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Biomedical subjects

D M Dent

Publications and source records attributed to D M Dent.

At least 19 recordsLinked to original sources
PubMed1992

Splenectomy in the chronic myeloproliferative syndromes. A retrospective risk-versus-benefit analysis.

The effect of splenectomy on the course of the chronic myeloproliferative syndromes was retrospectively analysed and compared in 96 patients who underwent this procedure and 195 who did not. The operation had a 4% mortality and a 47% morbidity rate, mainly attributable to haemorrhage, infection and respiratory complications. While splenectomy conferred benefit in certain selected cases with hypersplenism, there was no significant overall improvement in the postoperative haematological values and no influence on the rate of blastic transformation. Splenectomy did not improve survival in the group as a whole, or in any subset (P greater than 0.5). In the non-splenectomy group, only a minority of patients experienced massive progressive splenomegaly and in most individuals the spleen size varied little from the time of presentation to death. Splenectomy in patients with the chronic myeloproliferative syndrome carries a significant mortality and has a high morbidity, does not reduce the rate of blastic transformation and has no influence on survival. The majority of patients on conventional therapy do not experience the discomfort of massive splenomegaly during the course of their disease and the routine use of this operation is inappropriate.

Adolescent↗
PubMed1992

Assessing malnutrition in gastric carcinoma: bioelectrical impedance or clinical impression?

The value of bioelectrical impedance (BI) as an index of body composition was assessed in 32 patients with gastric carcinoma, 20 with advanced disease. Bioelectrical impedance was compared with standard nutritional parameters: weight, body mass index (BMI), albumin, transferrin and triceps skinfold thickness. There was no correlation between BI and these parameters with the exception of weight and BMI in the male patients. Clinical assessment of nutrition on the other hand correlated well with the standard parameters. Although BI may be a useful adjunct to the routine assessment of nutritional status in normal subjects, its use in clinical patients should be treated with caution, particularly in those with advanced gastrointestinal malignancy.

Adult↗
PubMed1992

Presentations to the Surgical Research Society of Southern Africa--the second 10 years (1982-1991).

Over the 10-year period 1982-1991, 594 papers were read at the annual meetings of the Surgical Research Society of Southern Africa. One hundred and thirty-five (23%) reported work performed on experimental animals with a trend to an increase from this base; 152 (26%) were presentations from surgeons-in-training, also with a trend to increase over the decade. The distribution by subspecialty was: upper gastro-intestinal tract 28%; hepatobiliary 12%; vascular 16%; immunology/transplantation 9%; further subspecialties 9%; and miscellaneous 26%. Major observations are that the number of papers has doubled since the first decade, probably due to establishment of the poster session, and that presentations by surgeons-in-training remain in the minority at the Society.

General Surgery↗
PubMed1992

Does surgical experience influence mastectomy complications?

Mastectomy remains the most commonly performed surgical procedure for breast cancer, and complications such as infection or wound breakdown (which may relate to the experience of the operator) could expensively prolong hospital stay and retard the administration of additional therapy. We examined the complications, hospital stay and cost of therapy of total mastectomy and axillary node clearance in 164 women, comparing these between four grades of surgeon: registrar (67 operations), senior registrar (58), part-time consultant (21) and professor (18). Our policy, for local reasons, was to perform mastectomy whenever possible rather than select lesser surgical or non-surgical management options. There was no significant difference between operators when the percentage of seromas requiring aspiration (9, 3, 5, 6), infection (16, 7, 23, 11), or wound breakdown (7, 3, 5, 6) were compared. Neither the length of hospital stay (9.3 +/- 6.9, 8.2 +/- 4.7, 9 +/- 7.3, 9.2 +/- 11.2 days), nor cost (2005, 1939, 1966, 1927 rands) differed. Surgical experience did not significantly influence mastectomy complications.

Aged↗
PubMed1990

Combination chemotherapy for advanced diffuse large cell lymphoma. The adverse effects of bone marrow invasion, gastrointestinal tract involvement or high bulk disease.

Thirty-nine adults with clinical stage III or IV diffuse large cell lymphoma were prospectively randomised to receive etoposide with doxorubicin (Group 1: n = 17), the same schedule of etoposide with carminomycin (Group 2: n = 8), or BACOP (Group 3: n = 14). The complete remission rates were respectively 24%, 25% and 28%, and further good partial remissions were 41%, 25% and 14%. The incidence of adverse prognostic factors was examined with the first two groups combined for comparison to patients receiving BACOP. The low complete remission rates were attributable to bone marrow invasion in 64% (16/25) of patients in groups 1 and 2, and 64% (9/14) in group 3; to extensive gastrointestinal tract involvement in 24% (6/25) of patients in groups 1 and 2, and 36% (5/14) in group 3; and to high bulk disease in 24% (6/25) of patients in groups 1 and 2, and 36% (5/14) in group 3. Actuarially predicted survival has not been reached for group 1, is 12 months for group 2, and 8 months for group 3; these different trends are not statistically significant. The trial was discontinued when it became clear that there was no difference between the two- and five-drug treatment regimens and that unacceptably low remission rates were obtained in patients having a high incidence of these poor prognostic factors, particularly when compared with results being reported in regimens that contain high or intermediate doses of methotrexate.

Adolescent↗
PubMed1989

Cape crusaders.

Explore the source record for details and available documents.

Hospitals, Teaching↗
PubMed1989

Stereotaxic localisation and aspiration cytology of impalpable breast lesions.

As part of a programme of assessment of the 'Sterotix' localisation device, aspiration cytology was carried out on 50 patients with 52 impalpable, mammographically detected breast lesions using the stereotaxic guidance device. This was followed by an open localisation biopsy of the area for confirmation. In 12 patients (23%) the aspirations failed to yield sufficient material for diagnosis. This was frequently due to the poorly cellular nature or very small size of the lesions. Of the remaining 40 patients, 15 were regarded as having both mammographically and cytologically benign changes which were confirmed histologically; they could thus have been spared diagnostic surgery. Ten patients had a diagnosis of malignancy with both investigations, and could have had planned investigation and subsequent definitive surgery. Of the remainder, 14 lesions had a report of malignancy or suspicion of it with either technique and these patients would have come to conventional localisation biopsy. Only one patient was found to have a malignancy, who had cytologically benign and mammographically 'probably benign' disease: this was an invasive lobular carcinoma with a dominant in-situ component and may well have been an incidental finding on biopsy.

Adult↗
PubMed1988

Randomized comparison of R1 and R2 gastrectomy for gastric carcinoma.

The contention that the R2 radical gastrectomy for localized and potentially curable gastric carcinoma may be superior to gastrectomy without lymphadenectomy (R1) was assessed by randomized trial. Five years after commencement 403 patients have been evaluated at surgery and only 43 (11 per cent) found eligible (S0-2, P0, H0, N0-1), 22 of whom underwent R1 and 21 R2 gastrectomy. Seven patients had final histological stages in excess of the protocol. The R2 group had a longer operating time (P less than 0.005), a greater blood transfusion requirement (P less than 0.005), a longer hospital stay (0.05 greater than P greater than 0.025) and required reoperation in four cases. There were no postoperative deaths. Four patients have died from the disease in the R1 group and five in the R2 group, there being no difference in the probability of survival at a median follow-up of 3.1 years. The small proportion of patients suitable for radical R2 surgery, the high associated morbidity and the fact that survival advantage has yet to be proven in trial suggest that this procedure should not yet be performed outside of controlled clinical trials.

Adult↗
PubMed1988

Gastric carcinoma in young adults.

Of 720 patients with gastric carcinoma treated over a 6-year period, 37 (5%) were 35 years of age or younger. They differed from older patients in that the usual sex ratio was altered (18 men: 19 women), and in certain histologic features. Poorly differentiated or undifferentiated lesions predominated (34 patients), and the distribution of histologic types was unusual; two thirds each were of the diffuse type (Lauren classification) or signet ring type (World Health Organization classification), and over three quarters were infiltrative (Ming classification). Intestinal metaplasia was absent in the majority of patients, and gastritis was less commonly seen than in older patients. Although most patients had long histories of disease and advanced disease, the TNM stages and the proportion undergoing curative resection (8%) were similar to those seen in older patients. Except for one who has survived 5 years, all patients in this study have died.

Adenocarcinoma, Mucinous↗
PubMed1988

Lack of an association between carcinoma of the stomach and the major histocompatibility complex (HLA) in Cape Coloureds.

A possible genetic contribution to the high incidence of gastric carcinoma in the Cape Coloured population of the Western Cape region of South Africa was investigated. The HLA-A, B, C, DR and DQ antigens were determined with a microcytotoxicity assay, and their frequencies compared in 124 individuals with gastric carcinoma and 4,560 controls. No significant difference was found, thus supporting the view that a genetic component has a minor, if any, role in gastric carcinogenesis.

Black People↗
PubMed1987

Fine-needle aspiration biopsy cytology of the breast. A review of the Groote Schuur Hospital experience.

The results of the first 1,500 cytological diagnoses of fine-needle breast aspirates performed at Groote Schuur Hospital Breast Clinic are compared with the histological diagnoses of Tru-cut and excision biopsies of the same lesions. A cytological diagnosis of malignant disease was made in 358 cases, 349 of which were confirmed histologically. The 10 false-positive and 1 false-negative diagnoses are discussed. The reliability of diagnosis in the first 500 cases is compared with that in the second and third 500 cases. There were no false-positive diagnoses in the last 500 cases, and only 3 in the second 500 cases compared with 7 in the first 500 cases. Similarly, the 1 false-negative diagnosis was made in the first 500 cases. The results confirm the reliability of fine-needle aspiration biopsy cytology as a diagnostic technique. The number of incorrect diagnoses decreases as experience with the technique increases.

Biopsy, Needle↗
PubMed1987

Sensitivity of endoscopic detection of malignancy in resectable gastric carcinoma.

In 50 consecutive cases of resected gastric carcinoma the absolute sensitivity in making an unequivocal pre-operative diagnosis was 54% for endoscopic inspection, 76% for biopsy and 48% for cytology. Inspection and biopsy in combination yielded 90% and adding cytology achieved 92% absolute sensitivity. The relative sensitivity (which included equivocal reports) was far higher for each individual test, and 100% for the combination of all three, but did not reflect the clinical value of these investigations as clinicians did not react appropriately to equivocal reports. Thus for the endoscopic detection of gastric carcinoma in routine clinical practice, inspection was insensitive, biopsy mandatory, cytology of little additional value and endoscopic followup of apparently benign lesions appeared important.

Biopsy↗