Treating elderly patients with breast cancer.
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Biomedical subjects
Publications and source records attributed to R Windle.
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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.
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.
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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.
Classic teaching implies that arterial walls are a resistance to tumour invasion. We report a case of tumour cell infiltration of an obturator artery aneurysm following an abdomino-perineal excision of rectum.
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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.
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.
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Cell mediated immunity was studied before and after surgery in patients with colorectal cancer. Thymus-derived (T) lymphocytes were enumerated and their non-specific activity was measured by assessing phytohaemagglutinin (PHA)-induced blastogenesis. Specific T lymphocyte activity was measured by leucocyte migration inhibition in response to purified protein derivative of tuberculin (PPD) and autochthonous tumour extract. One group of patients received levamisole postoperatively and the other group consisted of controls. There was a more rapid return to preoperative levels of leucocyte migration inhibition to both antigens by the levamisole group. However, levamisole administration had only a marginal effect on the postoperative depression of cell counts and did not restore depressed lymphoblast transformation.
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Dextran 70 ('Lomodex') roduced significant increases in thymidine incorporation in a modified whole-blood method of investigating lymphocyte blastogenesis. This blastogenesis occurred at molar concentrations of 7 X 10(-6) and 7 10(-5). At 7 X 10(-7) mol/l dextran alone did not significantly increase thymidine incorporation; however, when this concentration of dextran was added simultaneously with phytohaemagglutinin there was a significant increase in incorporation. Conversely when dextran was added before P.H.A., thymidine incorporation was decreased. These variable effects indicate that dextran 70 may be a B-cell mitogen. Dextran 70 is widely used and these effects on lymphocyte blastogenesis may be clinically relevant.
A 15-year follow-up of 57 patients who underwent portocaval anastomosis is reported. Twenty-seven patients were still alive and the progress of these and of those who died is followed. The young cryptogenic cirrhotic with no encephalopathy, normal liver function tests and absence of portal vein mural thrombus at the time of operation is best benefited. The only factor from the series to suggest a poor prognosis is deterioration in liver function in the post-jaundice cirrhotic, and the development of encephalopathy in cryptogenic cirrhotics suggests a poor long term prognosis, but its onset is not related to the time before death.