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Biomedical subjects

J M Stone

Publications and source records attributed to J M Stone.

At least 37 records · Page 2Linked to original sources
PubMed1992

Time trends in accuracy of classification of testicular tumours, with clinical and epidemiological implications.

Initial classifications of 1009 testicular tumours were reviewed as part of a population based survey of all testicular neoplasms in Victoria, Australia, between 1950 and 1978. All reviews were made by one of two pathologists at the Peter MacCallum Cancer Institute, using the system of the British Testicular Tumour Panel. Accuracy of diagnosis varied markedly over the time period and with pathological category. Seven cases were initially designated malignancies but were determined to be non-malignant conditions upon review. In each decade, review reduced the proportion of seminomas and increased the proportion of non-seminoma germ cell tumours (NSGCT) and non germ cell tumours. Reclassification resulted in changed age specific incidences of seminoma and NSGCT, most noticeably in 1950-59. Trends in age standardised incidence of seminoma and NSGCT were not affected by reclassification although the values were. The trend in age standardised incidence of non germ cell tumours was affected by reclassification. The implications of the changes in classification for epidemiological studies and clinical management are discussed.

Age Factors↗
PubMed1991

Trebling of the incidence of testicular cancer in victoria, Australia (1950-1985).

Changes in the incidence of testicular cancer in Victoria, Australia were studied from 1950 to 1985. Cases from the period 1950 to 1978 were derived from many sources (1116 cases). Emphasis was placed on diagnostic reliability; 97% of cases were confirmed histologically, and of these, 86% were reviewed at the Peter MacCallum Cancer Institute. For the years 1982 to 1985, Victorian Cancer Registry data were used. The incidence rose by a factor of 2.9 from 1.44 (95% confidence interval [CI], 1.15 to 1.73) per 100,000 in 1950 to 1954 to 4.16 (95% CI, 3.73 to 4.59) per 100,000 in 1982 to 1985. Between 1950 to 1954 and 1965 to 1969, there was a sharp rise, followed by a plateau or dip, then a further rise. Among seminomas, the rates rose in most adult age groups, whereas among nonseminomas, the rise was concentrated in younger age groups. There was a significant trend to earlier age of occurrence among nonseminomas (P = 0.0004) but not among seminomas (P = 0.89). Cohort analysis revealed a trend toward increasing rates for both seminomas and nonseminomas, and confirmed the trend toward earlier age of onset for nonseminomas. Disproportionate increases were observed for the 1915 to 1924 cohort of seminomas and the 1930 to 1939 cohort of nonseminomas. Analysis of available data from other Australian states indicated comparable rising incidence in New South Wales, Tasmania, and Western Australia.

Adolescent↗
PubMed1991

Laterality, maldescent, trauma and other clinical factors in the epidemiology of testis cancer in Victoria, Australia.

Clinical factors were studied in a population based survey of 1,116 cases of testicular neoplasms in Victoria, Australia, between 1950 and 1978. The ratio of right to left sided tumours was 54:46, but the left side predominated among sarcomas (P = 0.006), and in older men. The relative risk (RR) for men with unilateral maldescent was 15 (CI 10-23) and for men with bilateral maldescent 33 (CI 20-55) (odds ratio 1.4, CI 0.5-4, P = 0.7). Calculations per testis in men with unilateral maldescent showed an elevated risk for both the maldescended testis (RR 28, CI 19-41, P less than 0.0001) and the normally descended testis (RR 3, CI 1.2-6, P = 0.04). The RR for men with abdominal maldescent was 55 (CI 36-83) compared to 7 (CI 4-11) for those with inguinal maldescent (odds ratio 8, CI 3-20, P less than 0.0001). Seminomas were more common than nonseminomas (NSGCT) in men with a history of maldescent (odds ratio 1.7, CI 1.1-3, P = 0.02) and also among corrected cryptorchids compared to uncorrected (P = 0.005). Seminomas were diagnosed at an earlier median age in men with corrected cryptorchid testes compared to uncorrected (P = 0.03) and in men with corrected cryptorchid testes compared to normally descended (P = 0.001). Maldescent was also associated with hernia (P = 0.04). Twenty-eight per cent of patients recorded a history of trauma with a higher proportion among NSGCT than among seminomas (P = 0.03). Prior malignancies were reported in nine patients, compared to 3.6 expected; prostate cancer (2) and malignant melanoma (2) were the greatest contributors to the excess.

Adolescent↗
PubMed1991

Gastrointestinal complications of chronic spinal cord injury.

Gastrointestinal problems are important in the chronic stage of spinal cord injury. We review the literature on problems of specific segments of the alimentary tract in this setting and add observations based on clinical experience. Emphasis is placed on the colon and rectum, where most clinically apparent problems occur. While bowel management programs are often successful in the near-term, long-term dysfunctions are common and difficult to treat. Studies to determine colonic transit time and rectal physiologic responses are useful to provide scientific basis of management of such patients. More information is needed on the relative roles of extrinsic and intrinsic nervous system in GI function.

Digestive System↗
PubMed1991

Volvulus of the splenic flexure: radiographic features.

Six cases of splenic flexure volvulus were studied over a 14-year period. The patients were aged 15-62 years. Five of the six patients were mentally retarded, lifelong residents of a long-term-care institution. Two patients had congenital absence of normal colonic attachments; the other four patients had elongated mesocolons, presumably from chronic constipation. All patients underwent abdominal radiography, followed by a barium enema study. In the appropriate clinical setting, radiographic diagnosis of a splenic flexure volvulus is suggested when the following are seen: (a) a markedly dilated, air-filled colon wtih an abrupt termination at the anatomic splenic flexure; (b) two widely separated air-fluid levels, one in the transverse colon and the other in the cecum; (c) an empty descending and sigmoid colon; and (d) a characteristic beak at the anatomic splenic flexure at a barium enema examination.

Adult↗
PubMed1990

Colonic transit in spinal cord-injured patients.

This report describes a study of transit time through the colon, as well as the caliber of the colon and distal small bowel, in 28 spinal cord-injured patients to see if there is a correlation between those findings and difficulty with bowel care and symptoms. In 15 of these 28 patients anorectal dynamic studies were also done. Each patient ingested 20 radiopaque markers, after which colon transit times were measured by multiple abdominal radiographs. The width of the ileum was measured and correlated with symptoms. The findings indicate that transit time was delayed in the left and rectosigmoid colon; four patients had a large and highly compliant rectum, whereas six had anorectal dyssynergia. All ten had difficulty with bowel care. The distal small bowel was dilated in ten patients, all of whom had symptoms and nine of whom had spinal cord lesions superior to T5.

Adult↗
PubMed1990

Accuracy of death certificates and mortality statistics in Victorian testis cancer deaths 1950-1977.

426 death certificates relating to testicular cancer in Victoria, from 1950 to 1977, were examined for inaccuracies in cause of death narrative and coding for cause of death statistics. the narrative was inaccurate in major diagnosis in 33 certificates (21 false positives and 12 false negatives) and 17 accurately written certificates were mis-coded (12 false positives and 5 false negatives). Review of the pathological terms used revealed 10 lymphomas incorrectly ascribed to germ cell malignancy. The term "seminoma" seems to have been employed as a generic term for testis tumour, only 50 per cent of the tumours so designated being confirmed as seminoma. It is concluded that although Victorian figures relating to mortality from testis cancer are reasonably accurate (for 337 cases for which relevant records were available the detection rate was 95%, the confirmation rate 96% and concordance 91%), little reliance can be placed on the recorded pathological sub-type.

Cause of Death↗
PubMed1990

Colostomy as treatment for complications of spinal cord injury.

We reviewed our experience with colostomy performed in 20 spinal cord injury (SCI) patients to determine the effectiveness and safety of colostomy when it is performed for a late complication of SCI. Objective evaluation of gastrointestinal function, ie, colonic transit time and anorectal manometry, was performed in six patients with chronic gastrointestinal complaints to identify the site and severity of bowel dysfunction. Twelve patients had colostomy performed for chronic gastrointestinal problems, seven as an adjunct in the treatment of perineal pressure ulcers, and one for rectal cancer. When patients with difficult bowel evacuation or incontinence were considered, colostomy reliably simplified bowel care, relieved abdominal distention, and prevented fecal incontinence. The amount of time spent on bowel care decreased from an average of 98.6 min/day to 17.8 min/day (p less than .05) after colostomy. When performed as an adjunct in the treatment of pressure ulcers, colostomy provided a dry, clean environment, and seven of seven ulcers healed. Colostomy was well accepted by all patients; all patients with chronic gastrointestinal complaints reported that colostomy improved the quality of their lives. Objective testing differentiated between failure of the colon to adequately transport material to the rectum and inability to adequately evacuate the rectum. Testing was useful in choosing the level at which a colostomy was created, and, in one instance, it identified a specific syndrome (ischemic proctitis) which required colostomy.

Colostomy↗
PubMed1990

Chronic gastrointestinal problems in spinal cord injury patients: a prospective analysis.

Detailed interviews of 127 consecutive patients seen by our spinal cord injury service were performed in order to determine the prevalence and characteristics of chronic gastrointestinal problems in spinal cord injury (SCI) patients. Chronic gastrointestinal problems were defined as recurring symptoms that were significant enough to alter lifestyle or require chronic treatment. Thirty-four (27%) of the patients had a significant chronic gastrointestinal problem. The limited manner through which SCI patients can manifest symptoms resulted in complaints which were characteristically quite vague. The most common problems that impaired quality of life were poorly localized abdominal pain (14%) and difficulty with bowel evacuation (20%). Hemorrhoids (74%), abdominal distention (43%), and autonomic hyperreflexia arising from the gastrointestinal tract (43%) were also very common, but had a lesser impact on lifestyle. Twenty-three percent of our population required at least one admission to the hospital for a gastrointestinal complaint following their injury. The prevalence of chronic gastrointestinal symptoms increased with time after injury, suggesting that these problems are acquired, and may therefore be avoided by the adoption of certain chronic care routines. Chronic gastrointestinal problems in SCI patients merit more study because they are: 1) very different from those in the general population, 2) responsible for a disproportionately great amount of morbidity in these patients, 3) potentially preventable.

Adult↗
PubMed1989

Transendoscopic balloon dilatation of complete colonic obstruction. An adjunct in the treatment of colorectal cancer: report of three cases.

Complete colonic obstruction secondary to colorectal cancer has traditionally been managed by a staged approach. Simple diversion or resection with colostomy is performed followed by reestablishment of intestinal continuity at a subsequent operation. The use of a transendoscopic technique of balloon dilatation for complete malignant obstruction in the management of three patients is discussed. Successful balloon dilatation allowed for complete bowel preparation and either elective single-stage resection or controlled Nd:YAG laser palliation in a clean field. Although not applicable to all clinical situations, balloon dilatation is a valuable adjunct in the management of obstructing colorectal cancer. Relief of obstruction by tumor dilatation allows 1) correction of fluid and electrolyte abnormalities, 2) administration of a complete bowel preparation, 3) single-stage resection and anastomosis, or 4) palliative laser photoablative therapy that avoids the need for colostomy.

Aged↗
PubMed1989

Therapy of serious gram-positive infections with teicoplanin.

Teicoplanin was used as monotherapy in 17 seriously ill patients (mean age 51 years, range 18-71) with infection due to Gram-positive organisms. The dose used was 200 mg teicoplanin intravenously once daily after an initial intravenous dose of 400 mg. Most of the patients (15 out of 17) were septicaemic (confirmed by blood culture), the other two had deep abscesses. The pathogens isolated were Staphylococcus epidermidis [15], Streptococcus faecium [1] and JK Coryneform [1]. The 15 patients with Staph. epidermidis infections had all been treated previously with a beta-lactam (usually flucloxacillin)/aminoglycoside combination to which Staph. epidermidis was resistant. All patients were still pyrexial after 48 h of therapy and were then changed to teicoplanin as monotherapy. Patients were treated with teicoplanin for 5 to 7 days. One was withdrawn because of vomiting associated with the teicoplanin infusion, and another was withdrawn because she was given amikacin for a separate Gram-negative infection, but all the other 15 patients responded well to therapy, usually becoming apyrexial within 48 h. All 15 septicaemic patients had central lines in situ: 10 responded to therapy with the line left in situ but in 5 the lines were removed, either before or during teicoplanin therapy. Teicoplanin levels were determined in all patients, usually on day 2, with no evidence of toxicity from these levels. Teicoplanin was found to be effective as monotherapy for septicaemia mainly due to Staph. epidermidis in patients with severe underlying disease.

Adult↗
PubMed1986

The effect of age on plasma zinc uptake and taste acuity.

Plasma uptake of a 25 mg oral dose of zinc was measured at 0, 1, 2, 3, and 4 h postdose in 16 elderly (mean age = 7.25 yr) and 12 young (mean age = 24.0 yr) subjects selected from a group of 62 healthy nonsmokers. Elderly and young subjects were divided into two groups based upon low or high detection thresholds for solutions of sodium chloride and sucrose. Mean fasting concentrations of plasma zinc were almost identical for the two age groups. Plasma response to a zinc dose was lower (p less than 0.05) in the elderly compared to that in the young, as indicated by plasma zinc levels at hours 2 and 3 postdose and by total area under the response curve. Moderate but significant age-associated increases in detection thresholds for both sodium chloride and sucrose were found; taste thresholds were not correlated to plasma uptake of the zinc dose in either age group.

Adolescent↗
PubMed1983

Enteral and parenteral feeding influences mortality after hemoglobin-E. coli peritonitis in normal rats.

Enteral feeding with 25% dextrose-4.25% Freamine II (TPN) improves the survival of malnourished animals to normal levels after hemoglobin-E. coli adjuvant peritonitis, whereas intravenous feeding does not. To determine whether intravenous feeding maintained a high survival rate in previously well-nourished animals, 81 rats received TPN via gastrostomy or intravenous infusion for 12 days. They were then fasted for 24 hours and given a septic challenge. Gastrostomy-fed animals survived the challenge significantly better than intravenously fed animals. Enteral feeding appears to be important in producing a high survival rate after hemoglobin-E. coli adjuvant peritonitis.

Animals↗