PubMed Health⌕ Search

Biomedical subjects

A B Ball

Publications and source records attributed to A B Ball.

At least 19 recordsLinked to original sources
PubMed2000

A prospective evaluation of the combined use of the modified Alvarado score with selective laparoscopy in adult females in the management of suspected appendicitis.

BACKGROUND: A diagnostic scoring system such as the modified Alvarado score, combined with selective laparoscopy in adult females, can be used in the assessment of acute abdominal pain suggestive of appendicitis. METHOD: A total of 84 consecutive patients presenting to our surgical team with suspected appendicitis were assessed prospectively using the modified Alvarado score. The definitive management of this study group was instigated according to a set algorithm based on the score. The algorithm included the use of diagnostic laparoscopy in adult female patients with scores suggestive of appendicitis. A negative appendicectomy rate was obtained from those undergoing appendicectomy using this approach and compared to that obtained from the 97 patients that had undergone appendicectomy under the care of the other surgical teams in our unit during the study period. RESULTS: The rate of negative appendicectomy in the study group was 0% compared to 18% in the control group (P < 0.05); 10% of adult female women had negative diagnostic laparoscopies for appendicitis thus saving this group an unnecessary appendicectomy. This was achieved without an increase in total in-patient stay. CONCLUSION: An algorithm combining the modified Alvarado score with selective laparoscopy is recommended for widespread use in the management of suspected acute appendicitis.

Acute Disease↗
PubMed1995

Malignant epithelial parotid tumours: a rational treatment policy.

Formal parotidectomy was undertaken in 271 patients by one surgeon over 11 years. Forty patients were treated for malignant salivary tumours (nine were recurrent). Low-grade tumours (45 per cent) were treated by surgery alone, untreated high-grade tumours (55 per cent) by surgery and radiotherapy, before or after operation, depending on clinical findings. The aims of surgery were to obtain tumour clearance, to preserve the facial nerve if possible, and to perform radical neck dissection for palpable malignant lymphadenopathy proven cytologically and for high-grade tumours when intraoperative jugulodigastric lymph node biopsy confirmed metastasis. Four patients sustained facial weakness as a result of surgery. At a median of 46 months follow-up two patients had developed local recurrence. Eleven patients with high-grade but none with low-grade tumours died from metastases. Patients with high-grade lesions with facial weakness from malignant infiltration and those with lymphatic metastasis have a significantly worse prognosis than those without. Locoregional control of parotid cancers can be achieved by formal parotidectomy and selective irradiation without routine sacrifice of the facial nerve.

Adolescent↗
PubMed1992

Preoperative radiotherapy for initially inoperable extremity soft tissue sarcomas.

The results and complications of a combination of preoperative radiotherapy and surgery in the treatment of 70 patients with large or fixed extremity soft tissue sarcomas are reported. Sixty-one patients were referred with a primary tumour and 9 had recurrences. Thirty-three patients had tumours in the thigh and 38 tumours were fixed to neighbouring structures. The mean preoperative dose was 53 Gy (range 21-75). Eleven patients received a postoperative boost to tumour site. Four patients received preoperative intra-arterial Adriamycin. Overall, 42 patients (60%) responded to the radiotherapy, 4 with complete tumour resolution. Eighty per cent of those receiving greater than or equal to 60 Gy responded and a significant correlation between 2 Gy equivalent dose and response was demonstrated (P less than 0.005). The degree of tumour necrosis was increased in 23 of 52 evaluable patients following radiotherapy, although there was no correlation with dose or clinical response. There have been eight local recurrences and 17 deaths after a median follow-up of 2 years. Tumour size less than 10 cm was the only significant factor in the development of local recurrence (P = 0.04). Thirty-six patients developed immediate postoperative complications: 9 major (13%), 13 moderate (19%) and 14 minor (20%). Increasing patient age was the only significant independent factor for the development of complications (P = 0.015). Preoperative radiotherapy will usually permit limb conservation of extremity sarcomas which otherwise would be inoperable or require amputation. However, the increased incidence of wound complications in older patients demands meticulous technique.

Adolescent↗
PubMed1992

Radical axillary dissection in the staging and treatment of breast cancer.

The results of 237 radical axillary dissections undertaken by one surgeon in patients with breast cancer were reviewed to evaluate the role of this procedure in staging and treatment. The accuracy of physical examination in detecting axillary metastases was 68%. With a policy of enforced shoulder immobilisation for 10 days postoperatively, the incidence of postoperative wound complications was 8%. There have been three axillary recurrences during a median follow-up period of 44 months (range 6-97 months). Late complications were assessed in 50 patients followed up for greater than 12 months. While eight patients complained of constant swelling of the arm, only three had a difference in arm circumference of greater than 3 cm and only one had persistent limitation of shoulder abduction. Radical axillary dissection ensures accurate clinical staging and provides excellent local control with few complications and without the need for axillary irradiation.

Axilla↗
PubMed1991

Limitations of surgery in the treatment of retroperitoneal sarcoma.

A retrospective analysis was undertaken of 120 patients with retroperitoneal sarcoma referred to the Royal Marsden Hospital over a period of 20 years. The actuarial 5-year survival rate of all cases following referral was 29 per cent. On univariate and multivariate analysis the principal factors associated with an unfavourable prognosis were the presence of metastases, poor performance status at presentation, high tumour grade and incomplete excision of the primary tumour. The single most important factor affecting the ability to remove the primary tumour completely was multiple organ involvement. After apparently complete excision, however, the probability of local recurrence by 5 years was 85 per cent (95 per cent confidence interval 56-99). The prognosis of patients with retroperitoneal sarcoma is poor.

Adolescent↗
PubMed1991

Factors influencing local recurrence and survival in patients with soft tissue sarcoma of the upper limb.

Fifty-one patients with soft tissue sarcoma of the upper limb were studied to identify risk factors for local recurrence and survival. More than half (53 per cent) of the patients referred had locally recurrent disease. The flexor aspect of the forearm was the most common site of origin. The majority of patients were managed by a combination of conservative surgery and radical radiotherapy. Wide or radical excision was achieved in 49 per cent of cases. One-third of patients required partial resection of bone or neurovascular structures; 75 per cent of them had presented with local recurrence after treatment elsewhere. Skin grafts and flap repairs were used more often in patients with local recurrence (P = 0.013) and 20 (74 per cent) of those referred with locally recurrent disease have had no further local relapse. The overall 5-year survival rate of 80 per cent (95 per cent confidence interval 61-90 per cent) supports a policy of conservative surgery. Factors associated with a lower survival rate were deep fixation, origin in the flexor aspect of the forearm, and previous local recurrence. Deep fixation was also associated with an increased risk of local recurrence. Referral to a specialist unit at the time of initial presentation may result in lower rates of local recurrence and may improve the survival rate.

Adolescent↗
PubMed1991

Bilateral malignant phyllodes tumours.

We report a rare example of bilateral primary malignant phyllodes tumours. The diagnosis was supported by the identification of a benign epithelial element in each lesion. The case illustrates the typical dimorphic features of malignant phyllodes tumours. A contralateral tumour should not be regarded as metastatic without histological confirmation.

Adult↗
PubMed1991

Primary soft tissue tumours of the pelvis causing referred pain in the leg.

Referred pain in the leg is occasionally due to a pelvic soft tissue tumour. Among 11 patients who presented this way, one had a lymphoma, one had a benign schwannoma, and nine had soft tissue sarcomas. Most patients had undergone a variety of procedures, including laminectomy, before the correct diagnosis was established. In five cases, an accurate diagnosis was obtained by needle biopsy. The lymphoma responded to chemotherapy, and the benign schwannoma was excised. Of the nine patients with soft tissue sarcoma, six underwent marginal/intracapsular excision, three receiving supplementary radiotherapy, and two were treated by nonsurgical means. Hindquarter amputation was technically impossible or inappropriate in these cases. All those with high-grade tumours have died or have metastases. Of four patients with low-grade tumours, three have exhibited only slow disease progression. Careful judgment and a precise histopathological diagnosis are required in planning treatment for patients with pelvic soft tissue tumours causing referred pain in the leg.

Adult↗
PubMed1991

Regional chemotherapy for colorectal hepatic metastases using degradable starch microspheres. A review.

Biodegradable starch microspheres (DSM) given by intra-arterial injection provide a way of improving the delivery of cytotoxic drugs to hepatic metastases and simultaneously reducing systemic toxicity. Their effect depends on exploiting the different vascular properties of neoplastic and healthy tissue. Although clinical evaluation is at an early stage, the ability of DSM to produce a selective increase of drug concentration in hepatic metastases represents an improvement on conventional techniques of regional chemotherapy.

Antineoplastic Agents↗
PubMed1991

Chondrosarcoma of the pelvis: the role of palliative debulking surgery.

Curative resection of pelvic chondrosarcoma is sometimes technically impossible. In such cases, surgical debulking on one or more occasions may provide symptomatic relief. In a series of 12 patients with pelvic chondrosarcoma, three have undergone a single debulking procedure and three two or more such procedures. All six patients obtained symptomatic relief and five remain alive and well at a median of 12 months from surgery. Two patients have no clinical evidence of recurrent disease 21 and 25 months after the last debulking procedure.

Adolescent↗
PubMed1991

Treatment of metastatic para-aortic paraganglioma by surgery, radiotherapy and I-131 mIBG.

A patient with a malignant, functioning, aortico-sympathetic paraganglioma and a solitary bone metastasis causing paraplegia was treated by spinal decompression, irradiation of the metastasis, surgical excision of the primary tumour and systemic I-131 meta-iodobenzyl-guanidine (mIBG). Sixteen months after treatment there was no clinical, radiological or biochemical evidence of residual disease and neurological function was restored. The case supports the use of combined treatment incorporating mIBG in patients with metastatic neuroendocrine tumours which demonstrate mIBG uptake.

3-Iodobenzylguanidine↗
PubMed1990

Diagnosis of soft tissue tumours by Tru-Cut biopsy.

Tru-Cut biopsies were obtained from 52 consecutive patients referred with soft tissue tumours. Forty-five patients had soft tissue sarcomas; seven had benign soft tissue tumours. Of the biopsies 96 per cent provided adequate material for diagnosis. The histological diagnosis made from the Tru-Cut biopsy was compared with that made from the resected specimen. There were no false positive diagnoses of malignancy. The accuracy of Tru-Cut biopsy was 98 per cent for the diagnosis of malignancy and 94 per cent for the diagnosis of sarcoma. Tumour subtype was correctly specified in 85 per cent of sarcomas and tumour grade in 88 per cent. Tru-Cut biopsy should replace open biopsy as the primary means of diagnosis of soft tissue tumours unless a satisfactory tissue sample cannot be obtained.

Adolescent↗
PubMed1990

Management of parotid metastases from cutaneous melanoma of the head and neck.

Parotid metastases from a cutaneous malignant melanoma are uncommon. Although the long-term prognosis is poor, loco-regional palliation is important. In a group of eight patients with parotid metastases, local control was obtained by superficial parotidectomy. Occult cervical lymph node metastases were identified in five cases in whom radical neck dissection provided regional control. Superficial parotidectomy with elective neck dissection is advocated for patients with parotid metastases from cutaneous melanoma to ensure optimal loco-regional palliation.

Adult↗
PubMed1990

Silicone implant to prevent visceral damage during adjuvant radiotherapy for retroperitoneal sarcoma.

The incidence of local recurrence after surgery for retroperitoneal sarcoma is reduced by high-dose adjuvant radiotherapy but treatment is restricted by the effects of irradiation on adjacent viscera. By securing a silicone gel-filled implant (breast prosthesis) in the tumour bed after excision of the tumour, adjacent viscera are displaced from the site of maximum irradiation and may thereby be protected. We used this technique in three patients in whom excision of a retroperitoneal sarcoma was followed by high-dose adjuvant radiotherapy. Post-operative radiotherapy was well tolerated but local recurrence developed in one patient, and delayed perforation of the large bowel occurred in another. Both cases underwent further surgery at which the implant was removed. The same two cases also developed asymptomatic hydronephrosis on the side of the implant, attributed to local fibrosis.

Female↗
PubMed1990

Formal axillary dissection.

Formal axillary dissection is a precise anatomical procedure by which the lymphatic contents of the axilla are removed en bloc. It is used as both a staging and a therapeutic procedure for carcinoma of the breast, and as a therapeutic or palliative procedure for established axillary metastases.

Axilla↗