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Biomedical subjects

S Kay

Publications and source records attributed to S Kay.

At least 55 records · Page 3Linked to original sources
PubMed1994

p53 tumor suppressor oncogene expression in squamous cell carcinoma of the hypopharynx.

BACKGROUND: Although abnormalities of the p53 tumor suppressor oncogene system are being detected in many human cancers, the frequency and prognostic significance of such events in squamous cell cancer of the head and neck remain unknown. METHODS: Immunohistochemical studies were performed on archival tumor tissue taken from 43 patients with squamous cell carcinoma of the hypopharynx. Statistical analyses examining potential associations between p53 oncoprotein accumulation and various clinicopathologic parameters (including survival) were conducted. RESULTS: Sixteen (37%) tumors demonstrated strong specific staining for p53. Patients whose tumors stained strongly for p53 were significantly younger, presented at a more advanced clinical disease stage, and tended to have increased expression of epidermal growth factor receptor (P = 0.056). There was no correlation between p53 expression and the incidence of multiple primary cancers, tumor grade, DNA ploidy, or percent of S-phase. Median survival times were 11.6 months and 18.0 months for the p53-positive and p53-negative groups (NS). A Cox regression analysis confirmed the lack of significance of p53 in overall survival. CONCLUSIONS: These data suggest that although abnormalities of the p53 oncoprotein are common in this cancer, this finding is of little clinical significance.

Age Factors↗
PubMed1994

SAPPHIRE: scenarios, architecture, and process.

General Medical Practice (GMP) information systems within the UK are becoming more sophisticated and more complex and are widely available from numerous suppliers. Although such systems are viewed as being important, they are problematic in terms of interpreting and assessing their usefulness, and their impact upon work and the organisation (G. Walsham, Interpreting Information Systems in Organizations (Wiley, Chichester, 1993)). In particular, it is difficult for any who have an interest in these systems to apply existing technical specifications to a specific situation, and to match individual requirements with the supplier's products. The research project SAPPHIRE seeks to inform the decision making of stakeholders, e.g. GPs, facilitators and suppliers, with respect to procurement, update, design and supply of GMP systems by developing the means of evaluating such systems, and by facilitating an accreditation process through that evaluation. This extended paper introduces the multi-faceted approach, scenarios, architecture and process of SAPPHIRE.

Accreditation↗
PubMed1994

Abductor digiti minimi transfer for the restoration of opposition in children.

Abductor digiti minimi transfer was used to restore opposition in 20 patients, the majority suffering from congenital anomalies of the hand. The transfer was shown to be effective in restoring abduction, but less effective in restoring the rotational component of opposition in these cases. The donor site was critically reviewed and found to be acceptable. The surgical techniques and benefits of this transfer are reviewed.

Adolescent↗
PubMed1994

Measures of salivary secretory immunoglobulin A and state anxiety after a nursing back rub.

This study examined the effects of a 10-minute nursing back rub on salivary secretory immunoglobulin A (s-IgA) and state anxiety in well older adult subjects. A control group (n = 14) received no intervention, and an experimental group (n = 18) received a slow stroke effleurage back rub. All subjects initially completed the state portion of the Spielberger State/Trait Anxiety Inventory (STAI) and provided a timed, nonstimulated saliva sample. Control subjects lay positioned in bed for 10 minutes, and experimental subjects received the back rub. Both groups then provided a second saliva sample and completed the STAI again. Anxiety scores decreased for both groups, but not significantly, and s-IgA concentration increased in the experimental group. This study provides rationale for further research into the holistic benefits of the nursing back rub and should encourage nurses to continue to provide caring touch interventions to patients.

Adult↗
PubMed1994

Postoperative radiotherapy improves survival in squamous cell carcinoma of the hypopharynx.

BACKGROUND: Postoperative radiation is considered to be "standard of care" therapy for advanced, resectable squamous cell carcinoma of the head and neck. This approach has been supported by retrospective data but has not been validated in randomized clinical trials. PATIENTS AND METHODS: The present analysis examined the clinical course of 110 patients with squamous cell cancer of the hypopharynx treated with surgery alone (n = 65) and postoperative radiotherapy alone (n = 45) between 1966 and 1990. Staging of patients was performed using the 1988 American Joint Committee on Cancer criteria. Cox regression analyses identified clinical and pathologic factors that were significant for disease-free and overall survival. Crude and adjusted cancer-specific survival rates were calculated. RESULTS: The postoperative radiotherapy group presented with more advanced disease than the surgery alone group (stage III and IV combined, 96% versus 77%, P = 0.015). Crude 5-year cancer-specific survival probabilities were 43% for the postoperative therapy group and 27% for the surgery alone group (P = NS). Adjusted 5-year survival rates, correcting for differences in significant prognostic variables between groups, were 18% and 48%, respectively, for the surgery and postoperative radiotherapy groups (P = 0.029). CONCLUSIONS: The addition of postoperative radiotherapy was associated with improved disease-free and adjusted overall cancer-specific survival in patients with advanced hypopharyngeal squamous cancer. The potential survival benefit of postoperative radiotherapy should be addressed in a randomized clinical trial.

Carcinoma, Squamous Cell↗
PubMed1994

Primary carcinoid tumor of the bladder arising beneath an inverted papilloma.

We describe a 54-year-old woman with a primary carcinoid tumor of the bladder arising beneath an inverted papilloma diagnosed by light microscopy and immunohistochemical studies. After the patient complained of hematuria and voiding difficulties, a polypoid mass was detected during cystoscopy and removed for examination. The distinctive histologic features of an inverted papilloma were readily identified. The characteristic pattern of a carcinoid tumor was confirmed with immunohistochemical studies.

Carcinoid Tumor↗
PubMed1993

Epidermal growth factor receptor expression in squamous cell carcinoma of the hypopharynx.

Expression of the epidermal growth factor receptor (EGFR) has been demonstrated in normal and malignant squamous epithelia. Its presence has been suggested to be important in the pathophysiology and prognosis of epithelial cancers. Archival tumour specimens from 57 patients with squamous cell carcinoma of the hypopharynx were studied using OM-11-951, a new murine anti-EGFR monoclonal antibody which recognizes the receptor on deparaffinized tissue. By visual inspection, 28 (49%) tumours were EGFR negative; 29 (51%) tumours were EGFR positive. While patients whose tumours were EGFR positive were younger, there was no significant correlation with other clinical or pathological variables (including grade and stage). Patients whose tumours were EGFR negative had a median survival of 21 (95% CI 4.3-37.7) months compared with a median survival of 17 (95% CI 11.4-22) months for patients whose tumours were EGFR positive. The difference was not statistically significant. A multiple regression analysis did not demonstrate EGFR status to be important in predicting survival. These data cast doubt on the prognostic significance of EGFR expression in this neoplasm.

Antibodies, Monoclonal↗
PubMed1993

A framework for modelling the electronic medical record.

This paper presents a model for an electronic medical record which satisfies the requirements for a faithful and structured record of patient care set out in a previous paper in this series. The model underlies the PEN & PAD clinical workstation, and it provides for a permanent, completely attributable record of patient care and the process of medical decision making. The model separates the record into two levels: direct observations of the patient and meta-statements about the use of observations in decision making and the clinical dialogue. The model is presented in terms of "descriptions" formulated in the Structured Meta Knowledge (SMK) formalism, but many of its features are more general than the specific implementation. The use of electronic medical records based on the model for decision support and the analysis of aggregated data are discussed along with potential use of the model in distributed information systems.

Computer Simulation↗
PubMed1992

Serine-to-alanine substitutions at the amino-terminal region of phytochrome A result in an increase in biological activity.

We have used a tobacco transgenic plant system to assay the structure/function relationship of phytochrome A (phyA), a plant photoreceptor. The amino terminus of phyA from different plant species is very rich in serine residues. To investigate whether these serine residues are required for phytochrome function, the first 10 serine codons encoding amino acid residues 2-4, 10-14, 19, and 20 in the amino-terminal domain of the rice phyA gene (phyA) were changed to alanine codons. The mutant (S/A phyA), as well as the wild-type phyA cDNA, was placed under the control of the 35S promoter, and the chimeric genes were transferred into the tobacco genome by Agrobacterium-mediated transformation. Transgenic tobacco plants expressing either wild-type or S/A phyA showed similar phenotypic alterations, including dwarfism and dark-green leaves. However, hypocotyl elongation experiments revealed that transgenic seedlings expressing S/A phyA showed a higher amplitude of the red light response with respect to the inhibition of hypocotyl elongation. The observed difference is not correlated with expression levels of the transgene. The chromophore is attached to the mutant phyA apoprotein (PHY A), and the mutant photoreceptor is photoreversible, giving a difference spectrum indistinguishable from that of the rice phyA. Our results indicate that the S/A mutant has a higher biological activity as compared with the wild-type rice phyA.

Alanine↗
PubMed1991

A patient care workstation based on user centred design and a formal theory of medical terminology: PEN&PAD and the SMK formalism.

The PEN & PAD clinical workstation is for use by clinicians for direct patient care. It is based on a highly structured and detailed medical record but is intended to be simple and intuitive to use, allowing clinicians to summarise and view information in many ways, and quickly enter information through structured forms. It also provides mechanisms for tailoring the system to individual users without compromising its overall integrity. This has been achieved by following a process of user centred design and by developing a novel formalism, Structured Meta Knowledge, to represent the terminological knowledge, the medical record, and pragmatic knowledge about clinical practice.

Ambulatory Care Information Systems↗
PubMed1991

Foundations for an electronic medical record.

Given the many efforts currently under way to develop standards for electronic medical records, it is important to step back and reexamine the fundamental principles which should underlie a model of the electronic medical record. This paper presents an analysis based on the experience in developing the PEN & PAD prototype clinical workstation. The fundamental contention is that the requirements for a medical record must be grounded in its use for patient care. The basic requirement is that it be a faithful record of what clinicians have heard, seen, thought, and done. The other requirements for a medical record, e.g., that it be attributable and permanent, follow naturally from this view. We use the criteria developed to re-examine Weed's Problem Oriented Medical Record and also relate the criteria to secondary uses of the medical record for population data, communications and decision support.

Decision Making↗
PubMed1991

Multimodal treatment of adult intracranial gliomas.

Recent advances, experimental treatments and future protocols of adult intracranial gliomas are discussed in this article. Adult intracranial gliomas are not benign, and most are incurable with poor prognosis, despite aggressive treatment. Breakthroughs will be found only through well-designed, experimental protocol evaluation on patients with intracranial gliomas.

Adult↗
PubMed1990

A 268 bp upstream sequence mediates the circadian clock-regulated transcription of the wheat Cab-1 gene in transgenic plants.

We previously reported that the expression of the wheat Cab-1 gene is regulated by an endogenous circadian rhythm and by the photoreceptor phytochrome both in wheat and in transgenic tobacco plants. To define regulatory elements necessary for the circadian rhythm-regulated Cab-1 gene expression, we now analysed the fluctuation of steady-state mRNA levels in a series of 5' deletion mutants in transgenic tobacco plants. We found that the expression of a deletion mutant containing 211 bp upstream sequence still exhibited circadian rhythm. Furthermore we show that an enhancer-like sequence of the Cab-1 promoter (from -357 to -90) can endow a chimaeric gene consisting of a truncated 35S promoter (from -90 to +8) and the bacterial beta-glucuronidase (GUS) gene with circadian clock-regulated gene expression. Finally we demonstrate by nuclear run-off experiments that the transcription rates of the Cab genes in wheat oscillate in a rhythmic manner, with a periodicity of approximately 24 hours. Consistent with our previous findings these results (i) indicate that the expression of the wheat Cab-1 gene is regulated mainly at the transcription level and (ii) identify a short promoter region between -211 and -90 that is responsible for the circadian clock-regulated gene expression.

Amino Acid Oxidoreductases↗
PubMed1990

Computed tomography staging of the paranasal sinuses in chronic hyperplastic rhinosinusitis.

In this study, the computed tomography scans of 100 patients with chronic hyperplastic rhinosinusitis were reviewed to establish a clinical staging system. Fourteen percent of the patients were classified as Stage I (single-focus disease); 36% as Stage II (multifocal disease responsive to conservative therapy); 32% as Stage III (diffuse disease partially responsive to medication); and 16% as Stage IV (diffuse disease associated with bony changes and poorly responsive to conservative treatment). The incidence of recurrent or persistent disease ranged from 13% for Stage II to 30% for Stage IV. Stage I and III patients had 13% and 18% recurrence rates, respectively. Computed tomography staging is shown to be useful in outlining operative strategies and is a reliable prognosticator of the disease process.

Chronic Disease↗