PubMed Health⌕ Search

Biomedical subjects

B Gudjonsson

Publications and source records attributed to B Gudjonsson.

14 recordsLinked to original sources
PubMed1996

Pancreatic cancer. The need for critical reassessment.

A review of results of 60 years of resections for pancreatic cancer reveals no consistency in reporting. Resected survivors have been reported up to seven times, even from different countries, and nonresected survivors are overlooked. The claimed 5-year survival rate of 30-55% is achieved by reducing the subset on which calculations are based and using methods such as the Kaplan-Meier, which lead to higher figures the more patients are lost to followup (censored). The excess cost of resection versus bypass can be expected to be ca. $150,000, with one in 30 patients living for 5 years. The overall survival rate is < 0.4%; the best proven surgical result is 3.6% and the best nonsurgical result is 1.7%. Resections have had no discernible impact on survival.

Actuarial Analysis↗
PubMed1995

Carcinoma of the pancreas: critical analysis of costs, results of resections, and the need for standardized reporting.

BACKGROUND: The incidence of carcinoma of the pancreas is increasing in Western societies at great cost. Pancreatic resections have been performed for 60 years and there are hundreds of papers written on the subject, but there is no agreement on the efficacy of resections. Authors have reported on different groups and subsets of patients and have used different statistical methods. Most authors are unable to report a single five-year survivor; others claim a five-year survival rate of 30 to 55 percent. STUDY DESIGN: I have standardized and compared the results reported in 340 papers that deal with survival rates and where there is apparently adequate confirmation of disease. RESULTS: Survivors who have been resected may be reported up to six times even from different countries, whereas survivors who were not resected are frequently overlooked. Actuarial statistical methods exaggerate results when data are lost. After corrections for repetitions, approximately 300 survivors were found, of whom 10 percent had not undergone resection, of the estimated 80,000 patients reported. The overall survival rate was less than 0.4 percent. The best overall survival rate in surgical studies reported in detail is only 3.6 percent and for a nonsurgical study it was 1.7 percent. The average excess cost for each resection was at least $150,000. With only one in 30 patients who underwent resection living for five years, the cumulative cost per "successful" resection was therefore approximately $4.5 million. CONCLUSIONS: Pancreatic resections have had minimal impact on survival rates in patients with carcinoma and are wasteful of resources.

Adenocarcinoma↗
PubMed1987

Cancer of the pancreas. 50 years of surgery.

The course of 196 patients with proven carcinoma of the pancreas seen at Yale New Haven Hospital from 1972 to 1982 was analyzed. Only 73% of the patients were preoperatively expected to have cancer of the pancreas. The patients who underwent resection had the longest mean survival but also the longest total hospital stay. Twenty-seven patients survived 1 year or more, but nonresected patients constituted 81.5% of this group. The only 5-year survivor did not undergo resection. Forty-seven percent of patients who survived 1 year and had not undergone gastroduodenal bypass, developed duodenal obstruction. It was not possible to identify a subset of patients with a favorable prognosis. A review totaling approximately 37000 patients, of whom 4100 had undergone resections, revealed only 156 survivors, 12 of whom had not been resected, for an overall survival rate of only 0.4%. No author had more than 3.4% of the total number of patients as 5-year survivors.

Adenocarcinoma↗
PubMed1979

Late appearance of intra-abdominal abscesses after total colectomy for inflammatory bowel disease.

Intra-abdominal abscesses after colon surgery usually appear within eight weeks. Over the past few years, we have observed nine patients who underwent colectomy for inflammatory bowel disease in whom large and relatively asymptomatic abscesses developed, requiring surgical drainage as long as three to five years after the operation. In five patients, there was no report of intraoperative complications such as perforation or fecal spillage. At the time of discharge from the hospital, all patients were afebrile. In three of these patients, abscesses were discovered when they were readmitted to the hospital for elective abdominal procedures; most of the others had localized abdominal pain.

Abdomen↗
PubMed1978

"Body-brace" oesophagitis, a complication of kyphoscoliosis therapy.

Oesophagitis developed in 4 patients, 3 of whom had scoliosis braces and 1 a body cast after surgery for kyphoscoliosis. Symptoms varied from chronic epigastric pain to gastrointestinal haemorrhage. Prophylaxis of oesophageal disease in children undergoing correction of scoliosis may prevent severe oesophagitis.

Adolescent↗
PubMed1978

Cancer of the pancreas: diagnostic accuracy and survival statistics.

We have reviewed the natural history, reliability of diagnosis, and survivorship of 100 patients with adenocarcinoma of the pancreas, in the context of a thorough review of the literature on survival after therapy for adenocarcinoma of the pancreas. There is 40--62.5% error in the histologic confirmation of the diagnosis of pancreatic cancer. The error by inspection and palpation alone at the time of surgery may be as great as 25%. The absolute 5 year survival rate calculated from 61 clinical studies representing approximately 15,000 patients is 0.4%. The best series in the current literature has only 3% 5 year rate based upon the total population of pancreatic cancer patients. 12.3% of 5 year survivors from the world literature did not have curative surgery. This study shows the necessity for standardization of reporting methods. The same patients and survivors should not be used repeatedly in different reports. Some authors who claim the most effective palliation by pancreatic resection have the highest mortality rates.

Adenocarcinoma↗
PubMed1976

Eosinophilic cholecystitis.

A somewhat obese, 40-year old female presented with a classic history of gallbladder disease and a peripheral eosinophilia of 14% without an allergic history. A nonvisualizing oral cholecystogram was followed by an uneventful cholecystectomy. Pathological examination revealed a calculus in the cystic duct and a pure transmural eosinophilic infiltrate of the gallbladder wall. Postoperatively the peripheral eosinophilia returned to normal. Biopsies of the small bowel one year later showed focal mucosal eosinophilia when the patient had recurrent abdominal pain, diarrhea and peripheral eosinophilia. Eosinophilic cholecystitis may represent a descrete entity in search of an etiology or involvement of the biliary tract by eosinophilic gastroenteritis.

Adult↗