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Biomedical subjects

K Goulston

Publications and source records attributed to K Goulston.

At least 19 recordsLinked to original sources
PubMed1995

Inflammatory bowel disease: a retrospective review of a specialist-based cohort.

OBJECTIVE: To study the morbidity and mortality of inflammatory bowel disease in Australia and whether it decreases life expectancy. DESIGN: A retrospective review of patient case notes from two Sydney teaching hospitals and the consulting rooms of the 17 gastroenterologists appointed to these hospitals, examining all presentations with a diagnosis of inflammatory bowel disease from January 1977 to September 1992. RESULTS: 997 cases were identified: 533 with ulcerative colitis, 417 with Crohn's disease, and 47 with indeterminate colitis. In patients diagnosed from 1977 onwards (n = 730), no difference in survival was demonstrated for inflammatory bowel disease overall, or any subgroup, or in males or females, as compared with an age- and sex-matched control population. Gastrointestinal malignancies occurred in 19 cases (18 colorectal carcinoma and one cholangiocarcinoma). The most commonly encountered problems were the use of immunosuppressants and the need for surgery. Inflammatory bowel disease, particularly Crohn's disease, entails appreciable morbidity. CONCLUSION: Since 1977, despite a significant requirement for medical and surgical treatment in patients with inflammatory bowel disease, there has been no adverse effect on survival in a specialist-referred cohort as compared with the general population.

Australia↗
PubMed1994

Inflammatory bowel disease--its history, current status and outlook.

In conclusion, it seems there has been a definite change in the epidemiology and course of IBD since earlier this century. Several points are worth emphasising: The diseases are relatively common, and there has been a general increase in their incidence, more so in some regions than others. The largest group affected is young adults, who will have their disease over several decades. This could potentially impact markedly on the workforce and on health care services. There is clearly a range of severity of this disease, and a greater number of mild cases have probably been diagnosed recently. This also helps to explain the differences in severity, need for surgery, and survival noted between community based studies and referral centre groups. Treatment has improved, particularly surgery (which usually takes place earlier on less critically ill patients), better operations, including continence surgery for most patients with UC and gut sparing procedures in Crohn's disease such as stricturoplasty. Medical management of acute disease has also improved which, in particular, has reduced mortality in elderly patients. Except for a subset of patients, life expectancy is close to normal, and time lost from the workforce, when considered in perspective over a working lifetime, is negligible. We can therefore be justifiably optimistic about the current long term outcome of IBD, and encourage our patients, their families and their employers to share in this outlook. With the promise of newer medical therapies on the horizon, prognosis may be further improved. Corticosteroids with little or no systemic side effects are currently in clinical trials and new anti-inflammatory agents are being examined for their efficacy through prostaglandin, leukotriene, or oxygen free-radical inhibition. Now that mortality from IBD is largely a thing of the past, we need to concentrate our attention more closely on the associated morbidity. It is to be hoped that future long term studies attempt the difficult clinical measurements of morbidity and quality of life.

Employment↗
PubMed1990

Psychological factors in dyspepsia of unknown cause: a comparison with peptic ulcer disease.

Patients with dyspepsia of unknown origin (DUO) and those with similar upper abdominal symptoms but with an organic cause (peptic ulcer) were assessed on personality and psychological symptom measures. The DUO patients had significantly more symptoms of anxiety and tension and higher scores for trait tension and hostility than the organic group. The two groups did not differ significantly in terms of depressive symptoms, neuroticism, psychoticism, or suppression of negative affects. The implications of these findings for the aetiology and diagnosis of DUO are discussed.

Adult↗
PubMed1987

Type A behaviour and other psychological factors in peptic ulcer disease.

A variety of personality traits and psychological symptom states have been reported to be associated with peptic ulcer disease. In the present study, male patients with confirmed duodenal or gastric ulcer(s) are compared with patient and non-patient control groups in terms of Type A behaviour, the Eysenck personality dimensions, hostility, state and trait anxiety, and depression. By comparison with cardiac patients, the peptic ulcer groups obtained lower Type A scores but were similar on the other variables. By comparison with age and sex matched community controls. GU patients obtained higher trait anxiety and psychoticism scores while the DU group had higher state anxiety levels. The implications of these findings in terms of the role of psychological factors in the aetiology of peptic ulcer disease are discussed.

Anxiety↗
PubMed1986

Psychological correlates of gastric and duodenal ulcer disease.

Psychological correlates of gastric and duodenal ulcer disease were assessed in a group of somewhat older patients with ulcer disease identified by endoscopy. Associations between both ulcer types and symptom measures (anxiety and depression) seemed only to reflect severity or chronicity of gastrointestinal symptoms or the impending endoscopy procedure. Associations with 'trait' psychological indices may be of causal significance. Duodenal ulcer patients had higher 'introversion' and 'psychoticism' scores (on the EPQ) than controls, while gastric ulcer patients had higher psychoticism scores and 'trait anxiety' scores. These findings could not be attributed to confounding variables. When the two ulcer groups were compared, the gastric ulcer group had significantly higher neuroticism, psychoticism and hostility scores which were not attributable to confounding variables. The higher depression scores in gastric ulcer patients, however, simply reflected the greater chronicity of their physical symptoms. The groups did not differ significantly on measures of trait anxiety, tension, introversion or Type A behaviour.

Anxiety Disorders↗
PubMed1986

Clinical psychiatric illness in prisoners of war of the Japanese: forty years after release.

Clinical psychiatric and medical assessments were carried out on a randomly selected sample of Australian prisoners of war captured by the Japanese in 1942 and a sample of combatants from Pacific theatres of war who were not captured. Prisoners of war had significantly more anxiety and depressive 'neuroses' and more major affective illness, although the latter finding was not statistically significant. The two groups did not differ in the risk of alcohol abuse and dependence.

Alcoholism↗
PubMed1986

In situ carcinoma of the pancreas.

Two cases of pre-invasive in situ carcinoma of the pancreas treated by surgery are reported. In each case the resection was carried out because of the probable diagnosis of invasive carcinoma of the pancreas. In situ carcinoma of the pancreas is not included in standard clinical classifications of pancreatic cancer. This is an important omission because of the prognostic implications of this diagnosis, and because of the difficulties in interpreting fine needle aspiration cytology or histology on needle biopsy in such cases.

Carcinoma, Intraductal, Noninfiltrating↗
PubMed1986

Australian prisoners of war of the Japanese: post-war psychiatric hospitalisation and psychological morbidity.

Evidence of chronic psychiatric and psychosomatic morbidity was found in a randomly selected sample of Australian prisoners of war (POWs) of the Japanese over the 40-year period following the Second World War. A clinical interview revealed more contemporary depressive and anxiety disorders and more post-war psychiatric illness overall than in a comparison group of randomly selected combatant veterans of the Pacific and South East Asian campaign. The POWs were no more likely to have had psychiatric admissions than non-POWs and fewer of them had had multiple psychiatric admissions. POWs had more duodenal ulcers than controls but otherwise their physical health was similar, as was their age-adjusted mortality in the post-war years. Finally, POWs were more likely to have Totally and Permanently Incapacitated Service Pensions than controls.

Aged↗
PubMed1985

Immunochemical testing for faecal occult blood in patients with colorectal cancer.

Eighty-six stool specimens collected from 36 patients with colorectal cancer were tested for occult blood by chemical and immunochemical methods. There was no dietary restriction. Positive results were obtained in 94% of patients by the immunochemical method when the presence of any positive immunochemical test was taken as a positive result. If greater than 1 mg of haemoglobin per gram of faeces was regarded as positive result, then 75% of patients would have been diagnosed as having occult blood in the stool by means of the immunochemical method. Positivity rates for Hemoccult II and rehydrated Hemoccult II were 53% and 81%, respectively.

Colonic Neoplasms↗
PubMed1984

Geographic distribution and demographic correlates of colorectal cancer mortality in Sydney, New South Wales.

Colorectal cancer (CC) has the highest incidence of any internal malignancy in Australia and is a major cause of death. A knowledge of the geographic distribution of CC will aid in the identification of high risk groups for whom diagnostic and treatment facilities should be provided and may give clues to aetiological factors. Total CC deaths and age-standardized mortality ratios for Local Government Areas in Sydney, Australia were mapped and the relationships between mortality and selected demographic measures were examined. Several statistically significant zero-order correlation coefficients were found but multiple regression analysis showed a dominant independent negative effect of distance from the centre of the city on CC mortality. No substantial independent effects of demographic variables were observed. The existence of presently unmeasured environmental aetiological factors is postulated.

Adolescent↗