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GRANOWSKA M, MATHER SJ, BRITTON KE, et al., 1990, TC-99M RADIOIMMUNOSCINTIGRAPHY OF COLORECTAL-CANCER, MEETING ON ADVANCES IN THE APPLICATIONS OF MONOCLONAL ANTIBODIES IN CLINICAL ONCOLOGY, Publisher: STOCKTON PRESS, Pages: 30-33, ISSN: 0007-0920
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- Citations: 21
Granowska M, Mather SJ, Britton KE, et al., 1990, 99mTc radioimmunoscintigraphy of colorectal cancer., Br J Cancer Suppl, Vol: 10, Pages: 30-33, ISSN: 0306-9443
The monoclonal antibody PR1A3 against a normal colonic columnar cell surface antigen has been labelled with 99mTc and used for imaging colorectal cancer. High uptake in undifferentiated cancer is seen. The tumour to mucosa ratio was up to 63:1 and the percentage of the injected activity in the tumour up to 1.7 X 10(-2%)g-1. As 99mTc is continuously available in a Nuclear Medicine Department, on receipt of a request the study may be completed within 24 h enabling radioimmunoscintigraphy to be used routinely in the management of patients with colorectal cancer.
McIntyre AS, Gertner DJ, Wood S, et al., 1990, Long-term parenteral nutrition: problems with venous access., J R Soc Med, Vol: 83, Pages: 371-372, ISSN: 0141-0768
Long-term parenteral nutrition requires central venous access, often difficult in patients who have had several central venous catheterizations. Therapy may be complicated by thrombosis and sepsis which may further compromise central access. We report five cases illustrating such difficulties and suggest that these patients be referred early to specialist centres where experienced catheter insertion and management results in a greatly reduced incidence of complications.
Spigelman AD, Uff CR, Phillips RK, 1990, Vitamin C levels in patients with familial adenomatous polyposis., Br J Surg, Vol: 77, Pages: 508-509, ISSN: 0007-1323
Spigelman AD, Thomson JP, Phillips RK, 1990, Towards decreasing the relaparotomy rate in the Peutz-Jeghers syndrome: the role of peroperative small bowel endoscopy., Br J Surg, Vol: 77, Pages: 301-302, ISSN: 0007-1323
Relaparotomy occurs commonly in patients with the Peutz-Jeghers syndrome, and at quite short intervals. Between 1943 and 1987 laparotomies were performed on 54 occasions in 23 patients with the Peutz-Jeghers syndrome who at some time came under the care of St. Mark's Hospital. In four patients repeat laparotomy was performed within a single year. Between 1987 and 1989 a further five patients have undergone laparotomy with on-table small bowel endoscopy. External palpation and small bowel transillumination failed to demonstrate 17 out of a total of 45 hamartomas (38 per cent). Of these 17 polyps identified endoscopically, 11 (65 per cent) were sufficiently large that a snare was used to remove them. We recommend peroperative enteroscopy as an adjunct to surgery in the Peutz-Jeghers syndrome.
Spigelman AD, Williams CB, Ansell JK, et al., 1990, Pneumatosis coli: a source of diagnostic confusion., Br J Surg, Vol: 77, ISSN: 0007-1323
Cheslyn-Curtis S, Fielding LP, Hittinger R, et al., 1990, Large bowel cancer: the effect of perioperative blood transfusion on outcome., Ann R Coll Surg Engl, Vol: 72, Pages: 53-59, ISSN: 0035-8843
Perioperative blood transfusion has been reported to adversely affect survival in cancer patients, but the evidence is inconclusive and may be an epiphenomenon. From the Large Bowel Cancer Project, 961 patients who underwent curative resection and left hospital alive have been reviewed to compare the effect of perioperative blood transfusion on outcome; 591 patients (61%) had been given a blood transfusion while 370 (39%) had not been transfused. Some clinical variables were equally distributed between the two groups; ie age, sex, obstruction, perforation, tumour differentiation. Three other variables known to influence patient prognosis were not equally distributed, ie tumour site, Dukes' stage and tumour mobility. Patients with tumours of the rectum and rectosigmoid, with Dukes' stage C lesions and with some degree of tumour fixation were more likely to have received blood transfusions. Using the logrank method of multivariate analysis to allow for differences in distribution of all those variables known to affect prognosis, there was no survival disadvantage for those patients who had received perioperative blood transfusion. Furthermore, there were no overall differences between the two groups of patients in their risk of developing local tumour recurrence or distant metastases. The distribution of metastases differed: in the 'transfused' group only 37% of distant metastases were found in the liver, while 71% were found in this site in the 'not transfused' group (chi 2 = 18.46, d.f. = 1, P less than 0.001). By contrast, there was a larger proportion of patients with lung metastases in the transfused group (27% vs 11%) (chi 2 = 5.59, d.f. = 1, P less than 0.05). Therefore, these data do not support the concept of an overall deleterious effect of blood transfusion on patient survival, but suggest that blood given in the perioperative period may change the biology of the metastatic process.
Spigelman AD, Murday V, Phillips RK, 1989, Cancer and the Peutz-Jeghers syndrome., Gut, Vol: 30, Pages: 1588-1590, ISSN: 0017-5749
Among 72 patients with the Peutz-Jeghers syndrome malignant tumours have developed in 16 (22%) of whom all but one have died. There were nine gastrointestinal and seven nongastrointestinal tumours. The relative risks of death from gastrointestinal cancer and all cancers were 13 (95% CI 2.7-38.1) and 9 (95% CI 4.2-17.3) respectively. The chance of dying of cancer by the age of 57 was 48%. There is evidence for a hamartoma/carcinoma sequence in the Peutz-Jeghers syndrome, suggesting that the gene locus involved is relevant to the development of malignancy in general.
Spigelman AD, Phillips RK, 1989, Management of the Peutz-Jeghers patient., J R Soc Med, Vol: 82, ISSN: 0141-0768
Spigelman AD, Williams CB, Talbot IC, et al., 1989, Upper gastrointestinal cancer in patients with familial adenomatous polyposis., Lancet, Vol: 2, Pages: 783-785, ISSN: 0140-6736
102 patients with familial adenomatous polyposis underwent upper gastrointestinal endoscopy as a screening test for gastroduodenal adenomas. 100 had duodenal abnormalities (dysplasia in 94, and hyperplasia in 6), usually in the second and third parts of the duodenum (91%). The periampullary area was abnormal in 87 of 97 patients who had a biopsy specimen taken from this site (dysplasia 72, hyperplasia 13, and inflammation 2). By contrast, gastric dysplasia was found in only 6 patients. Classification of duodenal polyposis on a 5-grade scale (stages 0-IV), based on polyp number, size, histology, and severity of dysplasia, showed that 11 had stage IV disease: these patients are at greatest risk of malignant change and require close surveillance. The pattern of dysplasia observed in the upper gastrointestinal tract resembled the pattern of mucosal exposure to bile.
Scott A, Hawley PR, Phillips RK, 1989, Results of external sphincter repair in Crohn's disease., Br J Surg, Vol: 76, Pages: 959-960, ISSN: 0007-1323
The results of anal sphincter repair in a group of six patients with anorectal Crohn's disease are reported. All patients had previously undergone anal surgery which was followed by faecal incontinence in five. The sixth patient became incontinent following obstetric injury. Of the six patients, five are completely continent and one has a permanent stoma (follow-up from 18 months to 16 years, mean 7.8 years). Anal sphincter repair in this highly selected group of patients with Crohn's disease has not been complicated by wound breakdown or fistula formation, and has given good results.
Phillips RK, Ritchie JK, Hawley PR, 1989, Proctocolectomy and ileostomy for ulcerative colitis: the longer term story., J R Soc Med, Vol: 82, Pages: 386-387, ISSN: 0141-0768
Elective surgery for ulcerative colitis usually involves the removal of the entire large bowel with either a conventional ileostomy or the formation of an ileoanal pouch anastomosis. Seventy patients undergoing a one stage elective total proctocolectomy and ileostomy between 1976 (the first year an ileoanal pouch was carried out in this hospital) and 1986 have been studied. We have confirmed that proctocolectomy and ileostomy for ulcerative colitis is not the trouble free operation many presume it to be when considering the alternative of an ileoanal pouch.
Spigelman AD, Thomson JP, Phillips RK, 1989, Cholecystectomy, duodeno-gastric reflux and polyposis., J R Soc Med, Vol: 82, Pages: 436-437, ISSN: 0141-0768
Fielding LP, Phillips RK, Hittinger R, 1989, Factors influencing mortality after curative resection for large bowel cancer in elderly patients., Lancet, Vol: 1, Pages: 595-597, ISSN: 0140-6736
Mortality rates from the Large Bowel Cancer Project are presented with special reference to patients older than 70 years. The in-hospital mortality rate among those who underwent curative resection for colorectal carcinoma was 7%. Unlike long-term prognosis, which is influenced by pathological features, in-hospital mortality is influenced largely by clinical factors. Age was an adverse factor (78% of deaths occurred among those aged over 70, who formed 46% of the study population), as was obstruction or perforation. 55% of deaths were due to cardiopulmonary complications. Educating patients to seek treatment early, careful preoperative assessment and postoperative monitoring of cardiopulmonary function, and, in selected patients, use of local treatments rather than wide resections may help to reduce mortality in elderly patients.
ARMITAGE NC, JASS JR, RICHMAN PI, et al., 1989, PAGETS-DISEASE OF THE ANUS - A CLINICOPATHOLOGICAL STUDY, BRITISH JOURNAL OF SURGERY, Vol: 76, Pages: 60-63, ISSN: 0007-1323
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- Citations: 52
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