1
|
Knox F. Rapid sequence spinal anaesthesia: are we being serious? Anaesthesia 2010; 65:1144; author reply 1144-5. [PMID: 20946398 DOI: 10.1111/j.1365-2044.2010.06520.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
2
|
Bundred N, Cramer A, Morris J, Landberg G, Renshaw L, Winter M, Coleman R, Grassby S, Knox F, Dixon M. Randomised Placebo Controlled Trial Studying Short Term Biological Effects of the Combination of Letrozole and Zoledronic Acid on Invasive Breast Cancer. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-2009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
To determine whether the addition of Zoledronic Acid to endocrine therapy increases apoptosis or decreases proliferation in early invasive breast cancer, a placebo controlled randomised trial comparing 14 days treatment with Letrozole or Letrozole and Zoledronic Acid pre-operatively was performed.PatientsIn total 109 postmenopausal women with early invasive hormone receptor positive breast cancer were randomised (1:1:1) to either placebo, Letrozole 2.5mg/day or Letrozole with Zoledronic Acid 4mg single dose intravenously 2-4 days before definitive surgical excision. Epithelial proliferation and apoptosis were measured on paired baseline and surgical biopsy specimens (after 14 days of treatment) using Ki67 and Activated Caspase 3 immunohistochemistry. Alterations in angiogenic markers (VCAM/VEGF and CD31) were also studied. The primary endpoint was fall in Ki67 between diagnosis and surgical excision.ResultsOverall 109 women were enrolled but paired biopsies were only available for 101 patients. PlaceboLetrozoleLet + Zoln323435Absolute Ki67 change (median,range)-0.8 (-12,12)8.6 (-14,37)12.9 (-12,29) Caspase 3 change (median,range)0.1 (-3.8, 9.3)0.4 (-2.7, -4.1)0.2 (-10.9, -14.4) Absolute change (Cell turnover index)-0.3 (-142, -59)18.9 (-201, 192)17.7 (-14, 379) Statistically significant reductions in Ki67 and Cell Turnover Index were seen with Letrozole and Let & Zol (p ≤ 0.001) but there was no significant different between Letrozole and Letrozole plus Zoledronic Acid groups (p = 0.26). Apoptosis did not change between the three groups.ConclusionLetrozole reduces proliferation by 70% when used for 14 days prior to surgery. Zoledronic Acid administration prior to surgery is safe but when administered as a single dose at a median of 3 days before surgery did not significantly increase apoptosis or decrease proliferation compared to Letrozole alone.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2009.
Collapse
Affiliation(s)
- N. Bundred
- 1University of Manchester, United Kingdom
| | - A. Cramer
- 1University of Manchester, United Kingdom
| | - J. Morris
- 1University of Manchester, United Kingdom
| | | | - L. Renshaw
- 2University of Edinburgh, United Kingdom
| | - M. Winter
- 3University of Sheffield, United Kingdom
| | - R. Coleman
- 3University of Sheffield, United Kingdom
| | - S. Grassby
- 1University of Manchester, United Kingdom
| | - F. Knox
- 1University of Manchester, United Kingdom
| | - M. Dixon
- 2University of Edinburgh, United Kingdom
| |
Collapse
|
3
|
Evans DGR, Lalloo F, Cramer A, Jones EA, Knox F, Amir E, Howell A. Addition of pathology and biomarker information significantly improves the performance of the Manchester scoring system for BRCA1 and BRCA2 testing. J Med Genet 2009; 46:811-7. [PMID: 19542080 DOI: 10.1136/jmg.2009.067850] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Selection for genetic testing of BRCA1/BRCA2 is an important area of healthcare. Although testing costs for mutational analysis are falling, costs in North America remain in excess of US$3000 (UK price can be 690 pounds). Guidelines in most countries use a 10-20% threshold of detecting a mutation in BRCA1/2 combined within a family before mutational analysis is considered. A number of computer-based models have been developed. However, use of these models can be time consuming and difficult. The Manchester scoring system was developed in 2003 to simplify the selection process without losing accuracy. METHODS In order to increase accuracy of prediction, breast pathology of the index case was incorporated into the Manchester scoring system based on 2156 samples from unrelated non-Jewish patients fully tested for BRCA1/2, and the scores were adapted accordingly. Results/ DISCUSSION Data from breast pathology allowed adjustment of BRCA1 and combined BRCA1/2 scores alone. There was a lack of pathological homogeneity for BRCA2, therefore specific pathological correlates could not be identified. Upward adjustments in BRCA1 mutation prediction scores were made for grade 3 ductal cancers, oestrogen receptor (ER) and triple-negative tumours. Downward adjustments in the score were made for grade 1 tumours, lobular cancer, ductal carcinoma in situ and ER/HER2 positivity. Application of the updated scoring system led to four and nine more mutations in BRCA1 being identified at the 10% and 20% threshold, respectively. Furthermore, 65 and 58 fewer cases met the 10% and 20% threshold, respectively, for testing. Moreover, the adjusted score significantly improved the trade-off between sensitivity and specificity for BRCA1/2 prediction.
Collapse
Affiliation(s)
- D G R Evans
- University of Manchester, Central Manchester Foundation Hospital NHS Trust, St Mary's Hospital, Manchester, UK.
| | | | | | | | | | | | | |
Collapse
|
4
|
Absar MS, Barr N, Wilson M, Beetles U, Knox F, Morris J, Bundred NJ. Value of axillary ultrasound and cytology in assessing nodal status preoperatively. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #1007
Preoperative identification of axillary node involvement in early breast cancer allows correct surgical procedures to be performed and avoids second axillary operations. We compared preoperative axillary assessment using ultrasound ± cytology with the eventual histopathological results to identify the accuracy of preoperative axillary node assessment.
 Methods: Preoperative axillary ultrasound was used to identify the presence of suspicious or malignant nodes which were then confirmed with cytological assessment to allow management decisions regarding axillary clearance (or sentinel node biopsy (SNB) if nodes appeared negative).
 Results: Overall 79/365 (21%) early breast cancer patients had suspicious or malignant nodes on ultrasound, of which 78 were confirmed on cytology, thus avoiding an unnecessary SNB operation in these patients. Ultrasound and cytology accurately identified patients with ER negative (P=≤0.001), high grade (P=≤0.001) and large size tumours ≤20mm (P=≤0.001), with involved nodes. Only 11% ER negative compared to 46% ER positive tumours were incorrectly classified (P=0.002). In contrast ER positive, low grade, small tumours were most likely to have a false negative axillary assessment. Specificity of cytological assessment of nodes was 99% and sensitivity 54%.
 Conclusions: Axillary ultrasound combined with cytological assessment of suspicious nodes accurately identifies majority of women who require axillary clearance.
 

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1007.
Collapse
Affiliation(s)
- MS Absar
- 1 University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - N Barr
- 1 University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - M Wilson
- 1 University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - U Beetles
- 1 University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - F Knox
- 1 University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - J Morris
- 1 University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - NJ Bundred
- 1 University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| |
Collapse
|
5
|
Wilson GR, Cramer A, Welman A, Knox F, Swindell R, Kawakatsu H, Clarke RB, Dive C, Bundred NJ. Activated c-SRC in ductal carcinoma in situ correlates with high tumour grade, high proliferation and HER2 positivity. Br J Cancer 2006; 95:1410-4. [PMID: 17060931 PMCID: PMC2360601 DOI: 10.1038/sj.bjc.6603444] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Overexpression and/or activity of c-Src non-receptor tyrosine kinase is associated with progression of several human epithelial cancers including breast cancer. c-Src activity in ‘pure’ ductal carcinoma in situ (DCIS) was measured to assess whether this predicts recurrence and/or correlates with HER2 expression and other clinical parameters. Activated c-Src levels were evaluated in DCIS biopsies from 129 women, with median follow-up at 60 months. High levels of activated c-Src correlated with HER2 positivity, high tumour grade, comedo necrosis and elevated epithelial proliferation. In univariate analysis, high activated c-Src level associated with lower recurrence-free survival at 5 years (P=0.011). Thus, high c-Src activity may identify a subset of DCIS with high risk of recurrence or progression to invasive cancer where therapeutics targeting c-Src may benefit this patient subset.
Collapse
MESH Headings
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Intraductal, Noninfiltrating/metabolism
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Cell Proliferation
- Disease-Free Survival
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Immunoenzyme Techniques
- Middle Aged
- Neoplasm Recurrence, Local/pathology
- Neoplasm Staging
- Predictive Value of Tests
- Proto-Oncogene Proteins pp60(c-src)/metabolism
- Receptor, ErbB-2/metabolism
Collapse
Affiliation(s)
- G R Wilson
- Department of Academic Surgery, Research and Education Building 2nd floor, South Manchester University Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
- Cellular & Molecular Pharmacology, Cancer Research-UK, Paterson Institute for Cancer Research, Manchester, UK
| | - A Cramer
- South Manchester University and Christie Hospital NHS Trusts, Manchester, UK
| | - A Welman
- Cellular & Molecular Pharmacology, Cancer Research-UK, Paterson Institute for Cancer Research, Manchester, UK
| | - F Knox
- Department of Pathology, South Manchester University Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
| | - R Swindell
- South Manchester University and Christie Hospital NHS Trusts, Manchester, UK
| | - H Kawakatsu
- Lung Biology Centre, University of California, San Fransisco, USA
| | - R B Clarke
- Breast Biology Group, Division of Cancer Studies, University of Manchester, Paterson Institute for Cancer Research, Manchester, UK
| | - C Dive
- Cellular & Molecular Pharmacology, Cancer Research-UK, Paterson Institute for Cancer Research, Manchester, UK
| | - N J Bundred
- Department of Academic Surgery, Research and Education Building 2nd floor, South Manchester University Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
- E-mail:
| |
Collapse
|
6
|
Ellis IO, Coleman D, Wells C, Kodikara S, Paish EM, Moss S, Al-Sam S, Anderson N, Bobrow L, Buley I, Connolly CE, Dallimore NS, Hales S, Hanby A, Humphreys S, Knox F, Lowe J, Macartney J, Nash R, Parham D, Patnick J, Pinder SE, Quinn CM, Robertson AJ, Shrimankar J, Walker RA, Winder R. Impact of a national external quality assessment scheme for breast pathology in the UK. J Clin Pathol 2006; 59:138-45. [PMID: 16443727 PMCID: PMC1860326 DOI: 10.1136/jcp.2004.025551] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND This article presents the results and observed effects of the UK National Health Service Breast Screening Programme (NHSBSP) external quality assurance scheme in breast histopathology. AIMS/METHODS The major objectives were to monitor and improve the consistency of diagnoses made by pathologists and the quality of prognostic information in pathology reports. The scheme is based on a twice yearly circulation of 12 cases to over 600 registered participants. The level of agreement was generally measured using kappa statistics. RESULTS Four main situations were encountered with respect to diagnostic consistency, namely: (1) where consistency is naturally very high-this included diagnosing in situ and invasive carcinomas (and certain distinctive subtypes) and uncomplicated benign lesions; (2) where the level of consistency was low but could be improved by making guidelines more detailed and explicit-this included histological grading; (3) where consistency could be improved but only by changing the system of classification-this included classification of ductal carcinoma in situ; and (4) where no improvement in consistency could be achieved-this included diagnosing atypical hyperplasia and reporting vascular invasion. Size measurements were more consistent for invasive than in situ carcinomas. Even in cases where there is a high level of agreement on tumour size, a few widely outlying measurements were encountered, for which no explanation is readily forthcoming. CONCLUSIONS These results broadly confirm the robustness of the systems of breast disease diagnosis and classification adopted by the NHSBSP, and also identify areas where improvement or new approaches are required.
Collapse
Affiliation(s)
- I O Ellis
- Department of Histopathology, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Parham DM, Coleman D, Kodikara S, Moss S, Ellis IO, Al-Sam S, Anderson N, Bobrow L, Buley I, Connolly CE, Dallimore NS, Hales S, Hanby A, Humphreys S, Knox F, Lowe J, Macartney J, Nash R, Patnick J, Pinder SE, Quinn CM, Robertson AJ, Shrimankar J, Walker RA, Wells C, Winder R, Patel N. The NHS breast screening programme (pathology) EQA: experience in recent years relating to issues involved in individual performance appraisal. J Clin Pathol 2006; 59:130-7. [PMID: 16443726 PMCID: PMC1860311 DOI: 10.1136/jcp.2004.025619] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The original role of the National Health Service breast screening programme (pathology) external quality assessment (EQA) scheme was educational; it aimed to raise standards, reinforce use of common terminology, and assess the consistency of pathology reporting of breast disease in the UK. AIMS/METHODS To examine the performance (scores) of pathologists participating in the scheme in recent years. The scheme has evolved to help identify poor performers, reliant upon setting an acceptable cutpoint. Therefore, the effects of different cutpoint strategies were evaluated and implications discussed. RESULTS/CONCLUSIONS Pathologists who joined the scheme improved over time, particularly those who did less well initially. There was no obvious association between performance and the number of breast cancer cases reported each year. This is not unexpected because the EQA does not measure expertise, but was established to demonstrate a common level of performance (conformity to consensus) for routine cases, rather than the ability to diagnose unusual/difficult cases. A new method of establishing cutpoints using interquartile ranges is proposed. The findings also suggest that EQA can alter a pathologist's practice: those who leave the scheme (for whatever reason) have, on average, marginally lower scores. Consequently, with the cutpoint methodology currently used (which is common to several EQA schemes) there is the potential for the cutpoint to drift upwards. In future, individuals previously deemed competent could subsequently be erroneously labelled as poor performers. Due consideration should be given to this issue with future development of schemes.
Collapse
Affiliation(s)
- D M Parham
- Department of Pathology, Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
BACKGROUND Various methods of sedation and analgesia have been used for pain relief during oocyte recovery in IVF/ICSI procedures. The choice of agents has also been influenced by quality of analgesia as well as by concern about possible detrimental effects on reproductive outcome. OBJECTIVES To assess the efficacy of conscious sedation and analgesia versus alternative methods on pregnancy outcomes and pain relief in patients undergoing transvaginal oocyte retrieval. SEARCH STRATEGY We searched the Specialised Register of the Menstrual Disorders and Subfertility Group, The Central Register of Controlled Trials (CENTRAL) , MEDLINE (1966 to present), EMBASE (1980 to present), CINAHL (1982 to present), the National Research Register, and Current Controlled Trials. There was no language restriction. All references in the identified trials and background papers were checked and authors contacted to identify relevant published and unpublished data. SELECTION CRITERIA Only randomised controlled trials comparing conscious sedation and analgesia versus alternative methods for pain relief during oocyte recovery were included. DATA COLLECTION AND ANALYSIS Two reviewers independently scanned abstracts of the reports identified by electronic searching to identify relevant papers, extracted data and assessed trial quality. Interventions were classified and analysed under broad categories/strategies of pain relief comparing conscious sedation/analgesia with alternative methods and administration protocols. MAIN RESULTS Our search strategy identified 390 potentially eligible reports and 12 papers met our inclusion criteria. There were no significant differences in clinical pregnancy rates per woman and patient satisfaction between the methods compared. Women's perception of pain showed conflicting results. Due to considerable heterogeneity, in terms of types and dosages of sedation or analgesia used, and tools used to assess the principal outcomes of pain and satisfaction, a meta-analysis of all the studies was not attempted. Of the three trials which compared the effect of conventional medical analgesia plus paracervical block versus electro-acupuncture plus paracervical block, there was no significant difference in clinical pregnancy rates per woman in the two groups (OR 1.01; 95% CI 0.73 to 1.4). For intra-operative pain score as measured by visual analogue scale (VAS), there was a significant difference (WMD -4.95; 95% CI -7.84 to -2.07), favouring conventional medical analgesia plus paracervical block . There was also a significant difference in intra-operative pain by VAS between patient-controlled sedation and physician-administered sedation (WMD 5.98; 95% CI 1.63 to 10.33), favouring physician -administered sedation. However, as different types and dosages of sedative and analgesic agents were used in these trials, these data should be interpreted with caution. For the rest of the trials, a descriptive summary of the outcomes was presented. AUTHORS' CONCLUSIONS There is insufficient evidence to determine the effect of different methods of pain relief when compared with conscious sedation and analgesia used during oocyte recovery. In this review, no one particular pain relief method or delivery system appeared to be better than the other. In future, greater consensus is needed to determine both the tools used to evaluate pain and the timing of pain evaluation during and after the procedure. Pain assessment using both subjective and objective measures may merit consideration. In addition, future trials should include intra- and post-operative adverse respiratory and cardiovascular events as outcomes.
Collapse
Affiliation(s)
- I Kwan
- National Collaborating Centre for Women's and Children's Health, Royal College of Obstetricians & Gynaecologists, 27 Sussex Place, Regent's Park, London NW1 4RG, UK.
| | | | | | | |
Collapse
|
9
|
Campbell S, Larsen J, Seif MW, Allen TD, Knox F, Jones CJ, Aplin JD. Mosaic characteristics of human endometrial epithelium in vitro: analysis of secretory markers and cell surface ultrastructure. Mol Hum Reprod 2000; 6:41-9. [PMID: 10611259 DOI: 10.1093/molehr/6.1.41] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Specific terminal carbohydrate structures and mucin-associated glycans increase in expression within the human endometrial epithelium during the secretory phase of the menstrual cycle but exhibit wide intercellular variation. We postulated that variation in glycosylation between cells would produce differences in the glycocalyx and result in complex mixtures of cells bearing different combinations of glycans. MUC-1 mucin, keratan sulphate and fucosylated lactosaminoglycans were examined in epithelial gland fragment cultures with antibodies (HMFG1, 5D4) and a lectin (Dolichos biflorus agglutinin). The glycocalyx was examined by transmission and high resolution scanning electron microscopy. The data were related to patterns of expression seen in vivo. The MUC-1 mucin was expressed relatively uniformly in culture, but heterogeneity was evident in mucin sialylation within the epithelial cell population. Double labelling of gland explant cultures for combinations of fucosylated lactosaminoglycans, keratan sulphate and MUC-1 demonstrated cells expressing all combinations of these markers. Ultrastructural examination confirmed remarkable intercellular variation in the glycocalyx. Though the human endometrial epithelium is relatively morphologically homogeneous, these observations reveal complex variations of cell surface glycosylation between neighbouring cells and suggest that secretory function might vary in a similar fashion.
Collapse
Affiliation(s)
- S Campbell
- Department of Obstetrics and Gynaecology, University of Glasgow, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
| | | | | | | | | | | | | |
Collapse
|
10
|
Hargreaves DF, Knox F, Swindell R, Potten CS, Bundred NJ. Epithelial proliferation and hormone receptor status in the normal post-menopausal breast and the effects of hormone replacement therapy. Br J Cancer 1998; 78:945-9. [PMID: 9764588 PMCID: PMC2063113 DOI: 10.1038/bjc.1998.606] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The proliferation rate (as assessed by Ki67 expression) and expression of oestrogen-regulated progesterone receptor (PR) was studied in normal post-menopausal breast epithelium. Normal breast epithelium from patients receiving hormone replacement therapy (HRT) at the time of surgery containing either oestrogen alone (E2) or oestrogen and progesterone combined activities (E2 + P) was also studied, as HRT has been linked to an increased breast cancer risk. Samples of breast tissue, containing normal epithelium, from 185 patients undergoing surgery for benign or malignant disease were immunocytochemically stained for PR and Ki67. The percentage of labelled cells was expressed as the labelling index (LI). The median Ki67 LI in normal post-menopausal breast epithelium was 0.19 and median PR LI was 4.75, and both were unaffected by patient age, duration of menopause or if the tissue sample originated from a breast with benign or malignant disease. Proliferation did not alter significantly in patients taking HRT (P = 0.61); however, PR expression was up-regulated in both E2 and E2 + P users (P = 0.01). The dose and duration of HRT had no effect on either parameter. A possible attenuation of sensitivity to oestradiol-induced proliferation but not to PR expression occurs in the post-menopausal breast.
Collapse
Affiliation(s)
- D F Hargreaves
- Department of Epithelial Biology, Paterson Institute for Cancer Research, Christie Hospital NHS Trust, Manchester, UK
| | | | | | | | | |
Collapse
|
11
|
Pal B, Burton I, Knox F, Weighill F. Non-Hodgkin's lymphoma of the femur presenting as a pathological fracture in a patient with lupus/Sjögren's syndrome overlap. Br J Rheumatol 1998; 37:462-3. [PMID: 9619902 DOI: 10.1093/rheumatology/37.4.462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
12
|
Abstract
Parathyroid hormone-related protein (PTHrP) is the cause of humoral hypercalcaemia of malignancy and interacts with parathyroid hormone (PTH) receptors. Breast cancer cells produce PTHrP in vitro and in vivo. The breast cancer cell line MCF-7, which products PTHrP and expresses PTHrP receptors, proliferates in response to PTHrP. The aim of these studies was to determine the tissue location of PTHrP/PTH receptors (PTHrPR) in primary breast carcinomas and to establish whether they had the potential to respond to PTHrP. The cellular location of mRNA for the PTHrP/PTH receptor was identified using in situ hybridization in primary breast carcinomas and normal breast tissue. Immunohistochemistry for PTHrP was carried out on the same specimens. Tumours were assessed and scored by two observers using the product of intensity of signal and number of positive tumour cells (possible range 0-9). Tumours were also assessed for Ki-67 expression by counting positive nuclei. Non-malignant ductular epithelium expressed mRNA for the PTHrP receptor (mean score 2.6, range 1-4). Breast carcinomas (mean score 4.4, range 0-9) showed variable expression of PTHrP receptor mRNA: eight tumours were negative, 50 had scores similar to normal breast tissue, and 49 had higher scores for the receptor. Levels of expression of the receptor within the primary breast carcinomas were unrelated to immunohistochemical detection of PTHrP or to any standard prognostic factor. There was a significant (P = 0.05) relationship between Ki-67 and PTHrPR expression in individual tumours. The presence of PTHrP and its receptor in normal breast epithelium and breast carcinomas demonstrates that most breast tumours are able to respond to PTHrP. The Ki-67 data suggest that PTHrP is a potential autocrine growth factor in primary breast carcinoma.
Collapse
Affiliation(s)
- S E Downey
- Department of Pathological Sciences, University of Manchester, U.K
| | | | | | | | | | | |
Collapse
|
13
|
Holland PA, Walls J, Boggis CR, Knox F, Baildam AD, Bundred NJ. A comparison of axillary node status between cancers detected at the prevalence and first incidence breast screening rounds. Br J Cancer 1996; 74:1643-6. [PMID: 8932348 PMCID: PMC2074862 DOI: 10.1038/bjc.1996.602] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Screen-detected breast cancers are smaller than those detected in symptomatic populations and, for any given size, they are associated with fewer lymph node metastases. The management of axillary lymph nodes in patients with screen-detected breast cancer remains controversial. We have previously reported that prevalence (initial screen)-detected cancers are associated with nodal metastases in 17.4% of cases overall. Cancers < or = 10 mm, of any grade, are associated with metastases in only 5% of cases, and grade I cancers <30 mm are not associated with metastases. This led to our recommendation that axillary surgery is unnecessary for these groups of women. The present study compared the nodal status of cancers detected at the prevalence and first incidence (second) screens in order to determine whether our recommendation is appropriate for cancers detected at the first incidence screen. Overall, 30.1% of cancers detected in the first incidence screen presented axillary nodal metastases. At all size ranges, cancers detected at the first incidence screen were associated with significantly more lymph node metastases than prevalence-detected cancers. In particular, cancers < or = 10 mm were associated with metastases in 14.3% of cases. With the possible exception of grade I cancers, we believe that surgical staging of the axilla is essential for cancers detected at the first incidence screen, irrespective of size.
Collapse
Affiliation(s)
- P A Holland
- Department of Radiology, University Hospital of South Manchester, UK
| | | | | | | | | | | |
Collapse
|
14
|
Dey P, Bundred N, Baildam A, Asbury D, Hopwood P, Readman L, Knox F, Coyne J, Richardson J, Woodman C. PP-4-28 Randomised controlled trial comparing the effectiveness of rapid diagnosis and routine outpatient clinics. Eur J Cancer 1996. [DOI: 10.1016/0959-8049(96)84152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
15
|
Walls J, Downey S, Ratcliffe W, Boggis C, Knox F, Bundred N. 23. Does parathyroid hormone related protein (PTHrP) cause microcalcification in breast cancer? Breast 1995. [DOI: 10.1016/0960-9776(95)90115-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
16
|
Walls J, Knox F, Baildam AD, Asbury DL, Mansel RE, Bundred NJ. Can preoperative factors predict for residual malignancy after breast biopsy for invasive cancer? Ann R Coll Surg Engl 1995; 77:248-51. [PMID: 7574313 PMCID: PMC2502342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The presence of malignancy at the resection margins of a malignant breast biopsy requires difficult therapeutic decisions about whether a re-excision biopsy is necessary. The aim of this study was to determine the factors predisposing to the involvement of the resection margins in 280 women undergoing breast biopsy for invasive malignancy from a single breast screening practice. Resection margins were assessed independently by a single pathologist who noted either the presence of tumour at the margins of the biopsy specimen or in the shavings taken from the biopsy cavity. Resection margin involvement (RMI) occurred in 113 patients. Mammographic microcalcification (MM) was seen in 87 women with invasive cancer and RMI occurred in 53 (61%) compared with 60/193 invasive cancers without MM (P < 0.001). If RMI was present the patients underwent a second procedure to ensure complete tumour excision, and 68% of re-excision specimens from tumours with MM and 36% of tumours without MM contained residual malignancy (P < 0.005). Statistical analysis demonstrated that these observations were independent of tumour size, grade, type, and axillary node status. The presence of mammographic microcalcification therefore indicates that wider than usual surgical resection margins should be taken.
Collapse
Affiliation(s)
- J Walls
- Department of Surgery, University Hospital of South Manchester
| | | | | | | | | | | |
Collapse
|
17
|
Abstract
To assess the possible role of endotoxaemia in the pathogenesis of sudden infant death syndrome (SIDS), antibodies to endotoxin core (EndoCAb), which have previously been shown to be depressed by systemic endotoxaemia, were measured. IgG and IgM EndoCAb and total serum IgG and IgM were measured in serum samples from 25 children who had died from SIDS and 164 control children under 1 year of age. Twelve (48%) of the 25 children who had died from SIDS had no detectable IgG EndoCAb compared with 28 (17%) of the 164 control children, and this difference was concentrated in children aged less than 3 months. There was no significant difference between the two groups in the percentage of children with no IgM EndoCAb, nor in the total IgG and IgM concentrations. For IgM EndoCAb, the younger children who had died from SIDS had higher concentrations than the controls. These results suggest that, in children who have died from SIDS, due to either unusually early or severe exposure to endotoxin, maternal IgG EndoCAb have been depleted and early IgM EndoCAb triggered.
Collapse
Affiliation(s)
- B A Oppenheim
- Department of Microbiology, Withington Hospital, Manchester
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Walls J, Donne A, Knox F, Redford J, Swindell R, Howell A, Bundred N. The contribution of full axillary dissection to a prognostic index. Breast 1993. [DOI: 10.1016/0960-9776(93)90145-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
19
|
Abstract
OBJECTIVE To evaluate and appraise skin biopsies performed by general practitioners and compare their performance with that of hospital doctors. DESIGN Retrospective analysis of histology records. SETTING University hospital. SUBJECTS Records of 292 skin biopsy specimens obtained by general practitioners and 324 specimens obtained by general and plastic surgeons. MAIN OUTCOME MEASURES Clinical and pathological diagnoses and completeness of excision. RESULTS The number of specimens received from hospital surgeons and general practitioners increased over the study period; the proportion of specimens from general practitioners rose from 17/1268 (1.3%) in 1984 to 201/2387 (8.7%) in 1990. The range of diagnoses was similar among hospital and general practitioner cases, although malignancy was commoner in hospital cases (63/324 (19%) v 14/292 (5%) in general practitioner cases; chi 2 = 28, p less than 0.00001). Completeness of excision was less common among general practitioners than hospital surgeons (150/233 (3/15 malignant) v 195/232 (57/63); chi 2 = 22, p less than 0.00001). CONCLUSIONS The increase in minor surgery has implications for the staffing and finance of histopathology departments. General practitioners must be given proper training in performing skin biopsies, and all specimens should be sent for examination.
Collapse
Affiliation(s)
- L J McWilliam
- Department of Pathological Sciences, University Hospital of South Manchester
| | | | | | | |
Collapse
|
20
|
Kempson SA, Berndt TJ, Turner ST, Zimmerman D, Knox F, Dousa TP. Relationship between renal phosphate reabsorption and renal brush-border membrane transport. Am J Physiol 1983; 244:R216-23. [PMID: 6130706 DOI: 10.1152/ajpregu.1983.244.2.r216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
21
|
Lucas DR, Knox F, Davies S. Apparent monoclonal origin of lymphocytes and plasma cells infiltrating ocular adnexal amyloid deposits: report of 2 cases. Br J Ophthalmol 1982; 66:600-6. [PMID: 7104281 PMCID: PMC1039865 DOI: 10.1136/bjo.66.9.600] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
22
|
Abstract
The light microscopic, immunohistological and ultrastructural findings in two cases of malignant fibrous histiocytoma arising in salivary glands are presented and the features of seven previously reported cases are reviewed. This neoplasm is extremely rare in this site and may pose problems in diagnosis. It has to be distinguished from other spindled cell tumours, in particular from epithelial tumours of predominantly spindled cell pattern; immunohistological markers for histiocytic cells may be of value. The histogenesis of this neoplasm is controversial but our electron microscopic findings support an origin from mesenchymal cells which differentiate along a broad fibrohistiocytic spectrum.
Collapse
|
23
|
|
24
|
|
25
|
Sigman EM, Elwood CM, Knox F. The measurement of glomerular filtration rate in man with sodium iothalamate 131-I (Conray). J Nucl Med 1966; 7:60-8. [PMID: 5907195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
|