL AND METHODS: High resolution ultrasound of both breasts was undertaken in 149 women at moderate risk of breast cancer who were referred for mammographic screening. The two tests were read blind to the other. Core biopsy was undertaken for solid lesions found on ultrasound. RESULTS: 149 Patients, mean age 42.15 years, were screened with bilateral ultrasound. 90 Examinations were normal. 46 Women had cysts, two had lesions previously biopsied and found to be benign, and one had a lymph node. 10 Focal solid lesions were biopsied on account of their ultrasound findings, 6.7% (95% confidence intervals (95% CIs) 2.7% to 10.7%). All but one of the 149 mammograms were normal. In this case both mammography and ultrasound showed a focal solid lesion that at core biopsy was found to be a fibroadenoma. Histology showed seven fibroadenomata, two areas of fibrocystic change, and one adenoid cystic carcinoma. Positive predictive value for biopsy was 10%. Mean follow up was 13.7 months. There was one interval cancer. CONCLUSION: Screening with breast ultrasound, in a cohort of women at moderate risk of breast cancer due to family history, has an acceptable biopsy rate. Screening with ultrasound and mammography in patients with an increased risk of breast cancer may be beneficial and a randomised study to examine issues of acceptability, reproducibility, and cost effectiveness is apt.

Adult↗
PubMed2001

A method of coil localization for breast lesions seen only on MRI.

Breast lesions may be identified on MRI that are not shown on mammography or ultrasound owing to the high sensitivity and relatively poor specificity of contrast enhanced MRI. Techniques for diagnostic biopsy of such lesions are not widely available. A method is described that uses standard mammographic localization methods to place an MR compatible cerebral coil at the site of the suspect lesion. Confirmatory MRI can then be obtained before the lesion is surgically removed using a mammographic hook wire. This method is described and illustrated in detail for one case, and in summary for three further cases, to show the potential flexibility of application. The method is commended because it is simple and cheap, uses standard breast procedures and can be undertaken outside the MRI suite. The procedure will make full use of breast MRI possible to those who do not have dedicated localization equipment.

Adult↗
PubMed2000

Classification of drug-resistant tuberculosis in an epidemic area.

BACKGROUND: Traditionally, patients with drug-resistant tuberculosis are classified as having acquired drug-resistant or primary drug-resistant disease on the basis of a history of previous tuberculosis treatment. Only cases of primary drug resistance are assumed to be due to transmission of drug-resistant strains. METHODS: This descriptive study of 63 patients with drug-resistant tuberculosis assessed the relative contribution of transmission of drug-resistant strains in a high-incidence community of Cape Town, South Africa, by restriction-fragment length polymorphism (RFLP). The RFLP results were compared with the results obtained by traditional classification methods. FINDINGS: According to RFLP definitions, 52% (33 cases) of drug-resistant tuberculosis was caused by transmission of a drug-resistant strain. The proportion of cases due to transmission was higher for multidrug-resistant (64%; 29 cases) than for single-drug-resistant (no cases) tuberculosis. By the clinical classification, only 18 (29%) patients were classified as having primary drug-resistant tuberculosis (implying transmission). The clinical classification was thus misleading in 25 patients. INTERPRETATION: The term acquired drug resistance includes patients infected with strains that truly acquired drug resistance during treatment and patients who were initially infected with or reinfected with a drug-resistant strain. This definition could lead to misinterpretation of surveillance studies, incorrect evaluation of tuberculosis programmes, and delayed diagnosis and treatment of patients with multidrug-resistant disease. The clinical term acquired drug resistance should be replaced with the term "drug resistance in previously treated cases", which includes cases with drug resistance due to true acquisition as well as that due to transmitted drug-resistant strains.

Adolescent↗
PubMed2000

Mammographic screening and mammographic patterns.

Mammography is an effective screening modality for the early detection of breast cancer. The reduction in breast cancer mortality is greater for women aged over 50 at screening than for women aged under 50. Mammography can also contribute to an understanding of the biology of breast cancer. Screening trials provide good evidence for the dedifferentiation of a cancer as it develops over time, and the age dependency of this dedifferentiation explains much of the age difference in the effectiveness of screening. Mammographic density is an important predictor of future breast cancer risk, and has potential as an early endpoint in breast cancer prevention trials. Mammographic density is also an important determinant of mammographic screening sensitivity.

Adipose Tissue↗
PubMed2000

Interval cancers as an indicator of performance in breast screening.

BACKGROUND: The literature shows that breast screening performance varies between centers. Those who monitor the performance of screening programs must use appropriate methods to demonstrate quality. Analysis of interval cancer rates provides one such measure. This study analyses interval cancers over a ten-year period in a single center of the UK National Breast Screening Program, offering screening to a population of 45,000 women. METHODS: 108,948 screening examinations were undertaken between 1987 and 1996. Sequential interval cancer rates were studied and compared with the results of the Swedish Two-County trial. More detailed analysis of the first prevalence round was undertaken. RESULTS: Improvement in rates occurred after three years. Two-year time bands show some fluctuation in rates, indicating variation in performance. For one time period, rates equivalent to the Two County Trial were achieved, but this was not consistently maintained. Overall rates equate to performance reported elsewhere in the UK (25% in the first year after screening, 48% in the second year after screening and 48% in the third year after screening, equivalent Two County rates are 17%, 32% and 57%). The prevalence round analysis shows that undiagnosed cancers arose after the film reading stage in 88% of interval cases. The team was able to distinguish minor signs from significant lesions effectively. Assessment procedures were effective once the patient had been recalled. CONCLUSION: Interval cancer rates fell initially but reached a plateau. Recall procedures were effective in making the diagnosis, and cases were missed at the film reading stage. Consistency of performance may be important in achieving low rates.

Breast Neoplasms↗
PubMed2000

Size, node status and grade of breast tumours: association with mammographic parenchymal patterns.

A case-control study was designed to assess the association of mammographic parenchymal patterns with the risk of in-situ and invasive breast cancer. In addition, the relationship between tumour characteristics and mammographic patterns were also investigated. A total of 875 patients with breast cancer were selected and matched with 2601 controls. Mammographic parenchymal patterns of breast tissue were assessed according to Wolfe's classification, and statistical analysis was by conditional logistic regression. Relative to the N1 pattern, the odds ratios of having an invasive breast cancer associated with the P2 and DY patterns were 1.8 and 1. 4, respectively. In addition, the odd ratios of having an invasive grade 3 breast cancer associated with the P2 and DY patterns were 2. 8 and 3.9, respectively. Relative to the combined N1/P1 pattern, the odd ratios of having a breast cancer smaller than 14 mm, 15-29 mm, or larger than 30 mm associated with the combined high-risk P2/DY pattern (P2 + DY) were 1.2, 1.6, and 2.0, respectively. Finally, women with the P2/DY pattern were twice as likely to have a breast cancer which had already spread to the axillary nodes, compared to women with women with the N1/P1 pattern (odds ratios of 2.1 and 1.4, respectively). Our results confirm previous findings suggesting that mammographic parenchymal patterns may serve as indicators of risk for breast cancer. Our results also suggest that mammographic parenchymal patterns are associated with the stage at which breast cancer is detected.

Breast Neoplasms↗
PubMed2000

Mood, personality disorder symptoms and disability in obsessive compulsive hoarders: a comparison with clinical and nonclinical controls.

Hoarding is a symptom of obsessive compulsive disorder (OCD), as well as a diagnostic criterion for obsessive compulsive personality disorder (OCPD). One recent study suggests that people who suffer from compulsive hoarding report more general psychopathology than people who do not [Frost, R.O., Krause, M.S., & Steketee, G. (1996). Hoarding and obsessive compulsive symptoms. Behavior Modification, 20, 116-132]. The present study addressed whether persons with OCD hoarding exhibit more depression, anxiety, OCD and personality disorders symptoms than community controls, OCD nonhoarders, or other anxiety disorder patients. Disability was also examined. Hoarding subjects were older than the other three groups, but age did not account for any of the differences observed among the groups. Compared to controls, OCD hoarding, nonhoarding OCD and anxiety disorder patients showed elevated YBOCS scores, as well as higher scores on depression, anxiety, family and social disability. Compared to nonhoarding OCD and anxiety disorder patients, OCD hoarding patients scored higher on anxiety, depression, family and social disability. Hoarding subjects had greater personality disorder symptoms than controls. However, OCD hoarding subjects differed from OCD nonhoarding and anxiety disorder subjects only on dependent and schizotypal personality disorder symptoms. The findings suggest that hoarding is associated with significant comorbidity and impairment compared to nonhoarding OCD and other anxiety disorders.

Adult↗
PubMed2000

Assessment of education and counselling offered by a familial colorectal cancer clinic.

We have evaluated whether or not client expectations, in terms of education and information needs, have been met by a multi-disciplinary familial colorectal cancer clinic. The study used a pre- and post-clinic questionnaire design and 126 (84 women, 42 men) clients of the clinic participated. The most common reason for coming to the clinic is to 'find out whether there is a gene for colorectal cancer in the family', followed by 'to reduce risk for bowel cancer' and 'concern for children's risk'. Clients would have preferred to receive more information before attendance at the clinic to help with preparation. Information given during the clinic increased knowledge of bowel cancer genetics and had a positive effect on the accuracy of some clients' perceptions of their risk of developing cancer. In multivariate analysis, higher risk perceptions, higher education level and greater baseline knowledge predicted post-clinic knowledge of bowel cancer genetics and an increase in knowledge. Client reports of the presence of a genetic counsellor or medical geneticist in the session also predicted post-clinic knowledge and an increase in knowledge. Most participants felt they received enough information during the clinic session on various aspects of familial colorectal cancer, but the desire for more written information on prevention, including lifestyle actions, was expressed by many.

Adult↗
PubMed2000

Cancer worries, risk perceptions and associations with interest in DNA testing and clinic satisfaction in a familial colorectal cancer clinic.

Multi-disciplinary familial cancer clinics are becoming an integral part of cancer services. It is, therefore, important to assess how attendance at these clinics impacts on cancer-related concerns, risk perceptions and behavioural intentions, and how the clinic services are being received by those using them. This study has assessed a familial colorectal cancer clinic with respect to cancer-related worries and risk perceptions and their impact on interest in DNA testing and overall satisfaction with the clinic. Pre- and post-clinic questionnaires were completed by 127 patients and relatives attending the clinic. After attending the clinic, the proportion of people 'very' or 'extremely' worried about developing bowel cancer reduced from 49 (pre-clinic) to 34% (p = 0.002). Worry about bowel cancer was positively associated with younger age, higher education level and higher perceived risk of developing cancer. A reduction in level of risk perception correlated with a lower likelihood of feeling 'very worried' about developing bowel cancer. Of those intending to go ahead with DNA testing, 58% were 'very worried' about bowel cancer compared with 15% of those not intending to proceed with testing, suggesting that worry was a motivation for interest in DNA testing. One-third of participants indicated another session of genetic counselling would be helpful. Within this group, a higher proportion was very worried about bowel cancer (43%) than for those who did not want another session (17%). Attendance at this familial colorectal cancer clinic alleviated worry for many individuals, partly due to improved information about risk of colorectal cancer.

Adult↗
PubMed2000

An exploratory investigation into the housing preferences of consumers of mental health services.

In the present qualitative study, 10 mental health consumers living in the community were interviewed in relation to their housing situations. Three themes emerged from the interview data: 'The place', 'Other consumers' and 'A normal life'. Consumers rejected congregated housing because it enables the larger community to more easily identify them as former psychiatric patients. The views of participants consistently indicate a desire to live a normal life. Results of this study highlight the need for greater consumer participation with mental health nurses and policy makers, in relation to the development of housing services.

Activities of Daily Living↗
PubMed2000

Can we be sure about a radiological diagnosis of fat necrosis of the breast?

AIMS: We performed a review of the clinical, mammographic and sonographic findings of fat necrosis in a group of patients who presented with a lump in the breast. We aimed to show that, in the light of a non-specific combination of findings, an ultrasound-guided core-biopsy (CB) is a safe, quick and useful test to confirm the diagnosis. The procedure makes it possible to reassure the patient of the true identity of the lesion, thus avoiding the need for surgical excision or follow-up investigations. MATERIALS AND METHODS: We undertook a retrospective review of the clinical presentation, imaging findings and subsequent management of 23 histologically proven cases of fat necrosis. All patients had presented to a specialist breast clinic with a breast lump. RESULTS: Only 52% of patients had a definite history of trauma. Clinical examination intimated that the lump was possibly malignant in 22%, while 4.5% were probably malignant. Fifty-seven per cent of mammograms were completely normal, however ultrasound showed an abnormality in 100%. Of these 100%, 74% were interpreted as possibly malignant. The diagnosis of fat necrosis was histologically confirmed by ultrasound-guided needle core biopsy, performed at the time of initial presentation. All patients were subsequently discharged. The mean time interval from investigation and biopsy to final diagnosis and discharge of the patient was 5.9 days. CONCLUSION: We show that fat necrosis often has a confusing clinical presentation. Imaging by either mammography or ultrasound is often inconclusive and ultrasound-guided core biopsy will confirm the diagnosis sparing patients unnecessary radiological follow-up or surgical excision.

Adult↗
PubMed2000

High risk mammographic parenchymal patterns and diet: a case-control study.

Mammographic parenchymal patterns are related to breast cancer risk and are also thought to be affected by diet. We designed a case-control study comprising 200 cases with high-risk (P2 and DY) mammographic parenchymal pattern and 200 controls with low-risk (N1 and P1) patterns in order to investigate the effect of food and nutrient intake on mammographic patterns. Mammograms were evaluated according to the Wolfe classification system. Dietary data were obtained from 7-day food diaries. Mean daily intake of nutrients was computed from standard UK food tables. The adjusted odds ratio (OR) of having a high-risk pattern in women in the highest tertile of total protein and carbohydrate intake was twice that of women in the lowest tertile (OR = 2.00; 95% confidence interval (CI) 1.06-3.77; P = 0.04 and OR = 1.93; 95% CI 1.03-3.59; P = 0.04 respectively). There was no excess risk for fat intake. In addition, there was no association between intake of vitamins and mammographic parenchymal patterns. Total meat intake was strongly and positively associated with high-risk patterns among post-menopausal women (OR = 2.50, 95% CI 1.09-5.69, P = 0.03). Our study suggests that certain macronutrients and foods such as protein, carbohydrate and meat intake influence the risk of breast cancer through their effects on breast tissue morphology, whereas fat and vitamins do not affect mammographic density. It seems that parenchymal pattern acts as an informative biomarker of the effect of some macronutrient and foodstuffs intake on breast cancer risk.

Adipose Tissue↗
PubMed2000

High-risk mammographic parenchymal patterns, hormone replacement therapy and other risk factors: a case-control study.

BACKGROUND: Mammographic parenchymal patterns are of particular interest because the denser patterns reduce screening sensitivity as well as increasing breast cancer risk, and because they have been shown to be affected by exogenous oestrogens. METHODS: We designed a case-control study comprising 200 cases with high-risk (P2 and DY) pattern and 200 controls with low-risk (N1 and P1) pattern. Mammograms were evaluated according to the Wolfe classification. RESULTS: Parity, body mass index (BMI) and current smoking were inversely and independently associated, whereas late age of menarche and history of benign breast disease were positively associated with high-risk mammographic patterns. Current-users of hormone replacement therapy (HRT) were more than twice as likely to have a high-risk pattern than never-users (OR = 2.48, 95% CI : 1.32-4.61). Women who used HRT for more than 5 years were almost three times more likely to have a high-risk pattern than never-users (OR = 2.77, 95% CI : 1.11-6.91). Relative to never-users, women who started HRT before the menopause were more than twice as likely to have a high-risk pattern (OR = 2.53, 95% CI : 1.31-4.87). CONCLUSIONS: Careful clinical and mammographical follow-up might be appropriate in women undergoing HRT. The HRT-induced mammographic pattern might be regarded as a new baseline and changes with respect to this new pattern could then be monitored over time.

Aged↗
PubMed2000

Efflux and target mutations as quinolone resistance mechanisms in clinical isolates of Streptococcus pneumoniae.

The aim of this study was to characterize quinolone resistance mechanisms in strains of Streptococcus pneumoniae with increased MICs of ofloxacin. These strains were also tested for their susceptibility to a battery of quinolone antimicrobial agents, including gemifloxacin. Of the S. pneumoniae isolates used, 27 were susceptible to ofloxacin, 18 intermediate and 48 resistant (ofloxacin MIC <4, 4 and >4 mg/L, respectively). In general, the ofloxacin-susceptible strains had no amino acid substitutions in GyrA, GyrB, ParC or ParE. Moderate increases in MIC were associated with substitutions in the quinolone resistance-determining region (QRDR) of ParC, while the highest MICs were found for strains that also had substitutions in the QRDR of GyrA. The most common substitutions were Ser79-->Phe in ParC and Ser81-->Phe in GyrA. Other substitutions were identified within the QRDR of ParC and outside the QRDR of ParC and ParE; these did not appear to affect susceptibility. The effects of antimicrobial efflux pumps were studied by determining MICs of a range of quinolones in the presence and absence of reserpine, an inhibitor of Gram-positive efflux pumps. Our results indicated that high-level resistance, caused entirely by efflux, was seen in a minority of ofloxacin-resistant S. pneumoniae strains. Testing the susceptibility of quinolone-resistant strains to gemifloxacin, ciprofloxacin, norfloxacin, ofloxacin and trovafloxacin revealed that gemifloxacin was least affected by this large variety of resistance mechanisms and was the only quinolone with MICs of < or =0.5 mg/L for all strains in this study. These results suggest that gemifloxacin is highly potent against S. pneumoniae and may also be effective against strains resistant to other quinolones.

Anti-Infective Agents↗