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Biomedical subjects

B J Milne

Publications and source records attributed to B J Milne.

At least 37 records · Page 2Linked to original sources
PubMed1982

Long term results of restorative resection and total excision for carcinoma of the middle third of the rectum.

Restorative resection for carcinoma of the middle third of the rectum has been facilitated by the recent introduction of the staplers. Before restorative resection with end-to-end anastomosis can become the treatment of choice, it must be proved that survival prospects after restorative resection are similar to those obtained after total abdominoperineal excision. The results of curative restorative resection and total excision in 417 patients with a single carcinoma of the middle third of the rectum managed by one of us are examined. Between 1950 and 1980, the proportion of patients treated by restorative resection for carcinoma of the middle third of the rectum increased from 26 to 93 per cent. Distribution by sex, age, tumor stage and tumor differentiation did not differ significantly between the two groups of patients operated upon. Cancer specific survival did not differ significantly between patients treated by restorative resection or total excision. Ten year survival rates were 60 and 59 per cent, respectively. Survival related to tumor stage and differentiation was not influenced by the type of operation. Tumor size, greater--p less than 0.04--in patients managed by total excision, had no significant influence on survival prospects. The results justify sphincter preservation and suggest that increased usage of restorative resection by stapling technique is not likely to lessen survival prospects in patients with carcinoma of the middle third of the rectum.

Adenocarcinoma↗
PubMed1982

Effect of factors related to the recipient and insemination characteristics on the success of artificial insemination with frozen semen.

It is of clinical importance to determine the factors which influence the outcome of insemination with frozen human semen. The number of inseminations per cycle and the season of the year had significant effects on the outcome of the insemination in all the recipients in the AID programme and in those who became pregnant within six cycles of treatment. The chance of pregnancy was greater with increasing number of inseminations per cycle. During winter the proportion of insemination cycles resulting in pregnancy was lower than in the other three seasons. The proportion of insemination cycles resulting in pregnancy was higher when the maximum cervical scores of the cycle were high (greater than 10 in a scale of 12) when compared with lower scores in all the recipients but not in those who became pregnant within six cycles. Duration of infertility and previous fertility of the recipients had a significant effect on the outcome of insemination in all the recipients but not in those who became pregnant within six cycles. Age of the recipient had a positive effect on the abortion rate.

Abortion, Spontaneous↗
PubMed1981

Prognosis in relation to symptom duration in colon cancer.

Between 1950 and 1978 754 patients underwent operation by one of the authors for carcinoma of the colon. Follow-up data were available on 99 per cent. Tumour stage distribution did not differ significantly with increasing duration of symptoms. The proportion of curative to palliative operative procedures was unrelated to symptom duration. Cancer specific survival for the entire patient series was worse when symptoms had been present for less than 3 months compared with 3-6 months, 6-12 months or 12 months or more (P less than 0.001, P less than 0.02 and P less than 0.04, respectively). Cancer specific survival after curative resection was also worse in patients with a symptom duration of less than 3 months compared with 3-6 months or 12 months or more (P less than 0.02 and P less than 0.03, respectively). These results show that colon cancer patients in whom the diagnosis is made and operation performed after a short symptomatic period do not have less advanced tumours nor better survival prospects.

Adult↗
PubMed1981

Comparative results of surgical management of single carcinomas of the colon and rectum: a series of 1939 patients managed by one surgeon.

A comparative analysis has been made of the results of surgical management of single carcinomas of the colon and rectum in a series of 1939 patients treated by one surgeon. The data were prospectively collected, with 99 per cent follow-up. Cancer specific survival did not differ significantly between patients with colonic or rectal cancer. Survival prospects were better for women (P = 0.02) and for patients less than 40 years of age (P = 0.03). Survival was significantly related to tumour staging (P less than 0.002). Cancer specific survival was better after curative resection for colonic than rectal carcinoma (P = 0.003). Five-year survival for patients with colonic tumours was 76 per cent and for rectal tumours 69 per cent. The 10-year survival figures were 73 per cent and 51 per cent respectively. This difference was accounted for by a higher proportion of Dukes' stage C tumours in the rectum (P less than 0.001) and better survival prospects for colonic compared to rectal stage C1 tumours (P = 0.02). Sphincter-saving resections were performed in 64 per cent of rectal cancer patients managed by curative resection. Survival tended to be better than after sphincter-sacrificing operations. After palliative resection, median survival for colonic and rectal cancer was 14 and 13 months respectively. After palliative bypass operations the corresponding figures were 4 and 8 months.

Adenocarcinoma↗
PubMed1981

Disease-free survival and recurrence after resection of colorectal carcinoma.

Recurrence data from a series of 1,315 colorectal cancer patients managed by one surgeon with potentially curative resection are presented. Complete follow-up information was available on 1,287 (98%) patients. At the time of the last recurrences, 164 and 232 months for rectal and colonic tumours respectively, the long-time recurrence rate was significantly (P = 0.001) higher for rectal tumours (42%) than for colonic (33%). Although local recurrences tended to be more common in rectal than in colonic tumours (18% compared to 15%), only those in contiguity with the operative area were significantly (P less than 0.005) more common in rectal tumours. Systemic recurrences were also significantly (P less than 0.025) commoner for rectal tumours. The greater recurrence rates in rectal tumours were associated with significantly (P less than 0.001) higher incidence of stage C tumours shorter recurrence-free survival in rectal stage C tumours (P = 0.001) and higher incidence of pulmonary metastases (P less than 0.001).

Colonic Neoplasms↗
PubMed1981

Ovarian involvement in adenocarcinoma of the colon and rectum.

Thirty-six of 998 female patients with carcinoma of the colon and rectum had ovarian involvement at the time of the initial operation. Resection of tumor of the colon and rectum was performed upon 882 patients. The ovarian tumors were removed in 30 of the 36 patients with ovarian involvement. Ovarian involvement was associated with a significantly worsened, p = 0.009, cancer specific five year survival rate; five year survival prospects for patients with, and without, ovarian involvement were 38 and 60 per cent, respectively. Ovarian involvement also significantly, p = 0.014, worsened the survival rate of the 25 patients treated by curative resection of the tumor of the colon and rectum and associated ovarian spread. The five year cancer specific survival rate for female patients without ovarian involvement was 72 per cent, whereas ovarian involvement reduced the survival rate to 50 per cent.

Adenocarcinoma↗
PubMed1981

Symptom duration and survival prospects in carcinoma of the rectum.

Between 1950 and 1978, 1,228 patients were operated upon by one of us for carcinoma of the rectum. Symptom duration data were available for 1,081 patients. Forty-five per cent of the patients had symptoms preoperatively for less than three months, 22 per cent for three to six months, 15 per cent for six to 12 months and 18 per cent for 12 months or longer. The frequency of major symptoms did not differ significantly with increasing symptom duration. Symptom duration was not related to sex, age, tumor site within the rectum or tumor stage distribution. The proportion of curative to palliative operative procedures performed was unrelated to the duration of symptoms. The cancer specific survival rate was better for the total patient series and for those treated by curative resection if symptoms had been present for 12 months or longer compared with those of less than three months' duration, p = 0.001 and p = 0.01, respectively. Survival prospects were also better for patients with symptoms of less than six months' duration compared with those of six months or longer, p = 0.01 and p = 0.04, respectively. These results indicate that earlier diagnosis during the symptomatic period of carcinoma of the rectum cannot be expected to improve cancer specific survival rates. They direct attention to the importance of preclinical diagnosis.

Adult↗
PubMed1980

Labetalol: potent antihypertensive agent that blocks both alpha- and beta-adrenergic receptors.

Labetalol was administered as the sole antihypertensive agent to 20 ambulatory patients with mild to moderate hypertension. The mean systolic and diastolic blood pressures (+/- standard error of the mean) with the patients sitting fell significantly (P < 0.001), from 145.5 +/- 3.2 and 103.7 +/- 1.6 mm Hg respectively at the start of labetalol therapy (after a period free of antihypertensive medication) to 125.7 +/- 2.0 and 87.2 +/- 1.1 mm Hg by the end of the trial. The diastolic blood pressure was well controlled (90 mm Hg or less) with labetalol therapy in 90% of the patients. The medication was well tolerated, and no orthostatic fall in the diastolic blood pressure was observed. Pharmacologically labetalol most closely resembles a combination of a nonselective beta-adrenergic blocker like propranolol and a postsynaptic alpha-adrenergic blocker like prazosin.

Adult↗
PubMed1980

I. Carcinoma of the rectum and rectosigmoid: cancer specific long-term survival. A series of 1061 cases treated by one surgeon.

The long-term cancer specific survival based on individual follow-up and analysis of prospectively collected data from 1061 patients undergoing resection for carcinoma of the rectum is presented. All patients were operated on and managed by one surgeon. Survival data for 978 cases were analyzed according to the methods of Kaplan and Meier, and Gehan. Results have been presented as cancer specific survival times in months and as percentage survivor rates at five-year intervals. The median overall cancer specific survival time was 96 months. Five, ten, 15, and 20-year survival rates were 56, 49, 47, and 46%, respectively. After a potentially curative resection of the tumor, the corresponding percentages were 69, 60, 57, and 56%. Age and sex were not significant prognostic factors. A death rate from recurrent cancer of nil was seen after 15.4 years. At this point, the cancer specific survival rates were 77% for patients in Stage A, 59% in Stage B, 37% in Stage C, and 9% for patients with tumors invading adjacent organs (D1), while no patient with macroscopic metastases to distant organs (Stage D2) survived beyond four and a half years (median, 11 months).

Adenocarcinoma↗
PubMed1980

Changing survival prospects in carcinoma of the rectum.

The survival prospects for carcinoma of the rectum in a series of 1320 patients managed between 1950 and 1978 by one surgeon have been analysed by computer. Survival curve analysis showed a worsened survival after curative resection during 1970-8 in comparison with previous decades (P = 0.001). The 5-year cancer-specific survival after curative resection (832 patients) decreased from 73 per cent (1950-9) to 50 per cent (1970-3) (P = 0.001). An increase in the incidence of Dukes' stage C tumours from 22 per cent (1960-9) to 32 per cent (1970-8) (P = 0.003) explains, at least in part, the worsened survival prospects. Paradoxically the deterioration was paralleled by earlier presentation (P = 0.001). The worsened survival prospects were not explained by alterations in sex or age distribution, tumour site, or increase in the percentage of sphincter-saving resections. The alterative hypotheses that earlier presentation has resulted in a larger proportion of aggressive tumours coming to curative resection or that worsened survival prospects represent a real change in the behavior of carcinoma of the rectum in the Australian community are discussed.

Aged↗
PubMed1980

Results of operative management of Crohn's disease: A series of 50 patients managed by one surgeon.

A computer analysis has been made of clinical experience of Crohn's disease in Australian patients. Between 1950 and 1978, 50 patients were managed for Crohn's disease by one of the authors (E.S.R.H.). This group represented 3.1 per cent of 1608 patients treated during the same period for primary inflammatory bowel disease. The mean follow-up period was 8.4 years. Thirty-nine of the 50 patients were female and 11 male. The small intestine was involved in seven patients, large intestine in 17 and both small and large intestine in 26. Symptoms were related to the anatomic localization of disease. Four patients have died (two postoperative deaths and two unrelated to Crohn's disease). Forty-nine of the 50 patients required operative procedures and 36 underwent one or more definitive operations with curative intention. A total of 124 operations was performed, 70 of which were definitive. Twenty-nine of the 36 patients managed by a definitive operation developed recurrence, defined to include reactivation of disease in intestinal segments left in situ. Ten patients developed two or more recurrences. Multiple recurrences were most frequent after operation for combined small- and large-intestinal Crohn's disease. No patient with large-intestinal Crohn's disease alone developed more than one recurrence. Each patient undergoing subtotal colectomy with ileorectal anastomosis (six patients) or ileostomy (nine patients) required one or more further definitive operations. Recurrence was more frequent after the first than second definitive operation (P = 0.007), the median recurrence-free intervals being 11 and 23 months, respectively.

Australia↗
PubMed1980

Carcinoma of the colon. Cancer specific long-term survival. A series of 615 patients treated by one surgeon.

The cancer specific survival in 615 patients undergoing resection for carcinoma of the colon is presented. The patients were operated on and managed by one surgeon between 1950--1977. Computer analysis has been made of the prospectively collected data. Results are presented as median survival in months and as percentage survivors at 5, 10, 15 and 20 years. Curative resection gave a cancer specific survival at the seventy-fifth percentile of 66 months, corresponding to 76% survival at five years and 67% at 20 years. Age and sex were not significant prognostic factors. Dukes' Stages A, B and C had five-year survivals of 88%, 78% and 60% respectively, after curative resection. The median survival after palliative resection was 14 months. Site of the primary tumor within the colon was of significant prognostic importance only when the poor survival in tumors of the transverse colon was compared with the favorable survival in those of the splenic flexure, ascending, descending and sigmoid colon.

Adenocarcinoma↗
PubMed1980

An Australian experience of Crohn's disease.

A computer analysis has been made of the clinical experience of Crohn's disease of one of the authors (E.S.R.H.) (1950-78: 50 patients) and of the Alfred Hospital Medical staff, Melbourne (1959-78: 39 patients). The mean follow-up period for the combined data was 6.2 years. Sixty-two of the 89 patients were female and 27 male. The small intestine was involved in 24 patients, the large intestine in 21, and both small and large intestine in 44. Symptoms were related to the anatomical localization of the disease. Four patients have died (two postoperative deaths and two unrelated to Crohn's disease). Sixty-nine of the 89 patients required an operative procedure, and 53 underwent one or more definitive operations with curative intention. A total of 165 operations were performed, 88 of which were definitive. Thirty-four patients developed recurrence, defined to include reactivation of disease in intestinal segments left in situ. Ten patients developed two or more recurrences. Multiple recurrences were most frequent after operation for combined small and large intestinal Crohn's disease. No patient with large-intestinal Crohn's disease alone developed more than one recurrence. Each patient undergoing subtotal colectomy and ileorectal anastomosis (six patients) or ileostomy (nine patients) required one or more further definitive operations. Recurrence was more frequent after the first than the second definitive operation (P = 0.02), the median recurrence-free intervals being 12 and 23 months respectively.

Australia↗
PubMed1980

Lymphoid hyperplasia: a major prognostic feature in 519 cases of colorectal carcinoma.

The size of the regional lymph nodes, germinal center, and paracortical areas, and the degree of perivascular lymphocyte cuffing (PLC) at the edges of 519 carcinomas of the large bowel have been analyzed microscopically and assessed quantitatively. Hyperplasia of these lymphoid areas, defined as relative or absolute size exceeding the median for the tumor stage, has been related to cancer-specific survival data for each of Dukes' Stages A, B, and C, and for disseminated disease commonly referred to as Stage D. Germinal center hyperplasia was associated with a major survival advantage in Stage B (P = 0.003) and in Stage C (P = 0.04) if present in tumor-involved lymph nodes. Paracortical hyperplasia related favorably to survival in Stages B and C; in Stage C such hyperplasia was most favorable if present in tumor-involved lymph nodes (P = 0.009). PLC related to favorable survival data only in Stage B. Lymphoid hyperplasia showed no correlation with survival in Stages A and D.

Adenocarcinoma↗
PubMed1979

Work-site treatment of hypertension by specially trained nurses. A controlled trial.

The clinical efficacy of using specially trained nurses to treat hypertension at the patient's place of work was compared in a controlled trial with management by the patient's family doctor. The 457 study participants were selected from 21 906 volunteers in industry and government whose blood-pressure was screened. The nurses were allowed to prescribe and change drug therapy at the work site without prior physician approval. Patients randomly allocated to receive care at work were significantly more likely to be put on antihypertensive medications (94.7% vs 62.7%, to reach goal blood-pressure in the first six months (48.5% vs 27.5%), and to take the drugs prescribed (67.6% vs 49.1%). Only 6% of patients were dissatisfied with the care provided by the nurses. Thus provision of care at work by specially tranined nurses was well accepted and resulted in significantly improved blood-pressure control and medication compliance among employees with asymptomatic and uncomplicated hypertension.

Adolescent↗
PubMedDate not supplied

Palliative operative management in rectal carcinoma.

The results of palliative operative management of 338 patients with rectal carcinoma managed by one of the authors are presented. Postoperative mortality was higher for patients undergoing palliative resection (11.7 per cent) than colostomy bypass (5.3 per cent) or diagnostic laparotomy (6.8 per cent). Cancer specific survival following palliative resection was significantly (P less than 0.001) longer than that following colostomy bypass or diagnostic laparotomy for tumor Stages D1 (local visceral involvement) and D2 (distant metastases). However, in patients with liver or peritoneal metastases alone, cancer specific survival did not differ significantly after the operations of resection or colostomy bypass. The failure to demonstrate improved survival after resection of the primary tumor in these latter two groups with distant metastases indicates the dominant role of volume of tumor tissue present in these situations. The results suggest that longer survival following palliative resection reflects a bias of patient selection towards more favorable cases.

Aged↗
PubMedDate not supplied

Couples' experiences with in vitro fertilization.

In vitro fertilization (IVF) is one of the newest techniques for treatment of infertility. While the medical aspects of IVF have been extensively reported, little research has explored this procedure from the couple's point of view. In this descriptive study, 28 couples who had experienced at least one IVF procedure were interviewed. The results indicate that while IVF offers hope for infertile couples, the procedure, if unsuccessful, can be emotionally traumatic. In addition, the results suggest that comprehensive anticipatory information and emotional support are the primary needs of couples undergoing IVF.

Adaptation, Psychological↗