摘要:

AbstractFifty‐five patients with locally advanced breast cancer treated with initial endocrine therapy have been followed up for periods of between 6 and 64 months (median 17 months) with regular clinical and radiological examination. The aim of the study was to evaluate the role of mammography in initial assessment, and subsequent follow‐up. Fifty patients were available for evaluation and were classified by clinical, and by mammographic data independently. The clinical assessment, using UICC criteria of response, estimated 36 patients (72 per cent) as responders (complete response, partial response and no change). Mammographic assessment of response, using 8 radiological features of malignancy, agreed with the clinical estimate in 48 per cent of cases and 32 patients (64 per cent) were assessed as responders. Where clinical and mammographic assessment differed, it was usually due either to a smaller radiological reduction in tumour size, or mammography demonstrating features of progressive disease not observed clinically. Two other mammographic features studied were of prognostic significance. In 70 per cent of the responders in which microcalcifications were present, they became reduced in number but increased in size, a change not seen in non‐responders. A curvilinear band, or ‘rainbow sign’, is described which is an early sign of localized skin infiltration and was associated with a poor

ISSN:0007-1323    

DOI:10.1002/bjs.1800700802

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractThe performance of a fluorescent cytochemical oestrogen receptor (ER) assay has been compared with an established dextran‐coated charcoal ER assay in 85 cases of primary breast cancer. Both assays were performed on tissue samples from the same tumour, by independent observers in different laboratories. A good qualitative correlation between the two methods was found, with agreement in 92 per cent of cases (P<0·0005). Criticisms of the fluorescein‐labelled oestrogen methods are discussed. It is concluded that such methods should be validated in each laboratory by comparison with a conventional, quantitative ER assay before being used for clinical decis

ISSN:0007-1323    

DOI:10.1002/bjs.1800700803

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800700804

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractThe quality of life for patients with carcinoma of the lower two‐thirds of the rectum (5–12 cm from the anal verge) treated by abdominoperineal resection (APER, n = 38) was compared with that of a similar group of patients treated by low sphincter saving resection (SSR, n = 40). Assessment was by questionnaire conducted a minimum of one year after operation. Thirty patients (75 percent) after SSR were entirely continent and ten patients (25 percent) had occasional episodes of incontinence. Each patient with a colostomy was incontinent and 25 (66 per cent) had leaks from their appliance (12 frequent; 13 occasional). Patients after APER avoided more items in the diet and took more medication to control their bowel habit than patients after SSR. Fifteen of the 18 patients (83 percent) who were employed before SSR returned to work after operation; only 6 of 15 patients (40 percent) returned to work after APER (P<0.05). Sexual function was impaired in 6 of 20 men (30 percent) after SSR and in 12 of 18 men (67 percent) after APER (P<0.06). Depression was significantly more prevalent after APER than after SSR. Patients with low rectal cancer who are treated by modern sphincter saving resection have a quality of life superior to those who are treated by A

ISSN:0007-1323    

DOI:10.1002/bjs.1800700805

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractNinety‐five patients have been referred for the assessment and treatment of faecal incontinence. Incontinence was associated with previous anal trauma in 49 cases: 13 occurred after vaginal delivery, 32 were associated with anal operations and in 4 severe perineal trauma occurred after road accidents. Other causes were: idiopathic incontinence in 18, persistent incontinence despite successful rectopexy for prolapse in 10, diabetic neuropathy in 5 and in 13 the cause was not identified. Conservative treatment by control of diarrhoea, physiotherapy or electrical therapy was often successful in patients with minor incontinence. Fifty‐six patients have been treated surgically. Complete continence was achieved in 67 per cent of patients treated by postanal repair and in 61 per cent by sphincter reconstruction. We believe that postanal repair is the treatment of choice for idiopathic incontinence and incontinence after rectopexy or anal dilatation. Sphincter repair should only be performed with a covering colostomy and is the treatment of choice for recent or long standing division of the external sphincter r

ISSN:0007-1323    

DOI:10.1002/bjs.1800700806

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractAn analysis has been made of the symptomatic response and survival of 143 patients following radiotherapy for locally recurrent rectal cancer. Computerized tomography (CAT) was performed on 45 patients. Of 119 evaluable patients, 54 had a good response to radiotherapy, 29 a moderate response and 36 no apparent response. Median response was 9 and 3 months respectively in the good and moderate groups. Median survival was 15, 9 and 5 months for the three groups. Latent interval between surgery and radiotherapy appeared to be of prognostic importance. When this exceeded 2 yr median survival was 12 months compared with 7 months for patients with a latent interval of less than 2 yr. Tumour volume measured by computed tomography may have prognostic importance. Radiotherapy should be considered for most patients with symptomatic recurrence. Surgery might be combined with radiotherapy for selected groups of patients with good prognosis.

ISSN:0007-1323    

DOI:10.1002/bjs.1800700807

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractThree techniques (Clq, Raji and L1210 binding assays) alleged to measure circulating immune complexes (ICs) were applied to the sera of 101 patients with colorectal disease (54 carcinoma; 23 inflammatory; 13 benign tumour and 11 miscellaneous) at the time of diagnostic or definitive surgery, and 58 healthy adult controls. Elevated levels in the pathological sera were observed by all 3 methods in order of sensitivity: Raji>Clq>L1210. However, none of them differentiated between benign, inflammatory and neoplastic conditions nor, in the case of colorectal carcinoma, was there any correlation with stage of disease. With the exception of Raji v. L1210 (r = 0·43, P<0·001), correlations between the various assays were poor and levels of serum carcinoembryonic antigen (CEA) did not correlate with ICs measured by any of the techniques. Indeed, the IC assays were even less discriminatory than CEA, which was elevated mainly in the serum of carcinoma patients and which was positively correlated with serum γ‐glutamyl transpeptidase (γ GT) (r = 0·42, P<0·005). The data suggest that the lack of concordance between the IC assays is a reflection of heterogeneity among ICs, interfering factors present in pathological sera, or both. Thus the IC assays deployed here have neither diagnostic nor prognostic utility in colorectal disease at this time, and immunochemical characterization of the serum reactive material detected by the different assays is r

ISSN:0007-1323    

DOI:10.1002/bjs.1800700808

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractPeritoneovenous shunts have been inserted into 26 patients to control malignant ascites. All benefitted and most required no further paracentesis until death from progressive malignancy. Shunt blockage, which is the major problem at present, occurred in 8 patients. Five patients suffering from far advanced malignancy died within a month of operation. There was no clinical evidence of enhanced tumour spread or disseminated intravascular coagulation. We do not consider that the procedure is the first line of management, neither has it much to offer the patient with viscous, bloodstained or loculated ascites. We suggest criteria which help to identify the patient most likely to benefit from a peritoneovenous shunt.

ISSN:0007-1323    

DOI:10.1002/bjs.1800700809

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractA randomized trial of 41 patients undergoing truncal vagotomy with pyloroplasty (TV + P) or truncal vagotomy with graded pyloric dilatation (TV + PD) for chronic duodenal ulcer is reported after mean follow‐up of 34 months. There was no evidence of gastric stasis in patients who did not have a pyloroplasty. Liquid gastric emptying studies showed an increased rate of gastric emptying postoperatively in patients both with and without pyloroplasty. Overall clinical gradings at review were similar in both groups although there were more patients who were completely symptom free in the group with pyloric dilatation accompanying vagotom

ISSN:0007-1323    

DOI:10.1002/bjs.1800700810

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractIn a prospective randomized trial highly selective vagotomy (HSV) was compared with truncal vagotomy and pyloroplasty (TVP). One surgeon performed all the operations. Ninety‐eight per cent of patients were reviewed by two physicians after 20–97 mth (mean 61 mth). Fifty‐nine of 68 patients (87 per cent) had an excellent or very good result after HSV (Visick grades I and II) compared with 48 of 69 (70 per cent) after TVP (P<0·05). There was 1 proven recurrence after HSV and 4 after TVP. Diarrhoea, including mild symptoms, occurred in 5 patients (7 per cent) after HSV and in 27 (39 per cent) after TVP (P<0·001). Severe diarrhoea did not occur after HSV but was present in 4 patients (6 per cent) after TVP (P<0·001). Flatulence, epigastric fullness and weight loss were also significantly more common after TVP. On average HSV took 72 min to perform compared with 44 min for TVP (P<0·001). Transient dysphagia occurred in 19 patients after HSV compared with 8 after TVP (P<0·05). HSV gave better results than TVP and was associated with a low recurrence rate (1·5 per cent at a mean of 5 yr). Although technically more demanding, HSV in our hands is a better operation than TVP for uncomplicated duo

ISSN:0007-1323    

DOI:10.1002/bjs.1800700811

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY