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Biomedical subjects

H J Bussey

Publications and source records attributed to H J Bussey.

At least 19 recordsLinked to original sources
PubMed1991

Comparison of morbidity and function after colectomy with ileorectal anastomosis or restorative proctocolectomy for familial adenomatous polyposis.

Restorative proctocolectomy with an ileal reservoir (RPC) should prevent colorectal cancer in patients with familial adenomatous polyposis. Until this is confirmed its role compared with total colectomy and ileorectal anastomosis (IRA) will depend on the relative morbidity and postoperative bowel function after the two procedures. This was analysed in 99 patients (37 RPC, 62 IRA) operated on between 1977 and 1989. Morbidity was greater after RPC with subsequent ileostomy closure (median hospital stay, 24 versus 11 days; complications, 60 versus 21 per cent; reoperation, 29 versus 3 per cent; return to normal activity; 31 versus 14 weeks). There was little difference in bowel function; after IRA median frequency was 3/24 h and urgency (unable to wait 15 min) occurred in 50 per cent, compared with 4.5/24h and 17 per cent after RPC. Night evacuation occurred in 10 and 43 per cent respectively. IRA was performed in younger patients (median 19 versus 31 years) who had fewer bowel motions before operation (2 versus 5/24 h). The greater morbidity of RPC suggests that it should be restricted to patients at higher risk of developing later rectal cancer, including those unavailable for follow-up and those with large or confluent rectal polyps or with curable colon cancer at the initial colectomy.

Adenomatous Polyposis Coli↗
PubMed1991

A review of physical abnormalities in familial adenomatous polyposis.

Familial adenomatous polyposis (FAP) is an autosomal dominant condition wherein multiple polyps may be found in the gastrointestinal tract. Initially referred to as familial polyposis coli, it has become evident that virtually all patients with FAP develop adenomas in the upper gastrointestinal tract and thus the syndrome is now termed familial adenomatous polyposis. The number of associated conditions both malignant and benign has been increasingly recognized. Some of these lesions cause morbidity and mortality in affected individuals whilst others act as important clinical markers for identifying patients not yet expressing the phenotype. These abnormalities can arise from tissues of all three primary embryonic layers and are described in this paper.

Abnormalities, Multiple↗
PubMed1988

Upper gastrointestinal cancer in familial adenomatous polyposis.

Invasive upper gastrointestinal adenocarcinoma was found in 57 (4.5%) of 1255 patients with familial adenomatous polyposis, recorded in 10 registries. The most frequent sites were duodenum in 29, pancreatic ampulla in 10, and stomach in 7. These findings confirm an increased risk of upper gastrointestinal cancer in the polyposis patient, particularly distal to the pylorus, and support an adenoma-carcinoma sequence. Regular surveillance of the upper gastrointestinal tract is essential in patients with familial adenomatous polyposis.

Adenocarcinoma↗
PubMed1988

Juvenile polyposis--a precancerous condition.

Clinical and pathological findings in 87 patients with juvenile polyposis have been reviewed; 1032 polyps were available from 80 of these patients; 840 were typical spherical juvenile polyps whereas 169 differed in being multilobulated or showing a villous configuration; 79 (46.7%) of the latter contained foci of epithelial dysplasia whereas only 76 (9.0%) of the typical juvenile polyps were dysplastic. The series also included 21 adenomas and two hyperplastic (metaplastic) polyps. The demonstration of dysplasia provides a histogenetic mechanism for the evolution of colorectal cancer from hamartomatous polyps; 18 juvenile polyposis patients have developed colorectal cancer at a mean age of 34 years (range 15-59). The clinical outcome was generally poor. No clinical or pathological distinction could be made between polyposis patients with and without colorectal cancer. Thus, the development of cancer in juvenile polyposis appears to be a random event. A working definition of juvenile polyposis is provided: (1) more than five juvenile polyps of the colorectum; and/or (2) juvenile polyps throughout the gastrointestinal tract; and/or (3) any number of juvenile polyps with a family history of juvenile polyposis. It is suggested that the condition should be treated as seriously as familial adenomatous polyposis except that regular colonoscopic surveillance may obviate the need for prophylactic colectomy.

Adenomatous Polyposis Coli↗
PubMed1987

Adenomatous polyposis: an association with carcinoma of the thyroid.

A review of the St Mark's Hospital Polyposis Registry has revealed an association between adenomatous polyposis (familial polyposis coli) and thyroid carcinoma. Even though full clinical information was unavailable on all patients in the registry, it is evident that young women (below 35 years of age) are at particular risk of developing thyroid cancer, mainly of a papillary type, their chances of being affected being approximately 160 times that of normal individuals. All patients with adenomatous polyposis should thus have regular thyroid examination.

Adenomatous Polyposis Coli↗
PubMed1987

Historical developments in familial polyposis coli.

The emergence of familial polyposis coli from the general group of conditions with multiple polyps of the large intestine into a well-defined separate entity started when histopathology became a science. The recognition of its two main features--inheritance as a Mendelian dominant characteristic and its high incidence of associated colorectal cancer--greatly helped in establishing a policy of treatment designed to prevent cancer. The removal of all or most of the large intestine before cancer had supervened has had considerable success in reducing the cancer incidence. However, the more recent awareness that the adenomas can frequently be found also in the upper gastrointestinal tract has introduced new problems, the solution of which is currently a matter of investigation.

Adenomatous Polyposis Coli↗
PubMed1987

Epithelial misplacement in Peutz-Jeghers polyps. A diagnostic pitfall.

Early difficulties with the interpretation of the histopathology caused overdiagnosis of cancer in the Peutz-Jeghers syndrome; and there is still controversy about the magnitude of risk of gastrointestinal carcinoma. Most workers now believe that there is a small but definite increase in the incidence of gastrointestinal carcinoma in Peutz-Jeghers polyps and most of these cancers occur in the upper gastrointestinal tract. In a review of 491 Peutz-Jeghers polyps in the records of St. Mark's Hospital Pathology department, misplacement of epithelium was found in approximately 10% of small intestinal polyps and closely mimicked adenocarcinoma. This "pseudoinvasion" was not observed in polyps of the stomach or colon. The epithelial misplacement may involve all layers of the bowel wall; and the most helpful histological discriminators include a lack of cytological atypia, the presence of the normal epithelial cell subtypes and a brush border, hemosiderin deposition, and intramural mucinous cysts. Epithelial misplacement may account for the overdiagnosis of carcinoma arising in Peutz-Jeghers polyps as reported in the literature.

Adenoma↗
PubMed1987

The familial polyposis coli register.

Familial polyposis coli is an inherited condition in which many hundreds of adenomatous polyps develop in the colorectum usually during the second decade of life. There is a high incidence of associated carcinoma, a risk which approximates to 100% in untreated patients. Adenomas and carcinomas also occur in the upper gastro-intestinal tract though to a lesser extent. A policy of cancer prevention based on the genetic origin and natural course of the disease requires the identification of family members at risk in order that detection and surgical removal of the polyps can be effected before any malignant change has occurred. The identification of persons at risk requires knowledge of affected families. The establishment and maintenance of regional registers of polyposis coli families is advocated.

Adenomatous Polyposis Coli↗
PubMed1986

The grading of rectal cancer: historical perspectives and a multivariate analysis of 447 cases.

The grade of a tumour is gauged on the subjective assessment of a number of histopathological parameters. The problems associated with this exercise were viewed from a historical perspective and survival analysis of 447 patients receiving surgery for rectal adenocarcinoma was undertaken. Only deaths from rectal adenocarcinoma were included as events in the survival analysis. Seven grade-related parameters were scored by one observer. A grading system was constructed using the Cox regression model. The variables in the best-fitting parsimonious model comprised lymphocytic infiltration, tubule configuration and pattern of growth. Scores were derived from the model and a four grade system was created in which the groups were of similar size. Good reproducibility of the selected histopathological parameters was demonstrated. Grade-related parameters were then allowed to compete with stage-related parameters in an overall model of pathological prognostic categories. The parameters selected in the best model were number of affected lymph nodes, the presence of lymphocytic infiltration and extent of spread through bowel wall. A set of five prognostic categories was developed from this model.

Adenocarcinoma↗
PubMed1984

Histopathologic comparison of colorectal adenomas in English and Japanese patients.

Histopathologic comparison of colorectal adenomas removed at St. Mark's Hospital, London, England, and those removed at the University of Tokyo, Japan was performed. There were 1242 lesions in the St. Mark's series and 310 in the University of Tokyo series. All adenomas were removed either by colonoscopic polypectomy or hot biopsy. The indications and methods of colonoscopic removal were similar in the two series. Age distribution of the patients showed a younger peak incidence in the University of Tokyo series compared with the St. Mark's patients. The percentage of adenomas larger than 1 cm, of tubulovillous or villous type, and with moderate or severe dysplasia were greater in the St. Mark's series than in the University of Tokyo series. Percentages of adenomas with mild, moderate, or severe dysplasia in each category of size did not differ between the two series. In view of the fact that there is a high colorectal cancer risk in England and medium cancer risk in Japan, our results give further epidemiologic support to the concept of the adenoma-carcinoma sequence.

Adenoma↗
PubMed1982

A randomized trial of ascorbic acid in polyposis coli.

The possibility of pharmacological control of large bowel adenomas has been suggested by effectiveness of antioxidants in experimental tumor models and by the results of a limited clinical study using ascorbic acid. Over a two year period we tested this hypothesis in a randomized, double-blind study of 49 patients with polyposis coli. Of 36 patients who were evaluable at completion, 19 had received ascorbic acid, 3 g/day, and 17 had received a placebo. We found a reduction in polyp area in the ascorbic acid-treated group at nine months of follow-up (P less than 0.03) and trends toward reduction in both number and area of rectal polyps during the middle of the trial. A labeling study of rectal epithelium with tritiated thymidine also hinted at a treatment effect. Our data suggest that ascorbic acid temporarily influenced polyp growth or turnover. Although these results have no current therapeutic value, our findings support continued studies of chemoprevention in this and other high risk settings.

Adult↗
PubMed1982

En face histopathologic technic for examining colonic mucosa of resection specimens.

The en face histopathologic technic for examining colonic mucosa in the plane of the luminal surface is described and analyzed. Grossly normal colonic mucosa from 56 resection specimens was embedded en face and sectioned. The en face histopathologic slides showed sheets of mucosa with the crypts in cross section surrounded by lamina propria, an orientation to mucosal topography analogous to gross examination. A total of 1,931 cm2 of mucosa was embedded en face in 640 paraffin blocks, a mean of 3.0 +/- 0.8 (SD) cm2 per block. With routine processing of the same surface area, approximately 2,365 blocks (nearly four times as many as for the en face technic) would have been required. A total of 1,217 cm2 of mucosa appeared in the slides from the en face blocks, comprising 63 +/- 23% of the submitted tissue, compared with 0.3% in routine sections. Our analysis demonstrated that the en face technic is a useful tool in histopathologic studies of large areas of grossly normal colonic mucosa, particularly for quantitation and mapping of the findings.

Colon↗
PubMed1981

Spread of rectal cancer within veins. Histologic features and clinical significance.

Histologic evidence of venous invasion was demonstrated in 52 percent of 703 cases of rectal carcinoma. Quantitation of venous invasion and follow-up study showed that invasion of extramural veins was associated with a low 5 year survival rate (33 percent), whereas invasion limited to intramural veins was not. Spread into thick-walled extramural veins carries a very poor prognosis (15 of 91 patients survived 5 years). The corrected 5 year survival rate for stage C patients with invasion of thick-walled extramural veins was only 8 percent. Host reactions in and around the walls of invaded veins increase the survival rate; inflammatory damage to the vein walls and endarteritis obliterans are particularly important in this respect.

Adenocarcinoma↗