176
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Dershaw DD, McCormick B, Cox L, Osborne MP. Differentiation of benign and malignant local tumor recurrence after lumpectomy. AJR Am J Roentgenol 1990; 155:35-8. [PMID: 2112861 DOI: 10.2214/ajr.155.1.2112861] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
During a 5-year period, 28 women who had been treated conservatively for breast carcinoma had 29 reexcisions of the lumpectomy site because of suspicion of a recurrent malignant tumor. Biopsy results were benign in 19 cases and malignant in 10 cases. Sixteen of the 19 benign tumors had developed within 2 years after therapy. In 16 benign cases, a palpable lump developed at the scar and was found on biopsy to be fat necrosis or fibrosis. Seven of these cases had normal mammographic findings. Three women with abnormal mammographic findings but a normal breast examination had punctate microcalcifications develop at the scar; these were due to fibrosis in two and sclerosing adenosis in the other. Of the 10 malignant recurrent tumors, seven were palpable, four of which also were identifiable by mammography. Of seven mammographically identifiable recurrent tumors at the surgical site, four were palpable. Mammographic findings were a single mass in two cases, multiple masses in one, microcalcification in three, and a mass with microcalcifications in one. Malignant microcalcifications were all linear, irregular, and in one case branching. Mean time to recurrence in these 10 women was 3 years. This experience suggests that benign disease usually occurs at the scar within 2 years after the original therapy and when palpable may not show changes on mammography. When microcalcifications do occur, they are usually punctate.
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177
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Darendeliler F, Hindmarsh PC, Preece MA, Cox L, Brook CG. Growth hormone increases rate of pubertal maturation. ACTA ENDOCRINOLOGICA 1990; 122:414-6. [PMID: 2327220 DOI: 10.1530/acta.0.1220414] [Citation(s) in RCA: 112] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We have performed a retrospective analysis of the pubertal parameters of 134 children with isolated GH insufficiency on GH treatment and compared them to the standards of Tanner and to a recent longitudinal study of growth and development in the United Kingdom. The age at onset of puberty (13.0 years in boys, 12.1 years in girls) was found to be significantly delayed (Mann-Whitney p less than 0.001), but duration of puberty (1.5 years in both sexes) was shortened (Kolgomarov-Smirnov p less than 0.01). Skeletal maturity at the onset of puberty was not advanced excluding this as a contributory factor. There was no association between dose of GH administered and the pubertal parameters. The results suggest that GH accelerates the pubertal process.
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178
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McCormick B, Yahalom J, Cox L, Shank B, Massie MJ. The patients perception of her breast following radiation and limited surgery. Int J Radiat Oncol Biol Phys 1989; 17:1299-302. [PMID: 2599911 DOI: 10.1016/0360-3016(89)90540-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Seventy-four patients followed from 1 to 8 years post completion of breast-conserving surgery and radiation for early-stage breast cancer were asked to answer a questionnaire exploring their perception and awareness of the treated breast. The questionnaire was divided into several sections, including "Daily Activities", Pre-menstrual Changes", "Sexual Activities", and a summary "Satisfaction Index" section; when appropriate, comparisons were sought between the treated and untreated breasts. Preliminary results from this study indicate that 70% of all patients are aware of their treated breast in some way during everyday activities. The "Satisfaction Index" of this patient group is very high, with 75% rating their cosmetic result, and 81% their functional result "8" or higher on a scale of "0" to "10","10" indicating "best" or "normal".
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179
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Cox L, Hutner G, Kennett R. Creating the archives. NEW JERSEY MEDICINE : THE JOURNAL OF THE MEDICAL SOCIETY OF NEW JERSEY 1988; 85:734-53. [PMID: 3067131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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180
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McCormick B, Wesson MF, Cox L, Osborne MP, Petrek JA, Kinne DW. Iridium-192 implants for primary breast cancer: experience with placement at the time of wide local excision. Int J Radiat Oncol Biol Phys 1988; 15:745-8. [PMID: 3417493 DOI: 10.1016/0360-3016(88)90320-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
An Ir-192 boost is a technique frequently used to deliver an additional dose of radiation therapy to the tumor bed following breast conserving surgery and combined with external beam radiation therapy to the entire breast for patients with early breast cancer. Traditionally these catheters are placed following completion of 4500-5000 cGy, as a separate procedure. This paper described a Pilot Study identifying placement of the catheters at the time of primary wide local excision, or re-excision in 52 patients. The key to the success of this technique is the achievement of complete hemostasis in the primary cavity, the presence of the radiation oncologist during the surgical procedure itself, and closure of the wound prior to placement of the catheters. Details of the technique, and preliminary patient results are presented.
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181
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Holland C, Cox L, Johnson R. Medical short stay--a viable alternative. Nurs Manag (Harrow) 1988; 19:38-9. [PMID: 3399206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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182
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Abstract
A case of a large yolk sac tumor in an undescended testicle in a 2-year-old child is presented. No such similar finding has been reported in a young child. Despite the large size of the primary tumor, the high level of serum alpha-fetoprotein and the relatively late clinical presentation, this was a stage I lesion, and the child responded to surgical resection of the tumor and chemotherapy.
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183
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Hoey H, Cox L. Irish standards for triceps and subscapular skinfold thickness. IRISH MEDICAL JOURNAL 1987; 80:312-5. [PMID: 3501776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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184
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McCormick B, Kinne D, Petrek J, Osborne M, Cox L, Shank B, Hellman S, Yahalom J, Rosen PP. Limited resection for breast cancer: a study of inked specimen margins before radiotherapy. Int J Radiat Oncol Biol Phys 1987; 13:1667-71. [PMID: 2444573 DOI: 10.1016/0360-3016(87)90163-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This is an analysis of tumor margins of 108 patients who underwent a limited resection for infiltrating breast cancer, prior to starting radiation therapy. This represented the initial resection (IR) in 75 patients, and a re-excision (RE) after biopsy elsewhere in 33 patients. All specimens were processed by the India ink method prior to frozen and paraffin section analysis. Overall, the incidence of involved margins was 28% for the IR group, and 15% for the RE group. No correlation was found with the axillary node status, or with the type of prior surgery in the RE group. The data suggest a correlation between increasing tumor size and margin involvement. Further surgery in the IR group with involved margins yielded negative margins in all cases; the finding of residual carcinoma was correlated with the type of secondary surgery, that is, further re-excision or mastectomy.
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185
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186
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Hoey H, Cox L, Tanner J. The age of menarche in Irish girls. IRISH MEDICAL JOURNAL 1986; 79:283-5. [PMID: 3793421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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187
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Cooper TK, Traub AI, Magennis SD, Nevin NC, Darzi A, Kelly CJ, Broe PJ, Bouchier-Hayes DJ, McAteer E, O’Reilly G, Haddan DR, Hoey H, Tanner JM, Cox L, Lanigan O, Heffernan A, Chambers J, Kelleher C, Joyce C, Kelly G, Ferriss JB, Sullivan PA, Daly B, O’Connor R, Freyne M, Dineen M, Ritchie CM, Hadden DR, Kennedy AL, Weaver JA, Atkinson AB, Mcllrath E, Clark GE, Sequeira SJ, Cunningham S, Hannon S, McKenna TJ, Smith DF, Smyth PPA, Dalzell G, Kennedy L, Devery R, O’Donnell L, Tomkin GH, Keating JJ, Johnson PJ, Williams R, Loughlin T, Bertagna X, Collins WCJ, Cranny A, Cullen MJ, Feely J, Sheridan B, Dalzell GW, McCormack P, Devlin JG, Redington F, Wickham S, O’Meara N, Collins P, Johnson A. Irish endocrine society. Ir J Med Sci 1986. [DOI: 10.1007/bf02960713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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188
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Kelly WM, Gould R, Norman D, Brant-Zawadzki M, Cox L. ECG-synchronized DSA exposure control: improved cervicothoracic image quality. AJR Am J Roentgenol 1984; 143:857-60. [PMID: 6382980 DOI: 10.2214/ajr.143.4.857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
An electrocardiogram (ECG)-synchronized x-ray exposure sequence was used to acquire digital subtraction angiographic (DSA) images during 13 arterial injection studies of the aortic arch or carotid bifurcations. These "gated" images were compared with matched "ungated" DSA images acquired using the same technical factors, contrast material volume, and patient positioning. Subjective assessments by five experienced observers of edge definition, vessel conspicuousness, and overall diagnostic quality showed overall preference for one of the two acquisition methods in 69% of cases studied. Of these, the ECG-synchronized exposure series were rated superior in 76%. Linear intensity gradients across vessel margins generally showed improved or unchanged edge definition in the gated subtraction images as compared with their ungated pairs. These results, as well as the relatively simple and inexpensive modifications required, suggest that routine use of ECG exposure control can facilitate improved arterial DSA evaluations of suspected cervicothoracic vascular disease.
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189
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Hirji M, Gamsu G, Webb WR, Brito AC, Kuriyama K, Stern RG, Cox L. EKG-gated digital subtraction angiography in the detection of pulmonary emboli. Radiology 1984; 152:19-22. [PMID: 6374757 DOI: 10.1148/radiology.152.1.6374757] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Detection of pulmonary emboli was investigated using electrocardiographically gated (EKG-gated) intravenous digital subtraction angiography (DSA) in 6 anesthetized and paralyzed dogs. Six autologous blood clots were introduced into the internal jugular vein of each dog and both conventional pulmonary angiography and EKG-gated DSA performed in frontal and oblique projections. When two observers scored any definite or equivocal embolus as positive, sensitivity was 82.1% for one and 92.9% for the other; the respective positive predictive values (PPV) were 88.5% and 65%. When only definite emboli were considered positive, sensitivity was 75% for one observer and 71.4% for the other; PPV was 100% for both. The authors conclude that DSA can demonstrate individual emboli with good sensitivity and excellent precision. If several emboli are present, EKG-gated DSA should prove highly accurate; however, care must be taken because overinterpretation is more likely with DSA than with conventional pulmonary angiography.
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190
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Norman D, Axel L, Berninger WH, Edwards MS, Cann CE, Redington RW, Cox L. Dynamic computed tomography of the brain: techniques, data analysis, and applications. AJR Am J Roentgenol 1981; 136:759-70. [PMID: 6784472 DOI: 10.2214/ajr.136.4.759] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Rapid sequence computed tomography (CT) scanning has many potential applications in studying intracranial physiologic events. However, visual inspection of these rapid sequence scans fails to extract the large amount of information inherent in the digital data. The concept of corrected mean transit time applied to rapid sequence scans after intravenous bolus injection of contrast material provides quantitative data on relative hemispheric flow. Use of histogram-based areas of interest permits accurate and reproducible identification of anatomic structures including arteries and gray and white matter. Gamma variate curve fit techniques reduce statistical noise. The concept of transit time can be expanded to the creation of functional CT images.
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191
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Cox L. To whom are we accountable? THE AUSTRALIAN NURSES' JOURNAL. ROYAL AUSTRALIAN NURSING FEDERATION 1979; 8:35-6, 44. [PMID: 256484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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192
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Challand GS, Cox L. Identification of an unusual gamma counter fault using Trigg's technique for trend detection. Ann Clin Biochem 1978; 15:117-20. [PMID: 637510 DOI: 10.1177/000456327801500126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A simultaneous deterioration in performance of several radioimmunoassays suggested that equipment was malfunctioning. Replicate counts from an automated gamma counter showed unacceptable variation during a 24-hour period; this variation was detected using Trigg's technique, a sensitive method for trend analysis, and was not identified by the usual laboratory testing procedures. A defective capacitor was found in the voltage stabilisation unit in the gamma counter, which probably made it responsive to small variations in the power supply to the laboratory. It is suggested that the analysis of replicate counts using Trigg's technique is a valuable test of gamma counter function which should become routine.
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193
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Cox L, Bedbrook G. Nursing responsibilities in rehabilitation. THE NURSING JOURNAL OF SINGAPORE 1976; 16:10-3. [PMID: 1048451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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194
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Gusberg SB, Marinoff S, Hilsen J, Cox L, Young A, Cameron O. Therapeutic listening: an adolescent guidance program in motivation for contraception. THE MOUNT SINAI JOURNAL OF MEDICINE, NEW YORK 1975; 42:439-44. [PMID: 1081194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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195
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Cox L. Prevention of catheter-induced infections by the Shenton Park Urodrain. THE AUSTRALIAN NURSES' JOURNAL. ROYAL AUSTRALIAN NURSING FEDERATION 1974; 3:20-2. [PMID: 4494547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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196
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Schonholz DH, Gusberg SB, Astrachan JM, Davidson AB, Morganthau J, Young AT, Gouley C, Simon B, Cox L. An adolescent guidance program. Study in education for marital health. Obstet Gynecol 1969; 34:610-4. [PMID: 5822685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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197
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Schield PN, Cox L, Mahony DT. Anatomic demonstration of the mechanism of chyluria by lymphangiography, with successful surgical treatment. N Engl J Med 1966; 274:1495-7. [PMID: 5939849 DOI: 10.1056/nejm196606302742610] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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