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Biomedical subjects

R Windle

Publications and source records attributed to R Windle.

At least 19 recordsLinked to original sources
PubMed2004

An unusual presentation of Crohn's disease.

The first case of an inflamed, discharging urachal remnant associated with granulomatous appendicitis in which the patient was subsequently found to have Crohn's disease is described.

Adolescent↗
PubMed2002

Optimizing surveillance mammography following breast conservation surgery.

AIMS: Prompt detection and treatment of local recurrence (LR) following breast conservation surgery (BCT) may improve subsequent survival. Following early reports demonstrating increased LR in the first years after surgery, a practice of surveillance mammography starting 1 year from diagnosis has become established. Increasing use of adjuvant chemotherapy with adriamycin-containing regimens has resulted in radiotherapy being postponed, so that the first mammogram coincides with the acute radiotherapy reaction, resulting in patient discomfort and poor quality films. We wished to determine if the 1-year mammogram could safely be omitted. METHODS: We reviewed 1151 consecutive patients treated with BCT for in situ, stage I or II disease over a 10-year period. All patients had clear resection margins and, where indicated, underwent axillary surgery and adjuvant treatment. This consisted of radiotherapy (40 Gy with a 5 Gy boost), chemotherapy and/or tamoxifen. RESULTS: Overall, the 5-year actuarial rate of local recurrence was 4.8%. The cumulative risk of LR at 12 months was 0.3% (three patients) and 1.9% (20 patients) at 24 months. This included all cases of high-grade DCIS (>30 mm in size) and all but one tumour with a Nottingham Prognostic index (NPI) of >6.0 which recurred locally. CONCLUSION: Even including those patients generally accepted to be at high risk of LR, the cumulative risk of LR was only 0.3% at 12 months from surgery. We now therefore schedule routine biennial mammography from time of surgery except for those with high risk of early local recurrence such as extensive, high-grade in situ disease.

Breast Neoplasms↗
PubMed1998

Staging the axilla in breast cancer: an audit of lymph-node retrieval in one U.K. regional centre.

AIMS: Many surgeons undertake a level 1 axillary dissection in patients with invasive breast cancer. This dissection yields a variable number of lymph nodes for histological study. In this study, we report the consequences of this policy for staging of the axilla. METHODS: Between January 1995 and December 1995, 236 patients with a diagnosis of invasive breast cancer underwent axillary surgery. RESULTS: A median of eight nodes was identified (range 0-30). In only 11 patients less than four nodes were identified. An increase in the number of nodes harvested was associated with a higher proportion of node-positive patients and a higher number of metastatic nodes identified. CONCLUSIONS: We concluded that a standardized approach to axillary dissection consistently yields an adequate sample of lymph nodes for staging purposes. Most importantly, larger node samples yield higher detection rates for metastasis. This has a significant bearing on patient selection for adjuvant chemotherapy when compared with more limited sampling practices, including solitary sentinel node detection and biopsy.

Adult↗
PubMed1998

Anatomical variants during axillary dissection.

BACKGROUND: This study was done to document the variations encountered in the anatomy of the axilla because of the difficulty they can cause during dissection. METHODS: A record was made of the anatomy of the axilla in 100 patients with breast cancer who had an axillary dissection. RESULTS: The variants from the described normal included double axillary veins, abnormal bands of muscle from the latissimus dorsi stretching across the axilla and a medial lying thoracodorsal nerve. CONCLUSION: Damage to important structures in the axilla during axillary dissection can be minimized with an awareness of the possible anatomical variations.

Axilla↗
PubMed1996

Anxiety in patients with symptomatic breast disease: effects of immediate versus delayed communication of results.

Immediate reporting of fine needle aspiration biopsy (FNAB) specimens has been introduced into many breast clinics; in others, women return to a later clinic to receive the result. This delay in communication of results may lead to elevated anxiety. This study compared anxiety levels in two groups having FNAB. One group received results at the initial clinic visit (n = 51), the other having delayed communication (n = 51). Anxiety was measured using the six-item short form of the Spielberger State-Trait Anxiety Inventory (STAI-SSF) and was administered before and after each consultation. Initial anxiety was high in both groups. Women with malignant results had higher post-communication anxiety compared with women with benign results. However, within the group with benign results (the vast majority), immediate communication was associated with a significantly greater fall in STAI-SSF scores from before to after the first consultation (U = 587.0; P < 0.02). There was no difference between the immediate and delayed communication among women with a malignant diagnosis (U = 26.0; P = 0.91). These results provide preliminary support for the more widespread introduction of a cytologist into breast clinics to allow immediate communication of results.

Anxiety↗
PubMed1993

Nitric oxide modulates the release of vasopressin from rat hypothalamic explants.

The enzyme nitric oxide (NO) synthase is present in the paraventricular nucleus, while nitric oxide has recently been shown to inhibit the stimulated release of corticotrophin-releasing hormone (CRH) in vitro. Thus the possible role of NO in regulating, vasopressin (AVP), which also plays an important role in pituitary-adrenal activity, has been investigated. The effects were studied of the NO donors, L-arginine, syndnonimine-1 (SIN-1) and sodium nitroprusside, on both the basal and stimulated release of AVP, employing a previously validated system. Rat hypothalami were incubated in either medium alone or medium containing the test substances and hormone release was measured by RIA. The effect of L-arginine in the presence of the NO synthase inhibitor, L-NMMA, was also investigated. L-arginine reduced KCl-evoked AVP release; this effect was reversed by L-NMMA and reduced by the addition of ferrous human Hb. Similarly, SIN-1 and sodium nitroprusside attenuated KCl-evoked AVP release. L-arginine also reduced IL-1 beta-stimulated AVP release. NO appears to directly and specifically inhibit the stimulated release of AVP from rat hypothalamic explants in vitro, similar to its effects on CRH. These findings provide further evidence that NO may be involved in neuroendocrine regulation.

Amino Acid Oxidoreductases↗
PubMed1992

Hypnosis, Ericksonian hypnotherapy, and Aikido.

Several key Ericksonian concepts find cross-cultural validation and practical application in the Japanese martial art of Aikido. The Aikido psychophysiological state of centering shares several important attributes with the trance state, particularly in the relational aspects of shared trance. In Aikido methodology for dealing with others, blending is an almost exact parallel to Ericksonian utilization. The Aikido view of resistance offers an increased understanding of strategic/Ericksonian approaches. Therapist training may be enhanced by combining Aikido principles with traditional methods.

History, 19th Century↗
PubMed1991

The influence of reproductive status on vasopressin release in the rat.

It has been shown that surgical ovariectomy of the rat results in a fall in plasma vasopressin concentrations suggesting that ovarian steroids may influence hormone release. To determine whether a similar fall is found on suppression of the oestrous cycle, vasopressin concentrations were monitored after treatment with the antioestrogen preparation tamoxifen or a long-acting analogue of LH-releasing hormone (LHRH) which suppresses ovarian function. Treatment with either agent was found to result in a fall in circulating vasopressin concentrations, with little effect on fluid balance. To determine whether the ovary could influence the vasopressin release in response to known stimuli, hormone concentrations were measured in ovariectomized animals during extracellular fluid hypertonicity produced by an i.p. injection of hypertonic saline and hypovolaemia produced by an i.p. injection of polyethylene glycol. It was found that after ovariectomy or treatment with tamoxifen, the response to hypertonicity was unaffected but that to hypovolaemia was attenuated. Treatment with LHRH affected the response to both hypovolaemia and hypertonicity.

Animals↗
PubMed1990

Cosmetic results of early breast carcinoma treated with wide local excision, external beam radiotherapy and iridium-192 boost.

Cosmetic results of 80 patients with axillary lymph node negative or unknown T1 and T2 carcinoma of the breast who were treated with wide local excision, external beam radiotherapy and iridium-192 boost, were evaluated by the patient and the radiotherapist at 18-36 months. Their overall cosmetic results were assessed as good, very good or excellent by 80% of the patients. The radiotherapist's assessment was similar but in general the patients score was more favourable. After a follow-up of 24-72 months recurrence was found in only one patient at 40 months. This approach offers good cosmesis with low local recurrence rates in early breast carcinoma patients with negative axillary lymph nodes.

Adult↗
PubMed1987

Effect of four days of preoperative lactulose on posthaemorrhoidectomy pain: results of placebo controlled trial.

The effect of four days of preoperative lactulose on posthaemorrhoidectomy pain was studied in a prospective double blind randomized trial. All patients received lactulose on admission to hospital, 20 received lactulose for four days before admission, and 22 received placebo. The preoperative lactulose treatment group suffered significantly less pain on defecation for the first four days that they opened their bowels (visual analogue scores in cm: day 1, 4.4 v 5.9; day 2, 4.1 v 6.3; day 3, 4.5 v 6.1; day 4, 4.6 v 6.5), suffered significantly less pain during the first two 24 hour periods after defecation (visual analogue scores in cm: day 1, 5.0 v 7.0; day 2, 3.9 v 6.1), and required significantly less analgesia daily after defecation (0.76 g paracetamol/day v 1.29 g paracetamol/day). These results show that lactulose given for four days preoperatively reduces pain after haemorrhoidectomy.

Clinical Trials as Topic↗
PubMed1987

Five year results of a randomized trial of adjuvant 5-fluorouracil and levamisole in colorectal cancer.

Following curative surgery for colorectal cancer 141 patients were randomized to receive a 6 month course of 5-fluorouracil (5FU) with or without postoperative levamisole or supportive treatment only. The patients have been followed up for a minimum of 5 years and 52 per cent of patients in the control group, 44 per cent of the 5FU group and 32 per cent of the 5FU/levamisole group have died of tumour recurrence. This represents a significant survival advantage in the patients receiving levamisole, even when other patient and tumour factors are allowed for.

Adult↗
PubMed1987

Cannulation of the portal vein for cytotoxic liver perfusion in colorectal carcinomas: an alternative approach.

Cytotoxic liver perfusion via the portal vein has been used with some success as an adjuvant to surgery for colorectal carcinoma. We have used an alternative method of cannulating the portal vein at the time of operation and support the use of this method as well as the use of short-term 5FU infusion via the portal vein as being safe and of low systemic toxicity.

Adenocarcinoma↗